PANDEMIC INFLUENZA PREPAREDNESS AND RESPONSE. Atika BERRY, MD, MpH Communicable Diseases Dpt, MOH 02 May 2009. Introduction.
Atika BERRY, MD, MpH
Communicable Diseases Dpt, MOH
02 May 2009
The development of an Influenza pandemic can be considered as the result of the transformation of an animal influenza virus into a human influenza virus. At the genetic level, pandemic influenza viruses may arise through:
1968: “Hong Kong Flu”
1918: “Spanish Flu”
1957: “Asian Flu”
20-40 million deaths
1-4 million deaths
1920 1940 1960 1980 2000
(*) Adapted from European Centre for Disease Prevention and Control, Pandemics of the 20th century, October 2008
What can be happening now?
Swine Flu Virus
Pig to pig transmission &pig to human transmission
Human to human transmission
(& Human to pig transmission?)
Viral Reassortment CSR/EMRO)
Reassortment in humans
Reassortment in pigs
Pandemic Influenza Virus
As of 06:00 GMT, 1 May 2009, 11 countries have officially reported 331 cases of influenza A(H1N1) infection. (Ref: www.WHO.int)
WHO Pandemic Phases CSR/EMRO)
Pandemic alert period
-Phase 3. Human infections with a new subtype, but no or very limited human-to-human spread.
Phase 3a:cases outside Lebanon
Phase 3b: cases including Lebanon
-Phase 4. Small cluster(s) with limited human-to-human transmission but spread is highly localized.
Phase 4a: cases outside Lebanon
Phase 4b: cases including Lebanon
-Phase 5: Larger cluster(s) of human-to-human transmission
Phase 5a: cases outside Lebanon
Phase 5b: cases including Lebanon
-Phase 6. Pandemic: increased and sustained transmission in general population.
A- National preparedness and response as a whole-of-society responsibility:
B- Coordination under IHR (2005)
- Finalize preparations for an imminent pandemic (activation of crisis committees, and national command and control systems
- Update national guidance and recommendations (according to WHO recommendations and taking into account information from affected countries)
Pandemic Disease Surveillance:
- Elaborate a national case definition,
- Designate a RRT at the Mohafaza level,
- Detailed epidemiological investigation of the case
- Undertake a comprehensive assessment of the earliest
cases of pandemic influenza,
- Contact tracing for the two weeks prior to onset of
- Follow-up contacts for fever and cough for one week,
- Active case search to find any additional cases…)
Monitoring and Assessment of the Impact of the Pandemic:
Big droplets CSR/EMRO)
fall on people
surfaces bed clothes
Courtesy of CDC
A- Individual/household level measures:
B- Social level Measures:
Phase 5b (contd)
C- International travel measures:
D- Pharmaceuticals measures:
Containment measures at this point are not effective.
Isolation Precautions CSR/EMRO)
Droplet precautions: Surgical Masks CSR/EMRO)
Source: Rosie Sokas, MD MOH UIL at Chicago
Personal Protective Equipment CSR/EMRO)
Treatment is 75 mg twice a day for 5 days.
Prophylaxis is 75 mg once a day for 7 days after last exposure.
High risk exposure (household contacts)
Moderate risk (unprotected very close exposure to sick animals; HCW with unprotected exposure to patients)
Low risk exposure: no need for prophylaxis unless activation of exceptional measures.
Importance of the Early Treatment CSR/EMRO)
A- Planning & coordination
B- Situation monitoring & assessment
C- Reducing the spread of the disease:
D- Continuity of health care provision
Thank you CSR/EMRO)