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CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 1
PANDEMIC INFLUENZA
PREPAREDNESS AND RESPONSE
PLAN
Clark County Combined Health District
529 East Home Road Springfield, OH 45503 **** (937)390-5600 www.ccchd.com
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 2
TABLE OF CONTENTS
I Introduction 3
1.1 Purpose/Goals 6
1.2 References and Resources 6
II Situations and Assumptions 6
III Concept of Operations 9
3.1 General Overview 9
3.2 Command and Coordination Overview 9
3.3 Communication Overview 10
3.4 Pandemic Phases and Associated Activities 12
3.5 Pandemic Severity Index 44
IV Roles and Responsibilities 46
V Authorities 52
VI Attachments Listed 54
Plan Maintenance: Description of Change or Action 55
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 3
Introduction
I. INTRODUCTION
Severe influenza pandemics represent one of the greatest potential threats to the public’s health and are ranked as global public health emergencies.
Pandemics are distinct from seasonal influenza epidemics that occur nearly every year and are caused by influenza viruses, which circulate around the world.
Pandemics occur when a novel Influenza A virus emerges through major changes in genetic composition (antigenic shift) that enables a strain to jump the species barrier. Protective immunity in the population does not exist following an antigenic shift due to the absence of past exposure to the strain. See illustration below to note three ways an antigenic shift can occur: Source: National Institue of Allergies and Infectious Disease, Last Updated January 14, 2011 http://www.niaid.nih.gov/topics/flu/research/basic/pages/antigenicshiftillustration.aspx
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
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CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
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Historically, three criteria are necessary for a global influenza pandemic:
A novel subtype of human Influenza A virus emerges
Human infection causes serious illness due to minimal population immunity
Rapid and sustained person-to-person transmission occurs. Four influenza pandemics occurred within the 20th century.
20th Century Influenza Pandemic Human Deaths
Year Known As Antigen Classification
Worldwide Deaths United States Deaths
1918 Spanish Flu H1N1 20-40 million 500,000
1957 Asian Flu H2N2 1-2 million 70,000
1968 Hong Kong Flu H3N2 700,000 34,000
2009* Swine Flu H1N1 18,449 12,470 CDC estimate
*The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related. An influenza pandemic is a public health threat that could overwhelm existing public health, public safety, and health care system infrastructures in Clark County, Ohio. Related vulnerabilities include:
absence of an adequate stockpile of vaccines, antiviral medication, and possibly antibiotics for secondary bacterial infections
high absenteeism in critical positions in all workforces may result in a disruption of key resources and critical infrastructures (transportation, commerce, utilities, public safety, agriculture, and communications), limiting the provision of essential community services.
For planning purposes, it is appropriate to assume the course of the disease to be either consistent with or longer than seasonal influenza epidemics, which typically last three to six weeks. The management of the human health consequences of an influenza pandemic will require efficient coordination and collaboration among local response partners, as well as regional, state, and federal assistance when needed. To prepare for an influenza pandemic, the Clark County Combined Health District (CCCHD) has developed and continues to maintain the Pandemic Influenza Preparedness and Response Plan to address preparedness issues.
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
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1.1. Purpose / Goals
The purpose of this plan (hereinafter referred to as the Plan) is to provide a coordinated community response to an influenza pandemic in Clark County to limit illness and death, preserve continuity of essential government functions, and minimize social disruption and economic losses. This document details CCCHD’s preparedness activities and response and recovery actions associated with an influenza pandemic. It is designed to accomplish the following goals:
Reduce morbidity
Reduce mortality
Minimize essential service / social disruption
Facilitate planning for recovery
1.2. References and Resources
1.2.1: Clark County Emergency Support Function (ESF) # 8 under the Clark County Emergency Operations Plan (EOP); maintained by the Clark County Emergency Management Agency (EMA)
1.2.2: Clark County Combined Health District Emergency Response Plan (ERP) 1.2.3: West Central Ohio Regional Plans, including but not limited to the Regional Epidemiological
Response Plan and the Biological Response Plan 1.2.4: Ohio Department of Health Infectious Disease Control Manual (IDCM)
http://www.odh.ohio.gov/healthResources/infectiousDiseaseManual.aspx 1.2.5: Holloway, R., Rasmussen, S., Zaza, S., Cox, N., Jernigan, D., (2014). Updated Preparedness and
Response Framework for Influenza Pandemics. Centers for Disease Control and Prevention MMWR, Sept 26, 2014. Vol 63, No.6. http://www.cdc.gov/mmwr/pdf/rr/rr6306.pdf
II. SITUATIONS AND ASSUMPTIONS
Situations: 2.1 CCCHD is the public health authority for Clark County and is responsible for the protection of the health and
welfare of its citizens.
2.2 The Clark County Public Health Jurisdictional Risk Assessment identifies these hazards as priorities for
planning:
Severe Thunderstorm Hazmat Spill Tornado
Severe Ice Flooding Biological Terrorism
Severe Winter Storm Pandemic Nuclear Terrorism
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
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2.3 Characteristics of the threat addressed in this plan include:
2.3.1 Influenza is an acute viral disease of the respiratory system. 2.3.2 Symptoms, often classified as “Influenza Like Illness (ILI)” typically include:
fever (usually 101-102 degrees F) chills headache nonproductive cough sore throat exhaustion muscle aches Additional symptoms may include: ocular symptoms such as eye pain, sensitivity to light runny nose substernal chest burning Gastrointestinal symptoms may occur: Nausea vomiting diarrhea
2.3.3 Transmission of novel influenza viruses from person to person or from birds or mammals:
by droplet spread
direct contact with nasopharyngeal secretions
via objects recently contaminated with secretions 2.3.4 Communicability, human to human transmission of novel influenza may or may not occur. The
period of communicability specific to a novel influenza virus will not be known until the virus begins to circulate; however, for planning purposes, the period of communicability of seasonal influenza begins 1 day before symptoms develop and up to 5 days after onset of illness. Children may be infectious for up to 7 days after onset of illness.
2.3.5 The incubation period for novel influenza is unknown until virus begins to circulate, however, for
planning purposes, incubation periods of seasonal influenza are 1 – 4 days, usually 2 days. usually one to three days.
2.3.6 Complications include secondary viral and bacterial pneumonias, as well as febrile
seizures/convulsions. 2.4 A large-scale public health emergency in Clark County will exhaust local resources. 2.5 Clark County has a population of 135, 959 (Census population estimates, July1, 2015) and
includes two municipalities, ten townships, and eight villages.
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
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2.6 A public health emergency in Clark County will require a coordinated, multi-disciplinary,
multijurisdictional, local response as well as regional, state, and federal assistance if needed. The organization and concepts used for the response are based on the National Incident Management System (NIMS) set forth by FEMA.
Assumptions 2.7 On average, an infected individual will transmit the virus to at least two other individuals. 2.8 Multiple waves of infection / illness may occur in a community, each lasting six to eight weeks. 2.9 The number of ill individuals needing outpatient medical care and hospitalization may overwhelm
the local health care system. Prioritization criteria for limited health care services and resources may be needed. Medical standards-of-care may be adjusted.
2.10 Influenza-related illness may occur in thirty percent (30%) of the Clark County population during
an outbreak. Outpatient medical care may be needed for fifteen percent (15%) of the Clark County population and four percent (4%) of the population may require hospitalization.
2.11 The health care system should expect an increase (25% or more) in demand for inpatient beds and
needed respiratory equipment. The health care system may need to open alternate treatment sites to relieve demand on hospital Emergency Departments.
2.12 The number of influenza-related fatalities may overwhelm mortuary and burial services. 2.13 Demand for home care and social services may increase significantly. Individuals may need to
assume responsibility for the care of family members with mild to moderate influenza symptoms at home due to limited health care system services and resources.
2.14 Antiviral medicines may be in short supply, and may be prioritized by for high risk groups. 2.15 A vaccine may not be available for six to eight months following the emergence of a new human
Influenza A subtype. CCCHD will distribute / administer available vaccine based on national and state guidelines.
