Influenza Pandemic Planning

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Influenza Pandemic Planning

• Elizabeth Birbilis, Senior Policy and Planning
  Officer
• Communicable Disease Control Unit
• Public Health

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Presentation Outline

• International/National/State Pandemic Planning
• Victorian Influenza Pandemic Plan
• The role of GPs
• Future Directions

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International/National Pandemic Planning

• WHO Global Influenza Preparedness Plan March
  2005
• Australian Management Plan for Pandemic Influenza
  May 2006
• Australian Governance Plan for Pandemic Influenza
  August 2005
• COAG National Action Plan July 2006
• Interlocking arrangements
• Communicable Diseases Network of Australia (CDNA)
• National Influenza Pandemic Action Committee
  (NIPAC)
• Australian Health Protection Committee (AHPC)
• Exercise Cumpston 06
• 16 19 October

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(No Transcript)
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Victorian Pandemic Modelling

• Upper limit estimates (30 attack rate)
• 24,000 excess hospitalizations
• 10,000 excess deaths
• 710,000 excess outpatient visits
• Figures based on 6-8 week period
• Victorias current healthcare system would be
  under enormous stress

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Victorian Influenza Pandemic Plan

• Covers response activities including
• Surveillance
• Public health (contact tracing, isolation,
  quarantine)
• Clinical Care
• Community support
• Vaccine/antiviral policy and distribution
• Recovery arrangements
• Laboratory diagnostic testing
• Business continuity
• Communication

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Preparedness Initiatives

• The Federal government has established the NMS,
  to supplement existing state resources once a
  pandemic is declared. It contains items such as
  antivirals, and personal protective equipment
• Victoria has a small stock of starter
  antivirals and PPE for urgent cases before access
  to the NMS can be made
• Victorian Government recently provided additional
  funding to bolster state resources
• Governments working with manufacturers to develop
  a vaccine
• Likely to be 3-6 months before first doses
  available
• Priority administration based on
  exposure/morbidity risk

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National Medical Stockpile (NMS)

• Components of the NMS Influenza related
• Antiviral/prophylactic treatments
  (Tamiflu/Relenza)
• N95/P2 and surgical masks (fit test kits)
• Ventilators and negative pressure isolation units
• Quarantine caches
• Vaccination packs
• Gloves
• Personnel protective equipment for border workers
• Formal arrangement for state/territory access to
  the stockpile currently being finalised (MOU).
  Access via Chief Health Officer request

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Current Situation Overseas 3

• Enhanced surveillance
• raised awareness for health care workers
• international, rumors, border
• (Suspected) case definition clinical (Influenza
  Like Illness) epidemiological (travel poultry
  contact)
• Containment
• isolation of rare suspected cases
• rapid testing to exclude diagnosis
• antivirals if case confirmed
• contact tracing with isolation and antiviral
  prophylaxis if case confirmed

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Next phases Overseas 4 5Human to human
transmission overseas

• Strengthened border controls
• discouragement of travel to affected areas
• Strengthened communication
• Strengthened surveillance
• new case definition (no longer necessary to have
  poultry contact)
• close monitoring of international situation
• Intensive containment measures if any imported
  cases occur
• quarantine measures

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Next phases Aus 4 5Human to human
transmission in Australia

• Strengthened surveillance
• new case definition (no longer necessary to have
  overseas travel)
• laboratory testing of all cases will continue
• monitor epidemiology as evolves
• Strengthened communication
• opening of Health Services Support Centre
• Containment
• designated hospitals, stringent infection
  control, intensive contact tracing and
  prophylaxis
• escalation of isolation and quarantine

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Next phase Aus 6Pandemic in Australia

• Containment no longer feasible, maintenance of
  services new strategy
• Surveillance no longer confirm all cases,
  monitor morbidity, mortality, and health services
  utilisation, absenteeism
• Designated hospitals, fever clinics to manage
  demand
• Contact tracing no longer feasible
• education, voluntary home isolation

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Next phase Aus 6Pandemic in Australia

• Strengthen prevention activities
• social distancing
• cough etiquette/handwashing
• increased cleaning
• pre-exposure prophylaxis for front line health
  care workers, switch to vaccine when available
• Community support model and recovery

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Designated Hospital Model

• Patients will telephone or present to GPs or
  emergency departments
• In the pandemic alert period, suspected cases
  will be transferred to the EDs with isolation
  roomsif required
• During the pandemic period, confirmed cases will
  be transferred to EDs at designated hospitals
• Hospitals will be designated based on
• Location
• Isolation facilities (e.g. negative pressure
  rooms)
• Infectious diseases expertise

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Increasing patient numbers

• Admit patients to isolation rooms
• Cohort influenza patients in influenza wards
• Identify specific hospital/s that can be closed
  and used solely for influenza patients
• Consider use of non hospital facilities

