Professional Documents
Culture Documents
Pandemic Plan
Strategy for Austria
Manual
Forword
In January 2004 the appearance of influenza viruses which
could impair the health of animals and ultimately, as a
secondary effect, human beings, was confirmed by the World
Health Organisation (WHO). This confirmation proves that the
possibility that new aggressive influenza viruses will emerge in
future has grown. In the past, the emergence of new influenza
viruses was often only recognised after a massive increase in
the number of influenza cases, but since January 2004, on the
strength of epidemiological and virological research, it has
been possible to clarify that the possibility of an influenza
pandemic (that is a worldwide epidemic) is higher than it has
ever been since 1968 – when the last influenza pandemic occurred.
On account of this possibility, the WHO has called on all countries to prepare
corresponding measures in case an influenza pandemic breaks out.
The legal basis for the measures that could be taken to protect people in Austria
should this happen is based on the Epidemic Law by which the federal authorities
are assigned the coordinating tasks and the provincial authorities the operative
execution.
My ministry, together with national experts from the respective sciences and
experts from the Austrian provinces has, during the past 18 months, worked out
a plan entitled “The Influenza Pandemic Plan – Strategy for Austria”.
The aim of the Influenza Pandemic Plan is to lay down a clear outline with clearly
defined competencies so that, should the necessity arise, one will be able to
react efficiently and without delay to the prevalent situation. The Influenza
Pandemic Plan should be understood as a basic framework which contains the
essentials of operative plans for a pandemic on the provincial level but is at the
same time flexible enough so that it can be adjusted to the relevant concrete
situation at any time.
These measures guarantee that the scientific and administrative aspects have
been taken into account and that therefore the preconditions for optimal
execution are given.
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Influenza Pandemic Plan
Unlike many countries in the world, thanks to our economic prosperity and the
excellent standard of our national health and communications systems, we are in
the fortunate position of being able to offer the best preconditions to protect the
Austrian population.
Dr Andrea Kdolsky
Minister of Health, Family and Youth
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Influenza Pandemic Plan
Contents
Forword................................................................................................... 5
1. Summary of procedures and measures ............................................. 10
1.1. WHO und EU ..................................................................................10
1.2. The pandemic crisis committee .........................................................10
1.3. Information and communication........................................................11
1.4. Cooperation with the veterinarian services .........................................11
1.5. Measures to be taken in case of a pandemic .......................................12
1.5.1. Regional cooperation .................................................................12
1.5.2. Maintenance of public services ....................................................12
1.5.3. Legal foundations ......................................................................12
1.5.4. Vaccination ..............................................................................12
1.5.5. Medicines .................................................................................13
1.5.6. Protective masks .......................................................................14
1.5.7. Hospital preparedness................................................................14
1.5.8. Ambulance services ...................................................................14
1.5.9. Surveillance..............................................................................15
1.5.10. Increasing vaccination coverage for seasonal influenza .................15
1.5.11. Further development of the pandemic plan..................................15
2. Competencies and measures of the health authorities ...................... 16
2.1. Competencies ................................................................................16
2.1.1. Phases (following the WHO)........................................................16
PHASE 1 ........................................................................................17
PHASE 2 ........................................................................................18
PHASE 3 ........................................................................................19
PHASE 4 ........................................................................................20
PHASE 5 ........................................................................................21
PHASE 6 ........................................................................................22
The pandemic reaches Austria ..........................................................23
End of first wave of pandemic ...........................................................24
Second or further pandemic waves ....................................................24
2.2. Measures to be taken by the health authorities ...................................25
2.2.1. Expansion and improvement of the existing epidemiological and
laboratory diagnostic surveillance .........................................................25
2.2.2. Procuring stocks of prophylactic medicines....................................25
2.2.3. Contracts with vaccine manufacturers ..........................................26
2.2.4. Laying in stocks of masks ...........................................................26
2.2.5. Informing all those working in the health sector.............................26
2.2.6. Informing the population ............................................................27
2.2.7. Special measures of the health authorities ....................................27
3. Diagnostic ......................................................................................... 28
3.1. Clinical diagnosis of suspected cases .................................................28
3.2. Laboratory diagnosis .......................................................................28
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2. Epidemiology..................................................................................... 44
2.1. Epidemiology .................................................................................44
2.2. Vaccination coverage rates...............................................................48
3. Surveillance....................................................................................... 50
3.1. The national reference centre for influenza – epidemiology ...................50
3.2. National reference centre of influenza – laboratory ..............................51
4. Drugs ................................................................................................ 52
4.1. General information on effective influenza virostatics ...........................52
4.1.1. Amantadine..............................................................................52
4.1.2. Neuraminidase inhibitors ............................................................53
4.2 Prophylaxis/therapy with Oseltamivir/Tamiflu® (Roche) .........................54
4.2.1. Prophylaxis with Tamiflu®: ..........................................................54
4.2.2. Therapy ...................................................................................55
4.2.3. Dosage form.............................................................................56
4.3. Prophylaxis/therapy with Zanamivir/Relenza® (GSK)............................57
4.3.1. Prophylaxis with Relenza® : ........................................................58
4.3.2. Therapy with Relenza®:..............................................................58
4.3.3. Dosage forms ...........................................................................58
4.4. Accompanying therapy – antibiotics/NSAR..........................................59
5. Vaccines ............................................................................................ 60
5.1. Manufacture, documentation and licensing of a safe and effective vaccine60
5.1.1. Quality ....................................................................................61
5.1.1.1. Production .........................................................................61
5.1.1.1.1. The reference virus........................................................62
5.1.1.1.2. Possible use of gene technology ......................................62
5.1.2. Pre-clinical testing .....................................................................63
5.1.3. Clinical testing ..........................................................................63
5.1.4. Summary of product characteristics and package leaflet instructions
for use ..............................................................................................63
5.2. Marketing authorisation procedure ....................................................63
SUPPLEMENT ......................................................................................... 65
Appendix 1: Explanatory leaflet – influenza – pandemic ..............................66
Appendix 2: Risk stratification for CAP (=Community Acquired Pneumonia) ...68
Appendix 3: Antibiotic therapy for CAP .....................................................69
Appendix 4: Sample sheet for hygiene file ................................................70
Appendix 5: Influenza – sentinella fax-registration form .............................71
Appendix 6: EU – influenza case definition ................................................72
Contributors .......................................................................................... 73
Addresses.............................................................................................. 74
Imprint.................................................................................................. 75
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Influenza Pandemic Plan
• Crisis committees have been set up both at the federal and provincial levels.
They will be made up of the following:
• The members of the federal and provincial crisis committees must be on 24-
hour standby from Phase 5 onwards. An activation system via mobile phones
that has been tested beforehand will guarantee that these crisis committees
can meet within two hours. The MoH’s crisis committee and its contact
persons are included in the Pandemic Plan. The provincial public health
authorities will inform the BMGFJ as to who is in charge of their crisis
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Influenza Pandemic Plan
committees.
