Post on 18-Nov-2014
description
New Influenza A (H1N1) Real Pandemic??
Influenza A(H1N1)
A novel influenza virus, is
contagious and transmitted person
to person. Outbreaks in human
first occurred in Mexico and the
United States in March 2009. The
disease then spreads to other
countries in many parts of the
world through international
traveling.
Mexico has reported high abnormal peak of
flu and pneumonia
since 18 Mar. 09
Late Apr.09 : 2 confirmed cases of swine flu in US.
(2 States near the border, California and Texas)
Major Event Timeline of WHO
• 25 Apr.09 --Declared “Flu outbreaks in Mexico & US” as “Public Health of International Concern ; PHEIC”
• 27 Apr.09 – Raised level of pandemic alert from phase 3 to phase 4
-- not recommended travel restriction or border closure
• 29 Apr.09 – Raised phase 4 to 5-- Recommended Pandemic Preparedness Plan activation-- Renamed the novel virus “Swine flu” to “Influenza A (H1N1)”
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As of 8 June 09
Total 73 countries,
25,288 cases , 139 deaths
New flu A (H1N1) Situation in Thailand
Since 12 – 8 June 09 -- The Ministry of Public Health, Thailand has reported 10 Thai laboratory confirmed cases of Influenza A (H1N1).
9 cases Travel History from overseas to BKK,but 1 of these 10 cases has no travel history.
All are mild cases of URI with All are mild cases of URI with Antiviral drug Antiviral drug
(Oseltamivir) completion and now (Oseltamivir) completion and now are being recovery.are being recovery.
The close contacts are given The close contacts are given complete complete
oseltamivir prophylaxis with close oseltamivir prophylaxis with close monitoring.monitoring.
Global Response to New flu WHO is working aggressively and constantly to ensure
access to affordable drugs and pandemic vaccine, should that be required.
Most countries have warned travel advisory avoidance to the affected countries and implemented entry screening.
Several countries have imposed trade restrictions on countries exporting animals or products of animal origin that have declared human cases related to the new influenza of the type known as “A/H1N1”.
Some countries culled pigs for the propose of disease prevention.
Activated national Influenza Pandemic Preparedness plan.
OIE RESPONSE• The OIE advocates implementing international standards
for human killing of animals for disease prevention purposes.
• The OIE advised its Members that the culling of pigs will not help to guard against public or animal health risks presented by this novel A/H1N1 influenza virus and that such action is not recommended.
• The first transmission of “A/H1N1” virus from human to pigs in a single herd was officially notified to the OIE by Canada on the 5 May 2009
• Pork and pork products, handled in accordance with good hygienic practices recommended by the WHO , Codex Alimentarius Commission and the OIE, will not be a source of infection
• Authorities and consumers should ensure that meat from sick pigs or pigs found dead are not processed or used for human consumption under any circumstances.
Source : OIE
WHO Pandemic Phase, 2009
PHASE DESCRIPTIONPHASE
1No animal influenza virus has caused infection in humans
PHASE 2
An animal influenza virus has caused infection in humans
PHASE 3
Influenza reassortant virus has caused sporadic case or small cluster of disease in people
PHASE 4
Human to human transmission and sustain community-level outbreaks
PHASE DESCRIPTIONPHASE 5
Sustained community level outbreaks in two or more countries in one WHO region
PHASE 6
Sustained community level outbreaks in at least one other country in another WHO region
POST PEAK PERIOD
Levels of pandemic influenza dropped below peak levels
POST PANDEMIC PERIOD
Returned to the levels seen for seasonal influenza
WHO Pandemic Phase, 2009
Causative Agent
The disease is caused by a novel influenza
A(H1N1) virus. From current evidence, the virus is a result
of re-assortment between human, swine and avian
influenza viruses never before been found in human.
Transmission of Influenza Virus (1)
Influenza A(H1N1) virus in a
patient’s nose and throat
excretion is passed to other
persons directly through
coughing and sneezing.
Another person within 1 metre in
distance can also be exposed
to the virus by breathing in
contaminated air.
Transmission of Influenza Virus (2)
A person can be infected by touching contaminated hands, surfaces and utensils such
as glasses, telephone and door knob etc. The virus infects a person while they touch their nose,
eyes and mouth.
Transmission of Influenza Virus (3)
A patient can even transmit the virus 1 day before symptom appears. The most contagious period is the first 3 days of illness. The longest contagious period normally does not exceed 7
days.
Signs and Symptoms (1)
In a very rare case that incubation period approaches 7 days. After getting infected, a person will have fever greater than 37.5 Celsius. Symptoms of this new influenza A(H1N1) is quite similar to seasonal influenza starting with fever, headache, body aches, chills, fatigue, cough, sore throat, and in some cases, nausea, vomiting and diarrhea.
