Download - Pandemic Preparedness Plan
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PandemicPreparedness Plan
Dr.Murali VallipuranathanMBBS, PGD , MSc, MDConsultant Community Physician
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Pandemic PreparednessPlan
It can be at three levelsGlobal planning
Community planning Individual organization planning
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Key Elements
Introduction to PandemicReasons for Preparing a Pandemic
PlanPreparedness Planning ProcessCommunications Strategy ImplementationFollow up- Monitoring
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Past Influenza Pandemics
1900
1850
1950
2000
1847
1889
1918
1957
1968
42 yrs
29 yrs
39 yrs
11 yrs
Pandemic usually occur every 30 – 40 years
Last Pandemic was ≈ 40
years ago, in 1968....
Last Pandemic was ≈ 40
years ago, in 1968....
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Influenza Strains and Pandemics in 20th Century
1918-19 1957-58 1968-69
1920 1940 1960 1980 2000
H1N1 H2N2 H3N2
“Spanish Flu” “Asian Flu” “Hong Kong Flu”
20-40 million deaths 1 million deaths 1 million deaths
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an em cs ave eenoccurring throughout
human history.Three major pandemics in the 20th
century
Current Pandemic first in 21st
CenturyApril 2009-present: The “Swine
Flu” (H1N1):This is a novel strain of avian, swine
and human antigens that is stillmutating and spreading in the
human population worldwide.
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Genetic Shift - Pandemic Influenza
Human Strains
Avian Strains
Potential to ‘mix & match’ avian
& human strain genes
Unknown
Unknown
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Cause of Pandemic
A pandemic virus occurs when anantigenic shift takes place in the virusand the following conditions are met.
1. a new influenza virus subtypeemerges,2. the virus infects humans,3. the virus gains efficient and
sustainable transmission from human tohuman.
4. The new virus has a capacity to causeserious clinical disease and death
5. The population has little or no
immunity to the virus
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Phases of Pandemic
INTER-PANDEMIC PHASE
Low risk of human cases 1
New virus in animals,no human cases
Higher risk of human cases 2
PANDEMIC ALERT
No or very limited humanto human transmission
3
New virus causes
human cases
Evidence of increased human to
human transmission
4
Evidence of significant human tohuman transmission
5
PANDEMIC Efficient and sustained human to
human transmission
6
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WHO Pandemic Phase 6
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Explanation of WHOPhases Phase 1 - No viruses circulating among
animals have been reported to causeinfections in humans.
Phase 2 - An animal influenza virus isknown to have caused infection inhumans
Phase 3 - Limited human-to-humantransmission may occur
Phase 4 -Verified human-to-humantransmission able to cause “community-
level outbreaks.”
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Explanation of WHO Phases(cont.)
Phase 5 - Human-to-human spread of the virusinto at least two countries.
Phase 6 - The pandemic phase, is characterizedby community level outbreaks in at least oneother country in a different WHO region in
addition to the criteria defined in Phase 5.
Post-peak period - Disease levels in havedropped below peak observed levels. Additionalwaves may occur and countries will need to be
prepared for a second wave.
Post-pandemic period - Influenza diseaseactivity will have returned to levels normallyseen for seasonal influenza.
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WHO Pandemic Phase 6
“Phase 6, the pandemic phase, ischaracterized by community leveloutbreaks in at least one
other country in a different WHOregion in addition to the criteriadefined in Phase 5.
Designation of this phase willindicate that a global pandemic isunder way .”
- WHO
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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 thanfirst
Typically affects young, healthy adults(unlike regular seasonal flu)
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Pandemic Waves
3 month warning from first pandemicoutbreak to local outbreaks
• 1st wave - often out-of-season, maylast 6-8 weeks (peak at 3-4 weeks)
• 2nd wave - 3-9 months later; may
be more severe• 3rd wave may also occur
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T h re e Flu Pa n d e m ics in th e 2 0 th Century
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An influenza pandemic will happenThe timing and pattern will be
unpredictableA short lead time will exist from
first identification to full scale
pandemicOutbreaks will occur
simultaneously, in multiplewaves with devastating societalimpact
Known facts about a futurepandemic
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Young healthy people in our communitywill be affected
There will be shortages of medical
resources, equipment, supplies andpersonnel
ow ac s a o a epandemic( )continued
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Essential services will be severelydisrupted due to absenteeism
Media and public scrutiny will be
intense and unrelentingThere will be LIMITED TO NO
OUTSIDE ASSISTANCE available
Increases in both globaltravel and world populationwill likely contribute to rapid
virus spread
nown ac s a ou a u urepandemic( )continued
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Assumptions for SriLanka
Spread to Sri Lanka may takeseveral months, but may be
shorterA vaccine probably would not beavailable in the early stages
The numbers of health-care
workers and first respondersavailable to work can beexpected to be reduced
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Assumptions for SriLanka (continued)
once established in Sri Lanka, thedisease is likely to spread rapidlyover 2-3 weeks and then gradually
decline over the next 4-6 weeks; asecond wave of illness may occur 6-9months later
some 20 to 30% of the population oreven more may be affected over a 1-2 year period, including children andnormally fit young adults
a far greater proportion of people arelikely to require hospitalization or die
than for seasonal flu.