The federal and provincial crisis committees and the MoH can, if necessary,
communicate via email or audio conferences in a crisis situation. The technical
prerequisites for such communication will be secured in the interpandemic
phase and tested as to their efficiency in the course of nationwide tests (e.g.
Van Swieten, November 2006).
• The MoH’s crisis committee will announce the relevant phases or levels based
on the information it gets from the WHO or EU, and will coordinate the
measures according to the phases or levels as laid down in the pandemic
plan. This includes informing the population and the press.
• The crisis committee will also constantly keep the government informed.
• The Ministry’s crisis committee will immediately pass on information from the
WHO/EU to the provincial crisis committees.
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Influenza Pandemic Plan
• In March 2006, the first Regional Pandemic Meeting took place in Vienna to
which all the neighbouring states were invited so that cross-border issues in
the preparation for a pandemic (e.g. vaccine production, the closing of
frontiers) could be discussed. In future, regional cooperation will be
intensified.
• All the state and regional public services (e.g. police, fire brigade, garbage
collection, ambulance services etc…) were included in the stockage concept
for key personnel and an adequate stock of neuraminidase inhibitors and
facial masks procured. All private suppliers of public services (e.g. energy
supplying companies,…) were supported in the precaution concepts and crisis
plans that were drawn up in preparation for a pandemic.
1.5.4. Vaccination
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Influenza Pandemic Plan
the virus, there is lead time before the vaccine is available. The new
“verocell” vaccine (= produced in tissue cultures) will be used, as the time it
takes to produce, namely 10 weeks, is far shorter than for the the vaccine
used up to now which was produced from chicken embryos (and took three
months to produce). At the moment, moreover, this is the only way in which
a large amount of vaccine can be produced at short notice.
1. Persons who run a higher risk of infection (e.g. medical and nursing
personnel, …)
2. Persons who are essential for the maintenance of the infrastructure and
of public safety (e.g. those responsible for food and water supplies,
police, armed forces,…)
3. Persons who run a higher risk of complications (e.g. chronic heart or
circulatory diseases,...)
1.5.5. Medicines
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Influenza Pandemic Plan
• In order to avoid influenza infection, health care workers are advised to wear
FFP3 protective respirators with exhalation valves when in direct contact with
influenza patients. FFP3 respirators without exhalation valves are
recommended for patients (see chapter on “Hygienic measures in hospitals”).
Otherwise FFP1 or surgical masks should be used. If the national level does
not use the whole amount of stockpiled masks the Federal States will receive
a proportional part of these masks according to the population. The masks
will be released together with the stocks of antivirals by the command of the
MoH.
• A separate reception unit in which only vaccinated personnel will work must
be set up for influenza patients. This is where the diagnosis, triage and if
necessary admission to hospital will take place.
• The personnel escorting the patient keep to the guidelines defined for
protection of personnel. In so far as his or her condition permits, the patient
is provided with an FFP3 mask without a valve.
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Influenza Pandemic Plan
1.5.9. Surveillance
• In cooperation with the influenza reference centres, the BMGFJ will build up
one uniform Sentinella system by blending the two existing systems.
• The obligation to notify the authorities when human beings are infected with
H5N1 and other avian flu viruses (suspected cases must of course also be
reported) is already in force.
• Although the BMGFJ recommends vaccination against influenza for the whole
population and especially for risk groups, vaccination coverage in Austria is
only around 17%. In autumn 2006 a large scale advertising campaign was
therefore undertaken in order to boost the vaccination coverage especially of
hospital personnel.
• The manual on hand is continually updated with new developments and its
operability checked. This will be undertaken by the BMGFJ in cooperation with
the pandemic group and the work groups for pandemic preparation in the
provinces. Important supplements will moreover be provided by the following:
The subsidiary working group for health of the State Crisis and Disaster
Control Management (SKKM), the working group Generic Preparedness
Planning of the EU Health Security Committee, the ECDC as also the WHO
influenza workshops.
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Influenza Pandemic Plan
2. Competencies and
measures of the health
authorities
2.1. Competencies
Both the WHO and the EU have networks which continually monitor influenza
activity and are also able quickly to inform the international community of states
or EU members. In addition, both the WHO and the EU already have laid down
framework concepts which must be adapted to the prevailing situation in each
country.
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Influenza Pandemic Plan
PHASE 1
No new influenzavirus subtype/-strain in humans
BMFGJ
• Setting up of a national pandemic plan (completed)
• Nominating a crisis action committee (carried out)
• Standardising and optimating the early warning system (Sentinella-System)
• Provision of medicines/vaccinations (contracts with firms completed)
• Increasing vaccination coverage (negotiations with the main social insurance
associations and employees partial subsidies (ongoing)
• Recommending seasonal influenza vaccination
Hospitals
• Plans for increasing patient capacity (taking necessary isolation measures
and possible shortage of personnel into consideration (ongoing)
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Influenza Pandemic Plan
PHASE 2
Pathological influenza viruses in animals
which pose a considerable risk for infection in human beings
BMFGJ
• Cooperation with the WHO and the EU (exchange of information, coordination
of acitivities)
• National handing on of information (federal ministeries, provincial
authorities,…)
• Exercises in pandemic planning
• Continual adaptation of pandemic planning at the national level
• Media training
Hospitals
• Keeping personal protection equipment for personnel at the ready
• Informing and training personnel
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Influenza Pandemic Plan
PHASE 3
New influenza virus subtype in humans but no human-human transmission (i.e.
only very rarely when contact is particularly close)
BMFGJ
• Cooperation with the WHO and the EU (exchange of information, co-
ordination of activities)
• Nationwide passing on of information (federal ministries, provincial
authorities,…)
• Pandemic simulation exercises
• Expert(groups) are devoted to evaluating the latest research data and
experiences in the areas infected
• Continual adaptation of pandemic planning at the national level
• Preparation of information material for specifically oriented groups
• Media training
• Should Austria be affected: Informing the WHO, the EU, crisis committee
goes into action
Hospitals
• Continual adaptation of hospital disaster measures, simulation exercises
• If affected: isolation measures, use of protective equipment,
OBLIGATION TO INFORM THE AUTHORITIES!
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PHASE 4
A new influenza virus subtype in humans,
limited human-human transmission strictly confined locally
BMFGJ
• Cooperation with the WHO and the EU (exchange of information, putting
activities to the vote, informing about unusual events)
• Passing on information at the national level (federal ministries, provincial
authorities,…)
• Current evaluation of pandemic planning on national level
• Activating the crisis committee (evaluation: current situation and experience)
• Activating of the crisis communication plan (information of the population:
situation, travel advices, pandemic plan)
• Should Austria be affected: informing the WHO and the EU
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Influenza Pandemic Plan
PHASE 5
Bigger outbreaks but human-human transmission as yet limited
BMFGJ
• Cooperation with WHO, EU (exchange of information, co-ordination of
measures, informing about unusual events)
• Passing on information at the national level (federal ministries, provinces,..)
