Briefing on Swine Flu and Influenza Pandemic Threat

Briefing on Swine Flu and Briefing on Swine Flu and

IInfluenza Pandemic Threatnfluenza Pandemic Threat

WHO Country Office for Brunei, Malaysia and Singapore30 April 2009, Kuala Lumpur

Overview of Influenza Pandemics

• Bird virus - different from human influenza virus

• Spreads from birds to birds

• Can sometimes infect humans

• Can sometimes mutate into human virus

• Human viral respiratory infection

• Self-limiting, but can be serious & fatal in elderly,

infants & people with chronic diseases ~ 500,000

deaths globally / yr.

• Routine vaccination available

• Global outbreak of new human influenza (different

from seasonal and avian influenza)

• Rare event

• Associated with increased morbidity & mortality

Seasonal Influenza“The Flu”

Avian Influenza“Bird Flu”

Pandemic Influenza“A Pandemic”

Three Kinds of Influenza

Prerequisites for Influenza Pandemic?

A new influenza virus emerges to which the general population has little/no

immunity

The new virus must be able to replicate in humans and cause disease

The new virus must be efficiently transmitted from one human to another Yes?

Review of Influenza Pandemics in the 20th Century

2

How Many Might Die From Influenza Pandemic?

“Spanish Flu” in 1918-19

� Total population: 2 billion� Clinical infection: 400 millions

(20%)� Deaths: 40-50 millions (2%)� High CFR in healthy young

adults

Global Estimate of Death In A New Pandemic� WHO range: 2 to 7.4 millions

NEJM, November 24, 2005 The Origins of Pandemic Influenza— Lessons from the 1918 Virus. Robert B. Belshe, M.D.

ReRe--assortment and Direct Transmissionassortment and Direct Transmission

HumanHumanvirusvirus

ReassortantReassortant

virusvirus

NonNon--humanhuman

virusvirus

Swine influenza in humans

� Generally clinical symptoms are similar to seasonal influenza from asymptomatic infection to severe pneumonia resulting in death.

� Incubation period: (Time from exposure to onset of symptoms): 1 to 6 days?

� Clinical Illness: abrupt onset, fever, body aches, headaches, fatigue, cough, sore throat etc

Swine Influenza A/H1N1: Virology

� Reassortment - four different genes: Unique combination that has never been seen before

� North America swine� Asia/Europe swine� Human influenza� Avian (Non H5)

� Level of immunity in general community � Unlikely

� Antiviral resistance� Resistant to amandatines� Sensitive to oseltamivir (tamiflu) and zanamivir

(relenza)

Confirmed and Probable Cases as of 29.4.2009

91 cases / 1 deathUSA

1324 under investigation, 84 deaths

26 cases / 7 death:

1 case

Mexico

Austria

13 cases

3 cases

Canada

Germany

Probable caseLab. confirmed & deaths

Country

Note: Situation is evolving quickly. The numbers may change from this update

Confirmed and Probable Cases as of 29.4.2009

2Israel

4Spain

7 in Auckland3 in AucklandNew Zealand

1 South Korea

148 cases; 8 deathTotal

5UK

Probable caseLab Confirmed & deaths

Country

Phase 5• Human-to-human spread of the virus into at least two countries in one WHO region.

• While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Influenza Antiviral MedicationsInfluenza Antiviral Medications

Tamiflu: (Oseltamivir)

� Prophylaxis: (adult) � Oral: 75 mg once daily; � initiate treatment within 2 days of contact with an

infected individual; � duration of treatment: 7 -10 days � During community outbreaks, dosing is 75 mg once

daily. May be used for up to 6 weeks; duration of protection lasts for length of dosing period.

� Treatment: (adult)� Oral: 75 mg twice daily initiated within 2 days of onset

of symptoms; � duration of treatment: 5 days

Tamiflu Stockpiling

� Stockpiling

� Global and Regional: WHO/Roche � ASEAN/Japan: 0.5 millions located in Singapore� National target: 25% population

� Policy for use

�Defining priority between treatment and prophylaxis�Priority groups

Public Health Measures -- Vaccines

� Most effective control measure� Seasonal influenza vaccine:

Unlikely provide protection as it is developed from three circulating strains

� Stockpiling not possible

� Swine flu vaccine is not available at early stage: 6-8 months lead time

� WHO vaccine task force� Working with vaccine factories

Medical Care Capacity

� How to increase surge capacity of hospital care?

� Designated Hospitals and other facilities:

� Isolation facility:

� ICUs and ventilation machines:

� Staff training: Knowledge and skills for diagnosis,

treatment and infection control

What you can do as an individual?

� Avoid crowds and close contact with people who appear unwell and who have fever and cough.

� No hugging and shaking of hands, wash your hands frequently and thoroughly.

� If you are sick, stay home, do not come to office

� Wear a mask when you are sick, when you visit hospitals or caring for the ill person

� Practice good health habits including adequate sleep, eating nutritious food, and keeping physically active.

� Keep the environment clean with readily.

Action taken by Malaysia

� No case

� Active screening at ports of international entry: 125

� Active surveillance in all health settings

� Stockpile of Tamiflu: 2 millions / 9 distribution centres

� 29 Designated hospitals, 3 for swine flu now

� MOH operation room activated

� National multisectoral committee has been activiated

� National Pandemic preparedness plan has been activated

� 200,00 frontliners be given for seasonal flu vaccine

� Actively communicating with WHO

� 778 pig farms actively monitored by Veterinary Service Department

Main Actions for Phase 5

Phase 4:Sustained

H-2-H transmission

Situation monitoring and assessment• Increase surveillance• Actively monitor the evolving situation

Communication • Continue communication & updates

Security of health care provision • Implement contigency plan for Health care• Ensure pharmaceutical measures

Planning and coordination • Activate multisector coordination to mitigate the societal and economic impacts

Reducing the spread of disease• Implement individual & community precaution

measures

Phase 4

Suggestions for UN agencies and Staffs

� Prepare for worst situation

� Seek advice from UN medical services

� Office stockpile and policy for use: Tamiflu and PPE,

� Plan for minimum level of operation: critical staffs?

� Stay home, working at home?

� Communication between offices and staffs

� Health education and awareness among staffs

� Prepare essential stuffs for living

� Know how to access to local medical services

� AI Task Force meeting and UNCT meeting