William Schaffner, MD, FACPM Mark B. Johnson, MD, MPH, FACPM
Transcription
William Schaffner, MD, FACPM Mark B. JJohnson,, MD,, MPH,, FACPM Hugh Tilson, MD, MPH, DrPH, FACPM – Moderator y, and p Leader in the science,, p policy, practice of p preventive medicine Mission to improve population health status through evidence-based id b d di disease prevention ti and d health h lth promotion research, policies, practices, and programs 2,400 , members engaged g g in p preventive medicine practice, teaching and research General preventive medicine, public health, occupational and environmental medicine medicine, and aerospace medicine medicine. To learn more about the College, visit www.acpm.org y successes and failures in the federal,, state and Identify local public health response to the 2009-2010 H1N1 influenza pandemic D Describe ib potential t ti l iimprovements t tto public bli h health lth communications as they relate to response among private medicine institutions with diagnosis, infection control and use of antivirals Discuss how to incorporate lessons learned from the 2009 2010 H1N1 influenza pandemic to be better 2009-2010 prepared for future influenza epidemics and/or pandemics. This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME). ACPM is accredited by the ACCME to provide continuing medical education for physicians. ACPM designates this educational activity for a maximum of 1.0 Category 1 credits toward the American Medical Association (AMA) Physician's Recognition Award (PRA)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. To ensure an activity free of commercial bias, ACPM was responsible for decisions regarding content and allocation of funds. This activity has been funded through an unrestricted educational grant provided by Gilead Sciences, Inc. Indicate your primary professional role as it relates to the H1N1 influenza. Clinical Practice – Inpatient Clinical Practice – Outpatient Public Health Practice – Federal Public Health Practice – State Public Health Practice – County/Local Academic Other William Schaffner, MD, FACPM Department of Preventive Medicine V d bilt U Vanderbilt University i it S School h l off M Medicine di i Highly transmissible Conventionally virulent Child / Children/young adults d l (not ( ≥65!) 65!) Complications: Usual risk factors Pregnancy Obesity Some healthy Virus: Stable Susceptible to antivirals 1. Virus discovered in humans early 2. Mexico – bit of a slow start then an aggressive response 3. Virus characterized; tests developed shared findings in record speed 4 Quick 4. Q kF Federal d l response 5. Vaccine manufacturers collaborated 6. Vaccine clinical trials conducted 7. State and local public health organized 8. CDC’s excellent communication 9 Many 9. M media di reports t - good d 1. WHO “pandemic” designation 2. No good name for H1N1 (“swine”, “novel”, etc.) 3 Closing 3. Cl i national i lb borders d Slaughtering pigs in Egypt 4. Vaccine: Old manufacturing gp process Foreign factories Aversion to adjuvants Mistrust of vaccine 5. Over-promising vaccine delivery 6 S 6. Stretched h d clinical li i l resources Tiny hospital surge capacity 7. Need for enhanced surveillance 8. Utility of social distancing, school closures, masks and hand washing 9. Health care worker undervaccination Clinical Utility Who should be treated? Who should receive prophylaxis? p p y Public health utility Impact on transmission? F l outbreak Focal b k control? l? Institutional use? Mark B. Johnson, MD, MPH, FACPM President, American College of Preventive Medicine E Executive ti Director, Di t Jefferson J ff County C t Public P bli Health, H lth Golden, G ld C Colorado l d Trust is critical With public With providers p With media With elected officials With intra-department divisions and programs With State health department Be flexible B fl ibl Keep it simple Communication is key With private providers, both directions With emergency g y management g system y With media With elected officials With minority communities Word of mouth is critical Communicate about uncertainties Carefully! Every word matters With logistics g and human resources staff Utilize your strengths Know what you don’t know Practice exercises, p practice exercises, and more practice exercises Reaching school-aged children was fairly easy; reaching children in daycare and preschool was much harder Pre-registering private providers d streamlined l d process and engaged interested providers early on Getting some, even a minimal amount, of the vaccine to all providers mitigated anxiety and frustration Frequent small shipments helped keep them vaccinating even when they could not have a mass vaccination clinic Restrictions on vaccinating caused pushback from upset and confused older adults Tremendous demand from pregnant women Problems due to distribution and vaccine formulation Weekly communication with local agencies and hotline phone for providers with questions very helpful in some states Communicate with h videoconferencing d f when h possible – overcrowded telephone conferences are a mess One size does NOT fit all – local health departments have different needs & strengths Differentiation of H1N1 and seasonal influenza vaccine caused confusion Expanding the vaccination program from “high-risk” groups to general population was often not coordinated well, leading to anger, confusion and unexpected jump in demand for some providers Using a provider survey was an effective method in some states to assess when to expand vaccination to other groups Antiviral agents were available in adequate quantities Preplanned vaccine distribution had to be changed due to available vaccine formulation Planning g efforts for H5N1 p pandemic influenza were very helpful in the H1N1 influenza pandemic The H1N1 pandemic did not conform to prior planning assumptions Began g in Mexico, not Asia Not as lethal as predicted Season of origin was spring, not late fall Cohort at risk for disease and death were children and young adults, not infants and the elderly Global influenza surveillance has improved CDC still unable to give real-time number of p and deaths influenza cases,, hospitalizations Active animal surveillance may have detected this H1N1 strain much earlier Pandemic p preplanning p g increased the capacity p y to produce influenza vaccine, but the process needs to be updated and streamlined Cell-based manufacturing should provide process that is scalable and faster Still problems with cultivation and quality control H1N1 was already widespread when it was finally recognized We don don’tt have an adequate understanding in regard to why vaccines are refused, or how to overcome such refusals There was a major breakdown in the distribution of vaccines nationwide Viral testing methodologies are woefully inadequate, but this was quickly identified More effective influenza education needs to aimed at both the general public and health care workers k Antiviral agents are less effective in special populations Higher g doses of oseltamivir (Tamiflu) are required in obese patients Legal issues regarding mandatory vaccination policies li i ((e.g., h health l h care workers) k ) need d to b be resolved Th United The U it d States St t is i exceptionally ti ll dependent d d t on vaccine production in other countries The vaccine was protective CDC risk communication assessment Calls for accurate information; consistent, unified message; and candor about what is known and not known In spring outbreak Struck good balance describing disease that was contagious but not highly virulent In fall outbreak Problems with timeframe for vaccine delivery and convincing public and health care workers on safety of the new H1N1 vaccine Moderated by Hugh Tilson, MD, MPH, DrPH, FACPM Adjunct j Professor, University y of North Carolina, Gillings g School of Global Public Health, Chapel Hill, North Carolina How would you rate your national professional society in keeping you apprised of medical issues related to H1N1 (clinical management, vaccine priorities, antiviral use, etc.)? Excellent E ll t Very Good Good F i Fair Poor How would you rate the alignment of federal state and local public health agencies in their communications about H1N1? Excellent Very Good Good Fair Poor 1. Go to the Questions (Q & A) box located on the left side of your screen. 1 2. T Type in i your question. ti 3. Click the Arrow to send. 2 3 Thank you for your participation. p evaluation and request q credit for f CME. M Please complete
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