Tennessee 2009-2010 Flu Season

[Laidback Al]

Tennessee Dept. of Health

http://health.state.tn.us/

[cmmc]

Re: Tennessee Dept. of Health - Information and Case Counts

Tennessee Cases

as of May 3, 2009

Probable Cases -- 8

CDC Confirmed Cases -- 1

Total Cases -- 9

Specimens Tested at the State Lab -- 226

http://health.state.tn.us/swineflu.htm

[Niko]

Re: Tennessee Dept. of Health - Information and Case Counts

http://health.state.tn.us/H1N1.htm


Tennessee Cases

as of May 11, 2009
<table width="80%"><tbody><tr> <th class="data">County</th><th class="data">Confirmed Cases</th></tr> <tr> <td class="data">Blount</td> <td class="data">2</td> </tr> <tr> <td class="data">Bradley</td> <td class="data">1</td> </tr> <tr> <td class="data">Davidson</td> <td class="data">25</td> </tr> <tr> <td class="data">Knox</td> <td class="data">9</td> </tr> <tr> <td class="data">Maury</td> <td class="data">2</td> </tr> <tr> <td class="data">Montgomery</td> <td class="data">3</td> </tr> <tr> <td class="data">Shelby</td> <td class="data">1</td></tr> <tr> <td class="data">Sullivan</td> <td class="data">1</td> </tr> <tr> <td class="data">Williamson</td> <td class="data">10</td> </tr> <tr> <td class="data">Total</td> <td class="data">54</td> </tr> <tr> <td class="data">
</td> <td class="data">
</td> </tr> <tr> <td class="data">Total Specimens Tested</td> <td class="data">762</td></tr></tbody></table>

[Niko]

Re: Tennessee Dept. of Health - Information and Case Counts

Tennessee Cases

as of May 15, 2009
<!--<table width="80%"> <tr> <th class="data">County</th><th class="data">Confirmed Cases</th></tr> <tr> <td class="data">Blount</td> <td class="data">2</td> </tr> <tr> <td class="data">Bradley</td> <td class="data">1</td> </tr> <tr> <td class="data">Davidson</td> <td class="data">27</td> </tr> <tr> <td class="data">Knox</td> <td class="data">9</td> </tr> <tr> <td class="data">Maury</td> <td class="data">2</td> </tr> <tr> <td class="data">Montgomery</td> <td class="data">3</td> </tr> <tr> <td class="data">Shelby</td> <td class="data">2</td> </tr> <tr> <td class="data">Sullivan</td> <td class="data">1</td> </tr> <tr> <td class="data">Williamson</td> <td class="data">10</td> </tr> <tr> <td class="data">Total</td> <td class="data">57</td> </tr> <tr> <td class="data"> </td> <td class="data"> </td> </tr> <tr> <td class="data">Total Specimens Tested</td> <td class="data">796</td> </tr> </table>--> Total cases confirmed in the state: 76
Total specimens submitted for testing: 1003
Note: Next update will be posted Monday, May 18

http://health.state.tn.us/H1N1.htm


Apparently, TN is no longer breaking down the count by county.

[Niko]

Re: Tennessee Dept. of Health - Information and Case Counts

Tennessee H1N1 Case Count

as of May 22, 2009 at 11 a.m. CDT
<!--<table width="80%"> <tr> <th class="data">County</th><th class="data">Confirmed Cases</th></tr> <tr> <td class="data">Blount</td> <td class="data">2</td> </tr> <tr> <td class="data">Bradley</td> <td class="data">1</td> </tr> <tr> <td class="data">Davidson</td> <td class="data">27</td> </tr> <tr> <td class="data">Knox</td> <td class="data">9</td> </tr> <tr> <td class="data">Maury</td> <td class="data">2</td> </tr> <tr> <td class="data">Montgomery</td> <td class="data">3</td> </tr> <tr> <td class="data">Shelby</td> <td class="data">2</td> </tr> <tr> <td class="data">Sullivan</td> <td class="data">1</td> </tr> <tr> <td class="data">Williamson</td> <td class="data">10</td> </tr> <tr> <td class="data">Total</td> <td class="data">57</td> </tr> <tr> <td class="data"> </td> <td class="data"> </td> </tr> <tr> <td class="data">Total Specimens Tested</td> <td class="data">796</td> </tr> </table>--> Total cases confirmed in state: 95

