SPANISH PLAN FOR THE PREPARATION AND RESPONSE TO AN INFLUENZA PANDEMIC Dr. Carmen Amela Heras Public Health National Direction Ministry of Health and Consumption.

SPANISH PLAN FOR THE PREPARATION AND RESPONSE TO AN INFLUENZA PANDEMIC

Dr. Carmen Amela HerasPublic Health National Direction

Ministry of Health and ConsumptionMadrid, Spain

General Objectives

• Reduce the impact of the pandemic on the population’s health

• Take measures to reduce the transmission of the virus and protect the population.

• Guarantee that the response and the measures adopted correspond with UE and OMS recommendations in each phase.

National Plan Key Elements

1. Organizational structure and coordination2. Epidemiologic and virological vigilance3. Prevention and control measures

• Vaccines, • Antiviral, and• Non pharmaceutical intervention

measures4. Health system response, and5. Communication

Organizational and Coordination Structure

National Executive Committee for the prevention, control and follow up of the epidemiological evolution of the influenza virus (RD 1131/2003)

- Operative Group of the Executive Committee

- Technical Coordination Group

- Scientific Committee

- Public Health Committee

- Subcommittees or work groups

• Response to the sanitary emergency services •Epidemiological and virological vigilance•Antiviral and vaccines•Communication

National Plan. Work Groups.(Subcommittees)

The objective is for all the Autonomous Communities to have their own plan, in which they place special emphasis on the emergency response.

With Representation in the Autonomous Communities

Approved Protocols

Detection, by sanitary professionals, of suspicious cases of the bird flu in humans

Infection control measures in sanitary centers

Actions that would be taken in the case of people that work in farms or could be exposed to infected birds.

Definition of priority groups for the supply of antivirals.

Instructions for use for intervention with oseltamivir following exposure to the influenza virus A/H5N1.

Recommendations for travelers that are moving towards affected countries and other exterior sanitary measures.

Protocol for action when passengers arrive in Spain (via air or sea)

Public Health Measures Will help retrace diffusion, but will not avoid the Pandemic.

• Isolation

• Closing of Institutions

• Personal Security

• Travel restrictions

• Restrictions for celebrating large reunions

Organic Law of Special Measures in Public Health Matters 3/1996 0f 14th of April, articles 2 and 3.

The Litigious-Administrative Court authorizes the measures that the sanitary authorities consider urgent and necessary for health.

Scenarios , Consequences and Measures in the PANDEMIC ALERT PHASE

ARRIVAL OF INFECTEDBIRDS

ARRIVAL OFPERSONS

THAT ARE INFECTEDOR SUSPECTED

INCREASE IN THE RISK OF DIFUSSION ANIMALS -ANIMALSANIMALS - HUMANS

INCREASE IN SOCIAL UNREST

RISK OF TRANSMISSION FROMHUMAN TO HUAMN

Coordinated vigilance and control methods

Agriculture – Environment - SanitationTowns

CommunicationStrategies

Trust in the Ability of theAuthorities to Respond

Action protocol before a Dangerous Aerial transmission

disease (PAETAP)

Vigilance: algorithm suspicious caseP

AT

IEN

T R

EP

OR

TIN

G S

US

PIC

OU

S I

NF

LU

EN

ZA

SY

MP

TO

MS

Fever (> 38°C)

Respiratory symptoms:

CoughOr

Difficulty Breathing

Any other very serious disease

without an alternative diagnosis

EP

IDE

MO

LO

GIC

AL

HIS

TO

RY

History of travel to areas affected by bird flu2 in the last 7 days.

Close contact (at a distance of touching or talking) with other cases of severe

respiratory disease or

Unexplained death in a patient coming from an affected area

http://www.who.int/csr/don/2005

orBeing part of a group of workers with

severe respiratory disease without other alternative diagnosis.

orWork in a laboratory with accidental exposure to the influenza virus A/H5

or•Work or have been in close contact during the last 7 days with birds in a

corral, or live or dead animals (or thier products) that could have been exposed to the highly pathogenic bird flu virus

A/H5.

andClose contact

(1 meter) with domestic birds

live or dead,wild birds or pigs.

SUSPICIOUS CASE

Fever> 38°C+

Respiratory symptoms(cough or difficulty breathing)

Fever> 38°C+

Respiratory symptoms(cough or difficulty breathing)

Very serious disease Without an alternative

diagnosis

Very serious disease Without an alternative

diagnosis

Visit to areas affectedBy bird flu in the last

7 days

Visit to areas affectedBy bird flu in the last

7 days

Close contact (<1m.) with domestic

Birds, live or dead, wild birds and pigs

Close contact (<1m.) with domestic

Birds, live or dead, wild birds and pigs

Closecontact (<1m.) with severe respiratory

disease or unexplained death in a patient that comes from an

Affected area

Closecontact (<1m.) with severe respiratory

disease or unexplained death in a patient that comes from an

Affected area

Do you work in a laboratory

Do you work in a laboratory

HaveYou been exposed to the

Virus A/H5

HaveYou been exposed to the

Virus A/H5

SUSPICIOUS CASE

SUSPICIOUS CASE

YES

YES

YES

YES

YES

YES

YES

NO

NO

NO

NO

NO

NO

Are you part of a group of sanitary workers

with severe respiratory disease withoutan alternative diagnosis

Are you part of a group of sanitary workers

with severe respiratory disease withoutan alternative diagnosis

Do you work or have been in close contact during the last 7 days with birds in a

corral, or live or dead animals (or their products) that could have been

exposed to the highly pathogenic bird flu virus A/H5.

