SPANISH PLAN FOR THE PREPARATION AND RESPONSE TO AN INFLUENZA PANDEMIC

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SPANISH PLAN FOR THE PREPARATION AND RESPONSE TO
AN INFLUENZA PANDEMIC
Dr. Carmen Amela Heras Public Health National
Direction Ministry of Health and
Consumption Madrid, Spain
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General Objectives

• Reduce the impact of the pandemic on the
  populations health
• Take measures to reduce the transmission of the
  virus and protect the population.
• Guarantee that the response and the measures
  adopted correspond with UE and OMS
  recommendations in each phase.

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National Plan Key Elements

• Organizational structure and coordination
• Epidemiologic and virological vigilance
• Prevention and control measures
• Vaccines,
• Antiviral, and
• Non pharmaceutical intervention measures
• Health system response, and
• Communication

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Organizational and Coordination Structure

• National Executive Committee for the
  prevention, control and follow up of the
  epidemiological evolution of the influenza virus
  (RD 1131/2003)
• - Operative Group of the Executive Committee
• - Technical Coordination Group
• - Scientific Committee
• - Public Health Committee
• - Subcommittees or work groups

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National Plan. Work Groups. (Subcommittees)
With Representation in the Autonomous Communities

• Response to the sanitary emergency services
• Epidemiological and virological vigilance
• Antiviral and vaccines
• Communication

The objective is for all the Autonomous
Communities to have their own plan, in which they
place special emphasis on the emergency response.
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Approved Protocols

• Detection, by sanitary professionals, of
  suspicious cases of the bird flu in humans
• Infection control measures in sanitary centers
• Actions that would be taken in the case of people
  that work in farms or could be exposed to
  infected birds.
• Definition of priority groups for the supply of
  antivirals.
• Instructions for use for intervention with
  oseltamivir following exposure to the influenza
  virus A/H5N1.
• Recommendations for travelers that are moving
  towards affected countries and other exterior
  sanitary measures.
• Protocol for action when passengers arrive in
  Spain (via air or sea)

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Public Health Measures Will help retrace
diffusion, but will not avoid the Pandemic.

• Isolation
• Closing of Institutions
• Personal Security
• Travel restrictions
• Restrictions for celebrating large reunions

Organic Law of Special Measures in Public Health
Matters 3/1996 0f 14th of April, articles 2 and
3. The Litigious-Administrative Court authorizes
the measures that the sanitary authorities
consider urgent and necessary for health.
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Scenarios , Consequences and Measures in the
PANDEMIC ALERT PHASE
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Vigilance algorithm suspicious case
and Close contact (1 meter) with domestic
birds live or dead, wild birds or pigs.
History of travel to areas affected by bird flu2
in the last 7 days.
Respiratory symptoms Cough Or Difficulty
Breathing
Close contact (at a distance of touching or
talking) with other cases of severe respiratory
disease or Unexplained death in a patient
coming from an affected area http//www.who.int/cs
r/don/2005
or Being part of a group of workers with severe
respiratory disease without other alternative
diagnosis.
Fever (gt 38C)
EPIDEMOLOGICAL HISTORY
PATIENT REPORTING SUSPICOUS INFLUENZA SYMPTOMS
SUSPICIOUS CASE
Any other very serious disease without an
alternative diagnosis
or Work in a laboratory with accidental exposure
to the influenza virus A/H5
or Work or have been in close contact during the
last 7 days with birds in a corral, or live or
dead animals (or thier products) that could have
been exposed to the highly pathogenic bird flu
virus A/H5.
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Coordination and alert algorithms
Fevergt 38C Respiratory symptoms (cough or
difficulty breathing)
Very serious disease Without an
alternative diagnosis

• Patient barrier measures
• Surgery mask and hygienic measures
• Patient isolation measures.
• The patient will be confined in the examination
  room or a room.
• Personal protection measures
• Use personal protection equipment and hygiene
  measures.

Close contact (lt1m.) with domestic Birds, live
or dead, wild birds and pigs
Visit to areas affected By bird flu in the last 7
days
YES
YES
NO
NO
Close contact (lt1m.) with severe respiratory
disease or unexplained death in a patient that
comes from an Affected area
YES
NO
Are you part of a group of sanitary
workers with severe respiratory disease
without an alternative diagnosis
SUSPICIOUS CASE
ADOPT GENERAL PROTECTION MEASURES
CALL CICU
YES
NO
YES
Do you work in a laboratory
Have You been exposed to the Virus A/H5
YES
NO
NO
Do you work or have been in close contact
during the last 7 days with birds in a corral,
or live or dead animals (or their products) that
could have been exposed to the highly pathogenic
bird flu virus A/H5.
YES
NO
NO CASE
UPDATED FEBRUARY 20, 2006
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Basic Points PAETAP
ISOLATION
VIGILANCE
CASE
PANDEMIC COORDINATION CENTER
CICU
Laboratory Vigilance Protocol
EXTRA HOSPITAL
PRIMARY
SPECIALIZED
EMERGENCIES
NO CASE
ATTENTION
ATTENTION
PANDEMIC COORDINATION CENTER
CICU
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Evaluation of Risk
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Evaluation of Risk
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Risk evaluation.Asiatic region compared to
Europe.
Europe Asia
Geographic Extension Located in more limited areas Scattered throughout Asia
Endemnicity Not endemic Endemic
Management of animals Good. Industrial exploitation. Little hygiene in the majority of the homemade pens
Available resources and technical ability More resources and better capacity Limited resources and capacity
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Simulation Common Ground

• The exercise simulated an Influenza pandemic in
  Europe that affected all the member States,
• Objectives of the Exercise
• Evaluate the execution of the national plans of
  the Member States
• Improve compatibility and interoperability of the
  plans of the member States
• Examine the role and availability of control
  measures.
• Determine the availability and convenience of the
  contention measures and
• Examine the role of the European Commission
  during an influenza pandemic

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Messages

• The threat of a pandemic has not increased
  significantly due to the detection of the virus
  in Europe.
• All countries have to be prepared for the arrival
  of A/H5N1.
• The bird flu virus A/H5N1 is a great problem for
  animal health
• At this time it is assumed that it is a low risk
  for human health
• The people at risk are those that have close
  contact with infected birds and their products
• Even in them the risk of infection is low but the
  disease is serious

We cannot forget that the influenza has a
tendency to change and surprise!
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Communication of the Risk- Confusion about the
types of flu