Pandemic Preparedness Plan

Dr.Murali Vallipuranathan MBBS, PGD , MSc, MD Consultant Community Physician

Pandemic Preparedness Plan

It can be at three levels
 Global planning  Community planning  Individual organization

planning

Key Elements
 Introduction to Pandemic  Reasons for Preparing a Pandemic

Plan  Preparedness Planning Process  Communications Strategy  Implementation  Follow up- Monitoring

Past Influenza Pandemics
1850 1847 42 yrs 1889 1900 1918 1957 1968 29 yrs 39 yrs 1950 11 yrs Pandemic usually occur every 30 – 40 years

2000

Last Pandemic was ≈ 40 Last Pandemic was ≈ 40 years ago, in 1968.... years ago, in 1968....

Influenza Strains and Pandemics in 20th Century 1918-19 1957-58 196869 “Spanish Flu” 20-40 million deaths H1N1 “Asian Flu” 1 million deaths H2N2 “Hong Kong Flu” 1 million deaths H3N2 1920 1940 1960 1980 2000 .

 .Pandemics have been occurring throughout human history. Three major pandemics in the 20th century Current Pandemic first in 21st Century April 2009-present: The “Swine Flu” (H1N1):  This is a novel strain of avian. swine and human antigens that is still mutating and spreading in the human population worldwide.

Pandemic Influenza Human Strains Unknown Avian Strains Potential to ‘mix & match’ avian & human strain genes Unknown .Genetic Shift .

1. 3. the virus infects humans. The population has little or no immunity to the virus  A . the virus gains efficient and sustainable transmission from human to human. 2.Cause of Pandemic pandemic virus occurs when an antigenic shift takes place in the virus and the following conditions are met. a new influenza virus subtype emerges. The new virus has a capacity to cause serious clinical disease and death 5. 4.

Higher risk of human cases no human cases PANDEMIC ALERT New virus causes human cases No or very limited human to human transmission Evidence of increased human to human transmission Evidence of significant human to human transmission 3 4 5 6 PANDEMIC Efficient and sustained human to human transmission .Phases of Pandemic INTER-PANDEMIC PHASE  Low risk of human cases 1 2 New virus in animals.

WHO Pandemic Phase 6 .

An animal influenza virus is known to have caused infection in humans   Phase 3 .Limited human-to-human transmission may occur   Phase 4 -Verified human-to-human transmission able to cause “communitylevel outbreaks.” .Explanation of WHO Phases  Phase 1 .   Phase 2 .No viruses circulating among animals have been reported to cause infections in humans.

Human-to-human spread of the virus into at least two countries.The pandemic phase.   Post-peak period . is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5.  .)  Phase 5 .   Post-pandemic period .Influenza disease activity will have returned to levels normally seen for seasonal influenza.Explanation of WHO Phases (cont.   Phase 6 . Additional waves may occur and countries will need to be prepared for a second wave.Disease levels in have dropped below peak observed levels.

Designation of this phase will indicate that a global pandemic is under way. is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5.WHO .WHO Pandemic Phase 6   “Phase 6.” . the pandemic phase.

healthy adults (unlike regular seasonal flu)    .Characteristics of Pandemics More than one pandemic wave is likely Can be weeks or months between waves Severity of waves unpredictable: subsequent wave could be worse than first  Typically affects young.

may more severe 3rd wave may also occur  • • •    .often out-of-season.Pandemic Waves  3 month warning from first pandemic outbreak to local outbreaks 1st wave . may last 6-8 weeks (peak at 3-4 weeks) be 2nd wave .3-9 months later.

T h re e Fl Pa n d e m i i th e 2 0 th Century u cs n .

in multiple waves with devastating societal impact .Known facts about a future pandemic   An influenza pandemic will happen  The timing and pattern will be unpredictable  A short lead time will exist from first identification to full scale pandemic  Outbreaks will occur simultaneously.

supplies and personnel . equipment.Known facts about a future pandemic ( continued )  Young healthy people in our community will be affected  There will be shortages of medical resources.

Known facts about a future pandemic ( continued )  Essential services will be severely disrupted due to absenteeism  Media and public scrutiny will be intense and unrelenting  There will be LIMITED TO NO OUTSIDE ASSISTANCE available  Increases in both global travel and world population will likely contribute to rapid virus spread .

Assumptions for Sri Lanka  Spread to Sri Lanka may take several months. but may be shorter  A vaccine probably would not be available in the early stages  The numbers of health-care workers and first responders available to work can be expected to be reduced  .

a second wave of illness may occur 6-9 months later  some 20 to 30% of the population or even more may be affected over a 12 year period. the disease is likely to spread rapidly over 2-3 weeks and then gradually decline over the next 4-6 weeks.Assumptions for Sri Lanka (continued)  once established in Sri Lanka. including children and normally fit young adults  a far greater proportion of people are likely to require hospitalization or die than for seasonal flu.  .

