INFECTION PREVENTION CONTROL NURSES COLLEGE CONFERENCE 2019 “Managing Infectious Outbreaks – the Canterbury Collaborative Approach” Dr Phil Schroeder: Primary Care Coordinator Kelly Robertson: Nurse Advisor Canterbury Primary Response Group
NZ Health Organisational Structures and Plans Ministry of Civil Defence and Emergency Management (MCDEM) National CDEM Plan Ministry of Health National Health Emergency Plan Specialist plans: Burns, Pandemic Etc. CDHB North Island DHB Plans South Island DHB Plans Emergency Plan CPRG Community and Public Health Emergency Plan Emergency Plan Hospital(s) Emergency Plans Wards/Units Practices/Clinics/Providers Emergency Plans Emergency Plans
Canterbury Primary Response Group Agencies and Funders Primary • • Primary Health Organisations Ministry of Health • • General Practice Civil Defence and Council • 24HS & Urgent Clinics • Canterbury District Health Board • Community Pharmacy • Hospital & Secondary Care • Community Nursing + Home Care • Community and Public Health • Plunket and Midwives • St John Ambulance • Maori and Pasifika Community • Aid Agencies e.g. Red Cross Health • Mental Health NGOs • Allied Health Workers • • Private Hospitals Residential Care Facilities • • Radiology & Laboratories Hotels • Media & Communications
Canterbury Health Emergency Risk Register Health Infectious Mass Casualty Public Health Influenza Pandemic Outbreak eg. Event Emergency Emergency SARS Non Health Flood or Extreme Weather Earthquake Fire Tsunami Event Emergency Health Non- Noro-virus Measles Hazardous Community Outbreak Substances Event Emergency Outbreak
2005: Canterbury Primary Pandemic Group • Readiness plans for pandemic influenza (H5N1 Avian Flu) 2009: Pandemic Influenza • H1N1 Swine Flu • Central ChCh and Rural Flu Centres 2011: Canterbury Primary Response Group • Canterbury Earthquake Responses • Seven activations Primary EOC required 2012+: Annual Influenza Response • Canterbury annual response for predictable winter wave
2016: Canterbury Primary Response Group • Hurunui/Kaikoura Earthquake Responses 2019: Canterbury Measles Outbreak • Mass vaccination programme general practice 2019: Terrorist Mass Shooting Christchurch 1503 • Two Muslim mosques targeted with 50 fatalities and 40+ injured • Supports for Muslim community and healthcare workers
Infectious Risk – CPRG’s Responses 2009 – Pandemic – H1N1 (pdm09) 2012, 2015, 2019 – Influenza 2019 Measles
Threat of Pandemic 2005: Canterbury Primary Pandemic Group • Readiness plans for pandemic influenza (H5N1 Avian Flu) 2009: Pandemic Influenza • H1N1 Swine Flu • Central ChCh and Rural Flu Centres
“How We Managed It” - CPRG’s Response to Swine Flu • Local 0800 Flu Line • Flu Centres (CBACs) • Primary Care Control Room • Integrated intelligence process • Web-based technology: • Patient information application • Primary Response Website • FluInfo website (CDHB) + Advertising + Signage • Community volunteer database
A New Model of Care….. “Flu Centres”
Assessed patients by symptom 100% 90% Proportion of assessed population 80% 70% 60% 50% 40% 30% 20% 10% 0% Aching Shortness Fever Cough Sore throat Headache Diarrhoea Vomiting Chest Pain muscles of breath 79% 89% 67% 67% 72% 27% 25% 49% 30% 7 days to midnight Sun 26 July 76% 88% 71% 66% 72% 22% 26% 47% 24% 7 days to midnight Sun 2 Aug Symptom
Challenges Considered ………………………….
