Health System Response to Pandemic Influenza: A Clinician's Perspective

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Health System Response to Pandemic InfluenzaA
Clinician's Perspective

• Mary M. Klote, MD
• Walter Reed Army Medical Center

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Disclosures

• Financial None
• The views expressed in this presentation are
  those of the author and do not reflect the
  official policy of the Department of the Army,
  Department of Defense, or US Government.

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WHO 2005 Plan

• Revised from 1999
• Redefined the phases to more clearly aid in
  coordination of containment of the disease
• Potentially allow for increased lead time for
  vaccine development

WHO/CDS/CSR/GIP/2005.5
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WHO Phases

• Interpandemic Period
• Phase 1 - Animal infection - low risk to humans
• Phase 2 - Animal infection - risk to humans
• --------------------------------------------------
  ------
• Pandemic Alert Period
• Phase 3 - Close contact human transmission
• Phase 4 - Increased transmission
• Phase 5 - Virus adapting and spreading
• --------------------------------------------------
  ------
• Pandemic Period
• Phase 6 - Generalized transmission

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Phase Subcategories

• Planning and Coordination (PC)
• Situation Monitoring and Assessment (MA)
• Prevention and Containment (PreCon)
• Health System Response (HSR)

WHO/CDS/CSR/GIP/2005.5
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Phase 1 WHO Goal

• To promote contingency planning by health-care
  systems for response to an influenza pandemic.

WHO/CDS/CSR/GIP/2005.5
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Who to Vaccinate

• Tiered vaccine structure?
• 1st responders
• Their families?
• Healthcare workers
• Other Hospital/clinic employees
• City/County Service Workers
• Waste removal
• Electrical
• Water

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Contingencies to Consider

• Delivery of Quality Immunizations
• Immunization techniques
• Record keeping
• Adverse event tracking
• Legal Regulations

MMWR Mar 2000 Report of NVAC
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Contingencies to Consider

• Delivery Teams
• Right combination of skills
• Administrative
• Technical
• Right place
• Right time
• Right equipment

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Contingencies to Consider

• Method of Delivery
• Push Out
• Send teams to communities
• Security
• Vaccine storage
• Pull In
• Centralized locations
• Security
• Staffing
• Transport of vaccinees

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Contingencies to Consider

• Hospital Manning
• Who will come to work?
• How much of your staff works at another hospital
  part-time?
• Will you allow anyone to go home?
• Where will you house them?
• How will you feed them?

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Contingencies to Consider

• Surge capacity
• How many patients can your hospital hold?
• How many ventilators?
• Are you prepared for family members to bag
  patients?
• How many in your morgue?
• Scrubs?
• Linen?
• Cleaning supplies?
• Regulated Medical Waste Bags?
• Sharps containers?

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Contingencies to Consider

• Security
• Access to Hospital
• Staff
• Patients
• Visitors
• Quarantine Wards
• Triage outside of hospital

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Managing the Unexpected

• Adverse Events
• Swine Flu experience
• Myopericarditis with Smallpox Vaccine

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Questions?
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Phase 1 Objectives

• WHO
• To develop strategies and procedures to
  coordinate the rapid mobilization and deployment
  of global resources to foci of infection during a
  pandemic alert period (PC).
• Promote increased use of seasonal vaccine
  (PreCon)
• Resolve impediments to vaccine development,
  production and access (PreCon)

• National
• To develop effective mechanisms for mobilization
  and rapid deployment of resources to areas of
  need (PC).
• Share specimens for virus characterization and
  vaccine development (PreCon)
• Increase availability of vaccine (PreCon)
• Develop criteria for use of seasonal and pandemic
  vaccine (PreCon)
• Anticipate need for pandemic vaccine development
  (PreCon)

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Phase 2 Objectives

• WHO
• To consider the development of a human vaccine
  against the new strain.(PreCon)

• National

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Phase 3 Objectives

• WHO
• To enhance development or adjustment of
  diagnostic reagents and vaccines. (MA)
• To facilitate planning for pandemic vaccine
  development. (PreCon)

• National
• To increase readiness for possible pandemic
  vaccine development. (PreCon)

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Phase 4 Overarching Goal

• Vaccine Development

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Phase 4 Objectives

• WHO
• To enhance development or adjustment of
  diagnostic reagents and vaccines. (MA)
• To promote development and prepare for production
  of pandemic vaccine. (PreCon)
• To deploy pandemic vaccine to foci of disease, if
  appropriate and available. (PreCon)

• National
• To increase readiness for pandemic vaccine
  production and deployment (PreCon)
• To gain early experience in pandemic vaccine use
  under field conditions (if clinical trial lots
  are available) (PreCon)

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Phase 5 Objectives

• WHO

• National
• To support preparations for large-scale pandemic
  vaccine production and licensing, and prepare for
  deployment as supplies become available. (PreCon)
• To gain early experience in pandemic vaccine use
  under field conditions (if clinical trial lots
  areavailable).(PreCon)

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Phase 6 Objectives

• WHO
• To promote rational access to finite resources,
  including vaccines and other pharmaceutical
  supplies (when available) (PC)
• To promote maximum production and rational use of
  pharmaceuticals, e.g. vaccines and antivirals.
  (PreCon)

• National
• To ensure rational access to finite national
  resources, including pharmaceutical supplies and
  (when available) vaccine. (PC)
• To minimize morbidity and mortality through the
  rational use of available pharmaceuticals, e.g.
  vaccines and antivirals. (PreCon)