H1N1 Outbreak:
Lessons Learned and Preparation
for the Next Pandemic
Thursday, April 15, 2010
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Presenters
 Donna M. Barry, MSN, APN, FN-CSA, Nurse Practitioner and
the Director of the University Health Center at Montclair State
University
 Anita L. Barkin, Dr.P.H., M.S.N., C.R.N.P., Director of
Carnegie Mellon University Student Health Services
 Michael Mardis, Ph.D., Dean of Students & Associate
Vice President for Student Affairs at the University of Louisville
 Dennis K. Sullivan, Assistant Director of Environmental
Health and Safety, University Emergency Manager and adjunct
faculty in the University of Louisville School of Public Health
and Information Sciences
Outline
 H1N1 Activity
 International
 National
 College and University
 Regional
 Pre H1N1 Planning assumptions
 On point or not
National Activity
 H1N1 is still circulating and seasonal flu is quiet
 Disease rates are lower than in the fall
 Causing more disease in the southeast
 Hospitalizations are due to H1N1
Statistics as of 4/3/2010
 ~ 60 million Americans infected
 ~ 265,000 hospitalizations
 ~ 12,000 deaths

90% under the age of 65 (5 times higher than seen with
seasonal flu)
 ~122 million doses of vaccine have been shipped
Regional and Local Activity
 Regional
 Georgia, Alabama, South Carolina
 Local
 Arkansas, Louisiana, Mississippi, North Carolina,
Tennessee, Virginia
 Hawai’i, New Mexico, Puerto Rico
Georgia
 Increase in flu-related hospitalizations
 More than seen since October
 Adults with chronic illnesses like diabetes, heart
disease
 Not immunized with H1N1 vaccine
 Virus has not changed
 Vaccine is effective
What’s Next?
 Third wave remains uncertain
 Concern that disease among those unvaccinated with
chronic illness will continue to cause unnecessary
hospitalization and death
 Vaccine in fall with be trivalent
 Vaccinate now with H1N1 to protect until the fall
vaccine is available
Pre H1N1 Pandemic Influenza
Planning Assumptions
 Will arrive with little warning, likely from overseas
• Little time to act
 Simultaneous outbreaks throughout US
 The severity may not be immediately known
 Duration weeks to months
Pre H1N1 Pandemic Influenza
Planning Assumptions
• Large numbers affected
• Millions infected thus far
• Disproportionately affecting the young
• Decisions will be made on the basis of local conditions
• Guidance from the CDC/WHO
• Vaccine delayed
• Will probably have vaccine by late fall
Pre H1N1 Planning Assumptions
 High absenteeism
 Difficult to impossible to travel
 Disruptions and shortages of fuel, food stuffs,
health care
 Antiviral agents in short supply
Responding to the Second Wave
• Less about campus evacuation and body bags
• more about caring for ill students in the residential
population
• providing support for students living in the community
• Developed new criteria for student life, academic
and business decision making
• Number of students, staff and faculty ill
• Severity of illness
Public Health Strategy Goes Live
 Slow down the spread in order to preserve
resources (health care, critical services, supplies)
Lessons Learned
• Plan format should:

Follow ICS response structure



Identify leadership and roles before an incident
Train all decision makers in ICS format
Flow from institution’s Emergency Operations
Plan