Future Planning - Streaming & Designated Clinics Centralised Decentralised Response Options + +++ ++ + ++ The aim is to manage the + response so we: Go no further to the right than we have to, for no longer than we have to, with no more practices than we have to Level 1: Business as Usual Level 2: Sector-based Response Level 3: Centralised Response AVERAGE-BUSY SEASON EXCEPTIONALLY BUSY SEASON PANDEMIC • Patients ( green ) and ILI patients ( red ) attend • A practice/premise is established as a Designated • A Designated Clinic(s) is established for all red at their usual general practice. Clinic in a small geographic area. stream patients from a larger geographic area, • Recommend screening patients to green and • The Designated Clinic manages its own green and e.g. urban Christchurch. • Green stream patients continue to attend their red streams if experiencing higher levels of red stream patients and red stream patients from ILI. other practices. usual general practice.
Threat of Influenza 2005: Canterbury Primary Pandemic Group • Readiness plans for pandemic influenza (H5N1 Avian Flu) 2009: Pandemic Influenza • H1N1 Swine Flu • Central ChCh and Rural Flu Centres 2012+: Annual Influenza Response • Canterbury annual response for predictable winter wave
Canterbury Health Laboratories Influenza A
2019 Primary Care Annual Flu Response Plan Intelligence Immunisation Strategy Practice/Pharmacy/Facility Preparedness Hospital and Emergency Department
CPRG – Canterbury Influenza Group Agencies and Funders Primary • Ministry of Health/ESR • Primary Health Organisations • Civil Defence and Council • General Practice • CDHB - Hospital & Secondary • 24HS & Urgent Clinics Care • Community Pharmacy • Community and Public Health • Community Nursing + Home Care • St John Ambulance • Plunket and Midwives • Aid Agencies e.g. Red Cross • Maori and Pasifika Community • Mental Health NGOs Health • Private Hospitals • Allied Health Workers • Hotels • Aged Residential Care • Media & Communications • Radiology & Laboratories
Canterbury Primary Response Group Partners......... Community & Public Health: Intelligence Immunisation Service Level Alliance: Immunisation • • January-May Pre-activation January-May Pre-activation – Monitor Northern Hemisphere influenza trends – Advise on national immunisation strategy – Anticipate how this might translate to – Advise approved funding arrangements for Canterbury winter upcoming flu season – Maintain effective working relationships with – Confirm arrival dates of this year’s flu vaccines ESR to support ILI data collection from sentinel – Deliver communications package to health practices providers – Monitor for other global infections risks and reporting accordingly • June-October Activation – Report on immunisation uptake (patients and • June-October Activation staff) – Prepare weekly Respiratory Illness and virology – Advise any changes to the funded season status reports – Present trends at Influenza Group meetings with commentary – Track impact on Canterbury health system
Canterbury Primary Response Group: Primary Care January-May Pre-activation • Liaise with general practice and community pharmacy • Develop contingency plans for range of community-based response options (the Influenza Toolkit) • Prepare general practice, community pharmacy, community nursing and aged care facilities: • Correct signage and PPE practices, pharmacies and aged care facilities • Regular updates to reinforce workforce and practice responses June-October Activation Continue regular updates Contribute to Key Messages in Respiratory Illness reports Track influenza impact on Canterbury Health System
Measles 2019
Measles 2019 • Notifications to Community and Public Health of measles cases from February 16 th . • Contact tracing an isolation orders through Community and Public Health. • Recognition that the spread was: – Beyond the capacity for contract tracing alone. – Involving age groups felt to be reasonably covered with past vaccination (esp 29-50yrs ages). • CPRG called to coordinate a mass vaccination programme that would have involved about 125,000 potential individuals. • NZ MMR supplies limited and message was changed to vaccinating the most vulnerable in a prioritized vaccination approach with 30,000 available vaccine doses.
Measles 2019 Canterbury Lessons 1) Trust the vaccination rates and dedicate efforts to vaccinate the unvaccinated and children at 12 months age. 2) Future-proof the community by encouraging MMR as a normal travel vaccination especially to endemic areas.
Thank you and any questions? CPRG Emergency Planning & Response Website www.primaryhealthresponse.org.nz
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