1. MEXICO BEFORE AN INFLUENZA PANDEMIC BOGOTÁ, COLOMBIA APRIL, 2006 THE NEXT INFLUENZA PANDEMIC: A RESPONSE BY THE MEXICAN STATE Dr. Yessica Chaparro REGIONAL MEETING ABOUT THE PREPAREDNESS AND RESPONSE OF THE HEALTH ATTENTION SERVICES TO AN INFLUENZA PANDEMIC

2. MEXICO BEFORE AN INFLUENZA PANDEMIC Created in 2003 Analysis definition, coordination, monitoring and evaluation of policies, strategies and actions in terms of Health Safety. National Committee for Health Safety Protect the health of the population from risks and damages originated by epidemiological emergencies and disasters

3. MEXICO BEFORE AN INFLUENZA PANDEMIC Strategic Components Flooding, hurricanes, earthquakes, volcanic eruptions, fires... Intoxication with chemical substances, explosions, toxic substance spills, environmental contamination... Intentional liberation of biological agents.… Contamination, overpopulation, risks to patients or personnel…. Dengue, VON, malaria, leptospirosis, influenza, ETAS, SARS...

4. MEXICO BEFORE AN INFLUENZA PANDEMIC OBJECTIVE To protect the Mexican population from the risk of an influenza pandemic through the coordination of actions that allow the preparation of a rapid response National Plan for Preparation and Response to an Influenza Pandemic Dynamic document under permanent evolution Created by the National Committee for Health Safety Second version currently under revision

5. MEXICO BEFORE AN INFLUENZA PANDEMIC PHASESPRE PANDEMICPANDEMIC ALERTPANDEMIC 123456OMS There are no new subtypes of the Influenza virus in human beings New subtype of the virus in animals with considerable risk of human disease Cases of disease in humans with a new subtype of the virus without transmission from human to human Small outbreaks of the disease. Transmission limited from person to person Large outbreaks of the disease. Transmission limited from person to person Transmission sustained by the disease PRE PANDEMICPANDEMICMEXICO Preparation activities at a National Level Cases in Asia Cases in two Continents except America Cases in America Cases in Mexico Stages of Alert National Plan for the Preparation and Response to an Influenza Pandemic 1 2345

6. MEXICO BEFORE AN INFLUENZA PANDEMIC Dissemination and social mobilizationDissemination and social mobilization CoordinationCoordination Epidemiological vigilanceEpidemiological vigilance Medical AttentionMedical Attention Strategic reserveStrategic reserve Investigation and DevelopmentInvestigation and Development National Plan for the Preparation and Response to an Influenza Pandemic Lines of Action

7. MEXICO BEFORE AN INFLUENZA PANDEMIC Dissemination and Social Mobilization Risk Communication StrategyRisk Communication Strategy Media Campaign in PhasesMedia Campaign in Phases Dissemination to the Population and Health ProfessionalsDissemination to the Population and Health Professionals Sensibilization of Strategic Groups (Teachers, Parents, Unions, Businesspeople etc.)Sensibilization of Strategic Groups (Teachers, Parents, Unions, Businesspeople etc.) Training of Strategic Personnel (Armed Forces and Public Order, Airports, Ports, Borders, Tourism)Training of Strategic Personnel (Armed Forces and Public Order, Airports, Ports, Borders, Tourism) Information on the Internet: www.salud.gob.mx www.salud.gob.mx Telephone: 01800 Telephone: 01800

8. MEXICO BEFORE AN INFLUENZA PANDEMIC Coordination Fundamental for a timely responseFundamental for a timely response Incorporation of all relevant areas through the National Committee for Health SafetyIncorporation of all relevant areas through the National Committee for Health Safety Health SectorHealth Sector Inter sector Inter sector State and Local LevelsState and Local Levels InternationalInternational International Federal Level State Level Local Level Federal Command SESA Red Cross SEGOB SEDENA SEMAR SHCP SFP SEDESOL STPS SE SEP SCT SALUD SAGARPA SEMARNAT SRE SSP SECTUR