2.16 Insufficient supplies of vaccines and antiviral medications may require social distancing strategies
and public education to control the spread of disease in Clark County. 2.17 The Plan will be updated periodically as required to incorporate new directives / strategies, new
information technology, legislative changes, and procedural changes based on lessons learned
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 9
and best practices identified during exercises and actual events. A full review, update, and approval of the plan will be conducted annually.
III. CONCEPT OF OPERATIONS
3.1 Overview
3.1.1 CCCHD will be the lead agency in coordinating the local health and medical response to a pandemic along with state and federal agencies and government officials when appropriate.
3.1.2 CCCHD will coordinate response actions with the ODH and local health jurisdictions, primarily in the West Central Ohio (WCO) Region.
3.1.3 CCCHD will respond under the auspices of this plan as well as the Clark County Emergency
Operations Plan (EOP), Emergency Support Function (ESF) # 8 coordinating with the local EMA. 3.1.4 CCCHD’s response actions will emphasize disease surveillance and investigation, social
distancing measures to reduce the spread of infection, and provide timely communication and education to the public regarding the pandemic, the public health response, and measures the public can initiate to reduce the risks of infection.
3.2 Command and Coordination
3.2.1 CCCHD has adopted an Incident Command Structure (ICS), consistent with the structures outlined in the National Incident Management Structure (NIMS) and National Response Plan (NRP).
3.2.2 To realize a consistent approach in the management of a pandemic event, Clark County response partners have adopted NIMS as the framework for preparation, response, recovery, and mitigation actions.
3.2.3 The Health Commissioner or designee will participate as the Public Health Incident Commander or as part of Unified Command.
3.2.4 After establishment of the overall incident objectives, the foremost responsibility of the Incident Commander will be to formulate the initial public health response strategy.
3.2.5 CCCHD has developed and maintains a Continuity of Operations Plan (COOP) to ensure the continuation of essential public health functions as much as possible during a pandemic.
3.2.5.1 As part of the COOP planning, the CCCHD Board of Health and CCCHD’s Health Commissioner have established a line of succession for the agency.
3.2.5.2 It is possible that nonessential public health functions may be suspended for a period of time in order to direct available resources to pandemic-related response actions.
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
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3.2.5.3 During a pandemic event, essential services will include, but are not limited to:
Incident Management
Surveillance and Epidemiology
Facilitating and assuring access to Laboratory Services
Community Mitigation
Facilitating the distribution of appropriate Medical Care and Countermeasures
Facilitating Vaccination if appropriate and available
Risk Communication
Coordination with local, state and federal partners as applicable. 3.3 Communication
3.3.1 Messaging to the General Public and CCCHD Staff
3.3.1.1 Responsible Party: CCCHD’s Public Information Officer{s} (PIOs) will coordinate appropriate
county-wide communication and public education during an influenza pandemic.
3.3.1.2 Dissemination of printed and web-based pandemic preparedness planning information to staff, community partners, elected officials, and the news media.
3.3.1.3 Utilization of radio, television, and print media as needed to disseminate information regarding public health interventions.
3.3.1.4 Identification of functional needs and traditionally underserved populations to disseminate
pandemic influenza educational messages. 3.3.1.5 Promotion and dissemination of pandemic influenza preparedness planning information to
community partners, county agencies, businesses, schools, and community-based organizations.
3.3.1.6 PIOs work with program personnel to assure that CCCHD staff is informed of situation.
3.3.2 Messaging to Partners as part of Information Sharing or Situational Awareness
3.3.2.1 Responsible Party: CCCHD’s Liaison, Planning Section or program personnel will be coordinate situational awareness among partners. Various methods may be utilized.
3.3.2.2 Ohio Public Health Communication System (OPHCS)
3.3.2.3 Clark County Combined Health District Public Health Directory for Health Alerts
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3.3.2.4 Strategic communication through Health District Liaisons as outlined in the procedure in Public Health Preparedness Capability 1, Community Preparedness.
3.3.3 Communicating Operational Information to Clinicians or other System Partners
3.3.3.1 Responsible Party: Operations or program personnel, such as the communicable disease staff
3.3.3.2 Examples would include case definitions, specific Personal Protective Equipment, precautions for shipping labs, etc.
3.3.4 Communication Resources / Methods include the following:
Public Health Directory for Health Alerts
MARCS (Multi-Agency Radio Communication System) Radios
OPHCS (Ohio Public Health Communication System)
JIC (Joint Information Center)
EOC (Emergency Operations Center)
Cell and land-line phones
CCCHD Telephone Tree
Clark County Hyper-Reach Notification System
Ohio Responds System
3.4. Pandemic Phases and Associated Activities 3.4.1 According to Holloway, R., Rasmussen, S., Zaza, S., Cox, N., Jernigan, D., (2014). Updated
Preparedness and Response Framework for Influenza Pandemics. Centers for Disease Control and Prevention MMWR, Sept 26, 2014. Vol 63, No.6. http://www.cdc.gov/mmwr/pdf/rr/rr6306.pdf the coexistence of CDC intervals is demonstrated in figure and chart below.
TABLE. Preparedness and response framework for novel influenza A virus pandemics: World Health Organization phases and CDC intervals, with federal and state/local indicators
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
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World Health Organization phases
CDC intervals Federal indicators for CDC intervals
State/Local indicators for CDC intervals
Interpandemic phase: Period between influenza pandemics
Alert phase: Influenza caused by a new subtype has been identified in humans
Investigation: Investigation of novel influenza A infection in humans or animals
Identification of novel influenza A infection in humans or animals anywhere in the world with potential implications for human health
Identification of novel influenza A infection in humans or animals in the United States with potential implications for human health
Recognition: Recognition of increased potential for ongoing transmission of a novel influenza A virus
Increasing number of human cases or clusters of novel influenza A infection anywhere in the world with virus characteristics, indicating increased potential for ongoing human-to-human transmission
Increasing number of human cases or clusters of novel influenza A infection in the United States with virus characteristics indicating increased potential for ongoing human-to-human transmission
Pandemic phase: Global spread of human influenza caused by a new subtype
Initiation: Initiation of a pandemic wave
Confirmation of human cases of a pandemic influenza virus anywhere in the world with demonstrated efficient and sustained human-to-human transmission
Confirmation of human cases of a pandemic influenza virus in the United States with demonstrated efficient and sustained human-to-human transmission
Acceleration: Acceleration of a pandemic wave
Consistently increasing rate of pandemic influenza cases identified in the United States, indicating established transmission
Consistently increasing rate of pandemic influenza cases identified in the state, indicating established transmission
Deceleration: Deceleration of a pandemic wave
Consistently decreasing rate of pandemic influenza cases in the United States
Consistently decreasing rate of pandemic influenza cases in the state
Transition phase: Reduction in global risk, reduction in response activities, or progression toward recovery actions
Preparation: Preparation for future pandemic waves
Low pandemic influenza activity but continued outbreaks possible in some jurisdictions
Low pandemic influenza activity but continued outbreaks possible in the state
3.4.2 Using the CDC intervals as thresholds for particular interventions, the following 6 charts provide a
guideline for suggested response activities:
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 13
Investigation
Interval
Investigation Interval: Investigation of novel influenza A infection in humans or animals
Indicator: Identification of novel influenza A infection in humans or animals in the United States with potential implications for human health.
Domain Local Activities Responsible
Agencies
Public Health
Staff in ICS
Public Health
Staff if not in
ICS
Notes for Public Health
Inve
stig
atio
n In
terv
al
Inci
den
t m
anag
emen
t
Review state/local response plans. All agencies All Staff All Staff CCCHD Plans are reviewed and
revised annually.
CCCHD Plans reflect intersection with
other the Clark County Emergency
Operations Center.
Coordinate activities and response plans with animal health officials, as appropriate.
Public Health
Operations Communicable
Disease Staff
Review and exercise all aspects of influenza response. All agencies All Staff CCCHD Emergency Response Team
meets no less than 10 times a year to
review and exercise responses.
Inve
stig
atio
n In
terv
al
Surv
eilla
nce
an
d e
pid
emio
logy
Maintain and enhance influenza and respiratory virus
surveillance systems
Public Health
Operations Communicable
Disease Staff
Surveillance reflects regional effort
with other counties in West Central
Ohio.
