Avian Influenza Pandemic An OHS Perspective

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Avian Influenza PandemicAn OHS Perspective
Presentation to the Commonwealth Safety
Management Forum 23 November 2006 Brian Ewert
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Presentation Overview

• Part 1
• What is Avian Influenza?
• Avian Influenza within Australia
• 20th Century Pandemics
• 21st Century Epidemic
• H5N1 History Epidemiology

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Presentation Overview

• Part 2
• The Key Facts
• What is the Risk?
• Antivirals
• Vaccines

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Presentation Overview

• Part 3
• Pandemic Preparedness
• Part 4
• OHS Considerations
• Part 5
• CSMF Assistance
• Part 6
• Open Forum

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Part 1

• What is Avian Influenza?
• Avian Influenza within Australia
• 20th Century Pandemics
• 21st Century Epidemic
• H5N1 History Epidemiology

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What is Avian Influenza?An infectious viral
disease that

• primarily affects birds
• chickens
• turkeys
• pheasants
• quail
• pigeons
• ducks
• geese
• guinea fowl
• ostriches
• sea birds
• migratory waterfowl

• less commonly
• rats
• ferrets
• white rabbits
• pigs
• tigers
• leopards
• domestic cats
• rarely
• humans

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What is Avian Influenza?

• There are numerous strains and subtypes of the
  virus.
• Strains vary from low to highly pathogenic.
• Highly pathogenic avian influenza was first
  identified 1878.
• 4 strains are known to cause human infection.
• Only H5N1 is currently linked to severe human
  infection and death (rare).
• All human cases of avian influenza have coincided
  with outbreaks in poultry.

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Avian Influenza within Australia

• Historically Australia has experienced avian
  influenza outbreaks
• 1976 Melbourne Suburbs, Victoria (H7N7 strain)
• 1985 Bendigo, Victoria (H7N7 strain)
• 1992 Bendigo, Victoria (H7N3 strain)
• 1994 Lowood, Queensland (H7N3 strain)
• 1997 Tamworth, New South Wales (H7N4 strain)
• To date no human avian influenza cases have been
  reported within Australia.

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Avian Influenza within Australia

• Highly pathogenic avian influenza in humans is
  subject to quarantine control (Quarantine Act
  1908).
• Since February 2004
• Australias pandemic alert phase has remained
  unchanged (Australia 0 no circulating animal
  influenza subtypes in Australia that have caused
  human disease)
• compared with
• the Global pandemic alert phase has remained
  unchanged (Overseas 3 human infection
  overseas with new subtypes but no human to human
  spread or at most rare instances of spread to a
  close contact)

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20th Century Pandemics

• 1918 1919 Spanish Influenza
• H1N1 strain
• estimated 40 50 million deaths
• 1957 1958 Asian Influenza
• H2N2 strain
• estimated 2 million deaths
• 1968 1969 Hong Kong Influenza
• H3N2 strain
• estimated 1 million deaths

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20th Century Pandemics

• 31 influenza pandemics have occurred since the
  middle ages.
• On average an influenza pandemic occurs every 30
  years.

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21st Century Epidemic

• 2002 2003 Severe Acute Respiratory Syndrome
• 26 countries (Western Pacific regional focus)
• coronavirus (not avian influenza)
• 8098 probable cases (774 deaths)
• raised awareness of the social and economic
  impacts of epidemics

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H5N1 History Epidemiology

• 1997 Avian Influenza
• Hong Kong
• 18 cases (6 deaths)
• notably 1.5 million birds were culled within 3
  days
• 2003 Avian Influenza
• China Vietnam
• 4 cases (4 deaths)

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H5N1 History Epidemiology

• 2004 Avian Influenza
• Thailand Vietnam
• 46 cases (32 deaths)
• 2005 Avian Influenza
• Cambodia, China, Indonesia, Thailand Vietnam
• 97 cases (42 deaths)

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H5N1 History Epidemiology

• 2006 (to 13 November 2006) Avian Influenza
• Azerbaijan, Cambodia, China, Djibouti, Egypt,
  Indonesia, Iraq, Thailand Turkey
• 111 cases (75 deaths)
• Since 2003, human H5N1 mortality rate
  approximates 60.

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H5N1 History Epidemiology
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H5N1 History Epidemiology
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H5N1 History Epidemiology
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H5N1 History Epidemiology
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H5N1 History Epidemiology
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Part 2

• The Key Facts
• What is the Risk?
• Antivirals
• Vaccines

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The Key Facts

• Avian influenza and human influenza are different
  diseases.
• Type A influenza viruses
• occur in birds and mammals (humans)
• cause flu
• can cause a pandemic (rare)
• Avian influenza is a type A virus.

