衞生署衞生防護中心 Centre for Health Protection Department of Health 19.12.2005

1. 香 港 工 業 總 會The Federation of Hong Kong Industries 香港流感大流行應變準備 - 企業如何於工作環境中預防流感 Emergency Preparedness of Hong Kong for influenza pandemic/avian influenza:-How do enterprises prepare for it? 衞生署衞生防護中心Centre for Health ProtectionDepartment of Health 19.12.2005

2. 目錄Content • 流感大流行 Influenza Pandemic • 政府應付大型傳染病爆發的應變機制 Government response system for handling major infectious disease outbreaks • 業界應變計劃的考慮 Business continuity planning considerations

3. 衞生福利及食物局 Health, Welfare and Food Bureau 社會福利署 Social Welfare Department 衞生署Department of Health 政府化驗所Government Laboratory 食物環境衞生署 Food and Environmental Hygiene Department 漁農自然護理署 Agriculture, Fisheries and Conservation Department 醫院管理局 Hospital Authority Centre for Health Protection

4. 衞生署DH 衞生防護中心CHP 政府的衞生事務顧問及執行政府健康護理政策的部門 Government’s health adviser and agency to execute health care policies 監測及 流行病學處 Surveillance & Epidemiology Branch 感染控制處 Infection Control Branch 公共衞生 化驗服務處 Public Health Laboratory Services Branch 公共衞生 服務處 Public Health Services Branches 緊急應變 及資訊處 Emergency Response & Information Branch 強化公共衞生系統以對抗傳染病及其他公共衞生危險 Strengthen public health system against communicable diseases and other public health hazards 項目管理及專業發展分處 Programme Management & Professional Development Branch 緊急應變架構Emergency Response Infrastructure 衞生福利及食物局 Health, Welfare and Food Bureau • 緊急應變及資訊處旨在: • ERIB aims to: • 協調緊急應變 • Facilitate emergency preparedness • 處理公共衞生緊急事故 • Manage public health crisis • 制訂通報風險策略 • Formulate risk communication strategy

5. 血凝素(即H) 神經胺酸酶(即N) 病毒的基因部份 流感是什麼？ What is Influenza? 流行性感冒（簡稱流感）Influenza (flu): • 是一種病毒所引致傳染性極高的疾病 It is a highly infectious viral disease • 由不同品種的流感病毒引起 caused by various types of influenza viral strains 流感病毒Influenza Virus 流感病毒可依據病毒表面兩種 抗原類型分類:The influenza viruses are categorized on the basis of two surface antigens: HA and NA

6. 季節性流感SeasonalInfluenza • 在香港，流感於一至三月及七至八月較為常見 • In Hong Kong, the disease is more common in periods from January to March and from July to August. • 2. 現有的流感疫苗只能預防季節性流感 • Current influenza vaccine only offers protection against seasonal flu 二零零四年度流行性感冒病類求診比率及分離出流行性感冒病毒株的數目 Consultation rate of influenza-like illness and number of influenza isolates, 2004 月份

7. 禽流感感染人類Avian Influenza infecting human 豬 Pigs 禽流感在豬隻特別令人煩惱，因為豬隻擁有禽流感和人流感的病毒受體。 他們成為了流感病毒的基因重組庫。 Avian flu in pigs are particularly worrisome as they possess bird flu and human flu receptors. They act as a reservoir for genetic reassortment for flu virus. 雞 Chicken 新接觸H5N1 病毒 當受攻擊時一般會致命 New to H5N1 virus Invariable fatal when attacked 禽鳥和水鳥 (例如: 鴨， 鵝) 禽流感自然載體, 可有症狀或無症狀 Birds and Waterfowls: (e.g. Ducks, geese) Natural carrier of avian flu, can be symptomatic or asymptomatic 人 Human 貓科類 (貓, 老虎和豹子) Feline (Cats, Tigers and Leopards) 先前限制H5N1 病毒於禽鳥和水鳥的種類障礙已經破壞，現在病毒已能傳染各種類生物 The species barrier that previously confined the H5N1 virus to birds and waterfowls had been breached and now it is able to infect various species

