Jefferson County Health Department Annex P (a) (to JCHD Emergency Response Plan) H1N1 2009 Pandemic Influenza Response Plan August 2009Table of Contents: Purpose Appendix 1: Isolation/ Quarantine Procedure Appendix 2: 19 CSR 20.20.010. : Adbendix 3: tsolation/Quarantine Orders, a eat Enlorty Populations for Vaccination and antviai Planning Process - Task Identification and Assignment, Public information Bulletins / Educational Material... Appendix 7: News Releases . Adbendix 8: Medical Provider Information Acronyms.|, Purpose The purpose of the Jefferson County Health Department (JCHD) H1N1 2009 Pandemic Influenza Response plan isto establish policy and procedures that will permit the ICHD to effectively prepare for, respond to, mitigate and recover from a pandemic of influenza or other widespread person-to-person airborne transmissible pathogens. ‘The JCHD H1Ni 2009 Pandemic Influenza Response Plan was developed in accordance with MDHSS guidance and is intended to work in coordination with regional, state and federal efforts, ‘The Plan should be read and understood by all those with responsibility for implementation. The plan should be updated annually, or at any time changes in the federal, state, regional or local response capacity warrant. New biological or epidemiological information that alters preparation, response, mitigation or recovery ‘methods should also trigger an update to this plan. (Return to TOC) tl, SCOPE ‘The Jefferson County Office of Emergency Services (JCES) is responsible for the Jefferson County All Hazards Response Plan, which is a county-wide plan, Within this plan, Annex M includes the duties of the JCHD during a disaster affecting the public's health: ‘The JCHD's Emergency Response Plan details the policies and procedures necessary to fulfil the responsibilities contained in Annex M of the county-wide plan. This plan 1s intended as an Annex, Annex P(a), to the JCHD’s Emergency Response Plan. In order to maintain consistency with the county-wide and department specific plans, annexes to the JCHD’s Emergency Response Plan will be referenced by this plan. This plan fs focused on the responses of the JCHD. It is intended to serve both as guidance for the JCHD, and as a dynamic document to facilitate planning with other agencies in the community. In the event of a pandemic of a highly pathogenic strain Of influenza, the actions taken by the JCHD will be within the context of an Incident ‘Command System (ICS)._ As such, it is within the scope of this document to define ‘objectives and to identify resources and methods to potentially achieve those objectives. It fs not within the scope of this document to limit or restrict the flexibility of the incident command to modify those objectives, methods or resources. This plan does not detail JCHD responses to instances of highly pathogentc influenza {in animal species. later version will define the role of the JCHO in animal heath. (Return to TOC)Il, Assumptions The following assumptions have been adapted from MDHSS documents and the most up-to-date research regarding a the H1N1 2009 influenza pandemic, and should be kept in mind at all times during the planning and response stages, 1. The flu may infect over 30% of the US population, causing 2 million deaths, 10 million hospitalizations, 45 million outpatient visits and 90, million cases. 2. Absenteeism could rise to 40%, severely crippling critical worker- dependent services and businesses, including first responders, health care workers, utility providers, etc. 3. Hospitals will run out of beds, medications and supplies (ventilators, masks, anti-virals, antibiotics, etc.) 4, The economic impact on the nation will range between $160 billion - $800 billion dollars. 5. LPHAs will not be able to rely on external resources beyond what they have already prepared. 6. Healthcare workers will be exposed to the disease more frequently than the general population, and will therefore be ill more often. 7. Antivirals, although in limited supply, have been pre-positioned under control of JCHD. Use of antivirals in treatment for symptomatic patients will potentially lessen symptom severity and shorten the course of the disease by a day or less. 8. Emergence of HIN1 during the spring of 2009 (readily transmissible from Person to person) triggered the research and production of an effective vaccine targeting HIN1. Vaccine will not be available until the fall 2009. At that point only limited quantities will be available and vaccination may require 2-3 doses in order to be effective. 9. Social distancing strategies~avoidance of gatherings, voluntary ‘quarantine isolation, school closures etc. - may have to be instituted to minimize disease spread 10, Basic hygiene (hand-washing etc.) and infection control strategies may have to be reiterated and encouraged. 11. The WHO pandemic phases paradigm will be used across the country to direct response activities. (Return to TOC)IV. Pandemic Periods and Phases This plan recognizes the WHO's Pandemic periods and six phases of Pandemic Influenza as the standard response paradigm. Planning factors listed in the next section are related to each phase. The phases should be considered operational periods in which JCHD personnel will carry out duties outlined in this plan. There is @ Possibility that pandemic influenza will not follow these phases sequentially. Status as of August, 2009 is Phase 6. WHO Pandemic Phase Definition interPandemic Period Phase 1 No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may b present in animals. If present in animals, the risk of human infection or disease is considered low. [Pandemic Alert — Period Phase 5 Phase 6 interpandemic ‘No new influenza virus subtypes have been detected in Period humans. However, a circulating animal influenza virus Phase 2 subtype poses a substantial risk of human disease. Pandemic Alert Human infection(s) with a new subtype, but no human-to- Period human spread, or at most, rare instances of spread to a close Phase 3 contac Pandemic Alert Pandemic Pariod — Small cluster(s) with limited human-to-human transmission | but spread is highly localized, suggesting that the virus is not well-adapted to humans. | Carge cluster(s) but human-to-human spread stil localized, suggesting that the virus is becoming increasingly better | adapted to humans, but may not yet be fully transmissible | (substantial pandemic risk, 7 Pandemic; increased and sustained transmigsion in general population. (Return to TOC)\V. FEDERAL AND STATE/LOCAL ROLES: ‘The role identified by the Federal government for itself has changed significantly since the Hurricane Katrina disaster in 2005. More responsibility for control of tthe pandemic has been shifted to state and local governments. Federal role: (Valid 1 Aug. 2006 - HHS Pandemic Plan) + Conducting outbreak investigations, as requested + Conducting epidemiologic and laboratory-based studies (“special studies") + Providing ongoing information from the national influenza surveillance system on the pandemics impact on heaith and the healthcare system + Expanding supply of antiviral drugs by stimulating increased U.S. based production capacity + Expanding U.S.