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Some experiences and lessons we have learned. may be of some assistance. Case development without planned interventions. Case development with planned interventions. Vaccine availability.

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Case development without planned interventions

Case development with planned interventions

Vaccine availability


Table 3: Current international confirmed cases and associated deaths, by region, reported by official health ministries* (1100 AEDT on 12 October 2009)


Region and Country Cases Deaths

Americas 135 645 3 196

USA 43 956 593

Mexico 36 593 248

Chile 12 252 134

Europe 55 085 162

Germany 19 893 2

UK 13 471 82

Portugal 2 983 2

Middle East 13 802 111

Saudi Arabia 4 119 28

Israel 2 880 24

Kuwait 2 459 7

Africa 13 574 80

South Africa 11 545 59

Egypt 927 2


Cases Deaths

Asia 114 318 722

China (including Hong Kong + Macao) 47 240 24

Thailand 26 270 165

India 10 375 328

Oceania 41 819 227

Australia 36 889 185

New Zealand 3 163 18

New Caledonia 500 9

Total 374 243 4498

total australian cases
Total Australian cases
  • In excess of 40000 ++
  • Limited serology conducted for majority of cases
  • 185 fatalities
  • ECMO emerged as an important ICU treatment modality for pandemic (H1N1) 2009 influenza, and will be an important consideration for future pandemic planning.

Table 1: New hospitalisations reported in the past week and cumulative number of hospitalised confirmed cases of pandemic (H1N1) 2009 in Australia (1100 AEDT on 12 October 2009).

Past Week Cumulative

Hospitalised ICU Hospitalised ICU

ACT 1 0 61 1

NSW 3 0* 1269 245

NT 5 0 302 45

Qld 7 0 1202 162

SA 7 2 531 76

Tas 1 0 108 9

Vic 0 0 513 118

WA 0 0 844 79

Total 24 2 4830 735

pandemic phases
Pandemic phases

Australia is an island state relatively non porous borders

Good opportunity to impose border measures to slow progress

The Australian pandemic phases are designed to describe the situation in Australia and to guide Australia\'s response. Thus, the Australian and the WHO phase may not always be the same.

Having an Australian system means that actions can be taken in Australia before a change of phase is declared by the WHO. The description of each phase is shown in the following table.



Note: the current phase has been highlighted

aims of australian plan
Aims of Australian plan
  • Early accurate communication of information
  • Minimise transmission to allow time for vaccine development
  • Recognize cant prevent
  • Early surveillance emphasis
  • Whole of Govt response required to reduce impact
some lessons we have learned
Some lessons we have learned
  • Whole of Govt response is key
  • Australian Govt Crisis Committee incl
    • PM&Cabinet chair
    • Health
    • D Foreign Affairs Trade
    • Quarantine
    • Police
    • Customs
    • Attorney Generals
    • Defence a small player
some lessons we have learned1
Some lessons we have learned
  • Australian Health Protection Committee
    • Important to provide expert advice to Govt
    • Dept of Health chair
    • All jurisdictions represented
      • States & territories, Emergency management, Defence, Chief Health Officer, Quarantine & Immigration reps
    • Not always agreement on the way ahead
    • Open communications vital
    • Aware of whole of Govt needs
some lessons we have learned2
Some lessons we have learned
  • State vs Federal Jurisdictions
    • Communication formally and frequently
    • Teleconferences daily / twice daily
  • Messages need to target
    • individuals and households
    • Health professionals
  • Legislation National Health Security Act 2007 formalised decision making and coordinated response arrangements and allowed information exchange
some lessons
Some lessons
  • Policies and plans need to be flexible
    • Planning based on assumptions incl incubation period, attack rate, transmission modes, virus survival, et al and some of above will prove to be incorrect
  • Social distancing will be a difficult issue, with political implications
  • Use oldest national stocks first
some lessons1
Some lessons
  • Transmission will vary in different parts of the country
    • The various jurisdictions may have differing priority requirements, all of which will need to be addressed
    • In Australia required modification of the Influenza plan
    • Required close cooperation between the State and Federal bodies

Some lessons

Plan revised in order to assure a measured, reasonable and proportionate health response to the risk that the virus poses to the Australian community. It is consistent with the message from the WHO when it lifted its Pandemic Alert to 6, that countries will need to adjust their responses to accommodate the knowledge we now have that this disease is moderate in most cases.


Identification and early treatment of those with moderate or severe disease especially in people with respiratory difficulty.

  • A focus on early treatment of people who may be vulnerable to severe outcomes. These people include pregnant women and those with respiratory disease (asthma, COAD), heart disease, diabetes, renal disease, morbid obesity, and immunosuppression.

Some lessons


Some lessons

  • Control of outbreaks required in institutional settings, such as special schools.
  • Widespread school closures or school exclusion for students who have travelled to areas of high prevalence are no longer appropriate and will not be continued on a national basis.
  • Voluntary home isolation for those with mild disease with supportive treatment only, such as over the counter medication.

Some lessons

  • Antivirals from the national or state medical stockpiles will be provided to those people with moderate or severe disease or whose underlying conditions, after appropriate clinical assessment, could make them vulnerable to severe infection. It is not appropriate to provide antivirals to their otherwise healthy household contacts, nor will those contacts be placed into quarantine.

Some lessons

  • Ongoing monitoring of the virus for the emergence of antiviral resistance, genomic drift or reassortment that could herald a change to greater virulence.
  • Additional border measures such as thermal screening and Health Declaration Cards will cease.

Some lessons

  • Testing would focus on to identification of H1N1 Influenza 09 in people with moderate or severe illness, people more vulnerable to severe illness, those in institutional settings and Indigenous Australians.
  • Increased identification and monitoring of H1N1 hospital admissions, ICU admissions and levels of morbidity and monitoring of clinical outcomes throughout the influenza season.

Some lessons

pathology testing of all potential cases will not be required or desirable. This is because most cases are mild and do not require treatment and confirmation is no longer required to inform clinical decisions about quarantine or use of antivirals.

australian lessons we have learned
Australian lessons we have learned
  • Vaccine now widely available
  • Slow uptake
  • Decision made to incorporate H1N1 strain into 2010 fluvax
  • Community made aware public health advice is available
  • Simple messages in relation to hand washing and coughing are important

ECMO emerged as an important ICU treatment modality for pandemic (H1N1) 2009 influenza, and will be an important consideration for future pandemic planning.



The anticipated demand for ExtraCorporeal Membrane Oxygenation in the wake of pandemic influenza A(H1N1) threatens to overwhelm the facilities currently equipped with the technology