1. Project Immunize Virginia Diane Helentjaris, MD, MPH Director, Office of H1N1 Response Virginia Department of Health March 25, 2010 West Henrico Health Department H1N1 – the Virginia Experience

2. 20 th Century Influenza Pandemics 1918-1919: Spanish Flu (H1N1) 1957-1958: Asian Flu (H2N2) 1968-1969: Hong Kong Flu (H3N2) 20-100 million deaths worldwide 675,000 U.S. deaths 1-4 million deaths worldwide 70,000 excess U.S. deaths 1-4 million deaths worldwide 34,000 excess U.S. deaths Credit: U.S. National Museum of Health and Medicine

3. Rapid Spread April 2009: First U.S. cases April 26,2009: U.S. declares public health emergency. May 1, 2009: First Virginia cases May 2009:Outbreak at VA university June 2009:World Health Organization declares a pandemic

4. H1N1 Response Pillars Surveillance Communication Mitigation Direct Medical Care / Surge Vaccination

5. Surveillance in Virginia

6. Percent of ED and Urgent Care Visits for ILI by Month, April 2009 – September 2009

7. Percent of ED and Urgent Care Visits for ILI by Month, October 2009 – January 2010

8. ILI Visits by Age Group

9. School Absenteeism

10. Lab Surveillance

11. H1N1 Deaths 37 deaths confirmed to have 2009 H1N1 influenza Ages 6-83 34 adults 3 children 1 pregnant or post-partum 36 with underlying medical conditions

12. H1N1 Communications: A critical pillar with three key components Prepare Respond Prevent

13. VDH Inquiry Center 877-1-ASK-VDH3

14. Vaccine information - Google Flu Vaccine Locator Allows users to find vaccination locations by ZIP code

15. Vaccination media campaign

16. “Dear Colleague” Letters Reaches over 120,000 licensed professionals

17. Health Commissioner’s Infectious Disease Advisory Committee Frederick G. Hayden, MD Professor of Internal Medicine and Pathology, Division of Infectious Diseases University of Virginia Health Systems Thomas M. Kerkering, MD Chief of Infectious Diseases Virginia Tech, Carilion School of Medicine Edward C. Oldfield, III, MD Chief of Division of Infectious Disease Eastern Virginia Medical School Donald Poretz, MD, FACP, IDSA Clinical Professor of Medicine, MCV School of Medicine And Georgetown University School of Medicine Richard P Wenzel, MD, MSc Chair of Internal Medicine Virginia Commonwealth University School of Medicine Michael B. Edmond, MD, MPH, MPA Chair of the Division of Infectious Disease Virginia Commonwealth University Health System James L. Pearson, DPh, BCLD Director, Division of Consolidated Laboratories Department of General Services Ronald B. Turner, MD Professor of Pediatrics Associate Dean for Clinical Research Department of Pediatrics University of Virginia School of Medicine Mark J. Levine, MD, MPH Deputy Commissioner of Emergency Preparedness & Response Programs Virginia Department of Health Diane Helentjaris, MD, MPH Deputy Director, Office of Epidemiology Virginia Department of Health James E. Burns, MD, MBA Deputy Commissioner of Public Health Virginia Department of Health Karen Remley, MD, MPH, FAAP Commissioner Virginia Department of Health

18. Direct Medical Care /Surge Treatment and infection control information State antiviral stockpile Hospital bed tracking

19. Mitigation

20. Vaccination

21. Seasonal Influenza Vaccine Timetable

22. H1N1 Vaccine Development

23. Vaccination Campaign Tenets Fair and ethical Public and Private partnership Focus initially on priority groups Virginia Immunization Information System required Distribute 100% of Allocated Vaccine

24. Targeted Vaccination and After Action Analysis

25. Vaccine Allocation Variables  Availability  Formulation  Distribution  Preferences

26. Results

29. H1N1 Vaccine Administered in Virginia Date: 03/24/10 Preservative -free vaccine Preservative -containing vaccine Intranasal vaccine (LAIV) Total Public providers 56,1501,102,980391,1101,550,240 Private providers 254,7401,507,830268,9502,031,520 Other providers 6,470288,26028,940323,670 Total317,3602,899,070689,0003,905,430

32. Vaccine Distribution by Provider Type Friday of WeekDosesProvider Types Start Receiving Doses 10/2/0948,400Hospitals, Health Departments 10/9/09137,750EMS, OB/GYNs, Pediatrics, Health Centers, K-12 10/16/0995,660Family Medicine 10/23/0999,570Internal Medicine 10/30/09267,900Colleges 11/6/09318,400Urgent Care, Correc. Facilities, LTC 11/13/0963,500 11/20/09317,700 11/27/09204,350 12/4/09254,050 12/11/09356,250 12/18/09314,100Occ. Health, Pharmacies, Comm. Vaccin. 12/25/09746,710 1/1/2010618,550

35. Vaccination – School-age children

39. Conclusions Partnerships key School-based vaccinations effective

41. Resources Virginia Department of Health Web site: www.vdh.virginia.govwww.vdh.virginia.gov; www.H1N1Get1.comwww.H1N1Get1.com Toll-free VDH Inquiry Center: 1-877-ASK-VDH3 (1-877-275-8343) Google Flushot Locator www.google.com/flushot CDC H1N1 Web site: www.cdc.gov/h1n1flu U.S. Dept. of Health & Human Services Flu center: www.flu.gov

42. Acknowledgements VDH staff CDC CDC Public Health Image Library Google