Oh! It’s just the flu The clinical impact of influenza in the tropics / subtropics

Oh! It’s just the flu

The clinical impact of influenza in the tropics / subtropics

Influenza: Seasonal, HPAI, Pandemic

Seasonal Influenza

Highly Pathogenic

Pandemic Influenza

Avian

Influenza

Etiology Influenza A (H3N2, H1N1)

Pathogenic to humans: A new subtype

Influenza B H5N1, H7N7 mutated H5N1 capable of

human- to -human

transmission

transmission

Incubation Period 2 to 3 days 3 days ?

(range 1 to 7 days)

(range 2 to 4 days)


Seasonal Influenza

Highly Pathogenic

Pandemic Influenza

Avian Influenza

Exposure from persons infected

infected birds from persons infected

with the usual circulating

with a new virus subtype

subtype, strains may vary

Clinical manifestations

fever, respiratory manifestations, may or may not progress

Fever, respiratory manifestations, 50-70% fatality, rapid progression

Fever, respiratory manifestations, severity to be determined


Seasonal Influenza

Highly Pathogenic

Pandemic Influenza

Avian Influenza

Who are at risk of complications

young children, persons > 50 y/o, with co-morbidities

those with contact with infected birds

Uncertain

Vaccine yearly vaccine strains

None none

Treatment supportive, antiviral agent

supportive, antiviral agent

supportive, antiviral agent, if new virus subtype is not resistant

What is Avian Influenza?• An infectious disease in

chickens, ducks and other birds caused by different subtypes of the influenza A virus – Ranges from mild infection to

acute, fatal disease– Two types depending on severity

of illness:• Highly Pathogenic Avian

Influenza (HPAI)– With mortality in poultry as

high as 100% • Low Pathogenic Avian

Influenza (LPAI) – Clinical signs much less

evident or even absent– Mortality much lower

1997 - H5N1 - first human cases seen in Hong Kong in 18 cases, 6 human1999 – H9N2 - Hongkong, I human case, mild infection 2003 – H5N1 – Hongkong – 2 human cases, 1 death H7N7 – The Netherlands, hundreds with conjunctivitis, ILI , 86 confirmed, 3 cases w/ human-to-human

transmission, 1 human death (a veterinarian) H9N2 – Hongkong – 1 human case, mild infection H5N1 - South Korea, Japan – death of chickens, no human case 2004 - H5N1 - human cases and death in Vietnam and Thailand.

Recent cases of human infection caused by avian influenza viruses

Spread from one country

to another

international trade in live poultry – game fowl, breeders

migratory waterfowl –wild ducks – - natural reservoir of bird flu viruses

- the most resistant to infection

- healthy carriers to great distances through

their droppings

• China• Hong Kong• Vietnam• Thailand• Indonesia• Cambodia• Lao PDR• Pakistan• South Africa• Malaysia• North Korea•Japan**Russia (7/18/05)**Kazakhstan(7/22/05)**Mongolia(8/10/05)

Total poultry mortalities / slaughtered

fr Jan‘04–Sept 30’05

63.2 million birds

Confirmed human cases of avian influenza A(H5N1), 26 Dec ’03 - 13 March ‘06

Cases Deaths

Cambodia 4 4

China 15 10

Indonesia 29 22

Iraq 2 2

Thailand 22 14

Turkey 12 4

Vietnam 93 42

Total 177 98CFR = 55%Reference: WHO

• Domestic birds can get the infection when they roam freely and share water supply that that might be contaminated by infected droppings

• Contaminated equipment, vehicles, feeds, cages, or clothing, especially shoes can carry the virus from farm to farm

How bird flu spreads within a country

• Wet markets -live chickens and other birds in crowded and often unsanitary conditions

• Movement of infected birds -trading or smuggling

Strait Times, Singapore Website

Transmission to humans

• Close contact with live infected birds through infected aerosols, discharges and surfaces

• Birds excrete the virus in their feces, which dries and becomes pulverized, and is then inhaled