Annex of overall EOP
Same structure as all other EOP annexes
Seamless coordination with outside agencies
Lessons Learned
• Unlink plan to WHO phases
• All “outbreak” approach a.k.a. all-hazards
• Plan needs to be adaptable to any level of public health
incident
• Flexibility with plan response is critical to success
• Don’t plan on lead time
• Virus hit quick and hard with both waves
• Eliminate time frames expected to be ready for onset or
next level of plan/response
Lessons Learned
 Integrate “triggers” in plan that will determine
next response action
 Disease extent
 What is its “acuity” level and risk factors to campus community?
 What is extent of campus “high risk” population and
vulnerability to the disease?
 Disease severity
 How easy does it spread and can we contain it?
 Absentee rate
 Establish parameters that trigger when to close offices, cancel
events, cancel classes, institute quarantine actions
Lessons Learned
• Expertise based
• CDC and state health guidelines should be foundation for
response
• Direct link to public health emergency notice
monitoring for campus health services
• Development of expert based knowledge by health
services administrators
• Redundancy
• Prevention
• Response
• Communication
Lessons Learned
 Training drills/Tabletop exercises
 Critical to effective, knowledgeable response
 All player approach
 Isolation and Quarantine
 Multiple, effective mechanisms used
 Rely on fundamental health principles and institutional
capabilities
Lessons Learned
 Transparency of communication paid off
 Students, staff, parents, alumni all benefited
 Internal communications among ICS team
 External communications using multiple forms
 Academic Affairs response
 Stockpiling paid off
 Efforts devoted to prevention and response
 Shortages had strong impact on control of virus
Lessons Learned
 Vaccination efforts
 Too much, too late
 Vaccine form made a difference in availability and
student response
 The impact of YouTube and the media
Lessons Learned
“ Some things are in our control….
…and some things are not.”
University of Louisville
Emerging Disease Planning Groups
 Planning and Coordination
 Infection Control Policies and Procedures
 Point of Distribution
 Continuity of Student Learning
 Communications Planning
Planning
 Groups developed objectives and they were adopted by
Coordination Group
 Individual Groups consisted of a diverse group from
the campus community
 Groups initially were to meet on a weekly basis, but
that was pushed back due to a flash flood that
damaged almost 80 buildings
Isolation Strategies
 Employee medical certification for absence was
suspended until further review
 Ill students were instructed to stay home
 Faculty were asked provide consideration for ill
students
 Residential Life isolation
 Return home if within an hour
 Moving roommates
 Providing food service
Prevention Strategies
 Education (Communications Strategy)
 Hand sanitizer
 Stockpiling supplies
 Vaccination
 Seasonal Flu vaccination
 H1N1 Vaccination
Communication/Prevention
 Dedicated Website
 http://louisville.edu/update/flu/
 Regular updates
 About H1N1
 Tips for flu prevention
 Flu Shots at UofL
 Consent form online
 FAQ for students, faculty, and staff
 Links to CDC and Flu.gov
Communication/Prevention
Communication/Prevention
 Video from High Profile students
 Handbills with information and prevention
 Targeted emails to the selected populations students
living on campus, health science students, parents
 Emails to the campus community
 Referring them to the website for more info
Hand Sanitizer
 Provided (funded) mainly by the central
Administration, but a number of units added units in
their areas. (Res Life, Food Service)
 Purchased 800 mountable units and several thousand
desktop/pocket bottles (.5-12 ounces)
 Provided an average of 100 containers weekly, costing
$49k over 14 weeks
Stockpiled Supplies
 Rubber gloves – 8,000 pairs (2k of each size)
 N-95 Masks – 6,000
 Surgical Masks - 8,000
 Disposable Gowns - 1,000
 12 oz Hand Sanitizer - 200
Seasonal Vaccine
 Free to all students, faculty and staff; $5.00 for family
members
 Administered 6,000 does
 Funded by Provost’s Office
 Previous year only administered 2,500
 Administered
 Two campus health offices
 Vaccination day in each dorm
 4 vaccination days at various locations
Campus H1N1 Vaccinations
 Operated minipods
 Only cost was salaries
 HSC (healthcare) 600 doses (mixed), 120 minutes
 HSC (healthcare) 600 doses (mixed), 120 minutes
 Belknap (students) 600 doses (flumist), 240 minutes
 Belknap (anyone) 1,000 doses (mixed), 5 hours
U of L’s Planning
 Fall Kick-off meeting was day before our Flood
 Vaccine distribution plan was joint effort by DEHS
and SPHIS
 2 MPH and an Engineering graduate students did
much of the planning
 Immediately began developing plans to administer
30-50K doses of vaccine
Local Health Department
 Did not have a plan in place for conducting a mass
vaccination POD
 U of L had plans and logistics in place, ready to
deliver vaccine to 30,000
 Health Department asked the University for Help
 A two page MOU turned into a 17 page contract
The Plan
 Hold a community-wide H1N1 mass immunization
point of dispensing.
 H1N1 vaccines were administered via one of two
methods: (1) a drive-thru or (2) a walk-up process.
 Injectable and intranasal vaccines were available.
 Vaccine recipients chose which method they
preferred.
Pod Results
 Total Hours of Operation – 19
 Totals vaccinated – 19,079
 Day 1 – 12,613
 Day 2 – 6,466
 Walkthru – 6,342
 Drivethru – 12,737
 Avg. 1004 vaccinations/hour
Cost-effectiveness
 Overall cost was $13.35 per immunization
administered.
 Costs were significantly higher for the walk-up
method ($29.61/immunization administered) (Does
not include public transportation costs)
 Drive-thru method($5.58/immunization
administered)
Results
 On average, the drive-thru strategy provided 400
additional immunization per hour (796 vs. 396).
 For 10 hours of the POD, about 50% of people
handled in walk-up tent were “forced” to choose
that option.
 The drive-thru strategy was the least expensive
method and was the process of choice by more than
60% of the citizens coming to the event for
immunization.
Questions?
Donna M. Barry,
barryd@mail.montclair.edu
Anita L. Barkin,
ab4x@andrew.cmu.edu
Michael Mardis,
m.mardis@louisville.edu
Dennis K. Sullivan,
dksull01@gwise.louisville.edu