1. Exercise Cold Play Introduction Host Name

2. Core Statement Most experts believe that it is not a question of whether there will be another severe influenza pandemic, but when Sir Liam Donaldson Chief Medical Officer, 2002

3. Aims & Objectives To raise awareness of the threat and consequences of an influenza pandemic and to highlight the associated major issues.

4. Seasonal flu vs Pandemic flu SEASONAL FLU Occurs every year during the winter Affects up to 10% of the population The very young, the very old and people with certain chronic illness are most at risk Annual vaccination available Antiviral drugs available for the at risk PANDEMIC FLU Occurs about 3 times each century – at any time of the year May affect up to 25% of the population People of every age may be at risk Vaccine wont be available initially - in the first wave Antiviral drugs are likely to be in limited supply

5. Previous flu Pandemics PandemicSpanish FluAsian FluHong Kong Flu Strain:A(H1N1)A(H2H2)A(H3N2) Year:1918-19191957-19581968-1969 Origin:Not knownChinaChina Estimated Deaths Global20-40 million1million1-4 million UK250,00033,00030,000 Age Group20-50 yrsunder 14 yrsunder 5 yrs over 65 yrsover 65 yrs Shortest interval = 11 years Longest interval = 39 years Current interval = 37 years

6. 07/68 08/68 09/68 06/69 09/68 01/69 C.W. Potter, Textbook of Influenza, 1998 Geographic Spread: 1968-69

7. Geographic Spread: 2006 ?? All major air hubs are less than 72 hours apart!

8. Avian Influenza or Bird 'Flu Common infection in birds – most 'flu strains are relatively harmless and cause Low Pathogenic Avian Influenza (LPAI) Some strains are highly pathogenic and cause large outbreaks, especially in poultry where death is rapid and 100%. First described in Italy in 1878 H5N1 is a type of Highly Pathogenic Avian Influenza (HPAI). First appeared in 1997 in Hong Kong H5N1 has affected poultry, wild birds, some animals Wild and migratory birds are spreading infection from Asia to Europe Source: Respiratory Diseases Department Health Protection Agency Centre for Infections, London

9. H5N1 Bird Flu – the story so far February 2006 Millions of birds have died or been slaughtered Virus has jumped directly from poultry to humans ~160 cases with ~ 80 deaths in humans in East and SE Asia and Turkey 21 countries worldwide affected by bird flu Europe - Turkey, Bulgaria, Croatia and Romania Africa - Northern Nigeria No bird flu in the UK Potential of H5N1 to mutate or mix with human virus to create new virus against which there would be no immunity Potential to start new pandemic However, pandemic influenza may start from a completely different strain Source: Respiratory Diseases Department Health Protection Agency Centre for Infections, London

10. DOMESTIC BIRDS MIGRATORY WATER BIRDS From Birds to Humans followed by re-assortment in Humans Source: Respiratory Diseases Department Health Protection Agency Centre for Infections, London

11. Influenza pandemics New strain of influenza - antigenic shift in influenza A virus Minimal or no population immunity –Rapid spread to UK –Predict 25% infection rate –May affect those of middle years Will occur in waves Source: Respiratory Diseases Department Health Protection Agency Centre for Infections, London

12. Preparing for the next pandemic Lessons learned from epidemiology & the current situation in Asia 1.Maximum recorded interval between pandemics is 39 years – it could be soon (but it remains unpredictable) 2.The likely origin will be SE Asia, but we cant say for sure 3.Global spread will be rapid – we must prepare now, or risk being caught by surprise 4.Several epidemic waves; first may be milder than subsequent ones – sustainability and resilience will be key issues Source: Respiratory Diseases Department Health Protection Agency Centre for Infections, London

13. Preparing for the next pandemic Lessons learned from epidemiology & the current situation in Asia 5. Excess mortality and morbidity difficult to predict but may be high (but it doesnt follow that the next pandemic will be like 1918) 6. Overall population clinical attack rate is likely to be 25-30% 7. Probably, there will be a shift from the current pattern of disease, towards younger age groups in terms of severity and mortality – with obvious implications for the workforce 8. Impact on Health Service business continuity likely to be considerable 9. Impact on all other organisations likely to be considerable Source: Respiratory Diseases Department Health Protection Agency Centre for Infections, London

15. Exercise Format Four blocks of time Week 0 – WHO Phase 5 Week 6 – WHO Phase 6, UK Alert Level 3 Week 11 - WHO Phase 6, UK Alert Level 4 Week 21 - WHO Phase 6, UK Alert Level 4 Each block represents a single day in the pandemic cycle Each block will bring out specific topics Broadly they are: Infection Control Vaccines Anti virals Staffing and resources Surveillance Media Business Continuity

16. Key Planning Assumptions The exercise has been developed using the Department of Health planning assumption (Oct 05) of: a 25% clinical attack rate and a case-fatality rate of between 0.37% and 2.5%

17. Guidance Available Department of Health Pandemic Influenza Plan http://www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/PandemicFlu/fs/en Flu key documents and resources for patients and health professionals http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Flu/fs/en Department of Health Emergency Preparedness Beyond a Major Incident – planning for potentially large numbers of casualties http://www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/fs/en The Health Protection Agency: http://www.hpa.org.uk/infections/topics_az/influenza/flu.htm http://www.hpa.org.uk/infections/topics_az/influenza/flu.htm NICE (National Institute for Health and Clinical Excellence) http://www.nice.org.uk http://www.nice.org.uk The WHO Influenza Pandemic Preparedness Plan is available at http://www.who.int/csr/resources/publications/influenza/GIP_2005_5Eweb.pdf

19. Block One DVD

20. Block One - Preparedness Questions Plans and Planning Process Roles & Responsibilities Data Gathering & Surveillance Co-ordination of Media & Public Communications

21. Block Two DVD

22. Block Two – Health Response Questions Distribution of anti-viral treatment Use of Personal Protective Equipment (PPE) and infection control guidance Local models of care Explore resilience of the emergency services (specifically ambulance)

23. Block Three DVD

24. Block Three – Multi Agency Response Questions Control Measures (Quarantine) Civil Contingencies Act 2004 Staff Shortages/Resources Business Continuity Body Holding Facilities

25. Block Four DVD

26. Block Four – Vaccination & the 2 nd Wave Questions Vaccination Lessons learnt from the first wave

27. Exercise Cold Play