DUVAL TB RESPONSE:
COMMUNICATING DURING A
CRISIS
BONNIE J. SORENSEN, MD, MBA
VOLUSIA COUNTY HEALTH DEPARTMENT
JANUARY 31, 2013
Innovation t Collaboration t Accountability t Responsiveness t Excellence
Outline / Objectives
• What is TB?
• Duval TB Response
• Incident Command
• Public Information
• Accomplishing the mission
• Lessons learned for public health
response
Innovation t Collaboration t Accountability t Responsiveness t Excellence
What is TB?
•
TB: short for
Tuberculosis
•
Globally, kills more
people than HIV/AIDS
•
Nationally on the
decline
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Global Hot Spots
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National TB
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National Cases of TB
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TB Transmission
• Spread
through
coughing
by air
droplets
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TB
•
Once infected, may have inactive
(latent TB infection-LTBI) or active TB
disease
Innovation t Collaboration t Accountability t Responsiveness t Excellence
TB Symptoms
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How is TB Treated?
•
Treatment of active cases requires
months of antibiotics, not just 10
days
•
TB drugs are old, subject to
shortage
•
Latent TB requires months of lesser
doses of same antibiotics to kill
hibernating TB germ
Innovation t Collaboration t Accountability t Responsiveness t Excellence
Treatment of TB
Innovation t Collaboration t Accountability t Responsiveness t Excellence
TB Funding
• TB allocation in the past across Florida
related to five-year average number of
active cases
• Duval had decreasing numbers of
cases over last five years, yet “one of
the most extensive TB outbreaks that
CDC has been invited to…both in terms
of its size and rapid growth.” (FL0046,
that is)
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Duval County’s TB History
2008
2009
2010
2011
2012
TB
102
Cases
89
72
71
83
0046 9
Cases
9
10
30
30
%
Genotyped
25%
64%
100%
100%
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TB Genotyping
• TB Genotyping is also known as
Spligotyping or DNA fingerprinting
• 2005 - CDC initiates Universal TB
Genotyping Program
• 2007 - Florida begins participation in
Universal TB Genotyping Program
Innovation t Collaboration t Accountability t Responsiveness t Excellence
Innovation t Collaboration t Accountability t Responsiveness t Excellence
Duval’s TB Response Efforts
Between July 12 and December 31,
2012:
•
4,067 individuals tested with T Spot
•
Four active cases discovered by screen,
others reported by docs/hospitals
•
476 individuals had LTBI (12% positive)
•
All active cases treated; nearly all LTBI
cases offered treatment to cure their TB
•
559 active, LTBI cases currently managed
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City Divided by Zone for Case
Management
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Jacksonville’s System of
Services for Homeless
• The good news: extensive
meals/showers/clothing/beds in
Jacksonville
• The challenge: dormitory style, 60 bunk
beds in one room and face-to-face
sleeping arrangements
Innovation t Collaboration t Accountability t Responsiveness t Excellence
Jacksonville’s System of
Services for Homeless, cont’d.
• The good news: a shared
database among shelters in the
city
• Another challenge: multiple
aliases used by homeless lessens
value of database
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Jacksonville’s System of
Services for Homeless, cont’d.
•
And more good news: the
reluctance of shelters to deny
anyone a bed
•
And another challenge: coughing
all night into shared air
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Jacksonville’s System of
Services for Homeless, cont’d.
• The good news:
• Excellent cooperation among providers - the
Jacksonville Community TB Coalition and
health department
• More challenges:
• Available personnel to test every client
seeking a bed
• Renewing 4,000 shelter clearance cards
when they began expiring in 2013
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TB, The Homeless, and Shelter
Guidelines
• TB, if untreated, can kill people
• Homeless people are at high risk for TB
• Guidelines are tools to help shelters:
• ID clients who may have TB
• Refer people with TB symptoms to health
care
• Regularly test people we serve
• Ensure annual testing of staff, volunteers
• Identify ways to minimize risk of TB in
facilities
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Quote
“In order to create
a complete
community for our
homeless
population, they
need a TB-free
environment.”
Cindy Funkhauser
CEO IM Sulzbacher
Center
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Incident Command System
•
ICS was vital in managing TB
response
•
Assigned as Incident Commander in
Sept of 2012
•
ICS experience included:
 E. coli outbreak at petting zoos
 H1N1
 Numerous hurricanes, disasters
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Public Information
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Public Information, cont’d.
•
Ability to communicate timely,
accurate and accessible information
on the incident’s cause, size and
current situation to the public,
responders, internal and external
stakeholders.
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Public Information Team
•
Florida Department of Health,
Office of Communications
•
Duval County Health Department PIO
•
Volusia County Health Department PIO
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Risk Communication Strategies and
Resources
•
Development of core messages
•
Identification of Subject Matter Experts,
Spokespersons to deliver messaging
•
Outreach to local governmental, state
legislative representation, local organizations
•
Weekly TB Update press calls
•
Weekly data updates sent to media
•
DOH Information Management Unit
•
Virtual Joint Information Center (V-JIC)
•
Public Records specialists
Innovation t Collaboration t Accountability t Responsiveness t Excellence
Risk Communication Strategies and
Resources, cont’d.
•
•
Availability for in-person interviews
Monthly Jacksonville TB Coalition
updates
•
Surgeon General Symposium on Crisis
and Risk Communications in Public
Health for community partners, public
•
and media
Risk communications training for all
CHDs
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Mission Accomplished
By the Numbers:
•24 weeks of ICS in Duval in 2012
•77 percent of the 2,100 priority contacts
located
•100 percent of TB cases treated, 90 plus
percent of LTBIs
•Media appreciated regular updates,
efforts continue
Innovation t Collaboration t Accountability t Responsiveness t Excellence
Lessons Learned
•
•
•
•
ICS works for prolonged cluster
investigations-mimics pandemic
response
Integrated Florida DOH critical to
address non-disaster events
Important to build media relationships
in advance of emergency
Consistency of messages across CHDs
in terms of reporting cases/contacts
Innovation t Collaboration t Accountability t Responsiveness t Excellence
Public Health at Work
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Public Health at Work, cont’d.
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Questions?
Bonnie Sorensen, MD, MBA
Volusia County
Health Department
Bonita_Sorensen@doh.state.fl.us
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