Seasonal and Pandemic Influenza Preparedness US Department of Veterans Affairs
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Transcript of Seasonal and Pandemic Influenza Preparedness US Department of Veterans Affairs
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Seasonal and Pandemic Influenza Preparedness
US Department of Veterans Affairs
Lawrence Deyton, MSPH, MD Chief Public Health and
Environmental Hazards Officer
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VA Medical Care
The largest integrated healthcare system in US
• 158 hospitals (18,828 beds, 5.4M BDOC)
• 132 nursing homes (33,408 ADC)
• 73 home care programs
• 43 domiciliary programs
• 206 veterans counseling centers
• 854 clinics (50 M outpatient visits)
• 186,600 employees (VHA)
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Fiscal Year 2004 – VHA Statistics
• 7.5 million total enrollees of 25 million US veterans
• 5.5 million patients treated
• $30 billion total budget
• 200 million 30-day equivalent Rx’s dispensed
• 190 million lab tests performed
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Who Are VA Patients?
• Older - 49% over age 65
• Sicker - Compared to Age-Matched Americans
– 3 Additional Non-Mental Health Diagnoses
– 1 Additional Mental Health Diagnosis
• Poorer
– 70% with annual incomes < $26,000
– 40% with annual incomes < $16,000
– 31% have no health insurance
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VA Seasonal Influenza Vaccination Program
• Influenza prevention is a public health priority for VA
• Annual Under Secretary for Health Flu Directive– Communicates priorities, implementation issues, clinical
issues
– Flu vaccine coordinator appointed at each facility
• National vaccination campaign launched each Fall
• Flu vaccine resource toolkit distributed
• Flu vaccine supplies purchased/distributed
• Flu vaccine Performance Measures established and monitored
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VHA Flu Directive
• Written and published annually
• Uses annual ACIP/CDC influenza vaccine recommendations
• Provides VHA policy and vaccine implementation guidance
• Covers patients and VA staff
• Provides documentation expectations
• Provides contacts for implementation of influenza vaccination program, legal issues, and questions on influenza/influenza vaccine
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VA’s Flu Vaccine Purchases
Year Doses Purchased
1998 986,530
1999 1,163,250
2000 1,461,280
2001 1,841,760
2002 1,587,250
2003 2,049,750
2004 2,070,790
2005 estimate 2,225,470
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VA’s 2004-2005 Flu Vaccine Utilization
• As of April 6, 2005
1,874,176doses used for 2004-2005 season
(91% of total doses ordered)
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Annual Flu Vaccination Rates
2003-2004 2004-2005VA Rates – age 50+
Clinic chart sample 70% 75%Self-report/survey 71% 78%
Source: VHA Office of Quality and Performance
Non-VA RatesAdults in US – age 65+ 68% 63%
Phone surveySource: National Committee for Quality Assurance
Medicare population – age 65+Survey 74% 75%
Source: National Committee for Quality Assurance
Commercial insurance plans – ages 50-64Mail/phone survey 52% 28%
Source: Centers for Disease Control and Prevention
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VA Annual Flu Vaccination Program
Influenza - http://www.publichealth.va.gov/flu
Wide dissemination of general and clinical information• VHA Directive: Influenza Vaccine• VA Influenza Vaccine Advisories• Messages, articles on flu vaccination
Focused dissemination to 8 categories of flu vaccination programs staff• VA Influenza Toolkit, 2005-2006, and regular bulletins
Manual– Strategies for Improving vaccination rates of health care workers and patients– Frequently asked questions (flu, novel/pandemic flu, eligibility, vaccine
storage and usage) – Resources, references and Web sites
Materials – Vaccine information statements (VISs)– 27 posters - Influenza vaccination, infection control, hand and respiratory hygiene– Buttons for health care staff, stickers for all who get flu shots
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VA Annual Flu Vaccination Program
Goals for VA’s 2005-2006 Influenza vaccination program:
• Increasing the vaccination rates of healthcare workers and all personnel at VA health care sites
• Maintaining or increasing vaccination rates of veteran patients
• Providing vaccination against pneumococcal illness where indicated.
