WHO Recommendations: Pandemic Influenza Planning Why prepare for a - - PowerPoint PPT Presentation

WHO Recommendations: Pandemic Influenza Planning

Why prepare for a pandemic?

• Be able to recognize it early and manage it
• Contain it or slow its transmission
• Decrease cases, hospitalizations, deaths
• Maintain essential services (i.e., medical)
• Reduce the economic and social impact

Broad Risks of a Pandemic

• Food and income loss from poultry deaths/

culling & decreased economic activity

Livelihoods

• High illness & potentially higher death rates
• Overstretched health facilities
• Disproportionate impact on vulnerable
• Increased demand for governance & security
• Higher public anxiety
• Reduced capacity due to illness & death

Governance & Security Human Health

• Deterioration of coping & support mechanisms
• Interruption in public services
• Quarantine policies

Social & Humanitarian Needs

• Trade & commerce disruptions
• Degraded labour force
• Interruption of regular supply systems

Economic Systems

How can you prepare?

• Recognize the pandemic phase

(set globally by the DG of WHO)

• Detect, report and investigate early signals
• Develop a pandemic preparedness plan;

conduct exercises/drills to make sure it works

WHO Pandemic Phases

Phase Period Level of Risk

1 Interpandemic period Low risk of human cases 2 New virus in animals, no human cases Higher risk of human cases 3 Pandemic alert No or very limited human-to- human transmission 4 New virus causes human cases Evidence of increased human- to-human transmission 5 New virus causes human cases Evidence of significant human- to-human transmission 6 Pandemic Efficient and sustained human- to-human transmission

Threat of H5N1 Human Influenza ?

Inter-pandemic Period Pandemic Alert Period Pandemic Period

• Circulating in wild birds

and poultry since 2003

• Highly contagious /

deadly among birds

• Spreading from Asia to

Europe, Middle East and Africa

• Has infected humans in

rare instances - resulting from close exposure to sick birds and/or their droppings

• If H5N1 evolves into a

human virus it could cause a human influenza pandemic

• Also possibility that H5N1

never evolves into a human virus

H5N1:

Scenarios - 3 Broad MODELS

Time Impact

Does avian virus become efficiently transmissible from human to human? Does human influenza virus immediately spread rapidly with high caseloads and increasing mortality?

Yes

MODEL 3 - Rapid Onset / Widespread impact

Little time for preparation, response is reactive and defensive

Yes

MODEL 2 - Slow Onset / Moderate & Localized Impact

Slowly acquires human infectiousness. Depending on the evolution of virus it may be contained after its emergence. May also develop into a pandemic

MODEL 1 – Extended WHO Phase 3 / Continued Outbreaks

• f Avian Influenza

Impact on livelihoods due to culling of birds

No No

Interpandemic period

Phase Goal

1: No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low Strengthen influenza pandemic preparedness at the global, regional, national, and subnational levels. 2: No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease. Minimize the risk of transmission to humans. Detect and report such transmission rapidly if it occurs.

Pandemic alert period

Phase Goal

3: Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact. Ensure rapid characterization of the new virus subtype and early detection, notification, and response to additional cases. 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans. Contain the new virus within limited foci or delay spread to gain time to implement preparedness measures, including vaccine development. 5: Larger cluster(s) but human-to- human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk). Maximize efforts to contain or delay spread, to possibly avert a pandemic and to gain time to implement pandemic response measures.

Pandemic period

Phase Goal

6: Pandemic: increased and sustained transmission in the general population. Minimize the impact of the pandemic.

http://www.paho.org/English/DD/PIN/ptoday08_sep05.htm

Discuss: Name events that would change a pandemic phase

• New virus subtype
• Documentation of human cases
• Evidence of human-to human transmission
• Increasing human-to human transmission by

geographic area

Discuss: Given a change in pandemic phase, what events follow?

