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Pandemic

Preparedness Plan

Dr.Murali Vallipuranathan
MBBS, PGD , MSc, MD
Consultant Community Physician
Pandemic Preparedness
Plan
It can be at three levels

 Global planning
 Community planning
 Individual organization planning
Key Elements

 Introduction to Pandemic
 Reasons for Preparing a Pandemic
Plan
 Preparedness Planning Process
 Communications Strategy
 Implementation
 Follow up- Monitoring
Past Influenza Pandemics

1847
1850 Pandemic usually occur
42 yrs every 30 – 40 years
1889
1900 29 yrs
1918
39 yrs
1950 1957
1968 11 yrs

2000 Last
Last Pandemic
Pandemic was was ≈≈ 40
40
years
years ago,
ago, in
in 1968....
1968....
Influenza Strains and Pandemics in 20th
Century
1918-19 1957-58 1968-
69

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

20-40 million deaths 1 million deaths 1 million deaths

H1N1 H2N2 H3N2

1920 1940 1960 1980 2000


Pandemics have been
occurring throughout
human history.
Three major pandemics in the 20th
century
Current Pandemic first in 21st

Century
April 2009-present: The “Swine

Flu” (H1N1):
 This is a novel strain of avian, swine
and human antigens that is still
mutating and spreading in the
human population worldwide.
Genetic Shift - Pandemic Influenza

Human Strains

Unknown
Avian Strains

Potential to ‘mix & match’ avian Unknown


& human strain genes
Cause of Pandemic

Apandemic virus occurs when an


antigenic shift takes place in the virus
and the following conditions are met.
1. a new influenza virus subtype

emerges,
2. the virus infects humans,

3. the virus gains efficient and

sustainable transmission from human to


human.
4. The new virus has a capacity to cause

serious clinical disease and death


5. The population has little or no

immunity to the virus



Phases of Pandemic

INTER-PANDEMIC Low risk of human cases 1


PHASE

New virus in animals, Higher risk of human cases 2


no human cases

PANDEMIC No or very limited human 3


ALERT to human transmission
New virus causes Evidence of increased human to 4
human cases human transmission

Evidence of significant human to 5


human transmission

PANDEMIC Efficient and sustained human to 6


human transmission
WHO Pandemic Phase 6
Explanation of WHO
Phases
 Phase 1 - No viruses circulating among
animals have been reported to cause
infections in humans.

 Phase 2 - An animal influenza virus is
known to have caused infection in
humans

 Phase 3 - Limited human-to-human
transmission may occur

 Phase 4 -Verified human-to-human
transmission able to cause “community-
level outbreaks.”
Explanation of WHO Phases
(cont.)
 Phase 5 - Human-to-human spread of the virus
into at least two countries.

 Phase 6 - The pandemic phase, is characterized
by community level outbreaks in at least one
other country in a different WHO region in
addition to the criteria defined in Phase 5.

 Post-peak period - Disease levels in have
dropped below peak observed levels. Additional
waves may occur and countries will need to be
prepared for a second wave.

 Post-pandemic period - Influenza disease
activity will have returned to levels normally
seen for seasonal influenza.

WHO Pandemic Phase 6

 “Phase 6, the pandemic phase, is


characterized by community level
outbreaks in at least one
other country in a different WHO
region in addition to the criteria
defined in Phase 5.
 Designation of this phase will
indicate that a global pandemic is
under 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 than
first
 Typically affects young, healthy adults
(unlike regular seasonal flu)
Pandemic Waves

 3 month warning from first pandemic


outbreak to local outbreaks

 1st wave - often out-of-season, may
last 6-8 weeks (peak at 3-4 weeks)

 2nd wave - 3-9 months later; may
be more severe

 3rd wave may also occur

T h re e Flu Pa n d e m ics in th e 2 0 th Century
Known facts about a future
pandemic

 An influenza pandemic will happen


 The timing and pattern will be
unpredictable
 A short lead time will exist from
first identification to full scale
pandemic
 Outbreaks will occur
simultaneously, in multiple
waves with devastating societal
impact
Known facts about a future
pandemic
( continued )

 Young healthy people in our community


will be affected
 There will be shortages of medical
resources, equipment, supplies and
personnel
Known facts about a future
pandemic
( continued )
 Essential services will be severely
disrupted due to absenteeism
 Media and public scrutiny will be
intense and unrelenting
 There will be LIMITED TO NO
OUTSIDE ASSISTANCE
available
 Increases in both global
travel and world population
will likely contribute to rapid
virus spread
Assumptions for Sri
Lanka
 Spread to Sri Lanka may take
several months, but may be
shorter
 A vaccine probably would not be
available in the early stages
 The numbers of health-care
workers and first responders
available to work can be
expected to be reduced

Assumptions for Sri
Lanka (continued)
 once established in Sri Lanka, the
disease is likely to spread rapidly
over 2-3 weeks and then gradually
decline over the next 4-6 weeks; a
second wave of illness may occur 6-9
months later
 some 20 to 30% of the population or
even more may be affected over a 1-
2 year period, including children and
normally fit young adults
 a far greater proportion of people are
likely to require hospitalization or die
than for seasonal flu.

