Title: Pandemic Flu Nigel Ineson April 2006
1Pandemic FluNigel InesonApril 2006
2What is a pandemic?
- Epidemic serious outbreak in a single community,
population or region - Pandemic epidemic spreading around the world
affecting hundreds of thousands of people, across
many countries
3Previous pandemics
- Spanish flu (1918) led to 20 million deaths
worldwide and 200000 deaths in United Kingdom - Asian flu (1957
- Hong Kong flu (1968)
- ?? H5N1 Bird flu (2006)
4Avian flu
- Avian flu is also known as bird flu. The deadly
strain currently worrying the world is called
H5N1, and was first seen in Hong Kong in 1997.
The World Heath Organisation (WHO) says its
the biggest and most severe outbreak on record,
with more than 150 million birds thought to have
been affected. Its also thought it could take
several years to control the disease in poultry - There have been 182 confirmed cases of avian flu
with the H5N1 strain, in people from Indonesia,
Thailand, Cambodia, China, Vietnam, Azerbaijan,
Iraq and Turkey, which have led to 103 deaths.
All the victims are thought to have been in close
or direct contact with infected birds.
5What causes pandemic flu?
- The emergence of a new flu virus
- The new virus passes easily from person to person
- Few, if any, people have any immunity
- This allows it to spread widely, easily and to
cause more serious illness - Because the virus will be new, there will be no
vaccine ready to protect against pandemic flu
6Fritz the Swan
- Single swan infected with H5N1 flu
- Traced to have arrived from Germany
- Containment procedures now relaxed and no further
cases - A near miss??
7Prerequisites for pandemic influenza
- New influenza A sub-type Haemagglutinin (H)
unrelated to immediate (pre pandemic )
predecessor - Little or no pre-existing population immunity
- Causes significant clinical illness
- Efficient person to person spread
8Prerequisites for pandemic influenza
- Avian flu does not meet this requirement as it is
spread via bird droppings and is rare in humans - BUT if a person became infected with Avian flu
AND has another type of flu which was spread
between humans (droplet) then there could be
mixing and mutation and the result could be a new
H5N1 virus - This new virus could lead to Pandemic Flu
- It might take only weeks for this to spread
worldwide
9Prerequisites for pandemic influenza - situation
in April 06
- New influenza A sub-type Haemagglutinin (H)
unrelated to immediate (pre pandemic )
predecessor YES - Little or no pre-existing population immunity YES
- Causes significant clinical illness YES
- Efficient person to person spread not yet
- Hence we are at WHO pandemic alert phase 3
10What is pandemic flu like?
- An acute illness, incubation period 1 to 4 days
- Generally of sudden onset, with fever, headache,
aching muscles, severe weakness, and respiratory
symptoms e.g. cough, sore throat, difficulty
breathing - Highly infectious, spreading rapidly person to
person - Some strains cause more severe illness than
others - (and we dont know what the pandemic strain will
be like) - Flu can kill, as can the complications
11How should it be treated
- Self management should be the norm there is no
need to see a doctor unless there are
complications - Rest at home avoid public places and do not go
to work and spread it to colleagues - Drink plenty of fluids
- Take simple remedies such as paracetamol
- There is NOT usually a need for antiviral drugs
such as Tamiflu
12How it spreads
- Easily passed from person to person through
coughing and sneezing - Transmitted through
- breathing in droplets containing the virus,
produced when infected person talks, coughs or
sneezes - touching an infected person or surface
contaminated with the virus and then touching
your own or someone elses face
13How to avoid spreading flu
- Avoid public places
- Use tissues and dispose of them hygienically
- Coughs and sneezes spread diseases
- Patients with flu should be kept separate for
other patients - Staff dealing with flu patients should wear a
mask and use simple barrier precautions
14Planning for a Pandemic
- DoH has been leading the UK planning
- Guidance in 1997, updated March and Oct 2005
- Advice from the Health Protection Agency (HPA)
- Expectations that all NHS organisations should
have plans - Limited instructions so far from resilience fora
and local government
15Local planning
- There is a Hertfordshire Pandemic Flu
Coordinating Committee planning for the county - There is also a local Primary Care Trust planning
and implementation group - We also have a Callowland Pandemic Flu
contingency plan
16Emergency planning prepare for the worst and
hope for the best
- Full range of possible mortality rates given in
UK flu guidance, but detailed assumptions based
on 25 attack and 0.37 mortality rate (as in
1957) - London planning for 2.5 mortality in the
infected - DH revising their figures/guidance upwards?