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The Key Facts

• Type B influenza viruses
• occur in humans and dogs
• cause seasonal flu
• do not cause pandemics
• Type C influenza viruses
• occur in humans only
• cause the common cold
• do not cause pandemics

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The Key Facts

• Human avian influenza (H5N1 crossing the species
  barrier) is primarily attributable to direct
  human contact with infected birds
• slaughtering, defeathering, butchering and
  preparation of infected poultry for consumption
• children playing in areas frequented by infected
  poultry
• domestic utilisation of water contaminated by the
  carcasses of dead infected birds
• chickens/ducks/turkeys/geese penned together in
  unhygienic conditions spreading infection

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The Key Facts
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The Key Facts

• Human to human transmission
• is possible
• in rare cases is suspected (2004 Thailand ill
  child to mother, and 2006 Indonesia amongst 8
  family members)
• has not been sustained
• Importantly
• H5N1 has yet to acquire the ability to spread
  efficiently amongst humans

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The Key Facts

• If avian influenza pandemic was to occur
• it is most likely to occur overseas amongst
  poverty stricken rural and periurban communities
• any spread to Australia would most likely be
  attributable to international travellers
• Avian influenza may not evolve into a pandemic
  virus.
• It is not possible to predict if/when a pandemic
  may occur.

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What is the Risk?

• If the avian influenza mutates (emergence of a
  new strain) there is a risk of
• human to human transmission
• virus rapidly spreading
• severe infection persisting and recurring in
  waves
• from status quo to influenza epidemic and
  possibly a pandemic within 20 30 day window

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Antivirals

• Clinical data supporting the effectiveness of
  antivirals as a treatment of avian influenza is
  limited.
• Antivirals may shorten the duration and lessen
  the symptoms of avian influenza.
• Timing of administration appears critical (48
  hour window).
• Unnecessary antiviral use is linked with drug
  resistance.
• Antivirals are currently available by
  prescription only.

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Vaccines

• Vaccines trigger an immune response bolstering
  the bodys ability to fight an infection.
• Vaccine production cannot usually commence until
  a virus outbreak (the virus strain must first
  be identified).
• Large scale vaccine availability is unlikely
  until after the first wave of infections.

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Part 3

• Pandemic Preparedness

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Pandemic Preparedness

• 8 steps to preparing for a pandemic
• Obtain senior management commitment and secure
  allocation of resources.
• Form a pandemic planning team.
• Develop pandemic business continuity plans.
• Form a crisis pandemic management team (with
  requisite delegations).

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Pandemic Preparedness

• Undertake workforce planning (skills inventory).
• Develop and implement an employee communication
  strategy.
• Test the effectiveness of preparations.
• Test employee confidence.

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Part 4

• OHS Considerations
• Employers Duty of Care
• Employees Duty of Care
• Consultation
• Risk Management and Hierarchy of Controls

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OHS Considerations

• Under Part 2 OHS Act, employers are required
  to
• take all reasonably practicable steps to protect
  the health and safety at work of their employees.
• Therefore
• employers should anticipate risks associated with
  a potential influenza pandemic (ie risk
  management)
• health and safety of employees should be
  integrated into business continuity planning for
  pandemic influenza
• However, in a pandemic scenario what constitutes
  reasonably practicable?

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OHS Considerations

• Under Part 2 OHS Act, employees are required
  to
• cooperate with their employers reasonable
  instructions and policies (including risk
  control)
• take all reasonably practicable steps to ensure
  any action or omission does not create or
  increase a risk to health and safety
• Therefore
• employees should comply with the pandemic health
  advice and emergency directives issued by their
  employer and employers should ensure directives
  comply with public health advice/emergency
  measures

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OHS Considerations

• Under Part 3 OHS Act, employers are required
  to
• consult employees when assessing risks to health
  and safety
• Therefore
• employers should consult widely utilising
  existing workplace arrangements (HSR and OHS
  Committees)
• employers should provide accurate and current
  information and education to employees addressing
  how a pandemic influenza may affect their work
  arrangements

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OHS Considerations

• Risks associated with an influenza pandemic can
  be categorised into
• the direct risks of infection (contact, airborne
  droplet and aerosol transmission)
• indirect risks arising from changes to usual work
  arrangements
• Question How useful is the traditional
  hierarchy of controls when planning for a
  pandemic (where do antivirals/vaccines fit)?

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OHS Considerations

• Elimination ?
• Substitution ?
• Isolation clinical quarantine
• Engineering improve natural ventilation of
  enclosed workplaces
• Administration cough etiquette, promotion of
  personal hygiene, additional workplace cleaning,
  home quarantine
• PPE mask/goggles/gloves/gowns

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Part 5

• Commonwealth
• Safety
• Management
• Forum
• How can you assist?

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CSMF

• Challenge
• integrating OHS risk management into business
  continuity plans (an employer responsibility)
• Objectives
• assist with across-government consultation
  (emphasis on health, safety and welfare of
  employees)
• develop consistent whole-of-government OHS
  people management influenza pandemic guidelines

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CSMFScope

• social distancing
• cough etiquette
• personal hygiene
• cleaning/disinfecting the workplace
• managing workplace entry
• teleworking
• contract management
• minimising unnecessary absenteeism

• managing staff who become ill at work
• provision utilisation of PPE
• home quarantine
• managing psychological anxiety
• emergency HR delegations
• training communication

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Open Forum

• Questions Answers
• Discussion
• Nominations CSMF AIP Sub-Committee

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Enquiries

• Brian Ewert
• 6225 8963
• brian.ewert_at_immi.gov.au