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Health System Response to Pandemic Influenza: A Clinician's Perspective

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The views expressed in this presentation are those of the author ... Swine Flu experience. Myopericarditis with Smallpox Vaccine. Questions? Phase 1 Objectives ... – PowerPoint PPT presentation

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Title: Health System Response to Pandemic Influenza: A Clinician's Perspective


1
Health System Response to Pandemic Influenza A
Clinician's Perspective
  • Mary M. Klote, MD
  • Walter Reed Army Medical Center

2
Disclosures
  • Financial None
  • The views expressed in this presentation are
    those of the author and do not reflect the
    official policy of the Department of the Army,
    Department of Defense, or US Government.

3
WHO 2005 Plan
  • Revised from 1999
  • Redefined the phases to more clearly aid in
    coordination of containment of the disease
  • Potentially allow for increased lead time for
    vaccine development

WHO/CDS/CSR/GIP/2005.5
4
WHO Phases
  • Interpandemic Period
  • Phase 1 - Animal infection - low risk to humans
  • Phase 2 - Animal infection - risk to humans
  • --------------------------------------------------
    ------
  • Pandemic Alert Period
  • Phase 3 - Close contact human transmission
  • Phase 4 - Increased transmission
  • Phase 5 - Virus adapting and spreading
  • --------------------------------------------------
    ------
  • Pandemic Period
  • Phase 6 - Generalized transmission

5
Phase Subcategories
  • Planning and Coordination (PC)
  • Situation Monitoring and Assessment (MA)
  • Prevention and Containment (PreCon)
  • Health System Response (HSR)

WHO/CDS/CSR/GIP/2005.5
6
Phase 1 WHO Goal
  • To promote contingency planning by health-care
    systems for response to an influenza pandemic.

WHO/CDS/CSR/GIP/2005.5
7
Who to Vaccinate
  • Tiered vaccine structure?
  • 1st responders
  • Their families?
  • Healthcare workers
  • Other Hospital/clinic employees
  • City/County Service Workers
  • Waste removal
  • Electrical
  • Water

8
Contingencies to Consider
  • Delivery of Quality Immunizations
  • Immunization techniques
  • Record keeping
  • Adverse event tracking
  • Legal Regulations

MMWR Mar 2000 Report of NVAC
9
Contingencies to Consider
  • Delivery Teams
  • Right combination of skills
  • Administrative
  • Technical
  • Right place
  • Right time
  • Right equipment

10
Contingencies to Consider
  • Method of Delivery
  • Push Out
  • Send teams to communities
  • Security
  • Vaccine storage
  • Pull In
  • Centralized locations
  • Security
  • Staffing
  • Transport of vaccinees

11
Contingencies to Consider
  • Hospital Manning
  • Who will come to work?
  • How much of your staff works at another hospital
    part-time?
  • Will you allow anyone to go home?
  • Where will you house them?
  • How will you feed them?

12
Contingencies to Consider
  • Surge capacity
  • How many patients can your hospital hold?
  • How many ventilators?
  • Are you prepared for family members to bag
    patients?
  • How many in your morgue?
  • Scrubs?
  • Linen?
  • Cleaning supplies?
  • Regulated Medical Waste Bags?
  • Sharps containers?

13
Contingencies to Consider
  • Security
  • Access to Hospital
  • Staff
  • Patients
  • Visitors
  • Quarantine Wards
  • Triage outside of hospital

14
Managing the Unexpected
  • Adverse Events
  • Swine Flu experience
  • Myopericarditis with Smallpox Vaccine

15
Questions?
16
Phase 1 Objectives
  • WHO
  • To develop strategies and procedures to
    coordinate the rapid mobilization and deployment
    of global resources to foci of infection during a
    pandemic alert period (PC).
  • Promote increased use of seasonal vaccine
    (PreCon)
  • Resolve impediments to vaccine development,
    production and access (PreCon)
  • National
  • To develop effective mechanisms for mobilization
    and rapid deployment of resources to areas of
    need (PC).
  • Share specimens for virus characterization and
    vaccine development (PreCon)
  • Increase availability of vaccine (PreCon)
  • Develop criteria for use of seasonal and pandemic
    vaccine (PreCon)
  • Anticipate need for pandemic vaccine development
    (PreCon)

17
Phase 2 Objectives
  • WHO
  • To consider the development of a human vaccine
    against the new strain.(PreCon)
  • National

18
Phase 3 Objectives
  • WHO
  • To enhance development or adjustment of
    diagnostic reagents and vaccines. (MA)
  • To facilitate planning for pandemic vaccine
    development. (PreCon)
  • National
  • To increase readiness for possible pandemic
    vaccine development. (PreCon)

19
Phase 4 Overarching Goal
  • Vaccine Development

20
Phase 4 Objectives
  • WHO
  • To enhance development or adjustment of
    diagnostic reagents and vaccines. (MA)
  • To promote development and prepare for production
    of pandemic vaccine. (PreCon)
  • To deploy pandemic vaccine to foci of disease, if
    appropriate and available. (PreCon)
  • National
  • To increase readiness for pandemic vaccine
    production and deployment (PreCon)
  • To gain early experience in pandemic vaccine use
    under field conditions (if clinical trial lots
    are available) (PreCon)

21
Phase 5 Objectives
  • WHO
  • National
  • To support preparations for large-scale pandemic
    vaccine production and licensing, and prepare for
    deployment as supplies become available. (PreCon)
  • To gain early experience in pandemic vaccine use
    under field conditions (if clinical trial lots
    areavailable).(PreCon)

22
Phase 6 Objectives
  • WHO
  • To promote rational access to finite resources,
    including vaccines and other pharmaceutical
    supplies (when available) (PC)
  • To promote maximum production and rational use of
    pharmaceuticals, e.g. vaccines and antivirals.
    (PreCon)
  • National
  • To ensure rational access to finite national
    resources, including pharmaceutical supplies and
    (when available) vaccine. (PC)
  • To minimize morbidity and mortality through the
    rational use of available pharmaceuticals, e.g.
    vaccines and antivirals. (PreCon)
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