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Influenza Preparedness in the Iran Petroleum Industry Health Organization


Influenza Preparedness in the Iran Petroleum Industry Health Organization Bijan Hamidi, MD MPH Director of Strategic Studies and Performance Analysis office – PowerPoint PPT presentation

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Title: Influenza Preparedness in the Iran Petroleum Industry Health Organization

Influenza Preparedness in theIran Petroleum
Industry Health Organization
  • Bijan Hamidi, MD MPH
  • Director of Strategic Studies and Performance
    Analysis office
  • Member of the Disaster Task Force
  • Secretary of the Influenza Epidemic Preparedness
    Task Force
  • Petroleum Industry Health Organization (PIHO),

World Conference on Disaster Management Toronto,
Canada June 2006
A deeper look into the process raher than the
Layout of the presentation
  • Iran and the Ministry of Petroleum 3
  • PIHO and its Mandate 7
  • Impact of AF at the ministerial, national and
    global levels 9
  • Challenges faced 15
  • Development of a plan 18
  • General overview of the plan 20
  • Phases 21
  • Case definitions 24
  • ToRs 26
  • Task Force and the liaisons 29
  • Experts team 31
  • specialized Medical Teams 32
  • Organization Capacity Assessment 33
  • Coordination 35
  • Surveillance 36
  • Training 38
  • Program ME, Research and documentation 39

Wherever needed, additional information is
brought in the notes sheet
  • Located in the Middle East, joining South Asia to
    the Europe
  • More than 1.6 million sq km, 12000 sq km of water
    and almost 2500 km of coastline
  • Mostly hot dry climate, but also sub-tropical in
    the North
  • Dense poultry population in the North and West
    part of the country

Note Original map from FAO, cases around Iran
added later.
Petroleum Industry (1)
  • Iran economy depends heavily on the petroleum
  • Oil makes up to 80 of the country exports, 4th
    exporter of oil to the world
  • Oil, gas and petrochemical plants and firms, are
    the major industries in the country
  • More than 360 companies and 270 major industrial

Petroleum Industry (2)
  • Almost 100,000 work in the Ministry of Petroleum
    and another 60,000 in the associated companies
  • Most of these employees work in remote, oil and
    natural gas reach areas in South and South West
    of the country
  • Industrial plants including refineries and
    petrochemical firms are all around the country

Petroleum Industry Health Organization (PIHO)
  • Is directly responsible for the health services
    of the Ministrys employees and their families in
    the operational sites and also in the cities
  • Operates at the national level 20 regional
    offices in the country
  • 9 hospitals, 19 dayclinics and polyclinics, more
    than 60 family clinics and 100 occupational
    health centers, all around the country

Petroleum Industry Health Organization (2)
  • More than 5,500 employees
  • All the specialty and sub-specialty curative
  • But the focus is on the preventive and emergency
    care, especially in the operational sites
  • Also provides services to the local communities
    in remote areas of the country

The hovering threat
  • If a full scale AF pandemic occurs, leading to an
    epidemic in Iran, lasting for 4 months
  • With an estimated attack rate of 30 in the first
    3 to 4 months,
  • And a work absence rate of at least 25 at each
    point in the time
  • Total work time lost will reach to 8,000
    man-years and
  • With 2 mortality, the work-force lost will be
    more than 8,700 man-years.

Impact of possible AF pandemic to the industry (1)
  • This will be equal to 330 m USD just based on
    average salaries and compensation rates
  • The 16,700 years of work force lost during the
    epidemic period is equal to 17 of the annual
    work force
  • This is expected to cause at least 10 (400,000 m
    BPD) reduction in Iran oil production equivalent
    to 3.12 b USD loss for the 4 months pandemic
    period based on present oil production and price

Impact of possible AF pandemic to the industry (2)
  • This losses excludes
  • Cost of reduction in petrochemical and gas
    production capacity
  • Cost of social disruption due to oil production
    and distribution failure
  • Cost of health system failure due to system
  • Cost of psychological and sociological trauma

Global impact
  • Following the Arabs Israel war and the Arabs
    oil embargo in 1973, a net 4 m barrels/day
    reduction in oil production led to 400 increase
    in the oil price1
  • If a direct relation is supposed, the oil
    production reduction in Iran per se, if not
    compensated, may contribute to 40 increase in
    global oil price
  • Still in another more optimistic scenario,
    decrease in Iran oil production may contribute to
    12 increase in global oil price2