• Activating the crisis committee (evaluation of current situation and
experience)
• Updated information and guidelines for doctors and pharmacists
• Crisis communication: target orientated information (updated)
• Contacting vaccine manufacturers
• Should Austria be affected: informing the WHO and the EU; activating the
national pandemic plan
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PHASE 6
PANDEMIC
formerly phase 1
BMFGJ
• The crisis action committee in permanent session (evaluation of the situation
and recommendation on how to proceed)
• Passing on information nationwide
• Informing the population: on the situation, travel recommendations,
pandemic plan
• Updated information and guidelines for doctors and pharmacists
• Contacting vaccine manufacturers: securing early supply
• Activating the pandemic plan
Vaccine manufacturers
• Producing a vaccine based on the pandemic strain
Pharmed Austria
• National marketing authorisation/approval of pandemic vaccine
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Influenza Pandemic Plan
BMFGJ
• The crisis action committee and experts on permanent duty
-> based on their recommendation:
• Execution of national pandemic plan as follow:
o Release of stocks of neuraminidase inhibitors for prophylactic use
o Assuring that Austria is supplied with pandemic vaccine
o Passing on information at the national level
o Informing the population (on the actual situation, symptoms,
transmission rate, instructions on preventive behaviour
o Graded prophylaxis – primary target groups for prevention with
neuraminidase inhibitors/vaccination
o Guidelines for doctors/pharmacists (prophylaxis, use of usual seasonal
vaccine, criteria for hospitalisation…)
o Commencement of mandatory reporting for pandemic influenza
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Influenza Pandemic Plan
formerly phase 3
BMFGJ
• Declaring the end of the first pandemic wave
• Continuation of the general vaccination against influenza (depending on the
availability of the vaccine) with special reference to the danger of further
pandemic waves
• Adapting the nationwide pandemic plan according to the insights won during
the 1st pandemic wave
formerly phase 4
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Influenza Pandemic Plan
New and hitherto unknown virus infections in humans keep emerging. There are
two particular factors to note in cases of infection with new influenza virus sub-
types/sub-strains:
• Effective, approved drugs for therapy and prophylaxis already exist, and
• one can reckon with the fact that within approximately ten weeks of the virus
strain reaching the WHO for vaccine production first supplies will be available.
• As it is highly probably that sufficient vaccine will not yet be available by the
time the pandemic reaches Austria, in the interim period, one will have to fall
back on medical prophylaxis. During a pandemic, however, the worldwide
demand for neuraminidase inhibitors suitable for prophylaxis cannot be met
with average production. In Austria as in most EU countries stocks in
accordance with the stock concept were therefore acquired. The amount of
neuraminidase inhibitors in stock is sufficient to maintain the area-wide
infrastructure of public life and the basic supply in Austria with particular
consideration of the maintenance of health care. In the event, these stocks
could also be used to protect particularly endangered persons. Vaccination
can be extended to a greater percentage of the population by way of a
phased plan depending on the danger and epidemiological parameter.
• The plans for distribution were drawn up at the federal level. Detailed plans
were drawn up at the provincial level supplementary to the detailed plans for
a pandemic in each province. They guarantee consumer supply for the core
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groups taking local conditions and the phased plans which orient themselves
to the given epidemiological situation into consideration. Regulating access
and preventing improper use are included in the logistic concept.
• Already in the interpandemic phase, doctors and health care institutions will
be informed of the contents of the pandemic plan, in order to allow the
hospitals for their part to co-ordinate the necessary detailed plans with the
pandemic plan.
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Influenza Pandemic Plan
• In a pandemic those working in the health care sector will need additional
updated information on the epidemiological situation. Uniform federal
guidelines for the prophylactic use of neuraminidase inhibitors, the use of the
pandemic vaccine and possibly remaining supplies of seasonal influenza
vaccines as also taking into consideration hospitalisation criteria etc.
guarantee optimal use of all available resources.
• Already today continual efforts are being made to inform the population on
the implications of influenza and the prudence of yearly vaccination against it.
• In an influenza pandemic the BMGFJ will actively contact the media so that
the population is informed as objectively and comprehensively as possible
about the illness itself, the possibilities of infection, the current
epidemiological situation and the phased procedure concerning prophylactic
measures. Recommendations for practical ways of behaving both for healthy
and sick persons will be broadcast.
• The provincial health authorities support this active information policy and will
supplement it with the specific situation in their provinces.
• Under the law for epidemics, infection with avian flu viruses must be
reported. In addition, influenza can be made notifiable at any time under this
law. The obligation to notify the authorities makes it possible to introduce
special measures such as forbidding public gatherings which would result in
larger numbers of people flocking together and of closing schools. The
decision to introduce such measures regionally depends on various
parameters like how infectious the virus is and how many people have
contracted it in the region. The fatality rate and the available prophylactic and
therapeutic resources also play a role in weighing up the situation.
• For detailed citation of all suitable legal measures that can be used see
Chapter 6.
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3. Diagnostic
3.1. Clinical diagnosis of suspected cases
From seasonal influenza waves, it is known that once the wave of influenza has
fully broken out, clinical diagnosis and laboratory diagnosis correlates in 80-85%.
During this period there is therefore no need for individual diagnoses. It would
only delay the beginning of treatment. The quick testing methods commercially
available at the moment are relatively insensitive and lead to wrong negative
results especially as far as older persons are concerned.
3.2.2. Samples
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For hospitalisation the following nationwide uniform triage criteria have been laid
down as a guideline:
2. Social indication:
• Competent care at home not guaranteed or
• In case of acute deterioration, transportation distance too far, i.e. more
than a four-hour journey
4.1.2. Hospitalisations
With an average hospital stay of 10-12 days the number of hospital beds
required rises. In this case, 8 900 additional beds would therefore be required.
*UNSTABLE PARAMETERS
• Impaired consciousness
• Blood pressure – must be judged according to age, but systolic
• values <90mmHg or a reduction >40mmHg of the patient’s starting value/normal value would be
“unstable”.
• Equally a MAP (mean arterial pressure) <60–70mmHg
• Oxygen saturation
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Influenza Pandemic Plan
The following antibiotics1 are suitable for treating bacterial secondary illnesses:
• Pneumonia: cerfuroxim (as a substitute curocef, p.o.zinnat). For details of
risk strategy and risk groups see supplement 2-3
• Bacterial superinfection in general: macrolides, ketolides, amoxillin
(+ clavulanic acid)2 and cefalexin
1
Expert opinion on CAP (CAP = Community Acquired Pneumonia), 14.11.02; chair: Univ-Prof Dr
F. Thalhammer, Prim Dr N Vetter, in: CliniCum, special edition 10/2003; guidelines of the Paul-Ehrlich-
Society and the European Respiratory Society; expert communication (Univ-Prof DDr W. Graninger, OA
Dr A. Lechner)
2
Acc. Univ-Prof DDr W. Graninger in Austria Amoxicillin only also possible
Agents
The agent is an up to now unknown influenza virus in humans, against which
neither human beings nor animals have developed natural immunity.