Education Compensation Communication

WHO 5 strategic actions for human pandemic influenza

1 Reduce human exposure to H5N1 2 Strengthen the early warning system 3 Intensify rapid containment operations 4 Build capacity to cope with a pandemic 5 Coordinate global science & research acceleration of vaccine development, expansion

• f production capacity

National/Regional/Global

• Sensitive detection system
• Rapid laboratory confirmation
• Real-time risk assessment
• Immediate communications

In response to human cases/clusters

• Rapid field investigation
• Contact tracing and monitoring
• Stringent infection control
• Intervention with international

rapid response stockpile National/regional/global preparedness requires

• Commitment
• Contribution by all sectors
• Communication with the public
• Command & Control systems
• Capital investment

Improve the ability to develop, produce and deliver vaccine to large numbers of people in a timely manner Strengthen WHO's capacity to gather data, access global expertise and translate into vital advice and guidance

Objectives by phase

The objectives of the strategic actions correspond to the principal opportunities to intervene Phase: Interpandemic

• 1. Reduce opportunities for human infection
• 2. Strengthen the early warning system

Phase: Pandemic alert

• 3. Contain or delay spread at the source

Phase: Pandemic period

• 4. Reduce morbidity, mortality, and social disruption
• 5. Conduct research to guide response measures

http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_05_8-EN.pdf

Recommended 5 components in a plan by phase

• Planning & coordination
• Situation monitoring/assessment
• Prevention & containment
• Health system response
• Communications

Of critical importance

1. High level political commitment 2. Intersectoral involvement

• Other government departments

(e.g. agriculture, labor, education, defense, transport, trade, judiciary)

• Private sector/civil society

(e.g. industry, NGOs)

3 Consideration of existing resources as well as unmet resource needs

Source: WHO Informal consultation on influenza pandemic preparedness in countries with limited resources, 2004

Activity: Does your country have a pandemic influenza plan?

Divide into groups and discuss/brainstorm current country-specific pandemic plans Examples:

–http://www.who.int/csr/disease/influenza/nationalpandemic/en/index.html –WHO checklist for preparedness (include in participant guide to use as a guideline for discussion)

Lessons learned from previous influenza pandemics

• Pandemics are unpredictable
• The need for medical services will increase quickly
• Disease in non-traditional groups defines a

pandemic’s overall impact

• Viruses attack in waves. Those not affected by the

first wave are vulnerable in the second wave.

• Surveillance plays a large role in confirming and

reacting quickly to pandemics

• Surveillance of animals can provide an early

warning

• Social distancing (e.g. temporary closing of

schools and other public gathering) can slow the pandemic

• Slowing the spread of the virus means that more

medical services will be available for those who are sick at any given time

• Limited vaccine production means that they may

arrive too late to have an impact

• Those who manufacture vaccines domestically

will receive them first

Source: WHO, Avian Influenza: Assessing the Pandemic Threat, 2005

WHO Tools

> 40 guidelines

http://www.who.int/csr/disease/avian_influenza/guidelines/

WHO pandemic influenza draft protocol for rapid response and containment

“The success of a strategy for containing an emerging pandemic influenza virus is strictly time dependent: Modelling studies suggest that mass administration of antiviral drugs must begin within 21 days following detection of the first case representing improved human-to-human transmission of the virus.”

http://www.who.int/csr/disease/avian_influenza/guidelines/

WHO pandemic influenza draft protocol for rapid response and containment

The feasibility of early detection and rapid containment depends on several assumptions:

• 1. The emerging virus causes moderate to severe acute

respiratory illness, thus making the event visible and increasing the likelihood that it will be detected.

• 2. The detection of clusters of such cases immediately

triggers the appropriate clinical, epidemiological, and laboratory investigations.

• 3. Notification and assessment of the event occur rapidly,

moving from the local, to the intermediate, to the national level.

• 4. WHO is immediately informed, as mandated by the

International Health Regulations, so that the international community can be alerted and support mobilized as required

http://www.who.int/csr/disease/avian_influenza/guidelines/

WHO pandemic influenza draft protocol for rapid response and containment I Recognizing the event

Detection, investigation, and reporting of early signals

II Verifying the event

Event assessment and immediate control measures

III Containing the event

Two-phased response and containment operation

WHO Draft Rapid Response + Containment, May 2006

Many unresolved issues

• Security, equity, ethics, knowledge gaps
• Major operational issues related to governance,

management, rotation, deployment/reception of stockpiles

• Off-label use of anti-virals, informed consent,

adverse events

• Harm of half-measures (e.g. quarantine)

Where to get more information

WHO global influenza sites: General information: www.who.int/ csr/ disease/ influenza/ pandemic/ en Updates on recent outbreaks: www.who.int/ csr/ disease/ avian_influenza/ updates/ en/ Guidelines http:/ / www.who.int/ csr/ disease/ avian_influenza/ guidelines

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