-based production capacity for pandemic vaccine and working with manufacturers to ensure that pandemic vaccine is produced at full capacity + Distributing public stocks of antiviral drugs and other medical supplies from the Strategic National Stockpite to the states + Distributing public stocks of vaccines, when they become available + Providing guidance on community containment strategies, including travel restrictions, school closings, and quarantine Communicating with the public via the news media + Monitoring the response (Return to TOC) State and Local Roles: + Enhancing disease surveillance to ensure early detection of the first cases Cf pandemic influenza in their jurisdictions + Distributing public stocks of antiviral drugs and vaccines and providing local physicians and hospital administrators with updated guidance on clinical ‘management and infection control as the situation unfolds + Preventing local disease transmission using a range of containment strategies + __ Providing ongoing communication with the public (about the response effort, {including the purpose and duration of containment measures) + Providing psychological and social support services to emergency field ‘workers and other responders (Return to TOC)VI. Pandemic Response According To Pandemic Periods and Phases Phases 1, 2 Interpandemic Period (Mitigation| Direction and Control 41. No changes to the normal operational command and control structure are anticipated during these phases. 2. The administration should assure that training needs are continually evaluated and deliver or obtain appropriate training to achieve anticipated response objectives, including advanced ICS training for staff who will serve as general or command staff. 3. Equipment and supplies for the response should be obtained or sources identified, 44. The JCERP, including this Annex, should be updated and modified as response capabilities change. Information Technology and Communications 1. The JCHD will enhance the current communication capacity by constructing towers to support amateur radio (HAM) antennas. 2. JCHD will improve reliability, and the ability to communicate with medical Providers and the public, by installing updated computer equipment. Public Information 1. Public education, especially for medical providers, will be used to increase uptake of seasonal influenza vaccine. Surveillance 1. Standard seasonal influenza surveillance will be conducted in addition to the surveillance systems described in Annex D. 2. Baseline data for age groups affected, case-fatality rates, and other characteristics of seasonal influenza episodes will be established. HINT specific data will also be collected, as above based upon recommendations of (CDC and DHSS. Investigation 1. Investigatory procedures outlined in the DHSS Bureau of Communicable Disease Control and Prevention (BCDCP), Communicable Disease Investigation Reference Manual (CDIRM) will be used. Prevention of Secondary Transmission 1. Control procedures outlined in the DHSS BCDCP CDIRM will be used.Isolation/Quarantine 1. The JCHD policy and procedures for isolation and quarantine are included as Appendix 1, 2 and 3. 2. ‘The Jefferson County Commission had expressed an interest in adopting a local ordinance to enhance that effort. JCHD will assist the County Commission to develop and adopt a local ordinance. ‘Mass Prophylaxis 7. Not anticipated during these phases, Mass Patient Care 1. The JCHD will continue to work with Jefferson Memorial Hospital (JMH) and ther medical providers to develop mutually supporting plans as part of Annex | {in the JCERP. ‘Mass Fatality Management 1. Continue to work with hospitals, funeral directors and the medical examiner to develop approaches to manage large numbers of deceased residents and incorporate into Annex J as appropriate. Nuclear and Chemical T. See Annex K. Foodborne and Waterborne Outbreaks 1, See Annex L. Volunteer Management 1. Efforts will continue to identify and train appropriate volunteers for @ response to pandemic influenza. 2, Updates will be made to Annex M as needed. Recover 1. Continue to meet with governmental and business leaders to anticipate challenges and develop strategies. 2. Update Annex N as needed. (Return to TOC)Phases 3, 4* & 5* Pandemic Alert Period (Preparedness) Direction and Controi 1. No changes to the normal operational command and control structure are anticipated during these phases. 2. The administration should assess the availability and training of staff. All staff should review and become familiar with the JCERP and Annex P. 3. Review the incident command structure located in Annex A and identify back-up personnel for key positions. Provide or arrange for advanced ICS training. 44. Assess current national vaccine status and stocks of antivirals. 5. Staff should ensure emergency preparedness at home. Information Technology and Communications 1. Fact sheets posted on the JCHD website should be updated with the most current information, 2. Communication systems, including back-up and alternative systems should be exercised. 3. The JCHD will enhance the current communication capacity by completing Construction of towers to support amateur radio (HAN) antennas. 2. JCHD will improve reliability, and the ability to communicate with medical Providers and the public, by completing the in stallion of updated computer equipment, Public Information 1. Acquire or develop fact sheets specific to the circulating strain(s). 2. Disseminate viral characteristic information obtained from surveillance to medical providers. 3. A focus group will be used to identify the most acceptable means of presenting information about pandemic influenza. A public education ‘campaign, utilizing the results of the focus group, will be used to make respiratory etiquette as a standard practice in physician’s offices, emergency rooms, schools, and businesses. Presentations to community groups about Pandemic influenza preparation will be conducted by health education staff and others. 4. Coordinate with regional and state partners to develop consistent messages. 5. Implement a committee within JCHD to focus on event planning, Communications to stakeholders, partnerships within Jefferson County, etc.Surveillance. 1. JCHD will collaborate with the hospital laboratory to establish a system whereby counts of positive rapid influenza test kits and influenza viral cultures are provided to JCHD on an ongoing basis. 2. JCHD will collaborate with the hospital to establish a system whereby counts of emergency room visits and deaths due to acute febrile respiratory illness are provided to JCHD on an ongoing basis 3. JCHD will collaborate with the schools in Jefferson County to ensure reports of ILI occurrences are provided to JCHD on a regular basis 44, CHD will utilize the regional and state ESSENCE surveillance systems to monitor levels of respiratory illness. 5. Monitor DHSS updates, CDC Health Alerts, EpiX, ProMed and other sources to ‘identify the viral characteristics of the circulating strain(s), including antiviral resistance, suspected incubation periods, clinical signs, symptoms and progression of the disease, Investigation 4. Investigatory procedures outlined in the DHSS Bureau of Communicable Disease Control and Prevention (BCDCP), Communicable Disease Investigation Reference Manual (CDIRM) will be used. 2. Beginning at WHO phase 4, collect pertinent travel histories and seasonal vaccination histories for rapid influenza A test positive cases. 