pandemic preparedness plan

8/7/2019 Pandemic Preparedness Plan

http://slidepdf.com/reader/full/pandemic-preparedness-plan 1/40

PandemicPreparedness Plan

Dr.Murali VallipuranathanMBBS, PGD , MSc, MDConsultant Community Physician



Pandemic PreparednessPlan

It can be at three levelsGlobal planning

Community planning Individual organization planning



Key Elements

Introduction to PandemicReasons for Preparing a Pandemic

PlanPreparedness Planning ProcessCommunications Strategy ImplementationFollow up- Monitoring



Past Influenza Pandemics

1900

1850

1950

2000

1847

1889

1918

1957

1968

42 yrs

29 yrs

39 yrs

11 yrs

Pandemic usually occur every 30 – 40 years

Last Pandemic was ≈ 40

years ago, in 1968....

Last Pandemic was ≈ 40

years ago, in 1968....



Influenza Strains and Pandemics in 20th Century

1918-19 1957-58 1968-69

1920 1940 1960 1980 2000

H1N1 H2N2 H3N2

“Spanish Flu” “Asian Flu” “Hong Kong Flu”

20-40 million deaths 1 million deaths 1 million deaths

http://www.clipart.com/en/close-up?o=3632397&memlevel=A&a=a&q=black%20arrow&k_mode=all&s=161&e=180&show=&c=&cid=&findincat=&g=&cc=&page=9&k_exc=&pubid=





an em cs ave eenoccurring throughout

human history.Three major pandemics in the 20th

century

Current Pandemic first in 21st

CenturyApril 2009-present: The “Swine

Flu” (H1N1):This is a novel strain of avian, swine

and human antigens that is stillmutating and spreading in the

human population worldwide.



Genetic Shift - Pandemic Influenza

Human Strains

Avian Strains

Potential to ‘mix & match’ avian

& human strain genes

Unknown

Unknown



Cause of Pandemic

A pandemic virus occurs when anantigenic shift takes place in the virusand the following conditions are met.

1. a new influenza virus subtypeemerges,2. the virus infects humans,3. the virus gains efficient and

sustainable transmission from human tohuman.

4. The new virus has a capacity to causeserious clinical disease and death

5. The population has little or no

immunity to the virus



Phases of Pandemic

INTER-PANDEMIC PHASE

Low risk of human cases 1

New virus in animals,no human cases

Higher risk of human cases 2

PANDEMIC ALERT

No or very limited humanto human transmission

3

New virus causes

human cases

Evidence of increased human to

human transmission

4

Evidence of significant human tohuman transmission

5

PANDEMIC Efficient and sustained human to

human transmission

6



WHO Pandemic Phase 6



Explanation of WHOPhases Phase 1 - No viruses circulating among

animals have been reported to causeinfections in humans.

Phase 2 - An animal influenza virus isknown to have caused infection inhumans

Phase 3 - Limited human-to-humantransmission may occur

Phase 4 -Verified human-to-humantransmission able to cause “community-

level outbreaks.”



Explanation of WHO Phases(cont.)

Phase 5 - Human-to-human spread of the virusinto at least two countries.

Phase 6 - The pandemic phase, is characterizedby community level outbreaks in at least oneother country in a different WHO region in

addition to the criteria defined in Phase 5.

Post-peak period - Disease levels in havedropped below peak observed levels. Additionalwaves may occur and countries will need to be

prepared for a second wave.

Post-pandemic period - Influenza diseaseactivity will have returned to levels normallyseen for seasonal influenza.



WHO Pandemic Phase 6

“Phase 6, the pandemic phase, ischaracterized by community leveloutbreaks in at least one

other country in a different WHOregion in addition to the criteriadefined in Phase 5.

Designation of this phase willindicate that a global pandemic isunder way .”

- WHO



Characteristics of Pandemics

More than one pandemic wave is likely Can be weeks or months between waves Severity of waves unpredictable:

subsequent wave could be worse thanfirst

Typically affects young, healthy adults(unlike regular seasonal flu)



Pandemic Waves

3 month warning from first pandemicoutbreak to local outbreaks

• 1st wave - often out-of-season, maylast 6-8 weeks (peak at 3-4 weeks)

• 2nd wave - 3-9 months later; may

be more severe• 3rd wave may also occur

http://www.clipart.com/en/close-up?o=898624&memlevel=B&a=a&q=waves&k_mode=all&s=201&e=220&show=&c=&cid=&findincat=&g=&cc=&page=11&k_exc=&pubid=

http://www.clipart.com/en/close-up?o=898624&memlevel=B&a=a&q=waves&k_mode=all&s=201&e=220&show=&c=&cid=&findincat=&g=&cc=&page=11&k_exc=&pubid=



T h re e Flu Pa n d e m ics in th e 2 0 th Century



An influenza pandemic will happenThe timing and pattern will be

unpredictableA short lead time will exist from

first identification to full scale

pandemicOutbreaks will occur

simultaneously, in multiplewaves with devastating societalimpact

Known facts about a futurepandemic



Young healthy people in our communitywill be affected

There will be shortages of medical

resources, equipment, supplies andpersonnel

ow ac s a o a epandemic( )continued



Essential services will be severelydisrupted due to absenteeism

Media and public scrutiny will be

intense and unrelentingThere will be LIMITED TO NO

OUTSIDE ASSISTANCE available

Increases in both globaltravel and world populationwill likely contribute to rapid

virus spread

nown ac s a ou a u urepandemic( )continued



Assumptions for SriLanka

Spread to Sri Lanka may takeseveral months, but may be

shorterA vaccine probably would not beavailable in the early stages

The numbers of health-care

workers and first respondersavailable to work can beexpected to be reduced



Assumptions for SriLanka (continued)

once established in Sri Lanka, thedisease is likely to spread rapidlyover 2-3 weeks and then gradually

decline over the next 4-6 weeks; asecond wave of illness may occur 6-9months later

some 20 to 30% of the population oreven more may be affected over a 1-2 year period, including children andnormally fit young adults

a far greater proportion of people arelikely to require hospitalization or die

than for seasonal flu.



