EMERGENCY DISEASE MANAGEMENT :NEED FOR PRACTICING HEALTH PRECAUTIONS AGAINST PANDEMICS IN EDUCATIONAL INSTITUTIONS

Dr Swati Jha Paediatrician & Director:Partnerships and Programs

Americares India Foundation

Pandemics timeline … 430 BC: First recorded instance of Bubonic plague hits Athens.

542 AD: Mediterranean epidemic kills between 25-50% of the population of the Roman Empire. 1334-1347: Black Death devastates Europe, 3/4th of the population are killed.1563: Bubonic plague in London. ½- 1/3 of population die.1665: The Great Plague of London. 20% of the population die.

1729-30: Worldwide influenza pandemic. The first officially recorded 'pandemic‘ in history. 1781: Worldwide influenza pandemic. 1817-23: First global cholera pandemic. 1829-51: Second cholera pandemic. 1852-59: Third cholera pandemic. 1857-59: Worldwide influenza pandemic.1863-79: Fourth cholera pandemic.1881-96: Fifth cholera pandemic.1889-90: 'Russian flu' pandemic. 1899-1923: Sixth cholera pandemic.

Pandemics timeline … 1918: 'Spanish flu' pandemic. 20m-40m die worldwide, more than were killed in the

first world war. The worst pandemic in history.1957-1958: 'Asian flu' epidemic. Affects 10-35% of the world population, though with proportionally low mortality rates (100,000 killed).1961-1970: Seventh cholera pandemic. 1968-69: 'Hong Kong' flu pandemic. 1989-90: 29,000 people killed in UK flu epidemic.1997: 'Avian flu' outbreak in Hong Kong. Six people die

Smallpox, Spanish flu, black death, malaria, AIDS, Cholera ,and typhus pandemic are the various diseases whose pandemics have historically rocked the world –some of them have been going on even now !

INFLUENZAINFLUENZA

How Influenza spreads ..I. Large droplets- that contact the nose, mouth or eyes.

II. Produced when infected people cough, sneeze, talk, sending relatively large infectious droplets and very small sprays (aerosols) into the nearby air and into contact with other people. (within 6 feet)

III. By touching objects contaminated with influenza viruses and then transferring the infected material from the hands to nose, mouth, eyes.

IV. By very small infectious particles (aerosols) traveling in air.

V. Contribution of each route of exposure to influenza transmission uncertain, and may vary based upon the characteristics of the strain.

 

What makes a pandemic? A pandemic is a worldwide disease outbreak.  An influenza

pandemic is a global outbreak of disease that occurs when a new flu virus appears(due to mutation ) that can spread easily from person to person. Because people have not been exposed to this new virus before, they have little or no immunity to the virus; therefore serious illness or death is more likely to result than during seasonal flu.

For a flu virus to cause a pandemic, three things must happen.  It must1.  Be a virus that people have not been exposed to before, and therefore have no immunity2.  Be able to cause illness in people3.  Have the ability to spread easily from person to person.

Lessons learnt ..

I. Pandemics are unpredictable but recurring events that can have severe consequences on human health and economic well being worldwide.

II. Increased understanding of past pandemics and strengthened outbreak communications has led to greater insight into disease spread and approaches to control.

III.  Advance planning and preparedness critical to help mitigate the impact of a global pandemic.

IV. Greater awareness of the issues that need to be addressed in pandemic preparedness.

Lessons learnt ..

I. Need to integrate pandemic preparedness and response into national emergency frameworks to encourage sustainable preparedness;

II. Pandemic preparedness requires the involvement of not only the health sector, but also the whole of society.

III. Even the WHO revised guidance paper focuses on incorporation of a “whole of society” approach that emphasizes not only the central role played by the health sector, but also the significant roles of other sectors such as businesses, families, individuals and communities (including in our case educational institutions) .

WHO pandemic phases(specific to flu)I. PHASE 1: No animal influenza virus circulating among animals has been reported to cause

infection in humans.