3. Beginning at WHO phase 5, investigate all cases of Adult Respiratory Distress Syndrome that do not have another cause. Prevention of Secondary Transmission 1. Use CDC information to monitor the rates of anti-viral resistance. 2. Notify medical care providers of current prophylaxis recommendations. 3. Continue to promote and encourage respiratory etiquette. Isolation/Quarantine 1. Beginning at phase 4, consider isolation for influenza A positive cases with a history of travei to an endemic area. ‘Mass Prophylaxis 1. CHD will expand the capacity to safely store temperature sensitive vaccines by acquiring additional refrigeration units and back-up generators. 2. Selected portions of POD operations (Annex H) will be exercised during seasonal influenza vaccination clinics. 3. After action reports will be used to update Annex H and this Annex. 4. JCHD will continue activities to enhance pneumococcal vaccination ‘coverage levels in high-risk groups to reduce the incidence and severity of secondary bacterial pneumonia Mass Patient Care1. The JCHD will continue to work with Jefferson Regional Medical Center (JRMC) and other medical providers to develop mutually supporting plans as part of Annex! in the JCERP. Two step down or alternative care sites have been identified with one completing an MOU with JRMC. JCHD will support RNC in developing an MOU with the other sit, 2. Regional plans under development by the Missouri Hospital Association (IMHA), the DHSS, the St. Louis Area Regional Response System (STARRS), and Local Health Agencies will be incorporated in whole or part into Annex when they are completed. ‘Mass Fatality Management 7. Continue to work with hospitals, funeral directors and the medical examiner to develop approaches to manage large numbers of deceased residents and incorporate into Annex J as appropriate. 2. Incorporate mass fatality management into table top and other exercises to test the procedures, coordination and response. 3. Prepare and use after action reports of the exercises to update Annex J. Nuclear and Chemical 1. See Annex K. Foodborne and Waterborne Outbreaks 2, See ANNEX L, Volunteer Management ‘Identify and develop appropriate training for volunteers. 2. Use the JCHD website to recruit volunteers. 3. Work with the Citizens Emergency Response Team and other service ‘organization to develop volunteers. 4. Updates will be made to Annex Mas needed. Recove 1. Continue to meet with governmental and business leaders to anticipate challenges and develop strategies. 2. Coordinate with regional and state partners to develop consistent approaches. 3. Update Annex N and this Annex as necessary. *For Phases 4 or 5 occurring locally see Phase 6 (Response) (Return to TOC)Phase 6 - Pandemic Period (Response) Direction and Control 7. Implement Annex A. 2. The Incident Commander may re-assign staff functions within the ICS to accommodate changing operational emphasis from investigation and ‘solation/quarantine measures to treatment and vaccination measures depending on the availability of resources, viral characteristics and progression Of the pandemic in Jefferson County. Information Technology and Communications 1. Implement Annex B. 2. Utilize enhanced computer systems to communicate updates to the medical community. 3._ Disseminate information for the public on the JCHD web site and though media 4. HINI specific meetings will be held with community partners, educational Institutions, day care facilities, etc, (See Appendix - 5) Public Infort 1. Implement Annex C 2. Utilize virus specific fact sheets developed during preparedness phases. 3. Work within a regional context ta enaure that public information 1s ‘consistent and that vaccination priority groups are appropriately identified (See Appendix 4, 6, 7& 8) Surveillance 1. Implement Annex D. 2. Monitor for anti-viral resistance, 3. Monitor for adverse vaccine reactions. 4, Analyze case fatality rates, age groups affected and novel means of transmission, 5. JCHD will monitor and institute recommendations from CDC for any additional surveillance activities that should be undertaken given the specific circumstances 6. Prepare reports for the Incident Commander as needed. Investigation 1. The Incident Commander may shift operational emphasis from investigation and isolation/ quarantine measures, to treatment and vaccination measures depending on the availability of resources, viral characteristics and progression of the pandemic in Jefferson County.2. JCHD will coordinate the collection of IL! specimens among area providers ‘and the hospital laboratory and facilitate the transfer of ILI specimens to DHSS, and/or CDC. 3. Implement Annex E. The ICS Safety Officer will ensure that investigation staff that may be exposed during an investigation will follow safety procedures, fneluding the use of PPE as appropriate, Prevention of Secondary Transmission 1. The Incident Commander may shift operational emphasis from investigation and isolation/ quarantine measures, to treatment and vaccination measures depending on the availability of resources, viral characteristics and progression Of the pandemic in Jefferson County. 2. Implement appropriate sections of Annex F. In the absence of vaccine or antivirals for prophylactic use, implement Annex G. Isolation/Quarantine The Incident Commander may shift operational emphasis from investigation and isolation/ quarantine measures, to treatment and vaccination measures depending on the availability of resources, viral characteristics and progression of the pandemic in Jefferson County. 2. Implement Annex G. The isolation and quarantine procedures are attached to this document as Appendix 4, 2, and 3. 3. The ICS Safety Officer will ensure that investigation staff that may be exposed during issuance of isolation or quarantine orders will follow safety procedures, including the use of PPE as appropriate. Mass Prophylaxis 1. The Incident Commander may shift operational emphasis from investigation and isolation /quarantine measures, to treatment and vaccination measures depending on the availability of resources, viral characteristics and progression Of the pandemic in Jefferson County. 2. Vaccinations will be administered per CDC and/or MDHSS recommendations and protocols, including current priority group structure or any updated priority group structure provided by MDHSS. See Appendix 4. 3. Antivirals will be administered per CDC and/or DHSS recommendations and protocols including current priority group structure or any updated priority group structure provided by MDHSS. See Appendix 4. 4. Applicable procedures and mechanisms outlined in the JCHD's Mass Prophylaxis/Mass Dispensing Plan (Annex H) will be utilized to guide POD ‘operations in dispensing any antivirals or vaccines received from MDHSS. 