Transcript Slide 1

The clinical impact of influenza
in the tropics / subtropics
Oh! It’s just the flu
Influenza: Seasonal, HPAI, Pandemic
Seasonal
Influenza
Highly
Pathogenic
Pandemic
Influenza
Avian Influenza
Etiology
Influenza A (H3N2,
H1N1)
Influenza B
Pathogenic to
humans:
H5N1, H7N7
A new subtype
mutated H5N1
capable of
human- to -human
transmission
transmission
Incubation
Period
2 to 3 days
3 days
(range 1 to 7 days)
(range 2 to 4 days)
?
Influenza: Seasonal, HPAI, Pandemic
Seasonal Influenza
Highly Pathogenic
Pandemic Influenza
Avian Influenza
Exposure
from persons
infected
infected birds
with the usual
circulating
from persons
infected
with a new virus
subtype
subtype, strains
may vary
Clinical
manifestations
fever, respiratory
manifestations,
may or may not
progress
Fever, respiratory
manifestations, 5070% fatality, rapid
progression
Fever, respiratory
manifestations,
severity to be
determined
Influenza: Seasonal, HPAI, Pandemic
Seasonal Influenza
Highly Pathogenic
Pandemic Influenza
Avian Influenza
Who are at risk
of
complications
young children,
persons > 50 y/o,
with co-morbidities
those with contact Uncertain
with infected birds
Vaccine
yearly vaccine
strains
None
none
Treatment
supportive, antiviral
agent
supportive,
antiviral agent
supportive, antiviral
agent, if new virus
subtype is not
resistant
What is Avian Influenza?
• An infectious disease in
chickens, ducks and other birds
caused by different subtypes of
the influenza A virus
– Ranges from mild infection to
acute, fatal disease
– Two types depending on severity
of illness:
• Highly Pathogenic Avian
Influenza (HPAI)
– With mortality in poultry as
high as 100%
• Low Pathogenic Avian
Influenza (LPAI)
– Clinical signs much less
evident or even absent
– Mortality much lower
Recent cases of human infection
caused by avian influenza viruses
1997 - H5N1 - first human cases seen in Hong Kong in
18 cases, 6 human
1999 – H9N2 - Hongkong, I human case, mild infection
2003 – H5N1 – Hongkong – 2 human cases, 1 death
H7N7 – The Netherlands, hundreds with
conjunctivitis, ILI , 86 confirmed,
3 cases w/ human-to-human
transmission, 1 human death (a
veterinarian)
H9N2 – Hongkong – 1 human case, mild infection
H5N1 - South Korea, Japan – death of chickens,
no human case
2004 - H5N1 - human cases and death in Vietnam and
Thailand.
Spread from one country
to another

international trade in live poultry – game
fowl, breeders

migratory waterfowl –wild ducks –
- natural reservoir of bird flu viruses
- the most resistant to infection
- healthy carriers to great distances through
their droppings
• China
• Hong Kong
• Vietnam
• Thailand
• Indonesia
• Cambodia
• Lao PDR
• Pakistan
• South Africa
• Malaysia
• North Korea
•Japan
**Russia (7/18/05)
**Kazakhstan(7/22/05)
**Mongolia(8/10/05)
Total poultry
mortalities /
slaughtered
fr Jan‘04–Sept 30’05
63.2 million birds
Confirmed human cases of avian influenza
A(H5N1), 26 Dec ’03 - 13 March ‘06
Cases
Deaths
Cambodia
4
4
China
15
10
Indonesia
29
22
Iraq
Thailand
Turkey
2
22
12
2
14
4
Vietnam
93
42
Total
177
98
Reference: WHO
CFR = 55%
How bird flu spreads within a country
•
•
•
•
Domestic birds can get the infection when they roam freely
and share water supply that that might be contaminated by
infected droppings
Contaminated equipment, vehicles, feeds, cages, or clothing,
especially shoes can carry the virus from farm to farm
Wet markets -live
chickens and other birds
in crowded and often
unsanitary conditions
Movement of infected
birds -trading or
smuggling
Strait Times, Singapore Website
Transmission to humans
• Close contact with live infected
birds through infected aerosols,
