AURIMS Dr. Scott Wilkinson MD Area Medical Director International SOS Australasia

2. Current Thinking on Pandemics and Planning AURIMS, Auckland17 May, 2006

3. Agenda Basics of Avian and Pandemic Influenza Latest on Avian Flu Risks to Educational Facilities Key Issues for Educational Facilities Effects on Travel Pandemic Planning

5. The Pandemic Clock is ticking…we just don’t know what time it is. Edgar Marcus University of Washington School of Medicine

6. Influenza pandemics 20th century

7. Influenza pandemics are recurring events

8. A Pandemic WILL occur:

9. The influenza pandemic of 1918-19 killed more humans than any other disease in a period of similar duration in the history of the world. Alfred W. Crosby, historian & author America’s Forgotten Pandemic: The Influenza of 1918 The “Forgotten Pandemic”

10. 1917-18 “Spanish Flu” Avian strain of influenza virus Virus was similar to current bird flu virus Spread around the globe in 4-6 months Had several "waves" of infection (each lasted 6-12 weeks) Infected between 25-30% of the world population Killed 40-100 million world-wide Majority of deaths were in persons 18 to 40 years old Similar to usual flu symptoms only worse

13. WHO Situational Assessment as at May 2006 Risk of Pandemic is great The risk will persist The evolution of the threat cannot be predicted The early warning systems are weak Preventative intervention is possible, current testing in Vietnam and Australia Reduction of morb/mort impeded by inadequate medical supplies Preparation is the best protection

14. Avian influenza H5N1 virus is now affecting poultry flocks in an increasing number of countries Aggressive infection - quickly kills whole flocks Can infect humans - mainly only people living/working with poultry Over 200 people infected - more than half have died (mortality rate >50%!!!!) Cannot yet easily spread from person to person H5N1 - The Basics

15. H5N1 - The Basics An Influenza Virus must have three (3) attributes to become a Pandemic Virus: A novel (new) virus which humans have no immunity ? The virus causes significant human illness and death ? The virus can spread easily from person to person x Avian Flu H5N1 has 2 out of 3 today…

16. Since the H5 and H9 investigation we have learned that a reassortment event that could create a pandemic strain could directly occur in humans potentially increasing the likelihood of a pandemic With this in mind…Since the H5 and H9 investigation we have learned that a reassortment event that could create a pandemic strain could directly occur in humans potentially increasing the likelihood of a pandemic With this in mind…

17. Infectivity period: 1 day before, 14 days after Can be transmitted in 3 main ways: 1. Contact transmission: Direct - Kissing Indirect – Sharing 2. Mainly by “droplet” spread: Coughing, sneezing and talking Mucous membranes Virus active on hard surfaces for 48 hours 3. “Aerosol” spread: Unusual but possible in very crowded conditions

18. WHO Classification of Pandemic Phases Reflects increasing risk of a pandemic Phases may be skipped (or rapidly moved through) Pandemic alert period is final opportunity to prepare

20. Could trigger a pandemic similar to 1918-19 But the world is different: 5 billion inhabitants (only 1.5 billion in 1917) Rapid spread via jet travel Few stockpiles due to “just in time” economies No specific antiviral treatments developed No vaccine (seasonal vaccine NOT protective) A New Pandemic?

21. Human infections (as at 8 May 2006): Turkey (12 cases, 4 deaths) Vietnam (93 cases, 42 deaths) Indonesia (33 cases, 25 deaths) Cambodia (6 cases, 6 deaths) Thailand (22 cases, 14 deaths) China (18 cases, 12 deaths) Iraq (2 cases, 2 deaths) Azerbaijan (8 cases, 5 deaths) Egypt (13 cases, 5 deaths) H5N1 Avian Flu – where is it now?

23. Risks to universities General effects of a pandemic in the community 7 - 150 million globally will die (WHO) 10x that will require medical attention. Healthcare systems may become overwhelmed Essential services may break down as key personnel are infected Businesses may close, and International travel may be limited as governments restrict entry.

25. Risks to universities Specific effects of a pandemic in universities Up to 40% of students may become infected – young healthy people may be the most vulnerable, and have the highest mortality rate Up to 30% of staff may become infected, up to 50% may be absent at any one time International students and those studying abroad may be stranded when boarders close Universities may be forced to close by governments Universities may be forced to care for residential students unable to return home

27. Pandemic Influenza is different to SARS

29. Highly mobile populations

30. Transmission of the virus within universities

31. Insurance issues

32. Entry point screening on campus

33. Medical care on campus

37. Sample Policy Areas Pandemic planning Communications – with staff, students and externally Business continuity – to close, or attempt to continue teaching Optimizing staff and student health Reducing the risk of staff and students becoming infected – including door screening, PPE, social distancing Managing infected staff and students on campus Assisting travelling staff and students Managing the deceased

39. Sample Action Table

40. Sample Information Sheets

41. Sample Information Sheets

42. Sample Checklist