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PANDEMIC INFLUENZA PREPAREDNESS AND RESPONSE

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Title: PANDEMIC INFLUENZA PREPAREDNESS AND RESPONSE


1
PANDEMIC INFLUENZA PREPAREDNESS AND RESPONSE
  • Atika BERRY, MD, MpH
  • Communicable Diseases Dpt, MOH
  • 02 May 2009

2
Introduction
  • The development of an Influenza
    pandemic can be considered as the result of the
    transformation of an animal influenza virus into
    a human influenza virus. At the genetic level,
    pandemic influenza viruses may arise through
  • Genetic reassortment genes mix between animal
    and human influenza viruses
  • Genetic mutation genes change in an animal
    influenza virus

3
Circulating Influenza Strains and Pandemics in
The 20th Century
1968 Hong Kong Flu
1918 Spanish Flu
1957 Asian Flu
20-40 million deaths
1-4 million deaths
1-4 million deaths
H3N2
H2N2
H1N1
1920 1940 1960 1980 2000
4
Characteristics of The Three Pandemics of The
20th Century ()
() Adapted from European Centre for Disease
Prevention and Control, Pandemics of the 20th
century, October 2008
5
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7
The Virus
8
What can be happening now?
Human Influenza Virus
Swine Flu Virus
Pig to pig transmission pig to human
transmission
Human to human transmission ( Human to pig
transmission?)
?
9
Viral Reassortment
Reassortment in humans
Reassortment in pigs
Pandemic Influenza Virus
10
Cumulative Number of Confirmed Swine-Origin Flu
Cases in The World
As of 0600 GMT, 1 May 2009, 11 countries have
officially reported 331 cases of influenza
A(H1N1) infection. (Ref www.WHO.int)
11
WHO Pandemic Phases
12
WHO classification of pandemic phases
  • Pandemic alert period
  • -Phase 3. Human infections with a new subtype,
    but no or very limited human-to-human spread.
  • Phase 3acases outside Lebanon
  • Phase 3b cases including Lebanon
  • -Phase 4. Small cluster(s) with limited
    human-to-human transmission but spread is highly
    localized.
  • Phase 4a cases outside Lebanon
  • Phase 4b cases including Lebanon
  • -Phase 5 Larger cluster(s) of human-to-human
    transmission
  • Phase 5a cases outside Lebanon
  • Phase 5b cases including Lebanon
  • Pandemic period
  • -Phase 6. Pandemic increased and sustained
    transmission in general population.

13
Roles and Responsibilities in Preparedness and
Response
  • A- National preparedness and response as a
    whole-of-society responsibility
  • Government Leadership
  • Health sector (public, private, NGOs)
  • Non-health sectors (electrical, water, business)
  • Communities, individuals, and families
  • B- Coordination under IHR (2005)

14
5-6 Pandemic Phases
  • Phase 5 human to human spread of the virus into
    at least two countries in one WHO region. It is a
    strong signal that a pandemic is imminent and
    that the time to finalize the organization,
    communication, and implementation of the planned
    mitigation measures is short.
  • During Phase 5-6, actions shift from preparedness
    to response. The goal of recommended actions is
    to reduce the impact of the pandemic on society

15
Preparedness Components Actions During Phases
5-6
16
National Actions During Phases 5-6Planning and
Coordination
  • Activation of the Government Leadership
    (Multisectorial resources coordination) in order
    to
  • - Finalize preparations for an imminent
    pandemic (activation of crisis committees, and
    national command and control systems
  • - Update national guidance and
    recommendations (according to WHO
    recommendations and taking into account
    information from affected countries)
  • Transparency
  • Continuous collaboration with WHO

17
National Actions During Phases 5-6Situation
Monitoring and Assessment(1)
  • Pandemic Disease Surveillance
  • Enhance surveillance, increase preparedness
  • - Elaborate a national case definition,
  • - Designate a RRT at the Mohafaza level,
  • - Detailed epidemiological investigation of
    the case
  • - Undertake a comprehensive assessment of
    the earliest
  • cases of pandemic influenza,
  • - Contact tracing for the two weeks prior
    to onset of
  • symptoms,
  • - Follow-up contacts for fever and cough
    for one week,
  • - Active case search to find any additional
    cases)
  • Document the evolving pandemic (geographical
    spread, trends and impact)
  • Document any changes in epidemiological
    clinical features of the pandemic virus
  • Provide the appropriate laboratory kit (RHUH)
  • Take appropriate laboratory specimens and share
    the specimen with WHO reference laboratories
  • Report probable, suspected and confirmed cases to
    the WHO.

18
National Actions During Phases 5-6Situation
Monitoring and Assessment(2)
  • Monitoring and Assessment of the Impact of
    the Pandemic
  • Monitor essential health related ressources
    (medical supplies antivirals, vaccines and other
    pharmaceuticals, health care worker availability,
    hospital occupancy/availability use of
    alternative health facilities, lab materials
    stocks and mortuary capacity)
  • Monitor and assess national impact (workplace and
    school absenteeism, regions affected)
  • Assess the uptake impact of implemented
    mitigated measures
  • Forecast economic impact of the pandemic, if
    possible

19
Big droplets fall on people surfaces bed clothes
Courtesy of CDC
20
National Actions During Phases 5-6Reducing the
Spread of the Disease (1)
  • Phase 5a
  • Be prepared to implement planned interventions to
    reduce the spread of pandemic disease
  • Update recommendations on the use of planned
    interventions based on experience and information
    from affected countries
  • Implement distribution and deployment plans for
    pharmaceuticals, and other resources as required
  • Consider implementing entry screening at
    international borders