• Flapping of wings hastens the transmission

Social, economic and political implications

– Economic loss in agriculture and the poultry industry

– Loss of livelihood of small-scale poultry players

– Threat to food security

– Widespread public anxiety

– Global and national attention on government’s response

Human Public Health Implications

• High mortality of H5N1 to humans • Emergence of a new influenza virus with

pandemic potential- Efficient human to human transmission- Vast majority of people have no immunity- No protective vaccine/ Inadequate quantity of developed vaccines for the world -High number of cases and deaths worldwide (pandemic)

Avian Flu and Influenza Pandemic,Impact

• During the current H5N1 > 150 million birds culled or died: direct economic cost to affected countries $8-12billion

• Next pandemic may cause very high morbidity and mortality in few weeks. It could cause 1 billion cases and 2-7 million deaths

• A modest pandemic lasting over one year might cause losses as high as 3% of Asia GDP and 0.5% of world GDP. Presently equivalent to a loss of $ 150-200 billion in GDP

The SARS experience and the influenza pandemic

•Economic impact of the six-month SARS epidemic:Asia-Pacific region at about $40 billion. Canadian tourism- $419 million. Ontario health-care system -$763 million, Flights in the Asia-Pacific area decreased by

45 % from the year before, the number of flights between Hong Kong and the United States fell 69 %•The impact of SARS would pale in comparison to that of a 12- to 36-month worldwide influenza pandemic.

Influenza Pandemics in 20Influenza Pandemics in 20thth Century Century

1968: “Hong Kong Flu”

A(H1N1) A(H2N2) A(H3N2)

1918: “Spanish Flu” 1957: “Asian Flu”

20-40 million deaths, 20-50 y/o

1-4 million deaths, infants

and children

1-4 million deaths

Credit: US National Museum of Health and Medicine

Recombination of human and avian influenza viruses

Avian source

Influenza Pandemics:Why are we concerned now?

3 pre-requisites to start an influenza pandemic:

1. Emergence of a new virus to which all are susceptible;

2. Virus is able to replicate and cause disease in human;

3. New virus is transmitted efficiently from human-to-human

H5N1 virus, is the potential candidate, but 3. not

fulfilled yet Geographical extent of the problem

Reservoirs of infection expanding (range of wild birds and

ducks) and virus changing

Number of human infections increasing (c/f last year)

Past Influenza Pandemics

1900

1850

1950

2000

1847

1889

1918

19571968

42 yrs

29 yrs

39 yrs

11 yrs

30 – 40 years cycle

No Pandemic for > 38 yearsNo Pandemic for > 38 years

H1N1

H2N2

H3N2

Signs and symptoms in humans

• A (H5N1) infection very similar to other influenza viruses, most are self-limiting

• Initial symptoms are fever, malaise, myalgia, sore throat and cough.

• Conjunctivitis in some patients

• Persistently high fever

• Complications and death due to severe pneumonia, respiratory distress syndrome and multi-organ failure.

Individuals at risk

In areas where H5N1 has been reported or is suspected

Poultry handlers/workers People living near poultry farms Sellers/people involved in live chicken sale Aviary workers Ornithologists Cullers involved in destruction of poultry

Diagnosis

• If the patient has had direct or indirect contact through handling or having taken care or getting near sick chickens or other birds.

• A laboratory confirmation of the bird flu infection and epidemiologic link with unusual death or epidemics of chickens will support the diagnosis of bird flu.

Prevention

• Hand hygiene • Cleaning and disinfection • Avoiding contact with wild birds• Safe food practices • Practice of proper hand washing and cleaning

and disinfection procedures in poultries

VaccinationNo vaccine developed against H5N1

Routine influenza vaccine – to prevent humans as mixing vessel for re-assortment into a new virus subtype

Selected groups for vaccination: • cullers involved in destruction of poultry• people living and working in poultry farms • health care workers involved in the daily care of H5N1 human cases• health care workers in emergency care facilities in areas where there is confirmed occurrence of influenza H5N1 in birds.

Emergence of Pandemic StrainReassortment in Humans or Pigs

Migratory water birds

Reassortment in human

Reference: WHO

Reassortment in pig

Treatment

• Treatment for H5N1, infection is essentially the same as for other influenza viruses.

