BONNIE J. SORENSEN, MD, MBAVOLUSIA COUNTY HEALTH DEPARTMENTJANUARY 31, 2013

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DUVAL TB RESPONSE:COMMUNICATING DURING A CRISIS

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Outline / Objectives

• What is TB?• Duval TB Response• Incident Command• Public Information• Accomplishing the mission• Lessons learned for public health response

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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

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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

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Treatment of TB

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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 Cases

102 89 72 71 83

0046 Cases

9 9 10 30 30

% Geno-typed

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

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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

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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 FunkhauserCEO 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

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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

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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

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Public Health at Work

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Public Health at Work, cont’d.

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Questions?

Bonnie Sorensen, MD, MBAVolusia County

Health DepartmentBonita_Sorensen@doh.state.fl.us