Mitigating the Impact of Pandemic H1N1: Options for Public Health Measures

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Mitigating the Impact of Pandemic (H1N1)Options
for Public Health Measures
Dr Li Ailan Communicable Disease Surveillance
Response (CSR) WHO Western Pacific Regional
Office (WPRO)
3rd Meeting of the National Influenza Centres in
the Western Pacific and South-East Asia Regions
18-20 August 2009, Beijing, China
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Outline

• What options are available for public health
  interventions?
• What have countries prepared for
  non-pharmaceutical interventions?
• What actual public health measures have been
  applied or being implemented in response to
  pandemic (H1N1) 2009?
• Conclusion

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Primary Strategies for Combating Influenza

• Pharmaceutical interventions
• Use of matched vaccines
• Use of effective antiviral drugs
• Non-pharmaceutical interventions
• Individual and household level public health
  measures
• Societal level public health measures, including
  social distancing

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Goals of Public Health Intervention

• Delay outbreak peak
• Delay spread and shift an epidemic curve to the
  right side
• to reduce peak burden on health care facilities
  (e.g. hospitals)
• to buy time for other measures (e.g.
  vaccination)
• Reduce morbidity and mortality through reducing
  the total number of cases

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Public Health Measures Available (theoretically)
at national and community level

• 1. Individual/household measures
• Personal protective measures
• Isolation quarantine
• Infection prevention and control in the home
  setting
• Use of masks in the community setting
• 2. Societal measures, including social distancing
• Suspension of classes and child care programmes
• Adjusting or changing work patterns
• Restriction of public or mass gatherings
• Domestic travel advisories and restrictions

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Public Health Measures Available (theoretically)
at the international border

• 1. International travel and screening
• Health advice and alerts to travellers
• Health declaration form
• Temperature screening
• On-board identification of suspected travellers
• International travel advisory, restriction,
  border closure?
• 2. Management of symptomatic exposed travellers
• Symptomatic travellers (isolation treatment)
• Exposed travellers (quarantine)

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Key considerations

• Decision on public health measures based on risk
  assessment, especially severity and potential
  impact
• Public health measures should be evidence-based
  whenever possible
• Countries should balance the benefits against the
  costs and potential consequences
• Need to be tailored to suit country or local
  context
• Planning, coordination and communication is
  essential

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Comparative risk of outbreaks

H5N1
SARS
1918 Pandemic
Pandemic (H1N1) 2009?
Seasonal Flu
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Possible strategies based on risk category

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Matching cost and consequences of interventions
with risk level
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Options for interventions Decision Matrix
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Pandemic Preparedness Assessment 2009

• Annual assessment of pandemic preparedness was
  conducted in May-June, using the WHO WPRO and CDC
  Joint Assessment Tool
• A supplementary questionnaire on public health
  measures was added in this readiness survey
• Is this public health measure included in your
  national response plan?
• Did you apply or consider applying this measure?
• What is your trigger to start and stop the public
  health intervention?
• The questionnaire was distributed to collect data
  from 17 countries and areas, 15 (88) responded
  to the survey

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Pandemic Preparedness Assessment 2009 Public
Health Measures at International Borders
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Pandemic Preparedness Assessment 2009
Individual/Household level Measures
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Pandemic Preparedness Assessment 2009 Societal
level Measures
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Responding to Pandemic (H1N1) 2009

• Based on risk assessment, most countries with
  community transmission have shifted from
  containment efforts to mitigation strategies
• Robust risk assessment help ensure appropriate
  public health measures are planned and
  implemented.
• Public health interventions have been dynamic in
  the region with most countries and areas
  implemented
• relatively aggressive border measures including
  passengers screening
• personal hygiene behaviour interventions
• school closures at the early stage of outbreaks

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Example School closure

• At the early stage of Pandemic (H1N1) 2009, the
  large proportion of school children and young
  adults affected
• School closure measure has been most frequently
  used as compared with other social level measures
  
• Many countries used school closure measures in
  the Asia Pacific Region, including Australia,
  China, Japan, Malaysia, New Zealand, the
  Philippines, Singapore and Thailand
• Types of measures varied from real school
  closure or class dismissal, from proactive or
  reactive approach
• Length of closure varied mostly 7-14 days

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School closure in Japan (May 2009)
17 May Schools closed, in Osaka
17 May Schools closed Hyogo Prefecture
Source NIID, Japan
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School closure in Japan (June 2009)
Schools and Kindergartens in Fukuoka were closed
on 7 June
Source NIID, Japan
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Conclusion

• The potential benefits of public health measures
  should be carefully balanced against their
  potentially significant social and economic costs
• Decision based on assessed situation and local
  context. No standard, single combination of
  measures will fit all countries one size will
  not fit all
• Available information indicated some public
  health measures have helped slow down the spread
  of the virus
• Need for continuing planning, monitoring and
  evidence

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Interim guidance available

• Mitigating the impact of pandemic (H1N1) 2009
  Options for public health measures
• Responding to pandemic (H1N1) 2009 Options for
  interventions at international points of entry
• http//www.wpro.who.int/health_topics/h1n1/tech/t
  ech_guidance.htm

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Acknowledgement

• Dr Takeshi Kasai, Regional Advisor, CSR/WPRO
• Dr Nobuhiko Okabe, NIID, Japan
• Ms Qiu Yi Khut, CSR/WPRO
• Ms Katie Harrigan, CSR/WPRO