Division of Disease Control amp Health Protection Bureau of Epidemiology February 20 2018 1 Influenza and ILI Update for FHCA To protect promote and improve the health of all people in Florida through integrated state county and community efforts ID: 757940
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Florida Department of HealthDivision of Disease Control & Health ProtectionBureau of EpidemiologyFebruary 20, 2018
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Influenza and ILI Updatefor FHCA
To protect, promote, and improve the health of all people in Florida through integrated state, county, and community efforts.Slide2
Brief highlights of 2018 surveillance dataBrief overview of vaccination/ treatment recommendationsDiscussion about current supply situationFacts vs rumors
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ObjectivesSlide3
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Percent of Emergency Department (ED) and Urgent Care Center (UCC) Visits for Influenza-Like Illness by Flu SeasonSlide4
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Percent of Emergency Department and Urgent Care Center Visits for Influenza-Like Illness in People 65 Years and Older by Flu Season
23,707
Visits since OctoberSlide5
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Deaths Due to Pneumonia and Influenza
National Data
Florida DataSlide6
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Reported Influenza and ILI Outbreaks by Facility Type
420
Total outbreaks to dateSlide7
209 outbreaks of influenza and influenza-like illness (ILI) reported75 (36%) in skilled nursing facilities
51 (24%) in assisting living facilities83 (40%) in long-term care facilities (LTCFs), not otherwise specified
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Outbreaks in Settings Serving the ElderlySlide8
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Outbreaks in Facilities Serving the Elderly: Vaccination of Residents
Goal = 100% residents
vaccinated
31
%
65
%
64
%Slide9
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Outbreaks in Facilities Serving the Elderly: Vaccination of Staff
Goal = 100%
staff vaccinated
48
%
55
%
55
%Slide10
Antiviral treatment was administered to at-risk ill individuals in 46 of the 75 outbreaks in skilled nursing facilities (61%)
Antiviral chemoprophylaxis was administered to at-risk individuals in 35 of the 75 outbreaks in skilled nursing facilities (47%)
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Outbreaks in Skilled Nursing Facilities – Administration of Antiviral Treatment and ChemoprophylaxisSlide11
Influenza VaccinationVaccinate residents annually
Before onset of influenza season, typically by the end of OctoberFor persons ≥65 years, any age-appropriate influenza vaccine formulation is acceptableFor persons ≥65 years, high-dose or adjuvanted vaccine may provide better protection
Vaccinate staff with patient/resident contactReduces transmission of influenzaReduces staff illness and absenteeism
Reduces influenza-related illness and death among persons at increase risk
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Advisory Committee on Immunization Practices.
Prevention and Control of Seasonal Influenza with Vaccines, 2017-18.
www.cdc.gov/flu/professionals/acip/index.htm
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No national shortageMay vary by vaccine distributor (seasonal ordering)Information on where to get an immunization:
www.floridahealth.gov/findaflushotPeople are more likely to get vaccinated if recommended by their providers. For example, pregnant women receiving a recommendation and offer of vaccination by their providers were over 6 times more likely to get vaccinated (65%) vs. women who did not receive a recommendation or offer (10%).
www.cdc.gov/flu/fluvaxview/pregnant-coverage_1516estimates.htm
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Vaccine SupplySlide13
Antiviral TreatmentAll long-term care facility residents who have confirmed
or suspected influenza should receive antiviral treatment immediately.Treatment should not wait for laboratory confirmation of influenza.
Antiviral treatment works best when started within the first 2 days of symptoms. May still have a benefit after 2 days.Three recommended antivirals :Oral oseltamivir (generic or Tamiflu®)
Inhaled zanamivir (Relenza®)
Intravenous peramivir (
Rapivab
®)
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CDC.
Influenza Antiviral Medications: Summary for Clinicians
www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
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Antiviral Chemoprophylaxis
All eligible residents in the entire long-term care facility (not just currently impacted wards) should receive antiviral chemoprophylaxis as soon as an influenza outbreak is determined.Threshold: A single positive influenza test along with other residents with ILI.
Antiviral chemoprophylaxis is recommended for all non-ill residents, regardless of their influenza vaccination status, in long-term care facilities that are experiencing outbreaks.Antiviral chemoprophylaxis can be offered to personnel.Duration: minimum of 2 weeks, and continuing for at least 7 days after the last known case was identified.
CDC.
Influenza Antiviral Medications: Summary for Clinicians
www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
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No national shortage of oseltamivir. Local supply delays of oseltamivir have been reported. Factors include high demand, delays in generic oseltamivir supply.
Actions: If suspension is not available, pharmacies are able to compound an oral suspension using oseltamivir 75 mg capsules per FDA-approved package inserts.
Patients may need to contact multiple pharmacies for oseltamivir availability.Antiviral drug manufacturer information available on the CDC antiviral drug supply webpage to assist pharmacies/facilities with purchases/availability. CDC is working with manufacturers and pharmacy benefit managers to improve access to brand product in areas where there are generic drug spot shortages.
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Oseltamivir SupplySlide16
Plan Now: Antiviral and Chemoprophylaxis AdministrationHaving preapproved orders from physicians or plans to obtain orders for antiviral medications on short notice can substantially expedite administration of antiviral medications.
Develop a plan on how to obtain antivirals for all residents simultaneously
for chemoprophylaxis.16Slide17
Reports of insurance companies requiring pre-approvalsDelays appropriate treatment and adversely impacts patient outcomesProvided letter signed by the State Surgeon General, Celeste Philip, MD, MPH
www.floridahealth.gov/diseases-and-conditions/influenza/_documents/state-surgeon-general-flu-letter.pdf
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Oseltamivir Pre-Approvals?Slide18
Visit www.FluFreeFlorida.com for more information about the fluCurrent information about flu activity in Florida – see Florida’s weekly surveillance report, the Florida Flu Review
www.floridahealth.gov/floridaflu Local county health departments
www.floridahealth.gov/chdepicontactBureau of Epidemiology 24/7/365: (850) 245-4401
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For More InformationSlide19
Questions?
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Q & A