Transcript Slide 1
Country Situation: Avian/Pandemic Influenza Preparedness Preparedness In for India Avian/Pandemic Influenza in India By DR Shashi khare Dr. Shashi Khare NICD Delhi. NICD Delhi. Influenza Pandemic • An influenza pandemic (global epidemic) occurs when a new virus subtype appears, against which no one is immune. • Several simultaneous epidemics worldwide with large numbers of cases and deaths. • Spreads rapidly around the world in view of global transport and urbanization. Pandemic Influenza Uniqueness • Limited resources because of widespread influenza pandemic 300 Bombay Madras Calcutta 200 150 100 50 0. 19 . 10 . 2.1 1. 16 . 11 . 30 . 11 . 14 . 12 28 . 12 . 5.1 7.9 21 .9 24 .8 10 .8 27 .7 13 .7 0 29 .6 deaths/1000 250 15 .6 • Reduced availability of Health-care workers and first responders Influenza -Weekly Death Rate in India 1918 1.6 • Will last much longer than most other emergency events with “waves” of influenza activity separated by months Week ending Consequences of the Influenza Pandemic Livelihoods • Income loss due to market changes Human Health • High illness & potentially higher death rates • Overstretched health facilities • Disproportionate impact on vulnerable groups Governance & Security • Higher public anxiety • Increased demand for governance & security • Reduced capacity due to absence and illness Social & Humanitarian Needs Economic Systems • Deterioration of coping & support mechanisms • Interruption in public services • Quarantine policies • Trade & commerce disruptions • Labour shortages • Interruption of regular supply systems Definition of WHO Pandemic Phases Note: 2005 definitions simplify and replace 1999 definitions • Pre-Pandemic Period Phase 1 – no avian virus poses a significant risk to human Phase 2 – new avian virus a risk to human poses Human infection • Pandemic Alert Period Current phase Phase 3 – but no human-to-human transmission Phase 4 – limited human-to-human transmission Phase 5 – human-to-human spread, larger clusters, but still localized • Pandemic Period Phase 6 – Transmission sustained, global spread Pandemic Preparedness - Strategies • Planning activities started in 2004 • Highest Political commitment • National Consultation • Multi sectoral involvement • Knowledge gap filled through WHO guidelines WHO Strategies Objectives according to the different periods • Pre-Pandemic Period 1 – Reduce opportunities for human infection 2 – Strengthen the early warning system • Pandemic Alert Period 3 – Contain or delay spread at the source • Pandemic Period 4 – Reduce morbidity, mortality, and social disruption 5 – Conduct research to guide response measures 6 - Minimise the impact of pandemic WHO Strategy Actions according to the different phases • Pre-Pandemic Period FAO/OIE AVIAN INFLUENZA CONTROL RESEARCH / INDUSTRY VACCINE DEVELOPMENT Pandemic Period PANDEMIC PREPAREDNESS WHO ANTIVIRAL GLOBAL STOCKPILE • COUNTRIES Pandemic Alert Period SURVEILLANCE • WHO Global Strategy Agreed Nov 2005 1 Stop influenza in animals through stamping out the disease at the place where the infection starts 2 Prevent emergence of pandemic by limiting human exposure; • if pandemic does start, contain it quickly; • if containment is not possible, mitigate pandemic consequences. 3 Countries in lead: Support from Global Partnership Pandemic preparedness: interventions • Pharmaceutical: use of antiviral drugs, vaccine & escalated medical services • Non-Pharmaceutical: personal Hygiene, PPE, travel restriction, social distancing, quarantine & risk communication Multisectoral & community Cooperation Requires strong leadership & Support of Govt. GETTING PREPARED 1 • GOALS – Early Detection, Investigation and Confirmation, Containment • STRATEGIES – Social distancing, personal protection, movement restriction, maintenance of essential infrastructure – Systematic use of anti-viral therapy (oseltamivir) – Rapid development and equitable distribution of effective vaccines (Major controversy: will poor countries have access) GETTING PREPARED 2 • APPROACH – Plan to mitigate effects of pandemic on Local Communities: Economies, Governance, Basic Needs, Border Movements – Build Resilience through high level of popular awareness, understanding and engagement – Government reaching out to and working with Private Entities and Voluntary Bodies – Government and voluntary bodies preparing for large scale Humanitarian Relief GETTING PREPARED 3 • PROCEDURES – Robust information systems established – Protocols developed for use of stockpiles, emergency operations – Civil society, NGOs, local government, Private Sector synchronized – Systems for disseminating information to public via media developed and tested – Continuity plans for different entities simulated and lessons applied – Concept for putting multiple plans into practice, together, developed and put to test Need for preparedness • Reduction of transmission of the pandemic virus strain • To decrease cases, hospitalizations and deaths • Maintenance of essential services • Reduction of economic and social impact Pandemic Preparedness - Strategies • Planning activities started in 2004 • Highest Political commitment • National Consultation • Multi-sectoral involvement • Knowledge gap filled through WHO guidelines Multisectoral Approach • Involvement of government sector at many levels, and people with various specialties: Policy development, legislative review and drafting Animal health Public health Patient care Laboratory diagnosis, research & development Risk communication Disaster management Multiple Sectors involved(1) • Human Health: Contain the pandemic Medicines, Commodities, Equipment, R and D, Patient Care, Lab services • Financial Services: Keeping financial systems going Banking (cash and settlements), financial regulation, risk management and insurance • Utilities, Personal Services: Electricity, Water, Food, Telecoms, Postal services, Retailing (Catering for the needs of the most vulnerable) • Transportation– Logistics, Business, Leisure: Supply systems Air, sea, rail; Ports; Pilgrimages; Sports and other events; Tourism Multiple Sectors involved(2) • Government, Security, Military: Public Services, Rule of law, Judiciary and Correction, Private Security, respect for rights • Information Management: Transparency Strategic communication; Broadcast and print; Good use of internet • Environment and hygiene Biosecurity: Cleaning, Maintenance, refuse management, wildlife • Food and Livestock Production Growing, Processing, Marketing and Distribution of animal meat for human consumption Preparedness for Avian/ pandemic influenza in India National Scenario • India-7th largest country areawise • 2nd most populated (1 billion+ popn.) • High Population Density in urban settings • Major poultry sector- ranks among the top 5 nations in egg production in the world • 1,00,000 wet lands National Scenario (contd) • Falls on the route of two major flyways of migratory birds • AI entrenched in SEA • 1918 outbreak killed 7 million people with one of the highest CFR • An influenza pandemic would have substantial impact on the growing economy . Preparedness for AI in India • Inter Ministerial Task Force & Joint Monitoring Group • Contingency Plan finalised • Training of RRTs • Stockpiling of drugs, PPE & critical care equipments • Laboratory strengthening & Networking – ICMR & IDSP Labs • Surveillance for seasonal influenza • International Partnership on Avian & Pandemic Influenza (IPAPI) Meet – 4-6 December 2007, New Delhi • Risk communication Legal and Institutional Frame work • • • • • • • • National Disaster Management Act-2005. National Disaster Management Authority established 2006. National Crisis Management Committee. National Influenza Pandemic Committee. Inter-ministerial