Avian Influenza Pandemic An OHS Perspective

1. Avian Influenza PandemicAn OHS Perspective Presentation to the Commonwealth Safety Management Forum 23 November 2006 Brian Ewert

2. Presentation Overview Part 1: • What is Avian Influenza? • Avian Influenza within Australia • 20th Century Pandemics • 21st Century Epidemic • H5N1 History & Epidemiology

3. Presentation Overview Part 2: • The Key Facts • What is the Risk? • Antivirals • Vaccines

4. Presentation Overview Part 3: • Pandemic Preparedness Part 4: • OHS Considerations Part 5: • CSMF Assistance Part 6: • Open Forum

5. What is Avian Influenza? Avian Influenza within Australia 20th Century Pandemics 21st Century Epidemic H5N1 History & Epidemiology Part 1

6. primarily affects birds: chickens turkeys pheasants quail pigeons ducks geese guinea fowl ostriches sea birds migratory waterfowl & less commonly: rats ferrets white rabbits pigs tigers leopards domestic cats & rarely: humans What is Avian Influenza?An infectious viral disease that

7. There are numerous strains and subtypes of the virus. Strains vary from low to highly pathogenic. Highly pathogenic avian influenza was first identified 1878. 4 strains are known to cause human infection. Only H5N1 is currently linked to severe human infection and death (rare). All human cases of avian influenza have coincided with outbreaks in poultry. What is Avian Influenza?

8. Historically Australia has experienced avian influenza ‘outbreaks’: 1976 Melbourne Suburbs, Victoria (H7N7 strain) 1985 Bendigo, Victoria (H7N7 strain) 1992 Bendigo, Victoria (H7N3 strain) 1994 Lowood, Queensland (H7N3 strain) 1997 Tamworth, New South Wales (H7N4 strain) To date no human avian influenza cases have been reported within Australia. Avian Influenza within Australia

9. Highly pathogenic avian influenza in humans is subject to quarantine control (Quarantine Act 1908). Since February 2004: Australia’s ‘pandemic alert phase’ has remained unchanged (‘Australia 0’ – no circulating animal influenza subtypes in Australia that have caused human disease) compared with the Global ‘pandemic alert phase’ has remained unchanged (‘Overseas 3’ – human infection overseas with new subtypes but no human to human spread or at most rare instances of spread to a close contact) Avian Influenza within Australia

10. 1918 – 1919 ‘Spanish Influenza’: H1N1 strain estimated 40 – 50 million deaths 1957 – 1958 ‘Asian Influenza’: H2N2 strain estimated 2 million deaths 1968 – 1969 ‘Hong Kong Influenza’: H3N2 strain estimated 1 million deaths 20th Century Pandemics

11. 31 influenza pandemics have occurred since the middle ages. On average an influenza pandemic occurs every 30 years. 20th Century Pandemics

12. 2002 – 2003 ‘Severe Acute Respiratory Syndrome’: 26 countries (Western Pacific regional focus) coronavirus (not avian influenza) 8098 ‘probable’ cases (774 deaths) raised awareness of the social and economic impacts of epidemics 21st Century Epidemic

13. 1997 ‘Avian Influenza’: Hong Kong 18 cases (6 deaths) notably 1.5 million birds were culled within 3 days 2003 ‘Avian Influenza’: China & Vietnam 4 cases (4 deaths) H5N1 History & Epidemiology

14. 2004 ‘Avian Influenza’: Thailand & Vietnam 46 cases (32 deaths) 2005 ‘Avian Influenza’: Cambodia, China, Indonesia, Thailand & Vietnam 97 cases (42 deaths) H5N1 History & Epidemiology

15. 2006 (to 13 November 2006) ‘Avian Influenza’: Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Thailand & Turkey 111 cases (75 deaths) Since 2003, human H5N1 mortality rate approximates 60%. H5N1 History & Epidemiology

16. H5N1 History & Epidemiology

17. H5N1 History & Epidemiology

18. H5N1 History & Epidemiology

19. H5N1 History & Epidemiology

20. H5N1 History & Epidemiology

21. The Key Facts What is the Risk? Antivirals Vaccines Part 2

22. Avian influenza and human influenza are different diseases. Type ‘A’ influenza viruses: occur in birds and mammals (humans) cause ‘flu’ can cause a pandemic (rare) Avian influenza is a type ‘A’ virus. The Key Facts

23. Type ‘B’ influenza viruses: occur in humans and dogs cause seasonal ‘flu’ do not cause pandemics Type ‘C’ influenza viruses: occur in humans only cause the common ‘cold’ do not cause pandemics The Key Facts