discharges and surfaces
• Birds excrete the virus in their
feces, which dries and becomes
pulverized, and is then inhaled
• Flapping of wings hastens the
transmission
Social, economic and political
implications
– Economic loss in agriculture and the
poultry industry
– Loss of livelihood of small-scale poultry
players
– Threat to food security
– Widespread public anxiety
– Global and national attention on
government’s response
Human Public Health
Implications
• High mortality of H5N1 to humans
•
Emergence of a new influenza virus with
pandemic potential
- Efficient human to human transmission
- Vast majority of people have no immunity
- No protective vaccine/ Inadequate
quantity of developed vaccines for the
world
-High number of cases and deaths
worldwide (pandemic)
Avian Flu and Influenza Pandemic,
Impact
•
•
•
During the current H5N1 > 150 million birds culled
or died: direct economic cost to affected countries
$8-12billion
Next pandemic may cause very high morbidity and
mortality in few weeks. It could cause 1 billion
cases and 2-7 million deaths
A modest pandemic lasting over one year might
cause losses as high as 3% of Asia GDP and 0.5%
of world GDP. Presently equivalent to a loss of $
150-200 billion in GDP
The SARS experience and the influenza
pandemic
•Economic impact of the six-month SARS epidemic:
Asia-Pacific region at about $40 billion.
Canadian tourism- $419 million.
Ontario health-care system -$763 million,
Flights in the Asia-Pacific area decreased by 45
% from the year before, the number of flights
between Hong Kong and the United States
fell 69 %
•The impact of SARS would pale in comparison to that of
a 12- to 36-month worldwide influenza pandemic.
Influenza Pandemics in 20th Century
Credit: US National Museum of Health and
Medicine
1918: “Spanish Flu”
20-40 million deaths,
20-50 y/o
A(H1N1)
Avian source
1957: “Asian Flu”
1-4 million
deaths, infants
and children
A(H2N2)
1968: “Hong Kong Flu”
1-4 million
deaths
A(H3N2)
Recombination of human
and avian influenza viruses
Influenza Pandemics:
Why are we concerned now?


3 pre-requisites to start an influenza pandemic:
1.
Emergence of a new virus to which all are susceptible;
2.
Virus is able to replicate and cause disease in human;
3.
New virus is transmitted efficiently from human-to-human
H5N1 virus, is the potential candidate, but 3. not
fulfilled yet

Geographical extent of the problem

Reservoirs of infection expanding (range of wild birds and
ducks) and virus changing

Number of human infections increasing (c/f last year)
Past Influenza Pandemics
1847
1850
42 yrs
1889
1900
29 yrs
1918
H1N1
30 – 40 years cycle
39 yrs
1950
H2N2
H3N2
2000
1957
1968
11 yrs
No Pandemic for > 38 years
Signs and symptoms in humans
•
A (H5N1) infection very similar to other influenza
viruses, most are self-limiting
•
Initial symptoms are fever, malaise, myalgia, sore
throat and cough.
•
Conjunctivitis in some patients
•
Persistently high fever
•
Complications and death due to severe pneumonia,
respiratory distress syndrome and multi-organ
failure.
Individuals at risk
In areas where H5N1 has been reported or is
suspected






Poultry handlers/workers
People living near poultry farms
Sellers/people involved in live chicken sale
Aviary workers
Ornithologists
Cullers involved in destruction of poultry
Diagnosis
•
If the patient has had direct or indirect contact
through handling or having taken care or getting
near sick chickens or other birds.
•
A laboratory confirmation of the bird flu infection
and epidemiologic link with unusual death or
epidemics of chickens will support the diagnosis
of bird flu.