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Patients Presenting to Hospitals

• Patients will (typically) present to EDs
• Hospitals will need protocols for rapid id of
  patients with suspected PI including
• Separating patients from non flu patients
• Signage
• Patient infection control measures
• Triage

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Patients Presenting to Hospitals

• Influenza clinics will assess and triage
  patients
• Home
• Hospital (isolation room or ward)
• To another facility (when hospital-level care not
  required but patient is unfit to return home)
• Provide medication or other treatment and advice
  as appropriate

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Proposed Hospital Care Model
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Possible Community Support Model
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Municipal Coordination Centre

• Proposed roles and responsibilities for community
  support
• Provide support to individuals/communities
  quarantined/isolated in homes/institutions
• Provision and/or coordination of health
  staff/volunteer helpers for general
  medical/essential service support for those in
  need
• Provision of personal support services, eg
  counselling, advocacy
• Provision and staffing of recovery/information
  centre(s)
• Convening of municipal/community recovery
  committees as necessary
• Provision of mass vaccination (if/once
  available) LGA specific

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Staffing of Centre

• Proposed groups represented
• LGA response, recovery, communication, senior
  manager/s
• Division/s of GPs
• Volunteer agency rep eg. Red Cross, SES
• Health agencies rep eg. RDNS, HACC Co-ordinator,
  hospital liaison, DHS regional liaison
• Others eg. Police, MAS/RAV

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Business Continuity

• What is business continuity?
• Maintaining critical business activities
• Why should organisations undertake planning?
• To minimise the impact of an influenza pandemic
  on your organisation
• To protect your business and ensure business
  continuity
• To protect staff

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Business Continuity Guide

• The Australian Government Department of Industry,
  Tourism and Resources has developed Being
  prepared for a Human Influenza A Business
  Continuity Guide for Australian Businesses, it is
  a practical guide outlining
• What government is doing in preparation for a
  potential pandemic
• The likely impacts on businesses
• How businesses can minimise those impacts
• How to help protect staff from getting sick
• Useful internet reference sources for more
  information
• A pandemic planning checklist and
• A series of health posters for the workplace

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What can organisations be doing now?

• Start business continuity planning for pandemic
  influenza
• Education
• Provision of accurate up to date information
• OHS
• Infection control cough etiquette, handwashing,
  cleaning surfaces, PPE, antivirals
• Seasonal influenza vaccine

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What can GPs be doing now?

• Check DHS website for Health Alerts
• Contact DHS if you suspect avian influenza
• Have access to appropriate PPE
• Promote seasonal vaccination
• Immunisation with pneumococcal vaccine will
  prevent a major complication ie pneumococcal
  pneumonia
• Important to attain high inter-pandemic coverage
  with conjugate vaccine (for children) and
  polysaccharide vaccine (for older persons and
  those at medical risk)

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What can individuals be doing now?

• Understand pandemic influenza and current
  developments of avian influenza overseas by
  checking reliable websites
• WHO, DoHA, DHS
• Practice prevention activities
• cough etiquette/handwashing
• travel safe
• stay home if unwell
• Immunisation (seasonal influenza and
  pneumococcal)

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Research

• Vic research
• Community
• 600 CATI survey Vic adults aged 18 years over
  (400 metro, 200 rural)
• 6 focus groups young mums, low income men,
  working women, men aged 65, low income women,
  working men
• Business
• 200 small/medium/large online survey
• Health providers
• 60 online surveys nurses pharmacists
• Local government
• 25 in depth interviews with CEO or equivalent

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Research Results

• In the event of a pandemic, most Victorians
  expect to receive critical advice and information
  from the Government (42), while 22 will expect
  this information from their GP
• When asked where people would go to for further
  information about a serious health issue such as
  a pandemic, 50 said their GP
• When businesses were asked who they would expect
  to provide their employers with critical advice
  and information in the event of a pandemic 61
  said their GP

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Available resources

• Material for business
• Australian Government Department of Industry,
  Tourism and Resources
• www.industry.gov.au/pandemicbusinesscontinuity
• Materials for the general public
• Materials for health professionals
• Australian Government Department of Health and
  Ageing
• www.health.gov.au
• Victorian Department of Human Services
• http//www.health.vic.gov.au/ideas/regulations/vic
  _influenza.htm

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Further Information?

• Communicable Diseases Section
• ?[phone]
• email
• elizabeth.birbilis_at_dhs.vic.gov.au
• Web www.health.vic.gov.au/ideas/
• (Victorian Pandemic Plan at this address)

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Where to from here?

• General Practitioner package
• Local Government preparedness
• Plans modified as new evidence/information is
  gathered
• Communication strategy (Commonwealth and State)