Signs and Symptoms (2)
Most patients have only mild symptoms and do not require any hospitalization. A patient will gradually recover within 5 – 7 days. However some ill individuals might have severe complications such as pneumonia which can be observed through rapid and trouble breathing.
Treatment (1)
Patients with severe illness should seek medical care at a nearby hospital immediately. Antiviral drug such as oseltamivir prescribed within 48 hours after
onset on illness under care of a physician usually gives good treatment result.
• Take prescribed medicine for relief of symptoms such as paracetamol etc. Wipe the patients’ skin gently and intermittently using towel soaked with clean water to help relief fever.
• Drink plenty of clean water and fruit juice. Avoid drinking cold water.
Treatment (2)Patients with Patients with mild sicknessmild sickness i.e. low grade i.e. low grade
fever and appetite should seek care at a private fever and appetite should seek care at a private clinic or consult a pharmacist for proper medicine clinic or consult a pharmacist for proper medicine
and advice. Home care of a sick person are as and advice. Home care of a sick person are as follows :follows :
• Eat soft nutritious food including eggs, vegetables and fruits. In case of low appetite, supplement vitamins will be helpful.
• As the disease is caused by a virus, there is no need to take any antibiotics. Only in case of bacterial complications, antibiotics will be prescribed and a patient must take all of the medicine to prevent drug resistance problem.
Treatment (3)
Prevention from Infection (1)
• Avoid close contact with influenza
ill persons.
• if you have to care for an ill
person, you should wear a mask.
Wash your hands with soap and
water thoroughly after each
contact with the ill person.
• Avoid sharing the same glasses,
straw, spoon, handkerchief etc.
with other persons especially
influenza ill persons.
Prevention from Infection (2)• Use serving spoon when eating with
other persons.
• Wash hands with soap and water
thoroughly and often especially after
coughing and sneezing. Alcohol-
based gel hand cleaners are also
effective disinfectants.
• take actions to stay healthy
including nutritious food, proper and
regular exercises, adequate safe
water and sleep and avoidance of
cigarettes and alcoholic drink.
Prevention of Virus Spreading (1)
• Ill persons should sta y at home or seek me
- dical care for 3 7 days. Thiswi l l pr event spr e adingof i nfl uenza.
• Avoidcl ose cont act wi t hothers.
Prevention of Virus Spreading (2)
Wear mask when happen to be with others or cover
nose and mouth with tissues after coughing and sneezing.
Throw used tissues in a trash can. Clean hands with soap a
nd water right after.
High-Level Consultation for all Member States at the start of the 62nd World Health Assembly
Geneva, 18 May 09 Current Epidemiological Situation• As at 18 May 09, 40 countries reported
8,829 confirmed cases of new flu A (H1N1) infection. 74 deaths.
• The virus is transmitted easily from H-H to sustain in communities and to spread regionally.
• Most are mild and self-limited.• Severe illness and deaths has occurred
among young and healthy adults including adults with underlying disease.
Key Uncertainties
• Nothing is certain.
• How fast the virus will spread
throughout the world.
• Infectivity and virulence.
• Southern hemisphere could have different and more severe effects than seen in the northern hemisphere.
Source : High-level consultation, 18 May 09, Geneva
Lessons Learnt from new flu A (H1N1)
• Being prepared has made a vital difference.
• Success depends on a multi-stakeholder approach.
• Effective communication is paramount.
• Science-based approaches remain the bedrock of the response.
• Health systems matter.
Source : High-level consultation, 18 May 09, Geneva
Challenges on new flu A (H1N1)
• Living proof of the value of international cooperation.
• Seasonal and new influenza A (H1N1) vaccines.• From containment to mitigation.• Guarding against complacency.• Maintaining surge capacity and
institutional coordination.• Sustaining solidarity.• Protecting lives, restoring livelihoods.
Source : High-level consultation, 18 May 09, Geneva
Mainly for rapid containment of pandemic at origin.
