Pandemic Flu Nigel Ineson April 2006

1
Pandemic FluNigel InesonApril 2006
2
What is a pandemic?

• Epidemic serious outbreak in a single community,
  population or region
• Pandemic epidemic spreading around the world
  affecting hundreds of thousands of people, across
  many countries

3
Previous pandemics

• Spanish flu (1918) led to 20 million deaths
  worldwide and 200000 deaths in United Kingdom
• Asian flu (1957
• Hong Kong flu (1968)
• ?? H5N1 Bird flu (2006)

4
Avian flu

• Avian flu is also known as bird flu. The deadly
  strain currently worrying the world is called
  H5N1, and was first seen in Hong Kong in 1997.
  The World Heath Organisation (WHO) says its
  the biggest and most severe outbreak on record,
  with more than 150 million birds thought to have
  been affected. Its also thought it could take
  several years to control the disease in poultry
• There have been 182 confirmed cases of avian flu
  with the H5N1 strain, in people from Indonesia,
  Thailand, Cambodia, China, Vietnam, Azerbaijan,
  Iraq and Turkey, which have led to 103 deaths. 
  All the victims are thought to have been in close
  or direct contact with infected birds.

5
What causes pandemic flu?

• The emergence of a new flu virus
• The new virus passes easily from person to person
• Few, if any, people have any immunity
• This allows it to spread widely, easily and to
  cause more serious illness
• Because the virus will be new, there will be no
  vaccine ready to protect against pandemic flu

6
Fritz the Swan

• Single swan infected with H5N1 flu
• Traced to have arrived from Germany
• Containment procedures now relaxed and no further
  cases
• A near miss??

7
Prerequisites for pandemic influenza

• New influenza A sub-type Haemagglutinin (H)
  unrelated to immediate (pre pandemic )
  predecessor
• Little or no pre-existing population immunity
• Causes significant clinical illness
• Efficient person to person spread

8
Prerequisites for pandemic influenza

• Avian flu does not meet this requirement as it is
  spread via bird droppings and is rare in humans
• BUT if a person became infected with Avian flu
  AND has another type of flu which was spread
  between humans (droplet) then there could be
  mixing and mutation and the result could be a new
  H5N1 virus
• This new virus could lead to Pandemic Flu
• It might take only weeks for this to spread
  worldwide

9
Prerequisites for pandemic influenza - situation
in April 06

• New influenza A sub-type Haemagglutinin (H)
  unrelated to immediate (pre pandemic )
  predecessor YES
• Little or no pre-existing population immunity YES
• Causes significant clinical illness YES
• Efficient person to person spread not yet
• Hence we are at WHO pandemic alert phase 3

10
What is pandemic flu like?

• An acute illness, incubation period 1 to 4 days
• Generally of sudden onset, with fever, headache,
  aching muscles, severe weakness, and respiratory
  symptoms e.g. cough, sore throat, difficulty
  breathing
• Highly infectious, spreading rapidly person to
  person
• Some strains cause more severe illness than
  others
• (and we dont know what the pandemic strain will
  be like)
• Flu can kill, as can the complications

11
How should it be treated

• Self management should be the norm there is no
  need to see a doctor unless there are
  complications
• Rest at home avoid public places and do not go
  to work and spread it to colleagues
• Drink plenty of fluids
• Take simple remedies such as paracetamol
• There is NOT usually a need for antiviral drugs
  such as Tamiflu

12
How it spreads

• Easily passed from person to person through
  coughing and sneezing
• Transmitted through
• breathing in droplets containing the virus,
  produced when infected person talks, coughs or
  sneezes
• touching an infected person or surface
  contaminated with the virus and then touching
  your own or someone elses face

13
How to avoid spreading flu

• Avoid public places
• Use tissues and dispose of them hygienically
• Coughs and sneezes spread diseases
• Patients with flu should be kept separate for
  other patients
• Staff dealing with flu patients should wear a
  mask and use simple barrier precautions

14
Planning for a Pandemic

• DoH has been leading the UK planning
• Guidance in 1997, updated March and Oct 2005
• Advice from the Health Protection Agency (HPA)
• Expectations that all NHS organisations should
  have plans
• Limited instructions so far from resilience fora
  and local government

15
Local planning

• There is a Hertfordshire Pandemic Flu
  Coordinating Committee planning for the county
• There is also a local Primary Care Trust planning
  and implementation group
• We also have a Callowland Pandemic Flu
  contingency plan

16
Emergency planning prepare for the worst and
hope for the best

• Full range of possible mortality rates given in
  UK flu guidance, but detailed assumptions based
  on 25 attack and 0.37 mortality rate (as in
  1957)
• London planning for 2.5 mortality in the
  infected
• DH revising their figures/guidance upwards?

