Presentation on theme: "Pandemic influenza – preparing now"— Presentation transcript:
1Pandemic influenza – preparing now Dr Chloe Sellwood PhD FRIPHPandemic Flu Lead, NHS London
2Most experts believe that it is not a question of whether there will be another severe influenza pandemic, but whenSir Liam Donaldson, CMO2002
3learning from previous pandemics current threat from avian influenza seasonal influenzalearning from previous pandemicscurrent threat from avian influenzapreparing for the next pandemichealthwider society
4Seasonal flu occurs every year winter affects up to 10% of the populationthe very young, the very old and people with certain chronic illness are most at riskannual vaccination availableantiviral drugs available for the at risk (RCGP threshold)
5Pandemic fluoccurs about 3 times each century – at any time of the yearmay affect up to 50% of the population (up to 90% in closed communities)people of every age may be at riskvaccine won’t be available initially - in the first waveantiviral drugs are likely to be in limited supply; antibiotics, OTC meds, fluids…
6Previous pandemics A/H2 A/H3 P P P 1918 1957 A/H1N1 1968 1957 A/H2N2 1920195019802000A/H2A/H3PPP19181957A/H1N1Spanish flu3 waves<40m deaths worldwide, incl. ~200,000 xs UK civilian deathsmainly year olds19681957A/H2N2A/H3N21968Asian fluworldwide: ~1.0m deathsUK: 33,000 deaths, under 14’s and over 65’sA/H1N11977A/H?N?20??Intervals:Shortest = 11 yearsLongest = 39 yearsCurrent = 40 yearsHong Kong fluworldwide: ~0.8–1.0m deathsUK: 30,000 xs deaths (cf. 26,000 ’89/90), under 5’s and over 65’s
7NOW: all major air hubs are less than 72 hrs apart… Geographic Spread:09/6809/6801/6909/6807/6809/68NOW: all major air hubs are less than 72 hrs apart…08/6806/6909/68C.W. Potter, Textbook of Influenza, 1998
8Learning from previous pandemics maximum recorded interval between pandemics is 39 years – it could be soon (but it remains unpredictable)the likely origin is south east Asia – but we can’t say for sureglobal spread will be rapid – we either prepare now, or risk being caught by surprisemay be several waves; first may be ‘milder’ than later wavesexcess mortality and morbidity difficult to predict but may be high (but not necessarily like 1918)overall population clinical attack rate is likely to be 25-33%there may be a shift towards younger age groups in terms of severity and mortalityimpact on public services for business continuity likely to be considerableimpact on all organisations likely to be considerable
9“Experts at WHO and elsewhere believe that the world is now closer to another influenza pandemic than at any time since 1968, when the last of the previous century's three pandemics occurred.” WHOThe world is presently in WHO Phase 3: a new influenza virus subtype is causing disease in humans, but is not yet spreading efficiently and sustainably among us.
10Avian flu Live bird market China May 06, Defra primarily a disease of birds – natural reservoir is wild aquatic birdsmost strains are relatively harmless (Low Pathogenic Avian Influenza)some strains are highly pathogenic (HPAI) and cause large outbreaks, especially in poultry, where death is rapid and near 100%A/H5N1 first appeared in Hong Kong in 1997, re-appeared in 2003has affected wild birds, poultry and some other mammals, including peoplewild and migratory birds are spreading infection
11A/H5N1– the story so fardetected in birds in many countries – including UKmillions of wild birds and poultry have died or been slaughteredvirus has jumped directly from poultry to humans in 15 countries<400 human cases with 60% case fatality ratepotential to mutate or mix with human virus to create new influenza virus against which there would be no immunitypotential to cause the next pandemic…However, the next pandemic may be caused by a completely different subtype…
12Potential impact to the UK one or more national waves lasting ~15 weeks, local epidemics lasting ~8 weeks25 – 50% population with symptoms80,000 – 1,115,000 nationally needing hospital care50,000 – 750,000 excess deaths nationally15–20% absent from work at the peak, ?impact of schools closure£1,242 billion cost to society
13Potential impact to London Clinical Attack Rate25%35%50%NationalLondonBoroughCases15,000,0001,880,00050,00021,000,0002,632,00070,00030,000,0003,760,000100,000CFR0.4%55,0007,50020077,70010,500280111,00015,0004001.0%150,00018,800500210,00026,300700300,00037,6001,0001.5%225,00028,200750315,00039,5001,050450,00056,4001,5002.5%375,00047,0001,250525,00065,8001,750750,00094,0002,500CFR – case fatality rateRange of possible cases and excess deaths based on various permutations at case-fatality and clinical attack rates in a single wave. London figures based on ONS 2005 Mid-Year Population Estimates (rounded to nearest hundred), Borough based on typical size of 200,000.
