Transcript swine influenza (swine flu) - Disaster Management and Mitigation

PANDEMIC INFLUENZA H1N1 2009
STATE OF PREPAREDNESS
Presentation to District Commissioners (DCs)
Dr Victor Mukonka
Director Public Health and Research
Ministry of Health HQ
Lusaka
1st October 2009
OUTLINE OF PRESENTATION
 Introduction
 Definitions
 Facts on Pandemic Influenza H1N1 2009
 Country response to the pandemic
 Pandemic Influenza H1N1 2009 National Action Plan
 Challenges
 Conclusion
1. Introduction
 Pandemic Influenza (H1N1) 2009 is a respiratory
disease caused by the Influenza A virus
 Initially, the current Influenza A/H1N1 was being
called Swine Flu because it was thought to be the
respiratory disease caused by a virus spread by and
found in pigs
 Affects all age groups and has caused infection and
death worldwide
 In our region; South Africa, Tanzania, Botswana,
Namibia, Zimbabwe, Congo DR and Zambia have all
reported cases
2. Definitions
 Flu – a contagious respiratory illness caused by viruses. It
can cause mild to severe illness, and at times can lead to
death.
 Epidemic – cluster of cases in a defined location;
infectious, spreading

Pandemic – worldwide epidemic; infectious,
spreading, affecting substantial proportion of
population
 Efficient,
sustained
human-to-human
transmission
 May be caused by major changes in the
influenza virus arising from inter-species
transmission
 New virus may emerge against which the
population does not have immunity
3. Influenza virus
 Three types: A, B, C
 A, B
 A
Seasonal flu
Epidemic flu, severe disease
 Surface proteins determine subtype
 H (hemagglutinin)
 N (neuraminidase)
H1 – H16
N1 – N9
 Influenza A viruses infect multiple species
depending on subtype
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Humans
Birds (wild birds, domestic poultry)
Pigs
Other mammals: horses, dogs, seals, whales, ferrets,
tigers
4. Mode of transmission of Pandemic
Influenza A/H1N1 2009
“The 2009 influenza pandemic has spread with unprecedented speed. In past
pandemics, influenza viruses have needed more than six months to spread
as widely as the new H1N1 virus has spread in less than six weeks”
 Same way as common flu
 through coughing or sneezing and unclean hands
 Spread from person to person
 Touching contaminated objects
Infected people may be able to spread the virus beginning 24 hours before
symptoms develop, and up to 24 hours after becoming sick.
5. Signs & symptoms of Pandemic Influ.H1N1
 Similar to seasonal human flu
 Fever
 Cough
 Sore throat
 Runny or stuffy nose
 Body aches
 Headache
 Chills
 Fatigue
 Diarrhoea and vomiting
6. How Influenza Viruses Spread? (Source: CDC)
 Primarily through
respiratory droplets
 Coughing
 Sneezing
 Touching respiratory
droplets on self, another
person, or an object,
then touching mucus
membranes (e.g.,
mouth, nose, eyes)
without washing hands
7. Basics on self protection
 Educate yourself and your families
 Know the symptoms of influenza
 Know how to avoid spreading influenza

