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AHMPPI policy on antiviral prophylaxis and the implications for pathology and research staff

This position statement arises from a discussion session on antiviral use for laboratory staff working with H5/Pandemic Influenza A virus at the October 2006 face-to-face meeting of the Public Health Laboratory Network (PHLN).

In this section:

Public Health Laboratory Network

Position paper endorsed by the Public Health Laboratory Network
27 November 2006
Reference Number: PHLN [PS]2006:001

Intended audience

Pathologists and Medical Laboratory Scientists
Veterinary Pathologists and Veterinary Laboratory Scientists
Researchers working with Influenza A viruses

Background

This position statement arises from a discussion session on antiviral use for laboratory staff working with H5/Pandemic Influenza A virus at the October 2006 face-to-face meeting of the Public Health Laboratory Network (PHLN).
The Australian Health Management Plan for Pandemic Influenza (May 2006) describes the process and criteria for use of the National Medicines Stockpile (NMS) during an influenza pandemic. Stockpile components, which include antivirals, are distributed to states and territories according to a deployment plan, under memoranda of understanding between the Department of Health and Ageing and each state and territory health department. Components of the stockpile will be used according to criteria agreed to by the Australian Health Protection Committee (AHPC) and underpinned by principles agreed to by Cabinet in December 2005 and April 2006.
The use of antiviral medication will depend on the phase of the outbreak in Australia and will be carefully monitored. Antiviral medication can be used for:
    • treatment, with one 5 day course of medication
    • prevention of infection after exposure, with one 10 day course of medication
    • continuous prevention of infection, where more than 10 days of medication is required.
PHLN members were informed that the current decision-making structure stipulates that AHPC would decide when laboratory testing will no longer be required to define cases, based on recommendations made by the Communicable Diseases Network Australia, although testing may still be requested by clinicians during all stages of a pandemic.
During maintenance phase, health care workers at high risk of continuous exposure and who are likely to spread the disease in the course of their work would be candidates for continuous pre-exposure prophylaxis.
Laboratory workers who handle certain types of specimens (notably viral cultures) are regarded as at high risk of exposure in the event of an accidental release of viral agent.

Recommendations

1. In the event of a suspected exposure to cultured H5/Pandemic Influenza A virus, staff should be immediately assessed by an infectious diseases physician (or if appropriate, clinical microbiologist). If an exposure is deemed to have occurred the exposed staff should urgently be commenced on post-exposure antiviral prophylaxis. Oseltamivir 1 is recommended;
    2. Laboratory staff must adhere to the highest standards of procedures,2 including safe handling, appropriate use of PPE and biological safety cabinets, as well as an awareness of symptoms to reduce the risk of exposure;
    3. Laboratory staff should be considered candidates for pandemic strain immunisation once a suitable preparation becomes available (Laboratory staff could consider enrolling in clinical trials of vaccine or antiviral treatment/prophylaxis);
    4. Laboratory staff should ensure that they are vaccinated annually against seasonal human influenza, and with pneumococcal vaccine where indicated;
    5. Laboratory owners/proprietors/directors should consider a range of measures to ensure business continuity during stages of a pandemic;
    6. Laboratory staff including management, should stay up to date regarding potential availability of tests that allow confirmation of symptomatic or asymptomatic pandemic strain infection after treatment or prophylaxis with oseltamivir; and
    7. Public health laboratory operators should direct enquiries regarding access to antivirals to their State/Territory Chief Health Officer.
Top of page

Contact List for Accessing Antiviral Stockpile

    New South Wales

    Dr Denise Robinson
    Chief Health Officer and Deputy Director-General Population Health
    NSW Health Department
    Locked Bag 961
    NORTH SYDNEY NSW 2059

    Queensland

    Dr Jeannette Young
    Chief Health Officer
    Queensland Health
    GPO Box 48
    BRISBANE QLD 4001

    Western Australia

    Dr Andrew Robertson
    Group Director
    Health Care and Disaster Preparedness
    Department of Health
    Floor 3C
    189 Royal Street
    EAST PERTH WA 6004

    Northern Territory

    Dr Tarun Weeramanthri
    Principal Medical Adviser and Chief Health Officer
    NT Department of Health and Community Services
    PO Box 40596
    CASUARINA NT 0811

    Tasmania

    Dr David Boadle
    Chief Health Officer
    Department of Health and Human Services
    PO Box 125
    HOBART TAS 7001

    South Australia

    Prof. Chris Baggoley
    Executive Director
    Public Health and Clinical Coordination
    Department of Health
    PO 287, Rundle Mall
    ADELAIDE SA 5001

    Victoria

    Dr Robert Hall
    Chief Health Officer
    Department of Human Services
    50 Lonsdale Street
    MELBOURNE VIC 3000

    Australian Capital Territory

    Dr Paul Dugdale
    Chief Health Officer
    Population Health
    ACT Health
    GPO Box 825
    CANBERRA ACT 2601
Footnote
  1. Should resistance to Oseltamivir be suspected or detected a suitable alternative agent, e.g., Zanamivir should be considered.
  2. As found in the Interim Pathology Guidelines for Pandemic Influenza of the Australian Health Management Plan for Pandemic Influenza (AHMPPI) http://www.health.gov.au/internet/main/publishing.nsf/content/ohp-pandemic-ahmppi.htm