Novel A Influenza Virus is a Class A
reportable Disease
Non Novel Influenza Viruses are
reportable when they are linked to
pediatric mortality or hospitalization.
During a pandemic, CCCHD’s
Epidemiologist and Infectious Disease
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 14
Investigation
Interval
Control Nurse, along with other
trained back-up staff will enhance
existing surveillance activities.
Implement case-based investigation of novel
influenza infections in humans and animals.
Public Health
OSU Extension
OSU School of
Veterinary
Medicine
OSU School of
Agriculture
Farm Bureau
Veterinarians
Operations Communicable
Disease Staff
Environmental
Health Staff
Assess contacts of ill persons to determine human-to-
human transmission and risk factors for infection.
Public Health
Healthcare
Providers
Operations Communicable
Disease Staff
Report cases according to the Ohio Department of
Health (ODH) and identify whether state or local
assistance is necessary
Public Health
Healthcare
Providers
Operations Communicable
Disease Staff
Reporting to be consistent with Ohio
Revised Code and Ohio
Administrative Code, as well as ODH.
If only animal cases are identified, assess human
exposures and risks for infection.
Public Health
OSU Extension
OSU School of
Veterinary
Medicine
OSU School of
Agriculture
Operations Environmental
Health Staff
Communicable
Disease Staff
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 15
Investigation
Interval
Farm Bureau
Veterinarians
Coordinate activities with animal health
representatives as appropriate.
Public Health
OSU Extension
OSU School of
Veterinary
Medicine
OSU School of
Agriculture
Farm Bureau
Veterinarians
Operations Environmental
Health Staff
Inve
stig
atio
n In
terv
al
Lab
ora
tory
Assess laboratory capacity available to detect and
characterize influenza cases.
Public Health
Healthcare
Providers
Operations Communicable
Disease Staff
Coordinate activities with state/local veterinary
diagnostic laboratories.
Public Health
OSU Extension
OSU School of
Veterinary
Medicine
OSU School of
Agriculture
Farm Bureau
Veterinarians
Operations Environmental
Health Staff
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
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Investigation
Interval
Inve
stig
atio
n In
terv
al
Co
mm
un
ity
Mit
igat
ion
Public Health Public
Information
Officers
Operations
Public
Information
Officers
Communicable
Disease Staff
If human-to-human transmission is suspected,
consider recommending isolation of ill persons and
voluntary quarantine of close contacts (e.g.,
household members).
Public Health
Healthcare
Providers
Public Health
Incident
Commander
Operations
Health
Commissioner
Communicable
Disease Staff
Enhance all usual influenza pandemic preparedness
activities with schools and businesses.
Public Health
Schools:
School Nurses
Superintendents
Public Health
Incident
Commander
Operations
Health
Commissioner
Communicable
Disease Staff,
Nursing Division
Medical
care and
counter-
measures
Advise health-care providers to promptly diagnose
influenza and promptly treat ill persons.
Public Health
Healthcare
Providers
Operations Communicable
Disease Staff
Based on current recommendations: Public Health Operations Communicable Distribution of Public Health Advisory:
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 17
Investigation
Interval
1) Implement infection-control practices;
2) Distribute health advisory notices with information on
case definitions and infection-control measures to
hospitals and outpatient care centers.
Healthcare
Providers
Safety Officer
Disease Staff
Safety Officer
Respiratory
Protection
Coordinator
Emergency
Preparedness
Coordinator
__Healthcare Providers, Clinics:
__Use fax list
__Use groups on CCCHD Outlook
* Other Partners, use CCCHD/EMA Gmail
lists, including:
__Churches (partial coverage)
__ Veterinarians (partial coverage)
__ Pharmacies (partial coverage)
__Extended Care/Assisted Living
__Law Enforcement
__EMS
__Functional Needs Representatives
__Dialysis Clinics
__EMS Medical Directors (partial)
If human-to-human transmission is suspected,
monitor and assist with early access to post-exposure
chemoprophylaxis for case contacts per current
recommendations.
Public Health
Hospital
Healthcare
Providers
Operations
Communicable
Disease Staff
Review all guidance documents, update as needed for
the situation, and communicate with key
Public Health Operations Communicable
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
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Investigation
Interval
stakeholders. Disease Staff
Medical Director
Nursing Division
Emergency
Preparedness
Coordinator
Conduct all usual influenza pandemic preparedness
activities with health-care facilities.
Public Health
Healthcare
Providers
Operations
Liaison
All Staff
Emergency
Preparedness
Coordinator
Vaccine Evaluate all usual influenza pandemic preparedness
activities, including:
o review and update of vaccine distribution
and administration plans
Public Health Public Health
Incident
Commander
Operations
Planning
Nursing Division
Emergency
Response Team
o process for rapid contract negotiation and
staffing
Public Health Planning,
Finance/
Logistics
Finance Officer
Administrative
Assistant to
Health
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Investigation
Interval
Commissioner
o mechanisms to identify and provide vaccine
and document vaccination for critical
infrastructure personnel and possible
priority groups for vaccination
Public Health
Hospital
Emergency
Services
Other
Operations,
Planning,
Finance/
Logistics
Nursing Division
o plans and staffing for mass vaccination
clinics and points of dispensing
Public Health Planning,
Operations
Nursing Division
Review guidance documents, update as needed for
the situation, and communicate to key stakeholders.
Public Health Planning,
Operations
Nursing Division
Risk
communi
cation
Frequently update clinicians and veterinarians
through the health alert network.
Public Health Operations
Nursing Division
Emergency
Preparedness
Coordinator
Share information with key federal and local
partners, such as animal and human health public
affairs officers and other agencies or organizations.
Public Health Planning (Sit
Unit) or Liaison
Emergency
Preparedness
Coordinator
Information Sharing:
__Healthcare Providers, Clinics:
__Use fax list
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 20
Investigation
Interval
__Use groups on CCCHD Outlook
* Other Partners, use CCCHD/EMA Gmail
lists, including:
__Churches (partial coverage)
__ Veterinarians (partial coverage)
__ Pharmacies (partial coverage)
__Extended Care/Assisted Living
__Law Enforcement
__EMS
__Functional Needs Representatives
__Dialysis Clinics
__EMS Medical Directors (partial)
Disseminate timely and relevant messages to the
public as appropriate.
Public Health Public
Information
Officers
Public
Information
Officers
Public Education could include:
Pandemic Influenza: What it is, signs
and symptoms, prevention including
respiratory etiquette and increased
hand hygiene, treatment, how to
care for someone at home,
stockpiling for a medical emergency,
information about social distancing
and community containment plan,
and resource for public information.
Consider Joint messaging with local
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
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Investigation
Interval
partners such as the hospital.
State/Loc
al
coordinati
on
Determine whether state or federal assistance is
required
Public Health
Emergency
Management
Agency
Command and
General Staff
All Staff
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 22
Recognition
Interval
Recognition Interval: Recognition of increased potential for ongoing transmission
Indicator: Increasing number of human cases or clusters of novel influenza A infection in the United States with virus characteristics indicating increased potential for ongoing
human-to-human transmission.
Domain Local Activities Responsible
Agencies
Public Health
Staff in ICS
Public Health
Staff if not in
ICS
Notes for Public Health
Incident
management Continue or initiate actions described for the investigation
interval for all domains. See above See above See above See above
Consider activation of the local emergency operations center.
Emergency
Management
Agency
Public Health
N/A N/A If EOC opened, Public Health must
provide a representative for the EOC.
Forecast future resource needs for a potential response All agencies Incident
Commander,
Planning,
Operations
Emergency
Response Team
Surveillance
and epi-
demiology
Conduct enhanced novel influenza A surveillance. Public Health
Operations Communicable
Disease Staff
Continue case-based investigation and control using
standard methods.