• Antiviral drugs for both treatment and prevention, but have some limitations

• OSELTAMIVIR: 1 tab BID x 5 days; Prophylactic: 1 tab OD x7 days

Phases of Pandemic Influenza Preparedness and Response - 1

PANDEMIC PHASES (WHO) DESCRIPTION PHILIPPINES

Interpandemic Phase Phase 1- No new influenza virus subtypes detected in humans, but may be present in animals and the risk of human infection or disease is low

New influenza virus subtype in animals, no poultry outbreaks, no human cases

Stage 1 - Avian influenza-free Philippines

Phase 2 - New influenza virus subtypes detected in animals and substantial risk of human infection or disease

New influenza virus subtype in animals, there are poultry outbreaks, no human cases

Stage 2 - Avian influenza in domestic fowl in the Philippines

Pandemic Alert Period

Phase 3 – Human infections with a new sub-type, but no human-to-human spread, or at most, rare instances of spread to a close contact

• >1 unlinked human cases with clear history of exposure to an animal source/non-human source

Independent clusters of human cases from a common source/ spread from case to close household or unprotected health-care contacts, no sustained human-to-human transmission •Cases with source of exposure which cannot be determined, no clusters or outbreaks of human cases

Stage 3 - Confirmation of avian influenza from poultry to humans in the Philippines

Phases of Pandemic Influenza Preparedness and Response - 2

PANDEMIC PHASES (WHO) DESCRIPTION PHILIPPINES

Pandemic Alert Period

Phase 4 – Small clusters with limited human-to-human transmission but spread is highly localized

>1 clusters involving a small number of human cases, e.g. a cluster of <25cases lasting <2 weeks

Small number of human cases in one of several geographically linked areas without a clear history of a non-human source of exposure

Stage 4 - Avian Influenza with human-to-human transmission of pandemic influenza causing outbreaks in the country.

Phase 5 – Larger clusters but human-to-human spread is still localized

•Ongoing cluster-related transmission, but total number of cases is not rapidly increasing, e.g. cluster of 25-50 cases and lasting for 2 to 4 weeks

Ongoing transmission, but cases appear to be localized (remote village, university, military base, island)


Phase 6 – Pandemic phase: increased and sustained transmission in general population

Sustained transmission, increasing number of cases


Post-pandemic phase

Return to interpandemic period

Post-pandemic phase

Return to inter-pandemic period

Early Signals • Bird/animal death (unexplained/unusual)• Human respiratory infections assoc. with bird/animal

deaths • Unusual respiratory disease/deaths-cluster of cases

among - Travelers - Cullers - Poultry Handlers - Health care worker - Laboratory workers • Rumor surveillance in the early warning phase to

identify possible cases of pandemic strain influenza that might not be notified by routine or enhanced surveillance

Keeping the Philippines Bird Flu FreePreparedness from the National to the Local Level

Executive Committee

Secretariat

Committee on Human Health

Protection

Quarantine

Public Health Response

Resource Mobilization

Clinical Mgt / Hospitals

Surveillance / Lab

AI National Task Force • Secretary of Agriculture• Secretary of Health• DA USec for Livestock and Fisheries• DOH Usec for Health Operations• BAI Director• NMIS Director• DOH Program Director for Emerging & Re-emerging Infections • Private Sector Representatives

• Broilers• Layers• Gamefowl• Poultry Veterinarians

Logistics

Policy Communications

Committee on Animal Health

Protection

Quarantine


Containment

Surveillance / Lab

Keeping the Philippines Bird Flu FreePreparedness from the National to the Local Level

AI Regional/ Provincial Task Force

Census Team

Quarantine Team

Surveillance Team

Committee

Rapid Action Team

IEC Team

• DA Regional Director• DOH Regional Director• DILG Regional Director• PNP Regional Director• Regional Disaster Coordinating Council• Private Sector Representative/s

• DA Provincial Officer• DOH Provincial Officer• PNP Provincial Director• Provincial Disaster Coordinating Council• Private Sector Representative/s

AI TASK FORCE

Stage 1: Keeping the Philippines Bird Flu Free

• Ban of all poultry and poultry products from AI-infected countries

• Border control• Ban on sale, keeping in

captivity of wild birds• Biosecurity measures• Standardized footbath • Confiscation and

destruction of unlicensed cargo

• Surveillance of Poultry in Critical Areas

• Influenza vaccination for all poultry workers, handlers

Keeping the Philippines Bird Flu Free

• Biosecurity control points e.g.gates, shower rooms, footbaths, fumigation boxes

