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Pandemic Influenza - The Australian Response

Presentation by John Horvath, Chief Medical Officer, to the Business Council of Australia, 16 December 2005.

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16 December 2005

Slide 1

Pandemic Influenza - The Australian Response
Business Council of Australia, 16 December 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 2005
• 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.

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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: 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 11: 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 12

[image: National Incident Room (NIR)]

Slide 13: Preparedness 2003-2005

Stockpile:

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

Slide 14: 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

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Slide 15: 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 16

[graph: Quarantine - infection and symptoms]

Slide 17: Neuraminidase Inhibitor Drugs

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

Slide 18

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 19: Antiviral Recommendations

• 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 20: Communications

• Phase specific during pandemic alert
• Current educational materials
  • Information kit for general practitioners
  • DVD on infection control
  • Department of Health and Ageing's website
• Qualitative research underway to inform Communications strategy and materials
• Informed Communications strategy by June 2006

Slide 21: Research

• NHMRC pledged $7.5m to emergent infectious diseases research
• $23.2m to upgrade the World Health Organisation collaborating influenza laboratory in Melbourne
• Priorities for pandemic influenza
  • Rapid diagnostic tests
  • Modeling public health interventions
  • Social issues/communication
  • Transmission parameters
  • Antivirals/vaccine development
  • Antiviral resistance

Slide 22: 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 23

Thank you.

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