pandemics & infectious diseases: stepping up your business continuity prepareness by dr wan...
TRANSCRIPT
Presentation in MTE on 4 August 2015 at Furama Hotel Bukit Bintang KL
By
DR WAN NORAINI WAN MOHAMED NOOR
Dr. Wan Noraini Wan Mohamed Noor Public Health Physician Disease Control Division
Ministry of Health Malaysia 4 August 2015
Source: Morens DM et al. 2004. The challenge of emerging and re-emerging infectious diseases. Nature. 430: 242-249
GLOBAL DISTRIBUTION OF EMERGING AND REEMERGING INFECTIOUS DISEASES
SARS
H5N1
Nipah Virus Pandemic (H1N1) 2009
MERS-CoV Ebola (2014)
H7N9
The Threats Continue
• Populations grow and move …
Microbes adapt …
Changing climates …
Increasing global interconnectedness …
WHO Briefing Notes: Pandemic (H1N1) 2009
“…. The 2009 influenza pandemic has spread internationally with unprecedented speed. In past pandemics, influenza viruses have needed more than six months to spread as widely as the new H1N1 virus has spread in less
than six weeks ….”
WHO , Geneva (16 July 2009)
Emerging Infectious Diseases (EIDs): Our Fair Share
Global burden largely unknown
Data available mainly from temperate climate
WHO estimation of illness & deaths due to seasonal
influenza: Annual illness: 3 – 5 million
Annual deaths: 250,000 – 500,000
In the US (per year): > 200,000 hospitalizations and ~ 35,000 deaths
USD 37.5 billion in economic cost
Pandemic influenza – an ever present threat
Seasonal Influenza: Influenza that occurs every year with gradual variations in the previous year’s virus surface proteins (antigenic drift)
Avian Influenza: A disease of birds that occasionally jumps species and infects humans. Ultimately is the source of new viruses in humans causing pandemics
Pandemic Influenza: A worldwide surge in cases caused by the introduction of a new type A surface protein (antigenic shift)
Influenza is an acute respiratory disease
Transmission of influenza viruses:
Person-to-person transmission through close contact
Primarily through contact with respiratory droplets
Transmission from objects (fomites) possible
Viral shedding can begin 1 day before symptom onset
Peak shedding first 3 days of illness
Subsides usually by 5th to 7th day in adults
Infants, children and the immunosuppressed may shed virus longer
Clinical symptoms non-specific Symptoms overlap with many pathogens Coupling with lab data to verify diagnosis
Abrupt onset
Fever, chills, body aches, sore throat, non-productive cough, runny nose, headache
Gastrointestinal symptoms and muscle inflammation more common in young children
Influenza infection is not a direct cause of deaths in many influenza associated deaths (bacterial pneumonia, heart failure etc.)
Elderly > 65 years
Young children (<2 years)
Persons with chronic medical conditions Immunosuppression Conditions that can compromise respiratory function or the
handling of respiratory secretions
Pregnant women
Nursing home residents
Children on long-term aspirin therapy
Annual vaccination
Best way to prevent seasonal influenza
Contains antigens representing three (trivalent vaccine) or four (quadrivalent vaccine) influenza virus strain
- Trivalent vaccine: influenza A(H1N1) + influenza A(H3N2) + either one of the two influenza type B virus strain
- Quadrivalent vaccine: influenza A(H1N1) + influenza A(H3N3) + influenza B (Victoria lineage) + influenza B (Yamagata lineage)
Will not work on pandemic strains
A new influenza A subtype emerges that can infect humans (antigenic shift); AND
Ability to cause serious illness; AND
Ability to spread easily from human-to-human (i.e. sustained human-to-human transmission)
The occurrence: on average three times each century (based from past history)
The Pandemic (Common Name)
Timeframe Mortality Virus Subtype
Asiatic (Russian) Flu 1889 – 1890 ≈ 1 million H2N2 (possibility)
Spanish Flu 1918 – 1920 20 – 100 million H1N1
Asian Flu 1957 – 1958 1 – 1.5 million H2N2
Hong Kong Flu 1968 – 1969 0.75 – 1 million H3N2
Pandemic H1N1/09 2009 – Aug. 2010 18,000 H1N1
The impact has increased dramatically as the world becomes ever more interconnected
Spanish Flu 1918 caused a form of viral pneumonia that could kill the perfectly fit within 48 hours or less
Potential Impacts on Non-Health Sectors (Pandemic influenza could infect >35% of world’s population)
Breakdown of Services Economic and Social Disruption
• Changed of demands • Lack of BCP
ABSENTEEISM
Death / Illness Quarantine
Care Fear
Decreased Demand
• Retail trade • Transportation • Leisure travel • Gastronomy
Decreased Supply Increased Supply
• Reduced production • Disrupted transportation • International trade of
commodities • Cross-sectoral
interdependencies
• Military support for logistics etc.
• Mortuary & burial services • Water & sanitation • Telecommunication (phone
& internet) • ATM, online banking • Health & life insurance • Protection against
insecurity • Electricity / power supply • Healthcare
The Global Approach
WHOLE-OF-SOCIETY PANDEMIC READINESS
Source: WHO (2009). Whole-Of-Society Pandemic Readiness: WHO Guidelines for Pandemic Preparedness and Response in the Non-Health Sector. Geneva.
