Pandemic Influenza and Preparedness

1. Pandemic Influenza and Preparedness Dr Michael Hills Associate Director Critical Response Coordination Health Services Functional Area Coordinator South Eastern Sydney and Illawarra AHS Fences or Flowers

2. Acknowledgement • Several slides come from the UK Department of Health’s website http://www.dh.gov.uk/ - Pandemic Flu Fences or Flowers

3. Outline • Influenza • Historical • Management • Health Planning • Business Continuity Fences or Flowers

4. Understanding 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 Fences or Flowers

5. What is a flu pandemic? • Flu pandemics are global epidemics of a newly emerged strain of flu (a new influenza Asubtype) • Three pandemics in the last century • Worst killed 20 - 40 million worldwide – more lives lost than during the First World War Fences or Flowers

6. What causes pandemic flu? • Emergence of a new flu virus • 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 Fences or Flowers

7. Who is at risk? • Everyone is at risk • Certain groups may be at greater risk of serious illness than others • Until the virus starts circulating we will not know for sure who is at most risk Fences or Flowers

8. Is there a vaccine? • Because the virus will be new, there will be no vaccine ready to protect against pandemic flu • A specific vaccine cannot be made until the virus has been identified • Cannot be predicted in same way as ‘ordinary’ seasonal flu • ‘Ordinary’ flu vaccine or past flu jab will not provide protection Fences or Flowers

9. What is influenza? • An acute illness resulting from infection by an influenza virus • Highly infectious • Can spread rapidly from person to person • Some strains cause more severe illness than others Fences or Flowers

10. Symptoms • Generally of sudden onset • Fever, headache, aching muscles, severe weakness • Respiratory symptoms e.g. cough, sore throat, difficulty breathing Fences or Flowers

11. Incubation period of influenza • Estimates vary • The range described is from 1 to 4 days • Most incubation periods are in the range of 2-3 days Fences or Flowers

12. How influenza 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 else’s face Fences or Flowers

13. Previous pandemics 1580 - 1900 - 28 pandemics Fences or Flowers

14. Circulating Influenza strains and pandemics in 20th Century 1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu” 20-40 million deaths 1 million deaths 1 million deaths H3N2 H2N2 H1N1 H1N1 1920 1940 1960 1980 2000 Fences or Flowers

15. Lessons from past pandemics • Occur unpredictably, not always in winter • Great variations in mortality, severity of illness and pattern of illness or age most severely affected • Rapid surge in number of cases over brief period of time, often measured in weeks • Tend to occur in waves - subsequent waves may be more or less severe Key lesson - unpredictability Fences or Flowers

16. Framework • Australian Health Management Plan for Pandemic Influenza June 2005 May 2006 • NSW Interim Pandemic Plan – Nov 2005 • Area Interim Plan – March 2006 • Hospitals etc. • New national and state plans mid-2006 • COAG • National Action Plan for a Human Influenza Pandemic • States • Whole of Government planning Fences or Flowers

17. Australian Health Management Plan for Pandemic Influenza • Two core strategies: • Containment • initial priority • Maintenance of Social Functioning • as it progresses • Phases • Overseas Level 3 • Australia Level 0 Fences or Flowers

18. Challenges • Health planning • Non-health planning • Universal impact • Scarcity • Unpredictable • Unknown • Information will change • Volume Fences or Flowers

19. Manage Workforce • Absenteeism • Vaccination • Education and training • Protection, prophylaxis • Allocation of duties • Re-allocation of staff to ‘flu response • Return to work • Child care requirements Fences or Flowers

20. Manage Workload • Curtailing of non-priority services • Establishment of fever clinics (if designated) • Triaging at ED’s and procedures • Inpatient units (isolation, wards, ICU/HDU) • Shift services to other sites • Run new services • Management of cases Fences or Flowers

21. Wider linkages • Emergency Accommodation • Community links • General practice (through Divisions) • Home discharge • Travellers’ management • Roles of community service staff • Support at home and in nursing homes • Public health surveillance and reporting • Communication and coordination across sectors (National, State, Area, Sector, Public, Individuals) Fences or Flowers

22. Non-Health Sector • COAG • National Action Plan for a Human Influenza Pandemic • States and Territories • Businesses • Department of Industry, Tourism and Resources (mid-2006): www.industry.gov.au/avianflubusinesscontinuity Fences or Flowers

23. Business Continuity Planning • “The most important thing businesses and community organisations can do to prepare for a pandemic is have a business continuity plan in place.” AHMPPI May 2006 • Different from other emergencies. • emphasis on continuity in the event of high absenteeism and interruptions to the supply of goods and services • Absenteeism could be as high as 30% to 50% Fences or Flowers

24. Key issues • Identify essential business activities + alternative arrangements • Identify what is required for the organisation to continue operating at the minimum acceptable level • Develop mitigation strategies for business disruptions and shortages • Ensure wide awareness of contingencies • Minimising illness in workers, drawing on the guidance on infection control in this plan. Fences or Flowers

25. Where Next? • Consider it as one of the sources of risk in organisational planning • Use the opportunity to review critical aspects of services • (Re) Learn interdependencies • Start reading • Be engaged Fences or Flowers

26. Thank - you www.health.gov.au www.industry.gov.au/avianflubusinesscontinuity www.fluready.net http://www.dh.gov.uk Fences or Flowers