ethical considerations among response to h1n1 pandemic in china
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Ethical considerations among Response to H1N1 Pandemic in China. China CDC, CFETP Huilai Ma, Guang Zeng. General Ethical Considerations during response to pandemic H1N1. Balancing potentially conflicting individual and community interests Evidence base for public health measures - PowerPoint PPT PresentationTRANSCRIPT
Ethics Conference on Asian Flu Pandemic
Ethical considerations among Response to H1N1 Pandemic in
China
China CDC, CFETPHuilai Ma, Guang Zeng
Ethics Conference on Asian Flu Pandemic
General Ethical Considerations during response to pandemic
H1N1
• Balancing potentially conflicting individual and community interests
• Evidence base for public health measures
• Resource constraints
– Limited resources and immediate health-care needs
Ethics Conference on Asian Flu Pandemic
Factors affecting Public health policy during pandemic H1N1 in
China
• A new influenza virus emerges:– Four different genes
• Estimated case fatality ratio (CFR)– 0.4% (range 0.3% to 1.5%)– Clinical severity
• WHO raised Level of influenza pandemic alert at phase 6 on June 11, 2009
Ethics Conference on Asian Flu Pandemic
Fundamental Realities of China
• > 1.3 billion population– >700 million rural population
• High and variable population density
• About 140 million migrant population
Ethics Conference on Asian Flu Pandemic
Significant Rural-Urban Differences in Medical Resources in China
Hospital beds/1000 population, 2008
0
1
2
3
4
5
City County Township
0
1
2
3
4
5
6
City County Township
Health professionals/1000 population, 2008
Ethics Conference on Asian Flu Pandemic
Amend statute on management of the pandemic H1N1 in due time
Category B notifiable DiseaseAdopt Category A Diseases
StageⅠ: April 30
Managed as a Quarantinable Disease”
Ethics Conference on Asian Flu Pandemic
Confirmed pandemic (H1N1) influenza cases: China (as of June 11, 2010)
June 11Community transmission occurred
May 29First documented transmission
May 111st imported case documentedN
um
ber
of
Case
s
May June 2009
• Quarantine and Isolation• Free treatment • Strategy for prevention school outbreak
Ethics Conference on Asian Flu Pandemic
Management of Close Contacts
If fever or If fever or respiratory respiratory symptomssymptoms
• Transfer to designated medical service institution• Advise to stay home for isolation and treatment• Start specimen collection and testing immediately• Conduct medical observation for all close contacts
Close Close ContactsContacts
Reporting & Investigation
Medical ServiceMedical Service
Medical check-up
CDCCDC
End medical observation for
all close contacts
If tested (-) for H1N1 influenza
Endmedical
observation
If close contacts showed no symptoms after 7 days of medical observation
Ethics Conference on Asian Flu Pandemic
CFETP finding: highlight the need to prevent transmission by droplets and fomites during a pandemic H1N1
Ethics Conference on Asian Flu Pandemic
Population at High Risk for Developing Severe H1N1 Infection
Ethics Conference on Asian Flu Pandemic
Amend statute on management of the pandemic H1N1 in due time
Category B notifiable DiseaseAdopt Category A Diseases
StageⅠ: April 30
Managed as a Quarantinable Disease
Category B notifiable DiseaseAdopt Category B Diseases
StageⅡ: July 10
Managed as a Surveillance Disease
Ethics Conference on Asian Flu Pandemic
Confirmed pandemic (H1N1) influenza cases: China (as of Feb.
21, 2010)
May June July Aug. Sep. Oct. Nov. Dec. Jan. Feb.
2009 2010
Num
ber
of
Case
s (×
1000
)
June 11Community transmission occurred
14
10
6
2
Sept. 16Pandemic (H1N1) vaccination startedStrategy for reduce fatality rate
Ethics Conference on Asian Flu Pandemic
“Severe Patients First” Principle
• Specify treatment responsibilities for different levels of medical providers
• Arrange for patients in hospitalization based on patient condition and available resources
Severity Treatment
Mild patients Community healthcare institutions
High risk patients Designated hospitals
Severe/critical patients Designated tertiary hospitals with strong capability
Ethics Conference on Asian Flu Pandemic
Help people in need
• Enhanced cooperation among financial, human resource and social security departments
• Provided assistance to people with financial difficulties– Needs-based– Various forms of assistance– Improved contents of assistance
• Gave priority to treatment of hospitalized patients
Ethics Conference on Asian Flu Pandemic
Vaccination Strategy in China
• Make sure the vaccines were:– Well-informed of benefits as well as potential risks– Voluntary– Free of charge
• The following areas were vaccinated first– Areas with outbreaks– Areas with high population density and mobilization
• High priority group was selected by local government– Public service personnel at critical positions– Patients with chronic diseases– Pregnant women– Children aged 6-35 months– Others
Ethics Conference on Asian Flu Pandemic
Thank you!
Ethics Conference on Asian Flu Pandemic
Ethics Conference on Asian Flu Pandemic
Isolation and Quarantine
• Was the decision on isolation and quarantine ethical?
• Ethics problems include:– Should isolation and quarantine be
implemented? – How should isolation and quarantine be
carried out?
Ethics Conference on Asian Flu Pandemic
Treatment Prioritization
• If not all patients can receive medical treatment, which patients should be treated first?
• What is the criteria for hospitalization?• What is the criteria for receiving intensive
care?• How to provide medical services in
western region, where resources are less abundant?
Ethics Conference on Asian Flu Pandemic
Ethical issues to be incorporated into the current
draft plan
• Is airport temperature check necessary?
• Is quarantine of contacts necessary?• Containment at source country vs.
quarantine• Priority of fund use