Prevention
•
•
•
•
•
Hand hygiene
Cleaning and disinfection
Avoiding contact with wild birds
Safe food practices
Practice of proper hand washing and cleaning
and disinfection procedures in poultries
Vaccination
No vaccine developed against H5N1
Routine influenza vaccine – to prevent humans as mixing
vessel for re-assortment into a new virus subtype
Selected groups for vaccination:
• cullers involved in destruction of poultry
• people living and working in poultry farms
• health care workers involved in the daily
care of H5N1 human cases
• health care workers in emergency care
facilities in areas where there is confirmed
occurrence of influenza H5N1 in birds.
Emergence of Pandemic Strain
Reassortment in Humans or Pigs
Migratory
water birds
Reassortment in human
Reassortment in pig
Reference: WHO
Treatment
•
Treatment for H5N1, infection is essentially the
same as for other influenza viruses.
•
Antiviral drugs for both treatment and
prevention, but have some limitations
•
OSELTAMIVIR: 1 tab BID x 5 days;
Prophylactic: 1 tab OD x7 days
Phases of Pandemic Influenza Preparedness and Response - 1
PANDEMIC PHASES (WHO)
DESCRIPTION
PHILIPPINES
Interpandemic Phase
Phase 1- No new influenza virus
subtypes detected in humans, but
may be present in animals and the
risk of human infection or disease is
low
New influenza virus subtype in animals,
no poultry outbreaks, no human cases
Stage 1
Philippines
-
Avian
influenza-free
Phase 2 - New influenza virus
subtypes detected in animals and
substantial risk of human infection or
disease
New influenza virus subtype in animals,
there are poultry outbreaks, no human
cases
Stage 2 - Avian influenza in domestic
fowl in the Philippines
• >1 unlinked human cases with clear
history of exposure to an animal
source/non-human source
Independent clusters of human cases
from a common source/ spread from
case to close household or unprotected
health-care contacts, no sustained
human-to-human transmission
•Cases with source of exposure which
cannot be determined, no clusters or
outbreaks of human cases
Stage 3 - Confirmation of avian
influenza from poultry to humans in the
Philippines
Pandemic Alert Period
Phase 3 – Human infections with a
new sub-type, but no human-tohuman spread, or at most, rare
instances of spread to a close contact
Phases of Pandemic Influenza Preparedness and Response - 2
PANDEMIC PHASES (WHO)
DESCRIPTION
PHILIPPINES
>1 clusters involving a small number of human
cases, e.g. a cluster of <25cases lasting <2
weeks
Stage 4 - Avian Influenza with humanto-human transmission of pandemic
influenza causing outbreaks in the
country.
Pandemic Alert Period
Phase 4 – Small clusters with
limited human-to-human
transmission but spread is highly
localized
Small number of human cases in one of
several geographically linked areas without a
clear history of a non-human source of
exposure
Phase 5 – Larger clusters but
human-to-human spread is still
localized
•Ongoing cluster-related transmission, but total
number of cases is not rapidly increasing, e.g.
cluster of 25-50 cases and lasting for 2 to 4
weeks

Ongoing transmission, but cases appear to
be localized (remote village, university, military
base, island)
Stage 4 - Avian Influenza with humanto-human transmission of pandemic
influenza causing outbreaks in the
country.
Phase 6 – Pandemic phase:
increased and sustained
transmission in general population
Sustained transmission, increasing number of
cases
Stage 4 - Avian Influenza with humanto-human transmission of pandemic
influenza causing outbreaks in the
country.
