A(H1N1) Influenza Outbreak in Bulgaria and ECDC Mission 44, 45, 46 - - PowerPoint PPT Presentation

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A(H1N1) Influenza Outbreak in Bulgaria and ECDC Mission 44, 45, 46 - - PowerPoint PPT Presentation

Nov 06, 2022 251 likes •814 views

A(H1N1) Influenza Outbreak in Bulgaria and ECDC Mission 44, 45, 46 week (26.10-15.11.2009) 44 45 46 AH1N1 RT-PCR tests done in the National Reference Laboratory, May-November, 2009 748 Total number of samples - 2191 Positive for

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A(H1N1) Influenza Outbreak in Bulgaria and ECDC Mission

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44, 45, 46 week (26.10-15.11.2009) 44 45 46

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AH1N1 RT-PCR tests done in the National Reference Laboratory, May-November, 2009

748

Total number of samples - 2191 Positive for A(H1N1)pdm - 748 (34,1%)

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Distribution of samples by age groups

149 370 703 872 97 37 201 279 220 11 100 200 300 400 500 600 700 800 900 1000 0-4г. 5-14г. 15-29г. 30-64г. 65+

Total number of samples Posititve for A(H1N1)pdm

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50 100 150 200 250 300 350 400 450 40 41 42 43 44 45 46 47 48

Distribution of samples by week 40 – 48, 2009

.

Total number of samples Positive for A(H1N1)pdm

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Distribution of deaths by age groups

34% 34%

66% 6% 11 11 21 21

15-29 15-29 30-64 0-64

cases %

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Distribution of deat Distribution of deaths by sex hs by sex

women 44% men 56%

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Distribution of deaths by time of seeking medical help

  • n

n time ime late ate

cases %

72 2 % 28 % 28 % 23 23 9

20 40 60

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Distribution of deaths by antiviral treatment Distribution of deaths by antiviral treatment starting time starting time

  • n time

31% late 56% no treatment 13%

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Distribution of deaths by presence of risk factors

no risk; 41 pregnancy; 9 chronic illnesses; 38

  • besity; 12
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Fatal cases EU/EFTA countries Week 50

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Fatal cases EU/EFTA countries Week 17

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Fatal cases EU/EFTA countries Week 18

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Fatal cases EU/EFTA countries Week 19

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Fatal cases EU/EFTA countries Week 20

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Fatal cases EU/EFTA countries Week 21

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Fatal cases EU/EFTA countries Week 22

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Fatal cases EU/EFTA countries Week 23

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Fatal cases EU/EFTA countries Week 24

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Fatal cases EU/EFTA countries Week 25

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Fatal cases EU/EFTA countries Week 27

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Fatal cases EU/EFTA countries Week 28

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Fatal cases EU/EFTA countries Week 29

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Fatal cases EU/EFTA countries Week 30

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Fatal cases EU/EFTA countries Week 31

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Fatal cases EU/EFTA countries Week 32

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Fatal cases EU/EFTA countries Week 33

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Fatal cases EU/EFTA countries Week 34

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Fatal cases EU/EFTA countries Week 35

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Fatal cases EU/EFTA countries Week 36

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Fatal cases EU/EFTA countries Week 37

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Fatal cases EU/EFTA countries Week 38

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Fatal cases EU/EFTA countries Week 39

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Fatal cases EU/EFTA countries Week 40

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Fatal cases EU/EFTA countries Week 41

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Fatal cases EU/EFTA countries Week 42

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Fatal cases EU/EFTA countries Week 43

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Fatal cases EU/EFTA countries Week 44

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Fatal cases EU/EFTA countries Week 45

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Fatal cases EU/EFTA countries Week 46

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Fatal cases EU/EFTA countries Week 47

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Fatal cases EU/EFTA countries Week 48

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Fatal cases EU/EFTA countries Week 49

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Fatal cases EU/EFTA countries Week 50

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Purpose of the visit

  • to exchange experience regarding pandemic

influenza, as Bulgaria was increasingly affected by the pandemic

  • to review and discussion of measures taken to

control the epidemic of pandemic influenza – based on mission check list prepared by ECDC influenza team and

  • planning of further actions and cooperation

points

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ECDC experts’ conclusions

  • The threat to health posed by the A(H1N1) pandemic

influenza virus in Bulgaria does not substantially differ from that in other EU Member States.

