Emergency Preparedness for School to Manage Large Outbreak of Influenza ?????????????????

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Emergency Preparedness for School to Manage Large
Outbreak of Influenza?????????????????
December 2005

• Centre for Health Education and
• Health Promotion, CUHK

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(No Transcript)
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Current WHO phase of pandemic alert
Inter-pandemic phase New virus in animals, no human cases Low risk of human cases 1
Inter-pandemic phase New virus in animals, no human cases Higher risk of human cases 2
Pandemic alert New virus causes human cases No or very limited human-to-human transmission 3
Pandemic alert New virus causes human cases Evidence of increased human-to-human transmission 4
Pandemic alert New virus causes human cases Evidence of significant human-to-human transmission 5
Pandemic Evidence of sustained human-to-human transmission 6
Source WHO
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Will pandemic of influenza occur????????????

• If one has a crystal ball to view the future,
  this question would be answered.
• ????????,????????!

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We would make some prediction based on the
epidemiological triangle recognizing the three
main factors-agent, environment and host in the
pathogenesis of disease. ?????????????????-???????
??,????/????????? If we can control any
two of the main factors, one would prevent the
occurrence of a communicable diseases.
???????????????,?????????????
??
HOST
Vector
??
??
???
AGENT
ENVIRONMENT
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For an influenza pandemic to occur, there should
be three pre-requisites ????????????

• Novel influenza virus subtype emerge for an old
  subtype re-emerges to which there is no herb
  immunity???????????????????, ?????????????,
  ?????????
• The new virus must be able to replicate in humans
  and cause serious illness and ??????????????????
  ?? ??
• The new virus must be able to transmit from human
  to human.????????????????????

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• Three pandemics occurred in last century
• ????????????
• 1918/19 (Spanish Flu) causing death of 20 to 40
  million people worldwide (??????)????????? 20 ?
  40 ?
• 1957/58 (Asian Flu)(?????)
• 1968/69 (Hong Kong Flu)(?????)

At present, there is no place with
influenza pandemic yet. ?????????????
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What is avian influenza????????

• Avian influenza, or bird flu, is a contagious
  disease of animals caused by viruses that
  normally infect only birds and, less commonly,
  pigs.
• ??????????,???????,???????????
• Avian influenza viruses are highly
  species-specific, but have, on rare occasions,
  crossed the species barrier to infect humans.
• ????????????????????,????????????????

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What is avian influenza????????

• In domestic poultry, infection with avian
  influenza viruses causes two main forms of
  disease, distinguished by low and high extremes
  of virulence.????????,???????????????????
• Low pathogenic form commonly causes only mild
  symptoms.????????????????
• The highly pathogenic form spreads very rapidly
  through poultry flocks, causes disease affecting
  multiple internal organs, and has a mortality
  that can approach 100, often within 48 hours.
  ?????????????,? 48 ?????? 100?????

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• Influenza A viruses1 have 16 H subtypes and 9 N
  subtypes2. Only viruses of the H5 and H7 subtypes
  are known to cause the highly pathogenic form of
  the disease. However, not all subtypes will cause
  severe disease in poultry.??????? 16? H ??? 9 ?
  N ??????????????????????,?? H5 ? H7 ??????????
• H5 and H7 viruses are introduced to poultry
  flocks in their low pathogenic form. When allowed
  to circulate in poultry populations, the viruses
  can mutate, usually within a few months, into the
  highly pathogenic form. H5 ? H7??????????????,???
  ?????????????????
• 1 Influenza viruses are grouped into 3 types, A,
  B, and C. A and B viruses are of concern for
  human health. Only A viruses can cause pandemics.
• ???????????????????????????????????????
• 2 H subtypes are epidemiologically most
  important, as they govern the ability of the
  virus to bind to and enter cells, and
  multiplication of the virus then occurs. N
  subtypes govern the release of newly formed virus
  from the cells
• ???????,H ?????? H ??????????,??????N?????????????
  ????

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Common types of Flu
??? A/Beijing/262/95 (H1N1) ??? A/Fujian/411/2002
(H3N2) ???? A/Moscow/10/99 (H3N2)
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Do migratory birds spread highly pathogenic avian
influenza viruses? ??????????

• Considerable circumstantial evidence suggests
  that migratory birds can introduce low pathogenic
  H5 and H7 viruses to poultry flocks, which then
  mutate to the highly pathogenic form.
• ???????????? H5 ? H7 ??????,???????????????
• Recent events make it likely that some migratory
  birds are now directly spreading the H5N1 virus
  in its highly pathogenic form. Further spread to
  new areas is expected.
• ????????,?????????? H5N1 ????????????????

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What is special about the current outbreaks in
poultry? ?????????????

