pandemic influenza: preparedness & response at local level royal united services institute for...
TRANSCRIPT
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)
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