Total specimens submitted for testing: 1,206

http://health.state.tn.us/H1N1.htm

[Niko]

Re: Tennessee Dept. of Health - Information and Case Counts

This is the html version of the file http://www.tha.com/swine-flu/7-27-09...-ic-update.ppt.
Google automatically generates html versions of documents as we crawl the web.

2009-2010 Seasonal and Pandemic Influenza Vaccine Update

Kelly L. Moore, MD, MPHMedical Director, Immunization ProgramTN Department of HealthTennessee Hospital Association WebinarJuly 27, 2009

Objectives

• Seasonal vaccine
  • One dose, LAIV (nasal spray) or TIV (injection)
  • Will arrive in clinics first
  • ~115 million doses for the season
  
  
• Pandemic vaccine
  • Expected 2 doses, at least 3 weeks apart
  • LAIV or TIV
  • Could start shipping by mid-late October
  • Up to 600 million doses, if demand exists
  
  

2009-2010 Seasonal Influenza Vaccine

• an A/Brisbane/59/2007 (H1N1)-like virus
• an A/Brisbane/10/2007 (H3N2)-like virus
• a B/Brisbane/60/2008-like virus (new)

Production on schedule:
Majority of doses distributed by the end of October (though distribution likely to continue into December)

Seasonal Influenza Vaccination Advice

• Critical importance of seasonal vaccine is undiminished by pandemic virus
• Seasonal strains more likely to kill elderly
• Seasonal strain drug resistance
  • Seasonal H1N1 resistant to oseltamivir
  • Seasonal H3N2 resistant to adamantanes (M2 blockers)
  
  
• Seasonal viruses continue to circulate in Southern Hemisphere season
• Opportunities for genetic recombination

Seasonal Influenza Vaccination Advice

• Vaccinate as soon as supplies permit
  • Protection will not wane through season
  • Get inventory out of the way before pandemic vaccine arrives
  • Easier to attribute cause of adverse events if not co-administered with pandemic vaccine
  • Use opportunity to educate about pandemic influenza and forthcoming vaccine
  • Treat both pandemic and seasonal vaccine as important and essential for safe patient care
  
  

Pandemic H1N1 Virus

• Circulating through the summer
• Expected to increase when school resumes
• An early fall wave 2 is likely
• Vaccine distribution expected by mid-late October (after disease prevalent)
• Clinical trials beginning

Pandemic Vaccine Manufacturers

• Novartis (45.7%)

• - Also manufactures MF59 adjuvant for potential pre-formulation with vaccine
  

• Sanofi Pasteur (26.4%)

• CSL (18.7%)

• MedImmune (5.8%)

• GSK (3.4%)

• - Also manufactures ASO3 adjuvant in a separate vial for potential mixing at the place of administration

Vaccine products (general)

• Unadjuvanted multidose vials^*
• Unadjuvanted p-free pre-loaded syringes^?
• Nasal sprayers (live attenuated)^?

Potentially

• Multidose vials pre-formulated with adjuvant
• Multidose vials formulated for adjuvant to be mixed at the place of administration (separate antigen and adjuvant vials)

^*All multidose vials will contain thimerosal preservative
^?Up to 20% of vaccine may be p-free pediatric formulation

Vaccine ancillary supplies: provided with the vaccine

• Needle/syringe units for multidose vials

• Sharps containers

• Alcohol pads

• Mixing syringes if adjuvanted vaccine is used

Emergency Use Authorization: Maybe, Maybe Not

?? use of an unapproved medical product or an unapproved use of an approved medical product during a declared emergency ??

