1. Public Health Emergencies & Flu 101

2. Outline  Public Health in Los Angeles County  Public Health Impacts of Emergencies  Influenza - What is it - Types  What do we know –What don’t we know?  Effects

3. Vision and Mission of Public Health Vision “Healthy People in Healthy Communities” Mission “To protect health, prevent disease, and promote health and well-being” How does Los Angeles County Public Health do this? 3 Core Functions  10 Essential Services

4. LA County Public Health: 3 Core Functions of Public Health  Assessment  Policy Development  Assurance

5. LA County Public Health: 10 Essential Services What public health does to reach core function goals 1.Monitor: Find health problems in the community 2.Diagnose: Find what causes health problems 3.Inform, educate, empower: Teach people about health problems 4.Mobilize: Work with the community to solve health problems 5.Develop: Make rules/plans that help individual and community health 6.Enforce: Ensure rules are followed to protect people and their health 7.Link: Ensure enough medical services for people who need them 8.Assure: Prepare public health employees to do their job well 9.Evaluate: Ensure programs are working and doing a good job 10.Research: Study new ways to solve health problems

6. Emergency Public Health: Music changes, stay the same Day-to-Day Operations: TB, HIV, Tobacco Control What does Public Health Do? 1.Monitor, Inform/Educate 2.Mobilize work with community to solve problem 3.Ensure medical services/resources are available

7. Emergency Public Health: Music changes, stay the same Emergency Operations: Bio-terrorism, Disease Outbreaks, Pandemic Influenza What does Public Health Do? 1.Monitor, Inform/Educate 2.Mobilize work with community to solve problem 3.Ensure medical services/resources are available

8. Risk: Threats and Resources

9. It’s all about your resources  Disaster – any event that overwhelms a community’s capacity to respond  May or may not be different than an emergency  Dependent upon available resources

10. Risk of a Disaster RISK = HAZARD x VULNERABILITY – RESOURCES

11. Resources: Public Health Infrastructure Los Angeles County Department of Public Health  39 Departments, 3700 employees  Multiple community health clinics  Hundreds of service delivery partnering agencies However…

12. Los Angeles County Big County  11 million citizens; 88 cities  11 primary languages  108 Hospitals; 87 Emergency Depts. Distinct Challenges  Population density & scarcity  Urban v. rural  1/3 of <65 pop uninsured  100,000 homeless  36% foreign born  Over 200+ languages

13. Reinforcements!  YOU are a KEY Public Health Resource  By becoming a part of the emergency public health team, you can help reduce a disaster’s impact

14. Health Emergencies: Hazards & Resources Public Health Impact vs. Public Health Role

15. Emergency Ops  Potential Impact and Role(s) depend on the disease: –Anthrax v. Pandemic Influenza Contagious Incubation Response Timeline Prophy v. Treatment  Many unique variables to consider in spread and control of disease

16. Community Mitigation: Goals Centers for Disease Control. Interim Pre-Pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States Department of Health & Human Services, USA, 2007.

17. Public Health Response Mitigation Tools:  Isolation & Quarantine  Vaccines  Anti-Virals

18. Isolation –The physical separation of people who have a specific communicable disease from healthy people and the restriction of movement to stop the spread of disease

19. Quarantine –Quarantine refers to the separation and restriction of movement of people who are NOT yet ill, but who have been exposed to an infectious agent and are therefore potentially infectious –Quarantine lasts for the longest known incubation period for the applicable disease

20. Photo credit: CDC, Public Health Image Library

21. Vaccines & Anti-Virals  Use will depend on type and nature of disease— epidemiology of disease  Vaccines (generally) used in anticipation of exposure-to prevent population from becoming ill  Anti-Virals—i.e. Tamiflu—used to lessen effects of illnesses on exposed and/or sick individuals  No Magic Bullet

22. Biological Terrorism The use of biological agents to intentionally produce illness or intoxication in a susceptible population

23. Biological Terrorism  Disease causing microbes  Uncommon  Capable of causing widespread illness  Patients may require advanced medical treatments

