2009 Pandemic influenza A H1N1 in Alaska: temporal and geographic characteristics of spread and increased risk of hospitalization among Alaska Native and Asian/Pacific Islander people.

Alaska Native people have suffered disproportionately from previous influenza pandemics. We evaluated 3 separate syndromic data sources to determine temporal and geographic patterns of spread of 2009 pandemic influenza A H1N1 (pH1N1) in Alaska, and reviewed records from persons hospitalized with pH1N1 disease in 3 areas in Alaska to characterize clinical and epidemiologic features of disease in Alaskans. A wave of pH1N1 disease swept through Alaska beginning in most areas in August or early September. In rural regions, where Alaska Native people comprise a substantial proportion of the population, disease occurred earlier than in other regions. Alaska Native people and Asian/Pacific Islanders (A/PI) were 2-4 times more likely to be hospitalized than whites. Alaska Native people and other minorities remain at high risk for early and substantial morbidity from pandemic influenza episodes. These findings should be integrated into plans for distribution and use of vaccine and antiviral agents.

Influenza surveillance using electronic health records in the American Indian and Alaska Native population.

OBJECTIVE: Increasing use of electronic health records (EHRs) provides new opportunities for public health surveillance. During the 2009 influenza A (H1N1) virus pandemic, we developed a new EHR-based influenza-like illness (ILI) surveillance system designed to be resource sparing, rapidly scalable, and flexible. 4 weeks after the first pandemic case, ILI data from Indian Health Service (IHS) facilities were being analyzed. MATERIALS AND METHODS: The system defines ILI as a patient visit containing either an influenza-specific International Classification of Disease, V.9 (ICD-9) code or one or more of 24 ILI-related ICD-9 codes plus a documented temperature ≥100°F. EHR-based data are uploaded nightly. To validate results, ILI visits identified by the new system were compared to ILI visits found by medical record review, and the new system's results were compared with those of the traditional US ILI Surveillance Network. RESULTS: The system monitored ILI activity at an average of 60% of the 269 IHS electronic health databases. EHR-based surveillance detected ILI visits with a sensitivity of 96.4% and a specificity of 97.8% based on chart review (N=2375) of visits at two facilities in September 2009. At the peak of the pandemic (week 41, October 17, 2009), the median time from an ILI visit to data transmission was 6 days, with a mode of 1 day. DISCUSSION: EHR-based ILI surveillance was accurate, timely, occurred at the majority of IHS facilities nationwide, and provided useful information for decision makers. EHRs thus offer the opportunity to transform public health surveillance.

Alaska Native adolescent views on cervical cancer, the human papillomavirus (HPV), genital warts and the quadrivalent HPV vaccine.

OBJECTIVES: To understand the knowledge levels, attitudes and perceptions of Alaska Native adolescent girls about cervical cancer, HPV, genital warts and the HPV vaccine. STUDY DESIGN: A qualitative study. METHODS: Seventy-nine in-depth interviews were conducted with adolescent females aged 11 through 18 years in 4 communities in Alaska. The convenience sample was recruited through word of mouth, posters and flyers distributed in community schools, medical clinics and stores. RESULTS: Many of those surveyed didn't know the purpose of a vaccine and were not familiar with basic knowledge about HPV, genital warts and cervical cancer. After learning about cervical cancer and HPV, most teens felt that someone their age had an average likelihood of contracting the diseases and that having the disease would be quite bad. Most teens said they were interested in vaccination. When asked if they would get a vaccine, older teens most commonly cited concerns about side effects or doubts about vaccine efficacy, while younger teens were afraid the shot would hurt. Most teens stated that they preferred to learn about health topics such as these through television programming, followed by the Internet, brochures and posters. CONCLUSIONS: The findings provide valuable information on how to inform adolescents about the vaccine and alleviate their concerns. The design of an educational campaign should vary depending on the age of the adolescents. For younger teens, distribution of information should be at school using a brochure or curriculum, while for older teens a web page may be more appropriate.