OFFICE DISASTER PREPAREDNESS
Brian R. Crawford MD, MPH
Judith Reynolds, MD
Frankie Gales, LPN, COA
Introductions
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Brian R. Crawford MD, MPH
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Medical Director, Disaster
Preparedness Initiative
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El Paso County Medical Society
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Medical Director, Eastern Plains
Medical Clinic of Calhan.
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Emergency Physician, Penrose-St.
Francis Centura Health Systems
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Judith Reynolds, MD
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Medical
Director, Colorado College
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Medical Director, Colorado
Springs Comprehensive Treatment Center
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Associate Medical Director,
Disaster Preparedness Initiative
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El Paso County Medical Society
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Past Medical Director, El Paso
County Department of Health and Environment
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Frankie Gales LPN, COA
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El Paso County Disaster
Preparedness Initiative, Coordinator
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Medical Reserve Corp, El Paso
County Coordinator.
Schedule
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September 23d:
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Emergency Operations Procedures (EOP)
Document
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H1N1 Update
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Important NOW! Preparedness Steps
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October 21st:
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Review HVA’s
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Prepare your office staff
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“Recovery Box” concept
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Preparing yourself and home
Schedule
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November 18th:
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Documentation
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Financials
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Overall Review
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January 27th:
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NIMS 100/700
Plans and Tools
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Plans as a general guideline:
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Disaster Planning Initiative Emergency Office Procedures
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Clinic Template EOP
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Tools:
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FluAid 2.0 and Manual
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Stockpiling Respirators/Facemask document
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Hazard Vulnerability Assessments
Purpose
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Continuity Of Operations Planning (COOP)
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Federal Grant to El Paso County Medical Society for Disaster
Planning Initiative (DPI) from 2009 to 2010
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H1N1 update and Pandemic Influenza Planning
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Business Preparedness
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Educate and Train Physicians in Disaster Preparedness
Office Based Physician Preparedness:
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84% of office based physicians do not have a plan for a potential
pandemic.
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73% do not have a plan for their home or families.
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66% do not know what is taking place in their community for
pandemic preparedness.
El Paso County Estimates:
Challenges for Office Based Physicians:
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1- Office Preparedness and
development of a pandemic plan.
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2- Patient visits/demands may
increase from 30-200% in the first phase.
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3- Office worker absenteeism of
nearly 30-40%.
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4- Supplies (15% avg increased
demand) and reimbursement issues.
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5- Medical-Legal issues: Kitty
Genovese, 1964. “minimal decency” (greater ability, inherent job
definition, and societal contract)
Why? Being Unprepared: Costs Money!
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Severe Pandemic
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30-40% absenteeism (sick, fear,
or care of others)
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3 weeks avg time off per worker
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Mild to Mod Pandemic
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20-25% absenteeism (sick, fear, or
care of others)
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4-5 days off per worker
Why? Being Unprepared: Increases Demand!
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Outpatient Visits: will double
for all age and risk groups
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Hospitalizations: wide variance
from 2x to 10x rate increase across all age and risk groups.
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Outpatient Costs: 300 to 450$
across all age groups for treatment.
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Hospitalizations Costs: 3400 to
7700$ across all age groups for treatment.
What Helps and What Does not for Office
Staff Compliance:
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Attributes:
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Well-managed staff training
program
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An office climate that promotes
safety
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Personal feedback-loop of
compliance to program
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Barriers:
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Interference with work tasks
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Interference with pt communication
(ie-masks)
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Lack of supplies
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Lack of time with pt
Important Steps for the 2009 H1N1 and
Seasonal Influenza Period
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CDC Document 10 Steps You Can
Take: H1N1 Planning
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1. Business Continuity Plan
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Emergency Operations Procedures
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5. Plan for Surge of Patients and
Services
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FluAid 2.0
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7. Take Steps to Protect Your
Workforce:
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USDOL Proposed Guidance on
Respirator
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8. Vaccinate Your Staff and
Patients
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9. Incorporates or compliments
the local community response plan.
