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The threat of a flu pandemic: Australian and regional perspective

Presentation by John Horvath, Chief Medical Officer, at the Parliament Library – Vital Issues Seminar, 12 October 2005.

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12 October 2005

Slide 1

The Threat of a Flu Pandemic: Australian and Regional Perspective
Parliament Library - Vital Issues Seminar, 12 October 2005

Slide 2

Pandemics have been documented since 1889, occurring in 10-40 year cycles. Historical anecdotes date pandemic like events as far back as 1100’s, some catastrophic.

Slide 3

Deaths
1918-19	Spanish Influenza	20-50 million
1957	Asian Influenza	approx. 1 million
1968-9	Hong Kong Influenza	approx. 1 million

Slide 4

[image: makeshift influenza hospital]

Slide 5: Avian Influenza epidemic

• affected countries July 27
• Now also Mongolia and Russia

Slide 6: Avian Influenza epidemic human cases

• First human cases in 1997 in Hong Kong with 18 cases and 6 deaths and again in 2002 with 3 deaths. Wide spread culling of poultry was carried out, however,
• Widespread re emergence in 2003
• WHO notifications 112 cases with 57 deaths since 2003

Drug resistance:

• H5N1 is to one class of the two types of antiviral medication

Slide 7: The most recent wave In Vietnam & Cambodia

Changing epidemiological pattern:

• family clusters
• wider age range
• reduction in mortality

Genetic changes occurring.

The risk of pandemic is considered by many to be increasing.

Slide 8: Impact of pandemic strain in Australia

In Australia’s population with an attack rate of 25% we would expect over 6 - 8 weeks:

• 13,000 deaths (2,000 children, 7,000 elderly)
• 57,900 hospitalisations
• 2.6 million outpatient visits

Slide 9

[graph: Death Rate vs. Age, New South Wales 1919 and 1970]

Slide 10: Principle objective of the plan

• Minimize loss of life
• Minimize Social Disruption

Slide 11: Preparedness 2003-2005

Department of Health:

• The National Incident Room upgraded
• Increased resources centrally development of response plans and interagency roles
• High level representation on peak committees
• Scenario testing

Border (learning from SARS):

• Training for border workers


• Thermal scanners purchased


• Development of border protocols:
  • positive pratique
  • customs

Slide 12: Preparedness 2003-2005

Surveillance:

• Development of rapid on line surveillance and case management tools
• Secure networks

Laboratory:

• Upgrading of public health laboratory capacity
• Relocation and upgrading of the WHO Collaborating Centre for influenza

Slide 13: Preparedness 2003-2005

• Regional co-operation to improve animal / human disease surveillance
• Regional co-operation to support health infrastructure

Slide 14

[image: National Incident Room (NIR)]

Slide 15: Preparedness 2003-2005

Stockpile:

• $150 million antivirals
• Additional antibiotics
• Infection Control Equipment (masks, gloves)
• Vaccination Packs
• Negative Pressure Units
• Quarantine Caches

Slide 16: Preparedness 2003-2005

Vaccines:

• Two contracts, on soil and overseas


• Pandemic capacity plus research and development


• Recent additional funding to CSL Ltd:
  • fast track clinical trials (finalise Sept 06)
  • immediate and potential stockpile
  • pandemic vaccine capacity


• Vaccine Trials commenced 4 October 2005

Slide 17: Preparedness 2003-2005

Communications package:

• Information to general practitioners
• DVD on infection control
• Communications forums commencing

Review of urgent research needs:

• NHMRC and DoHA

Development of Australian Management Plan for Pandemic Influenza

Slide 18

[graph: Quarantine - infection and symptoms]

Slide 19: Neuraminidase Inhibitor Drugs

• Reduce time and severity of illness if given early
• ~86 per cent effective prophylactically

Slide 20

Period	WHO Phase	Australian Phase	Description of Phase
Inter-pandemic		Aus 0	No animal disease in Australia
	1	OS 1	Animal infection overseas: low human risk
		Aus 1	Animal infection Australia: low human risk
	2	OS 2	Animal infection overseas: high human risk
		Aus 2	Animal infection Australia: high human risk
Pandemic alert	3	OS 3	Human infection overseas with new subtype(s): no human-to-human spread
		Aus 3	Human infection in Australia with new subtype(s): no human-to-human spread
	4	OS 4	Human infection overseas- small cluster(s), limited human-to-human transmission
		Aus 4	Human infection in Australia- small cluster(s), limited human-to-human transmission
	5	OS 5	Human infection overseas- larger cluster(s), substantial pandemic risk
		Aus 5	Human infection in Australia- larger cluster(s), substantial pandemic risk
Pandemic	6	OS 6	Pandemic overseas- not in Australia: increased and sustained transmission in general population
		Aus 6a	Pandemic in Australia- localised (one area of country)
		Aus 6b	Pandemic in Australia- widespread (multiple areas)
		Aus 6c	Pandemic in Australia- subsided
		Aus 6d	Pandemic in Australia- next wave

Slide 21: Use of antivirals

• The objective of the Australian antiviral stockpile is to reduce mortality and morbidity through containment of the pandemic and maintenance of essential services.
• The best use of the antivirals will differ dependent on the phases of the pandemic.

Slide 22: Use of antivirals

It is recommended that the antivirals are used in the containment phase for those who:

1. Are exposed to a person or animal likely to be infected with pandemic influenza


2. Work in areas where there is high likelihood of exposure


3. That a clinical efficacy study be pre-prepared and commence on onset of cases in Australia

Slide 23: Use of antivirals

• It is recommended that up to 10% of the antiviral stock be used for treatment in the initial phases of the pandemic.
• The effectiveness of this strategy will be closely monitored.

Slide 24: Use of antivirals

What will influence usage?

1. Location of cases


2. Rate of transmission


3. Attack rates in different age groups


4. Clinical severity in different age groups


5. Potential strategies for control (for example isolated overseas outbreak)


6. Depletion of antiviral stockpile

Slide 25: Many policy changes

• Many health and social policy dilemmas
  • Degree of border control
  
  
  • School closures, banning of mass gatherings
  
  
  • International efforts to control disease
  
  
  • Quarantine of well contacts and areas of Australia
  
  
  • Communication approach
  
  
  • Level of social interaction at different phases
  
  
  • Priority groups of antivirals and then vaccines


• Maintaining essential services versus caring for the sick

Slide 26: What is maximally effective?

Depends on effectiveness of the intervention and the virulence and rate of transmission of the virus

Vaccination - Yes
Infection Control - Yes
Antivirals - Proven
Quarantine - Unknown
Border control - Unknown
School closures - Unknown

Slide 27: What is our state of readiness?

• The Plan is not static but continues to evolve
• WHO Assessment
• International comparisons

Slide 28

Thank you.