Victorian health management plan for pandemic influenza. July 2007

Transcription

1 Victorian health management plan for pandemic influenza July 2007

2 Victorian health management plan for pandemic influenza Published by the Communicable Disease Control Unit, Rural and Regional Health and Aged Care Services, Victorian Department of Human Services, State of Victoria 2007 This publication is copyright, however, whole or part thereof may be reproduced in the interests of public health provided that acknowledgement is made. This publication is available at the Internet address: Acknowledgements We would like to thank all the members of the Victorian Influenza Pandemic Planning Steering Committee and sub committees. Their generosity in giving up their time and expertise is greatly appreciated.

3 Victorian health management plan for pandemic influenza Chief Health Officer s foreword The threat of a pandemic has been in the news for some time, mainly because of the spread of avian influenza (bird flu) in parts of Asia, Africa and Europe. The greatest challenge involved in planning for a pandemic is that it is impossible to predict when it will occur and how virulent it will be. The best thing we can do is be prepared. The Victorian Government has developed a number of plans and will lead the State s response to a human pandemic. This plan aims to provide an effective health response framework to minimise the morbidity and mortality associated with an influenza pandemic and its impact on the Victorian community, health care system and the economy. This plan builds upon the foundation established by the Victorian influenza pandemic plan (November 2005) and plans developed by the Australian Government Department of Health and Ageing and the Australian Government Department of Industry, Tourism and Resources. The plan focuses on the containment of the virus and supporting and maintaining critical services. Containment means that, in the early stages of a pandemic, intensive efforts will concentrate on containing the virus to allow time for a pandemic influenza vaccine to be produced. Containment strategies may include reducing traveler numbers to Australia, social distancing and infection control measures, short-term home quarantine for those exposed to the virus and the targeted use of antivirals. Maintenance means that if the pandemic becomes widespread, efforts will concentrate on maintaining health and other services to keep society functioning until a pandemic vaccine becomes available or the pandemic abates. Public confidence in decision making processes at all stages of a pandemic is vital. The Victorian Government has been working closely with a range of government agencies at Commonwealth and local government levels, as well as professional, community and industry stakeholders, to ensure that organisations are prepared and that agreed processes are in place. While the Victorian Government has developed a number of plans and will lead the State s response to a pandemic, we need organisations and individuals to be properly prepared for this threat. I urge you to read this plan and ensure that you have plans in place to protect yourself and your organisation. Dr John Carnie Chief Health Officer, Victoria

4 ii Victorian health management plan for pandemic influenza

5 Victorian health management plan for pandemic influenza iii Contents Chief Health Officer s foreword Executive summary Section A: Introduction and background 1 1. Aim and objectives Aim Objectives 3 2. Background Disease description Transmission Infectious agents Emergence of new strains and sub-types 5 Section B: Planning and preparedness 7 3. Planning and preparedness Likely impact of an influenza pandemic in Victoria Influenza pandemic planning at national and global levels Influenza pandemic planning in the context of emergency management planning for Victoria Communication Clinical management Influenza pandemic planning for other agencies Surge capacity and business continuity Training and testing of the plan Review of the plan 15 i iv Section D: Appendices 43 Appendix 1 The impact of a pandemic 45 Appendix 2 Surveillance 46 Appendix 3 Hospitals and health services 49 Appendix 4 Mass fatality planning 58 Appendix 5 Community support and recovery issues 60 Appendix 6 Infection control 64 Appendix 7 Communication 70 Appendix 8 Mass vaccination guide 71 Appendix 9 Antivirals 83 Appendix 10 Isolation and quarantine arrangements 91 Appendix 11 Primary health care 95 Appendix 12 Ethical considerations 106 Appendix 13 Roles and responsibilities 108 Appendix 14 Key actions by Australian phases 112 List of abbreviations 122 Bibliography 124 Section C: Victorian influenza pandemic action plan Victorian influenza pandemic action plan Pandemic phases Victoria s approach to pandemic response Response at different phases 21

