Transcript National Response

Pandemic Influenza
The Australian Response
Professor John Horvath
Chief Medical Officer
Australian Department of Health and Ageing
Hayman Island – 27 August 2005
Pandemics have been
documented since 1889,
occurring in 10-40 year cycles
Historical anecdotes date
pandemic like events as far back
as 1100’s, some catastrophic
Makeshift Influenza Hospital
Avian Influenza Epidemic
- affected countries July 27
- Now also Mongolia and Russia
Avian Influenza Epidemic
Human Cases
• First human cases in 1997 in Hong Kong with 18 cases
and 6 deaths and again in 2002 with 3 deaths.
• Wide spread culling of poultry was carried out however
re emergence in 2003
• WHO notifications 112 cases with 57 deaths since 2003
Drug Resistance
H5N1 is to one class of the two types of antiviral medication
The most recent wave
In Vietnam & Cambodia
Changing epidemiological
pattern
- family clusters
- wider age range
- reduction in mortality
Genetic changes occurring
The risk of pandemic
is considered by
many to be increasing
IMPACT OF PANDEMIC STRAIN
IN AUSTRALIA
In Australia’s population with an attack rate of 25%
we would expect over 6 – 8 weeks
13,000 deaths (2,000 children, 7,000 elderly)
57,900 hospitalisations
2.6 million outpatient visits
(Meltzer CDC 2003)
Preparedness
2003
2005
Department of Health
• The National Incident Room upgraded
• Increased resources centrally development of
response plans and interagency roles
• High level representation on peak cmtees
• Scenario testing
Border (learning from SARS)
• Training for border workers
• Thermal scanners purchased
• Development of border protocols
- positive pratique
- customs
Preparedness
2003
2005
Surveillance
• Development of rapid on line surveillance
and case management tools
• Secure networks
Laboratory
• Upgrading of public health laboratory capacity
• Relocation and upgrading of the WHO
Collaborating Centre for influenza
Preparedness
2003
2005
Stockpile
• $150 M antivirals
• Additional antibiotics
• Infection Control Equipment (masks, gloves)
• Vaccination Packs
• Negative Pressure Units
• Quarantine Caches
Preparedness
2003
2005
Vaccines
• Two contracts, on soil and overseas
• Pandemic capacity plus research and development
• Recent additional funding to CSL Ltd
- fast track clinical trials (finalise Sept 06)
- immediate and potential stockpile
pandemic vaccine capacity
Preparedness
2003
2005
Communications package
• Information to general practitioners
• DVD on infection control
• Communications forums commencing
Review of urgent research needs
• NHMRC and DoHA
Development of Australian Management Plan for
Pandemic Influenza
Antiviral priority groups
Recommendations
The objective of the Australian antiviral
stockpile is to reduce mortality and
morbidity through containment of the
pandemic and maintenance of essential
services.
The best use of the antivirals will differ
dependent on the phases of the pandemic.
Antiviral priority groups
It is recommended that the antivirals
are used in the containment phase for
those who:
a. Are exposed to a person or animal likely to
be infected with pandemic influenza
b. Work in areas where there is high
likelihood of exposure
c. That a clinical efficacy study be preprepared and commence on onset of cases
in Australia
Antiviral priority groups
It is recommended that the designation of antiviral
priority groups is reconsidered both in containment and
essential maintenance phases frequently in relation to:
i.
ii.
iii.
iv.
v.
Location of cases
Rate of transmission
Attack rates in different age groups
Clinical severity in different age groups
Potential strategies for control (for example
isolated overseas outbreak)
vi. Depletion of antiviral stockpile
Many policy challenges
• Many health and social policy dilemmas:
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Degree of border control
School closures, banning of mass gatherings
International efforts to control disease
Quarantine of well contacts and areas of Australia
Communication approach
Level of social interaction at different phases
Priority groups of antivirals and then vaccines
• Maintaining essential services versus caring for the sick
THANK YOU