Source of infection
It is to be expected that the human pathogenic influenza virus can only be
transmitted from one human being to another, even if primarily a new type of
influenza virus can partly be transmitted from animals to human beings.
Transmission course
Direct transmission through airborne infection plays by far the greatest role as
far as influenza viruses are concerned. Transmission through hands and objects
cannot be excluded, as influenza viruses can survive for several hours outside
the body especially in low temperatures and when humidity is low.
Infectious substance
Repiratory secretion
Duration of contagiousness
Up to now, as far as the known influenza viruses in humans are concerned: 3-5
days after the outbreak of the disease for adults and up to 7 days for children. In
immunosuppressed patients virus secretion can last longer.
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Incubation period
1-3 days
Symptoms
(see materials for the pandemic plan – medical basis)
Transport of patients
Patients with a confirmed influenza infection or suspected of having influenza
may only leave the isolation area if this is urgently necessary. In such a case
they must wear masks over their mouths and noses, preferably FFP2 masks
without exhalation valves. If this is not possible, they should wear surgical
masks.
For the accompanying personnel the following personal protection measures are
valid.
Personal protection
As long as the personnel is not reliably protected by vaccination, the following
measures are necessary for every contact with patients with a confirmed
influenza infection or who are suspected of having influenza:
• Protective masks (nose and mouth protected) - the mask must fit tightly
o FFP2 masks with exhalation valve for normal work at the bedside and
in the out-patients
o FFP3 masks with exhalation valve for aerosol producing measures
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Influenza Pandemic Plan
In a pandemic all persons in medical institutions who have contact with patients,
even if there is no concrete suspicion of influenza infection, must wear multi-
layered mouth/nose masks as used on operation wards as a basic protection
measure.
Surface disinfection
All surfaces which patients who have a confirmed influenza infection or are
suspected of having been infected or come into contact with influenza infections
must be regularly disinfected and, within the framework of a final disinfection,
must undergo a wipe-down decontamination. All disinfectants listed in the
experts directory of the ÖGHMP (Austrian Society for Hygiene, Microbiology and
Preventive Medicine) may be used.
Beds
Matress covers that can be wiped clean with disinfectant must be used.
Medical equipment
Medical equipment like stethoscopes and blood pressure gauges must be kept in
the room and disinfected daily in an appropriate manner during the course of the
final disinfection. Equipment which has been in contact with infected patients and
which has had to be disposed of must undergo a thorough wipe-down
disinfection and then appropriate sterilisation.
Waste disposal
Waste, particularly the tissues used by patients with confirmed influenza
infection and patients suspected of having an influenza infection, must be put
into plastic bags, sealed and taken away.
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Influenza Pandemic Plan
Reports in the media, above all sensational ones, can understandably confuse
and frighten people and can veil scientific facts. Distorted reports of this kind can
lead to misunderstandings.
• Contain facts on the significance of the disease, details on the spread of the
virus and the extent of the epidemic
• Describe the problems and bottlenecks which can occur during vaccine
production and distribution, and particularly explain the reasons for the
introduction of priorities as far as the distribution of the vaccine and of
antiviral drugs are concerned
• Describe the possibilities and limits of self treatment
• Contain recommendations on how to behave in a given situation
• Inform people on the advantages and possible risks of vaccination
• Describe the therapeutic measures for cases with complications
The information will be prepared and released by the pandemic crisis committee.
Care should be taken to anticipate possible questions and provide answers
beforehand and not to sound high-handed. The information should be
comprehensive and honest. The pandemic plan proceeds from the assumption
that qualified and objective information will avoid panic in the population.
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Influenza Pandemic Plan
5.3.2. Pandemic
5.4. Competencies
During the preparatory stage, the provinces will keep in contact with the local
press. The BMGFJ will do the same at the national level. In the case of a
pandemic, the BMGFJ will publish national statements which will then be modified
regionally.
The distribution of information material will first and foremost be the job of the
provinces. Updated communiqués for the media and for the population will be
published daily should the pandemic have reached Austria. It would be advisable
to appoint a BMGFJ media spokes-person to cope with media work and equally
one for each province. After consultation, it will be their job to comment on the
current situation and to answer questions.
Interpandemic period
Phase 1 and 2
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Influenza Pandemic Plan
Phases 3 and 4
Phase 5
Pandemic period
Phase 6
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Influenza Pandemic Plan
6. Legal foundations
With the regulation under the Epidemic Law on notifiable diseases of January
2006, the obligation to notify the authorities of infections with the A/H5N1
influenza strain and other avian influenza viruses was introduced. This regulation
can now be found in § 1 of the Epidemic Law itself (amendment BGBI. I
Nr.114/2006 idgF).
6.1. Outline
This was introduced for every suspected, infected and fatal case of human
infection with the A/H5N1 influenza virus and other avian influenza viruses. If
necessary, the obligation to notify the authorities can be expanded by regulation
to include influenza in general.
• Every patient who has the disease (that is, in whom the disease has been
confirmed)
• Every death
• Every suspected case (all persons with symptoms which give rise to the
suspicion that they have the disease)
Infected persons, persons suspected of having the disease and those suspected
of carrying the disease* are obliged to:
• provide full information
• undergo the necessary medical examinations (including laboratory tests etc)
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Influenza Pandemic Plan
*Persons who show no signs of the disease but whose microbiological tests show that they are carriers, or who
have been exposed to the disease in such a way that they can be assumed to be carrying it and could therefore
pass it on.
6.4.1. Isolation
Isolation arrangements will be laid down when the time comes in the form of a
regulation according to necessity based on professional opinion.
• Public hospitals are not allowed to turn away a person who has been
committed to hospital by an administrative authority (such persons are to be
regarded as unrefusable) and hospitals are obliged to keep such a person in
hospital for the duration of the regulation (§22, §4 and §24 KAKuG)
• Furthermore, public hospitals are obliged to take in cases which require
immediate hospitalisation (even without an order!)
o If the person’s life is in danger or
o There is a danger that the person’s health will otherwise be seriously
damaged (=unrefusability)
The transport of an influenza patient may only be carried out by trained and
vaccinated personnel. Provision must be made for ambulances to be disinfected
after each transport.
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Influenza Pandemic Plan
If there are not enough public health officers to fight the pandemic, the district
administrative authorities can nominate epidemic doctors who will have the same
authority as public health officers.
N.B. Medical students doing practical work in a clinic may NOT vaccinate! (§41,
§5 Medical Law – concluding list).
6.7. Liability
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Influenza Pandemic Plan
This is possible within the framework of §12 of the Federal Drug Act if there is a
reason for it.