14Impact on healthstaff will be ill and/or have personal responsibilities as carerssupply chains could be disruptedtransport disruptions could prevent staff coming into workhospitals will fill up quicklycommunity services will need to care for people with a wider range of needs that usual – both health and social carelittle scope for mutual aid (other than local)
15Impact on businessstaff will be ill and/or have responsibilities as carers – up to 50% of your workforce off for 7-10 days over the pandemic, 20% at peak, more for small teams…schools likely to close – staff off to care for childrenexpect transport disruptions to prevent staff coming into workit will not be ‘business as usual’…
16UK planning – healthlead by the Department of Health, with Cabinet Office lead for cross-government planningUK Influenza Pandemic National Framework published 11/07, covers role of NHS and DH responsibilities for policy, practice and logisticsincorporates an escalating, graduated response based on WHO pandemic phases, and UK Alert Levels 1-4suite of supporting, area-specific guidance
18Reducing the impact through “defence in depth”… Reducing spread hygiene, stay at home, school closuresReducing infection vaccinesReducing illness/ complications antiviral drugs, healthcareReducing death antibiotics, healthcare
19Pandemic vaccine4-6 months to produce a pandemic specific vaccine, longer for sufficient quantities to vaccinate all who want/ need itunlikely to be available during the early stages of the pandemiclimited global production capacitymay need to prioritise the vaccine when availablehow many doses per person?what about pre-pandemic vaccination?
20Antiviral drugsMarch 2005: DH procured 14.6 million courses of oseltamivir (Tamiflu®), enough to treat 25% of the UK populationNow: expanding stockpile to treat 50% of the UK populationPrevents the virus from reproducingreduces period of infectivity/symptoms by ~1 dayreduces secondary complications and therefore reduces hospital admissions/ pressure on acute sectorBut:effectiveness against a pandemic virus is unknownmust be taken within 48 hours of onset of symptoms (ideally 12 hrs) – so how to do this??
21National Pandemic Flu Line Service Access via web, automated telephony and 24x7 call centresNHS number for UK nationals; ?foreign nationalsBasic Flu Line - algorithm to determine whether antivirals to be allocated (URN / local collection point) or caller needs to see GPFluLine Professional – health professionalsStock Management System – maintain local suppliesInformation Line – worried wellIf AVs appropriate – caller asked to direct Flu Friend to local collection pointNext steps: increased language capabilities, and ?texting URNs to mobile phones?PCTs identifying antiviral collection points; but how will social care users access the flu line, or get their antivirals (will they have flu friends?)
22Guidance relevant to Local Authorities Cabinet OfficeGuidance to local planners(www.ukresilience.gov.uk/pandemicflu/guidance/regional_local.aspx)DHGuidance on the Management of Death & Cremation CertificationEthical frameworkHR (NHS guidance)Social care(www.dh.gov.uk/en/Publichealth/Flu/PandemicFlu/DH_093202)
23Social care maintaining service – adult and children services increase in demandidentifying the existing vulnerable and those who are newly vulnerable due to the pandemicsupporting ‘informal’/private careworking with healthLondon Development Centre workshop
24Regional action Health working with the DH to ensure consistency across the country with other SHAsworking across the NHS in London through the steering group and workstreams to ensure consistency of preparedness and serviceWider than healthworking with London Resilience Team and others (HPA London, DH etc), to ensure consistency across the region and across sectorssocial care workshop – Januaryexcess deaths workshop – FebruaryIPC exercise – Juneother meetings – London First, local resilience groups etc
25Local actionengage with staff at all levels – communication is essentialengage with your partners/neighbours, particularly through the local Influenza Pandemic Committees – these should be meeting now to plan the response to a pandemictailor existing plans to pandemic flu, and identify how flu planning can help wider emergency preparedness/ business continuityget involved – locally and regionallyit’s not all just about the health response…
26Top tips… www.ukresilience.gov.uk/pandemicflu/guidance/business.aspx Now…familiarise yourself with the national guidance (HSE guidance for employers, UK Resilience www etc…)practice good hand and respiratory hygieneenable your staff to work from home (eg if schools close or they need to care for a family member)use existing BCP processes and adapt them to flu – what can you do without for a day, a week, a month, a quarter…When it happens…go to work if you are well, but stay at home if you are ill with pandemic flu – don’t spread itremember it won’t be business as usual, it could last for up to 3 months, and all aspects of society will be disrupted …
27What can we all do? Good hand and respiratory hygiene Identify a ‘Flu Friend’ and be a ‘Flu Friend’ for othersIdentify if/how you can work from home, can you work altered hours to avoid rush hour, or are there alternate ways to get to work…Stay at home if you are ill with pandemic flu