6 iv Victorian health management plan for pandemic influenza Executive summary An influenza pandemic occurs when a new viral strain appears which has had a significant antigenic shift to produce a sub-type for which there is little or no immunity in the population, and which is readily transferred between humans to produce infection in a high proportion of those exposed. Influenza pandemics are associated with high morbidity and significant mortality, and involve massive social and economic disruption. Three pandemics occurred in the twentieth century: in 1918, 1957 and Recent outbreaks of severe acute respiratory syndrome (SARS) and avian influenza overseas have brought the issues of pandemic preparedness to the forefront, as the possibility of a pandemic is real. While it is impossible to predict when a pandemic might occur, Victoria needs to be prepared. Planning and preparedness is the best way to mitigate the potentially serious consequences of an influenza pandemic. It is important that effective strategies for control be activated as early as possible in response to all potential pandemic threats 1. Early warning of unusual or unexpected influenza cases will rely upon a timely, reliable and effective animal and human influenza surveillance system. Influenza vaccines and antiviral drugs are essential components of a comprehensive pandemic response. Immunisation with a suitable vaccine during a pandemic will be a critical component of response strategies aimed at reducing resulting morbidity and mortality and social and economic disruption. Manufacture of the appropriate vaccine must be implemented as early as possible. As it will be impossible to vaccinate everyone at once during an influenza pandemic, priority groups must be identified in advance and quantified. Distribution of vaccines must be well planned and target the priority groups. Antiviral drugs play two principal roles in the management of influenza: prophylaxis, aimed at decreasing the likelihood of developing influenza; and treatment, aimed at reducing 1 Communicable Diseases Network Australia New Zealand 1999, A framework for an Australian influenza pandemic plan. Commonwealth Department of Health and Aged Care. Version 1. Canberra, Commonwealth Department of Health and Aged Care. Technical Report Series No. 4. the severity and duration of influenza. The indications for the use of antiviral medication should be clear and health professionals well acquainted with them. Distribution of antivirals must be well planned and target the priority groups. Primary health care (general practice, community pharmacy, community nurses, community health centres, and dental practice settings) will play an important role in providing information to the general public during all stages of a pandemic. All health services will need to develop a process for identifying, separating, triaging and admitting people with influenza to prevent cross-infection. The Department of Human Services will implement a Designated Hospital Model, which will include the implementation of influenza clinics when patient numbers increase, to minimise impacts on hospital emergency departments and general practice (GP) clinics. Effective communication during the various stages of a pandemic will be vital to minimise the impact on the social and economic infrastructure. Education of the community is a preventive measure that can be used to limit or slow the spread of an influenza pandemic throughout the pandemic phases. The Whole of Victorian Government Communication Strategy aims to maximise stakeholder engagement and existing networks. It targets a distinct but diverse group of key influencers who will channel the appropriate messages and planning actions through to their respective sectors. These key influencers include government departments, the health sector, local government, emergency services, infrastructure services, community services and business associations. This plan builds on the foundation established by the Victorian influenza pandemic plan (November 2005) and plans developed by the Australian Government Department of Health and Ageing and the Australian Government Department of Industry, Tourism and Resources. The change in the name of this plan from the Victorian influenza pandemic plan to the Victorian health management plan for pandemic influenza, is a step towards national consistency given the Australian Government Department of Health and Ageing plan is titled the Australian health management plan for pandemic influenza.

7 Section A: Introduction and background Victorian health management plan for pandemic influenza 1

8 Victorian health management plan for pandemic influenza

9 Victorian health management plan for pandemic influenza 3 1. Aim and objectives 1.1 Aim The aim of this plan is to provide an effective health response framework to minimise the morbidity and mortality associated with an influenza pandemic and its impacts on the Victorian community, health care system and economy. 1.2 Objectives To identify and detail the planning and preparedness activities needed to reduce the impact of an influenza pandemic in Victoria, including: a surveillance system that is able to detect emerging threats timely implementation of activities in the various phases of a pandemic rapid characterisation of a new virus sub-type and early detection, notification and response early containment through disease control measures limitation of morbidity and mortality maintenance of social functioning provision to the public, health care workers, the media and other service providers of timely, accurate information about the pandemic. To ensure intersectoral collaboration in the planning for, and implementation of, the Victorian health management plan for pandemic influenza. To detail the arrangements that will be put in place and actions that will be taken in the event of an influenza pandemic in Victoria. To detail the roles and responsibilities of the agencies involved.

