influenza pandemic and beyond
DESCRIPTION
A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO,to the PHAA 12th National Immunisation Conference in Adelaide 17 August 2010TRANSCRIPT
INFLUENZA PANDEMIC and
BEYOND
PHAA 12TH
National Immunisation Conference
ADELAIDE –
17 August 2010
Professor Jim BishopChief Medical Officer
Department of Health and Ageing
World Health Organisation stages of PANDEMIC ALERT
WHO declared: phase 4 on 27 April 2009phase 5 on 29 April 2009phase 6 on 11 June 2009post-pandemic 10 August 2010
H1N1 Influenza 09 Pandemic Phases
ALERT (pre 24 April 09)
DELAY (24 April 09)
CONTAIN (22 May 09)
SUSTAIN
Victoria moved to a MODIFIED SUSTAIN on 3 June 2009
CONTROL
RECOVER
PROTECT
17 June 2009
Evidence supports focusing efforts on protecting the ‘vulnerable’
Australia's response is continual informed by the emerging evidence around the virus and effectiveness of control measures
H1N1 Influenza 09, mild in most and severe in
some (the vulnerable)
Weekly rate of ILI reported from GP ILI surveillance systems from 1 January 2007 to 25 July 2010
0
10
20
30
40
50
60
1 3 5 7 9 11
13
15
17
19
21
23
25
27
29
31
33
35
37
39
41
43
45
47
49
51
53
Week
Rate
of I
LI p
er 1
,000
cons
ulta
tions
ASPREN 2007ASPREN 2008ASPREN + NT + VIDRL 2009ASPREN + VIDRL 2010
First case of Pandemic
(H1N1) 2009 t d i
Number of respiratory viral presentations to Western Australia EDs
from 1 January 2007 to 25 July 2010 by week
0
200
400
600
800
1000
1200
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Week
Num
ber
of E
mer
genc
y D
epar
tmen
t ILI
Pr
esen
tatio
ns in
WA
2007 Presentations2008 Presentations2009 Presentations2010 Presentations
Child deaths associated with
influenza
ILI presentations to NSW EDs
from 2007-2010, by week
0
5
10
15
20
25
30
35
40
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43Week
Rat
e of
Em
erge
ncy
Dep
artm
ent I
LI P
rese
ntat
ions
in
NSW
NSW ED 2007NSW ED 2008NSW ED 2009NSW ED 2010
Total number of specimens tested by sentinel laboratories, and proportion positive, 1 January 2010-30 July 2010, by week
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
8/01
/2010
22/01
/2010
5/02
/2010
19/02
/2010
5/03
/2010
19/03
/2010
2/04
/2010
16/04
/2010
30/04
/2010
14/05
/2010
28/05
/2010
11/06
/2010
25/06
/2010
9/07
/2010
23/07
/2010
6/08
/2010
20/08
/2010
3/09
/2010
17/09
/2010
1/10
/2010
15/10
/2010
29/10
/2010
12/11
/2010
26/11
/2010
10/12
/2010
24/12
/2010
Week ending (date)
Perc
ent o
f tes
ts p
ositi
ve fo
r in
fluen
za
0
100
200
300
400
500
600
700
Tota
l num
ber
of te
sts
Percent of tests influenza positive
Total number of tests
Percentage of specimens tested by sentinel laboratories influenza positive
1 January 2010 to 30 July 2010, by subtype
Pandemic (H1N1) 200967%
Seasonal A/H1N10%
Seasonal A/H3N224%
Influenza A untyped4%
Influenza B5%
Hospitalisations of pandemic (H1N1) 2009, 5 June –
23 October 2009, by week
10
0
100
200
300
400
500
600
700
21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43
Week of report
Num
ber o
f hos
pita
lista
tions
ass
ocia
ted
with
pan
dem
ic (H
1N1)
200
9
Australia
Severe Pandemic (H1N1) 2009
●
Hospitalisations-
Respiratory, diabetes, immuno compromised obesity, chronic cardiac, renal, pregnancy rapid deteriorating flu patient
●
Higher proportion of Indigenous Australians
●
Over 50% admitted within 48 hours of onset
●
Higher ICU Admissions than expected
2009 2010
CONFIRMEDPANDEMIC(H1N1 2009
CASES
HOSPITALISEDCASES
ICU CASES DEATHS CONFIRMED(H1N1) 2009
CASES
DEATHS
TOTAL NUMBER 37,636 13% 14% 191 362 2
CRUDE RATE PER100,000 POPULATION
172.1 22.8 3.1 0.9 1.7 n/a
M EDIAN AGE (YEARS)
21 31 44 53 28 38
FEMALES 51% 51% 53% 44% 48% 100%
SUMMARY of SEVERITY INDICATORS OFPANDEMIC (H1N1) IN AUSTRALIA,
2009 & 2010 (up to 30 July 2010)
SourceL: Australian Influenza Surveillance Report
2009 2010CONFIRMEDPANDEMIC(H1N1 2009
CASES
HOSPITALISEDCASES
ICU CASES DEATHS CONFIRMED(H1N1) 2009
CASES
DEATHS
Vunerable
groups (Indigenous persons, pregnant women& individuals with at least 1 co-
morbidity)
n/a 58% 74% 67% n/a n/a
INDIGENOUSPEOPLE
11% 20% 19% 13% 9% n/a
PREGNANT WOMEN
n/a 27% 16% 4% n/a 0%
Cases with at least 1 co-