• Proper rest period and disinfection between flocks

• Inaccessible to stray animals and free-flying birds

• Proper disposal of mortalities• No domestic ducks and free-

range poultry in migratory bird areas, especially wetlands

• No mixing of poultry and swine in same holding facility

• Record all movement to and from the facility e.g. visitors, vehicles, deliveries

Minimum Biosecurity Measures


• 20 critical sites identified• Target poultry are not

wildlife, but native chickens, ducks, gamefowl, etc. in the vicinity

• 6 barangays per location to be selected for sample collection

Surveillance of Poultry in Critical Areas


• Zamboanga del Norte• Zamboanga del Sur• Zamboanga City• Zamboanga Sibugay • Palawan near Quezon and Narra Towns• Pampanga – Candaba

Swamp• Ilocos Norte – Pagudpud• Cagayan – Aparri• Cebu – Olanggo Island• Negros Occidental –

Himamaylan

Priority Areas for Surveillance

• Isabela – Magat Dam, Ramon

• CARAGA – Lake Mainit, Agusan del Sur• Agusan del Norte• Surigao del Norte• Surigao del Sur• Panay Island – Roxas,

Capiz• Sorsogon – Bulan and

Matnog• General Santos City• Mindoro Oriental –

Naujan• Cotabato – Cabacan,

Liguasan Marsh


• To be led by PAWB-DENR, in coordination with the LGUs and local PNP

• No permits for poultry wildlife or exotic poultry species from AI-affected countries

• No collection of migratory birds, regardless of purpose or collection technique

Enforcement of Wildlife Act

• Influenza vaccination for all poultry workers, handlers

Preventive Measures in Humans

STAGE 2: Avian Influenza in Domestic Fowl in the Philippines

• Prevention of spread from birds-to birds: early recognition and reporting, mass culling, quarantine of affected area

• Prevention of spread from birds to humans: human protection through proper handling of infected birds, use of protective gear by residents, poultry handlers, and response teams

Keeping the Philippines Bird Flu FreeEstablishment of Compartmentalized Poultry Zones

Compartment 1

Compartment 2

Compartment 3

Compartment 4

Compartment 5

Compartment 6

Compartment 7

Compartment 8

• Objectives Establish boundaries

to prevent entry and limit or stop spread of AI

Facilitate surveillance, detection and control

Ensure availability of disease free production areas for export and local markets

STAGE 2: Avian Influenza in Domestic Fowl in the Philippines Community Response to sick or dead birds• Protection of exposed residents – gloves/ plastic

material in handling sick or dead birds, hand washing

• Personal protective equipment for cullers – caps, masks, goggles, gowns

• Slowly remove clothing and take a bath immediately after handling birds

• Identification of exposed individuals and quarantine for 10 days

• Inform the local health and agricultural officers

Stage 2:

Controlling and Eradicating Bird Flu in Domestic Fowl

CONTROL

ZONE 7 km

SUSPECT

PREMISES

QUARANTINE ZONE Level 1

3 kmINFECTE

D PREMIS

ES

3 km

QUARANTINE

ZONE Level 2

In case of an outbreak, a 3-kilometer quarantine zone shall be established and all birds within this area shall be stamped out. Moreover, a 7–kilometer control zone shall be secured so that intensive surveillance can be conducted to detect further outbreaks.

STAGE 3- Avian Influenza in Humans

Prevention of cases and deaths • Protection of exposed individuals

• Isolation and management of cases

• Judicious use of antiviral agents

• Infection control

• Quarantine of contacts

• Mobilization of the BHERTs

What should be done when there is a suspected case of avian influenza?