10 4 Victorian health management plan for pandemic influenza 2. Background 2.1. Disease description Influenza is an acute respiratory disease caused principally by influenza type A or B viruses. Symptoms usually include fever, cough, lethargy, headache, muscle pain and sore throat. Infections in children, particularly type B and A (H1N1), may also be associated with gastrointestinal symptoms such as nausea, vomiting and diarrhoea. Clinical features in babies and children may result in fever alone, fever and cough, croup, poor feeding or features suggestive of meningitis. One of the earliest indicators of the influenza pandemics in Melbourne in 1957 and 1968 was an increased incidence of croup. The incubation period for influenza is usually one to three days. Adults have been shown to shed the influenza virus from one day before developing symptoms to up to seven days after the onset of the illness. Young children can shed the influenza virus for longer than seven days. Generally, shedding peaks early in the illness, typically within a day of symptom onset. 2 The influenza virus remains infectious in aerosols for hours, viability being facilitated by low relative humidity, and potentially remains infectious on hard surfaces for one to two days. Most symptoms resolve within two to seven days although the cough may persist longer. Complications of influenza include middle ear infection, primary viral pneumonia, secondary bacterial pneumonia, a range of rare nonpulmonary complications, and exacerbations of underlying chronic health conditions. Reye s syndrome is a rare complication of influenza involving central nervous system disturbance, coma and death in per cent of affected persons. It is associated with infections in children, infections with H1N1 strains and with the use of aspirin or other salicylates to treat influenza symptoms. Aspirin and other salicylates should not be given to children with fever due to influenza or an influenza-like illness Transmission Transmission of human influenza virus is mainly by droplet transmission. This occurs when droplets from the cough or sneeze of an infected person are propelled through the air (generally up to 1 metre) and land on the mouth, nose or eye of a nearby person 3. Influenza can also be spread by contact transmission. This occurs when a person touches respiratory droplets that are either on another person or an object and then touches their own mouth, nose or eyes (or someone else s mouth, nose or eyes) before washing their hands. In some situations, airborne transmission may result from medical procedures that produce very fine droplets (called fine droplet nuclei) that are released into the air and breathed in 4. These procedures include: intubation taking respiratory samples performing suctioning use of a nebuliser. Personal protective equipment Summary of personal protective equipment (PPE) use: To help protect oneself (for example, health care workers, poultry cullers), wear a full gown (or coveralls), gloves, eye shield and mask (P2 or surgical mask depending on activity). See Table 1 Summary of PPE for health care settings. To minimise the risk of infecting others, infected persons should wear a surgical mask. For detailed information on infection control, see Appendix 6. 2 Centres for Disease Control and Prevention, Key facts about the flu, 3 World Health Organization 2005, Practical guidelines for infection control in health care facilities, 4 World Health Organization 2004, WHO interim guidelines on clinical management of humans infected by influenza A (H5N1) int/csr

11 Victorian health management plan for pandemic influenza 2.3. Infectious agents Three types of influenza are recognised types A, B, and C although most human infections involve either type A or B. Type C, causes a common cold-like syndrome. Influenza viruses are named according to type, sub-type and antigenic characterisation. Only Type A viruses are sub-typed. Influenza A is the more important epidemiologically and is associated with pandemics. Within influenza A there are: 15 distinct forms of hemagglutinin (HA) designated as H1-H15 nine distinct forms of neuraminidase (NA) designated as N1-N9. HA and NA are viral surface proteins (referred to as antigens) recognised by the body s immune system and are involved in viral replication: HA is responsible for attachment to cell receptors following which infection occurs and then virus replication. NA digests the cell receptor allowing the newly synthesised virus to escape from the cell surface. There may often be more than one type/strain of influenza circulating, however, one strain will usually dominate in a given season/location Emergence of new strains and sub-types Influenza viruses undergo two types of antigenic change antigenic drift and antigenic shift. Antigenic drift Antigenic drift refers to small antigenic changes in the HA and NA surface antigens due to the high rate of mutation in the virus ribonucleic acid. This is an ongoing process, which results in new epidemic strains of influenza A and B virus. These minor antigenic changes often result in localised outbreaks or regional epidemics. Epidemics of influenza usually occur between late autumn and early spring and last for up to two months in individual regions but may also occur progressively across the country. Populations with high susceptibility to epidemic strains of influenza include the elderly, the chronically ill and children. Antigenic shift Antigenic shift refers to major change in the HA and NA surface antigens of influenza A, resulting in the evolution of pandemic strains. This may involve the process of genetic re-assortment between human and avian influenza viruses possibly taking place in animal populations. These events occur at widely spaced intervals of many decades. The majority of the pandemics of the 20th Century seem to have arisen in Southern China. Novel influenza A strains arising through antigenic shift are usually associated with pandemics, that is, rapid worldwide spread and a high incidence of infection and disease. However, the H3N2 strain arising in 1968 was an exception to this; the mildness of this pandemic is thought to result, in part, from protection against severe disease conferred by the pandemic of If the human population has not been exposed to the new sub-type, or has not been exposed to a similar sub-type for many years, it will be highly susceptible. An influenza pandemic is defined as a worldwide epidemic. Research has identified three prerequisites for the start of a pandemic A novel virus sub-type must emerge to which the general population will have no or little immunity. 2. The new virus must be able to replicate in humans and cause serious illness. 3. The new virus must be efficiently transmitted from human to human. Pandemics, as opposed to epidemics, occur globally at unpredictable intervals, are trans-seasonal, and can last for up to two to three years. 5 World Health Organization 2005, Avian influenza: assessing the pandemic threat, Pre-publication.

