1. TM 1 PHIN Conference Atlanta, GA August 27, 2008 Jeanne Tropper, MS, MPH 1 and Al Romanosky, MD, PhD 2 1 Division of Emergency Preparedness and Response National Center for Public Health Informatics Centers for Disease Control and Prevention 2 Office of Preparedness and Response Maryland Department of Health and Mental Hygiene Use Cases for CRA at the Local, State and Federal Levels: Lessons Learned

2. TM 2 Co-authors Jeanne Tropper Nancy Lewis Guy Faler Tricia Gallagher Sanjeeb Sapkota Charles Williams Ulrica Andujar Al Romanosky

3. TM 3 Agenda CRA Background CRA Use at the Federal, State, and Local Levels CRA Use at Maryland Statewide Pandemic Influenza Exercise Summary

4. TM 4 What is CRA? Genesis was Pre-Event Vaccination System (PVS) for national smallpox vaccination campaign Capability to support mass tracking during an event System has since evolved to support any countermeasure, any event; may include medical interventions such as vaccinations, pharmaceuticals and non-medical interventions such as patient isolation and quarantine or social distancing measures Includes the ability to track both detail (person level) and aggregate counts of countermeasures

5. TM 5 When Would CRA be Used? SituationCRA Use Pre-event or early event National Smallpox Vaccination Campaign Pandemic Influenza - Early on to track vaccine – individual level Track program progress – aggregate level Track location of commercial antiviral inventory Post-event (Slower moving) OMS is used locally to investigate the outbreak It is determined to be broad in scope, mass prophylaxis is required Investigation data transferred to CRA repository Aggregate reporting of program progress Post-event (Fast moving) Aerosolized anthrax attack ; mass prophylaxis required within 48 hours

6. TM 6 CRA Use at all Levels LevelsCRA Use LocalCity of Long Beach, California Tracked regular vaccination among pre-teen and teenagers StateAlabama (Pandemic Influenza Medical Surge Exercise) Tracked antivirals dispensed Maryland (Statewide Pan Flu Exercise) Tracked antivirals dispensed and isolated individuals New Hampshire (Anthrax Exercise) Track scarce antibiotic dispensed Federal CDC Pandemic Exercise (March 2008) Reported on progress in reaching priority groups CDC Pandemic Exercise (September 2008) Will report on vaccine doses administered in each state and Isolation/ Quarantine monitored

7. TM 7 Maryland Pan Flu Exercise

8. TM 8 Conclusions CRA is an established informatics application to track the utilization/ administration of countermeasure used CRA has successfully provided support to public health agencies at the local, state, and federal level CRA successfully assisted in Maryland Pandemic Exercise including ensuring social distancing tested in Laurel Municipality Several challenges have been identified and will be addressed in future versions of CRA application

9. TM 9 Acknowledgements Maryland Department of Health and Mental Hygiene officials Staff in Howard county, Laurel municipality, Chester River Hospital center, Kent County, All in Maryland Contractors from Northrop Grumman, BearingPoint, SRA International Inc. CDC colleagues in NCPHI, COTPER and NCIRD

10. TM 10 CRA website: www.cdc.gov/phin/cra For questions/ comments: crainfo@cdc.gov www.cdc.gov/phin/cra

11. TM 11 Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official positions of the Centers for Disease Control and Prevention Thank you for your attention!