• - Unadjuvanted pandemic H1N1 vaccine may be licensed in a manner similar to a seasonal flu vaccine strain change and therefore would not need an EUA

• - Adjuvanted vaccines, if used (for the 2009-10 flu season), will be administered under an EUA

Vaccine purchase, allocation, and distribution

• Vaccine procured and purchased by US government
• Vaccine will be allocated across states proportional to population
• Vaccine will be sent to state-designated receiving sites: mix of local health departments and private settings

Vaccine planning assumptions:

• Vaccine available starting mid-October
• Initial amount: 40, 80, or 160 million doses

distributed in the first month

• Subsequent weekly production: 10, 20 or 30 million doses distributed
• 2 doses required (21 or 28 days apart)

Vaccine planning assumptions: probable target groups if early supplies are limited

• Students and staff (all ages) associated with schools (K-12) and children (age >6 m) and staff (all ages) in child care centers
• Pregnant women, children 6m-4yrs, new parents and household contacts of children <6 m
• Non-elderly adults (age <65) with medical conditions that increase risk of complications
• Health care workers and emergency services personnel

(because illness is distinctly uncommon in elderly, they will not be a priority)

Monitoring vaccine safety

• Vaccine Adverse Event Reporting System (VAERS)
  (1-800-822-7967, http://vaers.hhs.gov/contact.htm ) for signal detection
• Network of MCOs representing ~3% of U.S. pop., the Vaccine Safety Datalink (VSD) to test signals.
• Active surveillance for Guillain Barre Syndrome through states in Emerging Infections Program (including TN).

Monitoring vaccine effectiveness (VE)

• VE for prevention of PCR-confirmed medically attended influenza at 4 community-based sites
• VE for prevention of influenza hospitalizations diagnosed by provider-ordered clinically available tests at 10 sites nationwide through the Emerging Infections Program (includes TN)
• DoD will be assessing VE in active duty service members

Vaccine Delivery Model

• Public health-coordinated effort
• Blends vaccination in public health-organized clinics and in the private sector (provider offices, workplaces, retail settings)
• Tennessee will pre-register all non-public health facilities needing vaccine directly shipped (including all hospitals)

Tennessee Pre-Registration for Pandemic Vaccine Information/Shipment

• No cost, no obligation to order vaccine
• Only for facilities considering providing vaccine
• Includes hospitals, medical clinics, immunizing pharmacists, contract mass vaccinators
• Expected to go live about August 5
• Updates emailed to registrants, including ordering instructions

Tennessee Pre-Registration for Pandemic Vaccine Information/Shipment

• 2-step registration
  • Register to use the Tennessee Web Immunization System (TWIS), ?Registry?
  • Takes about 2 days to receive user id and password for TWIS
  • After log-on with user id / password, prompted to register for pandemic vaccine information
  • All registered providers will have full access to TWIS resources, including self-guided tutorial (renewal would be necessary in 1 year)
  
  

TN Pre-Registration for Pandemic Vaccine, contd.

• Registration serves multiple purposes:
  • Obtain contact information
    • Authorized Immunization Provider
    • Primary Point of Contact (will receive MOA and ordering instructions
    • Shipping Contact (to receive shipments)
    
    
  • Establish shipping record
  • Enable direct communication of new info (email/fax)
  • Gauge interest in the private sector
    • Estimate number of healthcare staff, others the facility plans to vaccinate
    
    
  
  

Provider Registration

• Hospitals will need to register
• Programming underway
• Notice will come through THA once system is live (within 2 weeks)
• Hospitals are priority vaccine recipients, will have to submit orders, follow reporting reqts.
  • Weekly Survey Monkey questionnaire on total doses administered by age category, dose #1 or #2
  • Not required to record doses in TWIS, but may be valuable
  
  

Pandemic Vaccine Planning

• Cannot predict when vaccine will arrive, size of initial shipments
• Begin planning strategies
  • Seasonal vaccine (Sept-Oct)
  • Pandemic #1 (Oct-Nov)
  • Pandemic #2 (3-4 weeks after #1)
  • Storage space? Communications? Time and locations?
  
  
• Much has yet to be decided - make plans practical and flexible

Discussion

Thank you!

