Review of the UNMS Review of the UNMS Influenza Pandemic Influenza Pandemic

Guidelines of May 2008Guidelines of May 2008

Dr Esther Tan, MSDDr Esther Tan, MSD

Outline of PresentationOutline of Presentation

1.1. WHO’s Post-Pandemic PeriodWHO’s Post-Pandemic Period

2.2. UNHQ Central Procurement of H1N1 UNHQ Central Procurement of H1N1 Vaccines for Field StaffVaccines for Field Staff

3.3. Discussion / Review of Discussion / Review of MSD’s Pandemic Guidelines MSD’s Pandemic Guidelines

WHO: Post-Pandemic PeriodWHO: Post-Pandemic Period

WHO: Recommendations for WHO: Recommendations for Post-Pandemic PeriodPost-Pandemic Period

H1N1 virus will H1N1 virus will continue circulatingcontinue circulating as as seasonal virus for some yearsseasonal virus for some years

Vigilance critical inVigilance critical in immediate immediate PPP PPP Continued surveillanceContinued surveillance of flu-like illness, of flu-like illness,

severe acute respiratory infections, deaths severe acute respiratory infections, deaths (esp clusters)(esp clusters)

Strongly recommends flu Strongly recommends flu vaccinationvaccination, especially of , especially of high-risk individuals high-risk individuals

WHO: Recommendations for WHO: Recommendations for Post-Pandemic PeriodPost-Pandemic Period

UNHQ Procurement of UNHQ Procurement of H1N1 Vaccine for Field Staff H1N1 Vaccine for Field Staff

(Timeline)(Timeline) 17 Sept:17 Sept: First discussed at DSG-chaired First discussed at DSG-chaired

Influenza Steering CommitteeInfluenza Steering Committee 16 Dec:16 Dec: Inter-agency Working Group Inter-agency Working Group

Report formally endorsed by Steering Report formally endorsed by Steering CommitteeCommittee

17 Dec:17 Dec: Formal guidance Formal guidance released to Country Offices released to Country Offices regarding how to order regarding how to order vaccines vaccines

UNHQ Procurement of UNHQ Procurement of H1N1 Vaccine for Field StaffH1N1 Vaccine for Field Staff

8 Jan:8 Jan: Formal Deadline for vaccine orders Formal Deadline for vaccine orders from country officesfrom country offices

Jan - 9 Apr:Jan - 9 Apr: Negotiation and signature of Negotiation and signature of UNICEF-UNHQ Memorandum Of UNICEF-UNHQ Memorandum Of UnderstandingUnderstanding

19 Apr:19 Apr: MSD formally submits MSD formally submits Vaccine Orders for staff in 130+ Vaccine Orders for staff in 130+ locations to UNICEF; with locations to UNICEF; with transfer of non-transfer of non-mission funds to UNICEFmission funds to UNICEF

UNHQ Procurement of UNHQ Procurement of H1N1 Vaccine for Field StaffH1N1 Vaccine for Field Staff

Apr – Jun:Apr – Jun: Missions redeploy funds to Missions redeploy funds to DPKO/DFS HQDPKO/DFS HQ

18 Jun:18 Jun: Funds for first half of Mission Funds for first half of Mission orders transferred from DPKO/DFS to orders transferred from DPKO/DFS to UNICEFUNICEF

16 Jul:16 Jul: Funds for 2 Funds for 2ndnd half half of Missions transferred of Missions transferred

17 Jul:17 Jul: UNICEF begins UNICEF begins issuing POs to Supplier issuing POs to Supplier

Objectives of This SessionObjectives of This Session

WHO: “In the post-pandemic period…..it is important to maintain surveillance and update pandemic preparedness and response plans …An intensive phase of recovery and evaluation may be required...”

Objectives of This SessionObjectives of This Session

1.1. Obtain specific feedback for Obtain specific feedback for revision of revision of MSD’s Pandemic PlanMSD’s Pandemic Plan

2.2. Understand what was Understand what was actually actually implementedimplemented in the field in the field

3.3. Share Share lessons learnedlessons learned

Use series of 18 questions based on Use series of 18 questions based on pandemic guidelinespandemic guidelines

No Right or Wrong responses!No Right or Wrong responses!

1. Did you coordinate/lead 1. Did you coordinate/lead business continuity?business continuity?

2. Was Action Plan Checklist 2. Was Action Plan Checklist useful?useful?

3. Were Annex 1 materials 3. Were Annex 1 materials distributed to staff?distributed to staff?

4. Was Pandemic Booklet 4. Was Pandemic Booklet distributed to staff?distributed to staff?

5. Were “Infection Control 5. Were “Infection Control Recommendations” useful?Recommendations” useful?

6. Did you categorize staff into 6. Did you categorize staff into one of five “Risk Categories”?one of five “Risk Categories”?

7. Did you use “Clinical Algorithms” 7. Did you use “Clinical Algorithms” to manage suspect cases?to manage suspect cases?

8. Did you refer to “Management of Close 8. Did you refer to “Management of Close Contacts” to manage suspect outbreaks?Contacts” to manage suspect outbreaks?

9. Did you use Fever Clinic 9. Did you use Fever Clinic principles?principles?

10. What do you think of Tamiflu 10. What do you think of Tamiflu stockpile guidelines?stockpile guidelines?

40% treatment doses40% treatment doses for staff and dept for staff and dept (25% ill and 15% buffer)(25% ill and 15% buffer)

6-weeks prophylactic doses6-weeks prophylactic doses for Risk for Risk Categories Staff 1,2, and 3Categories Staff 1,2, and 3

11. Did you use recommended 11. Did you use recommended procurement lists in Annex 8?procurement lists in Annex 8?

12. Was UN Doctor’s Pandemic 12. Was UN Doctor’s Pandemic Website useful?Website useful?

13. Was UN Doctor’s FAQ 13. Was UN Doctor’s FAQ useful?useful?

14. Convert pandemic website to generic 14. Convert pandemic website to generic UN doctor’s website?UN doctor’s website?

15. Generic outbreak 15. Generic outbreak management contingency plan management contingency plan

available for your mission?available for your mission?

Classic Components of an Classic Components of an Outbreak InvestigationOutbreak Investigation

Establish Establish case definitioncase definition Confirm diagnosisConfirm diagnosis and that cases are “real” and that cases are “real” Establish Establish baselinebaseline of this disease of this disease Find casesFind cases, decide if there is an outbreak, , decide if there is an outbreak,

define define scopescope of outbreak of outbreak Examine the descriptive epidemiologic features Examine the descriptive epidemiologic features

of cases, of cases, epicurveepicurve Generate / test Generate / test hypotheseshypotheses Collect / test Collect / test envt samplesenvt samples Implement Implement controlcontrol measures measures CommunicationCommunication

16. Top 3 changes for next 16. Top 3 changes for next revision of pandemic guidelines?revision of pandemic guidelines?

17. Other comments on the UN’s 17. Other comments on the UN’s Pandemic planning and response?Pandemic planning and response?

18. Other comments on your 18. Other comments on your mission’s Pandemic planning and mission’s Pandemic planning and

response?response?

Thank You!Thank You!