21
National Actions During Phases 5-6Reducing the
Spread of the Disease (2)
  • Phase 5b
  • A- Individual/household level measures
  • Advice people with ARI to stay at home minimize
    their contact with household members others
  • Advice household contacts to minimize their level
    of interaction outside home to isolate
    themselves at the first sign of any symptoms of
    influenza
  • Provide infection control guidance for household
    caregivers according to WHO guidance
  • B- Social level Measures
  • Implement social distancing measures
  • Encourage reduction of travel and crowding of the
    mass transport system
  • Assess and determine if cancelation, restriction,
    or modification of mass gathering is indicated

22
National Actions During Phases 5-6Reducing the
Spread of the Disease (3)
  • Phase 5b (contd)
  • C- International travel measures
  • Consider implementing exit screening as part of
    the early global response
  • Provide advice to travelers
  • D- Pharmaceuticals measures
  • Distribute antivirals, and other medical supplies
    in accordance with national plans
  • Implement vaccine procurement plans
  • Plan for vaccine distribution accelerate
    preparation for mass vaccination campaigns
  • Modify/adapt antiviral vaccine strategies based
    on monitoring surveillance information
  • Implement medical prophylaxis campaigns for
    antivirals /or vaccines according to priority
    status availability in accordance with national
    plans
  • Monitor safety and efficacy of pharmaceutical
    interventions to the extent possible monitor
    supply

23
National Actions During Phases 5-6Continuity of
Health Care Provision (1)
  • Phase 5a
  • Prepare to switch to pandemic working
    arrangements
  • Ministry of public health and health care
    institutions should plan ahead for the surge
    activities in this period
  • Implement pandemic vaccine procurement plans.
  • Prioritization of antiviral use based on
    availability and effectiveness.

24
National Actions During Phases 5-6Continuity of
Health Care Provision (2)
  • Phase 5b
  • Implement pandemic contingency plans for full
    mobilization of health systems, facilities,
    workers at national sub-national levels
  • Implement adjust the triage system as necessary
  • Enhance infection control practices in healthcare
    laboratory settings distribute PPE in
    accordance with national plan
  • Provide medical non-medical support for
    patients their contacts in households
    alternative facilities if needed
  • Provide social psychological support for health
    care workers, patients communities
  • Implement corpse management procedures as
    necessary
  • Containment measures at this point are not
    effective.

25
Isolation Precautions
26
Droplet precautions Surgical Masks
27
N-95 Filtering Masks
28
Personal Protective Equipment (PPE)
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National Actions During Phases 5-6Communications
  • Regularly update the public on what is known
    unknown about the pandemic disease, including
    transmission patterns, clinical severity,
    treatment prophylaxis options
  • Provide regular communications to address
    societal concerns, such as the disruption to
    travel, border closures, schools, or the economy
    or society in general
  • Regularly update the public on sources of
    emergency medical care, resources for dealing
    with urgent non-pandemic health care needs,
    resources for self-care of medical conditions
  • Provision of written information to all related
    sectors
  • Communicate transparently and with a consistent
    message with the public and local health care
    providers.
  • Consider declaring state of emergencies in the
    affected areas. 

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Antivirals- Oseltamivir
  • Treatment is 75 mg twice a day for 5 days.
  • Prophylaxis is 75 mg once a day for 7 days after
    last exposure.
  • Prophylaxis
  • High risk exposure (household contacts)
  • Moderate risk (unprotected very close exposure to
    sick animals HCW with unprotected exposure to
    patients)
  • Low risk exposure no need for prophylaxis unless
    activation of exceptional measures.

34
Importance of the Early Treatment
35
Pandemic Waves (1918-1919)
36
The Post-Peak Period (1)
  • A- Planning coordination
  • Determine the need for additional resources
    capacities during possible future pandemic waves
  • Begin rebuilding essential services
  • Address psychological impacts of the pandemic,
    especially on the health workforce
  • Consider offering assistance to countries with
    ongoing pandemic activity
  • Review the status replenish national, local and
    household stockpiles supplies
  • Review revise national plans
  • B- Situation monitoring assessment
  • Activate the surveillance activities required to
    detect subsequent pandemic waves
  • Evaluate the resources needed to monitor the
    subsequent waves

37
The Post-Peak Period (2)
  • C- Reducing the spread of the disease
  • Evaluate the effectiveness of the measures used
    update guidelines, protocols, algorithms
    accordingly
  • Continue with vaccination programmes in
    accordance with national plans, priorities, and
    vaccine availability
  • D- Continuity of health care provision
  • Ensure that health care personnel have the
    opportunity for rest recuperation
  • Restock medications supplies service renew
    essential equipment
  • Review and, if necessary, revise pandemic
    preparedness response plans in anticipation of
    possible future pandemic waves
  • Revise case definitions, treatment protocols,
    algorithms as required

38
The Post-Peak Period (3)
  • E- Communications
  • Regularly update the public other stakeholders
    on any changes to the status of the pandemic
  • Communicate to the public on the ongoing need for
    vigilance disease-prevention efforts to prevent
    any upswing in disease levels
  • Continue to update the health sector on new
    information or other changes that affect disease
    status, signs symptoms, or case definitions,
    protocols algorithms

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  • Thank you
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