Public Health Emergencies &

Flu 101

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

Vision and Mission of Public Health

VisionVision““Healthy People in Healthy Communities”Healthy People in Healthy Communities”

MissionMission““To protect health, prevent disease, and promote health and To protect health, prevent disease, and promote health and

well-beingwell-being””

How does Los Angeles County Public Health do this?

3 Core Functions 10 Essential Services

LA County Public Health: LA County Public Health: 3 Core Functions of Public Health3 Core Functions of Public Health

Assessment Policy Development Assurance

LA County Public Health: LA County Public Health: 10 Essential Services10 Essential Services

What public health does to reach core function goals

1. Monitor: Find health problems in the community2. Diagnose: Find what causes health problems3. Inform, educate, empower: Teach people about health problems4. Mobilize: Work with the community to solve health problems5. Develop: Make rules/plans that help individual and community health6. Enforce: Ensure rules are followed to protect people and their health 7. Link: Ensure enough medical services for people who need them8. Assure: Prepare public health employees to do their job well9. Evaluate: Ensure programs are working and doing a good job10. Research: Study new ways to solve health problems

Emergency Public Health:Music changes, stay the same

Day-to-Day Operations:TB, HIV, Tobacco Control

What does Public Health Do?1. Monitor, Inform/Educate2. Mobilize work with community to solve problem3. Ensure medical services/resources are available

Emergency Public Health:Music changes, stay the same

Emergency Operations:Bio-terrorism, Disease Outbreaks, Pandemic Influenza

What does Public Health Do?1. Monitor, Inform/Educate2. Mobilize work with community to solve problem3. Ensure medical services/resources are available

Risk: Threats and Resources

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

Risk of a Disaster

RISK = HAZARD x VULNERABILITY – RESOURCES

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…

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

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

Health Emergencies: Hazards & Resources

Public Health Impact vs.

Public Health Role

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

Community Mitigation: Goals

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

Public Health Response

Mitigation Tools: Isolation & Quarantine Vaccines Anti-Virals

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

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

Photo credit: CDC, Public Health Image Library

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

Biological Terrorism

The use of biological agents to intentionally

produce illness or intoxication in a

susceptible population

Biological Terrorism

Disease causing microbes Uncommon Capable of causing widespread illness Patients may require advanced medical

treatments

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

Influenza

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)

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-”?”

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

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

H1N1: What do we know

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?

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

Community Mitigation

Model

Model Results:Impact on

Community

Model Results:Impact on Hospitals

Plans & Polic ies

Community Attack Rate

Hospital Surge Model

How will a pandemic affect LA County?

How will a pandemic affectLA County hospitals?

What are the most effective interventions and policies?

Integration of Models

Results and Application

Results Influencing Planning and Response: NPI

Strategy Avg AR

0-4 5-18 19-29 30-34 65+ Cases (x10,000)

No intervention 36.0 % 40.8% 55.0% 29.1% 31.8% 25.8% 399.6

County Wide School Closure

2.1 1.9 1.9 2.1 2.3 1.9 23.1

Closure by Tract and Age

35.9 40.7 54.8 29.1 31.8 25.8 398.6

Combined NPI 0.2 0.2 0.2 0.2 0.2 0.1 1.8

Ro = 1.6

Aggressive school closure, where feasible is effective. Layered NPI extremely effective.

Results and Application

Results Influencing Planning and Response: Vaccine

Strategy Avg AR 0-4 5-18 19-29 30-34 65+ Cases (x10,000)

No intervention

36.0 % 40.8 % 55.0 % 29.1 % 31.8 % 25.8 % 399.6

Pre Vac 30 % 18.7 21.0 34.4 13.2 14.9 11.4 207.4

Pre Vac 50 % 0.8 0.8 1.7 0.5 0.6 0.4 8.8

Pre Vac 70 % 0.0 0.0 0.1 0.0 0.0 0.0 0.4

Ro = 1.6

Each subsequent level of vaccine coverage greatly reduces both Attack Rate and Total Cases

Results and Application: Vaccine Efficacy

Well Matched Vaccine

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

Provisional Dosing Schedule

Age Dose6 months thru 9 years 2 doses*

10 years and older 1 dose

*21-28 days apart

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?

QUESTIONS?