• The current outbreaks of highly pathogenic avian
  influenza, which began in SE Asia in mid-2003,
  are the largest and most severe on record. Never
  before in the history of this disease have so
  many countries been simultaneously
  affected.????????????,?2003 ????????,????????????
  ???????????????????????????????
• Despite the death or destruction of an estimated
  150 million birds, the virus is now considered
  endemic in many parts of Indonesia and Viet Nam
  and in some parts of Cambodia, China, Thailand,
  and possibly also the Lao Peoples Democratic
  Republic. Control of the disease in poultry is
  expected to take several years. ????? 1 ? 5
  ????????,???????????,????????????????????,????????
  ???

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What are the implications for human
health? ?????????????

• The widespread persistence of H5N1 in poultry
  populations poses two main risks for human
  health.H5N1??????????????????????
• The first is the risk of direct infection when
  the virus passes from poultry to humans,
  resulting in very severe disease.
  ??,???????????????????
• Unlike normal seasonal influenza, where infection
  causes only mild respiratory symptoms in most
  people, H5N1 infection follows an unusually
  aggressive clinical course, with rapid
  deterioration and high fatality.???????,H5N1
  ???????????????,???????????,????????

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What are the implications for human
health? ?????????????

• Primary viral pneumonia and multi-organ failure
  are common. In the present outbreak, more than
  half of those infected with the virus have died.
  ????????????????????????????????,??????????????
• Most cases have occurred in previously healthy
  children and young adults.?????????????????????
• A second risk, of even greater concern, is that
  the virus if given enough opportunities will
  change into a form that is highly infectious for
  humans and spreads easily from person to person.
  Such a change could mark the start of a global
  outbreak (a pandemic).??,????????????--??????????
  ?????????????????????????????

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How do people become infected? ????????

• Main route of human infection- direct contact
  with infected poultry, or surfaces and objects
  contaminated by their faeces.????????????????????
  ??????????
• Most human cases have occurred in rural or
  periurban areas where many households keep small
  poultry flocks, roaming freely, sometimes
  entering homes or sharing outdoor areas where
  children play.???????????????????????,?????????,
  ?????????????????????

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How do people become infected? ????????

• As infected birds shed large quantities of virus
  in their faeces, opportunities for exposure to
  infected droppings or to environments
  contaminated by the virus are abundant under such
  conditions. ?????????????????,?????????????
• Exposure is considered most likelyduring
  slaughter, defeathering, butchering, and
  preparation of poultry for cooking. ????????????

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Is it safe to eat poultry and poultry
products? ?????????????

• Yes, though certain precautions should be
  followed in countries currently experiencing
  outbreaks. In areas free of the disease, poultry
  and poultry products can be prepared and consumed
  as with no fear of acquiring infection.
• ?????????,?????????????,?????????????????????????
  ??,?????????????,?????????????

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Is it safe to eat poultry and poultry
products? ?????????????

• In areas experiencing outbreaks, poultry and
  poultry products can also be safely consumed
  provided these items are properly cooked and
  properly handled during food preparation.
  ?????????,???????????????,???????,??????????????
• The H5N1 virus is sensitive to heat. Normal
  temperatures for cooking (70oC in all parts of
  the food) will kill the virus. ???????H5N1????????
  ???????(????????70?)?

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Is it safe to eat poultry and poultry
products? ?????????????

• Consumers need to be sure that all parts of the
  poultry are fully cooked (no pink parts) and
  that eggs, too, are properly cooked (no runny
  yolks).

????????????????(??????????)??????????????(??????
????????)?
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Is it safe to eat poultry and poultry
products? ?????????????

• One should be aware of the risk of
  cross-contamination. Juices from raw poultry and
  poultry products should never be
  allowed, during food
  preparation, to touch or mix with items
  eaten raw.

????????????????????,???????????????????,?????????
??????????????????????
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Is it safe to eat poultry and poultry
products? ?????????????

• When handling raw poultry or raw poultry
  products, persons involved should wash their
  hands thoroughly and clean and disinfect surfaces
  in contact with the poultry products. Soap and
  hot water are sufficient for this purpose.
• ????????????????,???????,????????????????????????
  ???????

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Is it safe to eat poultry and poultry
products? ?????????????

• Avian influenza is not transmitted through cooked
  food. To date, no evidence indicates that anyone
  has become infected following the consumption of
  properly cooked poultry or poultry products, even
  when these foods were contaminated with the H5N1
  virus.
• ??????????????????????,?????????????,???H5N1????,
  ???????,?????????????????

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Does the virus spread easily from birds to
humans? ??????????????????

• NO. Though more than 100 human cases have
  occurred in the current outbreak, this is a small
  number compared with the huge
  number of birds affected and the numerous
  associated opportunities for
  human exposure, especially in areas where
  backyard flocks are common.

???????????,???100????????????????????????????????
???,??????????????????,???????????
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Does the virus spread easily from birds to
humans? ??????????????????