morbidity
n/a 46% 67% 62% n/a n/a
SUMMARY of SEVERITY INDICATORS OFPANDEMIC (H1N1) IN AUSTRALIA,
2009 & 2010 (up to 30 July 2010)
SourceL: Australian Influenza Surveillance Report
Age specific rates of hospitalised confirmed cases of pandemic (H1N1) 2009 to 3 October 2009, compared with average annual age specific rates of
hospitalisations from seasonal influenza 2004-05 to 2006-07*, Australia
14
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
0-4
5-9
10-1
415
-19
20-2
425
-29
30-3
435
-39
40-4
445
-49
50-5
455
-59
60-6
465
-69
70-7
475
-79
80-8
4
85+
Age group (5 Years)
Age
spe
cific
rate
(per
100
,000
pop
ulat
ion) Males pandemic (H1N1) 2009
Females pandemic (H1N1) 2009
2004-07 seasonal influenza
Rate of deaths classified as influenza and pneumonia from the NSW Registered Death Certificates 2005 to 25 June 2010
ATAGI Modelling of the Impact of Vaccination
Pandemic (H1N1) 2009 Vaccine
•
Safety profile good as dose levels recommended
•
One injection 15μg protects adults, two for young children
•
FDA licence/TGA registration
•
Emphasis on priority groups but available to ALL
•
Widespread uptake by the Population (over 9 Million doses)
Source: New England Journal of Medicine: 2009: 361, September 10
Pandemic H1N1 vaccine distributed (cumulative)
01,000,0002,000,0003,000,0004,000,0005,000,0006,000,0007,000,0008,000,0009,000,000
10,000,000
06-Oct
22-Oct
12-Nov
03-Dec
07-Jan
27-Jan
18-Feb
11-Mar
08-Apr
29-Apr
20-May
10-Jun
01-Jul
22-Jul
Cumulative total
Pandemic H1N1 Vaccine - Weekly distribution trends
0
100,000
200,000
300,000
400,000
500,000
600,000
06-Oct
19-Oct
29-Oct
12-Nov
26-Nov
10-Dec
07-Jan
21-Jan
03-Feb
18-Feb
04-Mar
18-Mar
08-Apr
22-Apr
06-May
20-May
03-Jun
17-Jun
01-Jul
15-Jul
29-Jul
Dos
es
IMMUNITY
Vaccine Distribution 9.71 million doses Panvax
distributed to 12 August
2010 6.44 million doses of 2010 seasonal vaccine
released by TGA
National Serosurvey
(healthy adults)May 2009 -
Pre-pandemic: 5-15%
October 2009 -
Post pandemic, pre Panvax: 22%March 2010 -
Post Panvax, pre Seasonal: 43%
CURRENT SITUATION –
2010
Influenza activity low in Australia but showing signs of increasing-
1713 Confirmed cases of Influenza in 2010, 362 pandemic (H1N1)
Pandemic strain predominant in Australia-
68% pandemic (H1N1) 2009 of specimens isolated
Pandemic (H1N1) 2009 predominant in most countries, low activity except NZ, India
Type B predominant in China (55.5%) with 46% the same strain as 2010 Southern Hemisphere vaccine
Weekly consultation rates for influenza-like illness in New Zealand, 2008-2010
Source: Institute of Environmental Science and Research, Influenza Weekly Update 2010/30
UK REVIEW SOME KEY FINDINGS
Containment phase lasted longer and consumed more resources than anticipated
Tension between common phased approach to pandemic planning and flexibility
Vaccine availability during the pandemic –
a significant
achievement
Flexible arrangements needed for purchasing vaccine
Need for vaccination implementation plans prior to a pandemic
Communications –
important to generate public
awareness and understanding
Coordinated media briefings
1.
National governance and decision making
2.
Public communication
3.
Public health measures
4.
Border measures
5.
Primary and secondary health care
6.
National Medical Stockpile deployment
7.
Surveillance
8.
Laboratories
9.
Vaccination
10.
Indigenous Australians
AUSTRALIAN PANDEMICRESPONSE REVIEW
Outcomes of the review will:
further strengthen Australia’s ability to respond;
publicly available 'lessons identified' report, at the
end of the 2010; and
Revise the Australian Health Management Plan
for Pandemic Influenza (AHMPPI)
KEY INDIVIDUALS FOR PANDEMIC RESPONSE
NIRMs Mary MurnaneMs Jenny BryantDr Gary LumMs Fay HoldenDr Bernie TowlerDr Andrew SingerDr Andrea FordeMs Kay McNieceDr Jenean Spencer
Prof Terry Nolan ATAGIDr Chris Mitchell RACGPDr Vicki Krause CDNA
NSW
Dr Kerry Chant
Dr Jeremy McAnulty
VIC
Dr John Carnie
Dr Rosemary Lester
QLD
Dr Jeanette Young
Dr Christine Selvey
TAS
Dr Craig White
Dr Chrissie Pickin
WA
Dr Tarun Weeramanthri
Dr Andy Robertson
SA
Dr Stephen Christley
ACT
Dr Charles Guest
NT
Dr Barbara Paterson