INFLUENZA PANDEMIC and

BEYOND

PHAA 12TH

National Immunisation Conference

ADELAIDE –

17 August 2010

Professor Jim BishopChief Medical Officer

Department of Health and Ageing

World Health Organisation stages of PANDEMIC ALERT

WHO declared: phase 4 on 27 April 2009phase 5 on 29 April 2009phase 6 on 11 June 2009post-pandemic 10 August 2010

H1N1 Influenza 09 Pandemic Phases

ALERT (pre 24 April 09)

DELAY (24 April 09)

CONTAIN (22 May 09)

SUSTAIN

Victoria moved to a MODIFIED SUSTAIN on 3 June 2009

CONTROL

RECOVER

PROTECT

17 June 2009

Evidence supports focusing efforts on protecting the ‘vulnerable’

Australia's response is continual informed by the emerging evidence around the virus and effectiveness of control measures

H1N1 Influenza 09, mild in most and severe in

some (the vulnerable)

Weekly rate of ILI reported from GP ILI surveillance systems from 1 January 2007 to 25 July 2010

0

10

20

30

40

50

60

1 3 5 7 9 11

13

15

17

19

21

23

25

27

29

31

33

35

37

39

41

43

45

47

49

51

53

Week

Rate

of I

LI p

er 1

,000

cons

ulta

tions

ASPREN 2007ASPREN 2008ASPREN + NT + VIDRL 2009ASPREN + VIDRL 2010

First case of Pandemic

(H1N1) 2009 t d i

Number of respiratory viral presentations to Western Australia EDs

from 1 January 2007 to 25 July 2010 by week

0

200

400

600

800

1000

1200

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Week

Num

ber

of E

mer

genc

y D

epar

tmen

t ILI

Pr

esen

tatio

ns in

WA

2007 Presentations2008 Presentations2009 Presentations2010 Presentations

Child deaths associated with

influenza

ILI presentations to NSW EDs

from 2007-2010, by week

0

5

10

15

20

25

30

35

40

18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43Week

Rat

e of

Em

erge

ncy

Dep

artm

ent I

LI P

rese

ntat

ions

in

NSW

NSW ED 2007NSW ED 2008NSW ED 2009NSW ED 2010

Total number of specimens tested by sentinel laboratories, and proportion positive, 1 January 2010-30 July 2010, by week

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

0.5

8/01

/2010

22/01

/2010

5/02

/2010

19/02

/2010

5/03

/2010

19/03

/2010

2/04

/2010

16/04

/2010

30/04

/2010

14/05

/2010

28/05

/2010

11/06

/2010

25/06

/2010

9/07

/2010

23/07

/2010

6/08

/2010

20/08

/2010

3/09

/2010

17/09

/2010

1/10

/2010

15/10

/2010

29/10

/2010

12/11

/2010

26/11

/2010

10/12

/2010

24/12

/2010

Week ending (date)

Perc

ent o

f tes

ts p

ositi

ve fo

r in

fluen

za

0

100

200

300

400

500

600

700

Tota

l num

ber

of te

sts

Percent of tests influenza positive

Total number of tests

Percentage of specimens tested by sentinel laboratories influenza positive

1 January 2010 to 30 July 2010, by subtype

Pandemic (H1N1) 200967%

Seasonal A/H1N10%

Seasonal A/H3N224%

Influenza A untyped4%

Influenza B5%

Hospitalisations of pandemic (H1N1) 2009, 5 June –

23 October 2009, by week

10

0

100

200

300

400

500

600

700

21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43

Week of report

Num

ber o

f hos

pita

lista

tions

ass

ocia

ted

with

pan

dem

ic (H

1N1)

200

9

Australia

Severe Pandemic (H1N1) 2009

●

Hospitalisations-

Respiratory, diabetes, immuno compromised obesity, chronic cardiac, renal, pregnancy rapid deteriorating flu patient

●

Higher proportion of Indigenous Australians

●

Over 50% admitted within 48 hours of onset

●

Higher ICU Admissions than expected

2009 2010

CONFIRMEDPANDEMIC(H1N1 2009

CASES

HOSPITALISEDCASES

ICU CASES DEATHS CONFIRMED(H1N1) 2009

CASES

DEATHS

TOTAL NUMBER 37,636 13% 14% 191 362 2

CRUDE RATE PER100,000 POPULATION

172.1 22.8 3.1 0.9 1.7 n/a

M EDIAN AGE (YEARS)

21 31 44 53 28 38

FEMALES 51% 51% 53% 44% 48% 100%

SUMMARY of SEVERITY INDICATORS OFPANDEMIC (H1N1) IN AUSTRALIA,

2009 & 2010 (up to 30 July 2010)

SourceL: Australian Influenza Surveillance Report

2009 2010CONFIRMEDPANDEMIC(H1N1 2009

CASES

HOSPITALISEDCASES

ICU CASES DEATHS CONFIRMED(H1N1) 2009

CASES

DEATHS

Vunerable

groups (Indigenous persons, pregnant women& individuals with at least 1 co-

morbidity)

n/a 58% 74% 67% n/a n/a

INDIGENOUSPEOPLE

11% 20% 19% 13% 9% n/a

PREGNANT WOMEN

n/a 27% 16% 4% n/a 0%

Cases with at least 1 co-

morbidity

n/a 46% 67% 62% n/a n/a

SUMMARY of SEVERITY INDICATORS OFPANDEMIC (H1N1) IN AUSTRALIA,

2009 & 2010 (up to 30 July 2010)