Impact of possible AF pandemic in PIHO (1)
  • With hospital admission rate of 50 percent and
    mortality rate of 2 percent
  • PIHO is estimated to face 5-7 fold increase in
    hospital admissions and more than 25 fold
    increase in mortalities
  • This sharp increase in health services demand, is
    along with at least 30 percent reduction in
    health work force

Impact of possible AF pandemic to PIHO (2)
  • This sharp increase in health services demand, is
    along with at least 30 percent reduction in
    health work force
  • Leading to a complete disaster state in health
    care services

Challenges faced in PIHO
  • Sensitizing PIHO top level managers and
    development of a consensus within the
    organization for resource mobilization
  • Awareness raising and sensitizing the petroleum
    Minister and Boards of Directors of companies and

Awareness raising and sensitization (1)
  • Turned out to be the major challenge
  • Financial resources needed for key preparedness
    actions (i.e. vaccination, stockpiling of
    medications and education of the population) was
    the major factor contributing to the decision
    makers unwillingness for commitment
  • Awareness raising was particularly found to be
    inadequate when a key decision maker in the
    ministry wrote on the letter requesting support
    for the plan that it seems unnecessary!

Awareness raising and sensitization (2)
  • A campaign for awareness raising was started
  • Among many activities, the following were
    particularly found to be useful
  • Participation in the Ministry of Petroleum
    Council of Deputies and meetings of Boards of
    Directors of the companies to discuss the threat
    and the consequences, face to face
  • Discussing the ongoing preparedness activities in
    other countries and industries
  • Bringing facts, reports and continuous news
    updates to the attention of the managers
  • And very interesting of all raising concerns in
    the families of the employees during daily
    clinical visits

Planning process
  • For different reasons (noteworthy of all, lack of
    adequate resources) the focus of the planning was
    on the process rather than the input
  • The planning process was initiated in June 2005
    and a team was organized for this
  • The first draft was submitted in August
  • The plan was continuously improved by subsequent
    discussions and consultations now in its fifth
  • An orientation and training workshop (ToT) for
    the regions liaisons was conducted in November
  • Subsequent orientation workshops were conducted
    for the heath care workers in the regions

Objectives and expected outcomes
  • To reduce the avoidable causes of mortality and
    morbidity (in the population covered) due to
    possible epidemic of influenza in the country
  • To improve efficiency and effectivity of health
    interventions in a frenzy state of soaring demand
    and to avoid confusions
  • To ensure business continuity and reduce
    workforce absenteeism and loss
  • To contribute to the national and global efforts
    to control the pandemic

Components of the plan
  • Actions phase definitions
  • Case definitions
  • ToRs and job descriptions
  • Influenza Task Force
  • Experts team
  • Specialized Medical Teams
  • Organization Capacity Assessment
  • Intrasectoral and intersectoral coordination
  • Surveillance
  • Training
  • Operations ME, research and documentation

Actions phase definitions
  • To get a clear view of what to do when
  • To avoid unnecessary actions and avoid delays in
    actions to be taken
  • Three phases were defined based on WHO 3 periods,
    6 phases to address specific needs of the
  • According to this definitions, we are (were?) in
    the first phase
  • The distinction between phase 2 and 3 will be
    official confirmation of the first human case in
    the country

(No Transcript)
Phases and specific priorities
Back to the components page
  • Phase I
  • Awareness raising and development of consensus
  • Planning and organization
  • Risk assessment
  • Development of intersectoral and intrasectoral
    coordination mechanisms
  • Vaccination and stockpiling of antiviral and
    other medicines and consumables
  • Training and capacity building
  • Medical examinations on return from abroad
  • Phase II
  • Broadening of vaccination
  • Enhanced surveillance activities
  • Regular meetings of TF and Expert team
  • Level one safety administrative regulations
    (limitations on public gatherings, reporting
    symptoms, )
  • Phase III
  • Provision of curative care
  • Control measures for the Epidemic
  • Level two safety administrative regulations
    (social gatherings banned, meetings frequency and
    participation reduced to the minimum, out of
    office working,)