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Objectives of Pandemicpreparedness Plan (PPP)
Slow the disease spreadReduce morbidity and mortality
Minimize social disruptionAvert economic disasterPreserve essential community
functions
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Delay onset of outbreak
Reduce the peak burdenon hospitals/infrastructure
Decrease a) number of cases of death andillness and b) overallhealth impact
Days Since First Case
Numbe
rofDa il
yCases
Goals of Pandemic Preparedness Plan
P a n d e m i c:O u t b r e a k
N o C om mun it y M ea su re s U se d
P a n d e m i c:O u t b r e a k
Wi th Me as ur esT a k e n
Delay onset of outbreak
Reduce the peak burdenon hospitals/infrastructure
Decrease a) number of cases of death andillness and b) overallhealth impact
2
1
3
P a n d e m i c:O u t b r e a k
N o C om mu nit y M ea su re s U se d
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Who should preparePPP?
Multi-sectoral approach§ Policy developers§ Legislative reviewers
§ Animal health experts§ Public health experts§ Patient care- clinicians§ laboratory diagnosis and test
experts§ communication expertise§ disaster management team§ Security forces
§ Ethicists
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Purposes of PPP
§ Provide guidance to State/localhealth 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
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What should be the coreareas in the PPP?
vDescribes national coordinationand decision-making
v
Provides an overview of keypreparedness issues
vDefines legal authorities forpandemic responses
vLists specific response activitiesby pandemic phase
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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
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Activities differ betweenPandemic Phases
Pandemic Phase Critical activities
Pandemic alert, level1: human cases, nop-to-p transmission
Enhance surveillanceDevelop/test candidate vaccineAccelerate/monitor preparedness
Pandemic alert, level2 & 3: p-to-p
transmission, localoutbreak(s)
Activate Central command center Enhance surveillanceInvestigate outbreak/define epidemiologyImplement containment activitiesInitiate pandemic vaccine productionContinue/accelerate preparednessImplement communications plan
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Activities differbetweenPandemic Phases(continued)
Pandemic Phase Critical activities
Pandemic phase,early
Implement strategy to decrease internal spreadRespond to initial cases
Define epidemiology/identify risk groupsInitiate vaccinationPrepare for full-scale pandemic response
Pandemic phase,widespreaddisease
Implement strategy to decrease communityspreadImplement full-scale pandemic response
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Communication in a crisis isdifferent
In a crisis, peopletake in, processand act on
informationdifferently
That increases thepotential for
miscommunication
C i i i
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Communication isessential.
People need information to preparefor/
respond to emergencies
Information to support gooddecisions
Information must be accurate,consistent,
credible, useful – PHASED
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Communication inemergency:
Show that you careDemonstrate competence/expertise
Tell what you know and don’t knowExplain process to find answers
C i ti i
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Communication inemergency:
Don’t over reassureAcknowledge uncertaintyAcknowledge fearLet people know what they can doAsk more of people
Assume the best of people.DO NOT assume that people will“panic”!
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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 myfamily? 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?
an em c repare ness
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an em c repare nessPlan in
Sri Lanka Cabinet approved Steering Committee
which includes the Secretaries andDirector Generals of Ministry of
Health, and Ministry of AnimalProduction and Health has beenappointed with the threat of AvianInfluenza Pandemic
Regular meetings of the Joint TechnicalCommittee are conducted to reviewthe pandemic preparedness activitiesin collaboration with the Ministry of
Estate Infrastructure & Livestock
Pandemic Preparedness
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Pandemic PreparednessPlan (PPP) in Sri Lanka(continued)
The committee is also represented bythe members from the Ministries of Environment & Wild Life.
Guidelines were developed andcirculated island wide on AvianInfluenza Pandemic Preparedness andResponse.
District plans are being prepared by theDeputy Provincial Directors of Healthin the districts: Individual plans forthe major hospitals have been
developed by the Heads of the
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Planned activities of PPP
Surveillance & early warningMonitoring & prompt reporting of
unusual eventsPrevention & control
Emergency response team in districtsand training of health staff
Health System ResponseRisk Communication
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Planned activities of PPP(continued)
Health System ResponseUpgrade lab facilities, sentinel
surveillance sites, triagearrangements and personalprotective equipment
Risk CommunicationCommunication strategic plan was
developed
I i P d i
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Issues in PandemicPreparedness in Sri Lanka
We have expertise in PandemicPlanning with the internationalcollaboration
Difficulty in implementation at theregional level
Issues in the availability of vaccines
Logistic issues Isolation issuesCost
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Panic is our enemyKnowledge is our friend
Preparation is our best line of defense
THANK YOU THANK YOU