Post-pandemic phase
Return to interpandemic period
Post-pandemic phase
Return to inter-pandemic period
Early Signals
• Bird/animal death (unexplained/unusual)
• Human respiratory infections assoc. with bird/animal
deaths
• Unusual respiratory disease/deaths-cluster of cases
among
- Travelers
- Cullers
- Poultry Handlers
- Health care worker
- Laboratory workers
• Rumor surveillance in the early warning phase to
identify possible cases of pandemic strain influenza
that might not be notified by routine or enhanced
surveillance
Keeping the Philippines Bird Flu Free
Preparedness from the National to the Local Level
AI National Task Force
Executive
Committee
Secretariat
Logistics
Policy
Communications
Committee on Human
Health Protection
Committee on Animal
Health Protection
Surveillance / Lab
Surveillance / Lab
Clinical Mgt / Hospitals
Containment
Resource Mobilization
Resource Mobilization
Public Health Response
Quarantine
Quarantine
• Secretary of Agriculture
• Secretary of Health
• DA USec for Livestock and
Fisheries
• DOH Usec for Health Operations
• BAI Director
• NMIS Director
• DOH Program Director for
Emerging & Re-emerging
Infections
• Private Sector Representatives
• Broilers
• Layers
• Gamefowl
• Poultry Veterinarians
Keeping the Philippines Bird Flu Free
Preparedness from the National to the Local Level
AI Regional/ Provincial Task Force
AI TASK
FORCE
Rapid
Action
Team
Surveillance
Team
Committee
Quarantine
Team
Census
Team
• DA Regional Director
• DOH
Regional
Director
• DA
Provincial
Officer
• DILG
RegionalOfficer
Director
• DOH
Provincial
• PNP
RegionalDirector
Director
• PNP
Provincial
• RegionalDisaster
Disaster
• Provincial
Coordinating
Council
Coordinating
Council
• Private
Sector
• Private
Sector
Representative/s
Representative/s
IEC Team
Stage 1: Keeping the Philippines
Bird Flu Free
•
•
•
•
•
•
•
•
Ban of all poultry and poultry
products from AI-infected
countries
Border control
Ban on sale, keeping in captivity
of wild birds
Biosecurity measures
Standardized footbath
Confiscation and destruction of
unlicensed cargo
Surveillance of Poultry in
Critical Areas
Influenza vaccination for all
poultry workers, handlers
Keeping the Philippines Bird Flu Free
Minimum Biosecurity Measures
•
•
•
•
•
•
•
Biosecurity control points
e.g.gates, shower rooms,
footbaths, fumigation boxes
Proper rest period and
disinfection between flocks
Inaccessible to stray animals
and free-flying birds
Proper disposal of mortalities
No domestic ducks and freerange poultry in migratory
bird areas, especially
wetlands
No mixing of poultry and
swine in same holding facility
Record all movement to and
from the facility e.g. visitors,
vehicles, deliveries
Keeping the
Bird
Flu Free Areas
Surveillance
ofPhilippines
Poultry in
Critical
•
•
20 critical sites identified
Target poultry are not
wildlife, but native
chickens, ducks, gamefowl,
etc. in the vicinity
• 6 barangays per
location to be
selected for sample
collection
Keeping the Philippines Bird Flu Free
Priority Areas for Surveillance
•
•
•
•
•
•
•
•
•
•
Zamboanga del Norte
Zamboanga del Sur
Zamboanga City
Zamboanga Sibugay
Palawan near Quezon
and Narra Towns
Pampanga – Candaba
Swamp
Ilocos Norte – Pagudpud
Cagayan – Aparri
Cebu – Olanggo Island
Negros Occidental –
Himamaylan
• Isabela – Magat Dam, Ramon
• CARAGA – Lake Mainit,
Agusan del Sur
• Agusan del Norte
• Surigao del Norte
• Surigao del Sur
• Panay Island – Roxas, Capiz
• Sorsogon – Bulan and Matnog
• General Santos City
• Mindoro Oriental – Naujan
• Cotabato – Cabacan, Liguasan
Marsh
Keeping the Philippines Bird Flu Free
Enforcement of Wildlife Act
•
•
•
To be led by PAWB-DENR, in
coordination with the LGUs and local
PNP
No permits for poultry wildlife or exotic
poultry species from AI-affected
countries
No collection of migratory birds,
regardless of purpose or collection
technique
Preventive Measures in Humans
•
Influenza vaccination for all poultry workers, handlers