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1. Medical bases
1.1. Clinical image
1.2. Agents
Continuous mutations are called an antigenic drift and occur both in influenza A
and influenza B viruses. This antigenic drift is the reason why influenza virus
infections do not result in lasting immunity and therefore why re-infections and
annual epidemics can reoccur. Sudden and drastic mutations, known as an
antigenic shift, are, however, a hallmark of the influenza A virus and turn up at
unforeseeable intervals. If such drastically altered variations of a virus jump
directly from one human being to another, extensive epidemics can occur and
can therefore, as a further consequence, lead to a pandemic.
A pandemic virus of this kind has occurred three times up to now in the recorded
history of influenza and a new variant of hemagglutinine or neuraminidase has
emerged each time. The worst pandemic, known as “Spanish Flu”, was caused by
a subtype of the virus H1N1 in the years 1918/19 which costed 20 to 40m people
their lives. The other two pandemics, in the years 1957 (“Hong Kong Influenza”)
and 1968 (“Asian Influenza”), were caused by subtypes of virus H2N2 or H3N2.
42
Influenza Pandemic Plan
vaccine with the actual viruses in circulation. Optimally, in healthy persons under
65, the influenza vaccine can prevent infection in 70%-90% of cases. In older
persons the effectiveness is only 30%-70%.
Various drugs are available both for specific therapies as also for prophylaxis.
Amantadine and Rimantadine are only effective against Influenza A viruses, while
the newer neuraminidase inhibitors (Zanamivir and Tamiflu®) cover the Influenza
B virus. If taken within the first 48 hours after onset of the infection, both groups
of drugs have proved effective in reducing the intensity and duration of the
symptoms, and if used prophylactically prevent infection in more than 70% of
cases.
The conditions for the emergence of new human pathogenic influenza viruses of
epidemic potential are given in nature, and occurrences of influenza in the form
of pandemics must therefore also be reckoned with in the future. As history
shows, such pandemics can definitely assume catastrophic proportions and effect
entire populations and the social structure of whole countries. In such a
situation, it can be assumed that massive bottlenecks in the supply of vaccines
and antiviral drug products will occur internationally. The organisation of an
appropriate stock of drugs or ensuring supplies is therefore an important
measure to keep morbidity and mortality rates low in the event of a pandemic.
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Influenza Pandemic Plan
2. Epidemiology
In Austria approximately 380 000 people per annum contract influenza, roughly
4 500 of whom have to be hospitalised. Thus, although influenza is among the
most frequent and serious infectious diseases, risk awareness in the population is
inadequate. This is evident from the dramatically low vaccination coverage of an
average 17% which, despite intensive efforts to inform the population, has only
risen very slowly.
2.1. Epidemiology
The following data sources were used to depict influenza epidemiology in Austria:
the sentinella data from the period between 1992 and 2001 was projected (1)
and ICD data as also the mortality data (2) between 2001 and 2005 was
evaluated. The sentinella data for the period between 1995 and 1998 could not
be projected because the data base was missing, and there are no evaluations
after 2001.
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Influenza Pandemic Plan
According to the Sentinella data, there were approximately 378 500 cases of
influenza per annum during the period of observation (ranging from 250 000 to
500 000), which corresponds to an average incidence of approximately 4 500 per
100 000 inhabitants per annum (fig 1). These figures are similar to the data
collected in neighbouring Switzerland (3) and Germany (4).
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
On account of the switch to ICD version 10 at the turn of 2000/2001 and the
differences in the documentation which occurred as a result of the switch
(particularly as far as the classification of influenza with confirmed influenza
viruses is concerned), a time series analysis which went back beyond the above
date was waived and the evaluation was limited to the data of the years 2001-
2005 (with uniform ICD-10 classification).
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Influenza Pandemic Plan
< 11
>= 11 and < 15
>= 15 and < 21
>= 21 and < 31
>= 31
*)
standardised rate (standard population = European population)
Sources: BMGFJ – documentation of diagnoses and procedures; ST.AT - population 2001-2005; calculations by GÖG/ÖBIG
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Influenza Pandemic Plan
< 1.5
>= 1.5 and < 2.0
>= 2.0 and < 2.5
>= 2.5 and < 4.0
>= 4.0
0
*)
standardised rate (standard population = European population)
Sources: BMGFJ – documentation of diagnoses and procedures; ST.AT - population 2001-2005; calculations by GÖG/ÖBIG
47
Influenza Pandemic Plan
< 0.2
>= 0.2 and < 0.3
>= 0.3 and < 0.4
>= 0.4 and < 0.6
>= 0.6
0
The following methods for calculating the vaccination coverage rates are
available:
• The cohort model (=the proportion of vaccinated persons to the total number
of a birth cohort)
• Individual vaccination record (=determining the vaccination coverage rate on
the base of records pertaining to individual persons)
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Influenza Pandemic Plan
• As the vaccine is not purchased centrally and as, moreover, there are
vaccines from several firms on the market, it is not possible to calculate
vaccine consumption. One can only ask the firms how much vaccine is
produced for Austria as a whole
Until then poll results will have to be used (5). Thus in 2003, a randomised study
showed that the average vaccination coverage for persons over 15 was at the
moment only around 17% (=a total of 1.1. million vaccinations). Particularly
younger people under 40 show a lack of health awareness, as in this group the
vaccination coverage is only 15%. In contrast, at least every third senior citizen
over 60 has been vaccinated (=a vaccination coverage of 33%). Ignorance of the
dangers of getting influenza as also trusting in one’s own physical robustness are
the main reasons why risk awareness is so poor.
Bibliographical references:
1. ARGE Influenza analysis for the period 1992-2001, without 1995 and 1998
(http://:www.arge-influenza.at ). Basic data: M15 – Vienna taking urban
demographic structure into consideration
4. Anonymous (http://www.rki.de )
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Influenza Pandemic Plan
3. Surveillance
The National Reference Centre for Influenza (NRI) is responsible for surveillance.
The NRI consists of two competence centres:
• The Institute for Medical Microbiology and Hygiene Vienna (NRI Epidemiology)
known as AGES
• The Institute for Virology at the medical school of Vienna University (NRI
Laboratory)
• With a time delay of one year, the death rate statistics for influenza and
pneumonia categorised into age groups provide important data for the
epidemiological analysis of influenza activity in Austria
• The NRI exchanges information with other European countries and with the
WHO
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Influenza Pandemic Plan
Influenza viruses from samples which doctors have taken from patients with
influenza and sent in, are isolated and classified at the Virological Institute of
Vienna University Medical School. The NRI laboratory sends this data in weekly
to NRI Epidemiology with details of the available data of the patients such as
age, gender, clinical complications and virus type, as also the method for
detection.