Task Force for Sectoral Coordination. Joint Monitoring Group for monitoring. National Task Force on Communications in I& B ministry Technical Committee for Laboratory Strengthening, vaccines, Import of poultry Products etc. Operational Frame-work • Ministry of Health: Nodal Ministry for Biological Disasters at National level including AI • Dept of Animal Husbandry: focal point for Animal Health • State Health and Animal Husbandry Departments: nodal agencies in states to operationalize State plans • District authority: implementing agency at grass root level • Disaster Management Authorities: National, State and District level Proposed AI Lab network Referred samples Provides Resources IGMC Shimla CRI Kasauli SGPGI Lucknow Reference Lab. IPM Hy d era ba d Refer enc e La b. IDSP NIV, Pune NIC National Lab. NICD ManipalMed College NIMHANS Bangalore Reference Lab. National Lab. J IPMER Po nd ich er ry Ha ffkines Mum ba i Reference Lab. BJ Med College Ahmedabad Reference Lab. Risk Communication • UNICEF with MOHFW has developed material targeted at three communication clusters: – preventing an outbreak – controlling an outbreak – emergency response to pandemic. • Communication tools have been identified and creative ideas being further refined IEC MATERIAL Situation of AI Outbreak in INDIA Avian Influenza Outbreaks in India Year Affected States 2006 Maharashtra Gujarat Madhya Pradesh Manipur 2007 2008- 09 Tripura, Assam, West Bengal contd.. 2009 Sikkim No human case reported in India Avian Influenza Outbreaks in Poultry, India 2008 Dated: 17 December 2008 North Tawang Dhemaji East Kameng Sikkim Sikkim Sikkim NEPAL BHUTAN Darjeeling Darjeeling Darjeeling Jalpaiguri 59 59 59 Supaul Araria Bihar Bihar Bihar Begusarai DINAJPUR DINAJPUR DINAJPUR DINAJPUR DINAJPUR DINAJPUR Banka Mon Mokokchung KURIGRAM KURIGRAM KURIGRAM KURIGRAM KURIGRAM KURIGRAM RANGPUR RANGPUR RANGPUR Wokha Nagaon Nagaland Nagaland Nagaland Dimapur West Khasi Hills JOYPURHAT JOYPURHAT JOYPURHAT JOYPURHAT JOYPURHAT JOYPURHAT NAOGAON NAOGAON NAOGAON BAGURA BAGURA BAGURA BAGURA BAGURA BAGURA Phek Kohima Meghalaya Meghalaya Meghalaya West Garo Hills North Cachar Hills East Khasi Hills South Garo Hills Fresh Outbreaks Nov-Dec 2008 Tuensang Karbi Anglong Jaintia Hills JAMALPUR JAMALPUR JAMALPUR JAMALPUR JAMALPUR JAMALPUR Godda Pakur 35 35 35 East Garo Hills 20 20 20 English Bazar Sahibganj Outbreak April - June 2008 58. Ranaghat - II 62. Kurseong 63. Bijanbari LALMONIRHAT LALMONIRHAT LALMONIRHAT LALMONIRHAT LALMONIRHAT LALMONIRHAT South South South Dinajpur Dinajpur Dinajpur 21 21 21 49 49 49 Lakhisarai Jamui Chirang Chirang Chirang Chirang Chirang Chirang Barpeta Barpeta Barpeta Nalbar Nalbar Darrang Nalbar Nalbar Nalbar Sidli Chirang Pachim Bongaigaon Bongaigaon BongaigaonBajali Nalbari Nalbari Nalbari Nalbari Boitamari Bezera Morigaon Hajo Kamrup Kamrup Metro Metro Metro Kamrup Metro Kamrup Kamrup Metro Dhubri Kamrup Kamrup Guwahati Kamrup Goalpara Gobardhana Rampur Rani Ri Bhoi NILPHAMARI NILPHAMARI NILPHAMARI NILPHAMARI NILPHAMARI NILPHAMARI Malda Malda Malda Bhagalpur Munger Sibsagar Jorhat Sonitpur A A S S S S A A M M 40 40 40 THAKURGOAN THAKURGOAN THAKURGOAN THAKURGOAN THAKURGOAN THAKURGOAN Purnia Katihar Fresh Outbreak in WB, Dec 2008 Khagaria 41 41 41 PANCHAGHARH North Dinajpur Madhepura Fresh outbreak Assam Nov-Dec 2008 Dibrugarh Dibrugarh Dibrugarh Lakhimpur Kokrajhar Cooch Cooch Cooch Behar Behar Behar Kishanganj Darbhanga Samastipur Arunachal Arunachal Arunachal Pradesh Pradesh Pradesh 62 62 62 62 62 62 63 63 63 63 63 63 Madhubani Dibrugarh West Kameng East SHERPUR Senapati NETROKONA NETROKONA NETROKONA NETROKONA NETROKONA NETROKONA SUNAMGANJ Cachar SYLHET SYLHET SYLHET SYLHET SYLHET SYLHET Ongoing Outbreaks in Bangladesh since 2007 Ukhrul Tamenglong Karimganj Manipur Manipur 03 03 03 Manipur Hailakandi MOULVI MOULVI BAZAR BAZAR BAZAR MOULVI BAZAR