STAGE 2: Avian Influenza in Domestic
Fowl in the Philippines
•
Prevention of spread from birds-to birds:
early recognition and reporting, mass
culling, quarantine of affected area
•
Prevention of spread from birds to
humans: human protection through
proper handling of infected birds, use of
protective gear by residents, poultry
handlers, and response teams
Establishment
of Compartmentalized
Poultry
Keeping the
Philippines Bird Flu Free
Zones
•
Compartment 1
Objectives

Establish boundaries
to prevent entry and
limit or stop spread of
AI

Facilitate surveillance,
detection and control

Ensure availability of
disease free production
areas for export and
local markets
Compartment 2
Compartment 3
Compartment 7
Compartment 4
Compartment 6
Compartment 5
Compartment 8
STAGE 2: Avian Influenza in Domestic
Fowl in the Philippines
Community Response to sick or dead birds
•
Protection of exposed residents – gloves/ plastic material in
handling sick or dead birds, hand washing
•
Personal protective equipment for cullers – caps, masks,
goggles, gowns
•
Slowly remove clothing and take a bath immediately after
handling birds
•
Identification of exposed individuals and quarantine for 10 days
•
Inform the local health and agricultural officers
Stage 2:
Controlling and Eradicating Bird Flu in Domestic Fowl
In case of an outbreak, a 3-kilometer quarantine zone shall be established and all birds
within this area shall be stamped out. Moreover, a 7–kilometer control zone shall be
secured so that intensive surveillance can be conducted to detect further outbreaks.
3 km
3 km
SUSPECT
PREMISES
CONTROL
ZONE
QUARANTINE
ZONE Level 1
INFECTED
PREMISES
7 km
QUARANTINE
ZONE Level 2
STAGE 3- Avian Influenza in
Humans
Prevention of cases and deaths
• Protection of exposed individuals
• Isolation and management of cases
• Judicious use of antiviral agents
• Infection control
• Quarantine of contacts
• Mobilization of the BHERTs
What should be done when there is a
suspected case of avian influenza?
Protection of caregiver :
face mask and goggles or eye glasses, hand washing,
self-monitoring for signs and symptoms
Patient:
face mask, in a separate area or at
least 1 meter distance from other people
Monitoring of contacts of the case
Immediate transfer to the Referral Hospital
Protection of the transporting team and disinfection of
vehicle
What should be done when there is
a suspected case of avian influenza?
• Through the Local Health Officer, immediately notify the
Provincial Health Office and the Regional Epidemiology
and Surveillance Unit regarding a suspected case of
HPAI.
• A holding area in the community or in the health center
will be set aside while awaiting transport.
Personal Protective Equipment
Who should use PPE?
•
•
Cullers and animal husbandry/veterinary staff and all those who are
handling infected or suspected poultry and poultry products.
•
All doctors, nurses and health care workers who provide direct patient
care to avian influenza cases
•
All support staff including medical aides, X-ray technicians, cleaners,
transport staff, laundry staff
•
All laboratory staff who handle patient specimens from suspect cases
•
Family members who care for avian influenza patients (no visits)
•
The patient(s) should wear a mask (N95 preferable) when other people
are in the isolation area.
•
Contacts and international travellers during home isolation/quarantine
must wear a mask (N95 preferable).
Cullers and transporters should be provided
with appropriate PPE
•Coveralls plus an
impermeable apron or
surgical gowns with long
cuffed sleeves plus an
impermeable apron
•Heavy duty rubber gloves
that may be disinfected
•N95 respirator masks or
standard well-fitted masks
•Goggles
•Rubber or polyurethane
boots or disposable
protective foot covers
Hand washing
• single most important and effective component for
preventing the transmission of infection.
