1. Pandemic Influenza An Immunization Perspective NACCHO Preparedness Committee Meeting Memphis, TN 4-5 April 2006

3. Framework for Discussion LHD preparedness leaders should provide states and CDC with input on where effort should be placed – guidance needs of local partners; research needs; communication needs LHD preparedness leaders should provide states and CDC with input on where effort should be placed – guidance needs of local partners; research needs; communication needs Balancing need for clear guidance to ensure consistent approach vs being too restrictive Balancing need for clear guidance to ensure consistent approach vs being too restrictive Policy must not be set that is too restrictive – it must allow for local flexibility but this is a tough balance to get – it raises key issues but does not offer solutions Policy must not be set that is too restrictive – it must allow for local flexibility but this is a tough balance to get – it raises key issues but does not offer solutions

4. Guidance Detailed operational plan and protocols for contact management (e.g., Q vs symptom monitoring, AV PEP) stratified by – WHO phase; geographic proximity of outbreak; recognition at airport vs once in the community Detailed operational plan and protocols for contact management (e.g., Q vs symptom monitoring, AV PEP) stratified by – WHO phase; geographic proximity of outbreak; recognition at airport vs once in the community Recommendations for facilities to lodge people under Q; how best to do medical monitoring of contacts Recommendations for facilities to lodge people under Q; how best to do medical monitoring of contacts Criteria for when to transition from case-based approach to community measures Criteria for when to transition from case-based approach to community measures Guidance for home care Guidance for home care Guidance on epi and other criteria for when to implement community measures such as school closures, canceling public events/gatherings Guidance on epi and other criteria for when to implement community measures such as school closures, canceling public events/gatherings Flexibility for different settings (urban v rural) Flexibility for different settings (urban v rural)

5. Research Needs Better characterization of avian-strain influenza transmission (period of contagiousness, droplet vs aerosol) Better characterization of avian-strain influenza transmission (period of contagiousness, droplet vs aerosol) Develop and pilot test epi protocols to assess these factors during seasonal influenza so ready to go at start of pandemic Develop and pilot test epi protocols to assess these factors during seasonal influenza so ready to go at start of pandemic Data on transmission of pandemic strain will help guide decisions re: isolation/Q/usefulness of community measures Data on transmission of pandemic strain will help guide decisions re: isolation/Q/usefulness of community measures Plan now for epi studies that will be needed during the pandemic to assess efficacy of containment measures – protocols (sampling strategies, analytic approach); template surveillance forms; get state & local PH input into feasibility of conducting these types of studies Plan now for epi studies that will be needed during the pandemic to assess efficacy of containment measures – protocols (sampling strategies, analytic approach); template surveillance forms; get state & local PH input into feasibility of conducting these types of studies

6. Research Needs Does wearing masks in public make a difference? Need for science-based recommendations Does wearing masks in public make a difference? Need for science-based recommendations Determining measures to limit transmission in households? Determining measures to limit transmission in households? Looking at impact of school breaks on transmission of seasonal influenza Looking at impact of school breaks on transmission of seasonal influenza Role of environmental decontamination? Role of environmental decontamination?

7. Communications Needs Need to develop concise consistent messages for multiple audiences – general public and its diversity; media; government decision makers Need to develop concise consistent messages for multiple audiences – general public and its diversity; media; government decision makers Address misconceptions Address misconceptions Set expectations on what will and wont be done Set expectations on what will and wont be done Conduct focus groups to measure public knowledge and practices re: likely community measures (respiratory etiquette/hand hygiene) that will work during an emergency Conduct focus groups to measure public knowledge and practices re: likely community measures (respiratory etiquette/hand hygiene) that will work during an emergency

8. Communications Needs Need to determine best messages and methods for preparing the public for the long-term community resiliency that will be needed throughout the pandemic – especially public health resiliency and how to say those things to get people to prepare for it and get through the emergency Need to determine best messages and methods for preparing the public for the long-term community resiliency that will be needed throughout the pandemic – especially public health resiliency and how to say those things to get people to prepare for it and get through the emergency

9. Other Issues Need to develop consistent approach to alternate standards of care Need to develop consistent approach to alternate standards of care Prepare public/media/policymakers ahead of time Prepare public/media/policymakers ahead of time It would help to know whats in the pandemic operational plans – not knowing whats coming is a problem because state & local PH may be working on things that may already exist It would help to know whats in the pandemic operational plans – not knowing whats coming is a problem because state & local PH may be working on things that may already exist

10. Other Issues The epi should be prioritized because those data will guide local interventions and recommendations. Flu is very nonspecific and LHDs may have to change the symptoms that they want to hear from physicians/hospitals so that they arent overwhelmed with tons of fever- backache reports. So how do they narrow it down to help them pinpoint highly suspect cases? The epi should be prioritized because those data will guide local interventions and recommendations. Flu is very nonspecific and LHDs may have to change the symptoms that they want to hear from physicians/hospitals so that they arent overwhelmed with tons of fever- backache reports. So how do they narrow it down to help them pinpoint highly suspect cases?