17Advice from DoH
Reduce impact through
- Surveillance
- Diagnosis
- Antiviral drugs
- Vaccines (once they become available)
- Public health interventions
But what about business continuity
planning planning for absenteeism maintaining
food and other basic supplies community resilience
18Advice from BMA/RCGP
- Wherever possible, those known to be or likely to
be infected with flu should be kept physically
apart from those without flu - Working practices and procedures which risk
enhancing transmission of flu should be avoided - Sensible barrier precautions should be used when
close contact with a flu-infected patient is
inevitable or likely - There should be no compromise in infection
control standards - High standards of patient care should be
maintained throughout, for those with flu and for
those with other conditions
19Pandemic flu and infection control
- Face masks and full protection for health care
workers close to those known to have flu, but
what about, eg informal carers, or with those who
only might be infected? - Keep patients with flu separate from patients who
do not have flu - Public awareness and publicity to promote
infection control - The possible closure of places where the public
congregate
20Personal interventions
- Basic measures to reduce the spread of infection
- Hand washing washing hands frequently with soap
and water reduces the spread of the virus from
the hands to the face, or to others - Respiratory hygiene covering the mouth and nose
when coughing or sneezing using a tissue when
possible disposing of dirty tissue promptly are
carefully bag and bin - Avoiding non essential travel and increasing
social distance non attendance at large
gatherings such as concerts, theatres, cinemas,
sports arenas etc
21Antiviral drugs
- Oseltamivir (Tamiflu) being stockpiled, one
course for 25 of the UK population, but the
value is uncertain - Best if given within 24-48hrs of start of illness
- Lots of logistical difficulties in achieving this
- Especially if the drug is in short supply and its
significance has been oversold - May turn out to be a distracting and divisive
issue
22Immunisation - ?? too late
- The present flu vaccine will NOT give protection
- Only when the pandemic starts will it be possible
to make a vaccine - It could take weeks or months to prepare
- Will then be run out to priority groups
- We will NOT be vaccinating patients instead
they will attend special centers. However we will
vaccinate our staff as soon as supplies are
available
23- Feeding wild birds
- You can still feed wild birds and ducks, but make
sure that you wash your hands thoroughly
afterwards and steer clear of sick or dead birds.
If you do see a dead duck, goose or swan, call
the DEFRA helpline on 08459 33 55 77. - Bird droppings
- The virus can be passed on through bird
droppings, either from bird to bird, or in very
rare cases, from bird to human. Try to keep away
from bird droppings if possible, and wash your
hands thoroughly if you accidentally touch some. - Protecting pets
- In general, you don't need to do anything
differently to look after your pets. If you have
a dog that sometimes catches wild birds, try and
avoid areas where that's likely to happen. In
theory, H5N1 can be passed on to other animals,
but it's very unlikely. - Food preparation
- The outbreak does not pose a food safety risk for
UK consumers because the virus is not blood borne
and is not transferred through cooked food. As a
precaution, always make sure you practise good
hygiene when cooking meat - use different
utensils for cooked and raw meat, wash your hands
thoroughly before and after handling meat, and
make sure that meat is thoroughly cooked and
piping hot before serving.
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25Callowland planning
- Self care is appropriate in most cases and we
should promote this - People with flu should not attend the surgery
- (strategies to increase telephone advice, prolong
repeat prescriptions, arrange prescriptions to go
direct to chemists) - If complications (such as chest infections) are
considered patients should attend separate flu
sessions - Separate areas will be used for flu patients and
non flu patients - The nebulisers will NOT be used
- Routine care will be suspended
- (minor ops, medicals, childhood immunisations,
well woman, diabetes and asthma checks will be
suspended)
26Callowland planning
- Masks should be worn when seeing patients with
flu and in some circumstances gloves and aprons - (maintain stocks and buy an initial supply of
masks) - Nebulisers should not be used
- Safe bins will be provided in patient areas for
discarded tissues - Soft furnishings and books should be removed from
flu areas to minimise infection risk - Careful cleaning of areas, especially after flu
patients are seen, is essential - (increased cleaning contract)
27Business continuity planning
- A pandemic might last three months and 25 of
workers will be off for 5 to 8 days during this - At any one time there will be a 10 to 35
absenteeism rate peaking at 8 to 9 weeks into the
pandemic
28Business continuity planning
- We will need to be flexible with rotas
- By cancelling routine tasks we can free up time
- Staff will need holidays and rest periods to
sustain care though we may need to reduce
numbers taking holiday and cancel study leave - We recognise the need to be sympathetic if staff
cancel holidays and lose money as a result - Childcare support may be needed for staff with
children or grandchildren that they look after - We are a TEAM and will pull together
29And finally