MOULVI MOULVI BAZAR RAJSHAHI RAJSHAHI RAJSHAHI 48 48 48 RAJSHAHI RAJSHAHI 05 Churachandpur 05 09 09 10 09 10 1005 Giridih HABIGANJ NATORE NATORE NATORE NATORE NATORE SIRAJGANJ 13 08 13 08 61 61 North Kolasib 08 61 12 12 13 12 TANGAIL TANGAIL TANGAIL KISHOREGANJ MYMENSINGH TANGAIL TANGAIL TANGAILMYMENSINGH MYMENSINGH Deoghar Dumka MYMENSINGH MYMENSINGH 06 06 57 57 Tripura 06 57 Murshidabad Murshidabad Murshidabad GAZIPUR GAZIPUR GAZIPUR GAZIPUR GAZIPUR Jharkhand Jharkhand Jamtara 54 54 36 36 36 14 14 54 Jharkhand 14 PABNA PABNA PABNA PABNA PABNA PABNA 04 04 04 56 56 56 07 07 07 27 27 West Tripura NARSINGDHI NARSINGDHI 27 B. B. Baria Baria Baria NARSINGDHI 47 47 B. Baria NARSINGDHI NARSINGDHI B. 47 B. Baria Tripura Tripura Aizawl Birbhum Birbhum 34 34 34 Tripura MANIKGANJ MANIKGANJ 23 MANIKGANJ Dhanbad KUSHTIA KUSHTIA 23 MANIKGANJ MANIKGANJ KUSHTIA KUSHTIA KUSHTIA 31 31 Birbhum DHAKA DHAKA 31 DHAKA DHAKA DHAKA 22 22 22 23 Mamit 17 17 17 02 02 02 24 NARAYANGANJ NARAYANGANJ 24 NARAYANGANJ NARAYANGANJ NARAYANGANJ 11 11 18 55 55 18 18 24 11 55 16 16 16 32 32 32 CHUADANGA RAJBARI RAJBARI RAJBARI RAJBARI South RAJBARI RAJBARI Bokaro Mizoram Mizoram 37 37 Mizoram 37 15 15 15 Tripura 28 28 28 43 43 01 43 COMILLA 01 19 19 01 19 29 29 29 JHENAIDAH JHENAIDAH JHENAIDAH MUNSHIGANJ MUNSHIGANJ MUNSHIGANJ MUNSHIGANJ MUNSHIGANJ 25 25 25 Outbreak 39 39 39 MAGURA MAGURA MAGURA MAGURA MAGURA FARIDPUR Serchhip June 2008 Burdwan Burdwan Burdwan Purulia Purulia Purulia 58 58 CHANDPUR CHANDPUR CHANDPUR 58 CHANDPUR CHANDPUR CHANDPUR 42 42 55. Bishalgarh 42 Bankura Bankura Bankura Nadia Nadia Nadia BANGLADESH Imphal Imphal Imphal 2007 2007 2007 Chandel MYANMAR Saraikela Bengal West West West Bengal Bengal East Singhbhum (Jamshedpur) hbhum sa) Midnapore Midnapore Midnapore West West West 38 38 38 Hooghly Hooghly Hooghly 52 52 52 24 24 24 Parganas Parganas Parganas 50 50 50 North North North Howrah Howrah Howrah 44 44 51 51 5144 Kolkata 45 45 45 Midnapore East Mayurbhanj Balasore Map not to scale 46 46 46 26 26 26 24 24 24 Parganas Parganas Parganas South South South JESSORE JESSORE JESSORE JESSORE JESSORE JESSORE GOPALGANJ GOPALGANJ GOPALGANJ GOPALGANJ GOPALGANJ GOPALGANJ BARISAL BARISAL BARISAL BARISAL BARISAL BARISAL SATKHIRA SATKHIRA SATKHIRA SATKHIRA SATKHIRA SATKHIRA NOAKHALI NOAKHALI NOAKHALI NOAKHALI NOAKHALI NOAKHALI KHULNA KHULNA KHULNA KHULNA KHULNA KHULNA BARGUNA BARGUNA BARGUNA BARGUNA BARGUNA BARGUNA Lunglei RANGAMATI BHOLA BHOLA BHOLA BHOLA BHOLA BHOLA PATUAKHALI PATUAKHALI PATUAKHALI PATUAKHALI PATUAKHALI PATUAKHALI 56. Mohanpur 57. Salema KHAGRACHARI PEROJPUR BAGERHAT FENI FENI FENI FENI FENI FENI CHITTAGONG Lawngtlai Tinsukia Tirap Human surveillance in affected area • Micro planning at block level (house to house activity ) - 0-3 KM daily – 3-10 KM bi-weekly • Screening of PUI /suspect at each level – Surveillance worker to medical officer – Medical officer to RRT members • Mechanism for collection and transportation of human sample (s) • Surveillance workers – Protective equipment – chemoprophylaxis Selected public health measures • Bird Handlers /Cullers – Use of Personal Protection Equipment – Chemoprophylaxis with Oseltamivir – Daily health check up • Quarantine – During culling – Post culling period Institutional set up • Identification of designated institution – Block Primary Health Center with isolation facility – Referral sub-divisional /district hospital with facility for critical care (27 such hospital are already set) – ID hospital at state level with facility for critical care • Capacity building of human resources – 54 nos of state RRT trained by GoI – 1st and 2nd line of state RRT allocated for each district • Arrangement of transport facility for shifting of patient. • Arrangement for sending clinical samples. IEC Materials used during Outbreak • Interpersonal communication with the community members • Leaflets containing