12 Victorian health management plan for pandemic influenza Previous pandemics have started abruptly without warning, swept through populations with ferocious velocity, and left considerable damage in their wake. They could not be stopped, but peaked rapidly and then subsided almost as abruptly as they began. Recovery was, however, impeded by the tendency of many pandemics to recur in second and sometimes third waves, often causing more severe disease. Subsequent waves often began simultaneously in several different parts of the world, intensifying the abrupt disruptions at the global level. 6 During the 20th century there were three recognised influenza pandemics (Spanish influenza ; Asian influenza ; and Hong Kong influenza 1968). All three pandemics were associated with increased mortality rates in Australia. The influenza pandemic of was unprecedented in terms of loss of human life. The illness was notorious for its rapid onset and progression to respiratory failure and death, and it is estimated that between 20 and 40 million people died worldwide, with the highest numbers of deaths among those aged between 20 and 40 years. By the end of 1919, 11,500 people in Australia had died of influenza, with 60 per cent of deaths in people aged 20 to 45 years. In these same age groups the male rates were 1.5 to twofold higher than in females. The Asian influenza of had infection rates reported to range between 20 to 70 per cent, but case fatality rates were low, ranging from one in 2000 to one in 10,000 infections. In Australia, mortality rates were two- to five-fold greater than in non-pandemic years. Age-specific mortality rates showed that those aged over 65 years were most affected. The Hong Kong influenza of 1968 had mortality rates similar in magnitude to those caused by the Asian influenza. Age-specific mortality rates were highest for those over the age of 65 years. Infection rates were around 25 to 30 per cent. The differences in past pandemics show the need for flexible contingency plans capable of responding efficiently to a pandemic threat. 6 World Health Organization 2005, Avian influenza: assessing the pandemic threat, Pre-publication.

13 Section B: Planning and preparedness Victorian health management plan for pandemic influenza 7

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15 Victorian health management plan for pandemic influenza 3. Planning and preparedness Planning and preparedness are essential to minimise the effect of an influenza pandemic on the Victorian community. This chapter outlines planning and preparedness that has occurred for pandemic influenza that is relevant to the State of Victoria and briefly describes planning at the local and national levels Likely impact of an influenza pandemic in Victoria Influenza pandemics have commonly been associated with attack rates of per cent of the population. However, attack rates of up to 70 per cent have occurred in some communities. Mortality, hospitalisations and staff absenteeism rates have increased substantially during pandemics. In the 1957 influenza pandemic in the United Kingdom, the recorded staff absentee rates in some organisations were between five and 30 per cent. Estimates of morbidity and mortality in Victoria Estimating the potential impacts of an influenza pandemic is difficult given we are unable to predict the virulence and infectivity of the particular strain involved, as well as the epidemiology of the specific strain and the rapidity and effectiveness of the response. In the absence of actual data on the specific strain, it is possible to model various pandemic scenarios given a series of predetermined assumptions and limitations. If a pandemic with an attack rate of 30 per cent (that is, 30 per cent of the population affected) were to occur in Victoria, and there was no pandemic vaccine or treatment available over a 6 8 week period, it could lead to: 2,265 10,145 deaths 6,236 24,323 hospitalisations 602, ,513 outpatient visits Influenza pandemic planning at national and global levels National planning In June 1999, the Influenza Pandemic Planning Committee (IPPC), a subcommittee of the Communicable Diseases Network of Australia (CDNA) developed A framework for an Australian influenza pandemic plan. This provided a strategic framework for the detection and management of pandemic influenza in Australia. Following publication of the framework, IPPC developed the Australian action plan for pandemic influenza 2003, which provided direction for the development of actions at Federal, state and territory, and local levels. The aim of the action plan was to increase awareness of national pandemic preparedness during the inter-pandemic period. The action plan indicated that the states and territories should prepare their own action plans. The action plan also provided guidance to health service providers and other agencies whose services are likely to be of critical importance during an influenza pandemic. One of the recommendations of the action plan was to establish the National Influenza Pandemic Action Committee (NIPAC). The role of NIPAC is to assist the Australian Government in progressing pandemic preparedness by providing expert advice on policy issues in the inter-pandemic period. In June 2005, the Australian Government Department of Health and Ageing (DoHA) released the Australian management plan for pandemic influenza. This document provides a detailed guide for the Australian response to a pandemic influenza threat. The plan targets the wide range of people who will be involved in planning and responding to an influenza pandemic: health planners, public health and clinical care providers, border workers, state and territory health departments, essential service providers and those in the media and communications. 7 These estimates are based largely on the work of Meltzer et al.

