Pandemic Influenza:Preparedness & Response at Local Level

Royal United Services Institute for Defence & Security Studies20 July 2005

Joyshri Sarangi, CCDC

Health Protection Director: Avon, Gloucestershire & Wiltshire

© Reproduced Courtesy of Health Protection Agency/Influenza Respiratory Virus Programme Board Manager

Pandemic Influenza: Preparedness and response at local level

Key Questions at local level How is pandemic flu different from normal seasonal ‘flu’ ?

How will we ensure effective Health Protection action is taken in the event of a local suspect initial case/cases of pandemic flu?

What escalation steps are necessary to activate a coordinated wider response (local-regional-national) within a short timescale?

What can we do in advance to prepare for pandemic flu?

Local Implications of the Variation in Virus Structure

Awareness of R&D activity for the development of a safe, effective vaccine

Timeline for vaccine manufacture

Site of production & delivery mechanisms

? Priority groups for vaccine administration

How is Pandemic Flu different from seasonal flu?

Local Implications of the Animal Reservoir of Influenza A

Detection of initial cases pandemic flu

History of exposure to `reservoirs`

The returning traveller with a fever

HPA links to DEFRA

How is Pandemic Flu different from seasonal flu?

Local Strategies

Standing emergency planning arrangements & Exercising

Threat specific approach to Civil Contingency planning

Systematic awareness raising

Development of Standard Operating Procedures for local HP response

Lessons from SARS experience

How will we ensure effective Health Protection action in the event of a local suspect initial case/cases of pandemic flu?

Local-Regional-National-International

Standing cascade arrangements

Agency specific

Multi-agency co-ordination

Timeframe

Specific HP Actions

What escalation steps are necessary to activate a coordinatedwider response ?

2 - 4 weeks

What can we do in advance to prepare for pandemic flu?

Historical Experience1889-1892 ? A/H2N21900 ? A/H3N8 mild pandemic1918 A/H1N1 Spanish influenza1957 A/H2N2 Asian influenza1968 A/H3N2 Hong Kong influenza

Shortest interval = 11 yearsLongest interval = 39 years

Current interval = 37 years

The window of opportunity

What can we do in advance to prepare for pandemic flu?

Mortality during Pandemics

1918: unprecedented, 40-80 million deaths over 3 distinct ‘waves’ (198,000 in Britain)

1957: 1 million

1968: 0.8 million

The Scale:

0

20

40

60

80

100

120

140

1600-

4

5-9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85+D

eath

Rat

e pe

r 1,0

00

4st quarter

1st quarter

Age specific influenza death rates among females in England & Wales during 1st and 4th quarters of 1918

Ministry of Health, GB, 1919

Population Clinical Cases

GP* consultations

Minimum Hospitalisationrequired*

Excess Deaths

A GP list (1,000)

250 50 2 1

A Primary Care Trust (population 100,000)

25,000 5,000 150 100

A Strategic Health Authority (population 1,000,000)

250,000 50,000 1500 1000

England and Wales total population(population 52,041,916 Census 2001)

13,000,000 2,600,000 72,000 48,000

Modelling predictions based on 25% clinical attack rate and 0.37% case-fatality

Local-Regional-National-International

Standing cascade arrangements

Agency specific

Multi-agency co-ordination

Timeframe

Specific HP Actions

What can we do in advance to prepare for pandemic flu?

• DH plan covers all of UK

• Covers role of DH as ‘lead government department’ inc. chains of command

• Covers NHS and wider issues such as essential services (civil emergency response)

• Covers DH responsibilities for policy and practice regarding antiviral drugs (oseltamivir: Tamiflu®) and vaccine (if/when available)

• Overarching CO & CCA arrangements

Wider Contingency Planningfor Pandemic Flu

• Specific NHS Operational Guidance Document

• Logistics of Antiviral therapy distribution• Prioritisation• Key Workers concept

• Mass vaccination arrangements• Timeline for development and delivery• Logistics of distribution and administration

• Public sector infrastructure

• Business continuity planning

• Data sources of societal impact for NHSDH plan covers all of UK

Wider Contingency Planningfor Pandemic Flu (2)

Contingency Planning for Pandemic Flu:

Health Protection Agency Specific Actions

What could `it` mean for the HPA• Timely influenza surveillance activity from diverse sources on:

– Suspect cases– Multi-agency data on sickness/absence at a regional/local level eg `blue light`

• Daily reporting requirement to DH/Cabinet Office - CfI/LaRS

• Civil Contingency Framework_- national/regional/local

• Likelihood of redeployment of staff at all levels with workload implications

• Likely interference with other activities - business continuity

• Increased demand for facilities support/management (Operations Room/Accommodation/Catering)

• HPA Staff sickness absence