essential messages • Posters & Handbills • Audio / Video CD’s & Short films for circulation through local cable channels • Public messages through ‘news dailies’ • Information through DOHFW website • IEC materials prepared in collaboration with UNICEF • CD containing TV clippings and short film for circulation through local cable channel Lessons Learnt • Inadequate inter-sectoral coordination • Problem in total destruction of backyard poultry • Surveillance of infection in poultry/birds to detect early focus – need strengthening • Quarantine – difficulty in operationalization • Infection control practices – use of PPE in hot & humid atmosphere • IEC – need strengthening Unsafe practices IEC material AI/ PI Plans • National Pandemic Preparedness Plan • Contingency plan for managing avian influenza in poultry • Contingency Plan for management of human cases of avian influenza AI/ PI Plans: Objectives • International, National, State & District Level co-ordination. • Identification of roles & responsibilities of all stake holders. • Prevent /delay entry of novel virus • Stamp out the disease if appearing in small clusters • Institutionalizing mechanism for developing sufficient quantity of vaccines. • Availability of adequate quantity of anti-viral drugs Critical Issues in the Pandemic Plan • • • • • • • • Sectoral Coordination Surveillance Augmenting critical care Stockpiling of drugs Management of Mass casualties Disposal of dead bodies Border/ Port/ Airport Control Imposing trade and travel restrictions India’s Pandemic Preparedness plan Scenario 2- India involved We have to face it ? Estimated Time Frame? It would be unrealistic for any state/ country to consider that it could prepare and implement a detailed and comprehensive pandemic plan in weeks, or even months. Time is now Start preparing Balanced Approach – the best Strategies that employ all aspects of the preparedness will have the greatest likelihood of success – Building healthy public policy – Creating healthy environments – Strengthening community action – Building personal skills – Reorienting health services Maintain significant investment in research and effective intervention strategies. Action springs not from thought, but from a readiness for responsibility G.M.Trevelyan (1876-1962) Actions to be taken at Industry Level 3 main aspects of preparedness at industrial level • Information & Technology • Infrastructure • People / Employee Information & Technology • Strengthened the key communication services such as email etc.. • Increased capacity for employees to work from home • Enhancement of Remote conferencing( eg: 24x7 outbreak monitoring cell NICD) • Distance / elearning platform for educating employees on behavior during pandemic should be incorporated by all industries It is important to build and test redundancy during non pandemic times. Infrastructure • Workplace preparedness Protocols on social distancing Protocols on seating inside the office to ensure a distance of minimum one meter from next employee Closure of common areas, meeting rooms, cafeteria etc Wash rooms with proper ventilation with doors opening inside Identification / equipping employee quarantine room in each location Protocols on “Deep” cleaning of workplace Training employees to maintain respiratory hygiene at workplace People / Employee In the services business people are the most critical resource, during a pandemic the dependency on critical resources will increase multifold • Identification of critical skills • Procured supply of Personal Protective Equipment • Protocols on Self evaluation mechanism for employees • Methodology for identification of Backup resources • Work from home Strategy • Distribution of IEC material to the employees Thank You Long wait for vaccine Influenza epidemic, New York, 1947. Times photograph • Prevention is easy…. but where is the vaccine