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Clinical Updates
(www.cdc.gov/h1n1flu/10steps)
2009 H1N1 Clinical Update
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Novel (new virus), most lack immunity
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Transmission: animal-animal, animal-human, human-human
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Incubation longer than seasonal influenza
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Persistence over the summer 2009
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Ofstead, H1N1 Influenza Update
slides, 9/10/09
2009 H1N1 vs Seasonal Influenza
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H1N1
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Attack Rate: 8%
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Deaths: 593
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Hospitalizations: 9079
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Case Fatality Rate of those
hospitalized:
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6.5%
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Seasonal Influenza
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Attack Rate: 5-20%
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Deaths: 36,000~
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Hospitalizations:
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200,000~
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Case Fatality Rate Hospitalized:
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18%??
2009 H1N1 vs Seasonal Influenza High Risk
Groups
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Seasonal Influenza:
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Elderly
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Children
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Immunocompromised
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Chronically Ill
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Obesity? BMI>40-30
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Ofstead, H1N1 Influenza Update,
slides 9/10/09
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2009 H1N1
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Elderly
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Children to young adults (0-24
years old)
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Pregnancy
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Chronic medical conditions
(asthma, neurological, diabetes, cardiovascular, immunocompromised)
2009 H1N1 Confirmed/Probable Cases
2009 H1N1 Hospitalizations
2009 H1N1 Deaths by Age Groups
2009 H1N1 Update
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During week 35 (August
30-September 5, 2009), influenza activity increased in the U.S.
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During week 35:
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97% of all subtyped influenza A
viruses being reported to CDC were 2009 influenza A (H1N1) viruses.
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The proportion of outpatient
visits for influenza-like illness (ILI) was above the national baseline..
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The 2009-10 influenza season
officially begins October 4, 2009.
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www.cdc.gov/flu/weekly
2009 H1N1 Symptoms
Seasonal Influenza
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Adults: Infectious for about 6
days
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Starts 1 day before symptoms are
evident.
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Continues for 5 days after onset
of symptoms.
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Pediatrics: Infectious for many
days
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Starts several days before
symptoms.
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Continues for about 10 days after
onset of symptoms.
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Immunocompromised may carry and
shed virus for several weeks
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Ofstead, H1N1 Influenza Update
slides, 9/10/09
Influenza Like Illness Reported
Influenza and Pneumonia Mortality
Pediatric Influenza Associated Deaths
Important Steps for the 2009 H1N1 and
Seasonal Influenza Period
n
CDC Document 10 Steps You Can
Take: H1N1 Planning
n
1. Business Continuity Plan
n
Emergency Operations Procedures
n
5. Plan for Surge of Patients and
Services
n
FluAid 2.0
n
7. Take Steps to Protect Your
Workforce:
n
USDOL Proposed Guidance on
Respirator
n
8. Vaccinate Your Staff
n
9. Incorporates or compliments
the local community response plan.
n
Clinical Updates
(www.cdc.gov/h1n1flu/10steps)
5. Plan for Surge of Patients/Services
n
FluAid 2.O
n
Estimates for Outpatient Clinic:
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Deaths
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Hospitalization Rates
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Outpatient Visits
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FluAid 2.0 for sample Family
Practice Clinic
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www.cdc.gov/flu/tools/fluaid/downloads.htm
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Demonstration
FluAid 2.0
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Demonstration
7. Staff Protection
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USDOL Document
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Estimates for use and stockpiling
of masks
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ie- Outpatient Clinic: 4 N-95 per
employee per shifts for high risk employees
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ie- Outpatient Clinic: 480 N-95
per employee per pandemic (120 work days) over 24 weeks.
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ie- Outpatient Clinic: 2 facemask
per patient per visit.
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Average Cost:
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0.12-0.2 dollars per facemask
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0.50-1.20 dollars per N-95
7. Staff Protection: Non-Pharmacological
Interventions:
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Transmission of Influenza:
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Respiratory (particulate, aerosol)
and contact.
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1/3 Work, 1/3 School, 1/3
Community
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Social Distancing:
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School Closure: will decrease
overall peak attack rates of 40% but little impact on overall attack rates.
Fails with R>2.