8. 過往在本港禽鳥間爆發的高致病性禽流感Previous HPAI Outbreaks among poultry in Hong Kong • 1997 • 2001 • 2002 年初 Early 2002 • 2002 年尾 Late 2002 • 2003 年初 Early 2003

9. 年份 Year 年份 Year 人數 No. of cases 人數 No. of cases 本地/外地感染 Local/Imported 本地/外地感染Local/Imported 死亡 Died 死亡 Died 1999 1997 18 2 本地 Local 本地 Local 6 0 2003 1 本地 Local 0 過往在本港的人類禽流感感染個案Human cases of avian flu infection in Hong Kong H5N1 - H9N2 -

10. 自2004年初開始，儘管鄰近地區仍有爆發，香港再無出現禽流感個案Hong Kong has been free from avian influenza since early 2004 despite the regional outbreaks

11. 流感大流行Influenza Pandemic 能導致世界性流感大流行的 三個先決條件： Three pre-requisites for the start of anInfluenza Pandemic: • 出現新型的流感病毒，在人群中普遍沒有抵抗力 • A novel influenza virus subtype emerge and humans in general have no immunity against it • 新型流感病毒可以在人類體內複製，並引起嚴重病況 • The new virus must be able to replicate in humans and cause serious illness • 新型流感病毒可以在人與人之間有效地傳播 • The new virus must be efficiently transmitted from one human to another 圖片來源:美國疾病控制和預防中心 Photo: CDC

12. 比較流感大流行與「沙士」 Compare Influenza with SARS

13. 影響 Impact • 亞洲開發銀行 (亞太地區) Asian Development Bank (Asian and Pacific region) : • 相對溫和的大流行：以 900 億到 1,100 億美元計 Mild pandemic: around US $90 billion to $110 billion • 相對嚴重的爆發：以 2,500 億到 2,900 億美元計 Severe outbreak: US $250 billion to $290 billion • 工人死亡及喪失工作能力則另外導致$150億美元損失 The loss of workers due to death and incapacity could cost an additional $15 billion • 世衞：全球損失$ 8,000億美元 WHO: US $800billion loss globally

14. 政府應付大型傳染病爆發的應變機制 The Government's three-tier response system for handling major infectious disease outbreaks

15. 流感大流行應變計劃Preparedness Plan for Influenza Pandemic 政府的計劃包括一個三級應變系統 The Government's 3-tier response system for handling major infectious disease outbreaks • 戒備應變級別 Alert Response Level • 嚴重應變級別 Serious Response Level • 緊急應變級別 Emergency Response Level

16. 三級應變系統 - 指揮架構Three-tier Response Levels - Command Structure • 戒備應變級別 Alert Response Level • 設立精簡的指揮架構： Simplified Command Structure : • 衞生福利及食物局(衞福局) Health Welfare & Food Bureau • 衞生署 Department of Health • 醫院管理局(醫管局) Hospital Authority • 漁農自然護理署(漁護署) Agriculture, Fisheries & Conservation Department • 食物環境衞生署(食環署) Food & Environmental Hygiene Department • 嚴重應變級別 Serious Response Level • 成立督導委員會由衞福局局長擔任主席 Steering Committee chaired by the Secretary of Health, Welfare & Food (SHWF) • 緊急應變級別 Emergency Response Level • 督導委員會會由行政長官擔任主席 Steering Committee chaired by the Chief Executive

17. 戒備應變級別Alert Response Level 當 : Scenarios : • 香港境外證實在家禽中爆發高致病性禽流感 Confirmation of highly pathogenic avian influenza (HPAI) outbreaks in poultry populations outside Hong Kong • 香港境內證實在檢疫中的入口禽鳥、野生禽鳥、休憩公園、寵物店或自然環境中出現高致病性禽流感個案 Confirmation of HPAI in Hong Kong in imported birds in quarantine, in wild birds, in recreational parks, in pet bird shops or in the natural environment • 香港境外證實出現人類感染禽流感的個案 Confirmation of human case(s) of avian influenza outside Hong Kong