24. Human avian influenza (H5N1 crossing the species barrier) is primarily attributable to direct human contact with infected birds: slaughtering, defeathering, butchering and preparation of infected poultry for consumption children playing in areas frequented by infected poultry domestic utilisation of water contaminated by the carcasses of dead infected birds chickens/ducks/turkeys/geese… penned together in unhygienic conditions spreading infection The Key Facts

25. The Key Facts

26. Human to human transmission: is possible in rare cases is suspected (2004 Thailand – ill child to mother, and 2006 Indonesia – amongst 8 family members) has not been sustained Importantly: H5N1 has yet to acquire the ability to spread efficiently amongst humans The Key Facts

27. If avian influenza pandemic was to occur: it is most likely to occur overseas amongst poverty stricken rural and periurban communities any spread to Australia would most likely be attributable to international travellers Avian influenza may not evolve into a pandemic virus. It is not possible to predict if/when a pandemic may occur. The Key Facts

28. If the avian influenza mutates (emergence of a ‘new’ strain) there is a risk of: human to human transmission virus rapidly spreading severe infection persisting and recurring in waves from ‘status quo’ to influenza epidemic and possibly a pandemic within 20 – 30 day window What is the Risk?

29. Clinical data supporting the effectiveness of antivirals as a treatment of avian influenza is limited. Antivirals may shorten the duration and lessen the symptoms of avian influenza. Timing of administration appears critical (48 hour ‘window’). Unnecessary antiviral use is linked with drug resistance. Antivirals are currently available by prescription only. Antivirals

30. Vaccines trigger an immune response bolstering the body’s ability to ‘fight’ an infection. Vaccine production cannot usually commence until a virus ‘outbreak’ (the virus strain must first be identified). Large scale vaccine availability is unlikely until after the first wave of infections. Vaccines

31. Pandemic Preparedness Part 3

32. 8 steps to preparing for a pandemic: Obtain senior management commitment and secure allocation of resources. Form a pandemic planning team. Develop pandemic business continuity plans. Form a ‘crisis’ pandemic management team (with requisite delegations). Pandemic Preparedness

33. Undertake workforce planning (skills inventory). Develop and implement an employee communication strategy. Test the effectiveness of preparations. Test employee confidence. Pandemic Preparedness

34. OHS Considerations: Employer’s Duty of Care Employees’ Duty of Care Consultation Risk Management and Hierarchy of Controls Part 4

35. Under Part 2 ‘OHS Act’, employers are required to: take all reasonably practicable steps to protect the health and safety at work of their employees. Therefore: employers should anticipate risks associated with a potential influenza pandemic (ie: risk management) health and safety of employees should be integrated into business continuity planning for pandemic influenza However, in a pandemic scenario what constitutes ‘reasonably practicable’? OHS Considerations

36. Under Part 2 ‘OHS Act’, employees are required to: cooperate with their employer’s reasonable instructions and policies (including risk control) take all reasonably practicable steps to ensure any action or omission does not create or increase a risk to health and safety Therefore: employees should comply with the pandemic health advice and emergency directives issued by their employer and employers should ensure directives comply with public health advice/emergency measures OHS Considerations

37. Under Part 3 ‘OHS Act’, employers are required to: consult employees when assessing risks to health and safety Therefore: employers should consult widely utilising existing workplace arrangements (HSR and OHS Committees) employers should provide accurate and current information and education to employees addressing how a pandemic influenza may affect their work arrangements OHS Considerations

38. Risks associated with an influenza pandemic can be categorised into: the direct risks of infection (contact, airborne droplet and aerosol transmission) indirect risks arising from changes to usual work arrangements Question: How useful is the traditional ‘hierarchy of controls’ when planning for a pandemic (where do antivirals/vaccines ‘fit’)? OHS Considerations

39. Elimination – ? Substitution – ? Isolation – ‘clinical’ quarantine Engineering – improve ‘natural’ ventilation of enclosed workplaces Administration – cough etiquette, promotion of personal hygiene, additional workplace cleaning, home quarantine PPE – mask/goggles/gloves/gowns OHS Considerations

40. Commonwealth Safety Management Forum: How can you assist? Part 5

41. Challenge: integrating OHS risk management into business continuity plans (an employer responsibility) Objectives: assist with across-government consultation (emphasis on health, safety and welfare of employees) develop consistent whole-of-government OHS ‘people management’ influenza pandemic guidelines CSMF

42. social distancing cough etiquette personal hygiene cleaning/disinfecting the workplace managing workplace entry teleworking contract management minimising unnecessary absenteeism managing staff who become ill at work provision & utilisation of PPE home quarantine managing psychological anxiety emergency HR delegations training & communication … CSMFScope:

43. Questions & Answers Discussion Nominations – CSMF AIP Sub-Committee Open Forum

44. Enquiries: Brian Ewert 6225 8963 brian.ewert@immi.gov.au