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Pandemic Influenza - The Australian Response

Presentation by Professor John Horvath, Chief Medical Officer, to the Sydney University Infectious Disease, Immunisation and Allergy Symposium, 14 June 2006.

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14 June 2006

Slide 1

Pandemic Influenza - The Australian Response
Sydney University Infectious Disease, Immunisation and Allergy Symposium, 14 June 2006

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: Areas reporting confirmed cases of H5N1 avian influenza in poultry and wild birds since 2003]

Slide 5: Affected areas with confirmed human cases of H5N1 avian influeza since 2003

Cambodia

• Cases: 4
• Deaths: 4

China

• Cases: 15
• Deaths: 10

Indonesia

• Cases: 27
• Deaths: 20

Iraq

• Cases: 2
• Deaths: 2

Thailand

• Cases: 22
• Deaths: 14

Turkey

• Cases: 12
• Deaths: 4

Vietnam

• Cases: 93
• Deaths: 42

Slide 6: Indonesia - Sumatran Cluster May 2006

• 8 cases in family cluster- 7 deaths.
• Index case - exposed to sick chickens? Onset illness 27th April
• Case 2- 7 onset 3-6th May, Case 8 onset 12 May - suggestive of chains of infection
• No H5N1 identified in animals or environment
• WHO statement - likely human to human transmission cannot exclude environmental source
• Key viral genetic sequences remain the same

Slide 7: 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
• Workplace absenteeism 30-50%

Source: Meltzer CDC 2003

Slide 8

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 9

What has Australia done to prepare?

Slide 10: Preparedness 2003-2006

Department of Health

• The National Incident Room upgraded
• Office of Health Protection
• High level representation on peak committees
• Scenario testing - Exercise Cumpston

Border (learning from SARS)

• Training for border workers


• Thermal scanners purchased


• Development of border protocols


• International Aid

Slide 11: Preparedness 2003-2006

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: Preparedness 2003-2006

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

Slide 13: Preparedness 2003-2006

Stockpile $342.7m

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

Slide 14: Preparedness 2003-2006

• Establishment of The Office of Health Protection
• Communications Strategy
• Review of Urgent Research Needs
• Australian Management Plan for Pandemic Influenza - June 2006, revised May 2006
• International Support $141m

Slide 15

What will we do if it happens?

Slide 16: Modelling

• Papers by Ferguson et al, Longini et al indicate a pandemic may be stopped by use of antivirals and quarantine*
• Modelling currently being carried out in Australia indicates home quarantine and social distancing can have a major effect in ‘blunting’ epidemiological curve

* Ferguson NM, Cummings DA et al. Strategies for containing an emerging influenza pandemic in Southeast Asia. Nature. Vol 437/8 September 2005. 209 - 214

Longini IM, Azhar Nizam et al. Containing Pandemic Influenza at the Source. Science Vol 309 12 August 2005. 1083-1085

Slide 17

[Graph: Pandemic Influenza Cases in Sydney 1919]

Slide 18

[Graph: Personal infection control and distancing]

Slide 19

[Graph: Quarantining households]

Slide 20

[Graph: Effect of combining interventions on delay]

Slide 21: Containment

Keeping it out

Border control

• screening to closure

Antiviral policy

• for prophylaxis

Use of quarantine

• home quarantine
• Consideration of mass quarantine in Overseas 5 and 6

Slide 22: Border control options

Current	Positive Pratique
Pratique by exception	Screening of select arrivals: declaration forms; thermal scanning nurse assessment isolation and quarantine
Screening baggage for chicken products	Screening all arrivals
Health information sheet	Diverting flights from specific locations

Slide 23: Containment

Stamping it out

• Use of antivirals for prophylaxis
• Treatment of index case
• Use of home quarantine
• Emphasis on early detection (testing)
• May use internal border controls or 'ring fencing'

Slide 24: Maintenance of social function

Keep society functioning

• Continuous antivirals
  • for health care workers
  • those at high risk of exposure
• Post exposure prophylaxis
  • for those at less risk
• Treatment if symptomatic
  • depends on effectiveness of antivirals
• Quarantine
  • Still advised, monitoring to cease
  • Ban on mass gatherings advised to continue

Slide 25: Whole of Government approach: Interdepartmental committees

Prime Minister and Cabinet

• Food Supply
• Business Continuity
• Social Services
• Economic impact
• Foreign Policy

Slide 26: Urgent research

• Symposium in April 2005
  • Confirmed capacity
  • Determined priorities


• $6.57 million awarded
  • Detection and monitoring (8)
  • Public Health Intervention (5)
  • Antivirals (incl resistance) (3)
  • Pandemic vaccine (9)
  • Behavioural response (4)
  • Other (4)

Slide 27

Thank you.