Department of Human Services

Influenza Pandemic Planning Influenza Pandemic Planning

Elizabeth Birbilis, Senior Policy and Planning OfficerCommunicable Disease Control UnitPublic Health

Presentation OutlinePresentation Outline

• International/National/State Pandemic Planning

• Victorian Influenza Pandemic Plan• The role of GPs• Future Directions

International/National International/National Pandemic PlanningPandemic Planning

• WHO Global Influenza Preparedness Plan – March 2005

• Australian Management Plan for Pandemic Influenza – May 2006

• Australian Governance Plan for Pandemic Influenza – August 2005

• COAG – National Action Plan – July 2006

• Interlocking arrangements– Communicable Diseases Network of Australia (CDNA)– National Influenza Pandemic Action Committee (NIPAC)– Australian Health Protection Committee (AHPC)

• Exercise Cumpston 06– 16 – 19 October

Period Global phase

Australian phase

Description of phase Main strategy

0 Australia 0 No circulating animal influenza subtypes in Australia that have caused human disease

Overseas 1 Animal infection overseas: the risk of human infection or disease is considered low

1 Australia 1

Animal infection in Australia: the risk of human infection is considered low

Overseas 2 Animal infection overseas: substantial risk of human disease In

ter-pandem

ic

2 Australia 2

Animal infection in Australia: substantial risk of human disease

Overseas 3 Human infection overseas with new subtype(s) but no human to human spread or at most rare instances of spread to a close contact

3

Australia 3 Human infection in Australia with new subtype(s) but no human to human spread or at most rare instances of spread to a close contact

Overseas 4

Human infection overseas: small cluster(s) consistent with limited human to human transmission, spread highly localised, suggesting the virus is not well adapted to humans

4

Australia 4

Human infection in Australia: small cluster(s) consistent with limited human to human transmission, spread highly localised, suggesting the virus is not well adapted to humans

Overseas 5

Human infection overseas: large cluster(s) but human to human transmission still localised, suggesting the virus is becoming increasingly better adapted to humans, but may not yet be fully adapted (substantial pandemic risk)

Pandem

ic a

lert

5

Australia 5

Human infection in Australia: large cluster(s) but human to human transmission still localised, suggesting the virus is becoming increasingly better adapted to humans, but may not yet be fully adapted (substantial pandemic risk)

Overseas 6 Pandemic overseas – not in Australia: increased and sustained transmission in general population

Australia 6a Pandemic in Australia: localised (one area of country) Australia 6b Pandemic in Australia: widespread Australia 6c Pandemic in Australia: subsided P

andem

ic

6

Australia 6d Pandemic in Australia: next wave

Containment

Maintain essential services

Victorian Pandemic ModellingVictorian Pandemic Modelling

• Upper limit estimates (30% attack rate)– 24,000 excess hospitalizations– 10,000 excess deaths– 710,000 excess outpatient visits

• Figures based on 6-8 week period

• Victoria’s current healthcare system would be under enormous stress

Victorian Influenza Pandemic PlanVictorian Influenza Pandemic Plan

• Covers response activities including– Surveillance

– Public health (contact tracing, isolation, quarantine)

– Clinical Care

– Community support

– Vaccine/antiviral policy and distribution

– Recovery arrangements

– Laboratory – diagnostic testing

– Business continuity

– Communication

Preparedness InitiativesPreparedness Initiatives

• The Federal government has established the NMS, to supplement existing state resources once a pandemic is declared. It contains items such as antivirals, and personal protective equipment

• Victoria has a small stock of “starter” antivirals and PPE for urgent cases before access to the NMS can be made

• Victorian Government recently provided additional funding to bolster state resources

• Governments working with manufacturers to develop a vaccine – Likely to be 3-6 months before first doses available– Priority administration based on exposure/morbidity risk

National Medical Stockpile National Medical Stockpile (NMS)(NMS)• Components of the NMS Influenza

related:– Antiviral/prophylactic treatments

(Tamiflu/Relenza)– N95/P2 and surgical masks (fit

test kits)– Ventilators and negative pressure

isolation units– Quarantine caches– Vaccination packs– Gloves– Personnel protective equipment

for border workers• Formal arrangement for

state/territory access to the stockpile currently being finalised (MOU). Access via Chief Health Officer request