Protection of caregiver : Protection of caregiver : face mask and goggles or eye glasses, hand washing, face mask and goggles or eye glasses, hand washing,

self-monitoring for signs and symptomsself-monitoring for signs and symptoms

Immediate transfer to the Referral HospitalImmediate transfer to the Referral HospitalProtection of the transporting team and disinfection of Protection of the transporting team and disinfection of

vehicle vehicle

Patient: Patient: face mask, in a separate area or atface mask, in a separate area or at

least 1 meter distance from other peopleleast 1 meter distance from other people

Monitoring of contacts of the caseMonitoring of contacts of the case

What should be done when there is a suspected case of avian influenza?

• Through the Local Health Officer, immediately notify the Provincial Health Office and the Regional Epidemiology and Surveillance Unit regarding a suspected case of HPAI.

• A holding area in the community or in the health center will be set aside while awaiting transport.

Personal Protective EquipmentWho should use PPE?

•

• Cullers and animal husbandry/veterinary staff and all those who are handling infected or suspected poultry and poultry products.

• All doctors, nurses and health care workers who provide direct patient care to avian influenza cases

• All support staff including medical aides, X-ray technicians, cleaners, transport staff, laundry staff

• All laboratory staff who handle patient specimens from suspect cases

• Family members who care for avian influenza patients (no visits)

• The patient(s) should wear a mask (N95 preferable) when other people are in the isolation area.

• Contacts and international travellers during home isolation/quarantine must wear a mask (N95 preferable).

Cullers and transporters should be provided with appropriate PPE

•Coveralls plus an impermeable apron or surgical gowns with long cuffed sleeves plus an impermeable apron

•Heavy duty rubber gloves that may be disinfected

•N95 respirator masks or standard well-fitted masks

•Goggles

•Rubber or polyurethane boots or disposable protective foot covers

Hand washing

• single most important and effective component for preventing the transmission of infection.

• Running water and soap with friction should be ideally used for 15 to 20 seconds.

• It is important to dry hands after washing

• A 70% alcohol-based hand rub solution after hand washing can be used.

Respiratory Etiquette• Cover your nose and mouth with tissue or handkerchief every time you sneeze,

cough or blow your nose. If you don’t have tissue, cough into your sleeve.

• Wash your hands with soap and water.

– Before touching your eyes, nose or mouth. – Before shaking hands with other people.

If water is not available, use an alcohol-based hand sanitizer.

• Don’t be offended if someone offers you tissue. Thank the person for the kind act.

• Don’t spit on the floor or on the road. Spit on a trash bin or on a small plastic bag.

• Put used tissues or plastic bags in the trash bin.• Wash used handkerchiefs separately from clothing.

• As much as possible, stay at home when you are sick.

• Maintain a safe distance of 1 meter from other people when you are sick.

• Do not share eating utensils, drinking glasses, towels or other personal items.

Exposed persons

Exposure:Exposure:During the 7 days During the 7 days before the onset before the onset of symptoms, of symptoms,

contact (within 1 contact (within 1 meter) with live or meter) with live or dead domestic dead domestic fowl or wild birds fowl or wild birds or with persons or with persons suspected to have suspected to have bird flu bird flu

Quarantine Quarantine exposed personsexposed persons for 10 days and for 10 days and

monitor for signs monitor for signs and symptoms of and symptoms of

illness.illness.

Quarantine of contacts

• Stay at home for 10 days

• Monitor self for fever, cough or difficulty of breathing or any sign and symptoms of illness.

• Refer sick persons to the Referral Hospital for SARS and other severe emerging infections.

Referral of Avian Influenza Cases A. Satellite Referral Hospitals – Regional Hospitals/ Medical Centers of 16

Regions

B. Sub-national Referral Centers San Lazaro HospitalLung Center of the Philippines Vicente Sotto Memorial Medical CenterDavao Medical Center

C. National Referral HospitalResearch Institute for Tropical Medicine

STAGE 4: Human-to-human transmission of influenza (pandemic influenza)

• High morbidity and mortality

• Increased demand for health services

• Maintaining essential services – disaster response team, security, peace and order, transportation, communication and utilities

• Public anxiety – epidemic of fear

Challenges

Coping with increased demand for health services and goods

• manpower augmentation • antipyretics, analgesics, liniments and antibiotics

• Shortage of beds, equipment and supplies• Only serious and urgent cases will be admitted• Back-up / buddy system • Supplies of relevant drugs (e.g. antibiotics) and equipment (e.g. Ventilator)