9. MEXICO BEFORE AN INFLUENZA PANDEMIC Coordination FEDERAL LEVEL CIVIL SOCIETYHEALTH SECTOROTHER SECTORS STATE LEVEL CIVIL SOCIETYHEALTH SECTOROTHER SECTORS LOCAL LEVEL CIVIL SOCIETYHEALTH UNITSOPERATIONAL AREAS

10. MEXICO BEFORE AN INFLUENZA PANDEMIC Coordination InternationalInternational Ministry Reunion, Ottawa, Oct 2005Ministry Reunion, Ottawa, Oct 2005 World Reunion on the Bird Flu and Pandemic, Geneva, Nov 2005World Reunion on the Bird Flu and Pandemic, Geneva, Nov 2005 6th. Ministerial Reunion of the Global Group on Health Safety (G7+México), Rome, Nov. 20056th. Ministerial Reunion of the Global Group on Health Safety (G7+México), Rome, Nov. 2005 IPAPI Reunion, Washington, D.C., 2005IPAPI Reunion, Washington, D.C., 2005 Workshop for Molding the Impact, San José, Costa Rica, 2005Workshop for Molding the Impact, San José, Costa Rica, 2005 Sub regional Workshop for Preparing for an Influenza Pandemic, Panama, February 2006Sub regional Workshop for Preparing for an Influenza Pandemic, Panama, February 2006

11. MEXICO BEFORE AN INFLUENZA PANDEMIC Epidemiological Vigilance Training of Health PersonnelTraining of Health Personnel Strengthening Routine VigilanceStrengthening Routine Vigilance Continuous Monitoring (UIES)Continuous Monitoring (UIES) Animal Vigilance (SAGARPA)Animal Vigilance (SAGARPA) Diagnostic CapacityDiagnostic Capacity Consolidation of the National Network of LaboratoriesConsolidation of the National Network of Laboratories Strengthening Laboratories P3 Strengthening Laboratories P3 International Agreements International Agreements

12. MEXICO BEFORE AN INFLUENZA PANDEMIC Preventive Actions Reduction of Social ContactReduction of Social Contact Limit the movement of People and MerchandiseLimit the movement of People and Merchandise Basic Hygiene measures (Washing hands, using masks)Basic Hygiene measures (Washing hands, using masks) Main strategies for Pandemic control (Public Health Measures): Triage schemeTriage scheme Strengthening hospital attention capacityStrengthening hospital attention capacity Protection measures for health personnelProtection measures for health personnel Attention Protocols (Children and Adults)Attention Protocols (Children and Adults) Management of RPBI/corpsesManagement of RPBI/corpses Medical Attention Servicio médico forense Fallecido a consecuencia de un cuadro clínico sospechoso o confirmado de Influenza. Compensación de enfermedad crónica y complicaciones. Unidad médica hospitalaria fija o de campaña Cuadro clínico de Influenza con complicaciones pulmonares y/o enfermedad crónica descompensada. Sintomático y antivirales Centro de Atención y Aislamiento Cuadro clínico de Influenza sin complicaciones pulmonares y/o enfermedad crónica controlada. Sintomático y medidas de bioseguridad Aislamiento domiciliario estricto Sintomatología sugestiva de influenza, sin complicaciones pulmonares y sin enfermedad crónica agregada. Sintomático y medidas de bioseguridad Domicilio Sintomatología respiratoria no compatible con influenza. Medidas de bioseguridad Domicilio Sano, sin sintomatología respiratoria. TratamientoReferenciaTipo de paciente Identification of the bird influenza stumps that are circlingIdentification of the bird influenza stumps that are circling Permanent bird vaccination campaignsPermanent bird vaccination campaigns Bird influenza outbreak control in farmsBird influenza outbreak control in farms Strategies to control outbreaks in birds:

