Inside Duke Medicine

ID experts led Duke’s response to swine flu

Christopher Woods, M.D. MPH, was at a conference in Italy when reports of a novel strain of flu began appearing in Mexico in late April. One of his first phone calls went to colleague Brett Caram, M.D., with whom he’d done research on respiratory infectious diseases at the Durham VA Medical Center.

Caram, too, had learned about the flu outbreak from e-mail messages and infectious diseases listservs and already was busy pulling together information to discuss with leaders within the Duke Division of Infectious Disease. Colleagues Dennis Clements, M.D. and Dan Sexton, M.D. agreed that she would be the go-to person for expertise, representing both the Health System and the VA.

“Based on her research interests and experience, she was best suited to take the lead on providing the necessary clinical expertise for coordinating a response to a potential outbreak,” said Woods, associate professor of medicine in the Division of Infectious Diseases.

Caram and Woods are just two examples of an impressive array of infectious disease experts at Duke. From HIV/AIDS Vaccine Immunology to ongoing virus research at the Duke-NUS Graduate Medical School in Singapore, Duke is well poised to address the threats posed to human health by pandemic flu and other diseases. Caram and the infectious diseases team worked with local and state hospital and public health care officials, including Duke’s new public health epidemiologist Robert Willis, RN, and Jessica Thompson, director of emergency preparedness and planning, to review and refine a response plan should the need arise.

“Brett really stepped up to the plate to provide invaluable leadership and clinical expertise during an intense period of emergency preparations,” said Monte Brown, M.D., vice president of administration.

The Health System and VA have several emergency response measures in line for dealing with a potential outbreak of pandemic influenza and other health threats, measures developed over the past ten years in response to several national and international events.

“With the events surrounding 9/11 and the subsequent anthrax attacks, followed a few years later by SARS and avian flu, Duke, worked with local, state, and national public health institutions to develop plans for responding to biological and other threats to the health of our community,” said Woods.

When the novel A:H1N1, or swine flu, began appearing in states surrounding North Carolina, Caram and Woods had the difficult task of reassuring patients and Duke-affiliated health care providers, as well as providing up-to-date definitions and suggestions from the Centers for Disease Control and Prevention (CDC).

“Things were changing every 24 hours. And on top of that, we were battling 24-hour news channels that were delivering all sorts of mixed messages,” said Caram. “It was important that we provide rapid and accurate communication.” Caram was interviewed by the local media, and helped to deliver updates to the community.
Said Woods, “It’s kind of a trade-off — you want heightened awareness but at the same time you don’t want people to overreact. I think we did a good job at keeping that balance.”

The infectious diseases team worked with the clinical microbiology laboratory to quickly bring new diagnostic technology on line to most accurately test specimens from suspected flu patients.

“Using gold-standard PCR technology, we were able to determine whether a patient had influenza A or B, to begin to separate out potential novel cases from lingering cases of seasonal flu,” said Caram.

Samples were then sent to the state lab and, if necessary, the CDC for further sub-typing to see if they were indeed H1N1.

Woods and Caram applauded the work of Employee Health, under the leadership of George Jackson, as well as Duke Medicine administrators in helping to facilitate a coordinated response to the swine flu threat, including communication with ambulatory services, Duke Raleigh Hospital, Durham Regional Hospital and Duke University affiliated physicians throughout the region. “Duke employees can rest assured that they are in good hands when it comes to emergency response,” said Woods. This sentiment was echoed in a message sent out on May 7 by Chancellor Victor J. Dzau, M.D., detailing the robust preparation and coordination of the infectious diseases team, employee health, local and state health officials and the Duke administration. The deft coordination of the flu emergency response teams was especially evident as Duke’s commencement approached, directly in the middle of the outbreak. Woods, with the help of Michael Merson, M.D., director of the Duke Global Health Institute, worked closely with vice president for student affairs Larry Moneta, Ed.D. to ensure the safety of the graduates and visitors.
“We’ve learned a number of valuable lessons and recognized areas for improvement over the past few weeks,” said Caram.

Added Woods: “Ultimately, we are better prepared for what may happen later this year or the following winter, whether it’s related to this current strain or not. We have the expertise and the flexibility to adapt to the unique challenges presented by each novel outbreak.”

Tips for avoiding the flu for important tips on remaining healthy through the flu season and during pandemic flu, visit http://www.duke.edu/flu2009/index.html