Current Situation Current Situation – “Overseas 3”– “Overseas 3”

• Enhanced surveillance– raised awareness for health care workers– international, rumors, border– (Suspected) case definition: clinical (Influenza Like

Illness) + epidemiological (travel + poultry contact)

• Containment– isolation of rare suspected cases– rapid testing to exclude diagnosis– antivirals if case confirmed– contact tracing with isolation and antiviral

prophylaxis if case confirmed

Next phases: “Overseas 4 & 5”Next phases: “Overseas 4 & 5”Human to human transmission overseasHuman to human transmission overseas

• Strengthened border controls– discouragement of travel to affected areas

• Strengthened communication• Strengthened surveillance

– new case definition (no longer necessary to have poultry contact)

– close monitoring of international situation

• Intensive containment measures if any imported cases occur– quarantine measures

Next phases: “Aus 4 & 5”Next phases: “Aus 4 & 5”Human to human transmission in AustraliaHuman to human transmission in Australia

• Strengthened surveillance– new case definition (no longer necessary to have

overseas travel) – laboratory testing of all cases will continue– monitor epidemiology as evolves

• Strengthened communication– opening of Health Services Support Centre

• Containment– designated hospitals, stringent infection control,

intensive contact tracing and prophylaxis– escalation of isolation and quarantine

Next phase: “Aus 6”Next phase: “Aus 6”Pandemic in AustraliaPandemic in Australia

• Containment no longer feasible, maintenance of services new strategy

• Surveillance – no longer confirm all cases, monitor morbidity, mortality, and health services utilisation, absenteeism

• Designated hospitals, fever clinics to manage demand

• Contact tracing no longer feasible– education, voluntary home isolation

Next phase: “Aus 6”Next phase: “Aus 6”Pandemic in AustraliaPandemic in Australia

• Strengthen prevention activities– social distancing– cough etiquette/handwashing– increased cleaning– pre-exposure prophylaxis for front line

health care workers, switch to vaccine when available

• Community support model and recovery

Designated Hospital ModelDesignated Hospital Model

Patients will telephone or present to GPs or emergency departments

• In the pandemic alert period, suspected cases will be transferred to the ED’s with isolation roomsif required

• During the pandemic period, confirmed cases will be transferred to ED’s at designated hospitals

• Hospitals will be designated based on • Location• Isolation facilities (e.g. negative pressure rooms)• Infectious diseases expertise

Increasing patient numbers…Increasing patient numbers…

1. Admit patients to isolation rooms

2. Cohort influenza patients in influenza wards

3. Identify specific hospital/s that can be closed and used solely for influenza patients

4. Consider use of non hospital facilities

Patients Presenting to Patients Presenting to Hospitals Hospitals

• Patients will (typically) present to ED’s

• Hospitals will need protocols for rapid id of patients with suspected PI including:– Separating patients from non ‘flu patients– Signage– Patient infection control measures– Triage

Patients Presenting to HospitalsPatients Presenting to Hospitals

Influenza clinics will assess and triage patients:•Home •Hospital (isolation room or ward)•To another facility (when hospital-level

care not required but patient is unfit to return home)

•Provide medication or other treatment and advice as appropriate

Proposed Hospital Care Proposed Hospital Care ModelModel

Present at hospital

Unwell person with flu like symptoms

Present at general practice or CHC

Assessment clinic(if available)

Emergency room

Meets case definition for pandemic flu

Meets case definition for pandemic flu

Home careManage on meritsNeeds admissionDoes not need admission

Isolate at homeAdmit to NPR in

designated hospitalSupport provided by lab,

ID, ICP, engineers

Transfer if not designated hospital

Cohort in dedicated wards or hospitals

Yes, but doesnot need

hospitalisationNo

No

Yes Yes

Hospitalsoverwhelmed

Yes, needshospitalisation?

Use non-hospital facilities

Possible Community Support Possible Community Support ModelModel

Community Care(home/residential/institutional/other)

Develop Management Plan

• Quarantine• Treatment

• Medical care/review/support

• Social support• Community support/ADL

Support required?

Home support?

Municipal Coordination Centre

Assess needs

Refer to community support services:

• GP/RDNS• LGA – HACC

• NGO

Management plan self implemented

Management plan implemented by home

support care

DHS Regions coordinate municipalities

DHS Health Services Support Centre

I f condition deteriorates?

