Supporting Health Protection Planning: Supporting Health Protection Planning: The Health Protection Agency dS i Fl and Swine Flu Professor Anthony Kessel Director of Public Health Strategy and Medical Director, HPA The King’s Fund Board Leadership Programme for London 14 July 2010 14 July 2010
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BLP Supporting health protection planning swine flu ... · Seminar outline • Health Protection Agency • Bk difl i dBackground: influenza virus and pandemic influenza • Evolution
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Supporting Health Protection Planning:Supporting Health Protection Planning:The Health Protection Agency
d S i Fland Swine Flu
Professor Anthony KesselDirector of Public Health Strategy and Medical Director, HPA
The King’s Fund Board Leadership Programme for London14 July 201014 July 2010
Seminar outline
• Health Protection AgencyB k d i fl i d• Background: influenza virus and pandemic influenza
• Evolution of the swine flu pandemic• HPA roles/activities in the pandemicHPA roles/activities in the pandemic• Recent developments
Di i hi ki• Discussion: partnership working on infection disease planning and response
Role of the Health Protection Agencyg y
Established in 2004 as an independent government p gagency with responsibility for health protection
• Infections – surveillance andInfections surveillance and diagnosis
• Chemical and radiation threats• Emergency planning andEmergency planning and
preparedness for public health threats
• Local and regional services for gcommunicable disease control
R ibilitiR ibilitiResponsibilitiesResponsibilities• Advice to Government on
health protection• Delivery of services to theDelivery of services to the
NHS and other agencies • Impartial, authoritative
information and advice to the public professionals
• Rapid response to new threats and emergencies
• Improved knowledge base through research and development, education and trainingand training
• Chemical incident surveillance and response systems - natural disasters.
• National Poisons Information Service
Batch release testing safety and efficacy- Official Medicines Control Laboratory
• R&D.• National Poisons Information Service and the Compendium of Chemical Hazards.
• Training - WHO Global Training Network.
Local & Regional Regional Microbiology gServices (LaRS)
Aims and Roles Aims and Roles
Network (RMN)
• Frontline services.• Investigation and management of public
health incidents and outbreaks.L l di ill
• Specialist advice and support- outbreaks and incidents.
• Referred tests.• Local disease surveillance.• Syndromic surveillance.• Port health.• Alert systems
• Molecular diagnostic tests• Emergency response
- outbreaks and incidents.• Alert systems.• Emergency response training courses
and exercises for health care providers.
outbreaks and incidents.• Specialist identification or typing.
Various DepartmentsVarious Departments
8 Regional Laboratories9 Regional Offices28 Health Protection UnitsEmergency Response Department
8 Regional Laboratories9 Food, Water, and Environment testing
Laboratories37 HPA Collaborating Laboratories
The Division of Public Health Strategy coversThe Division of Public Health Strategy covers the following areas of work:
• Public Health Strategy• Clinical & Health Protection GovernanceClinical & Health Protection Governance• Knowledge Management• Professional Development• International Health• Chair of the Influenza and Respiratory Virus Programme Board
B ildi id i l i l it• Building epidemiological capacity• Health Protection Training (oversight of 28 public health
and medical microbiological trainees)g )• CBRN policy lead• Medical Director
FundingFunding62% of funding from the Department of Health (government grant in aid)
38% (£117m) of funding from non-grant in aid sources – contracts and services, products and royalties and research grants
Expenditure by division 2008/09
Distribution of staff between centres and divisions 2009/10
2008/09 Staff Profile
RelationshipsRelationshipspp
Public
Academic &Professional
bodiesCommerce
HPALocal
InternationalNational Health
Service
LocalRegionalNational
Local Authorities& Government&
