PANDEMIC INFLUENZA H1N1 2009

STATE OF PREPAREDNESSPresentation to District Commissioners

(DCs)

Dr Victor MukonkaDirector Public Health and Research

Ministry of Health HQLusaka

1st October 2009

OUTLINE OF PRESENTATION

IntroductionDefinitionsFacts on Pandemic Influenza H1N1 2009Country response to the pandemicPandemic Influenza H1N1 2009 National

Action Plan ChallengesConclusion

1. IntroductionPandemic Influenza (H1N1) 2009 is a

respiratory disease caused by the Influenza A virus

Initially, the current Influenza A/H1N1 was

being called Swine Flu because it was thought to be the respiratory disease caused by a virus spread by and found in pigs

Affects all age groups and has caused

infection and death worldwide

In our region; South Africa, Tanzania, Botswana, Namibia, Zimbabwe, Congo DR and Zambia have all reported cases

2. Definitions Flu – a contagious respiratory illness caused by

viruses. It can cause mild to severe illness, and at times can lead to death.

Epidemic – cluster of cases in a defined location; infectious, spreading

Pandemic – worldwide epidemic; infectious, spreading, affecting substantial proportion of population

Efficient, sustained human-to-human transmission

May be caused by major changes in the influenza virus arising from inter-species transmission

New virus may emerge against which the population does not have immunity

3. Influenza virus Three types: A, B, C

A, B Seasonal flu A Epidemic flu, severe disease

Surface proteins determine subtype H (hemagglutinin) H1 – H16 N (neuraminidase) N1 – N9

Influenza A viruses infect multiple species depending on subtype Humans Birds (wild birds, domestic poultry) Pigs Other mammals: horses, dogs, seals, whales,

ferrets, tigers

4. Mode of transmission of Pandemic Influenza A/H1N1 2009 “The 2009 influenza pandemic has spread with unprecedented

speed. In past pandemics, influenza viruses have needed more than six months to spread as widely as the new H1N1 virus has spread in less than six weeks”

Same way as common flu through coughing or sneezing and unclean hands

Spread from person to personTouching contaminated objects

Infected people may be able to spread the virus beginning 24 hours

before symptoms develop, and up to 24 hours after becoming sick.

5. Signs & symptoms of Pandemic Influ.H1N1

Similar to seasonal human fluFeverCoughSore throatRunny or stuffy noseBody achesHeadacheChillsFatigueDiarrhoea and vomiting

6. How Influenza Viruses Spread? (Source: CDC)

Primarily through respiratory droplets Coughing Sneezing Touching respiratory

droplets on self, another person, or an object, then touching mucus membranes (e.g., mouth, nose, eyes) without washing hands

7. Basics on self protection Educate yourself and your families

Know the symptoms of influenza Know how to avoid spreading influenza

Cough hygiene Hand washing Social distancing

If you are sick, stay home from work Be prepared

8. Pandemic influenza H1N1 2009: current global situationAs at 13th August 2009, WHO States

Parties to IHR (2005) have reported 182,166 cases with 1799 deaths (CFR 0.99) affecting 177 countries

In Africa: Ethiopia, South Africa, Namibia, Zimbabwe, Botswana, Algeria, Morocco, Libya, Kenya, Egypt and Cote d’voire and Zambia have reported cases.

9. Update on pandemic influenza H1N1 2009 in Zambia

Thus far more than 1016 suspected cases have been tested for H1N1.

Of these fifty (50) were confirmed positive (+) for pandemic flu but no deaths recorded thus far.

Ongoing influenza like illness surveillance at UTH with more than 600 samples processed.

Of all confirmed cases 5 were individuals who had travelled abroad and the rest are community acquired cases

10. WHO Pandemic Influenza Phases (six)PHASE 1No new influenza virus subtypes in humansPHASE 2No new virus subtypes in humans; animal subtype poses

a risk of human diseasePHASE 3Human infection with novel virus; no instances of

human-to-human spreadPHASE 4Small, localized clusters of human-to-human spreadPHASE 5Larger clusters, still localized; virus adapting to humans PHASE 6Increased and sustained transmission in the general

population

11. WHO recommended preventive measures

Reinforce influenza surveillance by setting up sentinel sites in major towns & points of entry

Involvement of locals in surveillanceStrengthen laboratory capacity Development of national preparedness and

response planOrient health workers on case managementReinforce appropriate health promotion and

communication messages to the community at the same time avoid alarming the citizens

12. Country Response to the pandemic influenza H1N1 2009

Reactivated the multisectoral technical Task Force on Infectious diseases (subcommittee of the National Epidemic Preparedness, Control and Management Committee (NEPPC&MC)

Quarantine and isolation facilities planned in all districts

Surveillance planned countrywide – 2 activated Clinical and diagnostics Information, Education and communication

(IEC)LogisticsDevelopment of National Action PlanInterpret the provisions of the IHR (2005)

12.1 Task force on infectious diseasesMembers drawn from MoH, MACO, UNZA

(Vet), UTH (virology), NAC, WHO, CDC, UNICEF, ZNBC and other partners

Zoonotic infectious diseases – MoH and MACO (Veterinary) co-chair the task force.