Do you work or have been in close contact during the last 7 days with birds in a

corral, or live or dead animals (or their products) that could have been

exposed to the highly pathogenic bird flu virus A/H5.

NO

NO CASENO CASE

DO NOT MOVE THE PATIENT WITHOUT EXPESS ORDERS FROM CICU

900.161.161

•Patient barrier measures: Surgery mask and hygienic measures

•Patient isolation measures. The patient will be confined in the examination room or a room.

•Personal protection measures: Use personal protection equipment and hygiene measures.

•Patient barrier measures: Surgery mask and hygienic measures

•Patient isolation measures. The patient will be confined in the examination room or a room.

•Personal protection measures: Use personal protection equipment and hygiene measures.

ADOPT GENERALPROTECTION MEASURES

ADOPT GENERALPROTECTION MEASURES

CALL CICU

CALL CICU

UPDATED FEBRUARY 20, 2006

Coordination and alert: algorithms

Basic Points PAETAP

CASE

NO

CASE

LaboratoryVigilanceProtocol

PANDEMIC COORDINATIONCENTER

CICU

PANDEMIC COORDINATION CENTER

CICU

SANITARY PROFESSIONALS

AVOID TRANSMISSION

RAPID AND EFFICIENT WARNING

ADEQUATE AND SECUREASSISTANCE

CONTROL ANDPROTECTION MEASURES

DISSEMINATION PROTOCOLCOMMUNICATION

STRATEGIES

TIMELY DETECTION OF A SUSPICIOUS CASE

SELF PROTECTIONBARRIER MECHANISMS

HYGIENEISOLATION

INFROMATION FLOW ANDCOMMAND

CONCISE AND PREESTABLISHED

CONTACTMANAGEMENT

ISOLATIONVIGILANCE

PROTOCOLSASSISTANCE

SERVICES

PRIMARYATTENTION

SPECIALIZEDATTENTION

EXTRA HOSPITALEMERGENCIES

TIMELYCOMMUNICATION

INFORMATIONFLOW CHARTSCOORDINATION

CENTERS

Epidemiological Vigilance

G. Veterinary Vigilance - Environment

G. Hospital Vigilance

G. Laboratory Vigilance

Vigilance

G. Vaccines

G. Antivirals

G. Formation

Prevention

G. Special Public Health Measures

G. Special Veterinary Measures

G. Special Hospital and Laboratory Measures

Control and Protection

G. Attention Services

G. Sanitary Mortuary Police

G. Basic Services

G. Social and Voluntary Services

G. Entrance Alternatives

Mitigation of ConsequencesIntervention

G. Personnel Overload

G. Planning, Coordination and Logistics

G. Command, Alert and Mobilization

G. Interinstitutional Coordination

Planning and Coordination

G. Communication

G. Information Follow - Up

Information and Communication

STRATEGIC AREAS - PROGRAMSGROUPS-PROTOCOLS

Evaluation of Risk

Evaluation of Risk

Risk evaluation.Asiatic region compared to Europe.

Europe Asia

Geographic Extension Located in more limited areas

Scattered throughout Asia

Endemnicity Not endemic Endemic

Management of animals

Good.

Industrial exploitation.

Little hygiene in the majority of the homemade pens

Available resources and technical ability

More resources and better capacity

Limited resources and capacity

Simulation: Common Ground

• The exercise simulated an Influenza pandemic in Europe that affected all the member States,

• Objectives of the Exercise• Evaluate the execution of the national plans of the

Member States; • Improve compatibility and interoperability of the plans of

the member States;• Examine the role and availability of control measures.• Determine the availability and convenience of the

contention measures and• Examine the role of the European Commission during an

influenza pandemic

Messages• The threat of a pandemic has not increased significantly

due to the detection of the virus in Europe.• All countries have to be prepared for the arrival of

A/H5N1.• The bird flu virus A/H5N1 is a great problem for animal

health• At this time it is assumed that it is a low risk for human

health

– The people at risk are those that have close contact with infected birds and their products

– Even in them the risk of infection is low but the disease is serious

We cannot forget that the influenza has a tendency to We cannot forget that the influenza has a tendency to change and surprise!change and surprise!

Communication of the RiskCommunication of the Risk- Confusion about the types of flu - Confusion about the types of flu

““I could swear I just I could swear I just heard my egg sneeze”heard my egg sneeze”