17
Advice from DoH
Reduce impact through

• Surveillance
• Diagnosis
• Antiviral drugs
• Vaccines (once they become available)
• Public health interventions

But what about business continuity
planning planning for absenteeism maintaining
food and other basic supplies community resilience
18
Advice from BMA/RCGP

• Wherever possible, those known to be or likely to
  be infected with flu should be kept physically
  apart from those without flu
• Working practices and procedures which risk
  enhancing transmission of flu should be avoided
• Sensible barrier precautions should be used when
  close contact with a flu-infected patient is
  inevitable or likely
• There should be no compromise in infection
  control standards
• High standards of patient care should be
  maintained throughout, for those with flu and for
  those with other conditions

19
Pandemic flu and infection control

• Face masks and full protection for health care
  workers close to those known to have flu, but
  what about, eg informal carers, or with those who
  only might be infected?
• Keep patients with flu separate from patients who
  do not have flu
• Public awareness and publicity to promote
  infection control
• The possible closure of places where the public
  congregate

20
Personal interventions

• Basic measures to reduce the spread of infection
• Hand washing washing hands frequently with soap
  and water reduces the spread of the virus from
  the hands to the face, or to others
• Respiratory hygiene covering the mouth and nose
  when coughing or sneezing using a tissue when
  possible disposing of dirty tissue promptly are
  carefully bag and bin
• Avoiding non essential travel and increasing
  social distance non attendance at large
  gatherings such as concerts, theatres, cinemas,
  sports arenas etc

21
Antiviral drugs

• Oseltamivir (Tamiflu) being stockpiled, one
  course for 25 of the UK population, but the
  value is uncertain
• Best if given within 24-48hrs of start of illness
• Lots of logistical difficulties in achieving this
• Especially if the drug is in short supply and its
  significance has been oversold
• May turn out to be a distracting and divisive
  issue

22
Immunisation - ?? too late

• The present flu vaccine will NOT give protection
• Only when the pandemic starts will it be possible
  to make a vaccine
• It could take weeks or months to prepare
• Will then be run out to priority groups
• We will NOT be vaccinating patients instead
  they will attend special centers. However we will
  vaccinate our staff as soon as supplies are
  available

23

• Feeding wild birds
• You can still feed wild birds and ducks, but make
  sure that you wash your hands thoroughly
  afterwards and steer clear of sick or dead birds.
  If you do see a dead duck, goose or swan, call
  the DEFRA helpline on 08459 33 55 77.
• Bird droppings
• The virus can be passed on through bird
  droppings, either from bird to bird, or in very
  rare cases, from bird to human. Try to keep away
  from bird droppings if possible, and wash your
  hands thoroughly if you accidentally touch some.
• Protecting pets
• In general, you don't need to do anything
  differently to look after your pets. If you have
  a dog that sometimes catches wild birds, try and
  avoid areas where that's likely to happen.  In
  theory, H5N1 can be passed on to other animals,
  but it's very unlikely.
• Food preparation
• The outbreak does not pose a food safety risk for
  UK consumers because the virus is not blood borne
  and is not transferred through cooked food. As a
  precaution, always make sure you practise good
  hygiene when cooking meat - use different
  utensils for cooked and raw meat, wash your hands
  thoroughly before and after handling meat, and
  make sure that meat is thoroughly cooked and
  piping hot before serving.

24
(No Transcript)
25
Callowland planning

• Self care is appropriate in most cases and we
  should promote this
• People with flu should not attend the surgery
• (strategies to increase telephone advice, prolong
  repeat prescriptions, arrange prescriptions to go
  direct to chemists)
• If complications (such as chest infections) are
  considered patients should attend separate flu
  sessions
• Separate areas will be used for flu patients and
  non flu patients
• The nebulisers will NOT be used
• Routine care will be suspended
• (minor ops, medicals, childhood immunisations,
  well woman, diabetes and asthma checks will be
  suspended)

26
Callowland planning

• Masks should be worn when seeing patients with
  flu and in some circumstances gloves and aprons
• (maintain stocks and buy an initial supply of
  masks)
• Nebulisers should not be used
• Safe bins will be provided in patient areas for
  discarded tissues
• Soft furnishings and books should be removed from
  flu areas to minimise infection risk
• Careful cleaning of areas, especially after flu
  patients are seen, is essential
• (increased cleaning contract)

27
Business continuity planning

• A pandemic might last three months and 25 of
  workers will be off for 5 to 8 days during this
• At any one time there will be a 10 to 35
  absenteeism rate peaking at 8 to 9 weeks into the
  pandemic

28
Business continuity planning

• We will need to be flexible with rotas
• By cancelling routine tasks we can free up time
• Staff will need holidays and rest periods to
  sustain care though we may need to reduce
  numbers taking holiday and cancel study leave
• We recognise the need to be sympathetic if staff
  cancel holidays and lose money as a result
• Childcare support may be needed for staff with
  children or grandchildren that they look after
• We are a TEAM and will pull together

29
And finally