Kelly Moore, MD, MPH
Kelly.moore@tn.gov
615-741-7247

Update on Infection Control
Marion Kainer MD MPHDirector, Hospital Infections Program, Tennessee Department of Health

Recent Infection Control Breaches in TN

• Multiple instances of NO precautions (no PPE at all) taken by HCWs in looking after patients with fever and respiratory distress (later confirmed H1N1)
• Intubation, bronchoscopy, open suctioning
• Hundreds of HCWs exposed: PEP
  • Some HCW infected, some severely ill
  • Infected HCWs went to work & exposed co-workers and patients
  
  

• H1N1 was considered in the differential diagnosis (specimen taken), but NOT communicated to IP or other staff

• Patient NOT placed in isolation
• Patient did NOT receive antivirals
• One patient died

• Improve communications (consider closing loop with laboratory notifying IP if H1N1 test is ordered)

Think H1N1:
Just because it is not in the media,
it has NOT disappeared

Current Published CDC Guidelines

• Respiratory etiquette
• Hand Hygiene
• N-95 respirators for all direct patient contact if suspected/confirmed H1N1
• Prefer negative pressure room if performing aerosol-generating procedure

Current TDH Guideline

• Similar to WHO and Health Canada:
• http://www.who.int/csr/resources/publications/infection_control/en/index.html.
• For all patients with a febrile respiratory illness (FRI) (i.e., not just suspect or confirmed cases of H1N1):

Current TDH Guideline- All FRI:

• Practice good hand hygiene (patient and staff)
• Practice good respiratory hygiene (patient and staff)
• Practice standard precautions (i.e., treat all body-fluids as potentially infectious, including stool; wear gown, gloves and eye-protection if risk of splash)

Current TDH Guideline: All FRI

• Wear surgical mask if within 6 feet if:
  • the patient is compliant (willing and able) with respiratory hygiene practices or
  • the patient has a weak or no cough
    • individuals who may have a weak cough are the frail elderly and pediatric patients.
    
    
  
  

• Wear a N-95 respirator (fit-tested);
• Eye-protection (face-shield or goggles);
• Gown and gloves
  • IF conducting aerosol-generating medical procedures
  
  

• OR

• • WHEN the patient is coughing forcefully AND the patient is unable/unwilling to comply with respiratory hygiene (e.g., coughing patient who is unable or unwilling to wear a surgical mask)
  
  

Current TDH Guideline

• Face-shields are preferred over goggles because:
  • goggles may alter facial contours and impair the proper fit of N-95 respirators that were fit-tested without wearing goggles
  • face-shields are easier to clean than goggles
  
  

• Face-shields should cover the eyes and preferably extend over the chin

CDC Guidelines May Change

• APIC/SHEA position statement
• HICPAC voted for following recommendation to CDC:
  • Standard precautions
  • Droplet precautions
  • N-95 + Eye protection for aerosol-generating procedures
  
  
• Waiting for IOM report
  • (8/11 meeting; report by 8/30)
  
  
• September 1: possible guideline change

Aerosol-Generating Procedures (HICPAC: 7/23/2009)

• Intubation
• Bronchoscopy
• Induced Sputum
• Open Suctioning
• CPR

[Niko]

Re: Tennessee Dept. of Health - Information and Case Counts

Sentinel Provider Influenza-Like Illness (ILI) Surveillance Summary
For the Week of August 30 - September 5, 2009 (Week 35)

http://health.state.tn.us/Downloads/week35ILI_spnreport_2009.pdf

[Niko]

Re: Tennessee Dept. of Health - Information and Case Counts

Sentinel Provider Influenza-Like Illness (ILI) Surveillance Summary
For the Week of August 30 - September 5, 2009 (Week 35)

http://health.state.tn.us/Downloads/...eport_2009.pdf

[IMG]file:///C:/DOCUME%7E1/Lori/LOCALS%7E1/Temp/moz-screenshot.png[/IMG]

[JimO]

Re: Tennessee Dept. of Health - Information and Case Counts

The state of Tennessee is not reporting the total number of deaths. I've gone back and found a total of 12 as follows:

