1. MINISTRY OF HEALTH ACTION PLAN FOR THE PREVENTION AND CONTROL OF ANTHRAX Dr. Marion BullockDuCasse, SMO(H) Director, Emergency, Disaster Management and Special Services, 2001 / 10 / 20

2. FACTORS TO CONSIDER Increased terrorist activity Vulnerability of our people and country Threat of chemical and biological warfare

3. FACTORS TO CONSIDER Proximity to the USA Air travel patterns Incubation period – a few hours - 7 days and up to 60 days

4. Scenarios for humans Individual exposure Contaminated animals, meat or animal products Contaminated mail Mass exposure Aerosolized particles

5. Other Scenarios Importation of: Contaminated animals Contaminated meats Contaminated animal products

6. THE PLAN Covers all phases of management of Anthrax for the health sector Prevention Mitigation Preparedness Response Recovery

7. THE FOCUS The prevention and control of Anthrax, in order to minimize transmission, morbidity and mortality

8. The Plan Will be a part of the MOH Emergency and Disaster Management Plan and is to be used in conjunction with it Is a part of the MOH and National Plans for Response to Threats From Biological and Chemical Agents Is therefore a part of the National Disaster Plan

9. OBJECTIVES To detail all procedures, guidelines and actions to be taken by the heath sector for the prevention and control of Anthrax To outline the steps to be taken by other Ministries and agencies

10. AUTHORITY The plan is the authoritative guide of the health sector, for all actions required to effectively and efficiently deal with the health aspects of Anthrax exposure, infections and epidemics

11. AUTHORITY (cont.) The MOH is the lead agency All other agencies involved in the prevention and control of Anthrax must work in close collaboration with the MOH

12. ACTIVATION Any suspected or confirmed case of Anthrax or exposure to the Anthrax organism will necessitate activation of the plan and initiation of the response phase

13. ACTIVATION The Plan will be activated by: CMO PS Senior Medical Officer (Health) / Director, Emergency and Disaster Management

14. ACTIVATION Once activation takes place: The National Disaster Executive, and All other relevant Ministries and agencies are then notified.

15. ACTION PLAN Actions are listed for each phase Not to be carried out sequentially Many will have to be carried out simultaneously Hence, the need for early notification and call-out of the Response Team

16. PREVENTION Educate the publicInformation and Communication / Health Education Educate / Update health care workers MOH Technical team / RTDs / MOs(H) Educate / Update workers in at risk sectors MOH and MOA Technical teams / RTDs / MOs(H)

17. PREVENTION Develop and implement protocols for the handling of contaminated material and environments NPHL, Environmental Health Monitor and regulate the importation of animals, meats and animals products Ministries of Agriculture, Information, Commerce and Technology and Health

18. MITIGATION Determine vaccine availability and efficacy Directors, Family Health (FH) and EDMSS Develop policy for vaccine use, including priorities for use “ Vaccinate individuals at high risk for exposure Director, FH

19. PREPAREDNESS Develop and distribute patient management protocols Directors, HSPI and HPP Develop surveillance system for humans and animals Director, HPP, Directory, Veterinary Services Train / Update medical / laboratory community CMO, Directors, EDMSS and HSPI

20. PREPAREDNESS Ensure laboratory capabilities for rapid diagnosis Directors, HPP and NPHL Identify and train personnel involved in response activities Director, EDMSS

21. Response – National Plan Level 1 External situation exists which could pose a threat to the country No evidence of illness or disease or any agent that would cause illness or disease in the country

22. Response – National Plan Level 2 Investigation Response Team is called upon to respond to the possibility of existence of these agents MOH Action Plan activated MOH EOC partially activated

23. Response – Level 3 Cases of illness or disease or presence of the agent would be confirmed (dependent on number of cases / advise of MOH or other sector with responsibility for confirmation) FULL ACTIVATION OF THE NEOC FULL ACTIVATION OF THE MOH EOC

24. RESPONSE - MOH Will be initiated in two (2) phases The Alert Phase / Partial Response The Full Response

25. THE RESPONSE – Alert Phase and Full Response Will be initiated by the MOH, in accordance with the guidelines of this Plan Once a notification is received of a suspected case of Anthrax or the presence of a suspicious substance, letter, package or other material

26. THE ALERT PHASE For suspected cases: Includes those actions taken from the time of INITIAL NOTIFICATION until CONFIRMATION OF THE DIAGNOSIS by the MOH, whether by clinical and epidemiological or laboratory means

27. ALERT PHASE – ACTION PLAN Verify the presence of a suspicious substance, letter, package Place Investigation Response Team on ALERT

28. Alert Phase Verify the diagnosis of a case (suspected or confirmed) Initiate actions in patient management protocol

29. ALERT PHASE Confirm if case (suspected or confirmed) meets the diagnostic criteria – clinical and epidemiological or laboratory

30. THE ALERT PHASE For a suspicious letter, package or other material: Includes those actions taken from the NOTIFICATION until VERIFICATION of its existence

32. FULL RESPONSE Actions taken once the diagnosis of a suspected case is CONFIRMED by the MOH, or the presence of a suspicious substance, letter, package or material is VERIFIED, until DEACTIVATION of the Response

33. Full Response Initiate call-out proceduresDirector, EDMSS Activate (partially activate) MOH EOC Director, EDMSS Investigate case or suspicious mail, etc Investigation Response Team (IRT)

34. Full Response Identify and establish health facility(ies) and site(s) for clinical management of exposed or infected cases Director, HSPI Initiate isolation procedures – people, animals, buildings, material IRT / Director, EDMSS Close / secure site(s) / facility (ies)MOH / MNSJ / MO(H)

35. Full Response Contact and screen all persons suspected of exposure IRT Conduct interviews, examinations and take all required specimens IRT

36. Full Response Liaise with relevant laboratories and review tests results Directors, HPP / NPHL Investigate case or suspicious mail, etc Investigation Response Team Certify and re-open wards, offices, facilities, etc MOH / MO(H)

37. RECOVERY Actions in this Phase will return activities of all sectors to those routine activities which were in place before the response to Anthrax

38. DEBRIEFING A debriefing meeting will be convened by the SMO(H) / Director, EDMSS within seven (7) days of deactivation

39. FINAL REPORT Will be prepared within fourteen (14) days of the deactivation and seven (7) days of the debriefing