SourceL: Australian Influenza Surveillance Report

Age specific rates of hospitalised confirmed cases of pandemic (H1N1) 2009 to 3 October 2009, compared with average annual age specific rates of

hospitalisations from seasonal influenza 2004-05 to 2006-07*, Australia

14

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

0-4

5-9

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

60-6

465

-69

70-7

475

-79

80-8

4

85+

Age group (5 Years)

Age

spe

cific

rate

(per

100

,000

pop

ulat

ion) Males pandemic (H1N1) 2009

Females pandemic (H1N1) 2009

2004-07 seasonal influenza

Rate of deaths classified as influenza and pneumonia from the NSW Registered Death Certificates 2005 to 25 June 2010

ATAGI Modelling of the Impact of Vaccination

Pandemic (H1N1) 2009 Vaccine

•

Safety profile good as dose levels recommended

•

One injection 15μg protects adults, two for young children

•

FDA licence/TGA registration

•

Emphasis on priority groups but available to ALL

•

Widespread uptake by the Population (over 9 Million doses)

Source: New England Journal of Medicine: 2009: 361, September 10

Pandemic H1N1 vaccine distributed (cumulative)

01,000,0002,000,0003,000,0004,000,0005,000,0006,000,0007,000,0008,000,0009,000,000

10,000,000

06-Oct

22-Oct

12-Nov

03-Dec

07-Jan

27-Jan

18-Feb

11-Mar

08-Apr

29-Apr

20-May

10-Jun

01-Jul

22-Jul

Cumulative total

Pandemic H1N1 Vaccine - Weekly distribution trends

0

100,000

200,000

300,000

400,000

500,000

600,000

06-Oct

19-Oct

29-Oct

12-Nov

26-Nov

10-Dec

07-Jan

21-Jan

03-Feb

18-Feb

04-Mar

18-Mar

08-Apr

22-Apr

06-May

20-May

03-Jun

17-Jun

01-Jul

15-Jul

29-Jul

Dos

es

IMMUNITY

Vaccine Distribution 9.71 million doses Panvax

distributed to 12 August

2010 6.44 million doses of 2010 seasonal vaccine

released by TGA

National Serosurvey

(healthy adults)May 2009 -

Pre-pandemic: 5-15%

October 2009 -

Post pandemic, pre Panvax: 22%March 2010 -

Post Panvax, pre Seasonal: 43%

CURRENT SITUATION –

2010

Influenza activity low in Australia but showing signs of increasing-

1713 Confirmed cases of Influenza in 2010, 362 pandemic (H1N1)

Pandemic strain predominant in Australia-

68% pandemic (H1N1) 2009 of specimens isolated

Pandemic (H1N1) 2009 predominant in most countries, low activity except NZ, India

Type B predominant in China (55.5%) with 46% the same strain as 2010 Southern Hemisphere vaccine

Weekly consultation rates for influenza-like illness in New Zealand, 2008-2010

Source: Institute of Environmental Science and Research, Influenza Weekly Update 2010/30

UK REVIEW SOME KEY FINDINGS

Containment phase lasted longer and consumed more resources than anticipated

Tension between common phased approach to pandemic planning and flexibility

Vaccine availability during the pandemic –

a significant

achievement

Flexible arrangements needed for purchasing vaccine

Need for vaccination implementation plans prior to a pandemic

Communications –

important to generate public

awareness and understanding

Coordinated media briefings

1.

National governance and decision making

2.

Public communication

3.

Public health measures

4.

Border measures

5.

Primary and secondary health care

6.

National Medical Stockpile deployment

7.

Surveillance

8.

Laboratories

9.

Vaccination

10.

Indigenous Australians

AUSTRALIAN PANDEMICRESPONSE REVIEW

Outcomes of the review will:

further strengthen Australia’s ability to respond;

publicly available 'lessons identified' report, at the

end of the 2010; and

Revise the Australian Health Management Plan

for Pandemic Influenza (AHMPPI)

KEY INDIVIDUALS FOR PANDEMIC RESPONSE

NIRMs Mary MurnaneMs Jenny BryantDr Gary LumMs Fay HoldenDr Bernie TowlerDr Andrew SingerDr Andrea FordeMs Kay McNieceDr Jenean Spencer

Prof Terry Nolan ATAGIDr Chris Mitchell RACGPDr Vicki Krause CDNA

NSW

Dr Kerry Chant

Dr Jeremy McAnulty

VIC

Dr John Carnie

Dr Rosemary Lester

QLD

Dr Jeanette Young

Dr Christine Selvey

TAS

Dr Craig White

Dr Chrissie Pickin

WA

Dr Tarun Weeramanthri

Dr Andy Robertson

SA

Dr Stephen Christley

ACT

Dr Charles Guest

NT

Dr Barbara Paterson