Secondary care

Primary care

CRISIS MITIGATION MEASURES FOR STAGE IV

Maintaining essential services

Persons providing – Emergency and disaster response– Maintenance of peace and order– Transportation, including air traffic controllers– Utilities – water, electricity

In an explosive spread, efforts and resources will be shifted to maintenance of essential services

• Arrange ahead places of duties and schedule to cover the required duties during the pandemic • Back up

Slowing the spread of infection

Personal hygiene – cough etiquette, handwashing Social Distancing• Quarantine of persons/ areas • Reduction of unnecessary travel• Staying at home when sick • Isolation at home (separate room)• Closure of schools• Suspension of public events• Closure or limitation of people in public places or

establishments

What is the government doing

Organization/ Coordination

• Management Committee on Prevention and Control of Emerging and Re-emerging Infectious Diseases (DOHMC– PCEREID)

• National AI Task Force for Avian Influenza Protection Program (NATF-AIPP)

• Formulated structure for Regional and Local TF-AIPP

Moving forward:•Monitor Organization of Regional and Local Task Forces -AIPP•Identification of Team Leaders for each critical area


Planning Policy/ Technical Guidelines Development

• Preparedness and Response Plan for Avian and Pandemic Influenza

• Work and Financial Plan

• Guidelines: Consensus on the Prevention and

Management of Influenza (with medical specialties)Clinical Management of HPAIInfection Control

• Planning workshops

• Mobilization of DOH-Management Committee for PCEREID

• Interagency Avian Influenza Task Force Meeting

• Table top exercises

Moving Forward:Assist in Preparedness and Response Planning for Avian and Pandemic Influenza - LGUs - Hospitals - DepEd and other agencies - Regional offices

Orientation on Avian Influenza and Pandemic Influenza Preparedness

• Regional Directors and Chiefs of Hospitals in the National Staff Meeting

• Regional Coordinators and Epidemiology and Surveillance Units

• Rural Health Midwives- Olongapo City, Cebu City

• Ongoing Regional Meetings

Training on Infection Control (NCHFD)

• NCR Hospitals

Moving forward:

•Speakers’ Bureau

•Provincial, City and Municipal Health Officers and private practitioners

•Joint Agriculture-Health Officers Training

•Training on Infection Control Other regions – Hospital Staff (Luzon, Visayas and Mindanao



Advocacy • Legislators : Committee on Health,

Lower House • National Anti-Poverty Commission National Disaster Coordinating

Council Medical specialty organizations PPS, PSMID, PIDSP Diplomatic Corps American Chamber of Commerce

Asian Development Bank Japanese Consuls to Asian Countries

Business Sector

Moving Forward:

Continuing advocacy to:

Health sector Business sector Funding organizationsNon-government organizationsOther stakeholders/ support groups

What is the government doingAdvocacy and Information

Dissemination • Regional Summits (Joint DOH-

DA activity)– 6 regions –Regions 3, 4, 9, 10,

11 and Palawan • Development of IEC Materials

– Target audience-based, Cough manners, proper

handwashing • Quadri-media • DOH website for bird flu • Lectures to other agencies,

offices • Planning with UP-CPH for

Training on Risk Communication

Moving forward:• Local Bird Flu Summits in 40 provinces - DOH, DA, DILG, poultry industry

• Reproduction of IEC Materials – Target audience-based, cough manners, proper handwashing

• Tri-media bird flu features/ updates/ advisories


Resource Mobilization• Request to PCSO for P30

Million

• Request to PS-DBM for PPE (P8.5M)

• Procurement through WHO: 700 bottles of suspension, 10,000 capsules of Oseltamivir

• Project development – SARS Project to dovetail Avian and Pandemic Influenza, Meeting with CIDA, USAID (Pledge of $50,000)

Moving forward:• Procurement of additional 100,000 capsules of Oseltamivir for 10,000 treatments (to source out P8.5M) • Resource generation