13. MEXICO BEFORE AN INFLUENZA PANDEMIC Hospital Attention Servicio médico forense Fallecido a consecuencia de un cuadro clínico sospechoso o confirmado de Influenza. Compensación de enfermedad crónica y complicaciones. Unidad médica hospitalaria fija o de campaña Cuadro clínico de Influenza con complicaciones pulmonares y/o enfermedad crónica descompensada. Sintomático y antivirales Centro de Atención y Aislamiento Cuadro clínico de Influenza sin complicaciones pulmonares y/o enfermedad crónica controlada. Sintomático y medidas de bioseguridad Aislamiento domiciliario estricto Sintomatología sugestiva de influenza, sin complicaciones pulmonares y sin enfermedad crónica agregada. Sintomático y medidas de bioseguridad Domicilio Sintomatología respiratoria no compatible con influenza. Medidas de bioseguridad Domicilio Sano, sin sintomatología respiratoria. TratamientoReferenciaTipo de paciente Hospital Reconversion MINI CLINIC MINI CLINIC SECURITY PERIMETER

14. MEXICO BEFORE AN INFLUENZA PANDEMIC Strategic Reserves Reserve for the initial response:Reserve for the initial response: Antiviral (Oseltamivir) Antiviral (Oseltamivir) Post contact prophylaxis, treatment Post contact prophylaxis, treatment Priority scheme Priority scheme Antibiotics for managing complicationsAntibiotics for managing complications Protection equipment for health personnelProtection equipment for health personnel Laboratory equipmentLaboratory equipment Training materialTraining material Vaccine against H5N1 Vaccine against H5N1 Investment requirements in States and MunicipalitiesInvestment requirements in States and Municipalities Consideration of administrative aspectsConsideration of administrative aspects

15. MEXICO BEFORE AN INFLUENZA PANDEMIC Anti Influenza Vaccine Vaccine against seasonal influenza in humans Development of a prevention culture Development of a prevention culture Avoid genetic exchange between bird and human viruses Avoid genetic exchange between bird and human viruses Establishment of international agreements to transfer technology and training to personnel in Mexico 1 St STAGE VACCINE AGAINST SEASONAL INFLUENZA 2 nd STAGE VACCINE AGAINST THE INFLUENZA PANDEMIC VACCINE AGAINST BIRD INFLUENZA A (H5N1)

16. MEXICO BEFORE AN INFLUENZA PANDEMIC Need to increase basic investigation, clinical and epidemiological, for the development of technologies and national capacity in terms of:Need to increase basic investigation, clinical and epidemiological, for the development of technologies and national capacity in terms of: Investigation and Development AntiviralAntiviral New techniques for the production of vaccinesNew techniques for the production of vaccines Alternative treatmentsAlternative treatments Mathematical modeling for simulating scenariosMathematical modeling for simulating scenarios Participation of Higher Education Institutions

17. MEXICO BEFORE AN INFLUENZA PANDEMIC Steps to Follow National simulation in a real scale and command post exercise in the second semester of 2006National simulation in a real scale and command post exercise in the second semester of 2006 Escudo Centinela Exercise National Exercise to evaluate the Response capacity before an Influenza Pandemic

18. MEXICO BEFORE AN INFLUENZA PANDEMIC Steps to Follow Plan operation at a state and local levelPlan operation at a state and local level New version of PNPRPI: First Semester 2006New version of PNPRPI: First Semester 2006 Evaluation exercises at all levelsEvaluation exercises at all levels Coordination with Central America and the CaribbeanCoordination with Central America and the Caribbean Media campaign designed in phasesMedia campaign designed in phases

19. MEXICO BEFORE AN INFLUENZA PANDEMIC APRIL, 2006 THE NEXT INFLUENZA PANDEMIC: A RESPONSE by THE MEXICAN STATE www.dgepi.salud.gob.mx