Public Health
Operations Communicable
Disease Staff
Per the Ohio Infectious Disease Control
Manual or other guidance from CDC,
ODH
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 23
Recognition
Interval
Report cases according to Ohio Department of Health’s
Reportable Disease and Ohio Disease Reporting System
(ODRS) Guidance
Public Health
Healthcare
Providers
Operations Communicable
Disease Staff
If animal cases are identified, expand implementation of
joint investigation plan with agriculture officials
Public Health
OSU Extension
OSU School of
Veterinary
Medicine
OSU School of
Agriculture
Farm Bureau
Veterinarians
Operations Environmental
Health Staff
Laboratory Facilitate confirmation all suspected cases at a public
health laboratory as per ODH and CDC guidance
Public Health
Ohio
Department of
Health
Operations Communicable
Disease Staff
Facilitate Healthcare Provider compliance with ODH or
CDC guided specimen triage plans as directed.
Public Health
Healthcare
Providers
Hospital
ODH
Operations Communicable
Disease Staff
Implement surge plans as necessary to facilitate timely
collection and delivery of specimen to appropriate labs
Public Health
Operations Communicable
Disease Staff
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 24
Recognition
Interval
Healthcare
Providers
Hospital
Community
mitigation
Prepare for implementation of community mitigation
measures, such as:
o voluntary home quarantine of contacts
o use of face masks
o temporary closure of child care facilities and
schools
o social distancing measures
o These items are in addition to voluntary home
isolation of ill persons, respiratory etiquette, hand
hygiene, and infection control.
Public Health
Childcare
Facilities
Schools
Public Health
Incident
Commander
Operations
Safety Officer/
Respiratory
Protection
Officer
Public
Information
Officers
Health
Commissioner
Communicable
Disease Staff
Nursing Division
Safety Officer/
Respiratory
Protection
Officer
Public
Information
Officers
CCCHD Respiratory Health and Safety
Plan
Medical care
and counter-
measures
Consider implementation of voluntary contact
chemoprophylaxis based on current recommendations.
o Educate clinicians about recommended
treatment, prophylaxis, and infection-control
guidelines.
Public Health
Hospital
Healthcare
Providers/Clinici
ans
Operations Communicable
Disease Staff
o Initiate contact with local EMA to discuss Public Health Public Health Health Ohio has cache of antivirals
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 25
Recognition
Interval
coordination of Strategic National Stockpile (SNS)
request regarding the potential receipt and
distribution of SNS countermeasures, as
appropriate.
o Consider local caches of supplies
Emergency
Management
Agency
Hospital
Incident
Commander
Operations
Liaison
EOC rep
Commissioner
Nursing Staff
Emergency
Preparedness
Coordinator
Consider local supply through retail
pharmacies
o Assess impact on medical care facilities; Identify
whether medical resources are sufficient to
manage ill persons and conduct case-based
control efforts; determine if assistance is
required.
Public Health
Emergency
Management
Agency
Public Health
Incident
Commander
Operations
Liaison
EOC rep
Health
Commissioner
Nursing Staff
Emergency
Preparedness
Coordinator
Vaccine Prepare for vaccine availability and vaccine campaign;
refine vaccine distribution and administration plans if
a campaign will be initiated, including mass
vaccination initiatives and coordination with
pharmacies and other groups, as appropriate.
Consider enrolling adult, obstetrical, and pediatric
health-care providers, including pharmacies, to
promote vaccine access to persons in all indicated age
and risk groups and ability to identify and vaccinate
critical infrastructure personnel.
Ensure that all identified vaccinators are authorized,
and review policies and procedures regarding
identification, authorization and training of
Public Health
Hospital
Healthcare
providers
Closed PODS
Pharmacies
EMS
Public Health
Incident
Commander
Command and
General Staff
Incident
Commander
Nursing Division
Emergency
Preparedness
Coordinator
Emergency
Response Team
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 26
Recognition
Interval
nontraditional vaccinators.
Confirm vaccine providers have access to the
immunization information system (IIS) or alternative
systems (IMPACT SIIS via HDIS).
Review capacity and capabilities of Impact SIIS:
o for use by vaccine providers
o in mass vaccination clinics
o for the required dosing schedule anticipated
o with or without adjuvant
Risk
communicati
on
Develop or update a media relations and outreach
plan.
Disseminate risk communication messages, including
what is known, what is not known, and what is being
done by public health officials.
Disseminate messages for travelers, as well as
community mitigation messages, when to seek care,
and how to care for ill persons at home as
appropriate.
Public Health
Hospital
Public
Information
Officers
Public
Information
Officers
Conduct briefings with local, regional, and state
response partners, businesses, tribes, and health-care
facilities on the potential for escalation, response
actions underway, and preparedness steps that
Public Health
Operations
Planning (Sit
Unit)
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 27
Recognition
Interval
partners should consider. Liaison
Work with CDC, the U.S. Department of Agriculture,
and the Food and Drug Administration to disseminate
messages to address food safety concerns as
appropriate.
Public Health Operations
Planning
Public
Information
Officers
Environmental
Health
Nursing Division
Public
Information
Officers
State/Local
coordination Continue to coordinate with all partners All Agencies All Staff All Staff
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 28
Initiation
Interval
Initiation Interval: Initiation of pandemic wave
Indicator: Confirmation of human cases of a pandemic influenza virus in the United States with demonstrated efficient and sustained human-to-human transmission.
Domain Local Activities Responsible
Agencies
Public Health
Staff in ICS
Public Health
Staff if not in
ICS
Notes for Public Health
Incident
management Continue or initiate actions described for the recognition
interval for all domains. See above See above See above See above
Consider activation of the local emergency operations center.
Emergency
Management
Agency
Public Health
N/A N/A If EOC opened, Public Health must
provide a representative for the EOC.
Consider declaring a Public Health Emergency Public Health Incident
Commander,
Public Health
Incident
Commander
Process:
Surveillance
and epi-
demiology
If affected, continue enhanced novel influenza A
surveillance.
Conduct case investigation and control using standard
methods.
Public Health
Operations Communicable
Disease Staff
Per the Ohio Infectious Disease Control
Manual or other guidance from CDC,
ODH
If unaffected, prepare for investigation and response Public Health
Operations Communicable
Disease Staff
Conduct surveillance for influenza hospitalizations and
deaths as per ODH.
Public Health Operations Communicable
Disease Staff
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 29
Initiation
Interval
Healthcare
Providers
Hospital
Laboratory Facilitate confirmation all suspected cases at a public
health laboratory as per ODH and CDC guidance
Public Health
Ohio
Department of
Health
Operations Communicable
Disease Staff
Facilitate Healthcare Provider compliance with ODH or
CDC guided plan to limit testing using surveillance criteria.
Public Health
Healthcare
Providers
Hospital
ODH
Operations Communicable
Disease Staff
Community
mitigation
Consider implementation of community mitigation
measures in selected locations or institutions as indicated
by the Pandemic Severity Assessment Framework
Public Health
Public Health
Incident
Commander
Operations
Safety Officer/
Respiratory
Protection
Officer
Public
Health
Commissioner
Communicable
Disease Staff
Nursing Division
Safety Officer/
Respiratory
Protection
Officer
Refer to Pandemic Severity Framework
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 30
Initiation
Interval
Information
Officers
Public
Information
Officers
Medical care
and counter-
measures
Facilitate and support implementation of:
o voluntary quarantine contacts
o chemoprophylaxis of exposed persons
based on current recommendations
Public Health
Hospital
Healthcare
Providers/Clinici
ans
Operations Communicable
Disease Staff
Consider deployment of state and local caches Public Health
Emergency
Management
Agency
Hospital
Public Health
Incident
Commander
Operations
Liaison
EOC rep
Health
Commissioner
Nursing Staff
Emergency
Preparedness
Coordinator
Ohio has cache of antivirals
Consider local supply through retail
pharmacies
Monitor the surge in health-care needs and assess
whether assistance is needed to mitigate the surge.
Public Health
Emergency
Management
Agency
Hospital
Healthcare
Providers
Public Health
Incident
Commander
Operations
Liaison
EOC rep
Health
Commissioner
Nursing Staff
Emergency
Preparedness
Coordinator
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 31
Initiation
Interval
Review and prepare to deploy Mass Fatality Plan Coroner
Public Health
Emergency
Management
Agency
Public Health
Incident
Commander
Operations
Liaison
EOC Rep
Health
Commissioner
Vital Statistics
Communicable
Disease Staff
Vaccine If vaccine available, implement vaccination campaign in
accordance to guidance from ODH and CDC.