• Running water and soap with friction should be
ideally used for 15 to 20 seconds.
• It is important to dry hands after washing
• A 70% alcohol-based hand rub solution after hand
washing can be used.
Respiratory Etiquette
•
Cover your nose and mouth with tissue or handkerchief every time you sneeze,
cough or blow your nose. If you don’t have tissue, cough into your sleeve.
•
Wash your hands with soap and water.
– Before touching your eyes, nose or mouth.
– Before shaking hands with other people.
If water is not available, use an alcohol-based hand sanitizer.
•
Don’t be offended if someone offers you tissue. Thank the person for the kind
act.
•
Don’t spit on the floor or on the road. Spit on a trash bin or on a small plastic
bag.
•
•
Put used tissues or plastic bags in the trash bin.
Wash used handkerchiefs separately from clothing.
•
As much as possible, stay at home when you are sick.
•
Maintain a safe distance of 1 meter from other people when you are sick.
•
Do not share eating utensils, drinking glasses, towels or other personal items.
Exposed persons
Exposure:
During the 7 days
before the onset
of symptoms,
contact (within 1
meter) with live or
dead domestic
fowl or wild birds
or with persons
suspected to have
bird flu
Quarantine
exposed persons
for 10 days and
monitor for signs
and symptoms of
illness.
Quarantine of contacts
• Stay at home for 10 days
• Monitor self for fever, cough or
difficulty of breathing or any sign and
symptoms of illness.
• Refer sick persons to the Referral
Hospital for SARS and other severe
emerging infections.
Referral of Avian Influenza Cases
A. Satellite Referral Hospitals –
Regional Hospitals/ Medical Centers of 16
Regions
B. Sub-national Referral Centers
San Lazaro Hospital
Lung Center of the Philippines
Vicente Sotto Memorial Medical Center
Davao Medical Center
C. National Referral Hospital
Research Institute for Tropical Medicine
STAGE 4: Human-to-human transmission of
influenza (pandemic influenza)
Challenges
• High morbidity and mortality
• Increased demand for health services
• Maintaining essential services – disaster
response team, security, peace and order,
transportation, communication and
utilities
• Public anxiety – epidemic of fear
CRISIS MITIGATION MEASURES FOR STAGE IV
Coping with increased demand for health
services and goods
Primary care
• manpower augmentation
• antipyretics, analgesics, liniments and antibiotics
Secondary care
•
•
•
•
Shortage of beds, equipment and supplies
Only serious and urgent cases will be admitted
Back-up / buddy system
Supplies of relevant drugs (e.g. antibiotics) and
equipment (e.g. Ventilator)
Maintaining essential services
In an explosive spread, efforts and
resources will be shifted to maintenance
of essential services
Persons providing
– Emergency and disaster response
– Maintenance of peace and order
– Transportation, including air traffic controllers
– Utilities – water, electricity
• Arrange ahead places of duties and schedule to
cover the required duties during the pandemic
• Back up
Slowing the spread of
infection
Personal hygiene – cough etiquette, handwashing
Social Distancing
•
Quarantine of persons/ areas
Reduction of unnecessary travel
Staying at home when sick
Isolation at home (separate room)
Closure of schools
Suspension of public events
•
Closure or limitation of people in public places or establishments
•
•
•
•
•
What is the government doing
Organization/ Coordination
•
Management Committee on
Prevention and Control of
Emerging and Re-emerging
Infectious Diseases
(DOHMC– PCEREID)
•
National AI Task Force for
Avian Influenza Protection
Program (NATF-AIPP)
•
Formulated structure for
Regional and Local TF-AIPP
Moving forward:
•Monitor Organization of Regional
and Local Task Forces -AIPP
•Identification of Team Leaders for
each critical area
What is the government doing
Planning Policy/ Technical Guidelines
Development
•
Preparedness and Response Plan for
Avian and Pandemic Influenza
•
Work and Financial Plan