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Voluntary Isolation: more
effective than school closure. Results in 33% decrease of ILI in the community,
increases to 88% if household contacts are also isolated.
Haber M, Shay D, Davis X et al.
Effectiveness of interventions to reduce contact rates during a simulated
influenza pandemic. Emerg Inf Dis 2007;13 (4).
7. Staff Protection: Non-Pharmacological
Interventions:
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Gowns, Gloves, Masks, and GOOD
HAND HYGIENE!
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N-95 Mask: (penetration)
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Good Fit: <5% of viruses
(10-600nm)
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Poor Fit: mean 5.6% of viruses
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Surgical Mask:
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20.5-84.5% penetration values.
8. Vaccinate Your Staff
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Vaccination: Staff
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Only 44% of Healthcare workers in
2007-08 vaccinated
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Decreases all cause mortality
rates of patients
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8 workers vaccinated: 1 patient
death prevented.
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Decreases rates of ILI among
patients
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5 workers vaccinated: 1 patient
ILI prevented.
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Decreases overall healthcare
resources/expenditures
8. Vaccinate Your Staff
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Vaccination: Staff
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Inactivated Vaccine or Live
Attenuated Influenza Vaccine
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May see increased age range to 65
for LAIV
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Stable chronic illnesses
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Healthcare workers with the
exception of those who work with highly immunosuppressed (bone marrow
transplants, acute leukemia, neonates) for LAIV.
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Ring vaccinate healthcare workers
of chronic illness patients and highly immunosuppressed
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Increased Immunomemory; antibody
response
Cosgrove, SE, Fishman, NO, Talbot, TR, et
al. Strategies for use of a limited influenza vaccine supply. JAMA.
2005;293(2):229-232.
8. Vaccinate Your Patients
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Vaccination: Patients
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Age 2-4 yo (40.3%), 50-64 yo
(38.4%), >65yo (66.4%) vaccinated during 2007-08 season.
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Decreases all cause mortality
rates of patients
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5 deaths prevented: 100 patients
vaccinated
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Decreases rates of ILI among
patients
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9 ILI prevented: 100 patients
vaccinated
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Decreases overall healthcare
resources
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2 hospital admission prevented:
per 100 patients vacc.
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7 additional hospital
consultations: per 100 pts vacc.
8. Vaccinate Your Patients
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Vaccination: Patients
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Inactivated Influenza Vaccine
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Nearly all patients
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High Risk Patients (chronic medical
conditions, immunosuppressed)
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Pediatric Patients 6 months and
older
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Risk Stratification of Patients
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Patient Contacts/Household members
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Live Attenuated Influenza Vaccine
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Patients age 2-49 years old
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May see increased age range to 65
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May see decreased age to 12 months
and older of healthy, non-asthmatic children.
n
Stable chronic illnesses
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Not for highly immunosuppressed.
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Pneumococcal Vaccination
Cosgrove, SE, Fishman, NO, Talbot, TR, et
al. Strategies for use of a limited influenza vaccine supply. JAMA.
2005;293(2):229-232.
2009 H1N1 Vaccination Assumptions:
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Vaccine available starting mid-October
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Initial amount: 40, 80, or 160 million doses
over one month period
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Subsequent weekly production: 10, 20 or 30 million doses
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1 dose (maybe 2 doses required
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Preservative free single dose syringes for young children and
pregnant women
www.cdc.gov/h1n1/flu
2009 H1N1 Vaccination Groups:
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Students and staff (all ages)
associated with schools (K-12) and children (age >6 m) and staff (all ages) in
child care centers
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Pregnant women, children 6m-4yrs,
new parents and household contacts of children <6 months of age
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Non-elderly adults (age <65) with
medical conditions that increase risk of influenza
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Health care workers and emergency
services personnel
www.cdc.gov/h1n1/flu
Resources
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Medical Reserve Corp of El Paso
County at
www.mrcepc.org
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Situational Awareness Tool
www.satool.org
Communication
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Frankie Gales:
frankie@epcms.org
, office phone: 591-2424, cell phone: 244-4600
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Roster of participants with email
and phone numbers, distributed via email.
?Questions?