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Cough hygiene
Hand washing
Social distancing
 If you are sick, stay home from work
 Be prepared
Pandemic influenza H1N12009: current
global situation
8. Pandemic influenza H1N1 2009: current
global situation
 As at 13th August 2009, WHO States Parties to
IHR (2005) have reported 182,166 cases with
1799 deaths (CFR 0.99) affecting 177 countries
 In Africa: Ethiopia, South Africa, Namibia,
Zimbabwe, Botswana, Algeria, Morocco, Libya,
Kenya, Egypt and Cote d’voire and Zambia have
reported cases.
9. Update on pandemic influenza H1N1
2009 in Zambia
 Thus far more than 1016 suspected cases have been
tested for H1N1.
 Of these fifty (50) were confirmed positive (+) for
pandemic flu but no deaths recorded thus far.
 Ongoing influenza like illness surveillance at UTH
with more than 600 samples processed.
 Of all confirmed cases 5 were individuals who had
travelled abroad and the rest are community
acquired cases
10. WHO Pandemic Influenza Phases
(six)
 PHASE 1
No new influenza virus subtypes in humans
 PHASE 2
No new virus subtypes in humans; animal subtype poses a risk of
human disease
 PHASE 3
Human infection with novel virus; no instances of human-tohuman spread
 PHASE 4
Small, localized clusters of human-to-human spread
 PHASE 5
Larger clusters, still localized; virus adapting to humans
 PHASE 6
Increased and sustained transmission in the general population
11. WHO recommended preventive
measures
 Reinforce influenza surveillance by setting up
sentinel sites in major towns & points of entry
 Involvement of locals in surveillance
 Strengthen laboratory capacity
 Development of national preparedness and
response plan
 Orient health workers on case management
 Reinforce appropriate health promotion and
communication messages to the community at
the same time avoid alarming the citizens
12. Country Response to the pandemic
influenza H1N1 2009
 Reactivated the multisectoral technical Task Force
on Infectious diseases (subcommittee of the
National Epidemic Preparedness, Control and
Management Committee (NEPPC&MC)
 Quarantine and isolation facilities planned in all
districts
 Surveillance planned countrywide – 2 activated
 Clinical and diagnostics
 Information, Education and communication (IEC)
 Logistics
 Development of National Action Plan
 Interpret the provisions of the IHR (2005)
12.1 Task force on infectious diseases
 Members drawn from MoH, MACO, UNZA (Vet),
UTH (virology), NAC, WHO, CDC, UNICEF,
ZNBC and other partners
 Zoonotic infectious diseases – MoH and MACO
(Veterinary) co-chair the task force.
 Meets regularly depending on phase – started with
daily and NOW meets every Tuesdays.
 Receives updates from the sub committees on
quarantine, IEC, clinical and diagnostics, logistics,
surveillance, WHO, CDC and issues on the
Pandemic influenza H1N12009
12.2 Quarantine and isolation facilities
 Two (2) quarantine and isolation facilities identified
and equipped in Lusaka district and the Lusaka
International Airport.
 Each district requested to identify isolation facility
 Twenty (20) health personnel trained on viral
haemorrhagic fevers and infection control.
 ‘Standard operating procures activity flow chart’
developed on suspects from aeroplane to quarantine
and management at designated health centre.
12.3 Surveillance activities
 Forty (40) provincial and districts surveillance officers
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trained in May 2009 in Kapiri Mposhi.
Surveillance guidelines for human infection with
pandemic influenza A(H1N1) 2009 virus developed and
sent to districts and provincial health offices.
Port health staff put on alert at ports of entry especially
Lusaka and Ndola International Airports and land
crossings.
With WHO support, assessments conducted at Lusaka,
Ndola, Mfuwe and Livingstone International Airports.
Also assessments conducted to ground border crossings
in Chirundu, Victoria falls, Kasumbalesa, Mokambo,
Sesheke and Kazungula.
WHO donated copies of the IHR (2005) to MoH.
12.4 Clinical and diagnostics
A. Clinical
 Clinical guidelines on for human Infection with
pandemic influenza (H1N1) 2009;
- Aim is to provide guidance on the management
of pandemic influenza H1N12009 infection in
humans in resource limiting setting.
- Includes patients with confirmed, probable or
suspected pandemic influenza H1N1 2009
infection and their close contacts.
 Drug of choice availability – oseltamivir (Tami flu)
and zanamivir – WHO has donated tamiflu.
Clinical and diagnostics
B. Diagnosis
 Guidelines on collection and handling of specimens for
A/H1N1 influenza developed.
 Two (2) laboratories at UNZA (School of Veterinary
Medicine – level 3 Lab.) and UTH – Virology laboratory
are ready to handle specimens; former supported by JICA
and latter by CDC and WHO.
 Laboratory staff trained in sampling and examinations
 Sentinel sites for surveillance identified in all 9
provinces, selected districts and ports of entry.
12.5 Information, education and
communication (IEC)
 Hon. Minister of Health delivered a national
address on pandemic influenza H1N1 2009 on
ZNBC on 28 April 2009.
 Live TV and radio programmes featuring
experts (MoH & MACO) on the pandemic
influenza H1N1 2009 control and prevention
 Development and distribution of fact sheets on
human and animal done. Development of
posters, leaflets, factsheets and distributed to
all 9 provinces.
 Community radio programmes aired,
Electronic and print media
12.6 Logistics mobilisation
 WHO donated 3,000 doses of tamiflu drug and
guidelines on pandemic influenza H1N1 2009 virus to
Ministry of Health.
 Tamiflu made available to all the provincial health
offices and emergency stocks at HQ.
 CDC has donated 6,000 face masks as part of the
Personal Protective Equipments (PPEs).
 CDC/WHO provided PPE as well as diagnostic support
to the UTH virology Lab.
12.7 Pandemic influ. H1N1 2009 National
Action Plan
Human Health Action Plan
Reduce opportunity to infection
Strengthen risk communication to communities
Strengthen early warning system
Identify and equip place for treating patients
Mitigating for disease occurrence
Reduce morbidity mortality and social
disruption
 Conduct research to guide response measures
A.
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National Action Plan (cont’d)
B. Animal Health Action Plan
 Working group meetings
 Risk communications to communities and members of
staff
 Active surveillance
 Enhancing diagnostic capacity
EXPECTATION FROM DCS
 During the District Epidemic Meetings, the
District
Directors of Health will present to all key
stakeholders e.g. Immigration, Education,
Religious Leaders, Police etc and inform them
about H1N1
 Lobby and advocate from local resources within
the districts to respond to the pandemic.
 DC should take a leading role in managing the
pandemic since there is a wider audience within
these meetings.
 Collaborate and coordinate in conjunction with
the District Directors of Health -effective
intervention
 Each discipline such as schools should come up
13. Challenges
 Inadequate resources to implement some
activities in the National Action Plan
 Permanent site for quarantine, isolation and
patient management
 Resource support during pre-pandemic has
been very difficult
 Printing and distribution of various guidelines,
pamphlets and fliers has been a challenge
 Inadequate laboratory consumables and PPE
Conclusion
 WHO Director General in her letter dated11th June
2009 to Hon. Ministers of Health in WHO regions
raised the pandemic alert level to maximum phase
six (6).
 Phase 6 signifies the widespread nature of the
virus and not necessarily the severity of the
disease.
 WHO warns that we are in the 1st wave of the
pandemic which may last several months or years.
 Stakeholders should support the pandemic phase
activities in the Zambia national action plan to
avoid further spread.