11. Other We need to be clear about what we want to do with our disease prevention strategies and figure out how surveillance can support those efforts/goals. We need to be clear about what we want to do with our disease prevention strategies and figure out how surveillance can support those efforts/goals. That will help guide LHDs re: which symptoms they want to have reported. That will help guide LHDs re: which symptoms they want to have reported. Is your goal to find EVERY case? If your goal/strategy is to lower the size of the epi curve and mitigate the epidemic (recognizing that you cant stop it), then you need surveillance that tells you that information – you wont need info on every individual because youre not concerned about every individual. Is your goal to find EVERY case? If your goal/strategy is to lower the size of the epi curve and mitigate the epidemic (recognizing that you cant stop it), then you need surveillance that tells you that information – you wont need info on every individual because youre not concerned about every individual.

12. Other Issues Integrated surveillance – human and animal surveillance. Integrated surveillance – human and animal surveillance. The planning process is the model and not the plan itself – because you build the robust and sustainable relationships within the planning/preparedness processes. (Refer to the Eisenhower quote in your folder.) The planning process is the model and not the plan itself – because you build the robust and sustainable relationships within the planning/preparedness processes. (Refer to the Eisenhower quote in your folder.)

14. 2005 Profile of Local Health Departments Study NACCHO EH&BT Committee Meeting April 4, 2006

15. 2005 National Profile of Local Health Departments Study Census – includes all LHDs in U.S. Census – includes all LHDs in U.S. Three prior studies Three prior studies Conducted in 1989, 1992-93, and 1995-96 Conducted in 1989, 1992-93, and 1995-96 First National Profile to be conducted as web-based survey First National Profile to be conducted as web-based survey CDC is primary funder CDC is primary funder NLM and HRSA support for specific analyses NLM and HRSA support for specific analyses

16. 2005 Profile Questionnaire Structured as Core and Modules Core questionnaire sent to every LHD Core questionnaire sent to every LHD N = 2864 N = 2864 Three different modules Three different modules Each sent to sample of ~550 LHDs Each sent to sample of ~550 LHDs Stratified by population served Stratified by population served

17. Topics in Profile Core Governance Governance Population served Population served Finances Finances Characteristics of top executive Characteristics of top executive LPHA workforce LPHA workforce Activities and services provided Activities and services provided Community health assessment & improvement Community health assessment & improvement Information technology Information technology

18. Topics in Profile Modules Detailed information on: Finances Finances LPHA workforce LPHA workforce Community health assessment & improvement Community health assessment & improvement Information technology Information technology Additional Topics: Performance improvement Performance improvement Emergency preparedness Emergency preparedness Partnerships Partnerships Policy-making and advocacy Policy-making and advocacy Addressing health inequities Addressing health inequities

19. Overall Response Rate = 80%

20. Preview of 2005 Profile Data Data collection completed in November 2005 Data collection completed in November 2005 Data cleaning recently completed Data cleaning recently completed Analysis has just begun Analysis has just begun Report of findings expected in mid-2006 Report of findings expected in mid-2006 IMPORTANT NOTE: Data presented are preliminary

21. Percentage of LHDs involved in regulation, inspection or licensing activities Health-related facilities 30% Food processing 30% Mobile homes 29% Housing inspections 28% Solid waste disposal sites 28% Solid waste haulers 27% Tobacco retailers 21% Cosmetology businesses 11% Milk processing 9% Food service 76% Swimming pools 67% Septic tanks 65% School/daycare65% Private drinking water 57% Lead inspection 53% Hotels/motels49% Campgrounds/RVs39% Smoke-free ordinances 37% Public drinking water 30%

22. LHD Provision of Environmental Health Services – Direct or Contract

23. Organizations Providing Environmental Health Services

24. Amount of BT Funding LHDs Receive from CDC

25. Amount of BT Funding LHDs Receive from HRSA

26. Percentage of LHDs Reporting Selected Emergency Preparedness (EP) Activities (in past 12 months) Activity%age Participated in drills or exercises 92% Developed or updated written emergency plan 90% Provided EP training to staff 71% Assessed EP competencies of staff 65% Reviewed relevant legal authorities 65% Participated in an actual PH emergency 37% None of the above 2%

27. How are Profile Data Used? By LHDs to benchmark and advocate By LHDs to benchmark and advocate By state and federal agencies to better understand LPH practice By state and federal agencies to better understand LPH practice By policymakers addressing LPH issues By policymakers addressing LPH issues By NACCHO staff to support programs for LHDs By NACCHO staff to support programs for LHDs By researchers exploring specific hypotheses By researchers exploring specific hypotheses

28. Stay tuned for more information State-specific data files will be made available soon State-specific data files will be made available soon National report will be published in mid- 2006 National report will be published in mid- 2006 Free copy for all Profile respondents Free copy for all Profile respondents