28 September 2011

The HPA H1N1 ICU Clinical Network -Could such a model have a role in Could such a model have a role in

the management of emerging diseases?the management of emerging diseases?

Dr Gail Thomson, Consultant in Infectious DiseasesHPA Porton & Royal Liverpool University Hospital gail.thomson@hpa.org.uk Honorary member of the Intensive Care Society

Dr Gail Thomson, Consultant in Infectious DiseasesHPA Porton & Royal Liverpool University Hospital gail.thomson@hpa.org.uk Honorary member of the Intensive Care Society

28 September 2011

Contents:

•Why and how was it set up?•Who is in the network?•How did it work?•What did it do?•The future….

Why and how was it set up?

HPA NECC:

June 4th 2009 – meeting with Fred Hayden – influenza guru

At this time: 3 H1N1 cases in Intensive Care in Royal Alexandra, Paisley, Scotland

Health Protection Scotland (HPS) – go ahead to HPA to set up a teleconference call with disease experts to help the Scots

That evening – GT called members of the WHO clinical network and others to take part in call June 5th.

June 5th 2009The first teleconference call

WHO Geneva WHO Euro Fred Hayden Tim Uyeki & Scott Harper, CDC Edgar Bautista, Mexico City Karl Nicholson Jonathan Van Tam Barbara Bannister, DH Kevin Rooney, Intensivist, Paisley Alistair McConnachie, Gartnavel Nick Sherwood, Birmingham City Bruce Taylor, Intensive Care Society Nick Phin, HPA Nick Gent, HPA Rachel Kandt, HPA

Discussed the clinical management of the three cases.

Agreed to organise another call as the clinicians found it useful

Particular lessons learned from Mexico:

-Sudden deterioration -Run dry -Role of NIV -Concern over steroids.

Weekly calls begunMulti-disciplinaryCLINICAL, LAB & EPI all on thesame conference call…Accident & EmergencyInfection Control Infectious diseases Intensivists (adult & paediatric)MicrobiologistsNursesO&GPharmacistsVirologistsClinicians from outside the UKNHS support: 2 senior registrars

DH Royal Colleges

HPA - LaRS, Porton, CfI, Chiltern, Holborn, RMN

Relevant professional bodies: PICS, ICS, BPAIIG, APAGBI International experts US CDC World Health Organization

CommunicationCoordination

28 September 2011

Mexico

USA

CanadaWHO HQ

WHO EURO

Australia

NZ

Vietnam

Spain

Kosova

HPA H1N1 ITU Network

UK &Ireland

Hong Kong

Also:

Public health colleagues in Scotland,Northern Ireland, Ireland & Wales

Issues discussed

Antiviral – dosage and durationVentilator strategiesTriageECMOInfection control issuesNursing issuesCare of pregnant women & the unborn foetusCare specific to adultsCare specific to childrenHow to manage a case of antiviral resistant virusResuscitation of H1N1 patientsExperience from other countries: what can we learn and shareResearch

Guidance 1

Guidance 2

Fed into WHO networks

Teleconferences: with WPRO, EURO & SEARO

Web site: WHO Geneva

Missions: Cairo, Ukraine, Montenegro & Kosova

Clinicians presented at numerous WHO meetings & helped write guidance

ECDC on the calls 2010/2011

The astute clinician –asks the right questions & is vigilant

Early WarningEarly Warning

Health Care System Public Health Authority

CaseDetection Confirm

DecisionControlMeasures

Investigation

Response

Report

OUTBREAK

Good local relations with public health crucialDo you know how to contact them???

Intensivists comments

“ The links created and the information that was distributed widely provided really good backup to intensive care clinicians on the 'front line' - and it was particularly helpful that lessons learned could be shared quickly for the benefit of patients.

In addition, the various discussions resulted in us being made aware of other related issues which we may not have had time to explore in real time because of the workload - some of which helped in decision making but also in the ability to answer the many questions made by local colleagues etc.

I can't prove most of these comments - but that's how it feels to me!”

“…it was very good to know that someone was coordinating, and that there was an output useful to front-line staff.”

Comment from Dr Nikki Shindo, WHO

We would like to share our recognition of the importance of having clinical networks during the pandemic. Through the review process, we found that the teleconferences and e‐mail exchanges have been valuable source of information which have formed the foundation of WHO communication materials or guidance document.

The HPA clinical calls were extremely useful for us and pre‐defined topic discussions were timely and well organized. Experiences shared by the intensivists and paediatricians fed rich information for the WHO clinical management guidance.

We also would like to thank you for liaising us with the leading clinicians in UK, who contributed as WHO clinical experts in Regional and country activities, such as emergency response missions (Ukraine), Regional Meetings (EMRO, EURO), and other WHO meetings. 

Last but not least, let me take this opportunity to express our gratefulness for giving us the opportunity to join your network and we hope that this collaboration will continue.

Best regards,

Nikki ShindoTeam Lead, WHO pandemic(H1N1)response, Supporting Patient Care Team World Health Organization 

The future…..?

Managing UK borders outside of the UK

Research examples

Study of medical procedures in Intensive care to establish which are infectious aerosol generators

Proposal: Pilot Study of Safety, Tolerability, Efficacy, and Pharmacokinetics of Intravenous Plasma therapy in Hospitalized Patients with Severe Confirmed Influenza A (H1N1) Infection (SIMPLE)

The future…..?

Use this model to assist with future responses?

What can we learn from others?

How can we improve such a network for future responses?

Research network - linked

Feed into GOARN requests for assistanceAppropriate field training

Ongoing good relations between Public Health and clinical frontline

Continue to build on links with the Royal Colleges

Acknowledgements; demonstrate the cross agency collaboration (this list is not exhaustive)

HPA:Nick Gent, LaRS

M Sudhanva, RMN Judith Logan, Porton Nick Phin, John Watson, Shelley Bolotin & Richard

Pebody, CfI Jonathan van Tam, Nottingham NHS: Jake Dunning & Dan Taylor Kevin Rooney, Stephen Hancock, Scott Hackett , Nick

Sherwood, & Karl Nicholson DH:

Barbara Bannister & Calum Semple

ROYAL COLLEGES:RCPCH: Calum Semple, David ShortlandRCOA: Judith Hulf , David Menon & Julian BionRCOG: Boon LimAgencies & Societies:Bob Winter & Bruce TaylorIan Jenkins & Paula ListerEsse Menson & Saul Faust

Internationals:

WHO Geneva – Charles Penn, Nikki Shindo, Matt Limm WHO EURO – Roberta Andraghetti, Ana-Paula Coutinho ECDC – Angus Nicoll Fred Hayden, US Tim Uyeki, US Edgar Bautista. Mexico Jeremy Farrar, Vietnam Steve Webb, AUstralia Stephen Streat, New Zealand Anand Kumar, Canada Rob Fowler, Canada Randy Wax, Canada Mike Christian, Canada David Kimberlin, US Rich Whitley, US Faisal Siddiqui, Canada Jordi Rello, Spain Ignacio Martin-Loeches, Spain