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: Affected countries with confirmed human cases of H5N1 avain 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: "New" countries affected

Poultry

Albania
Azerbaijan
France
Austria
Romania
Russia
Turkey
Ukraine
Germany

Wild birds

Bosnia
Bulgaria
Croatia
Herzegovina
Greece
Italy
Switzerland
Sweden
Slovakia
Israel
Palestine Authority
Malaysia
Kazakhstan

Africa

Nigeria
Niger
Egypt

Slide 7: 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.
Widespread culling of poultry was carried out.
Widespread re emergence in 2003
WHO* notifications 190 cases with 107 deaths since 2003

* As at 03 April 2006

Slide 8: Turkey - human cases 2006

Strains similar to those from birds in China
12 cases - 4 deaths, Jan - March 2006.
Mutation at receptor binding site - similar to 2003 strain from Hong Kong
Hong Kong strain binds more strongly to human cells than other strains
Studies continuing on Turkish isolates
Concern over potential for emergence of pandemic strain.
Clinical significance of mutations unknown.

Slide 9

[Graph: WHO confirmed H5N1 cases - reported August 2005 to March 2006]

Slide 10

[Graph: WHO confirmed H5N1 deaths - reported August 2005 to March 2006]

Slide 11: 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 12

[Graph: Death Rate vs. Age, NSW 1919 and 1970]

Slide 13

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
	1	Aus 1	Animal infection Australia: low human risk
	2	OS 2	Animal infection overseas: high human risk
	2	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
	3	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
	4	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
	5	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 14

Will it happen?

Slide 15: 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 16: 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 17: Preparedness 2003-2005

Stockpile $342.7m

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

Slide 18: 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

Slide 19: Preparedness 2003-2005

Establishment of The Office of Health Protection
Communications Strategy
Review of Urgent Research Needs
NHMRC and DoHA
Development of Australian Management Plan for Pandemic Influenza
International Support $140m

Slide 20

What will we do if it happens?

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: Influencing peoples behaviour

Research
- Commissioned research - Blue Moon
- NHMRC projects
Education
Health promotion
Incentives
- Family well being
- Community rewards
Targeted messages
Enforcement

Slide 27

Social distancing

Slide 28: 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 29

What will your business do?

Slide 30: 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 31

Thank you.

Pandemic Influenza - The Australian Response

In this section:

Slide 1

Slide 2