Objectives of Pandemic preparedness Plan (PPP)  Slow the disease spread  Reduce morbidity and mortality  Minimize social disruption  Avert economic disaster  Preserve essential community functions  .

Goals of Pandemic Preparedness Plan 1 Delay onset of outbreak Reduce the peak burden on hospitals/infrastructure Decrease a) number of cases of death and illness and b) overall health impact Number of Daily Cases Pandemic Outbreak : No Community No Community Measures Used 2 3 Pandemic Outbreak : With Measures Taken Days Since First Case .

clinicians § laboratory diagnosis and test experts § communication expertise § disaster management team § Security forces § Ethicists .Who should prepare PPP?  Multi-sectoral approach § Policy developers § Legislative reviewers § Animal health experts § Public health experts § Patient care.

Purposes of PPP § Provide guidance to State/local health departments and health care organizations for planning § Outline coordination and implementation of a response § Define preparedness needs § Identify key issues that remain to be resolved .

What should be the core areas in the PPP? vDescribes national coordination and decision-making vProvides an overview of key preparedness issues vDefines legal authorities for pandemic responses vLists specific response activities by pandemic phase  .

Activities in PPP  Surveillance  Public health interventions to decrease disease spread  Screening and diagnosis  Case management  Inter-sectoral coordination locally and internationally  Vaccination strategies  Antiviral drug strategies  Communications  Autopsy and disposal procedures  Research .

level Activate Central command center 1: human alert.Activities differ between Pandemic Phases Pandemic Phase Critical activities Pandemic alert. no Develop/test candidate vaccine 2 & 3: p-to-p p-to-p transmission Enhance surveillance Accelerate/monitor preparedness transmission. local Investigate outbreak/define epidemiology Implement containment activities outbreak(s) Initiate pandemic vaccine production Continue/accelerate preparedness Implement communications plan . level Enhance surveillance Pandemiccases.

Implement strategy to decrease community early Respond to initial cases Define epidemiology/identify risk groups widespread spread Implement full-scale pandemic response Initiate vaccination disease Prepare for full-scale pandemic response .Activities differ betweenPandemic Phases (continued) Pandemic Phase Critical activities Pandemic phase. Implement strategy to decrease internal spread Pandemic phase.

people take in. process and act on information differently  That increases the potential for miscommunicati on  .Communication in a crisis is different In a crisis.

Communication is essential. credible. consistent.  People  for/ respond to emergencies decisions need information to prepare   Information   Information    to support good must be accurate. useful – PHASED .

Communication in emergency:  Show that you care  Demonstrate competence/expertise  Tell what you know and don’t know  Explain process to find answers   .

DO NOT assume that people will “panic”!   .Communication in emergency:  Don’t over reassure  Acknowledge uncertainty  Acknowledge fear  Let people know what they  Ask more of people   can do Assume the best of people.

Prepare to Answers for: What is happening? Are my family and I safe? What should I do? What can I do to protect myself and my family?  What is Government/ Health Ministry doing?  What can we expect?  Why did this happen?  Why wasn’t this prevented?  What else can go wrong?  What does this information mean?       .

and Ministry of Animal Production and Health has been appointed with the threat of Avian Influenza Pandemic  Regular meetings of the Joint Technical Committee are conducted to review the pandemic preparedness activities in collaboration with the Ministry of Estate Infrastructure & Livestock .Pandemic Preparedness Plan in Sri Lanka  Cabinet approved Steering Committee which includes the Secretaries and Director Generals of Ministry of Health.

 District plans are being prepared by the Deputy Provincial Directors of Health in the districts: Individual plans for the major hospitals have been developed by the Heads of the .  Guidelines were developed and circulated island wide on Avian Influenza Pandemic Preparedness and Response.Pandemic Preparedness Plan (PPP) in Sri Lanka (continued)  The committee is also represented by the members from the Ministries of Environment & Wild Life.

Planned activities of PPP & early warning Monitoring & prompt reporting of unusual events  Prevention & control Emergency response team in districts and training of health staff  Health System Response  Risk Communication  Surveillance .

triage arrangements and personal protective equipment  Risk Communication Communication strategic plan was developed  Health .Planned activities of PPP (continued) System Response Upgrade lab facilities. sentinel surveillance sites.

Issues in Pandemic Preparedness in Sri Lanka  We have expertise in Pandemic Planning with the international collaboration  Difficulty in implementation at the regional level  Issues in the availability of vaccines  Logistic issues  Isolation issues  Cost  .

 Panic is our enemy  Knowledge is our friend  Preparation is our best line of defense  THANK YOU .

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