July - August 2009

A Novel Virus Emerges and Public Health Responds

Usually the worst thing to happen on April 15 that has national ramifications for those who are unprepared is the IRS tax deadline. This year, a novel virus now known as H1N1 flu (originally swine flu) became the unwelcome guest. On this date, the Centers for Disease Control and Prevention (CDC) officially confirmed the first case in the United States.

One week later, Metro Health received notification from the Texas Department of State Health Services (DSHS) that South Texas may have not only its first case, but two. Over the ensuing days, Metro Health communicated and collaboratd with DSHS' Region 8 on the first confirmed H1N1 cases in Guadalupe County and prepared for the likely human-to-human transmission spread into Bexar County.

Whereas, the H1N1 outbreak may have caught a few communities off guard, Metro Health was well prepared and responded efficiently and effectively to the impact of this novel virus. Years of emergency planning and coordination for hurricanes and an expected avian flu pandemic yielded positive results.

The local response began with regular and ongoing communication and information-sharing with Region 8, emergency preparedness experts, City and County leaders, healthcare professionals, hospitals, first responders, local military installations, and a variety of other preparedness partners. The CDC sent a team to San Antonio to work with Metro Health and the State to begin an investigation and initiate local studies of viral shedding, transmission rates in health care settings, attack rates in households, and vaccine (seasonal influenza) effectiveness.

Meanwhile, a page dedicated to H1N1 was created and posted on the Metro Health website. The currently active page includes information; guidance for particular groups such as schools, healthcare, professionals, businesses and residents; downloadable materials; and links to resources such as the CDC and DSHS.

Within days, Metro Health leaders were invited to an issue briefing with Governor Rick Perry and then-Mayor Phil Hardberger. As the first cases of this novel virus began to appear in Bexar County and it became clear that young people were most affected, direct discussions began with schools about Metro Health's guidelines regarding school closures. The health department would not recommend school closures based on individual confirmed cases of H1N1 due to the generally mild symptoms of the illness. Instead, absenteeism rates would be the basis for closure recommendations.

The community, event organizers, and businesses also were encouraged to continue normal activities while taking appropriate preventive and protective measures. The most important of which is to stay home if you are sick with an influenza like illness and limit your contact with others.

As more cases developed as expected, Metro Health opened a hotline for people to call with questions about the virus and to address symptoms. Surveillance systems were strengthened to better monitor the virus and the Public Health Emergency Preparedness Division activated the Regional Medical Operations Center. This action allowed representatives from area hospitals to coordinate their needs and response with that of public health. Antivirals were distributed quickly and efficiently to needed locations.

Laboratory testing became crucial as additional cases developed first throughout South Texas, and then more within Bexar County. The Metro Health lab began receiving specimens from communities all across South Texas and, at the peak of the outbreak, processed about 1,300 flu specimens. The lab was one of the first in the state to be approved by the CDC to do confirmatory testing of specimens, which meant they no longer had to be shipped to Atlanta for official H1N1 confirmation. This efficiency, coupled with establishing sound criteria for specimen testing, allowed clinicians to receive results quicker and address illness appropriately.

The response to the H1N1 outbreak comes on the heels of a couple of major tuberculosis investigations, the end of a one-month reporting period for Methicillin-resistant Staphylococcus aureus (MRSA), and preparation for the current hurricane season. With limited resources and a team committed to ongoing initiatives aimed at improving and protecting our community by addressing issues such as diabetes, tobacco use, and food safety, Metro Health continues to perform as "San Antonio's Public Health Team."
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We Want to Hear From You

Without a doubt, there are some facets of emergency planning that can always be improved. Metro Health is assessing our most recent, and ongoing, response and will facilitate changes as necessary as the department prepares for the fall flu season and an anticipated increase (potentially in severity as well as cases) of H1N1.

In the meantime, we want to hear from you. Share your thoughts on the H1N1 outbreak - whether your experience came as a member of this community, a visitor, clinician, business owner, educator, event planner, or member of the media - we want to know how this outbreak impacted you and how we in public health can be a better resource or partner with you.

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