•
Guidelines:
Consensus on the Prevention and
Management of Influenza (with
medical specialties)
Clinical Management of HPAI
Infection Control
•
Planning workshops
•
Mobilization of DOH-Management
Committee for PCEREID
•
Interagency Avian Influenza Task
Force Meeting
•
Table top exercises
Moving Forward:
Assist in Preparedness and
Response Planning for Avian
and Pandemic Influenza
- LGUs
- Hospitals
- DepEd and other agencies
- Regional offices
What is the government doing
Orientation on Avian Influenza
and Pandemic Influenza
Preparedness
•
•
•
•
Regional Directors and Chiefs
of Hospitals in the National
Staff Meeting
Regional Coordinators and
Epidemiology and Surveillance
Units
Rural Health MidwivesOlongapo City, Cebu City
Ongoing Regional Meetings
Training on Infection Control
(NCHFD)
• NCR Hospitals
Moving forward:
•Speakers’ Bureau
•Provincial, City and Municipal
Health Officers and private
practitioners
•Joint Agriculture-Health
Officers Training
•Training on Infection Control
Other regions – Hospital Staff
(Luzon, Visayas and Mindanao
What is the government doing
Advocacy
•
Legislators : Committee on
Health, Lower House
•
National Anti-Poverty Commission
National
Disaster
Coordinating
Council
Medical specialty organizations
PPS, PSMID, PIDSP
Diplomatic Corps
American Chamber of
Commerce
Asian Development Bank
Japanese
Consuls
to
Asian
Countries
Business Sector
Moving Forward:
Continuing advocacy
to:
Health sector
Business sector Funding
organizations
Non-government
organizations
Other stakeholders/
support groups
What is the government doing
Advocacy and Information
Dissemination
•
•
•
•
•
•
Regional Summits (Joint DOHDA activity)–
6 regions –Regions 3, 4, 9, 10,
11 and Palawan
Development of IEC Materials
– Target audience-based,
Cough manners, proper
handwashing
Quadri-media
DOH website for bird flu
Lectures to other agencies,
offices
Planning with UP-CPH for
Training on Risk
Communication
Moving forward:
• Local Bird Flu Summits in
40 provinces DOH, DA, DILG, poultry
industry
• Reproduction of IEC
Materials – Target
audience-based, cough
manners, proper
handwashing
• Tri-media bird flu
features/ updates/
advisories
What is the government doing
Resource Mobilization
•
Request
Million
to
PCSO
for
P30
•
Request to PS-DBM for PPE
(P8.5M)
•
Procurement through WHO:
700 bottles of suspension,
10,000 capsules of Oseltamivir
•
Project development – SARS
Project to dovetail Avian and
Pandemic Influenza, Meeting
with CIDA, USAID (Pledge of
$50,000)
Moving forward:
• Procurement of
additional 100,000
capsules of Oseltamivir for
10,000 treatments (to source
out P8.5M)
• Resource generation
AVIAN & PANDEMIC INFLUENZA BUDGET
as of 2/22/06
ACTIVITY
DONOR
AMOUNT
GOP-DOH
Unilab
10.2 M
60 M
Allocated/Released
Pledged
AusAID
1.77 M
Requested
Procurement of PPEs
GOP-DOH
AusAID
20M
1.55M
Allocated
Requested
Workshops and Trainings
GOP-DOH
ADB
WB
AusAID
0.5 M
3M
0.5 M
2.0 M
Available (2006 budget)
Allocated (dovetailed with SARS funds)
Requested
Requested
AusAID
5.52
Requested
GOP-DOH
USAID
UNICEF
Spent
Pledged
Pledged
WB
AusAID
2.0 M
2.75 M
Amount
unspecified
3.0 M
5.0M
GOP
CDC(RITM)
1.0 M
5.0 M
Allocated
Allocated
PCSO
30M
Requested
Procurement of
Oseltamivir
Vaccine for health workers
Hospital Equipment
IEC
Survey/ Materials
Surveillance
Package of Trainings,
equipment, supplies
STATUS
Allocated ( with SARS funds)
Requested
Elements of the Preparedness Plan
1. Management structure, planning and policy
formulation
2. Surveillance system for HPAI and pandemic
influenza
3. Antiviral agents and pandemic influenza vaccine
4. Readiness of health facilities, service, manpower
and supplies
5. Maintaining non-health essential services
6. Public health interventions
7. Information, education and communication
8. Networking
Business Pandemic Influenza
Planning - 1
1. Strengthen management structure
a. Identify a pandemic coordinator &/or team for
preparedness and response planning
Planning Considerations:
a.