WHO-HQ, Geneva
WHO Regional Offices
ASEAN, Singapore
International stockpiles of Oseltamivir
5 July 07
WHOWHOGenevaGeneva
PAHOPAHO
EUROEURO
EMROEMRO
AFROAFRO
WPROWPRO
SEAROSEARO
Sub-reg.Sub-reg.StockpileStockpile
BKKBKK
Estimated pandemic Estimated pandemic influenza impact in influenza impact in
ThailandThailand
Cases 6,500,000
Cases rate 10% CFR 1 %
Cases 26,000,000
Case rate 40% CFR 1%
Deaths 260,000
deaths65,000 Tremendous
social and economic implications
16
Ap
r 0
5
Pandemic influenza preparedness
Multi-sector & international cooperation
Surveillance in animals and man
Safe animal husbandry
Pandemic influenzaPandemic influenza
Avian influenzaAvian influenza
2nd Strategic plan on 2nd Strategic plan on Avian Influenza and Avian Influenza and Influenza Pandemic Influenza Pandemic Preparedness Preparedness
(2008-2010)(2008-2010)
Pandemic build-up
;
Early phase Ro = 2 Later stage Ro = 4
Narrow window of
opportunity for containment
16 Nov 05
Private sector
Public sector
Essential service sector Energy, water supply, transportation, communication/IT, banking/financing,
security, etc
Health
Multi-sectoral Multi-sectoral pandemic pandemic influenza influenza preparednesspreparedness
30 Nov 07
Pandemic Pandemic preparedness preparedness strategiesstrategies
Modified from: David Nabarro at APEC-HMM, Sydney 8 June 2007
Non-medical /non-pharmaceutical
Medical /Pharmaceutical
Socio-economic, security and governence(to keep society running)
Risk communicationPersonal hygieneTravel restrictionSocial distancing
Quarantine
Security and rule of lawFood and water supply
Power supplyTransportation
TelecommunicationFinancial and banking
Antiviral drugPPE, Medical care
facilities, vaccine
27 Mar 08
Simulation Simulation exercises of exercises of AI response & AI response & pandemic influenza pandemic influenza preparedness: preparedness:
Tabletop exercise
Functional exercise
At all operation levels
Risk com. and public Education
Emergency response:
Non-medical,medical
Multi-sector& international
cooperation
Essentialservices/ business
continuity planning
Stockpiling and logistics
Surveillance and control
30 Nov 07
Pandemic influenza
preparednessstrategies
Expand on AI Expand on AI response response
Initiate and Initiate and escalate escalate
Stockpiling and logistics Stockpiling and logistics
3 Mar 06
Seasonal influenza
vaccineFor health personnel
Personal Protective
Equipment
Strategies toward pandemic Strategies toward pandemic vaccine accessvaccine access
National pandemic preparedness plan
Short term Import Resort to global stockpile
(emerging opportunity)
Long term Establish local capacity for development
and manufacture of influenza vaccine, ready for pandemic vaccine production
Stepwise expansion of seasonal flu vaccination Strengthen national capacity for vaccine
regulatory, logistics and delivery, R&D
Pandemic Pandemic preparedness preparedness strategiesstrategies
Modified from: David Nabarro at APEC-HMM, Sydney 8 June 2007
Non-medical /non-pharmaceutical
Socio-economic, security and governence(to keep society running)
27 Mar 08
Pandemic influenza vaccine a most important tool for health protection
National access to pandemic vaccine is preferably secured by establishing capacity for local production of influenza vaccine
Increased use of flu vaccine to provide market for locally produced seasonal flu vaccine in inter-pandemic period
Medical /Pharmaceutical
Antiviral drugPPE, Medical care
facilities, vaccine
Pandemic vaccine
Pandemic vaccine
Drive toward secure access to pandemic influenza vaccine
•Assess disease burden / justify flu investmentAssess disease burden / justify flu investment
• Establish flu vaccine production capacityEstablish flu vaccine production capacity
•Increase use of seasonal flu vaccine Increase use of seasonal flu vaccine
• Build research, regulatory Build research, regulatory and programmatic capacitiesand programmatic capacities
15 Aug 08
• 2007: MOPH was granted government support for establishing capacity for flu vaccine production
• 2007: GPO/ MOPH received WHO’s GAP support for flu vaccine capacity development
• 2007-2008: GPO made progress on GAP projects
• 2009: GPO to received 2nd year of WHO’s GAP support
Projected use of influenza vaccine in Projected use of influenza vaccine in Thailand, 2000–2015 : a favorable scenarioThailand, 2000–2015 : a favorable scenario
0
2000000
4000000
6000000
8000000
10000000
12000000
Note: 2000-2003 figures -- from Simmerman et al.
2004 -2005 figures – initial projection 15 Aug 08
Vaccine production project
Increased use of flu vaccine
Capacity building
Year?