II. PHASE 2 An animal influenza virus circulating in domesticated or wild animals is known to have caused infection in humans and is therefore considered a specific potential pandemic threat

III. PHASE 3 An animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks.

IV.  PHASE 4 Human-to-human transmission (H2H) of an animal or human-animal influenza reassortant virus able to sustain community-level outbreaks has been verified.

V.  PHASE 5 The same identified virus has caused sustained community level outbreaks in two or more countries in one WHO region.

VI.  PHASE 6 In addition to the criteria defined in Phase 5, the same virus has caused sustained community level outbreaks in at least one other country in another WHO region.

VII. .POST-PEAK PERIODLevels of pandemic influenza in most countries with adequate surveillance have dropped below peak levels.

VIII. POSSIBLE NEW WAVE Level of pandemic influenza activity in most countries with adequate surveillance rising again.

IX. POST-PANDEMIC PERIOD Levels of influenza activity have returned to the levels seen for seasonal influenza in most countries with adequate surveillance

Recommended actions before, during and after a Pandemic

Organized into the five basic components of preparedness and response (Mitigation and Prevention, Preparedness, Response and Recovery).

I. Planning and coordination

II. Situation monitoring and assessment

III. Reducing the spread of disease

IV.Continuity of health care provision

V. Communications 

Actions based on phases

I. Phases 1 to 3 : aimed at strengthening pandemic preparedness and response capacities at global, regional, national and sub-national levels.

II. Phase 4: containment of the new virus within a limited area or the delay of its spread. If successful, valuable time could be gained to implement interventions including the use of vaccines.

III. Phase 5-6 :Actions shift from preparedness to response at a global level to reduce the impact of the pandemic.

Because…

I. Precise timing and impact of a future influenza pandemic

II. Rapid spread

III. Medical facilities

IV. Shortage of resources.

V. New viral strain :implications on Vaccine/ Drugs

VI. Impact on social and economic activities of communities

Infection control and social distancing measures

Institutions…

I. Civil society organizations

II. Educational institutions

III. Positive behavior change

IV.Epidemiological behavior of pandemics

V. Source/ Contributor to spread

VI.Literacy/awareness levels of the adult population

Individual Level MeasuresI. Individuals measures such as covering coughs and

sneezes, hand washing during normal times and during episodes of flu.

II. Voluntary isolation of persons with respiratory illness during an epidemic.

III. People with acute respiratory illness to stay at home, minimize contact with others.

IV. Advise contacts to minimize their level of interaction with others and to isolate themselves at the first sign of any symptoms of influenza.

V. Provide infection control guidance for caregivers taking into account the WHO guidance.

Institution Level Measures

I. Provision of hygiene ie soap and water, hand sanitizer at institutions a all times and especially during epidemics.Cleanliness and disinfection, education material.

II. Establish protocols for use of social distancing measures-

1. Suspension of classes, especially in the event of a severe pandemic or if there is disproportionate or severe disease in children.

2. Cancellation /restriction of mass gatherings at the time of the pandemic

3. Promote reduction of unnecessary travel and overcrowding of mass transport systems.

4. Have plans for online distribution of educative material in event of long term disruption of school

5. Education against out -of-school social contacts and community mixing

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Phases of Response to Pandemic Influenza Related Incidents

Phase 1 Mitigation/ Prevention

Phase 2Advanced

Precautions

Phase 3Surveillance and Heightened

Awareness

Phase 4Prepare for Possible School Closures

Phase 5School Closure(s)

Phase 6 Recovery

Pandemic plan

I. Every institution esp the larger ones should have an Pandemic Management Plan

II. The Plan should be flexible to encompass all relevant diseases

III. Plans should address all four phases of emergency management planning: Mitigation and Prevention, Preparedness, Response and Recovery.

IV. Plans should be practiced on a regular basis.

V. Plans should be developed and communicated in an interactive manner with stakeholders, including parents, faculty, other community partners and first responders.

VI. Plans should be based on sound data and information

VII. Plans should be continually reviewed and updated as new information is available.