Tennessee 2009-2010 Flu Season

Laidback Al · May 4, 2009

Tennessee Dept. of Health

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

cmmc · May 4, 2009

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

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 · May 12, 2009

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

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 · May 18, 2009

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

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

Tennessee Cases

as of May 15, 2009
 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 · May 26, 2009

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

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

Tennessee H1N1 Case Count

as of May 22, 2009 at 11 a.m. CDT
 Total cases confirmed in state: 95

Total specimens submitted for testing: 1,206

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

Niko · Aug 13, 2009

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

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-flu-vaccine-and-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, MPH

Medical Director, Immunization Program

TN Department of Health

Tennessee Hospital Association Webinar

July 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<sup>*</sup>
Unadjuvanted p-free pre-loaded syringes<sup>?</sup>
Nasal sprayers (live attenuated)<sup>?</sup>

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)

<sup>*</sup>All multidose vials will contain thimerosal preservative
<sup>?</sup>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 MPH

Director, 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 · Sep 12, 2009

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

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 · Sep 17, 2009

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

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

Niko said:
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

View attachment TN ILI week 35.bmp

JimO · Sep 25, 2009

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

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 · Feb 12, 2010

Re: Tennessee Week 5

Re: Tennessee Week 5

Week 5:

ILI: 1.01% (stable)
Percent positive: 6.5% (increasing)

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

Missouriwatcher · Feb 18, 2010

Re: Tennessee Week 6

Re: Tennessee Week 6

Week 6:

ILI: 1.35%
Percent positive:5.3%
http://health.state.tn.us/Downloads/week06ILI_spnreport_2010.pdf

Missouriwatcher · Feb 24, 2010

Re: Tennessee Week 7

Re: Tennessee Week 7

Week 7:

ILI: 1.27% (decreasing)

Percent positive: 9.3% (increasing)
http://health.state.tn.us/ceds/WeeklyReports/WeeklyReports.asp?sYear=2010

Missouriwatcher · Mar 3, 2010

Re: Tennessee Week 8

Re: Tennessee Week 8

Week 8: sporadic

ILI: 1.11% (decreasing)
Percent positive: 9% (decreasing)
http://health.state.tn.us/ceds/WeeklyReports/WeeklyReports.asp?sYear=2010

Missouriwatcher · Mar 10, 2010

Re: Tennessee Week 9

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 · Mar 14, 2010

Re: Tennessee Week 9

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%
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

Missouriwatcher · Mar 17, 2010

Re: Tennessee Week 10

Re: Tennessee Week 10

Week 10:

ILI: 1.19%
Percent positive 7.7% (increase)
http://health.state.tn.us/ceds/WeeklyReports/WeeklyReports.asp?sYear=2010

Missouriwatcher · Mar 25, 2010

Re: Tennessee Week 11

Re: Tennessee Week 11

Week 11:

ILI decreased to 0.86% However, increased ILI in Knox and Davidson counties is consistent with an uptick in adults hospitalized with H1N1 disease in these counties. Pockets of increased H1N1 influenza activity are expected throughout the traditional influenza season: vaccination against H1N1 should continue.
8.4% were positive by PCR for influenza virus; 100% were subtyped as H1N1.
http://health.state.tn.us/Downloads/week11ILI_spnreport_2010.pdf
http://health.state.tn.us/H1N1.htm
http://health.state.tn.us/ceds/WeeklyReports/WeeklyReports.asp?sYear=2010

ILI:0.86
Percent positive: 10.4

Missouriwatcher · Mar 29, 2010

Re: Tennessee Week 11

Re: Tennessee Week 11

:tiphat: tetano

"The state knows that H1N1 in Tennessee has killed 66 people, of whom 13 were children."
http://www.tennessean.com/article/20100329/NEWS01/3290334/2066/NEWS03

Missouriwatcher · Mar 30, 2010

Re: Tennessee Week 12

Re: Tennessee Week 12

Week 12:

ILI: 0.78
Percent positive: 7.9
http://health.state.tn.us/ceds/WeeklyReports/WeeklyReports.asp?sYear=2010

Missouriwatcher · Apr 6, 2010

Re: Tennessee Week 13

Re: Tennessee Week 13

Week 13:

ILI: .77%
Percent positive: 18.2
http://health.state.tn.us/ceds/WeeklyReports/WeeklyReports.asp?sYear=2010

The percentage of patients with ILI reported by the TN SPN in Week 13 remained steady, at 0.87%, for the third consequetive week.
Pockets of increased H1N1 influenza activity are expected throughout the traditional influenza season: vaccination against H1N1 should
continue. Of 52 specimens tested, 6 (11.5%) were positive by PCR for influenza virus; 100% were subtyped as H1N1.
http://health.state.tn.us/Downloads/week13ILI_spnreport_2010.pdf

Tennessee 2009-2010 Flu Season

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