  • The clinical pattern of disease appeared to be similar

to that in other EU countries, with most affected people only experiencing mild illness. However, a number of people have been very seriously ill.

  • Bulgaria is well placed to respond to the 2009

A(H1N1) pandemic, though the plan had to be adapted to respond to the rapidly developing epidemiological situation.

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Immediate measures taken by public health authorities in Bulgaria

– activation of national and regional pandemic emergency

  • perational units (centres) – daily reporting from regional to the

national level required on the bed capacity and utilization, incidence rates, morbidity pattern and deaths, utilization and availability of antiviral in hospitals. – authoritative information about the pandemic virus was communicated to the public and health professionals - meetings with: hospital directors; directors of regional public health centres, emergency health care units, journalists and other relevant stake holders – clear clinical guidance has been elaborated, adapted and disseminated to different levels of medical care – morning filter in schools and closure of schools for one week – distribution of antivirals to regional centres and hospitals – changes in the legislation to facilitate vaccine and antiviral purchase agreements

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Identified strengths of preparedness

  • Dedication and high level of expert knowledge of staff of the

Department of Public Health and the National Center of Infectious and Parasitic Diseases working to address the rapidly developing epidemiological situation.

  • Availability of comprehensive pandemic plan and rapid

adaptation of the plan to changing epidemiological situation.

  • Efforts to increase the AV availability and plans to distribute to

Emergency Care centres.

  • Regional communicators were all trained in media relations

prior to the pandemic.

  • Combined actions with the ministry of education – introduction
  • f daily (morning) health checks and closure of schools.
  • Intensive discussions on vaccination policy and plans
  • Communication with international organizations (WHO,

ECDC, European commission)

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The main suggestions and advice

  • f ECDC team for further actions:
  • monitoring epidemiological situation in the country for early signs of

possible resurgence and / or possible second wave,

  • bserving the number of influenza-related hospitalizations and

deaths which may still be increasing for some period of time while ILI incidence may be going down,

  • planning and preparing vaccination campaigns, GPs can be used to

help in identifying persons in risk groups.

  • reinforcing the communication to clinicians, especially GPs, and the

public, about the need for early AV treatment (especially for those with underlying conditions predisposing to severe course of infection),

  • performing an overall evaluation of the impact of measures applied

for the control of the pandemic may be considered by the Bulgarian PH authorities.

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Further actions

  • Sharing experiences (ECDC advisory forum – 8

Dec; meeting in Bucharest – 15 Dec)

  • Elaboration and adaptation of vaccination plans

– Pandemic vaccination – Seasonal influenza vaccination § Prepare and review plans for resource availability during holidays (X-mas and new year) – staff at central and local levels, primary and specialized health system preparedness – based on planning assumptions of international and local planning assumption § Continuous monitoring of the epidemiological situation

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  • The great importance of preliminary information from affected countries –

risk groups, clinical manifestation, incidence rate and need for hospitalization, managing severe cases.

  • Massive panic among the population, despite the maximum transparency

and openness or namely because of them. The borderline between good information awareness and psychosis is rather thin and easy to cross.

  • Need for external expert support – benefit from the reputation of the

specialised international institutions. Nobody can be a prophet in his own land!

  • Emergency situations require emergency decisions! This also refers to the

legislation, most of the procedures envisaged are slow and cumbersome and not apt for emergencies.

  • No matter how prepared you may be, there will always be things you have

not prepared for. But, there is a positive touch, too – proposals which have been discussed for years are resolved very quickly in a time of crisis. Both the public and the politicians are much more open to health related issues.

Observations and notes

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Discussion issues

  • Unbalanced contracts for supply of pandemic vaccine. The current

provisions assign plenty of responsibilities to the national authorities and

  • nly one right, i.e., the right to pay no matter what. I, personally, would not

sign, nor would I advise the minister to sign under such a contract.

  • Long-term consequences of a pandemic. The public has only a certain

amount of threats it can absorb and we are on the verge of exhausting it. This will inevitably cause problems with the future actions to improve the seasonal influenza vaccine coverage, for example, or with the preparedness to face other challenges related to public health.

  • Lack of a quick, reliable and effective mechanism for mutual support

among EU member states. Practically, the only real support we received in response to our request for assistance with the supply of antivirals came from Austria and the WHO. Regardless of the long discussions, it has proved impossible to establish a virtual let alone a real community- wide stockpile of antivirals and vaccines. The common European procedure to deliver vaccines to several member states which was being drafted failed as well.