Variation in local public health response to the 2009 H1N1 outbreak: A comparative analysis from North Carolina

The H1N1 virus is continuing to cause illness, hospitalizations and deaths in the US. Although the virus was not as virulent as first anticipated, its high occurrence and subsequent publicity put a strain on health departments. Due to the ongoing nature of public health emergencies like H1N1, practitioners have had few opportunities to reflect upon their activities, comprehensively evaluate their response. The result is missed opportunities for learning which response strategies work best in which community contexts and why. As part of North Carolina's preparations for H1N1 and other unpredictable events, the NC Preparedness and Emergency Response Research Center undertook a study to: (1) test methods for evaluating the content and timing of local H1N1 responses retrospectively using surveys, document reviews and on-site facilitated discussions; (2) assess the causes and consequences of variation in H1N1 response activities across local jurisdictions; and (3) generate after-action reports (AARs) for local practitioners to use in planning and improving responses to future outbreaks. The approach is being tested in nine NC local public health jurisdictions with confirmed H1N1 cases during August/September 2009. This presentation will critically examine findings from the comparative analysis of response activities, focusing on variation in response content and timing. The stratified comparisons will be used to test for differences in outbreak responses that may be associated with selected public health system resources and capacities. The session will conclude with a discussion of areas for future research and opportunities for adapting the methodology for evaluating responses to other types of hazards.