Determine processes & services most essential to
maintain; affected most by high absenteeism
b. Identify essential employees & other critical inputs (e.g.
raw materials, sub-contractor services/products,
logistics) required to maintain business operations
c.
Plan for scenarios - or in demand for your products/
services; impact of pandemic on business-related local &
international travel
d. How to minimize illness among staff, customers
e. Labor representatives should be part of process
Business Pandemic Influenza
Planning - 2
1. Strengthen management structure
b. Develop policies, standards & guidelines
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Sickness & absenteeism policy
Set up authorities, triggers, procedures for activating
terminating company’s response plan, altering
operations
Inc. social distancing (e.g. frequency & type of faceto-face contact)
Flexible worksite, work-hours
Annual Influenza vaccination
Prevention of Influenza spread at worksite
Travel to affected areas
Infectious Control Measures
1. Respiratory etiquette
2. Handwashing
3. Avoid touching the eyes, nose, mouth
4. Stay home when sick, check w/ health
provider when needed
5. Practice other good health habits
Business Pandemic Influenza
Planning - 3
2. Operationalizing a Surveillance system
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Strengthen coordination & partnership with DA, DOH
Monitoring workforce absenteeism
Support for surveillance – reporting network,
communication
3. Enhancing capabilities of health & nonhealth key personnel
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Funds to support trainings of Municipal Health and
Agriculture Officers, BHERTs
Funds to reproduction of training modules
Business Pandemic Influenza
Planning - 4
4. Providing antiviral agents and pandemic
influenza vaccines
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Stockpile of antivirals for own company; Influenza
vaccination for workers
Employee access to healthcare services
Infection control supplies
5. Ensuring readiness of health facilities,
service, workforce & supplies
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Ensure health workers are knowledgeable on infection
control & 1st response
Private hospitals to accept patients during a pandemic
(Hospital checklist)
Non-traditional sites & workers: schools, hotels, etc. as
clinics, triage centers
Provision of food, supplies, other provisions
Business Pandemic Influenza
Planning - 5
6. Ensuring preparedness of agencies
delivering non-health essential services
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Preparation of contingency plans
Back-up system for personnel to maintain services during
a pandemic
Temporary permits to volunteers and workers
7. Public Health Interventions
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Infection control measures; use of masks
Suspension of public events; closure or limitation of
people in public places (e.g. schools)
Limitation of movement from one area with outbreaks to
area with no or few cases; suspension of travel to a
country w/ outbreaks
Transportation: curtains in buses, shut off airconditions
Business Pandemic Influenza
Planning - 6
8. Strengthening IEC campaign
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Establish emergency communication plan – directory of
contact persons; IT structures (for employee, customer)
Training of company speakers
Provide funds for the reproduction of IEC materials,
conduct of for a, etc.
Provide IEC (incl. Preparedness plan) materials to
employees
9. Soliciting support & networking
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W/ government agencies, other business groups, NGOs,
healthcare facilities, LGUs
Resource Mobilization
Self-monitoring against price increases
Plan ahead – it wasn’t raining when
Noah built the ark.