Update the state distribution plan based on CDC
prioritization, estimated allocation, epidemiology.
Public Health
Hospital
Healthcare
providers
Closed PODS
Pharmacies
EMS
Public Health
Incident
Commander
Command and
General Staff
Incident
Commander
Nursing Division
Emergency
Preparedness
Coordinator
Emergency
Response Team
Risk
communicati
on
Disseminate updated risk messages, including
information on what might be expected.
Share information regarding:
o antivirals
o possibility of implementation of community
mitigation measures as appropriate
Public Health
Hospital
Public
Information
Officers
Public
Information
Officers
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 32
Initiation
Interval
Provide regular updates to
o key partners, stakeholders,
o elected officials
Public Health
Public Health
Incident
Commander
Planning (Sit
Unit)
Liaison
Health
Commissioner
Nursing Division
Provide regular updates to
o Media
Public Health Public
Information
Officers
Public
Information
Officers
State/Local
coordination Continue to coordinate with all partners All Agencies All Staff All Staff
Prepare to receive funds to support response, if
available.
?????
Public Health
Emergency
Management
Agency
Hospital
Finance/
Logistics
Finance Officer
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 33
Acceleration
Interval
Acceleration Interval: Acceleration of pandemic wave
Indicator: Consistently increasing rate of pandemic influenza cases identified in the state, indicating established transmission.
Domain Local Activities Responsible
Agencies
Public Health
Staff in ICS
Public Health
Staff if not in
ICS
Notes for Public Health
Incident
management Continue or initiate actions described for the initiation
interval for all domains. See above See above See above See above
Maintaining processes to monitor effectiveness of response.
Emergency
Management
Agency
Public Health
Command and
General Staff
All staff
Surveillance
and epi-
demiology
If affected, transition surveillance from individual case
confirmation to:
severe disease surveillance
syndromic surveillance
as appropriate and as indicated by ODH.
Public Health
Operations Communicable
Disease Staff
If unaffected, continue individual case confirmation as
directed by ODH.
Public Health
Operations Communicable
Disease Staff
Monitor for changes in epidemiology Public Health
Operations Communicable
Disease Staff
Laboratory Facilitate laboratory confirmation as directed by ODH and
CDC. (Sample of cases may be requested for virology
Public Health Operations Communicable
Disease Staff
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 34
Acceleration
Interval
surveillance.)
Ohio
Department of
Health
Facilitate Healthcare Provider compliance with ODH or
CDC guided and revised specimen submission protocol.
Public Health
Healthcare
Providers
Hospital
ODH
Operations Communicable
Disease Staff
Community
mitigation
Consider implementation or expansion of community
mitigation measures for affected communities, examples:
o Temporary closure of child care facilities and
schools
o School and workplace social distancing measures
o Postponement or cancellation of mass gatherings
Public Health
Public Health
Incident
Commander
Operations
Health
Commissioner
Communicable
Disease Staff
Monitor effectiveness of community mitigation measures
Monitor Adverse Impact of Community Mitigation
measures on society; coordinate with local response
agencies as needed
Public health
All Agencies
Planning (Sit
Unit)
Public
Information
Officers
All Staff
Public
Information
Officers
Medical care
and counter-
measures
Educate clinicians about the need for prompt treatment of
ill persons.
Public Health
Hospital
Operations Communicable
Disease Staff
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 35
Acceleration
Interval
Healthcare
Providers/Clinici
ans
Educate the public about the need for prompt treatment
of ill persons.
Public health
All Agencies
Public
Information
Officers
Public
Information
Officers
Consider deployment of state and local caches Public Health
Emergency
Management
Agency
Hospital
Public Health
Incident
Commander
Operations
Liaison
EOC rep
Health
Commissioner
Nursing Staff
Emergency
Preparedness
Coordinator
Ohio has cache of antivirals
Consider local supply through retail
pharmacies
Monitor antiviral use to identify possible shortages. Public Health
Pharmacies
Hospital
Healthcare
Providers
Operations Nursing Staff
Monitor and respond to surge in health-care needs,
including setting up alternative care sites.
Hospital
Public Health
Emergency
Management
Public Health
Incident
Commander
Operations
Health
Commissioner
Nursing Staff
Emergency
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 36
Acceleration
Interval
Agency
Healthcare
Providers
Liaison
EOC rep
Preparedness
Coordinator
Review and prepare to deploy Mass Fatality Plan Coroner
Public Health
Emergency
Management
Agency
Public Health
Incident
Commander
Operations
Liaison
EOC Rep
Health
Commissioner
Vital Statistics
Communicable
Disease Staff
Vaccine If vaccine available, implement vaccination campaign in
accordance to guidance from ODH and CDC.
Public Health
Hospital
Healthcare
providers
Closed PODS
Pharmacies
EMS
Public Health
Incident
Commander
Command and
General Staff
Incident
Commander
Nursing Division
Emergency
Preparedness
Coordinator
Emergency
Response Team
Monitor vaccination coverage levels Public Health Operations Epidemiology
Monitor adverse effects Public Health Operations Nursing Division VAERS
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 37
Acceleration
Interval
Risk
communicati
on
Disseminate updated risk messages.
Share information regarding:
o vaccine
Public Health
Hospital
Public
Information
Officers
Public
Information
Officers
Provide regular updates to
o key partners, stakeholders,
o elected officials
Public Health
Public Health
Incident
Commander
Planning (Sit
Unit)
Liaison
Health
Commissioner
Nursing Division
Provide regular updates to
o Media
Public Health Public
Information
Officers
Public
Information
Officers
State/Local
coordination Continue to coordinate with all partners All Agencies All Staff All Staff
Support maintenance of critical infrastructure and key
resources as appropriate.
Public Health
Emergency
Management
Agency
Liaison
EOC rep
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 38
Deceleration
Interval
Deceleration Interval: Deceleration of Pandemic Wave
Indicator: Consistently decreasing rate of pandemic influenza cases in the state.
Domain Local Activities Responsible
Agencies
Public Health
Staff in ICS
Public Health
Staff if not in
ICS
Notes for Public Health
Incident
management Continue or initiate actions described for the acceleration
interval as appropriate See above See above See above See above
Review plans, evaluate whether response activities are proportionate to the situation.
Emergency
Management
Agency
Public Health
Command and
General Staff
All staff
Surveillance
and epi-
demiology
Continue
severe disease surveillance
syndromic surveillance
as appropriate and as indicated by ODH.
Public Health
Operations Communicable
Disease Staff
Monitor for changes in epidemiology Public Health
Operations Communicable
Disease Staff
Laboratory Facilitate laboratory confirmation as directed by ODH and
CDC. (Sample of cases may be requested for virologic
surveillance.)
Public Health
Ohio
Department of
Health
Operations Communicable
Disease Staff
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 39
Deceleration
Interval
Community
mitigation
Assess, plan for and implement targeted cessation of
community mitigation measures if appropriate.
Public Health
Public Health
Incident
Commander
Operations
Health
Commissioner
Communicable
Disease Staff
Medical care
and counter-
measures
Initiate targeted cessation of surge capacity strategies as
appropriate.
Maintain aggressive infection-control measures in the
community
Hospital
Public Health
Emergency
Management
Agency
Healthcare
Providers
Public Health
Incident
Commander
Operations
Liaison
EOC rep
Health
Commissioner
Nursing Staff
Emergency
Preparedness
Coordinator
Vaccine Continue vaccination as appropriate.
Public Health
Hospital
Healthcare
providers
Closed PODS
Pharmacies
EMS
Public Health
Incident
Commander
Command and
General Staff
Incident
Commander
Nursing Division
Emergency
Preparedness
Coordinator
Emergency
Response Team
Risk
communicati
on
Disseminate updated risk messages.
