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Ethical considerations among Response to H1N1 Pandemic in China

Ethical considerations among Response to H1N1 Pandemic in China. China CDC, CFETP Huilai Ma, Guang Zeng. General Ethical Considerations during response to pandemic H1N1. Balancing potentially conflicting individual and community interests Evidence base for public health measures

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Ethical considerations among Response to H1N1 Pandemic in China

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  1. Ethical considerations among Response to H1N1 Pandemic in China China CDC, CFETP Huilai Ma, Guang Zeng

  2. General Ethical Considerations during response to pandemic H1N1 • Balancing potentially conflicting individual and community interests • Evidence base for public health measures • Resource constraints • Limited resources and immediate health-care needs

  3. Factors affecting Public health policy during pandemic H1N1 in China • A new influenza virus emerges: • Four different genes • Estimated case fatality ratio (CFR) • 0.4% (range 0.3% to 1.5%) • Clinical severity • WHO raised Level of influenza pandemic alert at phase 6 on June 11, 2009

  4. Fundamental Realities of China • > 1.3 billion population • >700 million rural population • High and variable population density • About 140 million migrant population

  5. Significant Rural-Urban Differences in Medical Resources in China Hospital beds/1000 population, 2008 Health professionals/1000 population, 2008

  6. Amend statute on management of the pandemic H1N1 in due time StageⅠ: April 30 Category B notifiable Disease Adopt Category ADiseases Managed as a Quarantinable Disease”

  7. June 11 Community transmission occurred • Quarantine and Isolation • Free treatment • Strategy for prevention school outbreak May 29 First documented transmission May 11 1st imported case documented Confirmed pandemic (H1N1) influenza cases: China (as of June 11, 2010) Number of Cases May June 2009

  8. Reporting & Investigation Medical check-up Close Contacts CDC Medical Service If fever or respiratory symptoms • Transfer to designated medical service institution • Advise to stay home for isolation and treatment • Start specimen collection and testing immediately • Conduct medical observation for all close contacts If close contacts showed no symptoms after 7 days of medical observation If tested (-) for H1N1 influenza End medical observation for all close contacts End medical observation Management of Close Contacts

  9. CFETP finding: highlight the need to prevent transmission by droplets and fomites during a pandemic H1N1

  10. Population at High Risk for Developing Severe H1N1 Infection

  11. StageⅡ: July 10 Category B notifiable Disease Adopt Category BDiseases Managed as a Surveillance Disease Amend statute on management of the pandemic H1N1 in due time StageⅠ: April 30 Category B notifiable Disease Adopt Category A Diseases Managed as a Quarantinable Disease

  12. Confirmed pandemic (H1N1) influenza cases: China (as of Feb. 21, 2010) Strategy for reduce fatality rate Sept. 16 Pandemic (H1N1) vaccination started June 11 Community transmission occurred 14 10 Number of Cases (×1000) 6 2 May June July Aug. Sep. Oct. Nov. Dec. Jan. Feb. 2009 2010

  13. “Severe Patients First” Principle Specify treatment responsibilities for different levels of medical providers Arrange for patients in hospitalization based on patient condition and available resources

  14. Help people in need Enhanced cooperation among financial, human resource and social security departments Provided assistance to people with financial difficulties Needs-based Various forms of assistance Improved contents of assistance Gave priority to treatment of hospitalized patients

  15. Vaccination Strategy in China Make sure the vaccines were: Well-informed of benefits as well as potential risks Voluntary Free of charge The following areas were vaccinated first Areas with outbreaks Areas with high population density and mobilization High priority group was selected by local government Public service personnel at critical positions Patients with chronic diseases Pregnant women Children aged 6-35 months Others

  16. Thank you!

  17. Isolation and Quarantine Was the decision on isolation and quarantine ethical? Ethics problems include: Should isolation and quarantine be implemented? How should isolation and quarantine be carried out?

  18. Treatment Prioritization If not all patients can receive medical treatment, which patients should be treated first? What is the criteria for hospitalization? What is the criteria for receiving intensive care? How to provide medical services in western region, where resources are less abundant?

  19. Ethical issues to be incorporated into the current draft plan Is airport temperature check necessary? Is quarantine of contacts necessary? Containment at source country vs. quarantine Priority of fund use

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