Health Protection Response to Pandemic Influenza in Scotland

Dr Martin Donaghy, Health Protection Scotland,

15th September 2010

Contents

• Introduction

• Overview of Pandemic

» Timeline

» Pandemic management

• Pandemic Recommendations

» Policy

» Functions

» Processes

Investigation

Surveillance Surveillance &&

AssessmentAssessment

Control

Communication

Health ProtectionFunctions

Incident Response

On-going management

Priority programmes

Major Incident Response

Pandemic Response

Incident Response

On-going management

Priority programmes

Major Incident Response

Pandemic Response

Health Protection Health Protection ResponseResponse

Increasing RiskIncreasing Risk

ContingencyContingency

Surge CapacitySurge Capacity

Command and ControlCommand and Control

ResilienceResilience

RehabilitationRehabilitation

Increasing ResponseIncreasing Response

Scottish Government Health Directorate Policy & Performance Management

OperationalOperational

NHS BoardsNHS Boards

Pandemic Response Structures

UK Ministers/Officials

SAGE

JCVISPI-M

PICO

Scottish GovernmentHealth Protection, Healthcare, Civil

Contingencies, Public Communications

HPSNSS Divisions

Immunisation Steering Group

HPATacticalTactical

StrategicStrategic

SFREC

NHS 24NHS 24

ProcessesPreparedness

• Generic Planning• Health Protection Framework• Exercises• Quality assurance

Containment Phase• Response co-ordination (Policy, UK implementation, Scottish Boards)• Surveillance and investigation• Guidance and expert advice • Immunisation Planning• Communications (internal, service and public)• Information Management

Treatment Phase; Influenza Response Co-ordinating Team• Intelligence and Surveillance• Guidance and expert advice • Immunisation Programme Management• Communications (internal, service and public)• Information Management and Technology

Lessons learned.

•Laboratory testing of those suspected of having contracted H1N1• antiviral treatment of cases meeting the agreed case definition

• contact tracing, and prophylaxis of close contacts• closure of schools based on expert advice

• self-isolation of cases in the community• detailed investigation of cases and contacts

Containment: Reduce rate of transmission & gather evidence

Containment Phase

Containment Phase

Treatment phase: mitigate impact

• Cases would be identified through clinical diagnosis, not swabbing• Contact tracing would cease

• Cases would be offered antivirals on the clinical discretion of GPs•• Vaccination would be offered to those most at risk

• Increasing the coverage of surveillance by involving all GPs•• Ensuring preparedness of hospital services.

Treatment phase

Treatment phase

Policy

• Precautionary approach: international comparisons, triggers

• Flexibility: UK vs devolved

• De-escalation of response

• Scientific advice: openness, structures, understanding

• Prioritisation of public health activities

Functions

Surveillance • National and local needs• UK Harmonisation• Burden of disease: mortality, severe

morbidity• Review shape of surveillance

Investigation• Field epidemiology• Serological studies• Molecular testing• Socio-economic gradient

Functions

Risk Assessment • International collaboration• Modelling• Scottish dimension

Control• Immunisation: mass vaccination, effectiveness• Case & contact management: clinical input,

effectiveness, • Social mixing: PH legislation powers• Port health: UK collaboration• Infection Control: respiratory precautions

Functions

Communications• Importance of web• Co-ordination of service and

public communications

ProcessesGovernance

• Formal Framework: Boards, HPS, Scottish Government• Flexibility; national vs local• Performance monitoring• Intellectual property• Ethical Framework

Response Co-ordination • National framework• Common management structures• Primary care input, • National support: call centres, teleconferences• Labs, public health capacity

Processes

Preparedness•Primary care input•Incident Guidance frameworks•National and local surveillance

Good Practice • Rapid production of Guidance• Clinical Input• Evidence base in uncertainties

Processes

Information• Immunisation: Lifelong record• Health protection; SHPIMS• Primary care: consultation data• Capacity• Data management

Workforce Development• Capacity and resilience• Epidemiology• Leadership

Conclusion

• Overall management of the pandemic response went well

• Many lessons learnt now being reported

• Need for targeting and prioritising of recommendations

• Experience of great relevance to Health Protection Stocktake