Share information regarding:
Public Health
Hospital
Public
Information
Officers
Public
Information
Officers
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 40
Deceleration
Interval
o Measures to prepare for and respond to
possible additional pandemic waves
Provide regular updates to
o Media
Public Health Public
Information
Officers
Public
Information
Officers
State/Local
coordination Continue to coordinate with all partners All Agencies All Staff All Staff
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 41
Preparation
Interval
Preparation Interval: Preparation for future pandemic waves
Indicator: Low pandemic influenza activity with possible continued outbreaks in certain jurisdictions.
Domain Local Activities Responsible
Agencies
Public Health
Staff in ICS
Public Health
Staff if not in
ICS
Notes for Public Health
Incident
management Continue or initiate actions described for the deceleration
interval as appropriate See above See above See above See above
Consider deactivation of the EOC Emergency
Management
Agency
Public Health
Command and
General Staff
All staff
Prepare for subsequent waves All agencies Command and
General
All Staff
Create an after-action report to document lessons learned Public Health Planning Emergency
Preparedness
Coordinator
Consider suspending the public health emergency declaration
Public Health Public Health
Incident
Commander
Health
Commissioner
Surveillance
and epi-
demiology
Continue case confirmation of selected cases to monitor
progress of the pandemic and detect next acceleration.
Conduct interpandemic surveillance
Public Health
Operations Communicable
Disease Staff
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 42
Preparation
Interval
Laboratory Return to routine interpandemic virologic surveillance. Public Health
Ohio
Department of
Health
Operations Communicable
Disease Staff
Community
mitigation
Modify Community mitigation measures as necessary.
Continue to promote community mitigation preparedness
activities on standby for a subsequent wave.
Public Health
Public Health
Incident
Commander
Operations
Health
Commissioner
Communicable
Disease Staff
Medical care
and counter-
measures
Monitor medical surge trends.
Hospital
Public Health
Emergency
Management
Agency
Healthcare
Providers
Public Health
Incident
Commander
Operations
Liaison
EOC rep
Health
Commissioner
Nursing Staff
Emergency
Preparedness
Coordinator
Replenish stockpiles and caches as able. All agencies Planning,
Finance/Logistic
s
All Staff
Finance Officer
Monitor antiviral dispensing and usage trends. Public Health Planning Communicable
Disease Staff
Nursing Division
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 43
Preparation
Interval
Vaccine Facilitate vaccine recovery as directed.
Continue to vaccinate with focus on hard to reach
populations.
Public Health
Hospital
Healthcare
providers
Closed PODS
Pharmacies
EMS
Public Health
Incident
Commander
Command and
General Staff
Incident
Commander
Nursing Division
Emergency
Preparedness
Coordinator
Emergency
Response Team
Risk
communicati
on
Disseminate updated risk messages.
Share information regarding:
o Measures to prepare for and respond to
possible additional pandemic waves
Public Health
Hospital
Public
Information
Officers
Public
Information
Officers
State/Local
coordination Continue to coordinate with all partners All Agencies All Staff All Staff
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 44
3.5. Pandemic Severity Index
Pre-Pandemic Planning: the Pandemic Severity Index
Future pandemics will be assigned to one of five discrete categories of increasing severity (Category 1 to Category 5). The Pandemic Severity Index provides communities a tool for scenario-based contingency planning to guide local pre-pandemic preparedness efforts. Accordingly, communities facing the imminent arrival of pandemic disease will be able to use the pandemic severity assessment to define which pandemic mitigation interventions are indicated for implementation.
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 45
Community Mitigation Strategies by Pandemic Severity
Part 1
Generally Not Recommended = Unless there is a compelling rationale for specific populations or jurisdictions, measures are generally not recommended for entire populations as the consequences may outweigh the benefits.
Consider = Important to consider these alternatives as part of a prudent planning strategy, considering characteristics of the pandemic, such as age-specific illness rate, geographic distribution, and the magnitude of adverse consequences. These factors may vary globally, nationally, and locally.
Recommended = generally recommended as an important component of the planning strategy.
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 46
*All these interventions should be used in combination with other infection control measures, including hand hygiene, cough etiquette, and personal protective equipment such as face masks. Additional information on infection control measures is available at www.pandemicflu.gov.
†This intervention may be combined with the treatment of sick individuals using antiviral medications and with vaccine campaigns, if supplies are available
§Many sick individuals who are not critically ill may be managed safely at home
¶The contribution made by contact with asymptomatically infected individuals to disease transmission is unclear. Household members in homes with ill persons may be at increased risk of contracting pandemic disease from an ill household member. These household members may have asymptomatic illness and may be able to shed influenza virus that promotes community disease transmission. Therefore, household members of homes with sick individuals would be advised to stay home.
**To facilitate compliance and decrease risk of household transmission, this intervention may be combined with provision of antiviral medications to household contacts, depending on drug availability, feasibility of distribution, and effectiveness; policy recommendations for antiviral prophylaxis are addressed in a separate guidance document.
††Consider short-term implementation of this measure—that is, less than 4 weeks.
§§Plan for prolonged implementation of this measure—that is, 1 to 3 months; actual duration may vary depending on transmission in the community as the pandemic wave is expected to last 6-8 weeks.
IV. ROLES AND RESPONSIBILITIES
4.1 Public Health, State, Federal, and World Health Organization
4.1.1 Local Public Health (may)
A. Facilitate countywide pandemic planning and preparedness efforts. B. Coordinate the county-wide emergency public health response as outlined in ESF # 8 (Health and
Medical Services). C. Educate staff, the public, health care system partners, response partners, businesses, community
based organizations, and elected officials regarding influenza pandemics, expected impacts and consequences, and preventive measures.
D. Conduct countywide surveillance to track the spread of the human disease and its impact on the community. Encourage, through liaison with agriculture and wildlife agencies, influenza surveillance in animals, if indicated, and monitor surveillance data.
E. Implement public health infection control measures to limit the spread of disease, illness, and death.
F. Coordinate planning for and implementation of disease containment strategies and authorities.
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 47
G. Assist with technical support to the health care system including current surveillance guidelines, recommendations for clinical case management, infection control measures, and laboratory testing.
H. Support the health care system’s planning and response efforts for medical surge capacity including mass casualty and mass fatality incidents.
I. Coordinate receipt and distribution of Strategic National Stockpile (SNS) assets. J. Develop and implement protocols for the use of limited supplies of influenza vaccine and antiviral
medicines consistent with national guidelines and in consultation with the ODH. K. Direct distribution and administration of vaccine, including mass vaccination efforts. L. Provide effective communications to the public, the media, elected officials, health care providers,
business and community leaders throughout the public health emergency. M. Participate in a Joint Information Center, if needed, to ensure consistency of public health
messages. N. Participate in information-sharing, planning and response actions among the WCO Region hospitals
and health districts.
4.1.2 Ohio Department of Health (ODH)
A. Coordinate statewide pandemic planning and preparedness efforts. B. Coordinate statewide surveillance activities. C. Operate a CDC Laboratory Response Network public health reference laboratory for novel influenza
virus testing. D. Coordinate submission of pandemic epidemiological data to CDC and dissemination of statewide
data and situation updates to local health jurisdictions. E. Coordinate development and implementation of disease containment strategies across multiple
counties and regions within the state. F. Request federal assistance to support the local health and medical response, including antiviral
medicines and vaccines from the Strategic National Stockpile, when local and state resources are depleted.
G. Educate and inform the public on the course of the pandemic and preventive measures.
4.1.3 Department of Health and Human Services (DHHS)
A. Provide overall guidance on pandemic influenza planning within the United States. B. Coordinate the national response to an influenza pandemic. C. Provide guidance and tools to promote pandemic preparedness planning and coordination for
states and local jurisdictions. D. Provide guidance to state and local health districts regarding prioritization of limited supplies of
antiviral medications and vaccines. E. Determine and communicate the pandemic phase for the U.S. based on the global pandemic phase
(established by WHO) and the extent of disease spread throughout the country.
4.1.4 Centers for Disease Control and Prevention (CDC)
A. Conduct national and international disease surveillance. B. Serve as a liaison to the WHO.
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 48
C. Develop reference strains for vaccines and conduct research to understand transmission and pathogenicity of viruses with pandemic potential.