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Influenza Pandemic Plan
4. Drugs
4.1. General information on effective influenza
virostatics
4.1.1. Amantadine
Amantadine (and Rimantadine - not licensed in Austria), which has been used for
influenza prophylaxis and therapy for more than 30 years, is an ion channel
blocker of the M2 ion channel in the membrane of influenza A viruses. It
prevents the uncoating (blocking the release of the virus genome) of viral nucleic
acid in the infected cell. This medication does not seem suitable for extensive use
in a pandemic for the following reasons:
• The possibility that after a short treatment time (2-3 days) resistant variants
of the virus will appear which could spread and would therefore soon render
this therapy useless
• Amantadine has a narrower spectrum of activity than the newer drugs which
have proved specifically effective for influenza A and B. It is, moreover, only
usable for influenza A. This seems adequate, as on account of the antigen
shift, a pandemic can only be caused by the influenza A virus, according to
expert opinion. The disadvantage is, however, that Amantadine is not
effective for possible influenza B infections which may break out at the same
time as a pandemic
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Influenza Pandemic Plan
In the case of both substances, one has 36-48 hours after the appearance of first
symptoms in which to begin the therapy and achieve successful treatment. New
investigations show that in principle therapy should begin as early as possible,
optimally within the first 12 hours. Oseltamivir and more recently also Zanamivir
have been licensed for the therapy and prophylaxis of influenza infections in
Austria.
The way the drugs are administered, however, (Oseltamivir is administered per
os while Zanamivir is administered by inhaler) means that Oseltamivir is
preferable for use in an influenza pandemic. A drug that has to be inhaled like
Zanamivir does not seem very practical for use in a pandemic. (For this reason
Zanamivir is also unsuitable for small children/children and unlike Oseltamivir
licensed for children older than 5 years.) Furthermore, Zanamivir can lead to an
acute bronchospasm with a serious reduction of respiratory function in patients
with serious asthma or respiratory disease as also in older patients.
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Influenza Pandemic Plan
The reason for the Oseltamivir therapy or prophylaxis is, as stated above,
primarily to bridge the time gap until a sufficient supply of an effective vaccine is
available plus the time it takes for a protective immunity to develop. Extensive
use of Oseltamivir in a pandemic would therefore seem to be necessary in order
to keep the mortality and morbidity rate in the population as low as possible.
• Post exposition prophylaxis: for persons who have been in contact with
infected patients and who have not been vaccinated if chemoprophylaxis can
be begun within 48 hours
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Influenza Pandemic Plan
• Seasonal prophylaxis: for persons who have not been vaccinated, regardless
of whether they have been in contact with infected patients, for the duration
of the influenza wave until immunisation protection is assured
Oseltamivir is licensed for prophylaxis for adults and children from one year
upwards. The dosage is:
4.2.2. Therapy
For those persons who have already been infected, Oseltamivir can have a
causal-therapeutic effect. The drug must, however, be administered as soon as
possible, optimally within the first twelve hours (at the latest within 48 hours)
after the appearance of the first symptoms. The latest research again confirms
the necessity of beginning treatment as early as possible.
The effect of the treatment consists in relieving the symptoms (e.g. fever,
headaches, myalgia, coughing) as also in shortening the duration of the illness.
Typical complications (e.g. bacterial infections of the lower respiratory tracts,
mainly bronchitis) are moreover diminished.
The reduced virus secretion which has been observed in treated patients could
moreover have a positive effect on the infection rate.
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Influenza Pandemic Plan
Using various quick tests is at the moment still disputed. Sensitivity and
specificity have not yet been sufficiently evaluated and the cost plays an
essential role in extensive use. Furthermore, the diagnosis rate in recognising
cases of influenza is not a great deal higher than 70%.
For these reasons, during a pandemic, a clinical diagnosis should already be
made at the first consultation followed immediately by prompt treatment which is
essential if the treatment is to be effective.
Oseltamivir is licensed for the therapy of adults and children from one year
upwards. The dosage is as follows:
The latest studies indicate that (regardless of the specific resistance position of
the agent), a higher dosage or taking Oseltamivir for a longer time period than
shown above might be necessary in a pandemic. The dosage recommendations
for an emergency will therefore need to be adjusted to the actual situation
shortly beforehand.
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Influenza Pandemic Plan
shelf-life (at the moment the shelf-life for this form of storage has been
confirmed as 5 years and may possibly be extended to 10 years). Furthermore,
the barrels are more advantageous as far as storage and costs are concerned.
The cost of the necessary active substance for the treatment of a patient is
approximately half that of the treatment with hard capsules.
The preparation of the solution which is ready for use will be undertaken by
special pharmaceutical personnel at special locations or facilities (presumably
pharmacies and hospital pharmacies) who will be determined according to
demand.
• 355.3 litres of aqueous 0,1% sodium benzoate solution = 355.3 litres H²O
and 355.3g of sodium benzoate, as also for distribution among the population
• 7106 dark 50ml bottles for bottling as also for attaching a dispenser/syringe
• 7106 oral dispensers (with a 5ml marking) or 5ml syringes will be needed
The dosage for the solution prepared from the barrels will be measured in ml:
• 1ml of the prepared and ready for use solution contains 15mg of Oseltamivir
• 5ml (= individual dose for adults) therefore contains 75mg of Oseltamivir
The active substance content of one barrel is theoretically enough for the
individual treatment of 7 106 infected persons or for post-expositional
prophylactic treatment of the same number of healthy persons or, alternatively,
assuming that treatment is licensed for a total period of 6 weeks, enough for
1 692 seasonal prophylaxes.
Relenza® is licensed for the prophylaxis and therapy of adults and children of
over 5 years of age. In a pandemic, Tamiflu® suspension must therefore be used
for children under 5 years (licensed for children over one – see above).
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Influenza Pandemic Plan
Relenza® is available in folding boxes which each contain 5 round aluminium foil
disks (called rotadisk with a shelf life of 5 years. The substance is packed in 4
evenly piled blisters on each of these rotadisks (the contents of 2 blisters equal
one dosage, each blister contains 5mg of Zanamivir).
It is also planned to make Relenza® available in bulk for better stockpiling. It will
foreseeable be in boxes each of which will contain 77 inhalers with 5 rotadisks
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Influenza Pandemic Plan
and 77 directions for use plus instructions for the correct distribution of the bulk
ware components.
The complete content of the box would theoretically last for a single use of 77 ill
persons or for the same number of postexpositional prophylaxic in healthy
people, or, alternatively, starting from a licensed complete duration of treatment
of 4 weeks for 27 seasonal prophylaxes.
The accompanying treatment for influenza infections that have already broken
out depends on the seriousness of the illness and the patient’s general condition.
In most cases symptomatic treatment will suffice (besides using certain
virostatics as described above): relieving pain and reducing fever with the
appropriate drugs, using expectorants or antitussives (but not in combination!)
and above all sufficient rest and care.
Care must be taken when reducing fever in children: Acetylsalicylic acid must
never be used to reduce fever in children with influenza as it can cause the so-
called Reye Syndrom: this is a serious form of encephalopathy with fatty
degeneration of the liver cells and symptoms such as vomiting, fever, dizziness
and coma with a fatality rate of approximately 25%. Up to puberty, therefore,
ASS is contraindicated for virus infections in children.
Bacterial sinus infections (sinusitis) and bacterial ear infections (otitis media) can
also occur. In such cases treatment with the appropriate antibiotics is indicated.