Scale up to produce pandemicvaccine
Technology:Cell-culture
AdjuvantLAIV
Pre-AI period
AI response period
Pandemic preparedness
period
Pandemic Pandemic response response
Increased use of influenza vaccine in Increased use of influenza vaccine in Thailand, 2000–2015 : projected scenarioThailand, 2000–2015 : projected scenario
0
2000000
4000000
6000000
8000000
10000000
12000000
Seasonal influenza vaccination in high-risk
population
2008: 120,000 persons > 65 with health conditions
2009: 1.8 mill. People, all ages with health conditions
Seasonal influenza vaccination in health
care personnel
Started 2003Target 400,000 / yr
COPD, asthma, heart disease, cerebro-vascular dis., renal failure, chemotherapy, DM
CalenCalendar dar for for TTxTTx on on InflueInfluenza nza PandePandemicmic
Departmental level
StartJuly 06
8 Mar 07
Provincial level
Start Mar 06Now 76 provinces
completed
Ministerial level
Pending
National level
A Package of Guideline on Tabletop Exercise- Guideline for Tabletop Exercise on Influenza Pandemic Preparedness at the Provincial Level for Exercise Organizers and Facilitators, 2006- Master Operation Plan for Influenza Pandemic Preparedness for Multi- sector Coordination 2006- six compact discs containing different contents: CD1- tabletop exercise, CD2, 3, and 4- the video presentation of lectures, CD5- slide presentation, and CD6- document files.
TTX in Nakorn-nayok
Tabletop exercises
at provinces
Tabletop exercises at MOPH
Departments
27 Mar 08
Tabletop exercises at
MOPH
27 Mar 08
AI control and pandemic influenza AI control and pandemic influenza preparedness integrated in National preparedness integrated in National
Public Emergency PreparednessPublic Emergency Preparedness
27 Mar 08
National Strategic plan on Avian Influenza and
Pandemic Influenza Preparedness
National Committee on Avian Influenza Control
and Pandemic Influenza Preparedness
(chaired by Dep. PM)
National policy National policy on Public Emergency on Public Emergency
Preparedness 2005Preparedness 2005
National plan on Civil Public Emergency
Preparedness
National Public Emergency Preparedness Committee
(chaired by PM)
National Committee on Civil Public Emergency
Preparedness (chaired by PM/DPM)
PolicyPolicy
Exercises at all levels
National Operational
Plan
National Strategic
Plan
Operational Plan / Guidelines / Protocols
at all levels
From
Policy
Practice
Businesses, industries, markets, department stores,
hotels, travel & tourism, communications & IT, transportations, power
plants, gas stations, water supply, banks, hospitals, etc.
Business continuity planning Business continuity planning
•Safety of staff and owners•Continuation of business during pandemic •Cooperation with public sector in pandemic response • Rapid recovery after pandemic
Getting prepared
27 Mar 08
Private sector preparednessPrivate sector preparedness
Business Continuity Plan
Fact Sheet BCP for IPP Manual Poster (Hygiene ,
mask) CD (Power Point,
Video Presentation)
Business Continuity Plan for Influenza Pandemic Preparedness Package
Bilateral With neighbours: Laos, myanmar,
Cambodia, Vietnam, Malaysia With assistance providers: US,
Japan, EU, Australia, etc.
Regional Through ASEAN, APEC, ACMECS,
etc.
International Through WHO, OIE, FAO, UNICEF,
etc.
Regional / International collaboration
APEC Pandemic Response Exercise, 7-8 June 06
Mekhong Basin Countries Workshop on Pandemic Influenza Preparedness, Siemriep, Cambodia, 14-14 March 2007
Workshop on Pandemic Influenza Preparedness, Yangon, Myanmar, early 2007
Public Health Security Exercise
11-12 June 200829 May 08
Participation in regional exercises Participation in regional exercises for pandemic preparednessfor pandemic preparedness
ANTS’ PHILOSOPHYANTS’ PHILOSOPHY
ANTS THINK WINTER ALL SUMMER • So ants are gathering their winter food
in the middle of summer.• How much will an ant gather during
the summer to prepare for the winter?
• All that he possibly can.Do the most we can to maximize our preparedness and response
to emerging diseases !
Conclusion Conclusion Thailand has been struggling to control and prevent H5N1
AI on animal health and public health fronts with continuous improvement. Infections in poultry are under control, no new human cases have been seen since August 2006.
In awareness of the risk of pandemic influenza, the country is joining global efforts in pandemic preparedness. National preparedness plan highlights national capacity for self-reliance and regional / international cooperation.
Effective AI response & pandemic preparedness rely on: Government’s leadership and support Strength of existing infrastructure and manpower Extent and quality of multi-sector cooperation Knowledge and understanding of partners & the public
Problems and limitations prevail and change with time, need to be continuously managed among partners, with perseverance, reconciliation and transparency.
22 May 08