An Enhanced System for Monitoring Influenza and Pneumonia Deaths in Pennsylvania during the 2009- 2010 H1N1 Novel Influenza Pandemic Marina O. Matthew,

An Enhanced System for Monitoring Influenza and Pneumonia Deaths in Pennsylvania during the 2009-2010 H1N1 Novel Influenza Pandemic

Marina O. Matthew, RHIAPennsylvania Department of HealthBureau of Health Statistics and Research

Gateway to the Future:Improving the National Vital Statistics System

St. Louis, MO June 6th – June 10th, 2010

The Keystone State Population in 2008: 12,448,279 Population 65+: 1,941,000+

2nd largest percentage of elderly behind Florida;

Rural Population: 3,700,000 Area: 45,888 square miles 67 counties

If DE was a county in PA, it would rank 4th



Pennsylvania Firsts Nation’s Capitol

York High speed multi lane highway

the PA turnpike Hospital

Pennsylvania Hospital, Philadelphia Banana Split

Latrobe, PA- 1904



Rankings Rank first in the country in:

Mushroom production State Game Lands and licensed hunters

Scrapple production Potato Chip and Pretzel Production



Background

Mortality tracking important modality for defining the severity of seasonal influenza

Influenza mortality surveillance is traditionally done using the 122 Cities Mortality Reporting System (National MRS) at CDC Compiles summary mortality data by age group

for all causes and Pneumonia and Influenza (P&I)

Occurs weekly by fax or voice mail Six cities in PA participate

• Allentown, Erie, Philadelphia, Pittsburgh, Reading, Scranton



Issues with the National MRS Registrar District Coverage Areas only total 23% of PA

population and does not include major rural areas of the state

Delay in receiving the data – since only submitted weekly No consistency of data submitted

Some sites provide data on all death records submitted Some provide data only on the deaths that occur in the city in

which the office is located Some provide data only on deaths of residents of the reporting city Some provide the data only on deaths that occurred in the county

in which the city is located Some only provide data on deaths that are registered with the

local registrar in that city



Alternative Mortality Reporting System to Address the H1N1 Pandemic

In May 2009, PA implemented a facsimile-based system for reporting of deaths in ten sentinel sites by local registrars and branch offices Includes the six Pennsylvania cities

involved in the national MRS Covers 27.4% of population (16%

increase over national MRS)

Elk

Tioga

York

Erie

Potter

Centre

Berks

Bradford

Butler

Lycoming

Bedford

Clinton

Pike

Warren

Clearfield

McKean

Crawford

Blair

Somerset

Indiana

Luzerne

Wayne

Fayette

PerryBucks

Lancaster

Mercer

Franklin

Chester

Clarion

Schuylkill

Cambria

Monroe

Huntingdon

Venango

Greene

Allegheny

Adams

Washington

Westmoreland

Jefferson

Mifflin

Fulton

Forest

Dauphin

Armstrong

Beaver

Susquehanna

Sullivan

Juniata

Union Carbon

Columbia

Lehigh

Snyder

Cumberland

Wyoming

Cameron

Lebanon

Montgomery

Lawrence

Lackawanna

Northumberland

Northampton

Delaware

Montour

Philadelphia

Erie

Altoona

Reading

Scranton

Lancaster

Allentown

Pittsburgh

Harrisburg

Philadelphia

State College

2000 Census Population Density by Census TractWith Proposed Daily Mortality Reporting Areas



Local Registrars Entered into formal letters of engagement

with the six (6) local registrars Provided those without equipment a

combined fax and scanner machine to allow for daily reporting

Compensated at $100/month plus $1.00 for each record that had to be faxed/scanned

Maximum of $4999.99 for each local registrar



Responsibilities of 10 Sentinel Sites Review all records received on a daily basis Any death records with the following words were

to be faxed or emailed within one (1) day of receipt Pneumonia Influenza Flu H1N1 Swine

Complete and fax or scan in a daily report listing the number of deaths by age category in addition to the P&I deaths.



Costs of Alternate System Funding through Office of Public Health

Preparedness Relatively inexpensive

Scanners were $100 - only purchased for 4 of the 6 local registrars.

No equipment needed for the branch offices Total cost to registrars thus far: $4575.00 (May 2009-

February 2010) No monthly payments to branch offices

Staff time 30 minutes per day to process records and daily reports 30 minutes per week to update spreadsheets and maps



Results: May 2009-February 2010 22,828 deaths reported

6.3% were P&I Of the P&I deaths:

40.3% of records were received within 2 days after death;

77.4% within 4 days after death In contrast, CDC MRS system reports were

received 7-14 days after death Detected peak of P&I deaths in PA in

2010 one week before the National MRS.



For More InformationMarina O. Matthew, RHIADirector, Division of Statistical RegistriesBureau of Health Statistics and Research555 Walnut Street, 6th FloorHarrisburg, PA 17101(717) [email protected]

Website: www.health.state.pa.us

Documents

An Enhanced System for Monitoring Influenza and Pneumonia Deaths in Pennsylvania during the 2009- 2010 H1N1 Novel Influenza Pandemic Marina O. Matthew,