5. Unlike vaccine, antivirals do not require specialized storage conditions or cold-chain assurances. The medication must be secured and inventoried as any other pharmaceutical product, but can be done under more flexible conditions. RB6. JCHD will determine and maintain estimates of the number of persons within each priority population to receive prophylaxis and therapy, revising the estimates as needed. These estimates are included in Appendix 4, 7. JCHD will review and update the methodology within its Mass Prophylaxis Plan for providing antivirat prophylaxis and therapy to priority groups during a pandemic in the event of a Severe or moderately severe vaccine shortage, Priority groups are listed in Appendix 4 8. JCHD will collaborate with DHSS and other area jurisdictions to coordinate plans for the provision of antiviral prophylaxis and therapy, 9. JCHD will notify the medical community of the status of antiviral availability and plans to disseminate it to the established priority groups 10. JCHD will disseminate antiviral use guidelines to the medical community 11. Priority groups in Appendix 4 are valid as of 7/27/2006. Priority groups for vaccination in connection with 2009 HINI will be established and followed by JCHD, consistent with COC and DHSS recommendations and guidelines 12. JCHD will receive all vaccine for use in Jefferson County and distribute the vaccine to all identified partners who meet qualifications and have executed appropriate mandated agreements. 1. Implement Annex I 2. Regional plans for Mass Patient Care in the event of pandemic influenza are being developed. The ICHD and Jefferson Regional Medical Center will ‘implement the regional plan in Jefferson County. 3. Two step-down/triage facilities have been identified. Utilize equipment from the SNS surge trailers to equip the step-down/triage facilities. Mass Fatality Management 1. Implement Annex J. Nuet and Chemical 1. See Annex K Foodborne and Waterborne Outbreaks 1. See Annex L. Volunteer Management 1. implement Annex M. Recovery 1. Implement Annex N. 2. JCHD will discontinue and demobilize antiviral and/or vaccine administration, ensuring that supplies are inventoried and returned as appropriate 3. JCHD will develop a detailed summary of the pandemic. (Return to TOC)Appendix 1. Isolation and Quarantine Procedures 1. Definitions (1) Isolation and Quarantine are used as defined in the Missouri Code of State Regulations 19 ‘CSR 20-20.010 (22, 32). Attached as appendix A. {Q) Severe discase: A disease which i, or is suspected of being, a condition listed in 19 CSR. 20-20.020, or isa disease that has recently emerged, and which: 2. Is transmissible from person to person in normal day to day activities. ». Is capable of causing death or incapacitating liness. «©. Can not be rendered non- infectious by treatment, or if such treatment is impracticable or of significant duration. Or ifthe patient has refused available treatment. 4. Does not have immunity levels in the community, through vaccination or previous disease, sufficient to limit transmission, A. Kel Y= When vse. Duration, 1.) Isolation will only be used by the Jefferson County Health Department when itis ‘determined tobe the least restrictive and clinically appropriate means of controling the transmission ofa severe disease in an individual in Jefferson County, whether or not the individual isa legal resident of Jefferson County. 2,) Isolation orders willbe issued for the minimum amount of time necessary forthe case ‘of severe disease to be rendered noninfectious. This period of time will be established sing nationally recognized medical and public health texts, or recommendations of the Centers of Disease Control and Prevention or the Missouri Department of Health and ‘Senior Services. B. Isolation onders ~ How issue. 1.) Isolation orders may only be issued under the authority of the Director of the Jefferson County Health Department or his designee. 2,) Isolation orders wil be served in person by employees of the Jefferson County Health Department who are immune tothe disease by reason of vaccination oF previous infection. Or who have been fitted forthe typeof personal protective equipment (PPE) sufficient fo prevent transmission, and use that PPE while delivering the isolation order. Isolation orders wil be presented using the Jefferson County Order of Isolation form, attached as Appendix 23.) If.an individual placed in isolation is moved from the place of isolation for medical reasons, the emergency medical system personnel providing transportation, and the ‘medical personnel providing treatment, must be notified thatthe individual had been placed in isolation. ML. Quarantine ‘A, Quarantine ~ When used. Duration 1.) Quarantine will only be used by the Jefferson County Health Department when it is dterinined to be the least restrictive and clinically appropriate means of limiting the fransmission ofa severe disease in Jefferson County. 2.) Quarantine orders will be issued for the maximum incubation period forthe disease to which the individual was exposed. This period of time willbe established using nationally recognized medical and public health texts, or recommendations of the Centers ‘of Disease Control and Prevention orthe Missouri Department of Health and Senior Services. 'B. Quarantine orders ~ How issued. 1.) Quarantine onters may only be issued under the authority ofthe Director ofthe Jefferson County Health Department or his designee Health Department. Quarantine orders will be presented using the Jefferson County (Order of Quarantine form. Attached as appendix 3. 3.) Persons placed in quarantine may be required to monitor their own health status and report tothe Jefferson County Health Department on a schedule established by the Jefferson County Health Department. Or the Jefferson County Health Department may Contact the persons in quarantine, in person or otherwise, for the purpose of monitoring, ‘heir health status. 4) If an individual placed in quarantine is moved fom the place of quarantine for ‘medical reasons, the emergency medical system personnel providing transportation, and the medical personnel providing treatment, must he notified thatthe individual had been placed in quarantine. C. Quarantine orders ~ Modified 1.) Quarantine may be modified for individuals who are employed in critical ‘occupations. Individuals placed on modified quarantine mast be capable of monitoring their own health daily, and immediately report to the Jefferson County Health Department the appearance of signs or symptoms of disease as defined by the Jefferson 15‘County Health Department. Individuals placed on modified quarantine may be required {to wear PPE while at work, D. Revords retention 1.) Information collected in the course of issuing isolation or quarantine orders wil be retained by the Jefferson County Health Department for a period of not less than 5 years. {Return to TOC) 16Appendix 2. 