16 10 Victorian health management plan for pandemic influenza In May 2006, DoHA released an updated Australian health management plan for pandemic influenza, which builds on the 2005 plan and is a detailed national health action plan to guide Australia s response to pandemic influenza. It is designed to be accessible to a broad range of people and describes how pandemics occur, what the government is doing to prepare for a pandemic, what the government will do if it happens and what individuals, organisations and health practitioners can do to prepare. It is supported by a range of technical annexes that provide detailed information on issues such as infection control and clinical care. Additional annexes will be released regularly. It will be updated as new clinical evidence or other management strategies are developed. Global planning In April 1999, the World Health Organization (WHO) published the document, Influenza pandemic plan: the role of the WHO and guidelines for national and regional planning. The document was prepared to assist medical and public health leaders with their response to future threats of pandemic influenza. The document outlines the roles and responsibilities of WHO and national health authorities and pandemic planning committees. It defines the preparedness levels and phases of an influenza pandemic, and the various actions that will be undertaken by WHO and other health authorities in these periods. In May 2005, the WHO developed the WHO global influenza pandemic plan The role of the WHO and recommendations for national measures before and during pandemics. This plan updates, significantly revises and replaces the 1999 plan Influenza pandemic planning in the context of emergency management planning for Victoria While planning and preparation for illness/epidemics is part of the normal business activities of the Department of Human Services, the occurrence of an influenza pandemic will most likely constitute an emergency under the Emergency Management Act The Emergency management manual Victoria details the emergency roles and responsibilities of agencies in relation to the prevention, mitigation, risk reduction, response and recovery components of emergencies. The Department of Human Services, through the Public Health Branch, is the designated control agency for human illnesses/epidemics. Public health response The department s Public health emergency management arrangements (PHEMA) outlines the policies, procedures and emergency management arrangements for public health emergencies, including infectious disease incidents. The Victorian health management plan for pandemic influenza is a sub-plan of the PHEMA. Under the PHEMA, responsibility for controlling infectious disease emergencies, such as pandemic influenza, lies with the Communicable Diseases Control Unit of the Department of Human Services, with the Chief Health Officer (CHO) as the ultimate authorities. The Victorian health management plan for pandemic influenza also sits under the strategic framework of the Victorian human influenza pandemic plan (April 2007). Additional emergency management arrangements will also be put in place by the department to ensure clarity about the command and control of resources in responding to the incident, and that there is adequate communication within the department, the government, external agencies and the community. The National Medical Stockpile (NMS) was established by the Australian Government in 2002, initially as a national strategic reserve of essential vaccines, antibiotics, antiviral drugs, chemical and radiological antidotes. The NMS supplements existing medical stocks kept in the Australian health system and provides rapid access to large quantities of medications that may not be regularly used. The process to activate the NMS deployment plan is through application to DoHA. Each state/territory requesting agency has developed distribution plans, including details of security measures and arrangements for dispensing. Further details of this planning are included in Appendix 8 Mass vaccination guide and Appendix 9 Antivirals. Incident category classification The Department of Human Services emergency response arrangements will be put into place according to the scale/severity of the incident. The scope of an influenza pandemic will result in immediate classification as a high level incident, due to the need to manage issues

17 Victorian health management plan for pandemic influenza 11 across regions, statewide media interest, the need for a community call centre and management of whole of government interests. High level incidents activate the State Level Emergency Management Plan. The Executive Director, Operations, will command departmental statewide emergency management operations. The CHO will assume the role of Incident Controller, which may be delegated to an appropriate senior Public Health manager. The Emergency Coordination Centre will be activated to manage the department s response and recovery operations. Appropriate staff will be sourced to act as liaison officers representing response and recovery interests, assess and monitor the incident and its impacts, provide information and advice to senior management and Ministers, and maintain liaison with the State Government through the Central Government Response Committee. Coordination across and between governments The Australian Health Protection Committee (AHPC), formerly the Australian Health Disaster Management Policy Committee, is the key policy and coordinating body that plans for and responds to public health emergencies, communicable disease threats and environmental threats to public health. The AHPC reports to Health Ministers through the Australian Health Ministers Advisory Council. Membership of the committee, which is chaired by the Commonwealth Government, includes the Chief Medical Officer (CMO), the CHOs of the states and territories, the Chairs of each of the three sub-committees (Communicable Diseases Network of Australia (CDNA), Public Health Laboratory Network (PHLN) and the Environmental Health Committee), representatives of key government organisations involved in emergency management and response, and clinical experts and others to be co-opted as necessary. The AHPC is the key group responsible for high level, cross-jurisdictional collaboration in public health protection management planning, response, preparedness and recovery in relation to public health emergencies arising from either natural events or terrorist attack. The committee meets regularly and can be called together at short notice to respond to emergencies. The AHPC will be expected to meet in the development of a pandemic overseas and will meet urgently and regularly if a pandemic spreads to Australia. In a pandemic, the DoHA will provide advice to other agencies to trigger well-established emergency response arrangements. The CMO has a particular role to play as the key adviser to the Commonwealth Government on the development of a pandemic and on declaring the phases of the pandemic in line with the WHO model. The CMO is also the government s chief adviser on human quarantine, and has extensive powers under the Quarantine Act 1908, including the ability to restrict the movement of people in and out of Australia and within Australia to protect human health. Through the Council of Australian Governments, governments at all levels have recognised that the potentially broad-ranging social and economic impacts of a pandemic require a response from the whole of government, not just the health portfolio. In July 2006, the Council of Australian Governments issued a National Action Plan for a Human Influenza Pandemic, outlining how governments at all levels will cooperate in response to a pandemic. 3.4 Communication Effective communication during the various stages of a pandemic is vital to enable business and the community to minimise the impact on the social and economic infrastructure. Education of the community is a preventive measure that is used to limit or slow the spread of an influenza pandemic and is applicable throughout the pandemic stages. Communication strategy The Victorian Government has developed a Whole of Victorian Government Communication Strategy that maximises stakeholder engagement and use of existing networks. It targets a distinct but diverse group of key influencers who will channel the appropriate messages and planning actions through to their respective sectors. These key influencers include government departments, the health sector, local government, emergency services, infrastructure services, community services and business associations.