D. Develop, evaluate, and modify disease control and prevention strategies. E. Support vaccination programs; monitor vaccine safety. F. Investigate pandemic outbreaks; define the epidemiology of the disease. G. Monitor the nation-wide impact of the pandemic. H. Coordinate the stockpiling of antiviral drugs and other essential materials within the Strategic
National Stockpile (SNS). I. Coordinate the implementation of international and U.S. travel restrictions.
4.1.5 World Health Organization (WHO)
A. Monitor global pandemic conditions and provide information updates. B. Facilitate enhanced global pandemic preparedness, surveillance, vaccine development, and health
response. C. Declare global pandemic phase and adjust phases based on current outbreak conditions.
4.2 CCCHD (Specific Responsibilities of CCCHD Divisions)
A. The CCCHD Continuity of Operations Plan (COOP) should be consulted as a guide to filling the role of Health Commissioner when he/she is unavailable. Likewise, when staff roles are open due to illness, death or other impacts of the disaster, the CCCHD would make every effort to reassign the remaining personnel into roles in order to maintain essential services. Prioritizing Essential Services is discussed in the COOP.
4.2.1 Health Commissioner
A. Communicate and coordinate directly with the city and county officials, CCCHD Board of Health, and the local health care organization executives regarding pandemic preparedness and response activities.
B. Coordinate directly with partners and make decisions regarding strategies, thresholds, and methods for reallocating resources.
C. Authorize and communicate public health directives regarding social distancing strategies and other protective actions to elected officials, the business community, schools, and other partners.
D. Assign responsibilities to CCCHD staff for planning and responding to the pandemic. E. Ensure business continuity of critical CCCHD functions during all phases of the pandemic – see
Continuity of Operations Plan (COOP). F. Direct isolation and quarantine of individuals and groups, if feasible, based on recommendations
from ODH and CDC. G. Oversee the development of protocols for prioritizing limited supplies of antiviral medicines and
vaccines in Clark County.
4.2.2 Public Information Officer Team (one lead and two back-ups)
A. Provide accurate, timely information to the public regarding preparations for the pandemic, the impacts of the outbreak, local response actions and disease control recommendations.
CCCHD Pandemic Influenza Preparedness and Response Plan Updated: May 9, 2016
CCCHD Pandemic Influenza preparedness and Response Plan 49
B. Educate the public as to how they can protect themselves from becoming infected and infecting others.
C. Activate and direct the management of public information call centers focused on providing health information to the public.
D. Provide updates to CCCHD staff regarding the status of the pandemic response. E. Communicate with or participate in the regional JIC if established. F. See Public Information and Warning Plan.
4.2.3 Epidemiology and Communicable Disease Control A. Develop contact investigation protocol for pandemic influenza. B. Coordinate isolation and quarantine protocols if feasible. C. Lead surveillance and epidemiological data tracking and investigation efforts and keep the CCCHD
ERT apprised at all times of the local, national, and global status of the pandemic influenza outbreak.
D. See Epidemiological Response Plan.
4.2.4 Nursing Division A. Participate in planning activities focused to develop capacity for community-based influenza
evaluation and treatment clinics. B. Lead and coordinate all mass vaccination response activities. C. Lead efforts with community partners to manage a client care call center. D. Develop infection control plans for CCCHD sites to protect staff and clients. E. Coordinate countywide pandemic planning, education, and outreach efforts with:
School systems
Business community
Community and faith-based organizations
Hospital, Home Health agencies
Long-term care and Assisted living facilities
Other critical agencies such as EMA, Fire, and Law Enforcement (first responders)
4.2.5 Preparedness Staff
A. Lead pandemic planning and preparedness efforts for CCCHD in conjunction with local, regional, state, and federal response partners.
B. Conduct on-going training, drills, and evaluated exercises to enhance CCCHD’s readiness to respond to a pandemic.
C. Coordinate planning and response activities with hospitals and other community health clinics and stakeholders.
4.2.6 Environmental Health Services Division
A. Assist in surveillance for animal influenza viruses through liaison with the State Departments of Agriculture and Fish & Wildlife if appropriate.
B. Work with the CCCHD PIO to develop and disseminate risk communication messages to the public concerning zoonotic influenza virus transmission, food safety, and animal waste disposal issues.
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4.2.7 All Divisions
A. Identify mission critical functions that must be maintained during all hazards including a pandemic. B. Identify staff that can be cross-trained to perform emergency response functions. C. Identify functions that could be temporarily discontinued or performed via telecommuting for
several weeks. D. Be prepared to mobilize all necessary staff to support the CCCHD pandemic influenza response, as
directed by the CCCHD Incident Commander. E. See Continuity of Operations Plan
4.3 Local Stakeholders / Response Partners
4.3.1 Local Hospitals, Clinics, Providers, and other Health System Partners
A. Hospitals and other health care facilities will develop pandemic response plans consistent with the health care planning guidance from DHHS. Health care facility pandemic response plans will address medical surge capacity to sustain health care delivery capabilities when routine systems are overwhelmed.
B. Health care facilities and health care providers will participate in local influenza surveillance activities.
C. Hospitals will develop infection control plans to triage and isolate infectious patients and protect staff from disease transmission.
D. Fatality management will be addressed, as a large numbers of deaths will occur within the medical facility.
E. See Regional Healthcare Emergency Response Plan.
4.3.2 Local Law Enforcement
A. Local law enforcement agencies (Clark County Sheriff’s Office and Springfield City Police Division) cooperate with the CCCHD by assisting with security for isolation / quarantine, if feasible; increased security for antiviral and vaccine shipments and mass dispensing POD sites. They have assisted with developing security plans for each of the identified POD sites.
4.3.3 Fatality management
A. The CCCHD in partnership with the coroner and local funeral directors will develop within the pandemic response plan a description of the roles and responsibilities of the persons responsible for a mass casualty event
B. CCCHD Vital Statistics office will work closely with the morticians to ensure that the plan for death registration is complete and accurate and is consistent with the ODH Pandemic Influenza Mass Aftermath Casualty Plan.
C. The pandemic flu plan developed by the Coroner and local morticians will include mechanisms for handling aspects of fatality management such as: identification of sufficient refrigerated storage areas to serve as temporary morgues, plan for surge capacity when current morgue capacity has been exceeded, scene documentation, complete collection and recovery of the death victim’s personal effects and items of evidence, decontamination of remains and personal effects,
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maintenance of a paper backup registration in the event the Electronic Death Registration System (EDRS) or internet is not available, establishment of Memorandum of Understandings (MOU’s), exploring the role of alternative burial processes and the role for volunteers and the necessary training required for their tasks.
D. See Mass Fatality Plan
4.3.4 Medical Reserve Corps (MRC)
A. The MRC Coordinator maintains the demographic information for MRC volunteers as well as credentialing information, training provided by the CCCHD staff as well as any training acquired elsewhere.
B. The Clark County Volunteer Reception Center (VRC) is coordinated through the United Way of Clark, Champaign, and Madison Counties and has established a Clark County primary site and an alternate site if needed. Volunteers are trained periodically.
C. See Volunteer Management Plan.
4.3.5 Emergency Medical Response A. CCCHD will cooperate with city and local emergency response divisions to provide pandemic
influenza training and to assist them with developing their pandemic influenza preparedness plans when appropriate.
B. The plans will be consistent with the guidelines set forth by the Ohio Department of Health and the Centers for Disease Control and Prevention.
4.3.6 School Districts
A. CCCHD will work closely with officials within the city and county school systems if social distancing becomes necessary.
B. Education will be provided as needed on an ongoing basis. C. The school staff will cooperate with the CCCHD epidemiology / surveillance staff in conducting
ongoing surveillance for influenza like illnesses during the school year. D. MOU’s are place with specific schools that are utilized as POD sites.
4.3.7 Clark County Emergency Management Agency (EMA) A. Coordinates continuity of government planning and preparedness for county political jurisdictions. B. Ensures prompt and efficient emergency response and recovery.
C. Activates the county Emergency Operations Center (EOC) as needed. D. Activates the Emergency Support Functions (ESF) of the county EOP as needed E. Manages and coordinates county response and recovery resources. F. Notifies the Ohio Emergency Management Agency of the situation in Clark County. G. Facilitates requests for state emergency management assistance as needed
4.3.8 Other Stakeholders
1. CCCHD will participate in educational activities, as time is available, for other stakeholders such as non-governmental and governmental organizations.