Case definitions
  • An absolute need to reasonably identify and
    assign cases so that to
  • Avoid over-reactions and at the same time, life
    threatening delays in appropriate actions to be
  • The traditional categorization of the cases into
    suspected and definite cases in the surveillance
    systems, appeared to be insufficient to address
    the bursting nature of flu epidemic coarse
  • Before a case is diagnosed as a suspicious case
    to be reported, it may be assigned as a case to
    be closely followed up by local staff if certain
    sign and symptoms are observed
  • At the same time the definition of cases,
    extremely depends on the phases of the epidemic/
  • In the surveillance and health care system, these
    cases are treated appropriately

Case definitions
Back to the components page
Case Phase I (increased prevalence in the poultry no or limited human cases) Phase II (Increased human cases with evidence of man to man transfer) Phases III (Identification of first case in the country)
Under observation (By the local physician) High grade fever with positive auscultations and radiology FUO with positive clinical findings Travel outside of the country in the past 7 days or close contact with a definite case
Suspicious (should be report to the next level of care) Above sign and symptoms with travel outside of the country in the past 7 days Either of the following criteria FUO with recent (7 days) travel to the countries with prevalent bird or human cases High grade fever, cough and dyspnea High grade fever with close contact or inhabitants of cities with prevalent cases
Definite case (Generally a definite case is define on positive serologic findings as recommended by CDC/ WHO but in phase III, more liberalism in diagnosis is warranted) High grade fever with either of Positive A/H5 culture Positive PCR for A/H5 Positive IFA for H5 Ag 4 fold increase in H5 specific Ab titer Same as left High grade fever, cough, dyspnea, close contact (as defined) or inhabitant of cities with prevalent human cases plus High grade fever or Positive pulmonary radiology
Terms of Reference and job descriptions
  • The key factor to ensure a swift and effective
    health response is clear and specific actions for
    health staff, either the managers or the staff
    directly involved in patient care
  • This also depends on the phase of the epidemic
  • These ToRs are developed for GPs and Family
    Physicians, specialists, Directors of the
    regional offices, Hospital directors, Directors
    of the occupational health centers, regional
    directors of occupational health, regional flu
    liaisons, the organization deputies, members of
    the flu Task Force and even the President of the

Overview of individuals main tasks
  • GPs and family physicians to be involved in
    direct observation and care of the cases,
  • Specialists to provide specific care, especially
    to the critical cases
  • Managers at all levels to take care of the staff
    safety and health, and to ensure and monitor
    coordinated, supported response
  • Occupational health managers to be directly
    involved in care of the employees regarding
    public health issues at work and absenteeism
  • Regional Flu liaisons to ensure vertical
    information sharing, situation reporting, and
    performance monitoring in the regions

Sample action sheet
Back to the components page
Specialists Phase I Phase II Phase II
General tasks Specific chemotherapy Feed back to the GPs and Family Physicians in the referral system chain and to technically supervise then Planning and conducting training activities if necessary, at any point Specific chemotherapy Feed back to the GPs and Family Physicians in the referral system chain and to technically supervise then Planning and conducting training activities if necessary, at any point Specific chemotherapy Feed back to the GPs and Family Physicians in the referral system chain and to technically supervise then Planning and conducting training activities if necessary, at any point
Should be observed cases Palliative treatment and antibiotic therapy in case of superimposed bacterial infections All the previous actions Antiviral therapy Follow up of the cases at home with strict isolation procedures Follow up of all cases after two days Education of the victim family and reassurance
Upon observation of a suspicious case All the previous actions Routine reporting to the Director of the Health center/ hospital with c.c to the region flu liaison Lab request for definite diagnosis if necessary Specific chemotherapy Reporting to the Director of the Health center/ hospital with c.c to the region flu liaison Implementing strict isolation procedures if hospitalization is needed Lab request for definite diagnosis if necessary All the previous actions Patients should not be transferred to other health centers as much as possible Lab request for definite diagnosis only if necessary to control the epidemic
Upon observation of a definite case Specific chemotherapy Hospitalization (preferably in (ICU) and transfer if there is no ICU bed and patient condition permits All the previous actions All the previous actions
Influenza epidemic preparedness and response Task
  • A task force is formed as the highest body to
    govern the preparedness and response of the
  • The President of the organization works as the
    head of the TF. The secretary is in charge of the
    coordination and follow up of the issues (members
    listed in the slide note sheet)
  • All the members have clear and specific ToRs

