NonPharmaceutical Interventions to Face the Pandemic

1
Non-Pharmaceutical Interventions to Face the
Pandemic
INTERCOUNTRY MEETING ON AVIAN INFLUENZA AND
PREPAREDNESS FOR HUMAN PANDEMIC INFLUENZA EMRO,
CAIRO, EGYPT, 28-30 NOVEMBER 2005

• Dr John J. Jabbour
• Senior Epidemiologist
• IHR/CSR/DCD
• WHO/EMRO

2
Outline

• Why non-pharmaceutical interventions?
• What are the non-pharmaceutical interventions?
• Limitations
• Challenges

3
Why non-pharmaceutical intervention?

• Given the problems of
• inadequate vaccine supplies and
• the uncertain role of antiviral drugs,
• Several efforts have been made to determine
  whether non-pharmaceutical interventions could
  mitigate the initial impact of a pandemic

4
Why non-pharmaceutical intervention?

• the principal protective tools pending the
  augmentation of vaccine supplies.
• In resource-poor settings, non-pharmaceutical
  interventions may be the main line of defense
  throughout the first wave of a pandemic.
• The effectiveness of most of these interventions
  has not, however, been tested under the unique
  conditions of a pandemic.

5
The effectiveness of many interventions

• depends on
• the behavior of the virus as determined by its
• pathogenicity,
• principal mode of transmission (droplet or
  aerosol),
• concentration in different age groups,
• duration of virus shedding
• susceptibility to antiviral drugs.

6
Example

• If children are the most severely affected age
  group, or play a major role in transmission, then
  health authorities should make decisions about
• the effectiveness of school closure,
• travel measures (children travel less frequently
  than adults) and
• quarantine (children cannot be separated from
  their parents).

7
Selection of appropriate measures

• Driven by questions of feasibility, which are
  closely linked to
• costs,
• ease of implementation within existing
  infrastructures,
• likely acceptability to the public, and
• potential to cause social and economic
  disruption.

8
Non-pharmaceutical Interventions
9
Public health information, communication

• Information for public on risks and risk
  avoidance (tailored to target population)
• Information for professionals (Guidelines)
• Advice on universal hygiene behavior
• Preparatory information on next phase

10
Measures to reduce risk that cases transmit
infection

• Confinement
• Confine cases (mild and severe) as appropriate to
  local situation (provide medical and social care,
  face masks)
• Severity of illness depends on prior experience
  with related variants
• symptomatic persons
• exposed person undertake risk assessment
  considering evidence of human-to-human
  transmission closeness of contact frequencyof
  exposure
• persons seeking care (respiratory illness) in
  risk

11
Measures to reduce risk that contacts transmit
infection

• Tracing and follow-up of contacts (Not feasible
  once pandemic starts)
• Self-health monitoring and reporting if ill
• Voluntary quarantine (home confinement) of
  healthy contacts provide medical and social care
• Advise contacts to reduce social interaction
• Advise contacts to defer travel to unaffected
  areas
• Provide contacts with antiviral prophylaxis

12
Measures to increase social distance

• Voluntary home confinement of symptomatic persons
  
• Closure of schools (including pre-school, higher
  education) in conjunction with other measures
  (limiting after-school activities) to reduce
  mixing of children
• Population-wide measures to reduce mixingof
  adults (furlough non-essential workers, close
  workplaces, discourage mass gatherings)
• Masks in public places

13
Disinfection measures

• Hand-washing
• Household disinfection of potentially
  contaminated surfaces
• Widespread environmental disinfection
• Air disinfection

14
Measures for persons entering or exiting an
infected area within the country

• Advise to avoid contact with high-risk
  environments (infected poultry farms, live
  poultry markets)
• Recommended deference of non-essential travel to
  affected areas
• Restrict travel to and from affected areas
• Disinfection of clothing, shoes, or other objects
  of persons exiting affected areas

15
Influenza Surveillance

• Influenza surveillance network with NAMRU-3
  (Expansion and guidelines)
• Active search surveillance for persons coming
  from affected areas
• Distribute proper information to travelers for
  self reporting
• Facilitate the installation of proper
  communication means for data reporting
• Health facilities
• Laboratories
• Build analytical capacities at national levels
  capable of producing reports quickly

16
Laboratory Skills

• Guidelines sample collection, biosafety, etc.
• Building capacities
• Consultants
• Training of national staff
• Link to reference laboratory for virus isolation
  and information-sharing
• Laboratory surveillance networking

17
Limitations

• Pandemic influenza is considered far more
  difficult to control than SARS
• Influenza A viruses are much more contagious
  than the SARS corona virus
• The incubation period is shorter and the virus
  can be spread prior to the onset of symptoms
• Fever checks and border screenings will not be
  able to detect people in the incubation period
  who have no symptoms
• While SARS remained largely confined to hospital
  settings, pandemic influenza will rapidly and
  widely spread within the community

18
Challenges

• Select the appropriate non-pharmaceutical measure
• Strengthen human and animal health surveillance
  systems
• Enhance inter-sectoral collaboration
• Improve laboratory capacities for detecting and
  isolating the virus
• Ability to produce and disseminate guidelines and
  educational material to the health professionals
  and the public
• Ability to share and update information quickly
  among all concerned parties