Meets regularly depending on phase – started with daily and NOW meets every Tuesdays.

Receives updates from the sub committees on quarantine, IEC, clinical and diagnostics, logistics, surveillance, WHO, CDC and issues on the Pandemic influenza H1N12009

12.2 Quarantine and isolation facilities

Two (2) quarantine and isolation facilities identified and equipped in Lusaka district and the Lusaka International Airport.

Each district requested to identify isolation facility

Twenty (20) health personnel trained on viral haemorrhagic fevers and infection control.

‘Standard operating procures activity flow chart’ developed on suspects from aeroplane to quarantine and management at designated health centre.

12.3 Surveillance activitiesForty (40) provincial and districts surveillance

officers trained in May 2009 in Kapiri Mposhi.Surveillance guidelines for human infection

with pandemic influenza A(H1N1) 2009 virus developed and sent to districts and provincial health offices.

Port health staff put on alert at ports of entry especially Lusaka and Ndola International Airports and land crossings.

With WHO support, assessments conducted at Lusaka, Ndola, Mfuwe and Livingstone International Airports. Also assessments conducted to ground border crossings in Chirundu, Victoria falls, Kasumbalesa, Mokambo, Sesheke and Kazungula.

WHO donated copies of the IHR (2005) to MoH.

12.4 Clinical and diagnosticsA. ClinicalClinical guidelines on for human Infection

with pandemic influenza (H1N1) 2009;- Aim is to provide guidance on the management of pandemic influenza H1N12009 infection in humans in resource limiting setting.- Includes patients with confirmed, probable or suspected pandemic influenza H1N1 2009 infection and their close contacts.

Drug of choice availability – oseltamivir (Tami flu) and zanamivir – WHO has donated tamiflu.

Clinical and diagnosticsB. DiagnosisGuidelines on collection and handling of

specimens for A/H1N1 influenza developed.Two (2) laboratories at UNZA (School of

Veterinary Medicine – level 3 Lab.) and UTH – Virology laboratory are ready to handle specimens; former supported by JICA and latter by CDC and WHO.

Laboratory staff trained in sampling and examinations

Sentinel sites for surveillance identified in all 9 provinces, selected districts and ports of entry.

12.5 Information, education and communication (IEC)Hon. Minister of Health delivered a national

address on pandemic influenza H1N1 2009 on ZNBC on 28 April 2009.

Live TV and radio programmes featuring experts (MoH & MACO) on the pandemic influenza H1N1 2009 control and prevention

Development and distribution of fact sheets on human and animal done. Development of posters, leaflets, factsheets and distributed to all 9 provinces.

Community radio programmes aired, Electronic and print media

12.6 Logistics mobilisation

WHO donated 3,000 doses of tamiflu drug and guidelines on pandemic influenza H1N1 2009 virus to Ministry of Health.

Tamiflu made available to all the provincial health offices and emergency stocks at HQ.

CDC has donated 6,000 face masks as part of the Personal Protective Equipments (PPEs).

CDC/WHO provided PPE as well as diagnostic support to the UTH virology Lab.

12.7 Pandemic influ. H1N1 2009 National Action Plan

A. Human Health Action Plan Reduce opportunity to infection Strengthen risk communication to

communities Strengthen early warning system Identify and equip place for treating patients Mitigating for disease occurrence Reduce morbidity mortality and social

disruption Conduct research to guide response

measures

National Action Plan (cont’d)B. Animal Health Action PlanWorking group meetingsRisk communications to communities and

members of staffActive surveillanceEnhancing diagnostic capacity

EXPECTATION FROM DCS During the District Epidemic Meetings, the

District Directors of Health will present to all key

stakeholders e.g. Immigration, Education, Religious Leaders, Police etc and inform them about H1N1

Lobby and advocate from local resources within the districts to respond to the pandemic.

DC should take a leading role in managing the pandemic since there is a wider audience within these meetings.

Collaborate and coordinate in conjunction with the District Directors of Health -effective intervention

Each discipline such as schools should come up with various activities such as drama using their local languages.

13. ChallengesInadequate resources to implement

some activities in the National Action Plan

Permanent site for quarantine, isolation and patient management

Resource support during pre-pandemic has been very difficult

Printing and distribution of various guidelines, pamphlets and fliers has been a challenge

Inadequate laboratory consumables and PPE

ConclusionWHO Director General in her letter dated11th

June 2009 to Hon. Ministers of Health in WHO regions raised the pandemic alert level to maximum phase six (6).

Phase 6 signifies the widespread nature of the virus and not necessarily the severity of the disease.

WHO warns that we are in the 1st wave of the pandemic which may last several months or years.

Stakeholders should support the pandemic phase activities in the Zambia national action plan to avoid further spread.