• It is not presently understood why some
  people, and not others, become infected
  following similar exposures.
  How do people become infected?
• ???????????????????????????????????????

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How serious is the current pandemic
risk? ????????????????

• The risk is serious. With the H5N1 virus now
  firmly entrenched in large parts of Asia, the
  risk that more human cases will occur will
  persist. ?????H5N1?????????????,?????????????
• Each additional human case gives the virus an
  opportunity to improve its transmissibility in
  humans, and thus develop into a pandemic
  strain.????????????,???????????????,?????????????
  ?????

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How serious is the current pandemic
risk? ????????????

• The recent spread of the virus to poultry and
  wild birds in new areas further broadens
  opportunities for human cases to occur. While
  neither the timing nor the severity of the next
  pandemic can be predicted, the probability that a
  pandemic, will occur has increased.
• ??,??????????,???????????,???????????????????????
  ????????????,???????????????????

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What are the most important warning signals that
a pandemic is about to start? ?????????????????

• When clusters of patients with clinical symptoms
  of influenza, closely related in time and place,
  are detected, this suggests human-to-human
  transmission is taking place.
• ???????????????????,??????????????
• For similar reasons, the detection of cases in
  health workers caring for H5N1 patients would
  suggest human-to-human transmission.
  ?????????????H5N1??????????,???????????????

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What are the most important warning signals that
a pandemic is about to start? ?????????????????

• Detection of such events should be followed by
  immediate field investigation of every possible
  case to confirm the diagnosis, identify the
  source, and determine whether human-to-human
  transmission is occurring.
• ????????,?????????????????,??????,??????????????

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What is the status of vaccine development and
production? ????????????????

• Vaccines are produced each year for seasonal
  influenza but will not protect against pandemic
  influenza. ??????????????,????????????
• Because the vaccine needs to closely match
  the pandemic virus, large-scale
  commercial production will not
  start until the new virus has emerged and
  a pandemic has been declared. ??????????
  ???????,??,?????? ?????????????????

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What drugs are available for treatment?????????

• Two drugs (in the neuraminidase inhibitors
  class), oseltamivir (commercially known as
  Tamiflu) and zanamivir (commercially known as
  Relenza) can reduce the severity and duration of
  illness caused by seasonal influenza.?????????????
  ????????/Relenza ??????????????????
• The efficacy of the neuraminidase inhibitors
  depends on their administration within 48 hours
  after symptom onset.????????48?????????????????

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What drugs are available for treatment?????????

• For cases of human infection with H5N1, the drugs
  may improve prospects of survival, if
  administered early, but clinical data are
  limited.
• ?????H5N1????,??????????,?????????????,??????????
  ?????
• The H5N1 virus is expected to be susceptible to
  the neuraminidase inhibitors.
• ??????????????H5N1???

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What drugs are available for treatment?????????

• An older class of antiviral drugs, the M2
  inhibitors amantadine and rimantadine, could
  potentially be used against pandemic influenza,
  but resistance to these drugs can develop
  rapidly.
• ???????? M2???,??????rimantadine,????????????,???
  ????????????

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• Although Avian Flu has similar symptoms as
  seasonable influenza, Avian Flu is unlikely if
  one has not contacted infected poultry and/or
  birds.
• ??????????????????,??????,????????????

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If any students or staff has been to high risk
area and/or in contact with poultry or birds, and
develop flu like illness, they must consult
doctors immediately. They must give an accurate
account of history of traveling and history of
contact. ???????????????????,???????,?????????????
?????????????????
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• To prepare well to safeguard health of the
  community, the Government aims
• ???????,????
• Reduce risk of human infections ????????
• Early detection of influenza pandemic, and
• ?????????????
• Enhance emergency
  preparedness and response for influenza
  pandemic
• ????????

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Basic measures for keeping school premises
hygienic and healthy to prevent pandemic
influenza?????????????????????
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• For parents/students/staff??/??/???
• Parents should check the temperature of their
  children daily before school with proper
  recording duly signed by parent??????????????????
  ,????????
• Stay at home and consult doctor with fever or
  feeling unwell.?????????,???????????
• School staff and students should wear face masks
  when they have respiratory tract inflection
  symptoms????????????????,???????

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• Students should wash hands before meals and after
  sneezing, coughing or cleaning the nose. They
  should not share towels or utensils.?????????????
  ?????????????????
• Consult doctor promptly in case of fever and/or
  respiratory symptoms.????????????,???????
• School bus drivers and the assistants should not
  drive/get on the bus if they have fever. They
  should wear mask if they have respiratory tract
  infection.??????????????,???????????????????,????
  ????

