Hospital-Based Epidemiologist Program Aids H1N1 Response

North Carolina's hospital-based Public Health Epidemiologist (PHE) Program significantly aided the state H1N1 response and is credited with improving public health infrastructure and shortening emergency response time.

The program is composed of a director and eleven PHEs, based at eleven of the largest hospital systems in North Carolina. The core activities of the program include surveillance (active and syndromic), investigation, outreach and education, special studies, and collaboration with local health departments. During seasonal flu epidemics, PHEs regularly monitor influenza-like illness (ILI) in their facilities and track the number of positive influenza and other respiratory virus tests each week. These data assist clinicians and public health officials in the interpretation of influenza and viral pathogen activity in the area.

In an effort to assist public health response following the emergence of H1N1, the PHE program expanded its duties to include:

* Working with hospital admissions and the emergency department to develop a system for screening/isolating/testing suspected H1N1 cases.

* Tracking all patients with febrile respiratory illness admitted to the hospital and arranging for specimen collection for testing at the state laboratory or CDC.

* Managing a tracking list of all hospital suspect H1N1 cases with testing results.

* Conducting detailed case investigations with hospitalized H1N1 patients.

* Performing daily hospital H1N1 death surveillance.

* Using the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) for monitoring and analyzing hospital emergency department ILI data.

* Participating in NC DPH and hospital H1N1-related meetings and conference calls.

* Collaborating with hospital infection control and the department of health to provide documents to hospital clinicians based on CDC and NC DPH guidance.

* Providing reports to hospital staff, local public health, and the state department of health on the status of H1N1 in the hospital.

* Reporting situational status at the state and national level based on flu surveillance data.

* Maintaining updated H1N1-related educational resources and materials.

* Ensuring that PHEs serve as a hospital contact person regarding H1N1 for local public health, as well as an information resource for hospital staff.

The data gathered by the PHEs were used to guide recommendations for decisions regarding patient care and the creation of consistent infection control measures. The information collected also allowed public health to better understand the severity of the virus. The Hospital-based Epidemiologists (PHEs) provided daily reports to local public health, state health officials, and to their hospital's management. In addition, robust web-based weekly reports contained more data, such as respiratory viral pathogens, influenza-associated hospital admissions, influenza deaths, and a general influenza surveillance summary. In addition, they proved invaluable in identifying and providing timely information on the hospital's pregnant woman influenza-associated admissions and ICU admission.

Dr. Lana Deyneka, PHE Program Director, credits the program with serving as an early warning system for public health on unusual influenza clinical presentations, antiviral resistance cases, and other situations of public health significance. The program's flexibility and the timeliness of the detailed reports aided public health in reacting to the rapidly changing situation. It also strengthened communication channels and bridged activities between hospital clinicians, laboratory staff, and public health officials, shortening overall pandemic response time. Due to the uncertainty of pandemics, the program will maintain an enhanced level of surveillance throughout the 2010-2011 influenza season.

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