Orientation – swine influenza surge response

1. Orientation – swine influenza surge response 28 April 2009 version1

2. Aim of public health response • Detect and confirm cases of swine influenza A(H1N1) viruses infection • Establish the extent of spread within Australia • Assist in the early severity assessment of the disease. • Note • For suspected swine influenza to date the severity of symptoms has been mild, therefore cases are being notified through general practitioners.

3. Where will you be working • Hunter New England Population Health has three operational sites: • Wallsend • Tamworth • Taree • At present you will only be located at either Wallsend or Tamworth, however a pod may be placed a Taree in the near future.

4. Wallsend Site • The Wallsend site is located at: Booth Building Wallsend Health Services Longworth Avenue, Wallsend • Location • Map link • Parking information link • Please report to reception booth building to sign in. You will then be met by your pod leader.

5. Pod Leaders - Wallsend • For those who worked during XFG you will be familiar with some of the pod leaders: • Maggi Osbourn • Kerry Todd • Julie Kohlhagen • Note: pod leaders may change as situation changes.

6. Tamworth Site • The Tamworth site is located at: Level 2 Parry House 470 Peel Street Tamworth Phone: 6767 8630 • Location • Map • Parking information link • Please report to reception to sign in. You will then be met by your pod leader.

7. Pod leaders - Tamworth • For those who worked during XFG you will be familiar with some of the pod leaders: • Peter Massey • April Worley • Note: pod leaders may change as situation changes.

8. Daily timetable NOTE: daily timetable will change if the situation escalates. You will be kept updated on any changes as they arise.

9. Occupation Health and Safety • Please let your pod leader know if you have any occupational health and safety requirements • Regular breaks will be provided throughout the day. However if you need a break please do not hesitate to let your pod leader know and this will be accommodated as soon as possible.

10. Other issues • Computer and telephone log ons will be provided to you during orientation on your first day. • Each day lunch will be provided • If you cannot arrive on time or need to leave early please let your pod leader know. • If you cannot report to work please call logistics within the Public Health Emergency Operational Centre (PHEOC)

11. What’s involved • For those who participated in XFG your role will be fairly similar, that is: • Taking notifications of suspected cases • Interviewing suspected cases using a questionnaire over the telephone • Providing home quarantine advice (fairly standard respiratory etiquette, described in detail later) • Answering call from the general public, general practitioners and emergency departments. • Please familiarise yourself with the job action sheet (click here)

12. Case definition • A case definition is a set of criteria which allows you to determine if a person is a case or suspected case of swine influenza. • The case definition is changing regularly as new information becomes available • Your pod leader with distribute the new case definition to you.

13. Case Form • The case form attached is what you will use to interview suspected cases over the telephone. • Link to case form • The case form has six distinct parts: • Notification details • Case demographics • Case symptoms • Testing • Treatment-antivirals • Case outcomes

14. Case Form • Notification - the treating doctors or GPs details in case we need to contact them again for further information • Case demographics – details that describe the person eg sex, age, travel. This helps to build our epidemiological picture concerning those infected • Symptoms - information on date and time of onset. This helps build a picture of disease severity.

15. Case Form • Testing- this information lets us know what tests have been ordered and where they were sent. It is important to get a laboratory test done for swine influenza (H1N1) as we cannot confirm they are a case until we have the laboratory results. • Case outcomes - a summary of findings that answers the question. “is this person a case of swine influenza?”.

16. Laboratory testing information • GPs or ED doctors may ask you what specimens they are meant to collect and where they should be sent. • Firstly samples should only be collected if the person is still symptomatic. If symptoms have resolved there is little value in doing a test for influenza. • Specimens to be collected for public health are: • Infant < 2yrs: nasopharyngeal aspirate or nose and throat swab. • Other children and adults: nose and throat swab sample; must use correct swab type (green viral culture transport swab). Assay can also be performed on sputum.

17. Laboratory information • Other specimens may be required if clinically appropriate, however the above is all public health require for an influenza test to be conducted. It is up to the treating physician if they want to order additional tests. • http://intranet.hne.health.nsw.gov.au/__data/assets/pdf_file/0011/61103/Memo_-_To_HNE_Clin_Staff_-_Diagnosis_of_Influenza_final_final_2009.pdf

18. Anti-viral Use • A case who are still symptomatic should be prescribed anti-virals such as Tamiflu if their onset of symptoms was in the past 48hrs. • No prophylaxis has been recommended as yet for contacts. • Anti-virals can only be prescribed by a public health physician, GP or physician. You will not have to make the decision alone if antivirals are required.

19. Home Isolation • Isolation is a health strategy to keep people who are actually sick with an infectious disease away from other people as much as possible. • We cannot force suspected cases to isolate themselves at home, they must do so voluntarily. We can only provide information on how they can protect family and friends from illness. • Home isolation involves • Keeping away from other individuals in the house • Covering mouth when coughing or sneeze • Washing hands after coughing and sneezing

20. Home Isolation • If anyone else in the house feels unwell to go see their GP or go to the local ED. • If the cases symptoms worsen they should go to local ED immediately

21. Public Health Enquires • Many people in the community are concerned about swine influenza especially if they have traveled overseas or been in contact with someone who has traveled overseas. • An algorithm will be available which will guide you through questions from the public • On many occasions you may direct people to fact sheets on websites or send these by email or fax to them. • http://www.health.nsw.gov.au/publichealth/swine_flu.asp

22. Differences from XFG • During XFG contacts of cases were also followed up. At this stage contact are not being interviewed for swine influenza. However like everything this may change. • Anti-virals were not distributed during XFG however cases who’s onset of symptoms was in the past 48hours require anti-virals such as tamiflu. • Cases were isolated in hospital during XFG however currently most cases are not sick enough to be admitted to hospital therefore they are asked to isolate themselves at home

23. Thank you • We would like to thank you in advance for your assistance and work • We hope you find the experience interesting and rewarding. • If you have any concerns please do not hesitate to talk to your pod leader.