18 12 Victorian health management plan for pandemic influenza Research undertaken in Victoria has shown that these audiences require relevant and practical information that will empower them to develop their own pandemic plans and which is embedded in rational communications that are related to running their organisations as effectively as possible. There will be limited direct communication to the community during the preparedness phase, consistent with the research recommendations and the Australian Government s approach. Communication guiding principles Informed by research. Reach all Victorians by leveraging the reach and resources of key influencers. Accurate, consistent messages. Use existing communication channels and protocols wherever possible. Credible, trusted sources. Align with national plans. Communication objectives Mobilise key influencers across Victoria to prepare for a possible human influenza pandemic. Encourage all Victorians to take basic precautionary measures. Inform Victorians that the Victorian Government is leading the preparations for an influenza pandemic in this state. In most cases, where available, the CHO will be the spokesperson for the department. If unavailable, an appropriate senior Public Health manager may be appointed to this role. All media communication will occur through the Department of Human Services Media Unit, which will work with the Department of Premier and Cabinet to ensure a consistent, whole of government message. Advice on public messages will be communicated to the Department of Premier and Cabinet through the Media Unit, based on expert advice from Public Health Branch staff and the Emergency Operations Centre. A community call centre will be established to provide a central contact point for members of the public to obtain personal health and safety advice. The statewide Nurse on Call service may also act as an information outlet for concerned members of the community. DoHA has an information hotline for the general public that provides national information, as opposed to the local information provided by the community call centre. The DoHA information hotline number is The department s Health Service Coordination Centre (HSCC) is activated in an event that has a major impact on hospital capacity or demand, such as a mass casualty incident when the State Health Emergency Response Plan (Health Displan) requires coordination of health services to aid casualty management. The HSCC will provide coordination and a single contact point for health services. Further information about the HSCC can be found in Appendix 3 Hospitals and health services. 3.5 Clinical management All health services need to develop a process for identifying, separating, triaging and admitting people with influenza-like illness to prevent cross-infection. General practitioners (GPs) will also need to consider workload management and triage. To prevent the spread of pandemic influenza infection within hospitals, the department will implement a designated hospital model. This model includes the implementation of influenza clinics as patient numbers increase, to contain the transmission of influenza and to reduce the workload on hospital emergency departments and GP clinics. In the containment phase (the phases are detailed in Part 4 Victorian influenza pandemic action plan), confirmed cases will be treated with antivirals and close contacts, including health care workers, will be given antivirals as post-exposure prophylaxis. In the pandemic phase, antivirals will most likely be used as pre-exposure prophylaxis, to maintain health services. Decisions on this will need to be made at the time of a pandemic, based on availability of antivirals.

19 Victorian health management plan for pandemic influenza 13 Measures to increase social distance Measures to increase social distance, such as closure of schools and higher education centres and discouraging mass gatherings, will be considered during a pandemic. Closure of schools, child care, university and workplaces Infectious diseases can spread rapidly in schools, universities, child care centres and workplaces due to the close proximity of large numbers of people. It is not clear whether school children are responsible for a disproportionate amount of the disease transmission of pandemic influenza. Data on the effectiveness of school closures is limited. 8 Currently no data or analysis exists for recommending illness thresholds or rates of change that should lead to considering closing or reopening schools. Results of modelling suggest that closing schools does reduce the attack rate in children, and will reduce the overall attack rate effectively if school children were found to have a much higher risk of infection than adults. Mass gatherings Mass gatherings have the capacity to spread influenza among participants. Events that may need to be cancelled or closed include concerts or large sporting events. Other places of large gatherings that may also need to be closed or attendance staggered include venues such as casinos, cinemas, nightclubs and places of worship Influenza pandemic planning for other agencies The Department of Human Services has prepared this plan for Victoria. However, individual agencies (including government agencies and essential services) are responsible for ensuring that their own business continuity plans make provision for maintaining high priority activities, critical supply chain, staff and infrastructure in the face of predicted increased absentee rates associated with pandemic influenza. Health care providers (including hospitals and general practice) need to ensure that they have contingency plans to deal with an influenza pandemic. General practice, hospitals and primary health care will be at the forefront of the response to a pandemic, with increased clinical workloads and a need to strengthen and maintain infection control to reduce the chance of cross-infection of pandemic influenza from cases to patients and other staff. At the same time, all agencies and providers will be under pressure from staff absenteeism. Local government should also undertake influenza pandemic planning through their Municipal Emergency Management Committees, and all relevant emergency management stakeholders. The plans need to be interdependent Surge capacity and business continuity The very nature of an influenza pandemic will be unlike any other modern disaster and will create new challenges for business continuity planners. Business will need to rethink their existing continuity response strategies to cope with such an event. All agencies potentially affected by an influenza pandemic should consider their surge capacity/business continuity needs and plan accordingly. It is estimated that businesses should plan for per cent staff absenteeism at the peak of a pandemic. Staff absence can be expected for many reasons including: illness/incapacity voluntary or involuntary home quarantine staying home to care for ill family members staying home to look after children (as schools/child care centres may be closed) feeling safer at home fulfilling other voluntary roles in the community. 8 WHO Writing Group Nonpharmaceutical interventions for pandemic influenza, national and community measures. Emerging infectious diseases 12,