24. Anthrax 2001  October 4, 2001 – CDC reported a case of anthrax in a 63-year-old resident of Florida  23 cases (19 confirmed/4 suspect)  Not Contagious…spread by inhaling robust spores  Releases toxins that cause highly lethal pneumonia

25. Influenza

26. What is Influenza?  Virus  RNA Based –Messy  3 Types of Influenza –A: Many animals, quite common, ie H1N1 –B: Humans only, less common –C: Several animals, even less common  Type A: –H (16) and N (9)

27. Influenza: Seasonal, Swine and So Forth Drift v. Shift  Drift: slow change over time –Messy replication  Shift: abrupt introduction of new type  Previous Shifts: –1918-”Spanish Flu” –1957-”Asian Flu” –1968-”Hong Kong Flu” –2009-”?”

28. Seasonal, Swine and So Forth  Seasonal –Fairly common during winter months –Widespread illness, up to 36,000 deaths/year in U.S.  Pandemic –Uncommon –Global focus –Potential for approximately 36% of the population being ill  Avian –Primarily a bird disease –Many types; commonly found in birds –Rare human cases  Swine –A pig disease, many types –Many types; some can affect humans

29. H1N1: What do we know  Novel virus: Recombinant pieces from swine, avian and human influenza  Sudden appearance spring 2009 –“Index cases” San Diego and Imperial Counties  Rapid spread throughout world  Antigenically stable –Drift v. Shift  Is and will be dominant flu strain

30. H1N1: What do we know

31. What don’t we know  How many people will become ill?  How many people will be hospitalized?  How many people will die from this virus?  Will vaccines work? –Seasonal v. H1N1 specific  Will anti virals work? What is Public Health to do?

32. Modeling in Los Angeles Unique Project  Predictive mathematical disease models to: –Understand spread within community and hospital systems –Drive planning and policy development  Explicitly designed for local health department; –Local data, objectives  Incorporation of cutting edge methods and technology

33. How will a pandemic affect LA County? How will a pandemic affect LA County hospitals? What are the most effective interventions and policies? Integration of Models

34. Results and Application Results Influencing Planning and Response: NPI StrategyAvg AR 0-45-1819-2930-3465+Cases (x10,000) No intervention 36.0 %40.8%55.0%29.1%31.8%25.8%399.6 County Wide School Closure 2.11.9 2.12.31.923.1 Closure by Tract and Age 35.940.754.829.131.825.8398.6 Combined NPI 0.2 0.11.8 R o = 1.6 Aggressive school closure, where feasible is effective. Layered NPI extremely effective.

35. Results and Application Results Influencing Planning and Response: Vaccine StrategyAvg AR0-45-1819-2930-3465+Cases (x10,000) No intervention 36.0 %40.8 %55.0 %29.1 %31.8 %25.8 %399.6 Pre Vac 30 %18.721.034.413.214.911.4207.4 Pre Vac 50 %0.8 1.70.50.60.48.8 Pre Vac 70 %0.0 0.10.0 0.4 R o = 1.6 Each subsequent level of vaccine coverage greatly reduces both Attack Rate and Total Cases

36. Results and Application: Vaccine Efficacy Well Matched Vaccine

37. Initial Target Groups for H1N1 Vaccination  Pregnant women  People who live with or care for children younger than 6 months of age  Health care and emergency medical services personnel  Persons between the ages of 6 months through 24 years of age  People from ages 25 through 64 that have chronic health disorders or compromised immune systems

38. Provisional Dosing Schedule AgeDose 6 months thru 9 years2 doses* 10 years and older1 dose *21-28 days apart

39. Primary Public Health Role  Vaccines: Name of the Game  Push v. Pull Strategy –Push: Private Medical Plan Partnerships –Pull: Community Partnerships –80/20 split  Difficult Planning Challenge –Availability of Vaccine –How Many PODs? HOW MUCH STAFF?

40. QUESTIONS?