18. 嚴重應變級別Serious Response Level 當 : Scenarios: • 香港境內證實家禽所處環境 或在零售市場、批發市場或農場的家禽中爆發由已知會對人類健康造成影響的病毒所引致的高致病性禽流感 Confirmation of HPAI outbreaks in the environment of oramong poultry population in retail markets, wholesale markets, farms in Hong Kong due to a strain with known human health impact • 香港境內證實出現人類感染禽流感的個案，但無證據顯示病毒容易在人與人之間傳播 Confirmation of human case(s) of avian influenza in Hong Kong without evidence of efficient human-to-human transmission

19. 緊急應變級別Emergency Response Level 當 : Scenario : • 有證據確定外地 或 本港出現容易在人與人之間傳播的新型流感 Evidence of efficient human-to-human transmission of novel influenza overseas or in Hong Kong • 流感大流行 Pandemic influenza

20. 分級應變級別Staged Response Level • 世界衛生組織策略行動範疇 WHO strategic action areas • 減少人類感染的機會 Reduce opportunities for human infection • 加強預警系統 Strengthen the early warning system • 在源頭防止或延遲傳播 Contain or delay spread at the source • 減低傷亡、死亡及對社會的影響 Reduce morbidity, mortality, and social disruption • 進行研究以引導應變措施Conduct research to guide response measures 取材自世界衛生組織之” WHO Responding to the avian influenza pandemic threat: recommended strategic actions “ Adopt from WHO Responding to the avian influenza pandemic threat: recommended strategic actions 各級別的主要目標 Major objectives of each level 戒備應變級別 Alert Level • 從其他地區獲取即時及準確的資訊，以防止疾病傳入本港及儘早偵察本地個案 To attain timely and accurate information from other territories in order to prevent the disease from invading Hong Kong and facilitate prompt surveillance for any local cases 嚴重應變級別 Serious Level • 及早控制疾病傳播、找出感染源頭、防止病毒在本地傳播及散播至外地 To control the spread of the disease, identify the source of infection and contain the spread of the virus in and out of Hong Kong at the early stage of infection 緊急應變級別 Emergency Level • 減緩疫情擴散速度， 盡量減少人命損失，藉以爭取時間生產有效疫苗，對付造成流感大流行的新型流感病毒 To minimise mortality and mortality toll, and slow down progression of epidemic, and buy time for new interventions development

21. 應急準備 – 公共衞生措施Ongoing Preparedness － Public Health Measures • 疾病監測網絡(本地及全球) • Disease surveillance network (locally & globally) • 調查及控制措施 • Investigation and control measures • 化驗支援 • Laboratory support • 感染控制措施 • Infection control measures • 提供基本醫療服務 • Provision of essential medical services • 抗病毒藥物的儲備 • Anti-viral stockpiling • 防疫注射 • Vaccination • 港口衞生措施 • Port health measures • 風險傳遞及公眾教育 • Risk Communication & Public education

22. 應變措施 - 戒備應變級別 Action Plan - Alert Response Level

23. 應變措施 - 戒備應變級別 Action Plan - Alert Response Level • 與世衞及國際衞生機關聯絡，監察疫症在全球蔓延的情況和影響 Liaise with WHO and international health authorities to monitor global spread • 增強監察 Enhance Surveillance • 與中國大陸、廣東及澳門互通知訊 Exchange Information with the Mainland, Guangdong and Macau

24. 應變措施 - 戒備應變級別 Action Plan – Alert Response Level • 港口衞生措施 Port Health Measures • 風險傳遞 Risk communication • 特設網頁，提供健康建議及資訊(www.info.gov.hk/info/flu) Dedicated website provides updated information and advice (www.info.gov.hk/info/flu) 傳媒宣傳 Mass Media Publicity

25. 應變措施 - 戒備應變級別 Action Plan – Alert Response Level 個人保護裝備 PPE 疫苗 Vaccine • 抗病毒藥物 • Antiviral drug • 儲備超過2千萬劑 • Stockpile level to >20 million doses

