Exercise Cold Play Introduction Host Name. Core Statement Most experts believe that it is not a question of whether there will be another severe influenza.

Exercise Cold Play Introduction

Host Name

Core Statement

‘Most experts believe that it is not a question of whether there will be another

severe influenza pandemic, but when’

Sir Liam Donaldson Chief Medical Officer, 2002

Aims & Objectives

To raise awareness of the threat and consequences of an influenza pandemic and to highlight the associated

major issues.

Seasonal ‘flu vs Pandemic ‘flu

‘SEASONAL’ FLU

Occurs every year during the winter

Affects up to 10% of the population

The very young, the very old and people with certain chronic illness are most at risk

Annual vaccination available

Antiviral drugs available for the at risk

PANDEMIC FLU

Occurs about 3 times each century – at any time of the year

May affect up to 25% of the population

People of every age may be at risk

Vaccine won’t be available initially - in the first wave

Antiviral drugs are likely to be in limited supply

Previous ‘flu Pandemics

Pandemic Spanish Flu Asian Flu Hong Kong Flu

Strain: A(H1N1) A(H2H2) A(H3N2)

Year: 1918-1919 1957-1958 1968-1969

Origin: Not known China China

Estimated Deaths

Global 20-40 million 1million 1-4 million

UK 250,000 33,000 30,000

Age Group 20-50 yrs under 14 yrs under 5 yrsover 65 yrs over 65 yrs

Shortest interval = 11 yearsLongest interval = 39 yearsCurrent interval = 37 years

07/68

08/68

09/68

09/68

09/68

09/68

06/69

09/68

01/69

C.W. Potter, Textbook of Influenza, 1998

Geographic Spread: 1968-69

Geographic Spread: 2006 ??

All major air hubs are less than 72 hours apart!

Avian Influenza or Bird 'Flu

• Common infection in birds – most 'flu strains are relatively harmless and cause Low Pathogenic Avian Influenza (LPAI)

• Some strains are highly pathogenic and cause large outbreaks, especially in poultry where death is rapid and 100%. First described in Italy in 1878

• H5N1 is a type of Highly Pathogenic Avian Influenza (HPAI) . First appeared in 1997 in Hong Kong

• H5N1 has affected poultry, wild birds, some animals

• Wild and migratory birds are spreading infection from Asia to Europe

Source:Respiratory Diseases DepartmentHealth Protection AgencyCentre for Infections, London

H5N1 Bird ‘Flu – the story so farFebruary 2006

• Millions of birds have died or been slaughtered

• Virus has jumped directly from poultry to humans

• ~160 cases with ~ 80 deaths in humans in East and SE Asia and Turkey

• 21 countries worldwide affected by bird flu

• Europe - Turkey, Bulgaria, Croatia and Romania

• Africa - Northern Nigeria

• No bird flu in the UK

• Potential of H5N1 to mutate or mix with human virus to create new virus against which there would be no immunity

• Potential to start new pandemic

However, pandemic influenza may start from a completely different strain

Source: Respiratory Diseases DepartmentHealth Protection AgencyCentre for Infections, London

DOMESTIC BIRDS

MIGRATORY WATER BIRDS

From Birds to Humans followed by re-assortment in Humans

Source:Respiratory Diseases DepartmentHealth Protection AgencyCentre for Infections, London

Influenza pandemics

• New strain of influenza - antigenic shift in influenza A virus

• Minimal or no population immunity

–Rapid spread to UK

–Predict 25% infection rate

–May affect those of middle years

• Will occur in waves

Source:Respiratory Diseases DepartmentHealth Protection AgencyCentre for Infections, London

Preparing for the next pandemic

Lessons learned from epidemiology & the current situation in Asia

1.Maximum recorded interval between pandemics is 39 years – it could be soon (but it remains unpredictable)

2.The likely origin will be SE Asia, but we can’t say for sure

3.Global spread will be rapid – we must prepare now, or risk being caught by surprise

4.Several epidemic waves; first may be ‘milder’ than subsequent ones –

sustainability and resilience will be key issues

Source:Respiratory Diseases DepartmentHealth Protection AgencyCentre for Infections, London

Preparing for the next pandemic

Lessons learned from epidemiology & the current situation in Asia

5. Excess mortality and morbidity difficult to predict but may be high (but it doesn’t follow that the next pandemic will be like 1918)

6. Overall population clinical attack rate is likely to be 25-30%

7. Probably, there will be a shift from the current pattern of disease, towards younger age groups in terms of severity and mortality – with obvious implications for the workforce

8. Impact on Health Service business continuity likely to be considerable

9. Impact on all other organisations likely to be considerable

Source:Respiratory Diseases DepartmentHealth Protection AgencyCentre for Infections, London

Exercise Format

Four ‘blocks’ of time

Week 0 – WHO Phase 5

Week 6 – WHO Phase 6, UK Alert Level 3

Week 11 - WHO Phase 6, UK Alert Level 4

Week 21 - WHO Phase 6, UK Alert Level 4

Each block represents a single day in the pandemic cycle

Each block will bring out specific topics

Broadly they are:

• Infection Control• Vaccines• Anti virals• Staffing and resources• Surveillance• Media • Business Continuity

Key Planning Assumptions

The exercise has been developed using the Department of Health planning assumption (Oct 05) of:

a 25% clinical attack rate and a

case-fatality rate of between 0.37% and 2.5%

Guidance AvailableDepartment of Health Pandemic Influenza Plan

http://www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/PandemicFlu/fs/en

Flu key documents and resources for patients and health professionals

http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Flu/fs/en

Department of Health Emergency Preparedness

Beyond a Major Incident – planning for potentially large numbers of casualties

http://www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/fs/en

The Health Protection Agency:

http://www.hpa.org.uk/infections/topics_az/influenza/flu.htm

NICE (National Institute for Health and Clinical Excellence)

http://www.nice.org.uk

The WHO Influenza Pandemic Preparedness Plan is available at

http://www.who.int/csr/resources/publications/influenza/GIP_2005_5Eweb.pdf

Block One - Preparedness Questions

• Plans and Planning Process

• Roles & Responsibilities

• Data Gathering & Surveillance

• Co-ordination of Media & Public Communications

Block Two – Health Response Questions

• Distribution of anti-viral treatment

• Use of Personal Protective Equipment (PPE) and infection control guidance

• Local models of care

• Explore resilience of the emergency services (specifically ambulance)

Block Three – Multi Agency Response Questions

• Control Measures (Quarantine)

• Civil Contingencies Act 2004

• Staff Shortages/Resources

• Business Continuity

• Body Holding Facilities

Block Four – Vaccination & the 2nd Wave Questions

• Vaccination

• Lessons learnt from the first wave

Exercise Cold Play