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Influenza Pandemic Plan
5. Vaccines
Producing and making an effective vaccine that is well tolerable available as soon
as possible is the most urgent target in the case of an impending pandemic.
Already in the inter-pandemic phase, this task requires the most extensive
preparation possible as far as production, testing and licensing procedures for
the vaccine are concerned on the part of the manufacturers and licensing
authorities.
The Vaccine Working Party (VWP) of the EMEA (European Medicines Agency) has
for this reason produced several guidelines (adopted March 2004 and June
2005). On the one hand, the guidelines are to guarantee the quality, safety and
effectiveness of the vaccine, and on the other hand, to ensure that the licensing
authorities work together with the manufacturers and the WHO.
In 2005, the EMEA published a draft crisis management plan in the case of an
influenza pandemic for public consultation. The plan aims to establish efficient
procedures for evaluating and authorising pandemic influenza vaccines in a
centralised procedure and for the surveillance of vaccines and antiviral drugs for
a potential pandemic.
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Influenza Pandemic Plan
5.1.1. Quality
It is not possible from today’s point of view to give details about the final formula
of an influenza pandemic vaccine. The production and final formulation of an
influenza pandemic vaccine will differ in certain aspects from the influence
vaccine used in the inter-pandemic phase.
During the production of the vaccine strain, it can be assumed that gene
technology (reverse genetics) will be used.
5.1.1.1. Production
Propagation of the vaccine virus can – as in the influenza vaccines which are on
the market at the moment – take place in embryonated hens`eggs or by using
the cell culture method. “Vero” or “MDCK” cells, which have been used for cell
cultures for many years, are used for this purpose. They are biologically and
genetically very well characterised and free of pathogens and have been used for
the production of other vaccines.
Besides the general EMEA guidelines and monographs of the Pharmacopoeia and
the monograph of the European Medicines “Manual for Virus Promulgation in
embryonated hens’eggs”, the “Note for Guidance on Cell Culture inactivated
Influenza Vaccines” (CPMP/BWP/2490/00) should be taken into account in
production.
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Influenza Pandemic Plan
The typing of the Influenza A viruses occurs on the basis of the virus’s surface
proteins hemagglutinin (H) and neuraminidase (N).
Ducks were identified as the original hosts of the last three great pandemics
caused by influenza A viruses ( “Spanish Flu”, H1N1, 1918-20; “Asian Flu”,
H2N2, 1957-60; “Hong-Kong Flu” H3N2, 1968-70). New influenza A viruses can
evolve at any time in “avian influenza viruses” through “antigenic drift” (high
rate of point mutations) and/or through “antigenic shift” (reassortment of the
eight-part virus genome) which can in the final instance become contagious and
pathogenic for human beings.
Mixed infections in pigs have primarily been made responsible for the reassorting
of viral genomes. As 16 different H-subtypes and 9 N-subtypes are known at the
moment, there are many theoretical combination possibilities. The possibility of
antigenic drift in influenza viruses mentioned above manifoldly multiplies the
number of possible variants. For this reason it is not possible to characterise a
pandemic virus genetically and antigenetically and to produce a preventive
vaccine before the potential pandemic virus actually evolves.
Most experts assume that future influenza A viruses with the potential for a
pandemic will probably also be derived from avian influenza viruses. WHO, EMEA,
international research institutes and health authorities therefore attach particular
importance to those subtypes in the “three great epidemics” which already
proved to have pandemic potential (=H1 to H3; see above). No less attention is
being paid to subtype H5N1 which has been circulating in wild and domestic fowl
in Asia since at least 2003, and for which there is as yet no guaranteed proof of
human-human transmission, but which is also highly pathogenetic for humans.
High priority is also being given to subtypes H7 and H9, which are contagious for
humans but for which again there is as yet no guaranteed proof of human-
human transmission.
The actual virus strain for vaccine production will be determined by the WHO or
by a reference laboratory designated for this purpose by the WHO and then
made available.
The possibility of very high pathogenicity could, moreover, make it impossible for
the manufacturer, for safety reasons, to produce a vaccine directly from this
virus.
Both these potential problems for vaccine production (bad propagatability and
high pathogenicity) could be solved by the gene-technological method known as
“reverse genetics”. With this method, “virus hybrids” which carry the surface
proteins H and N of the pandemic virus mainly responsible for immunogenicity
are produced in a class 3 biosafety laboratory. The other genes derive from a not
very pathogenetic but at the same time well propagatable influenza A virus.
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Influenza Pandemic Plan
The production of such a vaccine strain was succesfully tested at the NIBSC
(National Institute for Biological Standards and Controls, UK) and should be
carried out in the case of a pandemic. Subsequently, this gene-technologically
produced not very pathogenic and well propagatable virus strain could then be
made available to the vaccine manufacturers. Such a procedure would be in the
charge of the WHO.
An adjuvantisation above all of the purity of the vaccine, the type of antigen
(“whole-virus or “purified antigen”) and the amount of antigen are responsible
for the reactogenicity. In this case, the knowledge and experience of more than
50 years of “influenza vaccine” research will be included in a benefit-risk analysis
so that a shorter period of pre-clinical testing may possibly be considered
adequate.
Clinical testing should verify adequate immunogenicity and the safety of the
vaccine. The evaluation of a suitable vaccine scheme is of particular significance
in order to be able to guarantee the efficacy. The status of the population, the
characteristics of the vaccine (adjuvantisation, antigen amount, type of antigen)
and the possible infection pressure must all be taken into consideration in the
case of a pandemic.
The professional and general instructions should be consulted for exact details
for the safe and effective use in the case of a pandemic.
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Influenza Pandemic Plan
Licensing procedure serves the purpose of checking the quality, safety and
efficacy of the vaccine. At the same time, in a pandemic, any unnecessary loss of
time must be avoided. For this reason joint coordinated action on the part of the
licensing authorities and vaccine manufacturers is imperative already in the
inter-pandemic period.
In order to avoid any unnecessary loss of time, the “Joint EMEA-Industry Task
Force” has been set up which is to guarantee the coordinated procedure already
during the interpandemic phase and also in the case of a pandemic.
The above cited EMEA guidelines concerning authorisation lay down the course of
the centralised authorisation procedure in detail in chronological and
organisational liaison with the WHO alarm system in an influenza pandemic.
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Influenza Pandemic Plan
SUPPLEMENT
Appendix 1 -11
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Influenza Pandemic Plan
APPENDIX 1:
What are the symptoms? (in the pandemic: in accordance with the WHO –
case definition)
Influenza is spread through so-called droplets which are exhaled from the mouth
or nose by coughing or sneezing. Transmission is also possible by contact with
surfaces contaminated with the influenza virus (e.g. work surfaces, objects) or
via hands. Adults are usually infectious for five days after the appearance of the
first symptoms, children for seven days or longer.