Objectives of Pandemic
preparedness Plan (PPP)
 Slow the disease spread
 Reduce morbidity and mortality
 Minimize social disruption
 Avert economic disaster
 Preserve essential community
functions

Goals of Pandemic Preparedness
Plan

1 Delay onset of outbreak

Reduce the peak burden


Pandemic 2
Number of Daily Cases

on hospitals/infrastructure
Outbreak :
No
No Community
Community 3
Decrease a) number of
cases of death and
Measures Used illness and b) overall
health impact

Pandemic
Outbreak :
With Measures
Taken

Days Since First Case


Who should prepare
PPP?
 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/local


health 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 core
areas in the PPP?
vDescribes national coordination
and decision-making
vProvides an overview of key
preparedness issues
vDefines legal authorities for
pandemic responses
vLists specific response activities
by 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 between
Pandemic Phases
Pandemic Phase Critical activities
Pandemic alert, level Enhance surveillance
Pandemic alert, level
1: human cases, no Activate Central
Develop/test command
candidate center
vaccine
2 & 3: p-to-p
p-to-p transmission Enhance surveillance
Accelerate/monitor preparedness
transmission, local Investigate outbreak/define epidemiology
outbreak(s) Implement containment activities

Initiate pandemic vaccine production

Continue/accelerate preparedness

Implement communications plan


Activities differ
betweenPandemic Phases
(continued)

Pandemic Phase Critical activities


Pandemic phase, Implement strategy to decrease internal spread
Pandemic
early phase, Implement
Respond tostrategy to decrease community
initial cases
widespread spread
Define epidemiology/identify risk groups

disease Implement full-scale pandemic response


Initiate vaccination
Prepare for full-scale pandemic response
Communication in a crisis is
different
 In a crisis, people
take in, process
and act on
information
differently
 That increases the
potential for
miscommunicati
on
Communication is
essential.
 People need information to prepare
for/
 respond to emergencies

 Information to support good
decisions

 Information must be accurate,
consistent,
 credible, useful – PHASED


Communication in
emergency:
 Show that you care
 Demonstrate competence/expertise
 Tell what you know and don’t know
 Explain process to find answers


Communication in
emergency:
 Don’t over reassure
 Acknowledge uncertainty
 Acknowledge fear
 Let people know what they can do
 Ask 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 my
family?
 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?


Pandemic Preparedness
Plan in
Sri Lanka
 Cabinet approved Steering Committee
which includes the Secretaries and
Director Generals of Ministry of
Health, and Ministry of Animal
Production and Health has been
appointed with the threat of Avian
Influenza Pandemic
 Regular meetings of the Joint Technical
Committee are conducted to review
the pandemic preparedness activities
in collaboration with the Ministry of
Estate Infrastructure & Livestock
Pandemic Preparedness
Plan (PPP) in Sri Lanka
(continued)

 The committee is also represented by


the members from the Ministries of
Environment & Wild Life.
 Guidelines were developed and
circulated island wide on Avian
Influenza Pandemic Preparedness and
Response.
 District plans are being prepared by the
Deputy Provincial Directors of Health
in the districts: Individual plans for
the major hospitals have been
developed by the Heads of the
Planned activities of PPP

 Surveillance & early warning


Monitoring & prompt reporting of

unusual events
 Prevention & control
Emergency response team in districts

and training of health staff


 Health System Response
 Risk Communication
Planned activities of PPP
(continued)

 Health System Response


Upgrade lab facilities, sentinel

surveillance sites, triage


arrangements and personal
protective equipment
 Risk Communication
Communication strategic plan was

developed
Issues in Pandemic
Preparedness in Sri Lanka
 We have expertise in Pandemic
Planning with the international
collaboration
 Difficulty in implementation at the
regional level
 Issues in the availability of vaccines
 Logistic issues
 Isolation issues
 Cost

 Panic is our enemy
 Knowledge is our friend
 Preparation is our best line of
defense

THANK YOU

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