1. Pandemic Influenza Planning for Maryland Schools Tiffany Tate, MHS Maryland Partnership for Prevention, Inc. National Immunization Conference March 7, 2006

2. Maryland Partnership for Prevention State’s adult immunization coalition and parent of childhood immunization coalition 501(c)3 since 1999 Awarded grant from DHMH for pandemic influenza planning

3. Why Pandemic Flu Planning? Experts consider a pandemic inevitable Little warning before a pandemic strikes A novel virus can circle the globe in days Pandemic will be widespread Pandemics pose significant threats to workforce and community institutions and resources

4. Potential Health Impact from a Mid- level Influenza Pandemic* JurisdictionDeathsHospitalizationsNumber of Cases District of Columbia 1,1554,974132,241 Maryland9,95844,5001,273,572 Virginia13,10458,8721,683,499 U.S. Total541,4332,358,08966,914,573 * Projections are based on CDC’s FluAid 2.0 program using a 25% attack rate. The estimated deaths and hospitalizations are for a pandemic strain three times more lethal than the 1968 pandemic, on which the default FluAid numbers are based.

5. Pandemic Influenza Planning in Maryland DHMH initiated planning in 1999 in partnership with local health and emergency response agencies Tabletop exercise in 2004 to test state’s plan Tabletop in 2005 to assess schools’ preparedness Pandemic Flu Summit in February 2006

6. Why Pandemic Flu Planning in Schools? Schools are…  Potential sites for spread of disease  Information sources for communities  Sources of valuable resources for emergency response  Sources for health monitoring information Recommendation from final report of previous statewide exercise

7. Maryland’s Pandemic Influenza Tabletop Exercise for Schools Purpose: To explore school-related issues, response roles, and decision-making in the context of a simulated event

8. Maryland’s Pandemic Influenza Tabletop Exercise for Schools Held August 3, 2005 Sponsored by Maryland DHMH, MPP, and Maryland State Department of Education (MSDE) Thirty-three participants, representing:  DHMH  School system  Public health  Parents  Emergency response agencies Seventy-five observers

9. Exercise Objectives Increase school community’s awareness of the scope, severity, and impact of an influenza pandemic. Identify issues, challenges, options, and implications for schools concerning pandemic response. Identify indicators that might be important for making decisions regarding school closures and re-opening.

10. Exercise Design Based on 35 issues expected to confront schools during a pandemic Four episodes/scenarios derived from the six phases offered through WHO’s pandemic influenza response guidance Simulated spread of H5N1 virus over seven month period Entailed facilitated discussion, open-ended questions and instruments

11. Key Findings Current local school emergency plans do not address pandemic influenza Maryland’s existing pandemic influenza plans do not sufficiently address school systems Gaps are present in communication needed to ensure timely and effective exchange of information during an influenza pandemic

12. Key Findings (cont.) School systems lack specific guidance and procedures on a myriad of issues relevant to an influenza pandemic

13. Recommendations MSDE and DHMH should provide guidance to schools in their preparedness efforts MSDE should encourage local jurisdictions to develop and test preparedness response plans DHMH and MSDE should develop a decision matrix

14. Recommendations (cont.) MSDE should encourage local school jurisdictions to develop and test comprehensive communications protocols DHMH and MSDE should jointly develop a communication protocol between school systems and public health

15. Recommendations (cont.) DHMH and MSDE should encourage procedures on each of the following topics:  School closure and re-opening  Cancellation or suspension of school events  Repurposing of school resources  Reassignment of non-school system employees

16. Recommendations (cont.) DHMH and MSDE should encourage procedures on each of the following topics:  School-based infection control measures  Screening of students and staff  Recommendations regarding vaccine and antiviral drugs for school staff and students.

17. Other Considerations Schools closures – when, how long? In-home instruction Satisfaction of minimum school year requirements School personnel reassignments Communication to parents Extracurricular activities

18. Conclusions Maryland has strong foundation for capacity- building Local public health, school system, and emergency response agencies have active interest in pandemic flu planning Much work remains to ensure schools’ preparedness

19. Future Planning in Maryland DHMH to host additional exercises MSDE Pandemic Influenza Workgroup MPP to provide assistance in developing schools’ pandemic influenza component of existing emergency response plans

20. Exercise Design Team David Blythe, MD, MPH Debra Collier, MPH Cheryl Duncan DePinto, MD, MPH Greg Reed, MPA Brenda Roup, PhD, RN, CIC Tiffany Tate, MHS Jean Taylor, DrPH

21. Contact Information Jean Taylor, DrPH DHMH Center for Immunization 201 W Preston St. Baltimore, MD 21201 410-767-6661; email: taylorj@dhmh.state.md.us Exercise Planning

22. Contact Information NIC Presentation Tiffany Tate Maryland Partnership for Prevention, Inc. P.O. Box 702 Owings Mills, MD 21117 Phone: 410-902-4677 mdpartnershipforprevention@msn.com