Bonnie j. sorensen , md, mba Volusia county health department January 31, 2013
description
Transcript of Bonnie j. sorensen , md, mba Volusia county health department January 31, 2013
BONNIE J. SORENSEN, MD, MBAVOLUSIA COUNTY HEALTH DEPARTMENTJANUARY 31, 2013
Innovation t Collaboration t Accountability t Responsiveness t Excellence
DUVAL TB RESPONSE:COMMUNICATING DURING A CRISIS
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
Innovation t Collaboration t Accountability t Responsiveness t Excellence
Global Hot Spots
Innovation t Collaboration t Accountability t Responsiveness t Excellence
National TB
Innovation t Collaboration t Accountability t Responsiveness t Excellence
National Cases of TB
Innovation t Collaboration t Accountability t Responsiveness t Excellence
TB Transmission
• Spread through coughing by air droplets
Innovation t Collaboration t Accountability t Responsiveness t Excellence
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
Innovation t Collaboration t Accountability t Responsiveness t Excellence
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)
Innovation t Collaboration t Accountability t Responsiveness t Excellence
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%
Innovation t Collaboration t Accountability t Responsiveness t Excellence
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
Innovation t Collaboration t Accountability t Responsiveness t Excellence
City Divided by Zone for Case Management
Innovation t Collaboration t Accountability t Responsiveness t Excellence
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
Innovation t Collaboration t Accountability t Responsiveness t Excellence
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
Innovation t Collaboration t Accountability t Responsiveness t Excellence
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
Innovation t Collaboration t Accountability t Responsiveness t Excellence
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
Innovation t Collaboration t Accountability t Responsiveness t Excellence
Quote
“In order to create a complete community for our homeless population, they need a TB-free environment.”Cindy FunkhauserCEO IM Sulzbacher Center
Innovation t Collaboration t Accountability t Responsiveness t Excellence
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
Innovation t Collaboration t Accountability t Responsiveness t Excellence
Public Information
Innovation t Collaboration t Accountability t Responsiveness t Excellence
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.
Innovation t Collaboration t Accountability t Responsiveness t Excellence
Public Information Team
• Florida Department of Health, Office of Communications
• Duval County Health Department PIO• Volusia County Health Department PIO
Innovation t Collaboration t Accountability t Responsiveness t Excellence
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
Innovation t Collaboration t Accountability t Responsiveness t Excellence
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
Innovation t Collaboration t Accountability t Responsiveness t Excellence
Public Health at Work, cont’d.
Innovation t Collaboration t Accountability t Responsiveness t Excellence
Questions?
Bonnie Sorensen, MD, MBAVolusia County
Health [email protected]