• The national government
• The health sector
• The diverse array of non-health sectors
• Civil society organizations
• Families and individuals
Adopting A Whole-of-Society Approach
A whole-of-society approach to pandemic influenza preparedness emphasizes the significant roles played by all sectors in the society:
Source: WHO (2009). Pandemic influenza preparedness and response – A WHO guidance document. Geneva: Global Influenza Programme
An international law which helps countries work together to save lives and livelihoods caused by the international spread of diseases and other health risks
Entered into force on 15 June 2007
Aim to prevent, protect against, control and respond to the international spread of disease while avoiding unnecessary interference with international traffic and trade
Are also designed to reduce the risk of disease spread at international airports, ports and ground crossings
Revision took place due to limitations of the IHR (1969) their narrow scope (i.e. cholera, yellow fever and plague)
dependence on official country notification
lack of a formal internationally coordinated mechanism to contain international disease spread
Addressing the growing and varied public health risks that resulted from increased travel and trade in the last quarter of the 20th century
Some countries were reluctant to promptly report outbreaks of these diseases for fear of unwarranted and damaging travel and trade restrictions
The IHR (2005)’s reporting procedures are aimed at expediting the flow of timely and accurate information
The Local Approach
MOH Malaysia: The Preparedness
• The preparedness plans:
– 2006: The National Influenza Pandemic Preparedness Plan (NIPPP)
– 2006: The National Crisis and Preparedness Response Centre (CPRC)
– 2008: The Risk Communication Work Plan
• The National Influenza Pandemic Preparedness Plan (NIPPP):
– Preparation started in 2003
– Drafted by the National Influenza Pandemic Planning (Technical) Committee and endorsed by the Cabinet
– Launched on 9 January 2006
• Organization of regular simulation exercises involving various levels and players / agencies
Pandemic Influenza: The Organizational Response
Multi-sectoral coordination operates through various organizational responses both at national and state levels:
i. National level:
• The National Inter-Ministerial Influenza Pandemic Committee (NIIPC) - Chairman: The Honourable Deputy Prime Minister
• The National Influenza Pandemic Planning (Technical) Committee (NIPPC) - Chairman: The Director General of Health
• The National Influenza Pandemic Committee (NIPC) - Chairman: The Deputy Director General of Health (Public Health)
ii. State & District Levels:
• State & District Influenza Pandemic Committee
The Multi-Sectoral Approach
• The National Security Council (NSC) of PMO: the highest government agency with a mechanism to coordinate disaster management (including pandemic influenza) and response involving various sectors
• The NSC Directive No. 20 (NSC No. 20): an integrated emergency management policy, which includes the responsibilities and functions of various related agencies
• Continuity of Operations Planning was developed by the Malaysian Administrative Modernization and
Management Planning Unit (MAMPU) of PMO – Directive was given to all public sector agencies for internal establishment of the planning by 2015
How a Severe Pandemic Influenza Could Affect Workplaces?
ABSENTEEISM
SICKNESS
CARE
FEAR
DEATH
A pandemic could affect as many as 40 percent of the
workforce during periods of peak influenza illness
During an influenza pandemic, the most realistic way to minimize absenteeism is to combine a mix strategies
• Reduce workforce exposure to the virus
• Encourage employees to get immunized when the vaccine is available
• Support their efforts to recover if they do become ill
A Quick Guide To Pandemic Response & Human Resource Issues
A. Protecting Employees
• Set the expectation that sick employees must stay at home
• Allow flexible work arrangements for employees who are at highest risk of developing severe complications if they become ill
• Promote hygiene practices
• Explore options for antiviral medications
• Stay current on vaccine availability
• Consider respiratory protection
A Quick Guide To Pandemic Response & Human Resource Issues
B. Making Good Decisions During Rapidly Changing Conditions
• Focus on sources of information and news
• Narrow the scope of work to what is possible
• Arrange daily (or more frequent) meetings or conference calls
• Use the principle of proportion response
• Involve legal counsel
A Quick Guide To Pandemic Response & Human Resource Issues
C. Managing Sick Employees • Temporarily suspend the requirement for a doctor’s note • Send sick employees home • Review policies on sick-leave and pay • Explore telework option
D. Communicating • Help employees understand that conditions can change
quickly • Communicate with accuracy, timeliness and commonality • Communicate with employees’ families • Contact local and state health department
Measuring The Progress – A Checklist (Use the checklist to assess the organization’s level of preparedness, identify gaps
and benchmark the effort)
STEPS TO TAKE IMMEDIATELY
Items The Status
Sick employees should stay home
Sick employees at work should be sent home
Encourage employees to wash their hands often
Encourage employees to cover their coughs and sneezes
Clean surfaces and items that are more likely to have frequent hand contact
Encourage employees to get vaccinated
Protected employees at higher risk for complications of flu
Prepare for increased numbers of employee absences due to illness in employees and their family members and plan ways for essential business functions to continue
Prepare for possibility od school dismissals or temporary closure of child care programs
Advise employees before traveling to take certain precautionary measures
Measuring The Progress – A Checklist (Use the checklist to assess the organization’s level of preparedness, identify gaps
and benchmark the effort)
STEPS TO WHEN SEVERITY INCREASES
Items The Status
Consider active screening of employees who report to work
Consider alternative work environments for employees at higher risk for complications of flu during periods of increased flu activity in the community
Increase social distancing
Advise employees about possible disruptions and special considerations while travelling abroad
Prepare for school dismissal or closure of child care programs
Thank You