Pandemic influenza update Prepared by Dr Sean Tobin Medical - - PowerPoint PPT Presentation
Pandemic influenza update Prepared by Dr Sean Tobin Medical Epidemiologist Communicable Diseases Branch Health Protection NSW May 2013 Overview Avian influenza A(H7N9) in China MERS Coronavirus (MERS-CoV) in the Middle East Pandemic
Prepared by Dr Sean Tobin Medical Epidemiologist Communicable Diseases Branch Health Protection NSW
May 2013
Avian influenza A(H7N9) in China MERS Coronavirus (MERS-CoV) in the Middle East Pandemic influenza planning update Existing ED / Flu Clinic Guidance Discussion on the role of ED’s in pandemic planning and response
[Exiting the cell] [Entering the cell]
31 March 2013, China reported 3 cases of human infection with a novel influenza A(H7N9) virus in Shanghai and Anhui. Novel virus is a reassortant – comprising H7 HA, N9 NA and the six internal genes of H9N2 influenza A viruses. Total132 cases / 37 deaths. Last onset 21 May. No sustained human-to-human transmission
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Highest pandemic potential of any known avian influenza virus – causes serious disease, including deaths (CFR 28%) – does not cause disease in poultry – hard to control – has caused more human infections in a short period of time than any other avian influenza virus – some H7N9 viruses show genetic changes that suggest they are partially adapted to infect humans more easily than other avian influenza viruses.
Middle East respiratory syndrome coronavirus Previously known as “novel coronavirus”
Not closely related to SARS. Most closely related to a Bat coronavirus but animal reservoir still not determined First case reported from Saudi Arabia in June 2012. Retrospectively identified in 2/11 cases in a hospital SARI
Continuing sporadic case reports through 2012 with links to the countries in the Arabian Peninsula. 3 UK cases in February 2013 associated with travel to Saudi Arabia and Pakistan (index case) with spread to two family members.
Since April 2013, over 25 new cases have been reported from Saudi Arabia, including several HCWs – most recent cases linked to a single hospital outbreak with a case fatality ratio (CFR) ~50%. Human-to-human transmission observed but not sustained All clusters reported to date in family contacts or in a health care setting after extensive close contact Cases mainly reported from the Arabian Peninsula – Cases exported to UK, Germany, France, Tunisia
Clinician alerts sent out and on NSW Health website www.health.nsw.gov.au/infectious Consider MERS-CoV or H7N9 infection in: – A person with an acute respiratory infection AND suspected pulmonary parenchymal disease AND a history of recent travel to: – (1) The Arabian Peninsula or neighbouring countries within 10 days before onset of illness (for MERS-CoV) (2) China within 7 days before onset of illness (for H7N9) – OR Close contact of a confirmed case AND not yet explained by any other cause
Pandemic viruses Existing pandemic plans Likely changes in the national pandemic plan
Avian influenza – wild birds are the natural host of influenza
Seasonal influenza – influenza viruses that have adapted to humans (usually commence as pandemic viruses) Swine influenza – influenza viruses that have adapted to pigs Pandemic influenza the global outbreak of influenza that occurs when a new influenza virus emerges that is adapted to humans – Novel virus: no prior immunity in the community – Able to pass efficiently from person to person – Causes illness: may vary from mild to severe
1918-19 1957 1968 2009
H3? “Asiatic Flu” H1N1 Spanish Flu 20-40M deaths H2N2 Asian Flu 1-2M deaths H3N2 Hong Kong Flu ~1M deaths pH1N1 “Swine Flu”
International – WHO Global Preparedness Plan National – National Action Plan Human Influenza Pandemic (Govt) – Australian Health Management Plan for Pandemic influenza (AHMPPI) State – NSW Human Influenza Pandemic Action Plan (Govt) – NSW Health Influenza Pandemic Action Plan Local – LHD plans; Hospital Pandemic Plans
Primary audience Govt decision makers – Covers severe seasonal influenza scenarios – Less emphasis on Border measures – More flexibility in response options A health emergency response model – (Prevention) Preparedness, Response, Recovery – Assessment phase to inform Targeted Measures Supported by the National Medical Stockpile
Surveillance Plan - Assess to Act “A key feature of the plan is the short-term enhanced data collection following the introduction of the virus to Australia. Placing a limit on the enhanced data collection activities will ensure an appropriate allocation of resources by limiting the reporting burden on front-line health professionals.”
PD2007_048 : Hospital Response to Pandemic Influenza Part 1: Emergency Department Response
Followed extensive consultation Proposes 3 levels of response : 1. Enhanced triage within EDs 2. Separate pandemic influenza screening stations (at the ED entrance) 3. Stand-alone influenza clinics Not necessarily sequential
When small clusters of human-to-human transmission of the new influenza virus have been reported overseas Aim to detect new cases imported into Australia Screening questions at Triage Supported by plans for managing single or small numbers
Reporting of cases to Public Health Units Public NOT being instructed to attend ED
When the likelihood of patients with pandemic influenza being encountered has increased and poses an imminent risk to NSW health facilities Situation warrants screening of all people presenting to ED before they enter the waiting room and before Triage All patients / accompanying persons attending ED screened at a station located at the entrance to the ED. If the patient does not meet the case definition, the patient proceeds to triage as normal.
When there is widespread circulation of the new influenza virus in the community, and it threatens essential health service delivery. Stand-alone influenza clinics will operate as influenza triage, assessment, and management facilities for potentially large numbers of sick people. Influenza clinic staff will determine whether the patient requires admission to a hospital or staging facility, or whether they can be discharged home with community follow-up as required.
Is the ED response model still appropriate? Is it flexible enough? In the Assessment Phase, how should suspect pandemic cases reported to Public Health Units be investigated? What is the role of EDs in pandemic planning? How should influenza clinics be established? Where should they be and staffed by whom? * Seasonal Flu