Avian Influenza PandemicAn OHS Perspective
Presentation to the
Commonwealth Safety Management Forum
23 November 2006
Brian Ewert
Presentation Overview
Part 1:• What is Avian Influenza?
• Avian Influenza within Australia
• 20th Century Pandemics
• 21st Century Epidemic
• H5N1 History & Epidemiology
Presentation Overview
Part 2:• The Key Facts
• What is the Risk?
• Antivirals
• Vaccines
Presentation Overview
Part 3:• Pandemic Preparedness
Part 4:• OHS Considerations
Part 5:• CSMF Assistance
Part 6:• Open Forum
Part 1
What is Avian Influenza?
Avian Influenza within Australia
20th Century Pandemics
21st Century Epidemic
H5N1 History & Epidemiology
What is Avian Influenza?An infectious viral disease that
primarily affects birds:• chickens• turkeys• pheasants• quail• pigeons• ducks• geese• guinea fowl• ostriches• sea birds• migratory waterfowl
& less commonly:• rats• ferrets• white rabbits• pigs• tigers• leopards• domestic cats
& rarely:• humans
What is Avian Influenza?
There are numerous strains and subtypes of the virus.
Strains vary from low to highly pathogenic.
Highly pathogenic avian influenza was first identified 1878.
4 strains are known to cause human infection.
Only H5N1 is currently linked to severe human infection and death (rare).
All human cases of avian influenza have coincided with outbreaks in poultry.
Avian Influenza within Australia
Historically Australia has experienced avian influenza ‘outbreaks’:
1976 Melbourne Suburbs, Victoria (H7N7 strain)1985 Bendigo, Victoria (H7N7 strain)1992 Bendigo, Victoria (H7N3 strain)1994 Lowood, Queensland (H7N3 strain)1997 Tamworth, New South Wales (H7N4 strain)
To date no human avian influenza cases have been reported within Australia.
Avian Influenza within Australia
Highly pathogenic avian influenza in humans is subject to quarantine control (Quarantine Act 1908).
Since February 2004:
• Australia’s ‘pandemic alert phase’ has remained unchanged (‘Australia 0’ – no circulating animal influenza subtypes in Australia that have caused human disease)
compared with
• the Global ‘pandemic alert phase’ has remained unchanged (‘Overseas 3’ – human infection overseas with new subtypes but no human to human spread or at most rare instances of spread to a close contact)
20th Century Pandemics
1918 – 1919 ‘Spanish Influenza’:• H1N1 strain• estimated 40 – 50 million deaths
1957 – 1958 ‘Asian Influenza’:• H2N2 strain• estimated 2 million deaths
1968 – 1969 ‘Hong Kong Influenza’:• H3N2 strain• estimated 1 million deaths
20th Century Pandemics
31 influenza pandemics have occurred since the middle ages.
On average an influenza pandemic occurs every 30 years.
21st Century Epidemic
2002 – 2003 ‘Severe Acute Respiratory Syndrome’:
• 26 countries (Western Pacific regional focus)
• coronavirus (not avian influenza)
• 8098 ‘probable’ cases (774 deaths)
• raised awareness of the social and economic impacts of epidemics
H5N1 History & Epidemiology
1997 ‘Avian Influenza’:• Hong Kong• 18 cases (6 deaths)• notably 1.5 million birds were culled within 3 days
2003 ‘Avian Influenza’:• China & Vietnam• 4 cases (4 deaths)
H5N1 History & Epidemiology
2004 ‘Avian Influenza’:• Thailand & Vietnam• 46 cases (32 deaths)
2005 ‘Avian Influenza’:• Cambodia, China, Indonesia, Thailand & Vietnam• 97 cases (42 deaths)
H5N1 History & Epidemiology
2006 (to 13 November 2006) ‘Avian Influenza’:• Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia,
Iraq, Thailand & Turkey• 111 cases (75 deaths)
Since 2003, human H5N1 mortality rate approximates 60%.
H5N1 History & Epidemiology
H5N1 History & Epidemiology
H5N1 History & Epidemiology
H5N1 History & Epidemiology
H5N1 History & Epidemiology
Part 2
The Key Facts
What is the Risk?
Antivirals
Vaccines
The Key Facts
Avian influenza and human influenza are different diseases.
Type ‘A’ influenza viruses:• occur in birds and mammals (humans)• cause ‘flu’• can cause a pandemic (rare)
Avian influenza is a type ‘A’ virus.
