Download Pandemic Preparedness

Prevention and Detection Workgroup:
Surveillance and Data Management
March 17, 2006
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Pennsylvania Department of
Agriculture
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Avian Influenza in Birds
Pennsylvania Response Plan for
Prevention and Detection
Wild Bird Prevention
• Not a practical goal
• However, USDA and other agencies worldwide aggressively assisting other countries
to reduce prevalence
• Newly infected countries are highest
priority for resources, not yet infected are
second priority, endemic are third priority
• $65.4 million supplement
Wild Bird Detection
• USDA WS and Dept of Interior
coordinating with State Wildlife Agencies
• $16.1 million to sample four major flyways:
– Alaskan>Pacific>Mississippi>Atlantic
• H5N1 Test-positive wild migratory water
birds likely to be found in Alaska in 2006
Wild Bird Surveillance
• Morbidity/Mortality Surveillance
• Live Bird (targeted catch & release) e.g. Teal
ducks in PA
• Hunter Harvested Surveillance
• Sentinel Bird Surveillance
• Environmental Surveillance
• In PA, 5 or more dead birds of any species
(except pigeons) reported to PGC for
investigation & AI testing
Domestic Bird Prevention
Federal Activities
• USDA Import Embargos from positive and “at
risk” countries
• USDA Port, Airport, and Border inspections
and interdiction activities to prevent
smuggling of live birds and illegal products
• Fighting game bird smuggling high risk
priority
• $1.5 million supplemental funding
Domestic Bird Prevention
Pennsylvania Activities
• New, stricter import requirements
• No exemption from testing for birds
destined for processing plants
• All imported poultry, waterfowl, rattites,
game birds must be tested prior to entry
into Pennsylvania
Domestic Bird Detection in
Pennsylvania
• Multiple firewalls of voluntary and mandatory
testing
• Surveillance of every sector:
– Commercial Flocks; Layers, Meat Birds, Turkeys
– Breeder Flocks
– Live Bird Market System
– Waterfowl, Ratites, Upland Game Birds
– Exhibitions, Sales & Auctions, Processing Plants
Domestic Bird Surveillance in
Pennsylvania
• Although not the largest poultry industry in any
category, more than 240,000 tests per year
• More than every other state and more than most
countries
• Pennsylvania poultry and poultry products are
the safest in the world
Surveillance in Other Species
Avian Influenza in Chickens
Avian Influenza in Pheasants
Live Bird Market
Live Bird Market
The End
Pennsylvania Department of
Health
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Pandemic Influenza Surveillance
• Find possible cases quickly
• Ensure that testing is performed in a
timely manner
• Investigate cases
– Identify sources of infection
– Identify exposed contacts
– Ensure that proper control measures are
applied
• Track spread, time trends,
demographic characteristics
Sources of Data
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PA-NEDSS (Pennsylvania’s National
Electronic Disease Surveillance System)
RODS (Real-time Outbreak & Disease
Surveillance)
Influenza Sentinel Provider Network (ISPN)
Long-term care facility outbreak reports
PA public health laboratory
(BOL)/Laboratory Response
Network (LRN)
PA-NEDSS
• Case-based disease reporting system
• On-line reporting by laboratories,
hospitals, and clinicians
• Integrated Electronic Laboratory Reporting
• Modifiable disease-specific questionnaires
• Stores information regarding contacts
• Used “for real” since Jan 2003
PA Disease Reporting
Regulations
• Influenza has been laboratoryreportable since 2002
• Per PA regulations [33 Pa.B. 2439],
reportable infectious diseases must
be reported via PA-NEDSS
(http://www.pabulletin.com/secure/
data/vol33/33-20/941.html)
PA-NEDSS Outbreak Response
• Monitoring trends over time
• Descriptive epidemiology
– Location, age, hospitalizations, deaths
• System flexibility
– Add conditions, questions; surge capacity
• Tested by two major outbreaks
– Multi-serotype Salmonella, 2004
– Hep A, 2003
INFORMATION FROM PA-NEDSS FROM 02OCT05 TO 04MAR06
COMPARISON OF NEDSS FLU CASES IN CURRENT SEASON
TO PREVIOUS SEASONS
RODS
• “Syndromic” surveillance system, not
case-based
• Tracks:
– Chief complaint from ED visits
– Non-prescription drug (OTC) sales
• Web interface displays real-time data
• Have registered users in all DOH district
offices and county health
departments
ED Data
• Data from >70% of PA hospitals
• Visits sorted into 7 categories
– Gastrointestinal, Constitutional, Respiratory,
Rash, Hemorrhagic, Botulinic, Neurologic
• Looks for increases in proportion of visits
due to specific syndromes
• Email alerts sent if increases
noted
OTC Sales Data
• Captures 55-70% of PA OTC sales
• Items sold sorted into 12 main
categories
– Antidiarrheal, Electrolytes, Cough/cold,
Thermometers, etc.
• Daily emails sent regarding
regional increases in specific
categories
Influenza Sentinel Provider Network
(ISPN) Surveillance Data
• National network of physician volunteers
(PA has >50)
• Report number of patients seen with
influenza-like-illness (ILI) and total number
of patients seen, to CDC weekly
• PA participates from October to May
• Data analyzed for trends in the % of total
visits due to ILI
PERCENT INFLUENZA-LIKE-ILLNESS STATEWIDE, BY WEEK
LTCF Influenza Outbreaks
• Outbreaks of influenza in long-term care
facilities are reported to DOH
• Standardized data collected regarding
each outbreak
• Summaries emailed to public health group
lists
• Number and location of LTCF flu
outbreaks help determine the
“flu code” reported to CDC
each week
PA Bureau of Laboratories
• PA member of the national Laboratory
Response Network
• Experience and training in molecular
testing methods
• Special biosafety facilities and
containment procedures
• Communication networks integrated with
public health
• Quick response with control
and prevention measures
Clinical Specimen Testing
• Commercial rapid diagnostic kits for influenza
A and B are available and widely used
• Confirm with viral culture
• Identify specific influenza strains, and
compare to vaccine strains
• Guide treatment and prophylaxis
recommendations by knowledge of circulating
strains
• Monitor for emergence of novel
influenza A subtypes
Influenza A/H5 Testing
• New test distributed to Laboratory
Response Network laboratories
• Nucleic acid test
• Provides preliminary results in 4 hours
• If H5 identified, further testing required
for specific H5 subtype (e.g. H5N1)
Current Issues Identified
• Working with a variety of jurisdictions
(state, county, and local) within the
framework of a Commonwealth
• Strengthening intra- and inter-agency
communication networks
– email, HAN, FRED, PEIRS, GEARS…
• County vs. state jurisdiction
and licensure
Current Issues Continued
• Training and awareness for staff
– NIMS, PEMA, Governor’s Office
preparedness activities
• Use of contracts to incorporate
prevention and preparedness activities
• Contingency plans: e.g. mobile
laboratories for additional/backup
detection capabilities