Pandemic Influenza
Guidance for Pandemic Influenza: Infection Control in Hospitals and Primary Care Settings
UK Pandemic Influenza Contingency Plan
Operational Guidance for Health Service Planners
UK Operational Framework for Stockpiling, Distributing and Using Antiviral Medicines in the Event of Pandemic
Influenza
Department of Health, England Health Protection Agency
Pandemic flu: clinical management of patients with an influenza-like illness during an influenza pandemic.
Provisional guidelines from the British Infection Society, British Thoracic Society and Health Protection Agency
in collaboration with the Department of Health
ThoraxJanuary 2007
Influenza A
Influenza A• 1918 - H1N1 ‘Spanish flu’ 40 million deaths
• 1957 - H2N2 ‘Asian flu’ 2 million deaths
• 1968 - H3N2 ‘Hong Kong flu’ 1 million deaths
Recent epidemiological and virological changes from outbreaks of flu in Asia indicate that a pandemic is a definite possibility.
‘Avian flu’ - H5N1 - Endemic amongst birds in Asia. Since December 2003, 100 cases in humans
? adapting towards human transmission
Anxiety about H5
Pandemic
• New influenza A virus infects humans
• Spreads efficiently from human to human
• Causes significant illness in a high proportion of those infected
• No immunity in susceptible population - the disease spreads widely and rapidly
International phases
Inter-pandemic phases
1. No new influenza viruses detected in humans
2. Animal influenza virus sub-type poses substantial risk
International phases
Pandemic alert period
3. Human infections with a new sub-type but no human to human spread to a close contact
4. Small clusters with limited human to human transmission but spread is highly localised, suggesting that the virus is not well adapted to humans
5. Large clusters but human to human spread is still localised, suggesting that the virus is becoming increasingly better adapted to humans
International phases
Pandemic period
6. Increased and sustained transmission in general population
Post-pandemic period
7. Return to inter-pandemic period
International phases
Pandemic alert period
3. Human infections with a new sub-type but no human to human spread to a close contact
4. Small clusters with limited human to human transmission but spread is highly localised, suggesting that the virus is not well adapted to humans
5. Large clusters but human to human spread is still localised, suggesting that the virus is becoming increasingly better adapted to humans
UK Alert levels
1. Virus/cases only outside UK
2. Virus isolated in UK
3. Outbreaks in the UK
4. Widespread activity across the UK
Epidemiology• Mortality globally 2.4 - 7 million• Mortality UK - 50,000, possibly higher• Elderly, children and young adults• One month for virus to arrive in UK• Widespread cases within 2 weeks, peak 6
weeks• Possibly more than one epidemic wave• Clinical and Serological attack rates of 25%
and 50% respectively
Clinically
• Incubation 2-4 days
• Abrupt onset of fever
Clinically
• Cough• Malaise• Chills• Headache• Anorexia• Coryzal symptoms• Myalgia• Sore throat
Clinical case definition
The presence of fever and new (or, in those with chronic lung disease, worsening) cough of acute onset in the context of influenza circulating in the community
Complications
• Usually uncomplicated with acute symptoms resolving within 7 days
• Pneumonia
• Myocarditis
• Encephalitis/Myelitis/Guillaine-Barre
• Otitis media
Provision of care in the event of a Pandemic
Significant changes to usual practice in order to cater for the excess caseload over a period of a few weeks,
perhaps encompassing;
• Treatment of patients in the community by healthcare professionals other than their usual GP
• Treatment of patients in their own homes or intermediate care settings by their GP who, under usual circumstances, would have been admitted to hospital
• Treatment of severely ill cases in hospital by medical and nursing teams in areas of the hospital not normally used for providing such care.
Planning in Secondary Care
• Vaccination
• Anti-viral therapy for healthcare workers
• Infection control
• Capacity planning
Anti-virals
• Neuraminadase inhibitors – Oseltamivir, Zanamavir
• M2 Ion channel inhibitors – Amantadine
• Ribavirin
Infection control
• Timely recognition of cases• Preparedness, good stocks of disposables/equipment• Hand hygiene• Personal protection equipment• Containment of respiratory secretions• Triage and separation of cases
Infection control
• Restriction on health care workers• Restrictions on Patients• Restrictions on Visitors• Education of patients/visitors and staff• Occupational health, screening symptomatic workers• Non-clinical areas – laundry/linen
Infection controlSeparation
• Dedicated wards, adopting surgical beds• Reception areas• Visiting areas• Laboratory and X ray areas
Capacity
• Overall co-ordinator of hospital management during pandemic
• Supported by multi-disciplinary committee• Early discharge schemes• Triage• Cancellation of elective activity