26. 應變措施 – 嚴重應變級別Action Plan – Serious Response Level

27. 應變措施 - 嚴重應變級別 Action Plan - Serious Response Level • 加強監測工作 Enhance surveillance • 監察感染個案和曾與患者接觸人士 Contact tracing, medical surveillance of close contacts • 化驗支援 Laboratory Support • 因應情況的需要執行隔離措施 Enforce quarantine measures as appropriate • 進行流行病學調查以確定感染源頭及傳播途徑 Epidemiological investigation to identify source of infection & mode of transmission

28. 資訊技術: 香港警務處的重大事件調查及災難支援工作系統 Information technology:Police’s Major Incident Investigation and Disaster Support System (MIIDSS) • 大型疫情時協助追蹤病人接觸者在社區及建築物分佈情況 • Contact tracing in case of large-scale outbreaks by ranking the affected districts or buildings in order of the number of cases accumulated • 協助衞生防護中心找尋群集性疫情並執行隔離措施 • Enable CHP to identify locations with case cluster and take immediate containment measures

29. 應變措施 – 嚴重應變級別Action Plan – Serious Response Level • 指定醫院作為隔離及治療病人並指定診所作發燒門診 Designated hospitals for isolation & treatment and designated clinics for triaging patients

30. 應變措施 – 嚴重應變級別Action Plan – Serious Response Level • 銷毀家禽行動 Culling Operation

31. 應變措施 - 緊急應變級別Action Plan – Emergency Response Level

32. 應變措施 - 緊急應變級別Action Plan – Emergency Response Level • 提供基本醫療服務 Essential medical services • 建立後備資源 Surge capacity • 人手/醫院病牀調配計劃 Staff and hospital bed mobilisation • 接種疫苗Vaccination • 抗病毒藥物Antivirals

33. 應變措施 - 緊急應變級別Action Plan – Emergency Response Level • 建立志願工作者名單 • Building volunteer databases on • 醫生 Doctors • 護士 Nurses • 藥劑師 Pharmacists • 社會工作者 Social workers • 非政府組織 NGOs • 輔助醫療 Paramedical staff • 為後備力量提供流行病學及傳染病控培訓 • Field epidemiological training program for basic and specialist infection control and infectious disease management training for both health and non-healthcare workers • 人手/醫院病牀調配計劃 • Staff / hospital bed mobilization plans

34. 應變措施 - 緊急應變級別Action Plan – Emergency Response Level • 學校停課? School closures? • 關閉公共地方? Public place closures? • 取消公眾集會? Cancel public gatherings?

35. 演習及演練以確保我們應變計劃的可行性 Drills & exercises to ensure workability of our plans 全政府演習及演練 Government-wide exercises and drills • 2004年尾：代號「楓葉行動」的演習 End of 2004: Exercise MAPLE • 2005年3月：代號「杉木行動」的演習 March 2005: Exercise CEDARS • 2005年尾：代號「楊木樹行動」的流感大流行演習 End of 2005: Exercise POPLAR for influenza pandemic 醫院演練 Hospital drills 個別部門演練 Individual department drills

36. 應變措施 - 緊急應變級別Action Plan – Emergency Response Level 復康階段支援 Expediting Recovery • 提供緊急支援予有須要的病患者家屬 Strategy for providing speedy support to the needy patients and their families • 設立社會服務計劃推動社區疫後復甦 Relevant social service scheme for recovering the resilience and stability of the community

37. 業界應變計劃Tourism sector business continuity planning

38. 應變計劃Continuity planning • 發展自政府的流感大流行應變計劃中的三級應變系統 Develop with reference to the three-tier response system of the Government’s Preparedness Plan for Influenza Pandemic • 已為不同界別舉辦簡報會 Has already conducted Briefings for • 金融銀行 Financial and banking sectors • 證券 Securities • 藥物供應 Drug supply • 公共事業 Utilities • 交通運輸等等 Transport, etc.