• Promoting non-vaccine methods of preventing infection through hand and respiratory hygiene (the VA “Infection: Don’t Pass It On” campaign)
• Involving all staff and providers in promoting influenza vaccination
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VA Pandemic Flu Preparedness
• Annual Influenza Vaccination Program– Under Secretary for Health’s Flu Directive
– Resources to enhance vaccine uptake
– Performance measure
• Oseltamivir Stockpile
• Oseltamivir Stockpile Use Plan
• Oseltamivir-Probenecid Study
• Respiratory Infex Disease Emergency Plan
• VA National Pandemic Influenza Plan
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Oseltamivir Stockpile
• Fall 2004 – VA purchased 5.5 million capsules (550,000 courses) of oseltamivir
• Quantity based on supply needed for– Treatment for 550 patients and staff and
– Prophylaxis for 5000 patients and staff
• At 40 of VA’s 157 medical centers = 25% coverage
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VA Oseltamivir StockpileUse Plan
• Stockpile divided in 7 geographically diverse locations
• Plan to coordinate distribution with CDC/DoD – Depending on epidemiology
• Geographic targeting for isolated or limited outbreak/control
• Widespread distribution for treatment and prophylaxis
• VA will act to protect veterans’ health when needed– Prefer to work with CDC under the cooperative model
of last year’s flu vaccine shortage
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VA Oseltamivir-Probenecid Research Project
• Oseltamivir is made by one non-US drug company – there is a worldwide shortage
• VA Public Health and clinical researchers have initiated a study of co-administration of oseltamivir with probenecid
• Hypothesis: probenecid will slow the elimination of oseltamivir resulting sustained therapeutic levels
• If successful, co-administration of oseltamivir with probenecid could extend the effective supply of oseltamivir potentially doubling or tripling supply
• IND approved; VA funding approved
• Study is underway
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Respiratory Infectious Disease Emergency Plan
Instructions to VA facilities:• Preparations/planning needed• Pandemic responses• Follow-up actions post event• Areas of Preparations/Responses:
– Communication– Education– Staffing and Human Resources– Environmental, Facility, and Equipment– Patient Care Management
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VA National Pandemic Influenza Plan
• Describe how VA will protect employees and veteran patients, maintain operations, and work with other agencies
• Help VA employees establish and implement pandemic flu-specific emergency procedures
• Help VHA, VBA, NCA leadership at national, regional, and local levels support employees and functions at all levels and sites
• Intersect with COOP plans, National Response Plan, NDMS, VA’s missions
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Developing the VA Pandemic Influenza Plan
• Lead: VA Public Health
• Working Groups– Patient and Healthcare Delivery
– Infrastructure Support
– Communications/Public Health Community Partners
– Workforce/Occupational Health/Unions
– Education
– Tabletop Exercises
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Ongoing Activities
• Non-vaccine preventive measures encouraged in a national campaign:
Infection: Don’t Pass It On
http://www.publichealth.va.gov/infectiondontpassiton
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Pandemic Flu US Government Strategy
• President Bush – Nov 1, 2005
• Three Pillars of US Govt Strategy:
• Preparedness and Communications
• Surveillance and Detection
• Response and Containment National Implementation Plan for Pandemic
Influenza (currently in draft) will flow from the National Strategy
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VA Role in National Plan
• White House Homeland Security Council leading development of National Pandemic Flu Implementation Plan from National Strategy
• VA is one of 5 Federal Agencies asked to draft Natl Plan (with DHHS, DHS, DoD, DOT)
• Public Health SHG backup and leading development of VA-specific response plan
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Agency-Specific Plans
The President has charged that Agency plans:• Be operational
• Protect employees
• Maintain continuity of operations
• Communicate with stakeholders
• Support US Govt efforts
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2004-2005 Flu Season VA’s Response to Shortage
• September 30, 2004: Annual Flu Directive released
• October 5, 2004: CDC announced shortage due to possible contamination at Chiron plant. – Assessed VA purchase: 100% purchased from
Aventis Pasteur – Expected shortage: 2003-4 season, of those who got
vaccinated, 38% from extra-VA source– Most of these expected to come to VA for vaccine– Entered discussions with CDC and Aventis Pasteur
to assure a vaccine supply for VA
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2004-2005 Flu Season VA’s Response to Shortage
Seven Under Secretary for Health “FluVaccine Advisories” issued October – February
• Established priority groups to receive vaccine• Defined “hands-on” health care providers• Provided contacts for questions• Provided status updates of vaccine supplies• Clarified VA’s relationship to state/local health
departments • Recommended appropriate use of antivirals• Redefined priority groups (CDC definitions)• Pushed for late vaccination due to flu epidemiology
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2004-2005 Flu Season VA’s Response to Shortage
• Constant two-way communication between front-line and VACO– Ascertained remaining supply at 3 points in time
– Recommendations re: redistribution to best meet VA demands
– Handled a myriad of questions – FAQs posted
– Regular updates on Friday calls, VISN Director and CMO calls, NLB meetings
– Assisted with Congressional/advocacy/press inquires
• Regular contact with HHS/CDC on VA issues