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Influenza Pandemic Plan
• Avoid close contact with relatives and friends who have not been infected
• Only use disposable paper handkerchiefs and dispose them safely in plastic
bags
• Drink a lot of fluids
• Avoid physical activities
• You must stay in bed
• Take your prescribed medicine regularly
• Avoid aspirin if you are under 15 or if you take certain coagulation inhibitors
• If in severe pain use a standard painkiller like paracetamol
(dosage prescribed by a doctor or as described in package leaflet instructions for
use, a maximum of 8x500 mg per day)
Contact your general practitioner if you notice that you have influenza
symptoms and if, moreover, one of the following conditions apply to you:
Contact your doctor immediately if you have influenza and, despite the
fact that you have kept to the above recommendations, you notice or
experience one of the following:
• A rash
• Extreme fatigue (drowsiness)
• Your condition deteriorates
• you are short of breath
• Piercing chest pain when you breathe in deeply
Do antibiotics help?
Antibiotics have no effect on viruses and are thus not effective against influenza.
Nevertheless, doctors sometimes prescribe antibiotics for virus infections in order
to prevent bacterial infection of the mucous membranes (tissues).
Further information can be obtained via the Info-Hotline, the homepage of the
Ministry of Health, the provincial health authorities,..
67
Risk stratification for CAP (= Community Acquired Pneumonia)*
*Taken from CliniCum, special edition 10/2003: Expert statement on CAP
patronage: ÖGCH (= Austrian Society for Chemotherapy) and ÖGLUT
(= Austrian Society for Lung Diseases and Tuberculosis)
Thorax X-Ray
INFILTRATION
68
Group I Group II Group III
APPENDIX 2:
Influenza Pandemic Plan
Babies and children up to 3 months Amoxicillin 3x1g p.o. Amoxicillin/Clac 3x1g p.o. Piperacillin/Taz 3x4,5g i.v.
Amoxicillin Cefadroxil 2x2g p.o. Ampicillin/Sulb 3x0,75g p.o.
Cefalexin 3x1g p.o. Bacampicillin 3x0,8g p.o. Cefotaxime
Children from 3 months to 14 years Cefetamet-P. 2x1g p.o. Cefepime 3x2g i.v.
Amoxicillin Cefixime 1x0,4g p.o. Cefpirome
Cefadroxil 50-100 mg/kg 3 ED p.o. Cefpodoxime 2x0,4g p.o. Azithromycin 1x0,5g p.o.
Cefalexin Cefuroxime-A. 2x1g p.o. Clarithromycin 2x0,5g p.o. Ceftriaxone
Cefetamet-P. 20mg/kg 2 ED p.o. Roxithromycin 2x0,3g p.o. Cefodizim 1x2g i.v.
Cefixime 8 mg/kg 1 ED p.o. Telithromycin 1x0,8g p.o. Ertapenem 1x1g i.v.
69
Cefpodoxime 5-12 mg/kg 2 ED p.o.
Cefuroxime-A 20-30 mg/kg 2 ED p.o. Acitromycin 1x0,5g p.o. PLUS
Clarithromycin (1-)2x0,5g p.o. Levofloxacin 1x0,5g p.o.
APPENDIX 3:
APPENDIX 4:
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Influenza Pandemic Plan
APPENDIX 5:
Influenza-reference centre for Influenza: AGES Vienna, Dr Peter Lachner: Fax 050555 37109
E-mail: peter.lachner@ages.at
(m=1, f=2)
Gender
(yes=x)
Pneumonia
(yes=x)
Inpatient
(yes=1, no 2)
Vaccinated
(yes=x)
Death
Antiviral therapy
Amantadine =1
Neuraminidase inhibitors =2
Patient Nr.
DOCTOR’S CODE
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Influenza Pandemic Plan
APPENDIX 6:
Clinical Description
Sudden onset of illness, coughing, fever >38° C, muscle pain and/or headache
Laboratory criteria
Case Definition
Comment:
In the case of a pandemic, the WHO will publish a case definition adjusted to the
actual clinical image which the EU – Austria included – will adopt. National and
international announcements will therefore be effected according to a uniform
worldwide case definition – analogous to SARS.
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Influenza Pandemic Plan
Contributors
Authors (in alphabetical order)
Dr Christoph Baumgärtel, Pharmed Austria
Mag Petra Falb, Pharmed Austria
DI Dr Gerhard Fülöp, Gesundheit Österreich GmbH, Geschäftsbereich ÖBIG
Dr Sylvia Füszl, Federal Ministry of Health, Family and Youth
Dr Wolfgang Gelbmann, EFSA (=European Food Safety Authority)
Univ-Prof Dr Franz. X. Heinz, Virological Institute of Vienna University Medical
School
DI Anton Hlava, Gesundheit Österreich GmbH, Geschäftsbereich ÖBIG
Dr Ursula Karnthaler, Provincial Health Authority, Vienna
Univ-Prof Dr Michael Kunze, Centre for Public Health, Medical University of
Vienna
Dr Peter Lachner, AGES (=Austrian Agency for Health and Food Safety)
Uni-Prof Dr Theresia Popow-Kraupp, Virological Institute of Vienna University
Medical School
DDr Reinhild Strauss, Federal Ministry of Health, Family and Youth
Univ–Prof Dr Günther Wewalka, AGES (=Austrian Agency for Health and Food
Safety)
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Influenza Pandemic Plan
Further associates
Univ-Doz Dr Hartmut Huemer (Innsbruck University Medical Faculty), Univ-Prof
DDr Armin Prinz (Vienna University Medical Faculty), HR Dr Michael Schönauer
(AGES=Austrian Agency for Health and Food Safety), Dr Herbert Tomaso (BMLV
= Federal Ministry of Defence)
OA Dr Hermann Laferl for his expert advice on the triage criteria for hospital
admission
Addresses
WHO Pandemic Plan:
http://www.who.int/csr/resources/publications/influenza/GIP_2005_5Eweb.pdf
National pandemic plans:
http://www.who.int/csr/disease/influenza/nationalpandemic/en/
Robert-Koch-Institut/Berlin:
http://www.rki.de/cln_049/nn_197444/DE/Content/InfAZ/I/Influenza/Influenzap
andemieplan.html?__nnn=true
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Influenza Pandemic Plan
Imprint
Proprietor, Publisher and Editor:
Federal Ministry for Health, Family and Youth (BMGFJ)
Radetzkystraße 2
A-1030 Vienna
Layout:
Christine Hain
Dpt. of Infectious Diseases, Health Threats and Crisis Management, BMGFJ
Printers:
Printed by The Federal Ministry for Health, Family and Youth (BMGFJ)’s printers
ISBN 978-3-90-2611-05-5
English translation of the third edition
Contact: reinhild.strauss@bmgfj.gv.at
75
An influenza pandemic is defined as the
worldwide occurrence of masses of cases
and deaths caused by a new influenza
subtype. Since avian flu in animals has
become endemic the risk for a new
influenza pandemic in human has increased
dramatically. WHO and the European
Commission therefore have urgently asked
the member states since years to provide
national contingency plans.