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• Schools should????
• Clean and disinfect school premises and
  facilities at least daily with diluted household
  bleach with disinfectant mats at school
  entrance.????????????????????????,?????????????
• Provide adequate facilities and cleaning
  material for hand-washing.?????????????
• Maintain good indoor ventilation and wash dust
  filters of air conditioners frequently.????????,?
  ???????????

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• Flexible break time and lunch time to avoid over
  crowding?????????????????
• Notify the Department of Health and EMB of
  unusual symptoms of infection are noted or large
  number of students on sick leave.????????????????
  ???,????????????
• Encourage students/staff to increase body
  immunity by eating a balanced diet, taking
  regular exercise, adequate rest??????????????????
  ????????????????

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• Strongly advise students and staff not to attend
  schools when they have fever.???????????????????
• Advice them to consult doctors.????????????
• Provide adequate and proper face masks, gloves
  and other appropriate protective
  equipment.????????????????
• Develop contingency plan.?????????

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All organisation should have its own practical
contingency plan.????????????????????
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• Points for consideration in planning-???????????
  
• Identify personnel for designated jobs, i.e.,
  infection control, liaison persons
  etc.?????????,?????????????
• Split into smaller working groups using different
  access points and reduce number of meetings with
  greater use of telephone conference.?????????????
  ?????,?????????????????

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• Stock pile personal protective equipment (PPE)
  such as masks, disinfectants.?????????????,??????
  ??
• To provide training and briefing for staff on
  general measures and also specific measures such
  as use of PPE.?????????????????(???????)???????
• Test and review contingency.???????????????
• Designate deputies of management if become
  ill.???????,???????????
• Specify responsibilities of key individual
  team.??????????????
• Establish inflection control procedures.

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• SARS prevention also applicable. Take reference
  from EMB handbook www.emb.gov.hk
  ???????????????????????????????? www.emb.gov.hk
• Spandemic preparedness can be accessed at the
  Centre for Health Protection website via the
  Influenza Page.
• English version
• http//www.chp.gov.hk/view_content.asp?langeninf
  o_id590
• Chinese version
• http//www.chp.gov.hk/view_content.asp?langtcinf
  o_id590
• School against SARS ???????http//www.hkedcity.ne
  t/project/cuhk_sars/index_e.phtml Hygiene Charter
  ???? http//www.hygienecharter.org.hk/eng/index.ph
  p

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Hygiene Charter????

• http//www.hygienecharter.org.hk/eng/index.php

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Hygiene Charter ????
As a continuing effort in the fight against SARS,
Operation UNITE (community initiated movement
comprising community leaders from all sectors to
help the community in fighting against SARS) has
conceived a Hygiene Charter with the academic and
professional advice by the Chinese University of
Hong Kong, which aims at encouraging individuals,
as well as business and industry sectors, to
pledge their commitment to improve hygiene
practices for the good of all. ??????????? -
?????????????????????????????????????????????????,
?????????,????????,?????????????????????,?????????
????,??????????????
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Schools Against SARS campaign???????????
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Schools Against SARS Campaign ???????????

• http//www.hkedcity.net/project/cuhk_sars/index_e.
  phtml

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One School One Doctor Healthy School Life II -
Learning Together with your Doctors(Chinese
Version Only)????????????(?)-???????(???????)

• http//www.cuhk.edu.hk/med/hep/crisis_management/S
  ARS/movie/movie.html

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Facilities of Medical Rooms at school ???????
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Contingency Plan for managing suspected /
confirmed cases of Flu or Avian Flu in
Schools?????? / ???????????
??? http//www.cuhk.edu.hk/med/hep/crisis_managem
ent/avianflu/chi_141005.pdf English
Version http//www.cuhk.edu.hk/med/hep/crisis_man
agement/avianflu/eng_101105.pdf
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Contingency Plan for managing suspected /
confirmed cases of Flu or Avain Flu in Schools
Student/staff Suspected to be infected
Discover Dead poultry/bird
EMB Education and Manpower Bureau DH
Department of Health AFCD Agricultural,
Fisheries and Conservation Department
Inform AFCD Hotline 1823
Isolate, inform parents/relatives, consult
doctor for advice
Action by school
Confirmed Avian Flu
Diagnosed Flu / common cold
Actions by AFCD
Number of infected persons. increases
No new incident reported
Follow Doctors advice
Routine precaution
Activate Contingency group
Special classroom arrangements
1.School Environment
2. Hygiene education
3. School policy
1. Notify EMB DH
5. School-based surveillance
2. Act according to Notify DH and act accordingly
???????? advice from DH EMB
Review hygienic status
3. school-parent communication
6. Student / Staff support
Parents
Staffs
Students
Cleaning Disinfection
7. Reinforce hygiene education Flu/ Avian Flu
alertness
4. Environment
Regular cleaning of Ventilation systems
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No one can be responsible for your own health
except you. Crisis can be turned into
opportunities with better management