1) First death reported 8/27 as a child
2) Woman in her mid 20s from Madison County
3) 5-yo male - Max Gomez
4) 13-yo male from Memphis
5) 60-yo male from Munford
6) 43-yo female - Tina Vick
7) Young male - Mike Lambert from Franklin
8) 23-yo female - Tierra Robertson died just after giving birth, the baby survived
9) 73-yo from Blount County
10) 43-yo male - Bobby Bean from Blount County
11) 59-yo female - Sondra Cash who was a school nurse
12) 12-yo female reported today

[Missouriwatcher]

Re: Tennessee Week 5

Week 5:

ILI: 1.01&#37; (stable)
Percent positive: 6.5% (increasing)

http://health.state.tn.us/ceds/WeeklyReports/WeeklyReports.asp?sYear=2010

[Missouriwatcher]

Re: Tennessee Week 6

Week 6:

ILI: 1.35&#37;
Percent positive:5.3%

http://health.state.tn.us/Downloads/week06ILI_spnreport_2010.pdf

[Missouriwatcher]

Re: Tennessee Week 7

Week 7:

ILI: 1.27&#37; (decreasing)

Percent positive: 9.3% (increasing)

http://health.state.tn.us/ceds/WeeklyReports/WeeklyReports.asp?sYear=2010

[Missouriwatcher]

Re: Tennessee Week 8

Week 8: sporadic

ILI: 1.11&#37; (decreasing)
Percent positive: 9% (decreasing)

http://health.state.tn.us/ceds/WeeklyReports/WeeklyReports.asp?sYear=2010

[Missouriwatcher]

Re: Tennessee Week 9

Week 9: Regional (increase)

ILI: 1.48% ( rising)
Percent positive: 7.6% (decrease)

http://health.state.tn.us/ceds/WeeklyReports/WeeklyReports.asp?sYear=2010

[gsgs]

Re: Tennessee Week 9

http://health.state.tn.us/ceds/WeeklyReports/Results.asp

up in the young, down (a lot) in the >25y


Percentage of Visits for Influenza-like Illness reported by the US Outpatient Influenza-like Illness
Surveillance Network (ILINet) in the Tennessee State
(3/8/2010 11:12:29 AM)

Percentage of Visits for Influenza-like Illness reported by the US Outpatient Influenza-like Illness
Surveillance Network (ILINet) in the Tennessee State
(3/8/2010 11:12:29 AM)
Week#
ReportingAge
0-4Age
5-24Age
25-49Age
50-64Age
over
64Total
ILITotal
Patients&#37;
ILI
2009 40 56 52 364 127 20 9 572 15513 3.68
2009 41 60 81 388 113 33 6 621 14797 4.19
2009 42 54 74 343 93 29 4 543 13904 3.90
2009 43 59 73 466 115 22 15 691 15507 4.45
2009 44 60 68 324 105 38 10 545 16743 3.25
2009 45 57 53 230 63 21 13 380 15389 2.46
2009 46 57 39 163 84 36 10 332 13868 2.39
2009 47 58 30 93 39 14 3 179 10693 1.67
2009 48 60 35 107 49 19 9 219 14131 1.54
2009 49 56 28 93 38 8 8 175 13365 1.30
2009 50 49 28 50 43 16 3 140 11015 1.27
2009 51 48 15 54 17 13 3 102 6617 1.54
2009 52 54 30 32 26 20 7 115 6967 1.65
2010 01 53 14 26 26 6 6 78 10596 0.73
2010 02 55 10 30 22 13 3 78 13199 0.59
2010 03 57 29 70 24 10 9 142 13428 1.05
2010 04 56 17 93 19 9 0 138 13491 1.02
2010 05 55 23 70 30 13 1 137 13511 1.01
2010 06 56 20 100 31 11 5 167 12468 1.33
2010 07 55 34 85 22 11 1 153 11959 1.27
2010 08 54 13 93 27 13 1 147 13290 1.10
2010 09 20 19 67 1 2 0 89 3254 2.73