Task Force main responsibilities
Back to the components page
  • To ensure health staff safety against influenza
    while in service
  • Governing, leadership, coordinating,
    prioritizing, and decision making during flu
    preparedness and response
  • Trend analysis and predicting short and long term
    effects of the pandemic on the petroleum industry
  • Providing resources and taking care of the gaps
  • Coordination with the national partners in the
    preparedness and response
  • Accountability against the Ministry of Petroleum
    and informing the media

Influenza expert team
Back to the components page
  • Is the technical and consultative body of the Flu
  • Members include distinguished experts in
    infectious. Pulmonary and ICU specialists,
    Internists, Pediatricians, anesthesiologists and
  • One of their main tasks is to develop ICU and
    hospital admission policies appropriate at each
    point of the crisis

Specialized Medical Teams
Back to the components page
  • Designed to act upon observation of first cases
    (in all the hospitals)
  • Specially trained and fully protected to work as
    the first line of inpatient care for influenza
  • When cases are abandoned and involvement of the
    whole medical staff is required, teams are
    increased and they are divided into that teams,
    later may work as supervisors and specialized
    care givers

Capacity assessment of the Regional Offices
  • A major component of risk assessment
  • A detailed form was developed to assess the
    situation of the 20 regions regarding
  • Vaccination and population education capacities
  • Outpatient and inpatient capacities at regular
    times and in case of surge in demands (Isolated
    and ICU beds, ventilators,)
  • Human resources with related expertise
  • Logistic capacities, transportation, storage,
    communications, public relations
  • Level of coordination with local MoH, and other
  • Capacities for indirect services (outsourcing)
  • Resources in the industry that can be mobilized
    in case of crises situations

Objectives of the capacity assessment
Back to the components page
  • Particularly directed to identify strengths and
    weaknesses based on the plan
  • So that gaps are recognized, prioritized and
    addressed accordingly
  • Fine tuning of the plan based on realities on the
  • And to assess managerial capacities to handle
    crises situations

Intrasectoral and Intersectoral Coordination
Back to the components page
  • Success in achieving the goals of the plan could
    only be viewed in terms of effective
    intrasectoral and intersectoral partnership
  • The priority of the global and national actions
    to the components of this plan is emphasized and
    encouraged to be respected, unless a gap or
    failure is noticed
  • Close collaboration of PIHO Regional Offices with
    local MoH and other partners is encouraged and
    emphasized in the plan
  • Rigorous coordination meetings and information
    exchange is mandatory with all the partners

  • The hallmark of a quick, effective, dynamic
    response to a variety of possible scenarios
    during an epidemic
  • Designed to be effective and at the same time as
    simple as possible so that it can be managed
    during a crisis and chaos situation
  • Forms developed for registering and report of
    different cases by related staff

Surveillance Objectives
Back to the components page
  • To monitor the epidemiologic situation of the
    epidemic and if needed to consider change of
  • Early diagnosis and secondary prevention of
    Influenza cases
  • Follow up of the cases for health outcomes
    evaluation and monitoring of efficacy of medical
  • To reflect case load and burden of disease for
    appropriate managerial decisions
  • Timely identification of shortage of resources
    and broadening gaps in the services in the
  • Documentation

Trainings and mock drills
Back to the components page
  • Capacity building among health care workers and
    even managers is the main factor to ensure
    automatic appropriate reactions to the rapidly
    evolving situation in crises
  • For this reason, extensive efforts was put on
    preparing training material, holding workshops at
    the national and regional levels, encouraging
    participation in online training courses and most
    important of all for planning mock drills.

Operations Monitoring Evaluation, Research and
Back to the components page
  • As a integral part of the plan, specific measures
    are taken to ensure appropriate monitoring and
    documentation so that lessons are not missed
  • A major responsibility of the communication and
    Media Officer in the Task Force is arrange for
    appropriate documentation of the whole
    preparedness and response activities
  • The real situation will provide the best
    opportunity to test the efficacy of the plan to
    improve in continuously, if only we do not miss
    the lessons

Thank you for your time
  • All the plan document is in the process of
    translation into English and will be launched on
    the organization site at
  • The author welcomes recommendations and exchange
    of information and experience,
  • Bijan Hamidi, M.D M.P.Hhamidi_at_piho.orghamidib_at_gm
    ail.comMobile (98) 912 387 3488Office (98)
    21 8894 2060