20 14 Victorian health management plan for pandemic influenza A pandemic may have other impacts on businesses, for example: shortages of supplies/inputs to produce goods and services the movement of people/goods may be delayed/ restricted by quarantine and isolation measures within Australia and overseas availability of services from key suppliers demand for services demand for some services may increase (for example, Internet access), while demand for others may fall (for example, certain types of travel) fuel and energy supplies may be disrupted to some locations at times temporary closure of venues/events financial implications. Workforce issues All agencies may be affected by staff absence. This will occur at a time when, for some agencies, the workload may be greater than normal. Key issues that agencies should consider include: establishing minimal staffing levels the need for staff to work in areas they are not formally trained in using volunteers, retired or trainee staff accommodation for staff in between shifts, if transport home is disrupted or not advised staff immunisation policy (for normal seasonal influenza vaccine) stockpiling of appropriate PPE and training on how to use PPE psychological support for staff. Particular issues for staff with occupational exposures to pandemic influenza and other essential workers who may be provided with antivirals and PPE include: availability of PPE and antivirals monitoring of staff for illness and adverse reactions to antiviral medications implementing rotations of staff on antivirals recorded dosing of antivirals. In June 2006, the Australian Government Department of Industry, Tourism and Resources released Being prepared for a human influenza pandemic A business continuity guide for Australian businesses and Being prepared for an influenza pandemic A kit for small businesses. The aim of these guides is to assist businesses in their own pandemic planning. Department of Human Services The department has identified key issues in surge capacity/business continuity needs including: Staffing issues associated with an influenza pandemic existing levels of technical and administrative staff will be decreased by an increased staff absenteeism associated with an influenza pandemic. Initially: there will be an increased demand for additional staff to be involved in the investigation and control functions of an influenza pandemic staff will be needed to backfill positions/programs vacated by staff who are involved in the response to the pandemic staff may be required for manning industry and community call centres. Contingency planning and other processes to deal with these issues include the following: The department s Business Continuity Plan identifies contingency arrangements that are in place to support the continuity of critical business activities in the event that normal processes are interrupted. This approach analyses the department s dependency on key resources and services. Contingency arrangements that provide alternative access to these critical resources enable the department to respond to an incident regardless of type or cause, including incidents resulting in high levels of staff absenteeism (such as an influenza pandemic).

21 Victorian health management plan for pandemic influenza 15 Staff will be seconded to the incident investigation and control team from other programs within the Communicable Disease Control Unit (CDCU). The department has identified staff with medical and nursing backgrounds, and other associated health professionals. These staff may be seconded to assist the department s response to the influenza pandemic, to backfill in the CDCU performing other essential functions or to staff the community and industry call centres Training and testing of the plan To maximise effectiveness of the plan, staff will require adequate training and the plan will require regular testing Review of the plan Due to the changing nature of influenza and changes within state and Federal planning, this document will be reviewed on an ongoing basis.

