One-page 'Mitigation Menu' created during H1N1 simplified communications and gave agencies current countermeasure recommendations

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In Brief

During an influenza pandemic, communities need clear, concise, and timely information in order to reduce the chance and spread of infection. Oregon health officials developed an electronic tool during the 2009 H1N1 pandemic to communicate disease countermeasure instructions and options to local and tribal health departments, health providers, state agencies, and schools.

Tools
Background

The primary strategies for warding off influenza are considered to be vaccination, antiviral medication for infected and exposed individuals, and infection control and social distancing measures. As seen in 2009, the timing, onset, and severity of an influenza pandemic are unpredictable, and the nation’s ability to produce sufficient quantities of a safe, effective vaccine early in the outbreak is uncertain. If healthcare systems become inundated with infected individuals, antiviral supplies may not be sufficient. In such a scenario, infection control and social distancing measures take on greater importance. Health officials need an effective way of communicating the diverse mitigation options according to the severity of the pandemic, local response efforts, and supply availability.

Specific issue

Communication. During the 2009 H1N1 pandemic, Oregon state health officials found they needed an effective way to communicate guidance on disease mitigation countermeasures in a brief, easily distributed, easy-to-update format that showed the spectrum of possible strategies as the pandemic progressed and receded.

The practice

The Oregon Public Health Division’s community mitigation work group developed a communication tool at the beginning of the 2009 H1N1 pandemic in order to announce mitigation recommendations for local and tribal health departments, health providers, state agencies, and schools.

The one-page Mitigation Menu communication tool featured:

  • A complete list of strategies, including isolation, quarantine, social distancing, facility closure, personal protective equipment, vaccine, and antiviral medications
  • A way for state health officials to select under each strategy the specific actions to be implemented at the local level. For example, under vaccine, actions included: vaccinate all persons who present without contraindications, market vaccine to high-risk groups, and only vaccinate according to the attached priority list. By selecting an action item, health officials communicated which mitigation measures were currently recommended, what was not recommended, and possible recommendations if things worsened.
  • Situation updates, including information on the global case-fatality ratio, antiviral resistance, number of cases in Oregon, and affected areas of Oregon
  • Information about timing. At the top of the page, recipients were instructed on when the measures would go into effect and expire. Recipients appreciated the start and end dates of the measures, commenting that it clarified the expected timeframe.
What made this practice possible?
  • Committed work group. A community mitigation work group was quickly formed at the beginning of the pandemic to create the tool.
  • Standardized tool format. As guidance slightly shifted over the course of the pandemic, state health officials were able to quickly update the Mitigation Menu and send it back out to listserv recipients. Having a standard format made it easy for recipients to follow and promoted clear communication. Officials updated the tool 4 times during the pandemic.
Results

User-friendly tool. Local health departments liked how the often-complicated guidance was boiled down into an easy, one-page summary and directive. Listing a start and expiration date gave clear direction to users.

Notes

Based on the Mitigation Menu’s positive reception, Oregon state health officials plan to adapt a similar menu format in future hazard tool kits.

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