19 CSR 20-20.010 Til 19—DEPARTMENT OF HEALTH AND SENIOR SERVICES Dion 20 Divison of Enyionmear eat art Gomme se (haper 20—Cenmicate eases 93H 20.29 010 Delors eng 0 Goran, aera aera PURPOSE: Tis ue dete omietony ‘ed teat the haps and dene forme ent te ts (i Aeminstatr the poaan charge of ‘ter, enperson of he bord. siesta, ‘Sriclan in charge of any eur £2) Ac respon css syatome (AROS) seyret oon {ab Hyponsna duc to tapumonary Surg ot od (hnreased king stnoes and (0) Chest xray eidoneing las iraton. {) Boda the Stole Bd! Heath (2) Commer prson whe harbors spec ‘sta agin ne ase of em Potent ees a reser ntsc fo {81 Caso, ae stint om aca, fos pean Irvahate desea tho cen age ot Communicable dzone present and woh Usually prosase ign or ym of ashes Evian a hs presence ola conmumabie faeeaso so may bo reveals by voutne Faortony vy (6) Glustar a. g0up of raat xno ‘rans tho same or een srs id pr Sleonss| (7) Communicate dzone is an theese 1 Srnfecto sont rs ox pct ed overs diay oy fs sep ‘ranted. or woah he agency on fame tates, vg he {8} Contact 2 parson or anna that has ‘bean in asecinon han ee pen hua ane sough at ascogaen has Aad {he opperumiy to aqure the wacton. {8} Dette represen ary person ‘goup ot porsoneoponied by the drecer {he Geparmsat ol Hea ant Sonor Sere teaston halo he dsr he Sate Gnd a est (G0) Dreier ha slae Dapatnent of Heath and Sonne Senscns stn (1) Dison ia he to pathogenic ‘gens sie te dy by eel o yal ‘reans. oct appa, {a} Concurent tarfecton sehecton Inmet aor te dachage ot nectous ‘ari rm the by fan ete poeon alterna sling st area wn he feta Sschagos (8) Terminal dsinocien me process of tendon to porcnal tig and weeedte pry! enweoment «point hes {rom te pecaity ol conveing the lato ‘amar ate the patenthas tthe promises or alr the patont has ceased tote sours fiechan ora lato procs howeboen dacorbed (2) Erwcnmerta pe occupational eeases Bnesses o atures hana eas feces am expos oa chemical, faaclgcal a pial agent {ts} Exosuoledetned as comet win, Sbeopton ingoston er ihaaton ot cham, Blope ade of oer pia! gens by a human Ba eaten Bacher ‘hysiteieal or etl changes (1) Foo say ta, cooks or prcossod ‘Satiesuttanc, oe, beverage organ! “eedor mene for urein whois on part. (5) Heat statin means reaction to ‘uoeesive eat marta by proaraion, weakness fa calopca eauting tom deat (16) Heat sro mane sve ees Enuzedby execute excocsray Mh tempers rehearsed by svere ado Fighter 9 dy ol hy sda nd eros ase cies, {T 7) ypormomia means a physcier-ingossa {hee eat easton or eat sce (ia) Hypothermia means a pryselar-lagosed ‘ago of cold mur associtod ia fb emparare flea an ninetyour and onotethcagoes ane {G41°F ad eating tom expocre toa {7a} krmunizaton i voament which renders Snneoual ns seep tothe Batologe lees of « daca of proves 3 Ineasure ol pretacson ages he dose. (20 nets mane wasteeapaba ot preaucing Sinessous case. Fora wasteto ie inecnus, most contan arog with ‘Sie wultce ae quarty 0 that Sos oie way nce at ‘aslo goecatod by eal qn gore {hot eas to folowing etepoes(a) Sharpe—al deed saps ining Frypodormie nodes. sng and sia aoe Broken gus orater sharp tes at awe como mcaract hm ea {B) Cures ana stow chnacious agents Ind aomiatodbidogcalsrluded Seeger ois ard uch tos Severs vers to toni seuss mie srs. {C} Otter wastes—those wscoe deegnatad by memoaca utortyesponsbo (phys, Pdi nt tena fore Fe ofthe pte wvch my bv eapte o prosusny an locos dese £21) nts any put nat Pest fusing home, clin mental hath acy, ome heath agen. ormedelo srofesinal {ton amped sh {22} aster ote separaten tr he pao ‘Steommuncabiey once enisle fpiacne sur conn 3 fr enmate to thr anni aale Whe are suscep wo ay po he Eat sbortry mane ay fr fnctoaclogealsoisugca chemical Irmmanoremnatogeal optysiea, ‘ological pata of thes etaminson ‘lrmte ved Hom he ura ‘ony tra purpae of pow areaton {ortho degrass, prevention or teak ‘lany dora er npaemairhe ‘soazaman of hs heh hua These ‘examinations als inde proces ‘Setemine, meas. oebwiee dasenbe {he preeancr or absanos af varus substances {rerganians mo nay Fates ely catecing S pein erento perormn {estng ate nt considered aboot {pottery neues rane stn lexpmen tein ants tb Fprevement funder 108 CIA — a2cFn pan 03) (24) Leet moa auton ho cay or teuny heat tion oto a0 ergo Feat depo oa rd 1 tha Beparmanto Fehon See Serves flere n whi the exuntymiacane fall serve 29 nel hoe oy (25) Local pub hen agony egy iosi, conte ody provid acy, county a ‘hou of counts to protec ho pubke haath hte oy cau or grup ol cor. (25) Nath essa Staptyoconais ures MS) aneoryerretan! (REY and nosocomial intecton are (UDMSA shale dines a8 8 siue ‘tas ha ae resistant oxacitn, ales Sra meta: atonal termed HSA, “hese orgniems re estan oat Satan pens, eluding coptalospors and ‘earoapenare, IHOTE: MASA colts ve otan fesslont 6 ater matin common used lasses of antimicrobial gon, eng. eryinonyai indamyes ap eeaeyete (@) VRE calbe dene ss enerocoes ‘ancomjeln, Save genes eng van, “an, va van. ane vane conte a ‘estore to vancomyen m srrecect {C)Nocosomal ton shat dene bythe natin Contre or leone Cant ‘ha Prewerton ona sped o iecons| ‘tin hosp, emery surges cones (27) Cutrek of epic the occurence fh alcormunty oregon ofan aos Srna, ety in eaooe of are! rpectancy and domed om a comer or ‘ropagted source (23) Potod of communica th pred ts cing whet a ele ape may ltandened dey ornare) rom 30 ‘nese peran to ante person ot fom 9m Inte anal oa pom (25) Pern ny neil, parrai, fexporan,ssotatonmethion, y, eur potteal sabavaionsahory, Sse Sey Sion erases sey {30} Postel plsoning moans human ‘Setrboncs tf urcon damage fo sroctre oipess “toch rents tom he snaion, “Eapen oringoson ot any postde {Gy Pocring means eu es ot deat uused by chemical meas, {Ge} Quaantne ea petod of tention tor Botts or animal tat may hve an Sipozadtoa repos dacase. The prod te ote larger ran to ngest ‘oto ot eommaniabaty fhe disease ‘The prpocs of quarantine ito preven toto ne! wth he gona pooaton (nh Conpiae quaantna ia tation of Freedem of movement of persons or annals fyposodtearopottledssasa fra perios ‘mena enge than re longest pts o! ommunesoay of he deeaeen oreoproven etlecive conta wt the geet Population (B) Moats quscantnee acolo. pal ltaton a reedom of wasnt st Siforancsem suseptaty a eongor of ase seta To moe para stan ard ‘neh tt noe the econ hig om choot the dese of fools an pcos of puble oF ate assent nde prosinn or estos! hase mosed io eammuneatie soso ken tengaging nn prin onus (Goh operate esaae ny deeasn or Ferenc root ie enon ‘ry oust exprton ones goOP ‘lindas cma be pbc heat ‘ho focal haan doparient. oct heath ‘Somnor Sorvces by the quachoet means, {Ga} Sma quent gone ola ‘rato ypc gna one nd ‘oprame (160 orn of aches waste formant ad as epastea n (CSR 8 (Go) Tevet eventietheorawil ue of force or wienre commited by 3 opr Indl ge psa oop Population vary sco tod Feteranco pao sae oben ‘ero aka cua a chem ian or coca [a Choe means my weap hat tegnod clones aise desnend hah sven boyy he te {8} Boogca! means any wicoorganien, ‘us ie atcante, or nabs ‘roa at ay bn ogee a st ot ‘otecnoiogy. any natal ceeutag or erbioge poaie {6} Racotogta aes ary weapon tat ‘aigned te ense radaton nosey ‘ta vel dangerous toon le (G5) Tote uineiance te any sustence, nag {ny raw maton, neta rod aaa ts prouoy recnts any manasa can conden Sabian hat hs he capacty Trough pst mca cr eos Dropeties to povs substan nak eth Scipio os icity er 0 xgarisms or any ore {201 Umut ieasee Exaras incl, but are net imtod to, a ato (Diseases uncommon loa goopaphie ‘a, ane group, or anatomic te (6) Costs of wert anes resting in espetoy (©) Absent comptetraal econ (0) Orman of pamrmagi ness, (23) Unival maniestaton of resoCeareles “ee, bt or nt oo, e folowing {Aue porsons presenting wih a SSitarcinca tyedeome steady (8) Large numbers of rap fata cases, tn or winout ecogrizaie signs an (ChTW0(2) or mor prsns, without a bres made hy prssg wih {1D} Persons presenting with grayish cokrod TE} Adit user te age of iy (50) yours, “ht preins made! Mito, presonig ‘hat expat dress eprom [aros} (G8) Veena (Chickenpox) seventy ofits ‘hat aca he ato