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V. Authorities 5.1 State of Ohio 5.1.1 Ohio Revised Code (ORC) Section 5923.21 authorizes the Governor to call-up by proclamation the Ohio
National Guard to aid civil authorities acting in the event of a disaster to promote the health, safety and welfare of Ohio citizens.
5.1.2 The Ohio Emergency Management Agency (OEMA) is the central point of coordination within the state
for response and recovery to disasters. 5.1.3 The Ohio Department of Health (ODH) has supervision of all matters relating to the preservation of the
life and health of the people and has ultimate authority in matters of quarantine and isolation, which it may declare and enforce, when neither exists, and modify, relax, or abolish, when either has been established. Whenever possible, the ODH shall work in cooperation with the health commissioner of a general or city health district, and may make and enforce orders in local matters when an emergency exists, or when the board of health of a general or city health district has neglected or refused to act with sufficient promptness or efficiency (ORC Section 3701.13).
5.1.4 The Director of Health shall investigate or make inquiry as to the cause of disease or illness, including
contagious, infectious, epidemic, pandemic, or endemic conditions, and take prompt action to control and suppress it (ORC Section 3701.14).
5.1.5 Boards of Health of a general or city health district, health authorities and officials, officers of state
institutions, police officers, sheriffs, constables, and other officers and employees of the state or any county, city, or township, shall enforce quarantine and isolation orders, and the rules the Department of Health adopts (ORC Section 3701.56).
5.2 Clark County Administrator 5.2.1 The County Administrator, the chief operating officer for the County, reports directly to the County
Commissioners and is responsible for continuity of county government functions. 5.2.2 The County Administrator, under the direction of the Board of County Commissioners, shall perform
any or all functions conferred or incumbent upon the Board of County Commissioners in the case of a disaster or emergency, provided that the board, by resolution, has delegated the specific functions or all of the functions to the Administrator (ORC Section 305.30). Disaster and emergency have the same meanings as in Section 5502.21 of the Revised Code. The specific functions delegated to the County Administrator, as listed in ORC Section 5502.21, are civil defense, emergency management, and emergency preparedness/Homeland Security actions.
5.3 Municipalities
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ORC Section 715.37 authorizes any municipal corporation to:
Provide for the public health
Secure the inhabitants of the municipal corporation from the evils of
contagious, malignant, and infectious diseases
Purchase or lease property or buildings for pesthouses (a house or hospital for
persons infected with pestilential disease; e.g., plague etc.)
Erect, maintain, and regulate pesthouses, hospitals, and infirmaries. 5. 4 Clark County Combined Health District Board of Health 5.4.1 The Board of Health is authorized to study and record the prevalence of disease within its district, to
provide for the prompt diagnosis and control of communicable diseases, and to take such steps as are necessary to protect the public health and to prevent disease (ORC Section 3709.22).
5.4.2 The Board of Health may make such orders and regulations as are necessary for its own government,
for the public health, and for the prevention or restriction of disease. In cases of emergency caused by epidemics of contagious or infectious diseases, or conditions or events endangering the public health, the Board of Health may declare such orders and regulations to be emergency measures, and such orders and regulations shall become effective immediately (ORC Section 3709.21).
5.4.3 The Board of Health has specific authority pertaining to the control of dangerous communicable
diseases as listed in the Revised Code, including quarantine and isolation, inspection and / or destruction of property, disposal of contaminated bodies, closure of schools, and prohibition of public gatherings (ORC Sections 3707.04 to 3707.26).
7.4.4 The Board of Health may seize, occupy, and temporarily use for a quarantine hospital a suitable vacant
house or building within its jurisdiction (ORC Section 3707.31). 5.5 Clark County Health Commissioner 5.5.1 The Health Commissioner is the executive officer of the Board of Health, and is authorized to carry out
all orders of the board and of the Ohio Department of Health (ORC Section 3709.11) 5.5.2 Quarantine and isolation authority granted to the Board of Health by the Ohio Revised Code has been
delegated to the Health Commissioner by Resolution #00-096 when the Health Commissioner finds that: (a) a threat to the public exists; or (b) the action is necessary to administer the provisions of ORC 3707.04 to 3707.32; and (c) circumstances have rendered a meeting of the board impractical or impossible; or,(d) delaying action until a meeting of the board would compromise the public health.
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VI. Attachments Attachment 1 – Prioritization for Influenza Vaccine or Antiviral Medication Attachment 2 – Consideration of Items Included in other CCCHD Plans Attachment 3 – Links to Resources and Planning Guides for Community Agencies
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Date Description of Change or Action Pages
Affected
Reviewed or
Changed by
10/2006 Created S Dobbins
09/2007 Revision JAndrews
11/2007 Revision JAndrews
02/2009 Revision JAndrews
04/2010 Revision JAndrews
03/2011 Review Only JAndrews
04/2012 Complete Revision JAndrews
04/25/2016 Format Change in multiples sections
Integrated Pandemic Phases as per MMWR September 2014
Minor language changes in Roles/Responsibilities
multiple C.Conover
05/06/2016 Reorganize sections of the plan
Refer to other parts of CCCHD Emergency Response Plan in place of maintaining set of
procedures in this Pan Flu Plan (former attachments, now Attachment 2)
Refer to weblinks for community planning guides in place of maintaining planning text as part
Pan Flu Plan (former attachments, now Attachment 2)
Minor language changes in Roles/Responsibilities
Reviewed content with Health Commissioner
multiple C.Conover
05/09/2016 Inserted page breaks between attachments
Corrected Table of contents (page numbers)
Added “interval overlays”
54-58
2
13-43
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ATTACHMENT 1 Prioritization of Vaccine and Antivirals
Assumptions:
1. Antivirals are recommended by the Centers for Disease Control as an effective method for post exposure prophylaxis and/or treatment of influenza vaccination
2. Vaccine is recommended as an effective method of prevention of influenza
3. Supply shortages necessitate prioritizing which groups of the population should be targeted to receive vaccine or antiviral.
The Clark County Combined Health District will prioritize the county’s allocation and local cache of vaccine or medical countermeasures such as antivirals, in accordance to the guidance from Center for Disease Control (CDC). It should be noted that the approach of mitigating disease transmission includes the administration of vaccine in addition to an aggressive social distancing policy.
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Attachment 2
Planning Items Related to Pandemic Influenza Plan
This list includes items which will be addressed in other sections of the CCCHD Emergency Response Plan.
Associated Concepts Refer to:
CCCHD Emergency Response Team PHP 1 Community Preparation
Periodic Testing of Pandemic Influenza Plan
Maintenance of Essential Services during Pandemic Continuity of Operations Plan
Dissemination of Information to Public for Pandemic Influenza Public Information and Warning Plan
Availability of Vaccinations for Personnel PHP 14 Responder Safety and Health Plan
Dissemination of OPHCS and Health Alerts PHP 6 Information Sharing
Influenza Surveillance PHP 13 Epidemiological Response Plan
Disease Investigation Orientation PHP 13 Epidemiological Response Plan
Reporting of Communicable Disease PHP 13 Epidemiological Response Plan
Monitoring Influenza-like Illness Among Staff PHP 14 Responder Safety and Health Plan
Employee Training for NIMS/ICS Multiyear Training and Exercise Plan
EOC Assignments and Responsibilities PHP 3 Emergency Operations Coordination
Medical Reserve Corp PHP 15 Volunteer Management
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Attachment 3
Links to Planning Resources for Community Partners
1. http://www.flu.gov/planning-preparedness/school/index.html
Child Care and Preschool Pandemic Influenza Planning Checklist
School District (K-12) Pandemic Influenza Planning Checklist
Colleges and Universities Pandemic Influenza Planning Checklist
2. http://www.flu.gov/planning-preparedness/community/index.html
Faith-Based & Community Organizations Pandemic Influenza Preparedness Checklist
3. http://www.flu.gov/planning-preparedness/business/index.html
Business Pandemic Influenza Planning Checklist