Re-present for reassessment

No

Yes

No

As indicated/required

Yes

Municipal Coordination CentreMunicipal Coordination Centre

• Proposed roles and responsibilities for community support – Provide support to individuals/communities

quarantined/isolated in homes/institutions – Provision and/or coordination of health staff/volunteer

helpers for general medical/essential service support for those in need

– Provision of personal support services, eg counselling, advocacy

– Provision and staffing of recovery/information centre(s)– Convening of municipal/community recovery committees as

necessary– Provision of mass vaccination (if/once available); LGA’

specific

Staffing of CentreStaffing of Centre

• Proposed groups represented– LGA; response, recovery, communication,

senior manager/s– Division/s of GP’s– Volunteer agency rep eg. Red Cross, SES– Health agencies rep eg. RDNS, HACC Co-

ordinator, hospital liaison, DHS regional liaison

– Others; eg. Police, MAS/RAV

Business ContinuityBusiness Continuity

What is business continuity?

• Maintaining critical business activities

Why should organisations undertake planning?

• To minimise the impact of an influenza pandemic on your

organisation

• To protect your business and ensure business continuity

• To protect staff

Business Continuity GuideBusiness Continuity Guide

• The Australian Government Department of Industry, Tourism

and Resources has developed Being prepared for a Human

Influenza – A Business Continuity Guide for Australian

Businesses, it is a practical guide outlining:

– What government is doing in preparation for a potential pandemic;

– The likely impacts on businesses;

– How businesses can minimise those impacts;

– How to help protect staff from getting sick;

– Useful internet reference sources for more information;

– A pandemic planning checklist; and

– A series of health posters for the workplace

What can organisations be What can organisations be doing now?doing now?

• Start business continuity planning for pandemic influenza

• Education– Provision of accurate up to date information

• OH&S– Infection control – cough etiquette,

handwashing, cleaning surfaces, PPE, antivirals

– Seasonal influenza vaccine

What can GPs be doing now?What can GPs be doing now?

• Check DHS website for Health Alerts• Contact DHS if you suspect avian influenza • Have access to appropriate PPE• Promote seasonal vaccination

– Immunisation with pneumococcal vaccine will prevent a major complication ie pneumococcal pneumonia

– Important to attain high inter-pandemic coverage with conjugate vaccine (for children) and polysaccharide vaccine (for older persons and those at medical risk)

What can individuals be What can individuals be doing now?doing now?

• Understand pandemic influenza and current developments of avian influenza overseas by checking reliable websites– WHO, DoHA, DHS

• Practice prevention activities– cough etiquette/handwashing– travel safe– stay home if unwell– Immunisation (seasonal influenza and

pneumococcal)

ResearchResearch

Vic research– Community:

• 600 CATI survey Vic adults aged 18 years & over (400 metro, 200 rural)

• 6 focus groups: young mums, low income men, working women, men aged 65+, low income women, working men

– Business: • 200 small/medium/large online survey

– Health providers: • 60 online surveys nurses & pharmacists

– Local government:• 25 in depth interviews with CEO or equivalent

Research ResultsResearch Results

• In the event of a pandemic, most Victorians expect to receive critical advice and information from the Government (42%), while 22% will expect this information from their GP

• When asked where people would go to for further information about a serious health issue such as a pandemic, 50% said their GP

• When businesses were asked who they would expect to provide their employers with critical advice and information in the event of a pandemic 61% said their GP

Available resourcesAvailable resources

• Material for business– Australian Government Department of Industry,

Tourism and Resources• www.industry.gov.au/pandemicbusinesscontinuity

• Materials for the general public• Materials for health professionals

– Australian Government Department of Health and Ageing

• www.health.gov.au

– Victorian Department of Human Services• http://www.health.vic.gov.au/ideas/regulations/vic_influenza

.htm

Further Information?Further Information?

• Communicable Diseases Section

(03) 9096 5220

– email: • elizabeth.birbilis@dhs.vic.gov.au

– Web: www.health.vic.gov.au/ideas/– (Victorian Pandemic Plan at this address)

Where to from here?Where to from here?

• General Practitioner package • Local Government preparedness• Plans modified as new

evidence/information is gathered • Communication strategy

(Commonwealth and State)