cage. (tata on an iy 9) esa ble {otountiesenswahn ity (3) secon (Bi Moderate iy tthe Manas {50-500} feions (ening nbetwoon mt nssaverel an Soog SS re nea mons sta om (Return to TOC)Appendix 3. Isolation and Quarantine Orders ORDER OF ISOLATION Date: To: Address: The Jefferson County Health Center (hereinafter JCHC) has reason to suspect that you are infected with and that you may have or develop this disease. If you are in fact infected with this disease you pose a substantial threat to the public health, In order to prevent transmission of this disease, the JCHC orders that you be placed in isolation, in accordance with § 192.020 RSMo and 19 CSR 20-20.050, as of the date of this Order. "The location where and conditions under which you afe to be isolated ae: te sc Considers this the least restrictive clinically appropriate method of isolation given the nature Of the disease you are suspected of having. You are ordered to remain at ths location and you shall not move or be moved without notice to and the consent of the JCHC; except that, ‘in the case of necessary medical care, you may move of be moved for medical care but you must notify the JCHC of the move in writing within seventy-two (72) hours. During this period you may also be required to undergo medical examination(s), and bodily specimens may be required for further analysis in accordance with § 192.320 RSMo and 19 CSR 20-20.040._ in addition, you should accept and follow any treatment recommended by your health are providers. Failure to accept and follow treatment ‘may significantly increase the duration of the isolation that will be necessary. This order will be in effect until you are deemed non-contagious by the JCHC and do ‘not pose a substantial threat to the public health. It is anticipated that you will need to be isolated for at least to verify a diagnosis and render you rnon-contagious provided you start, follow and respond to treatment. Failure to comply with this order is a class A misdemeanor. See § 192.320 RSMo. Hf you have any questions.» about this- order, please call at (Typed name), Title Jefferson County Health Center Receipt of the above and foregoing order of the JCHC is hereby acknowledged on this day day of 20Signature | hereby certify that this order was served in-hand to the above named individual on at___a.m./p.m, Signature Printed name and title aORDER OF QUARANTINE Date: To: Address: ‘The Jefferson County Health Center (hereinafter JCHC) has reason to suspect that yeu have been exposed to {nd that you may have or develop this disease. If you were to have this disease you pose a substantial threat to the public health, In order to prevent transmission of this disease, the JCHC orders that you be placed in quarantine, in accordance with § 192.020 RSito and 19 CSR 20-20.050, as af the date of this Order. The location where and conditions under which you are to be isolated are: The {ICHC considers this the least restrictive clinically appropriate method of quarantine given the nature of the disease with which you may have come into contact, You are ordered to remain at this location and you shall not move or be moved without notice to and the consent of the ICHC; except that, in the case of necessary medical care, you may move or be moved for medical care but you must notify the JCHC of the move in writing within seventy-two (72) hours. During this period you may also be required to undergo medical examination(s), and bodily specimens may be required for further analysis in accordance with § 192.320 RSMo and 19 CSR 20-70.040. This order will be in effect until you are deemed non-contagious by the JCHC and do not pose a substantial threat to the public health. It is anticipated that you will need to be quarantined for at least __ to verify whether or not you have a contagious disease. Failure to comply with this order is a class A misdemeanor. See § 192.320 RSMo. Hf you have any questions. about this order, please call at (Typed name), Title Jefferson County Health Center Receipt of the above and foregoing order of the JCHC is hereby acknowledged on this day __ day of Signature| hereby certify that this order was served in-hand to the above named individual on at_a.m./p.m. Signature Printed name and title 23‘AREA QUARANTINE ORDER Date: To: Address: The Jefferson County Health Center (hereinafter JCHC) is imposing an area quarantine order covering This order is necessary because widespread exposure to a communicable disease, has occurted, and the described area is affected by this exposure. The ‘JCAC has determined that there’ is the potential for an outbreak of this disease that ‘constitutes a threat to public health. By this order, individuals within the above-described area must Individuals in the area covered by this quarantine order will not be allowed to leave the area without proper authorization form health officials. Individuals outside the area covered by this quarantine order will not be allowed to enter the area without proper authorization from heatth officals, ‘This quarantine order will continue in effect for the period of time necessary to arrest, control and eradicate the threat to public health. Once the JCHC has determined there is n6 longer a threat to public health, the quarantine order will be terminated. It is anticipated that this order will remain in effect for at least to control the potential ‘outbreak of this communicable disease During this period individuals affected by this area quarantine order may also be required to undergo medical examination(s), and bodily specimens may be required for further analysis in accordance with § 192.320 RSMo and 19 CSR 20-20.040, In addition, individuals affected by this area of quarantine order should accept’ and follow any treatment recommended by health care providers. Failure to accept and follow treatment may significantly increase the duration of the quarantine. Notice of this order and any further instructions will be disseminated to the local ‘media during the period of quarantine. Information will also be posted on the JCHC web site, at = This order is issued pursuant to the authority granted the JCHC in $ 192.020 RSMo and the regulations promulgated thereunder, 19 CSR 20-20.050. The JCHC considers this action the least restrictive means of controlling the threat to public heatth. Failure to comply with this order Is a class A misdemeanor. See § 192.320 RSMo. 4If you have any questions about this order, please call at (Typed name), Title Jefferson County Health Center Receipt of the above and foregoing order of the JCHC is hereby acknowledged on this day day of Signature hereby certify that this order was served in-hand to the above named individual on at___a.m./p.m. ignature Printed name and title 25AREA ISOLATION ORDER Date: To: Address: ‘The Jefferson County Health Center (hereinafter JCHC) is imposing an area isolation order covering This order is necessary because widespread exposure to a communicable disease, , has occurted, and the described area is affected by this exposure. The ‘CHC Tas determined that there’ is the potential for an outbreak of this disease that Constitutes a threat to public health By this order, individuals within the above-described area must Individuals in the area covered by this isolation order will