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23 Section C: Victorian influenza pandemic action plan Victorian health management plan for pandemic influenza 17

24 18 Victorian health management plan for pandemic influenza

25 Victorian health management plan for pandemic influenza Victorian influenza pandemic action plan Table 4.1: Pandemic phases Period Inter-pandemic Pandemic alert Global phase Pandemic 6 AUS 0 Australian phase Overseas 1 AUS 1 Overseas 2 AUS 2 Overseas 3 AUS 3 Overseas 4 AUS 4 Overseas 5 AUS 5 Overseas 6 AUS 6a AUS 6b AUS 6c AUS 6d Description of phase No circulating animal influenza sub-types in Australia that have caused human disease Animal infection overseas: the risk of human infection or disease is considered low Animal infection in Australia: the risk of human infection or disease is considered low Animal infection overseas: substantial risk of human disease Animal infection in Australia: substantial risk of human disease Human infection overseas with new sub-type/s but no human to human spread or, at most, rare instances of spread to a close contact Human infection in Australia with new sub-type/s but no human to human spread or, at most, rare instances of spread to a close contact Human infection overseas: small cluster/s consistent with limited human to human transmission, spread highly localised, suggesting the virus is not well adapted to humans Human infection in Australia: small cluster/s consistent with limited human to human transmission, spread highly localised, suggesting the virus is not well adapted to humans Human infection overseas: larger cluster/s but human to human transmission still localised, suggesting the virus is becoming increasingly better adapted to humans, but may not yet be fully adapted (substantial pandemic risk) Human infection in Australia: larger cluster/s but human to human transmission still localised, suggesting the virus is becoming increasingly better adapted to humans, but may not yet be fully adapted (substantial pandemic risk) Pandemic overseas: increased and sustained transmission in general population Pandemic in Australia: localised (one area of country) Pandemic in Australia: widespread Pandemic in Australia: subsiding Pandemic in Australia: next wave

26 20 Victorian health management plan for pandemic influenza 4.1 Pandemic phases The phases of this plan are aligned with the stages used in the Australian health management plan for pandemic influenza (May 2006) and the World Health Organization (WHO) phases used in the WHO global influenza preparedness plan (March 2005). Two phases may be referred to simultaneously, for example, one phase for what is occurring overseas and one phase for Australia. The phases are intended to guide actions rather than be a strict categorisation of the events. 4.2 Victoria s approach to pandemic response 4.3 Determination of phases The determination of global phases, including upscaling and downscaling, will be made by the Director-General of the WHO. The Australian phases will be designated by the Australian Government Department of Health and Ageing (DoHA), in particular the Chief Medical Officer (CMO), with advice from an expert advisory group. Victoria will take guidance from DoHA, as well as determining its own actions, by direction of its Chief Health Officer (CHO). Three major strategies are used within Victoria to respond to a pandemic threat. The aim of the strategies is to minimise the morbidity and mortality associated with the pandemic. They are: Preparedness Containment Maintenance of social function This refers to the readiness of arrangements to ensure that Victoria is well prepared. This refers to delaying transmission for as long as possible by border control measures, widespread adoption of good hygiene and infection control practices, isolation of cases, quarantine of contacts, and use of antiviral medication. When community transmission is established, containment is no longer feasible. Pre-exposure prophylaxis for priority groups will be important to maintain societal functioning.

27 Victorian health management plan for pandemic influenza Response at different phases Phase: Australia 0 Inter-pandemic period Status: Goal: No circulating animal influenza sub-types in Australia that have caused human disease Preparedness Department of Human Services Maintain the Victorian health management plan for pandemic influenza. Representation on National Influenza Pandemic Committee (NIPAC), Communicable Disease Network of Australia (CDNA) and Australian Health Protection Committee (AHPC). Vaccines/antivirals/PPE Encourage high coverage of influenza and pneumococcal immunisation in identified high-risk groups using current vaccines (these risk groups are outlined in Appendix 8). Maintain supplies of antivirals and have distribution protocols. Maintain appropriate supplies of personal protective equipment (PPE). Surveillance Participate in national surveillance of influenza and ensure appropriate application of CDNA case definition for laboratory confirmed influenza. Maintain laboratory capacity for influenza surveillance. Monitor trends in deaths from all causes. Support routine inter-pandemic surveillance human surveillance. Sentinel surveillance for influenza-like illness includes: sentinel general practitioners throughout Victoria the Melbourne Metropolitan Locum Service. These occur during the influenza season May October, to be extended in 2007 from February November. Notification by laboratories and practitioners of laboratory confirmed influenza to the Communicable Disease Control Unit (CDCU). Communication Department of Human Services to keep a watching brief on overseas and interstate activity and liaise with other jurisdictions, including the DoHA. Ongoing engagement of stakeholders to ensure key groups are aware of developments and adequately prepared. Maintain communication strategy and supplementary material/website. Community support and recovery Department of Human Services branches and regions Work with local government authorities to assist with influenza pandemic planning. Work with health care providers to assist with influenza pandemic planning. Facilitate influenza pandemic planning within the regions and program areas. Local government Undertake influenza pandemic planning. Make provisions for business continuity in the face of increased absenteeism and demand on services. Promote vaccination for influenza and pneumococcal vaccine for the identified high-risk groups. Department of Primary Industries Animal surveillance: Notification by owners, veterinarians and laboratory staff of avian, swine and equine influenza to an Inspector of Livestock, Department of Primary Industries (DPI).