The Key Facts
Type ‘B’ influenza viruses:• occur in humans and dogs• cause seasonal ‘flu’• do not cause pandemics
Type ‘C’ influenza viruses:• occur in humans only• cause the common ‘cold’• do not cause pandemics
The Key Facts
Human avian influenza (H5N1 crossing the species barrier) is primarily attributable to direct human contact with infected birds:
• slaughtering, defeathering, butchering and preparation of infected poultry for consumption
• children playing in areas frequented by infected poultry
• domestic utilisation of water contaminated by the carcasses of dead infected birds
• chickens/ducks/turkeys/geese… penned together in unhygienic conditions spreading infection
The Key Facts
The Key Facts
Human to human transmission:• is possible• in rare cases is suspected (2004 Thailand – ill child to
mother, and 2006 Indonesia – amongst 8 family members)
• has not been sustained
Importantly: • H5N1 has yet to acquire the ability to spread efficiently
amongst humans
The Key Facts
If avian influenza pandemic was to occur:
• it is most likely to occur overseas amongst poverty stricken rural and periurban communities
• any spread to Australia would most likely be attributable to international travellers
Avian influenza may not evolve into a pandemic virus.
It is not possible to predict if/when a pandemic may occur.
What is the Risk?
If the avian influenza mutates (emergence of a ‘new’ strain) there is a risk of:
• human to human transmission
• virus rapidly spreading
• severe infection persisting and recurring in waves
• from ‘status quo’ to influenza epidemic and possibly a pandemic within 20 – 30 day window
Antivirals
Clinical data supporting the effectiveness of antivirals as a treatment of avian influenza is limited.
Antivirals may shorten the duration and lessen the symptoms of avian influenza.
Timing of administration appears critical (48 hour ‘window’).
Unnecessary antiviral use is linked with drug resistance.
Antivirals are currently available by prescription only.
Vaccines
Vaccines trigger an immune response bolstering the body’s ability to ‘fight’ an infection.
Vaccine production cannot usually commence until a virus ‘outbreak’ (the virus strain must first be identified).
Large scale vaccine availability is unlikely until after the first wave of infections.
Part 3
Pandemic Preparedness
Pandemic Preparedness
8 steps to preparing for a pandemic:
1. Obtain senior management commitment and secure allocation of resources.
2. Form a pandemic planning team.
3. Develop pandemic business continuity plans.
4. Form a ‘crisis’ pandemic management team (with requisite delegations).
Pandemic Preparedness
5. Undertake workforce planning (skills inventory).
6. Develop and implement an employee communication strategy.
7. Test the effectiveness of preparations.
8. Test employee confidence.
Part 4
OHS Considerations:
Employer’s Duty of Care
Employees’ Duty of Care
Consultation
Risk Management and Hierarchy of Controls
OHS Considerations
Under Part 2 ‘OHS Act’, employers are required to:• take all reasonably practicable steps to protect the health and
safety at work of their employees.
Therefore:• employers should anticipate risks associated with a potential
influenza pandemic (ie: risk management)• health and safety of employees should be integrated into
business continuity planning for pandemic influenza
However, in a pandemic scenario what constitutes ‘reasonably practicable’?
OHS Considerations
Under Part 2 ‘OHS Act’, employees are required to:
• cooperate with their employer’s reasonable instructions and policies (including risk control)
• take all reasonably practicable steps to ensure any action or omission does not create or increase a risk to health and safety
Therefore:
• employees should comply with the pandemic health advice and emergency directives issued by their employer and employers should ensure directives comply with public health advice/emergency measures
OHS Considerations
Under Part 3 ‘OHS Act’, employers are required to:• consult employees when assessing risks to health and
safety
Therefore:• employers should consult widely utilising existing
workplace arrangements (HSR and OHS Committees)• employers should provide accurate and current
information and education to employees addressing how a pandemic influenza may affect their work arrangements
OHS Considerations
Risks associated with an influenza pandemic can be categorised into:
• the direct risks of infection (contact, airborne droplet and aerosol transmission)
• indirect risks arising from changes to usual work arrangements
Question: How useful is the traditional ‘hierarchy of controls’ when planning for a pandemic (where do antivirals/vaccines ‘fit’)?
OHS ConsiderationsElimination – ?
Substitution – ?
Isolation – ‘clinical’ quarantine
Engineering – improve ‘natural’ ventilation of enclosed workplaces
Administration – cough etiquette, promotion of personal hygiene, additional workplace cleaning, home quarantine
PPE – mask/goggles/gloves/gowns
Part 5
Commonwealth
Safety
Management
Forum:
How can you assist?
CSMF
Challenge:• integrating OHS risk management into business
continuity plans (an employer responsibility)
Objectives:• assist with across-government consultation (emphasis
on health, safety and welfare of employees)
• develop consistent whole-of-government OHS ‘people management’ influenza pandemic guidelines
CSMF
Scope:• social distancing• cough etiquette• personal hygiene• cleaning/disinfecting the
workplace• managing workplace
entry• teleworking• contract management • minimising unnecessary
absenteeism
• managing staff who become ill at work
• provision & utilisation of PPE
• home quarantine• managing psychological
anxiety• emergency HR
delegations• training & communication• …
Open Forum
Questions & Answers
Discussion
Nominations – CSMF AIP Sub-Committee