not be allowed to leave the area without proper authorization form health officials. Individuals outside the area covered by this quarantine order will not be allowed to enter the area without proper authorization from health officals ‘This isolation order will continue in effect for the period of time necessary to arrest, control ‘and eradicate the threat to public health. Once the JCHC has determined there is no longer a threat to public health, the isolation order will be terminated. It is anticipated that this ‘order will remain in effect for at least — to controt the potential outbreak of this communicable disease. During this period individuals affected by this area isolation order may also be required to undergo medical examination(s), and bodily specimens may be required for further analysis in accordance with § 192.320 RSMo and 19 CSR 20-20.040. In addition, individuals affected by this area of isolation order should accept and follow any treatment recommended by health care providers. Failure to accept and follow treatment may significantly increase the duration of the isolation. Notice of this order and any further instructions will be disseminated to the tocal ‘media during the period of isolation. Information will also be posted on the JCHC web site, at _ am ‘This order fs issued pursuant to the authority granted the JCHC in § 192.020 RSMo and the regulations promulgated thereunder, 19 CSR 20-20.050. ‘The JCHC considers this action the least restrictive means of controlling the threat to public health. Failure to comply with this order is a class A misdemeanor. See § 192.320 RSMo.Hf you have any questions about this order, please call at : (Typed name), Title Jefferson County Health Center Receipt of the above and foregoing order of the JCHC is hereby acknowledged on this day __ day of = Signature | hereby certify that this order was served in-hand to the above named individual on at__a.m./p.m. Signature Printed name and title (Return to TOC)Appendix 4. Priority Groups for Vaccination and Antiviral Therapy Table 1. Vaceine Priority Groups Tier Subiier Population PR Vaccine and antiviral manufacturers and others essential to manufacturing ‘and critical support (~40,000) + Medical workers and public health workers who are involved in direct patient contact, other support services essential for cirect patient care, and Yaccinators (8-9 milion) 8 + Persons > 65 years with 1 or more Influenza high-risk conditions, not Incluging essential hypertension, (2pproximately 18.2 milion) +" ersons 6 months to 68 years with 2 oF more influenza high-risk Conditions, net including essential hypertension (approximately 6.9 rilion) + Persons 6 months or older with history of hospitalization for pneumonia or influenza oF other influenza high-risk condition in the past year (740,000) c + __ Pregnant women (approximately 3.0 millon} +" Household contacts of severely Immunecompromised persons who would not be vaccinated due to likely oor response to vaccine (1.95 milion with transplants, AIDS, and incident Cancer x 1-4 household contacts per person = 3.7 milion persons) «Household contacts of children <6 ‘month ofds (5.0 milion) ° + Public health emergency response workers critical to pandemic response (@ssumed one-third of estimated public health workforce=150,000) Eatimatad in Jefferson County 29 6450 Subtotel: 6.479 Total: 6,479 13043 4945 530 Subtotal:18,519 otal: 24,097 2150 1935 3583 Subtotal 2.668 Total: 32,666 108 ey government leaders 28Healthy 65 years and older (17.7 sition) 6 months to 64 years with 1 high= Fisk condition (35.8 milion) ‘6-23 montis old, healthy (5.6 milion) ther public health emergency responders (300,000 ~ remaining two- thirds of public health work force) Public safety workers including police, fire, 911 dispatchers, and Correctional facility stat (2.99 milion) Utlity workers essential for ‘maintenance of power, water, and sewage system functioning (364,000) “Transpertation warkers transporting fuel, water, food, and medical supplies 2s well as public ground public transportation (3.8 millon) ‘Telecommunications/TT for essential network operations and maintenance (4.08 mitten) other key government health decision-makers (estimated number rot yet determined) Funeral directors/embalmers (62,000) Healthy persons 2-64 years not Included in above categories (179.3 milion) ‘Subtotal: 108 Total: 32.074 12685, 25657 4013 ‘Subtotal: 62,335 Total:7.129 25 2143 261 23 4 48 128498Zz TINS percentages aocounted for 0795 of he population, Table 2. Anti-Viral Treatment and Prophylaxis Priority Groups A setae nfeaen oun # nue | Ff eum 2 por target | fre [Fpcgcimtcite Fe Se esos [2 heatheare wortes 0 [sci th aver pote contacto nerenc meds sere ens) powcr 3 te a 7 se [eapatene | [persons and pregnant | ‘women Pander heath 7 es] [sooner (otc | (eat, vocetors vaccine and antiviral Procure) poe Itty tptce, tre [eect on jpernment con ier [crest TE eas a fawpetetsyoo | Eten 1223 mrt i ‘old, persons >65 yrs } bt aa persone ah ‘underlying medical (rons ‘Cumulative © (Outbreak esponsein. | EP | 1433. (25,728 lpursing nomes and i her resiceniat| 30(enias [7 Howse energeny 1” fepeert ete | [oteones dons (Etc anes | Pevcos |e pantera ("sree ee (ct renracure | une o deta | fre vcore pores) tn HC waa let patent otc € ther eutpoens [toga sk i enti [it lomer Hows with (Return to TOC) 3400 1935 33608 n67 22993 5002 72,68 95,102 au‘Appendix Planning Process - Task Identification and Assignment Identification of Partners, Public Information Meetings, Target Assignment: S STAKEHOLDERS: PUBLICSCHOOLS PRIVATE SCHOOLS POTENTIAL, ASSISTANCE: ACTIVITIES DAYCARE CENTERS PRIVATE PHYSICIANS JEFFERSON REGIONAL FIRST RESPONDERS JEFFERSON COLLEGE PUBLIC & HIGH RISK GROUPS JEFFERSON COUNTY GOV'T DISABLED POPULATION RED Ross. VISITING NURSES JEFFERSON COLLEGE FIRST RESPONDERS. RETIRED JCHD STAFF CERT TEAMS JEFFERSON COUNTY GOV'T JEFFERSON REGIONAL, PRIVATE PHYSICIANS. ‘SCHOOL DISTRICTS/NURSES VOLUNTEERS DISABILITY RESOURCE ASSOCIATION MISSOURI EXTENSION HINI VACCINE MEET WITH PUBLIC SCHOOL SUPERINTENDENTS, 8/12/09 ‘© PROVIDE BACKGROUND INFORMATION © AGREEMENT ON SCHOOL-BASED CLINICS. © ESTABLISH COMMUNICATION CONTACTS. © WHO SHOULD WE PROVIDE INFORMATION T0? WHATIS. THE BEST WAY TO DO THAT? SCHEDULE IMMUNIZATION CLINICS ENVIRONMENTAL AND HEALTH ED WILL WORK ON HANDWASHING AND OTHER ISSUES CONTACT OTHER DISTRICTS (SANDY) MEBY WITH PREV FE SCHOOLS, DATE TRD (DENNIS) © SAME AS ABOVE MEET WITH DAYCARE CENTERS, INCLUDING HEAD START (JOE, TUESDAY, 8/25, ARNOLD: 10:00 AM; HILLSBORO: 2:00 PM) ©. SAME AS ABOVE CONTACT PRIVATE PHYSICIANS BY FAX, 8/13 PROVIDE BACKGROUND INFORMATION ‘0 ESTABLISH COMMUNICATION CONTACTS.