Links Helps Baltimore Develop a Flu Management Plan (web article)

Infectious disease experts from the Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Hospital played a key role in the development of a new Baltimore City Health Department plan to manage seasonal flu—an effort that reflects the growing collaboration between the School and Baltimore’s public health officials.

At a November 8 press conference at the School, Health Commissioner Joshua Sharfstein, MD, explained that the plan categorizes three stages of flu activity in the city as ‘minimal flu,’ ‘flu alert’ or ‘severe flu,’ and it outlines the department’s corresponding education messages and actions. Jonathan Links, PhD, professor and director of the Johns Hopkins Center for Public Health Preparedness (CPHP) at the Bloomberg School, and Trish Perl, MD, MSc, professor and hospital epidemiologist at Johns Hopkins Hospital, advised the Health Department on the plan.  

“We’re very pleased to have collaborated on this innovative approach to seasonal flu,” said Bloomberg School Dean Michael J. Klag, MD, MPH. “We’re good at generating data, and we look forward to collaborating with the Health Department in putting that data to use in saving lives in Baltimore.”

Sharfstein recently called on public health researchers in Baltimore to inform the Health Department of research that is relevant to its programs and services. 

The Health Department’s decision to build its seasonal flu management plan around a three-level flu severity scale grew out of Links’s work at CPHP to develop training programs for the public health workforce to respond to health emergencies, including pandemic influenza. Perl advised city health officials on the appropriate responses of health care workers and health care facilities during flu season. Influenza causes an average of 226,000 hospitalizations and 36,000 deaths each year in the U.S.

In planning for a pandemic influenza, Links said that CPHP developed a model that progresses through three stages of response as an outbreak increases in severity.

“The plan has well-defined triggers that take you from one stage to the next,” Links said. “The Health Department saw that we could use it for seasonal flu and to get us accustomed to these three stages should a pandemic ever hit.”

The Health Department plan identifies ‘minimal flu,’ ‘flu alert’ and ‘severe flu warning’ as the three flu activity levels. Throughout the flu season, a surveillance team is charged with collecting data from hospitals and hospital emergency rooms, 911 calls and health care providers to monitor the flu activity in Baltimore and the surrounding metropolitan region. The department determines the flu activity level, based on analysis of the most current data. 

If flu activity is found to be minimal, health department activities focus on educational messages like practicing proper hygiene and the importance of vaccinations for high-risk groups. A flu alert designation indicates a sustained increase in the number of flu cases and triggers stepped-up education campaigns that address high-risk groups, vaccinations for health workers and recognizing flu symptoms. A severe flu warning takes effect when high numbers of flu cases limit area hospitals’ abilities to provide timely and effective care.  

In the case of a severe flu warning, Sharfstein said that the health department may consider more aggressive prevention measures such as temporary school closings and required vaccinations for health care workers.  “We want to get as much good data as we can and respond in a way that makes sense,” he said. --Jackie Powder