Pandemic Influenza and Preparedness

1
Pandemic Influenza and Preparedness

• Dr Michael Hills
• Associate Director
• Critical Response Coordination
• Health Services Functional Area Coordinator
• South Eastern Sydney and Illawarra AHS

2
Acknowledgement

• Several slides come from the UK Department of
  Healths website http//www.dh.gov.uk/ -
  Pandemic Flu

3
Outline

• Influenza
• Historical
• Management
• Health Planning
• Business Continuity

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Understanding pandemic

• Epidemic serious outbreak in a single community,
  population or region
• Pandemic epidemic spreading around the world
  affecting hundreds of thousands of people, across
  many countries

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What is a flu pandemic?

• Flu pandemics are global epidemics of a newly
  emerged strain of flu (a new influenza A subtype)
  
• Three pandemics in the last century
• Worst killed 20 - 40 million worldwide more
  lives lost than during the First World War

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What causes pandemic flu?

• Emergence of a new flu virus
• New virus passes easily from person to person
• Few, if any, people have any immunity
• This allows it to spread widely, easily and to
  cause more serious illness

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Who is at risk?

• Everyone is at risk
• Certain groups may be at greater risk of serious
  illness than others
• Until the virus starts circulating we will not
  know for sure who is at most risk

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Is there a vaccine?

• Because the virus will be new, there will be no
  vaccine ready to protect against pandemic flu
• A specific vaccine cannot be made until the virus
  has been identified
• Cannot be predicted in same way as ordinary
  seasonal flu
• Ordinary flu vaccine or past flu jab will not
  provide protection

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What is influenza?

• An acute illness resulting from infection by an
  influenza virus
• Highly infectious
• Can spread rapidly from person to person
• Some strains cause more severe illness than others

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Symptoms

• Generally of sudden onset
• Fever, headache, aching muscles, severe weakness
• Respiratory symptoms e.g. cough, sore throat,
  difficulty breathing

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Incubation period of influenza

• Estimates vary
• The range described is from 1 to 4 days
• Most incubation periods are in the range of 2-3
  days

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How influenza spreads

• Easily passed from person to person through
  coughing and sneezing
• Transmitted through
• breathing in droplets containing the virus,
  produced when infected person talks, coughs or
  sneezes
• touching an infected person or surface
  contaminated with the virus and then touching
  your own or someone elses face

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Previous pandemics 1580 - 1900 - 28 pandemics
Year Strain Name Global deaths
1918-19 H1N1 Spanish Flu 20-40 million (11,500 Aus)
1957-58 H2N2 Asian Flu 1 million
1968-69 H3N2 Hong Kong Flu 1 million
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Circulating Influenza strains and pandemics in
20th Century
1918 Spanish Flu
1957 Asian Flu
1968 Hong Kong Flu
20-40 million deaths
1 million deaths
1 million deaths
H3N2
H2N2
H1N1
H1N1
1920 1940 1960 1980 2000
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Lessons from past pandemics

• Occur unpredictably, not always in winter
• Great variations in mortality, severity of
  illness and pattern of illness or age most
  severely affected
• Rapid surge in number of cases over brief period
  of time, often measured in weeks
• Tend to occur in waves - subsequent waves may be
  more or less severe
• Key lesson - unpredictability

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Framework

• Australian Health Management Plan for Pandemic
  Influenza June 2005 May 2006
• NSW Interim Pandemic Plan Nov 2005
• Area Interim Plan March 2006
• Hospitals etc.
• New national and state plans mid-2006
• COAG
• National Action Plan for a Human Influenza
  Pandemic
• States
• Whole of Government planning

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Australian Health Management Plan for Pandemic
Influenza

• Two core strategies
• Containment
• initial priority
• Maintenance of Social Functioning
• as it progresses
• Phases
• Overseas Level 3
• Australia Level 0

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Challenges

• Health planning
• Non-health planning
• Universal impact
• Scarcity
• Unpredictable
• Unknown
• Information will change
• Volume

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Manage Workforce

• Absenteeism
• Vaccination
• Education and training
• Protection, prophylaxis
• Allocation of duties
• Re-allocation of staff to flu response
• Return to work
• Child care requirements

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Manage Workload

• Curtailing of non-priority services
• Establishment of fever clinics (if designated)
• Triaging at EDs and procedures
• Inpatient units (isolation, wards, ICU/HDU)
• Shift services to other sites
• Run new services
• Management of cases

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Wider linkages

• Emergency Accommodation
• Community links
• General practice (through Divisions)
• Home discharge
• Travellers management
• Roles of community service staff
• Support at home and in nursing homes
• Public health surveillance and reporting
• Communication and coordination across sectors
  (National, State, Area, Sector, Public,
  Individuals)

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Non-Health Sector

• COAG
• National Action Plan for a Human Influenza
  Pandemic
• States and Territories
• Businesses
• Department of Industry, Tourism and Resources
  (mid-2006)
• www.industry.gov.au/avianflubusinesscontinuity

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Business Continuity Planning

• The most important thing businesses and
  community organisations can do to prepare for a
  pandemic is have a business continuity plan in
  place. AHMPPI May 2006
• Different from other emergencies.
• emphasis on continuity in the event of high
  absenteeism and interruptions to the supply of
  goods and services
• Absenteeism could be as high as 30 to 50

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Key issues

• Identify essential business activities
  alternative arrangements
• Identify what is required for the organisation to
  continue operating at the minimum acceptable
  level
• Develop mitigation strategies for business
  disruptions and shortages
• Ensure wide awareness of contingencies
• Minimising illness in workers, drawing on the
  guidance on infection control in this plan.

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Where Next?

• Consider it as one of the sources of risk in
  organisational planning
• Use the opportunity to review critical aspects of
  services
• (Re) Learn interdependencies
• Start reading
• Be engaged

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Thank - you

• www.health.gov.au
• www.industry.gov.au/avianflubusinesscontinuity
• www.fluready.net
• http//www.dh.gov.uk