39. 應變計劃重點Continuity planning considerations

40. 應變計劃重點Business continuity planning considerations • 維持基本服務應變措施 Measures to maintain core operations/services • 感染控制政策及措施 Infection Control Policies and procedures • 通訊及訊息傳遞 Communication

41. 維持基本服務應變措施Measures to maintain core operations/services • 維持必要運作中必不可缺的服務單位及僱員 Identify essential services and skeleton staff to maintain these services • 為管理層指定後備員工 Designate deputies of the management • 建立員工輪更計劃 Prepare staff roster plan • 以小型工作小組分擔大型工序的工作 Split working groups into smaller teams • 在不同地點工作 to work at different sites • 減少會議 reducing the number of meetings and • 盡量使用視像電話會議 use more video/telephone conferencing facilities • 定期檢討應變計劃並作演練 Test and review contingency / redeployment plans regularly

42. 感染控制政策及措施Infection Control policies and procedures • 確定足夠感染控制設施及指引: Ensure infection control facilities and guidance in place: • 洗手設施 Hand washing facilities • 清潔及消毒程序 Cleansing and Disinfection procedures • 垃圾清除等等 Waste disposal etc.

43. 感染控制政策及措施Infection Control policies and procedures • 儲備個人防護裝備(如口罩、消毒劑等): Establish stockpile of personal protective equipment (PPE) (such as masks, disinfectants): • 確立個人防護裝備數目 specify amount of PPE stockpile • 建立使用此等裝備情況 scenario under which PPE are to be used • 建立儲存及分發裝備機制 storage and distribution mechanisms • 為員工提供感染控制培訓 training and briefings on PPE provided to the staff

44. 感染控制政策及措施Infection Control policies and procedures • 在儲存個人防護裝備的數量時，應考慮以下各點 : In considering amount of PPE to be stockpiled, one has to take note of: • 過往經驗 the past experience that • 流感大流行可快速地在2至3週內擴散至整個香港 once pandemic is established, it is likely to spread rapidly in Hong Kong over 2-3 weeks • 可出現2個或以上的疫潮 there likely will be second and more subsequent waves of attack • 每個疫潮可相隔許多週或月份 the interval between each wave could span several weeks or months • 員工信心及士氣 the morale and confidence of staff • 在流感大流行時，購買個人保護裝備可能出現缺貨情況 the likely shortages and delays in the availability of PPE in a pandemic

45. 如何防備How to Prevent

46. 如何防備How to Prevent • 盡量避免接觸活鳥和家禽及其糞便 Avoid touching live birds and poultry and their droppings • 如曾接觸活鳥或家禽，要立刻用梘液和清水洗手 After contact with live birds and poultry, wash hands thoroughly with liquid soap and water immediately

47. 如何防備How to Prevent • 進食家禽肉類和蛋時應徹底煮熟 Poultry and eggs should be thoroughly cooked before eating • 旅客前往出現禽流感感染個案的地區後若有流 感徵狀，應立即找醫生診治，告知醫生近期到過的國家，並要戴上口罩，以防傳染他人 Travellers returning from areas with reported avian flu outbreaks should consult doctors promptly if they have symptoms of influenza after the trip. Let the doctors know the travel history and wear a mask to prevent spread of the disease

48. 如何防備How to Prevent • 保持空氣流通 Ensure good ventilation • 避免到人多擠迫的地方 Avoid visiting crowded places with poor ventilation • 預防隔氣彎管乾涸及消毒排水口，每星期一次把約半公升清水倒入所有排水口 Prevent the trap of drainage pipe from drying and disinfect drain outlets. Pour half a litre of water into each drain outlet once a week • 住屋常清洗，每天一次用1:99的稀釋家用漂白水抹拭家具及厠所等 Keep your home clean, wipe furniture and toilet with 1:99 diluted household bleach solution once a day

49. 時刻做好防範 Be prepared 養成良好個人衞生習慣 Build up good personal hygiene 家中常備口罩、以備不時之需的退燒藥、探熱針、洗手梘液及紙巾 Keep at home masks, antipyretics for use when necessary, thermometer, liquid soap & tissue 常備家庭醫生的資料及其他有用資訊 Be always ready with information of family doctor & other useful information 接種流感疫苗 Get vaccinated 對員工的個人健康建議Personal Health Advice to staff

50. 對員工的個人健康建議Personal Health Advice to staff • 保持雙手清潔 Keep hands clean • 正確使用口罩 Use mask properly • 認識流感徵狀 Know how influenza presents