AVIAN & PANDEMIC INFLUENZA BUDGET

as of 2/22/06ACTIVITY DONOR AMOUNT STATUS

Procurement of Oseltamivir

GOP-DOH

Unilab

10.2 M

60 M

Allocated/Released

Pledged

Vaccine for health workers AusAID 1.77 M Requested

Procurement of PPEs GOP-DOH

AusAID

20M

1.55M

Allocated

Requested

Workshops and Trainings GOP-DOH

ADB

WB

AusAID

0.5 M

3 M

0.5 M

2.0 M

Available (2006 budget)

Allocated (dovetailed with SARS funds)

Requested

Requested

Hospital Equipment AusAID 5.52 Requested

IEC

Survey/ Materials

GOP-DOH

USAID

UNICEF

WB

AusAID

2.0 M

2.75 M

Amount unspecified

3.0 M

5.0M

Spent

Pledged

Pledged

Allocated ( with SARS funds)

Requested

Surveillance GOP

CDC(RITM)

1.0 M

5.0 M

Allocated

Allocated

Package of Trainings, equipment, supplies

PCSO 30M Requested

Elements of the Preparedness Plan

1.Management structure, planning and policy formulation

2.Surveillance system for HPAI and pandemic influenza

3.Antiviral agents and pandemic influenza vaccine

4.Readiness of health facilities, service, manpower and supplies

5.Maintaining non-health essential services 6.Public health interventions 7.Information, education and

communication 8.Networking

Business Pandemic Influenza Planning - 1

1. Strengthen management structure

a. Identify a pandemic coordinator &/or team for preparedness and response planning

Planning Considerations:a. Determine processes & services most essential to

maintain; affected most by high absenteeismb. Identify essential employees & other critical inputs

(e.g. raw materials, sub-contractor services/products, logistics) required to maintain business operations

c. Plan for scenarios - or in demand for your products/ services; impact of pandemic on business-related local & international travel

d. How to minimize illness among staff, customerse. Labor representatives should be part of process


1. Strengthen management structure

b. Develop policies, standards & guidelines

Sickness & absenteeism policy Set up authorities, triggers, procedures for

activating terminating company’s response plan, altering operations

Inc. social distancing (e.g. frequency & type of face-to-face contact)

Flexible worksite, work-hours Annual Influenza vaccination Prevention of Influenza spread at worksite Travel to affected areas

Infectious Control Measures1. Respiratory etiquette2. Handwashing3. Avoid touching the eyes, nose,

mouth4. Stay home when sick, check w/

health provider when needed5. Practice other good health

habits


2. Operationalizing a Surveillance system

Strengthen coordination & partnership with DA, DOH

Monitoring workforce absenteeism

Support for surveillance – reporting network, communication

3. Enhancing capabilities of health & non-health key personnel

Funds to support trainings of Municipal Health and Agriculture Officers, BHERTs

Funds to reproduction of training modules


4. Providing antiviral agents and pandemic influenza vaccines

Stockpile of antivirals for own company; Influenza vaccination for workers

Employee access to healthcare services

Infection control supplies

5. Ensuring readiness of health facilities, service, workforce & supplies

Ensure health workers are knowledgeable on infection control & 1st response

Private hospitals to accept patients during a pandemic (Hospital checklist)

Non-traditional sites & workers: schools, hotels, etc. as clinics, triage centers

Provision of food, supplies, other provisions


6. Ensuring preparedness of agencies delivering non-health essential services

Preparation of contingency plans

Back-up system for personnel to maintain services during a pandemic

Temporary permits to volunteers and workers

7. Public Health Interventions Infection control measures; use of masks

Suspension of public events; closure or limitation of people in public places (e.g. schools)

Limitation of movement from one area with outbreaks to area with no or few cases; suspension of travel to a country w/ outbreaks

Transportation: curtains in buses, shut off airconditions


8. Strengthening IEC campaign Establish emergency communication plan –

directory of contact persons; IT structures (for employee, customer)

Training of company speakers

Provide funds for the reproduction of IEC materials, conduct of for a, etc.

Provide IEC (incl. Preparedness plan) materials to employees

9. Soliciting support & networking W/ government agencies, other business groups,

NGOs, healthcare facilities, LGUs


Self-monitoring against price increases

Plan ahead – it wasn’t raining when Noah built the ark.

Documents

Oh! It’s just the flu The clinical impact of influenza in the tropics / subtropics