Objectives of Pandemicpreparedness Plan (PPP)

Slow the disease spreadReduce morbidity and mortality

Minimize social disruptionAvert economic disasterPreserve essential community

functions



Delay onset of outbreak

Reduce the peak burdenon hospitals/infrastructure

Decrease a) number of cases of death andillness and b) overallhealth impact

Days Since First Case

Numbe

rofDa il

yCases

Goals of Pandemic Preparedness Plan

P a n d e m i c:O u t b r e a k

N o C om mun it y M ea su re s U se d


Wi th Me as ur esT a k e n

Delay onset of outbreak

Reduce the peak burdenon hospitals/infrastructure

Decrease a) number of cases of death andillness and b) overallhealth impact

2

1

3


N o C om mu nit y M ea su re s U se d



Who should preparePPP?

Multi-sectoral approach§ Policy developers§ Legislative reviewers

§ Animal health experts§ Public health experts§ Patient care- clinicians§ laboratory diagnosis and test

experts§ communication expertise§ disaster management team§ Security forces

§ Ethicists



Purposes of PPP

§ Provide guidance to State/localhealth departments and health

care organizations for planning§Outline coordination and

implementation of a response

§

Define preparedness needs§ Identify key issues that remain to

be resolved



What should be the coreareas in the PPP?

vDescribes national coordinationand decision-making

v

Provides an overview of keypreparedness issues

vDefines legal authorities forpandemic responses

vLists specific response activitiesby pandemic phase



Activities in PPP

Surveillance Public health interventions to decrease

disease spread

Screening and diagnosis Case management Inter-sectoral coordination locally and

internationally Vaccination strategies Antiviral drug strategies Communications Autopsy and disposal procedures Research



Activities differ betweenPandemic Phases

Pandemic Phase Critical activities

Pandemic alert, level1: human cases, nop-to-p transmission

Enhance surveillanceDevelop/test candidate vaccineAccelerate/monitor preparedness

Pandemic alert, level2 & 3: p-to-p

transmission, localoutbreak(s)

Activate Central command center Enhance surveillanceInvestigate outbreak/define epidemiologyImplement containment activitiesInitiate pandemic vaccine productionContinue/accelerate preparednessImplement communications plan



Activities differbetweenPandemic Phases(continued)

Pandemic Phase Critical activities

Pandemic phase,early

Implement strategy to decrease internal spreadRespond to initial cases

Define epidemiology/identify risk groupsInitiate vaccinationPrepare for full-scale pandemic response

Pandemic phase,widespreaddisease

Implement strategy to decrease communityspreadImplement full-scale pandemic response



Communication in a crisis isdifferent

In a crisis, peopletake in, processand act on

informationdifferently

That increases thepotential for

miscommunication

C i i i



Communication isessential.

People need information to preparefor/

respond to emergencies

Information to support gooddecisions

Information must be accurate,consistent,

credible, useful – PHASED



Communication inemergency:

Show that you careDemonstrate competence/expertise

Tell what you know and don’t knowExplain process to find answers

C i ti i



Communication inemergency:

Don’t over reassureAcknowledge uncertaintyAcknowledge fearLet people know what they can doAsk more of people

Assume the best of people.DO NOT assume that people will“panic”!



Prepare to Answers for:

What is happening? Are my family and I safe? What should I do?

What can I do to protect myself and myfamily? What is Government/ Health Ministry

doing? What can we expect? Why did this happen? Why wasn’t this prevented? What else can go wrong? What does this information mean?

an em c repare ness



an em c repare nessPlan in

Sri Lanka Cabinet approved Steering Committee

which includes the Secretaries andDirector Generals of Ministry of

Health, and Ministry of AnimalProduction and Health has beenappointed with the threat of AvianInfluenza Pandemic

Regular meetings of the Joint TechnicalCommittee are conducted to reviewthe pandemic preparedness activitiesin collaboration with the Ministry of

Estate Infrastructure & Livestock

Pandemic Preparedness



Pandemic PreparednessPlan (PPP) in Sri Lanka(continued)

The committee is also represented bythe members from the Ministries of Environment & Wild Life.

Guidelines were developed andcirculated island wide on AvianInfluenza Pandemic Preparedness andResponse.

District plans are being prepared by theDeputy Provincial Directors of Healthin the districts: Individual plans forthe major hospitals have been

developed by the Heads of the



Planned activities of PPP

Surveillance & early warningMonitoring & prompt reporting of

unusual eventsPrevention & control

Emergency response team in districtsand training of health staff

Health System ResponseRisk Communication



Planned activities of PPP(continued)

Health System ResponseUpgrade lab facilities, sentinel

surveillance sites, triagearrangements and personalprotective equipment

Risk CommunicationCommunication strategic plan was

developed

I i P d i



Issues in PandemicPreparedness in Sri Lanka

We have expertise in PandemicPlanning with the internationalcollaboration

Difficulty in implementation at theregional level

Issues in the availability of vaccines

Logistic issues Isolation issuesCost



Panic is our enemyKnowledge is our friend

Preparation is our best line of defense

THANK YOU THANK YOU

pandemic preparedness plan

Documents