Government Offices
in the Regions
GovernmentDepartments& Agencies
Influenza A =a zoonotic diseasea zoonotic disease
Naturally present in a range of animalsNaturally present in a range of animals
Cross species reassortmentCross species reassortment
Courtesy of the CDC
Influenza:h t i ihuman transmission
Pandemic InfluenzaPandemic Influenza
PAN (all, παν )PAN (all, παν )
+
DEMOS (people, δήμος )DEMOS (people, δήμος )
= an epidemic that affects all people
Circulating influenza strains in humans d d i i 20th 21st C t iand pandemics in 20th – 21st Centuries
• 12 April: outbreak of influenza-like illness in La Gloria, Veracruz Mexico
• 15-17 April: two cases of the new A(H1N1) virus infection identified in two southern California counties, USA
• 23 April: novel influenza A (H1N1) virus infection confirmed in23 April: novel influenza A (H1N1) virus infection confirmed in several patients in Mexico
• 24 April: WHO declares a public health event of international concern• 27 April: WHO declares pandemic phase 4 - sustained community
transmission in Mexico, cases confirmed in UK and Spain
• 29 April: WHO declares pandemic phase 5 (2 countries affected)• 29 April: WHO declares pandemic phase 5 (2 countries affected)• 11 June: WHO declares pandemic phase 6 (spread to more than 2
WHO regions)
• In 9 weeks, all WHO regions report cases of pandemic (H1N1) 2009
Pandemic (H1N1) 2009:what were the early challenges?
( )
• Recognition of the first human cases in the UK: di i d fi tidiagnosis and confirmation
• Monitoring the first cases and contacts very closely• Public health interventions: schools planes• Public health interventions: schools, planes• Hygiene and social distancing messages• Antivirals - systems for distribution• Antivirals - systems for distribution• Managing social disruption • Vaccine availabilityVaccine availability• Advising Government …
ill tPandemic (H1N1) 2009:
surveillance systemsGeneric surveillance systems• National laboratory reporting scheme• RCGP Weekly Returns Service• NHS Direct syndromic surveillance• Mortality monitoring• Hospital admissions
S l i fl ill tSeasonal influenza surveillance systems• QFLU (as a component of Q-Surveillance)• HPA spotter practice scheme
HPA A ti i l R i t M it i d Vi l S i f I fl• HPA Antiviral Resistance Monitoring and Viral Sequencing of Influenza • Medical Officers of Schools Association
Pandemic Preparedness SystemsPandemic Preparedness Systems• National Pandemic Flu Service• Enhanced surveillance of pandemic (H1N1) 2009• First Few Hundred (FF100)• First Few Hundred (FF100)• Flu Clinical Information Network (Flu-CIN) • Hospitalisation study
Policy decision making in emergencies
• Civil Contingencies Secretariat (CCC)– CCC (O) and CCC (M)
• Government takes (public) health advice from a variety of sources– Chief Medical Officer (DH)– SAGE– HPA– Other key bodies e.g. JCVI
Pandemic (H1N1) 2009:( )once established, what were the ongoing challenges?
GP swab kitsFlu Response Centres
school closure
Pandemic (H1N1) 2009:UK Strategy
C t i t Ph ( b d ill ) 27 A il
( )
Containment Phase (case based surveillance) 27 April• Meeting aircraft from Mexico, information for travellers• Identification of cases - treatment
Identification of close contacts prophylaxis• Identification of close contacts - prophylaxis• Closing of affected schools for 7 days
Outbreak management (case based surveillance) 19 JuneOutbreak management (case based surveillance) 19 June• No case finding at ports of entry• Flexible approach to schools - local risk assessment• Clinical diagnosis for contacts of confirmed cases• Clinical diagnosis for contacts of confirmed cases• Widespread community transmission areas
Treatment Phase (routine winter surveillance) 2 July• Clinical diagnosis, not laboratory testing• Treatment available for all (especially risk groups)• No contact tracing• No prophylaxis, except for risk groups• Move from daily reporting of laboratory confirmed cases to general
estimates of disease spread
situation could be a lot worsePandemic (H1N1) 2009:situation could be a lot worse
A pandemic emerging in SE Asia Pandemic strain emerging in the Americas emerging in SE Asia Pandemic strain emerging in the Americas