health protection response to pandemic influenza in scotland dr martin donaghy, health protection...
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Health Protection Response to Pandemic Influenza in Scotland
Dr Martin Donaghy, Health Protection Scotland,
15th September 2010
Contents
• Introduction• Overview of Pandemic» Timeline
» Pandemic management
• Pandemic Recommendations» Policy
» Functions
» Processes
Investigation
Surveillance Surveillance &&
AssessmentAssessment
Control
Communication
Health ProtectionFunctions
Incident Response
On-going management
Priority programmes
Major Incident Response
Pandemic Response
Incident Response
On-going management
Priority programmes
Major Incident Response
Pandemic Response
Health Protection Health Protection ResponseResponse
Increasing RiskIncreasing Risk
ContingencyContingencySurge CapacitySurge Capacity
Command and ControlCommand and ControlResilienceResilience
RehabilitationRehabilitationIncreasing ResponseIncreasing Response
Scottish Government Health Directorate Policy & Performance Management
OperationalOperational
NHS BoardsNHS Boards
Pandemic Response Structures
UK Ministers/Officials
SAGE
JCVISPI-M
PICO
Scottish GovernmentHealth Protection, Healthcare, Civil
Contingencies, Public Communications
HPSNSS Divisions
Immunisation Steering Group
HPATacticalTactical
StrategicStrategic
SFREC
NHS 24NHS 24
ProcessesPreparedness
• Generic Planning• Health Protection Framework• Exercises• Quality assurance
Containment Phase• Response co-ordination (Policy, UK implementation, Scottish Boards)• Surveillance and investigation• Guidance and expert advice • Immunisation Planning• Communications (internal, service and public)• Information Management
Treatment Phase; Influenza Response Co-ordinating Team• Intelligence and Surveillance• Guidance and expert advice • Immunisation Programme Management• Communications (internal, service and public)• Information Management and Technology
Lessons learned.
•Laboratory testing of those suspected of having contracted H1N1• antiviral treatment of cases meeting the agreed case definition
• contact tracing, and prophylaxis of close contacts• closure of schools based on expert advice
• self-isolation of cases in the community• detailed investigation of cases and contacts
Containment: Reduce rate of transmission & gather evidence
Containment Phase
Containment Phase
Treatment phase: mitigate impact
• Cases would be identified through clinical diagnosis, not swabbing• Contact tracing would cease
• Cases would be offered antivirals on the clinical discretion of GPs•• Vaccination would be offered to those most at risk
• Increasing the coverage of surveillance by involving all GPs•• Ensuring preparedness of hospital services.
Treatment phase
Treatment phase
Policy• Precautionary approach: international
comparisons, triggers
• Flexibility: UK vs devolved
• De-escalation of response
• Scientific advice: openness, structures, understanding
• Prioritisation of public health activities
FunctionsSurveillance
• National and local needs• UK Harmonisation• Burden of disease: mortality, severe
morbidity• Review shape of surveillance
Investigation• Field epidemiology• Serological studies• Molecular testing• Socio-economic gradient
FunctionsRisk Assessment
• International collaboration• Modelling• Scottish dimension
Control• Immunisation: mass vaccination, effectiveness• Case & contact management: clinical input,
effectiveness, • Social mixing: PH legislation powers• Port health: UK collaboration• Infection Control: respiratory precautions
Functions Communications
• Importance of web• Co-ordination of service and
public communications
ProcessesGovernance
• Formal Framework: Boards, HPS, Scottish Government• Flexibility; national vs local• Performance monitoring• Intellectual property• Ethical Framework
Response Co-ordination • National framework• Common management structures• Primary care input, • National support: call centres, teleconferences• Labs, public health capacity
Processes
Preparedness•Primary care input•Incident Guidance frameworks•National and local surveillance
Good Practice • Rapid production of Guidance• Clinical Input• Evidence base in uncertainties
ProcessesInformation
• Immunisation: Lifelong record• Health protection; SHPIMS• Primary care: consultation data• Capacity• Data management
Workforce Development• Capacity and resilience• Epidemiology• Leadership
Conclusion
• Overall management of the pandemic response went well
• Many lessons learnt now being reported
• Need for targeting and prioritising of recommendations
• Experience of great relevance to Health Protection Stocktake
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