WHO Recommendations: Pandemic Influenza Planning
Why prepare for a pandemic? • Be able to recognize it early and manage it • Contain it or slow its transmission • Decrease cases, hospitalizations, deaths • Maintain essential services (i.e., medical) • Reduce the economic and social impact
Broad Risks of a Pandemic • Food and income loss from poultry deaths/ Livelihoods culling & decreased economic activity • High illness & potentially higher death rates • Overstretched health facilities Human Health • Disproportionate impact on vulnerable • Increased demand for governance & security Governance & • Higher public anxiety Security • Reduced capacity due to illness & death • Deterioration of coping & support mechanisms Social & • Interruption in public services Humanitarian Needs • Quarantine policies • Trade & commerce disruptions • Degraded labour force Economic Systems • Interruption of regular supply systems
How can you prepare? • Recognize the pandemic phase (set globally by the DG of WHO) • Detect, report and investigate early signals • Develop a pandemic preparedness plan; conduct exercises/drills to make sure it works
WHO Pandemic Phases Phase Period Level of Risk 1 Interpandemic period Low risk of human cases 2 New virus in animals, Higher risk of human cases no human cases 3 Pandemic alert No or very limited human-to- human transmission 4 New virus causes Evidence of increased human- human cases to-human transmission 5 New virus causes Evidence of significant human- human cases to-human transmission 6 Pandemic Efficient and sustained human- to-human transmission
Threat of H5N1 Human Influenza Inter-pandemic Period Pandemic Alert Period Pandemic Period ? H5N1: • Circulating in wild birds • Has infected humans in • If H5N1 evolves into a and poultry since 2003 rare instances - human virus it could cause • Highly contagious / resulting from close a human influenza deadly among birds exposure to sick birds pandemic • Spreading from Asia to and/or their droppings • Also possibility that H5N1 Europe, Middle East never evolves into a human and Africa virus
Scenarios - 3 Broad MODELS MODEL 3 - Rapid Onset / Widespread impact Little time for preparation, response is MODEL 2 - Slow Onset / reactive and defensive Moderate & Localized Impact Slowly acquires human infectiousness. Impact Depending on the evolution of virus it may Yes be contained after its emergence. May Does human influenza virus also develop into a pandemic immediately spread rapidly No with high caseloads and increasing mortality? MODEL 1 – Extended WHO Yes Phase 3 / Continued Outbreaks Does avian virus become of Avian Influenza efficiently transmissible from Impact on livelihoods due to culling of birds No human to human? Time
Interpandemic period Phase Goal 1: No new influenza virus subtypes Strengthen influenza have been detected in humans. pandemic preparedness at the global, regional, national, and An influenza virus subtype that has subnational levels. caused infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low 2: No new influenza virus subtypes Minimize the risk of have been detected in humans. transmission to humans. However, a circulating animal Detect and report such influenza virus subtype poses a transmission rapidly if it occurs. substantial risk of human disease.
Pandemic alert period Phase Goal 3: Human infection(s) with a new Ensure rapid characterization of subtype, but no human-to-human the new virus subtype and early spread , or at most rare instances of detection, notification, and spread to a close contact. response to additional cases. 4: Small cluster(s) with limited Contain the new virus within human-to-human transmission but limited foci or delay spread to spread is highly localized , gain time to implement suggesting that the virus is not well preparedness measures, adapted to humans. including vaccine development. 5: Larger cluster(s) but human-to- Maximize efforts to contain or human spread still localized, delay spread, to possibly avert suggesting that the virus is a pandemic and to gain time to becoming increasingly better implement pandemic response adapted to humans, but may not yet measures. be fully transmissible (substantial pandemic risk).
Pandemic period Phase Goal 6: Pandemic: increased and Minimize the impact of the sustained transmission in the pandemic. general population. http://www.paho.org/English/DD/PIN/ptoday08_sep05.htm
Discuss: Name events that would change a pandemic phase •New virus subtype •Documentation of human cases •Evidence of human-to human transmission •Increasing human-to human transmission by geographic area
Discuss: Given a change in pandemic phase, what events follow?
WHO 5 strategic actions for human pandemic influenza Education 1 Reduce human Compensation exposure to H5N1 Communication National/Regional/Global 2 Strengthen the early - Sensitive detection system In response to human warning system - Rapid laboratory confirmation cases/clusters 3 Intensify rapid - Real-time risk assessment - Rapid field investigation containment operations - Immediate communications - Contact tracing and monitoring National/regional/global 4 Build capacity to cope preparedness requires - Stringent infection control with a pandemic - Commitment Improve the ability to develop, - Intervention with international produce and deliver vaccine to rapid response stockpile - Contribution by all sectors 5 Coordinate global large numbers of people in a timely manner - Communication with the public science & research Strengthen WHO's capacity to - Command & Control systems acceleration of vaccine gather data, access global development, expansion - Capital investment expertise and translate into vital advice and guidance of production capacity
Objectives by phase The objectives of the strategic actions correspond to the principal opportunities to intervene Phase: Interpandemic 1. Reduce opportunities for human infection 2. Strengthen the early warning system Phase: Pandemic alert 3. Contain or delay spread at the source Phase: Pandemic period 4. Reduce morbidity, mortality, and social disruption 5. Conduct research to guide response measures http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_05_8-EN.pdf
Recommended 5 components in a plan by phase • Planning & coordination • Situation monitoring/assessment • Prevention & containment • Health system response • Communications
Of critical importance 1. High level political commitment 2. Intersectoral involvement • Other government departments (e.g. agriculture, labor, education, defense, transport, trade, judiciary) • Private sector/civil society (e.g. industry, NGOs) 3 Consideration of existing resources as well as unmet resource needs Source: WHO Informal consultation on influenza pandemic preparedness in countries with limited resources, 2004
Activity: Does your country have a pandemic influenza plan? Divide into groups and discuss/brainstorm current country-specific pandemic plans Examples: –http://www.who.int/csr/disease/influenza/nationalpandemic/en/index.html –WHO checklist for preparedness (include in participant guide to use as a guideline for discussion)
Lessons learned from previous influenza pandemics • Pandemics are unpredictable • The need for medical services will increase quickly • Disease in non-traditional groups defines a pandemic’s overall impact • Viruses attack in waves. Those not affected by the first wave are vulnerable in the second wave.
• Surveillance plays a large role in confirming and reacting quickly to pandemics • Surveillance of animals can provide an early warning • Social distancing (e.g. temporary closing of schools and other public gathering) can slow the pandemic
• Slowing the spread of the virus means that more medical services will be available for those who are sick at any given time • Limited vaccine production means that they may arrive too late to have an impact • Those who manufacture vaccines domestically will receive them first Source: WHO, Avian Influenza: Assessing the Pandemic Threat, 2005
WHO Tools > 40 guidelines http://www.who.int/csr/disease/avian_influenza/guidelines/
WHO pandemic influenza draft protocol for rapid response and containment http://www.who.int/csr/disease/avian_influenza/guidelines/ “The success of a strategy for containing an emerging pandemic influenza virus is strictly time dependent: Modelling studies suggest that mass administration of antiviral drugs must begin within 21 days following detection of the first case representing improved human-to-human transmission of the virus.”
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