© SURVEY WHO WANTS HIN] VACCINE, HOW MUCH OF EACH TYPE, DEVELOP SPREADSHEET ‘+ CONTACT DEANNA AND INFECTION CONTROL AT JRHG, 8/20, 1:00 pM © PROVIDE BACKGROUND INFORMATION © DETERMINE HOW MUCH OF EACH TYPE OF HINI THEY WANT 0 CAN THEY OFFER REFRIGERATION SPACE? CONTACT FIRST RESPONDERS: DICK TUFTS © AMBULANCE DISTRICTS © FIRE © LAW ENFORCEMENT. © CONTACT JEFFERSON COLLEGE (DOUG) CONTACT SUSAN GREEN TO ARRANGE COUNTY MEETING (JUDY) © CONTACE VNA (DENNIS) COMMUNICATION + PRESS RELEASE, 8/17 (DENNIS) PURCHASE EQUIPMENT AND SUPPLIES HIRE/SCHEDULE PERSONNEL DEVELOP ICS ORGANIZATIONAL CHART 3Appendix 6: Public Information Bulletins / Educational Material Resources on the Internet: H1N1 Influenza ‘August 25, 2009 GENERAL INFORMATION ‘Shine Fs a You: Questions and Anewers sem ci goulhtotlvsea bn ‘what Do if You Get Fike Symptoms tp Pov ee gua ey UPDATES ON HAN1 INFLUENZ STATE AND NATIONAL Get the atest on whats happening in Missouri hind dsm gow/8t Sesponse/ Ht Mt Get the atest on whats happeingin the United States upiew se gouiodlyfengate hm RESOURCES FOR PARENTS “Taina Cate of People with HIN Influgnts a Homes Conversions with Chidren about HINT nna n/a nul aie Nn HIN: inflversa ond Fed Your by tof ce gov/ntns y/ilantendng tiaN tntuenza ans Your Pregnancy bugle gon nu puidend groans im EDUCATIONAL MATERIALS hace ne Fal Campaign huss magounwincs Preparing forthe Fu A Communiation Took for Schools Grades K-12 (CDC) o/h cdc gov Muschoosfook, ‘eady n Thee: Preparing fr Pandemic ens (MO DHSS) to//onnw dhs no gouedy ny 2/Pa Comic Cover Your Cough Campaign (COC pill ch gou/afprotes couscous (Gan Hands Sov Lies! Campaign (COC: ‘nue cSegow/cesnhands! ‘The Stop Diese” Method of Handwashing (MO OHSS Wash Your Hands (0 DHSS: stay Home You Are ik [MO OHSS) Fie the Fa (M0 OHSS ‘Staying Heathy During a Pander (MO DHSS): tpl hs no gou/Pandenidavesa/Sovingiathy.ft 35Appendix 7: News Release NEWS RELEASE FOR IMMEDIATE: ‘August 24,2009 Contact: Dennis Diehl, Director Jefferson County Health Deparment “Telephone: (686) 789-3372 ec 197-3737 ‘THIS INFLUENZA SEASON WILL BE DIFFERENT “There has areal heen much discussion in tbe media about the HINI or “swine Mu", some ofit confusing to people. Here is what everyone in Jefferson County needs to know “There will probaly be more than one sin of infuenza circulating thi fall, As result, everyone in the risk groups for reglar (or seasonal nfuenza), including Seniors aged 6S and aver as well a6 individuals with chronic medial eondiions, i srongly encouraged 10 get the seasonal vacene ths year. Seasonal vaccine wil be offred starting in Septembr, in the same settings as previous year including the senior antes, community eines nd at both Jefferson County Health Department offices. A “schedule willbe provided as soon as possible. Te Health Departmeat's fe for seasonal inluenza ‘vaccine i $25, which is eovered by Medicaid and private insurance “There will also be a separate vaccine forthe HINI influenza. Since most people do not natural immunity to thi new vine, wo doses ofthe vaccine wil be required given thee to four wecks spat ‘This vaccine is being purchased bythe federal goverment and will ot be available commercially. A supply wil be distributed to JelTrson County Heath Department (ICH) based on population a the vaccine becomes available, stating around the middle of October, The vaceine will be available othe following high risk groups (© Pregnant women (© Household and caregiver contacts of children younger than 6 months of age. (© Health care and emergency medical services personnel with direct medical contact with patients or infectious materials. ‘Children 6 months through 4 years ol CChildcea with chronic medical conditions under 19 years of age. Children and young adults ages 5 years through 24 years. Persons aged 25 through 64 years who have medical conditions which put them at high risk for complications or death fom influenza ‘There will be no change foc the HIN vaccine, but providers may charge a $15 administration fee. Seniors are not included inthe high risk groups because MINI case rates have been very low in that population. Its likely tht they were exposed toa similar influenza virus inthe past and have immunity tot g with community parners including Jefferson Regional Health Center, Jefferson County Emergency Management, first responders, Red Cross, schoo! districts, dayeare centers and other community based organizations. JCHD is planning o distribute HIN} vaccine ‘when it becomes available to participating private providers and to hold immunization elinies in 36schools, daycares and at the Health Department offices. It may be possible to get both types of| influenca vaccines al the same time, but the vaccines may not be available at the same times Cases of HIN] influenza may occur before vaceine becomes available. A stock of anti-viral ‘medications is available, but everyone is strongly encouraged to wash their hands frequently with soap and water; fo stay home from schoo! or work if you are sick; and to properly cover your ‘nose and mouth when sneezing or coughing. ICH will keep everyone informed as this situation develops, Please check our website at wivw:jotfeohealth.ong or the Centers fr Disease Control website at sw wdesow HIN Ny, Thank your oa 37Appendix 8: Medical Provider Notification ‘August 12,2009 Dear Medical Provider: ‘The Jefferson County Health Department (ICHD) is developing plans for the potential disteibution ofa vaccine against the novel HIN1 (Swine Flu) influenza vieus. When the vaccine will be available is unknown, as isthe exact quantity of vaccine that will be available and the umber of doses required ‘At the present, the Centers for Disease Control (CDC) has identified the following high risk ‘groups tobe targeted by the vaccine: + Pregnant women because they area higher tsk of complications and can potently, provide protection to infants who cannot be vaccinated; + Household contacts and caregivers for eildren younger than 6 months of age because younger infants are at higher risk of influenza-reated complications and cannot be vaccinated. Vaccination of thse in close contact with infants less than 6 moras old right help protect infants by “cocooning” them for the virus + Healthcare and emergency medical services personnel because infections among healthcare workers have been reported an this canbe a potential souee of infection for ‘vulnerable patents. Also, increased absentecsm inthis population could reduce Iealtheare system capaci, + All people from 6 months through 24 years of age © Children from 6 months through 18 years of age beceuse we have son meny cases of novel HINT influenza in chikron and they are in close contact with each ater in school and day ere settings, which increases the likelihood of disease spread, and © Young adults 19 through 24 years of age because we have seen many ease of| novel HINT influenza in these healthy young adults and they often liv, work, and study in close proximity, and they area frequently mobile population; and, ‘+ Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza. ‘The JCHD will likely take a day-care/school-based clinic approach to reach as many 8s possible india age group, However iLamussenyo shes hss gous in out nisean wold ac the JCHD via elephone cal, fx or eal of tough our conta is in on oUF eb page wilh an eat of our vaccine Sincerely, Dennis Diehl, Director CHD Contact: Phone: 636-780-3372, Fax: 636-797-4631, E-mai Webs sew jflenheul org 38‘Appendix ACRONYMS CDC - Centers for Disease Control and Prevention HAN - Health Alert Network LICHD - Jefferson County Health Department IRMC - Jefferson Regional Medical Center [MDHSS - Missouri Department of Health and Senior Services, ILL Influenza-Like illness ICES - Jefferson County Office of Emergency Services PIO - Public Information Officer SARS - Severe Acute Respiratory Syndrome WHO - World Health Organization (Return to TOC) 39