Influenza A H1N1(English version)

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.


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.


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.


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.


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

Influenza A H1N1(English version)

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