Home > Media Centre > Departmental media releases and speeches > Departmental Speeches

Departmental Speeches

Australian Health Management Plan for Pandemic Influenza

Presentation by Professor John Horvath, Chief Medical Officer, to the Allfinance BCP/DR Forum in Brisbane on 28 August 2006.

PDF printable version of Australian Health Management Plan for Pandemic Influenza (PDF 1.21 MB)

Downloadable Powerpoint presentation of Australian Health Management Plan for Pandemic Influenza (PDF 1.27 MB)

28 August 2006

Slide 1

Australian Health Management Plan for Pandemic Influenza, Allfinance BCP/DR Forum, Brisbane, 28 August 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 - status as of 14 August 2006]

Slide 5: Confirmed human cases

Indonesia

• Cases: 60
• Deaths: 46

Vietnam

• Cases: 93
• Deaths: 42

Thailand

• Cases: 24
• Deaths: 16

China

• Cases: 21
• Deaths: 14

Egypt

• Cases: 14
• Deaths: 6

Cambodia

• Cases: 6
• Deaths: 6

Azerbaijan

• Cases: 8
• Deaths: 5

Turkey

• Cases: 12
• Deaths: 4

Iraq

• Cases: 2
• Deaths: 2

Djibouti

• Cases: 1
• Deaths: 0

Of the 241 human cases reported, more than half have resulted in death.

Slide 6

[image: Affected areas with confirmed human cases of H5N1 avian influeza since 2003 - status as of 14 August 2006 ]

Slide 7: 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 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
• Workplace absenteeism 30-50%

Source: Meltzer CDC 2003

Slide 9

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 10: What has Australia done to prepare?

Slide 11: 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

• Training for border workers
• Thermal scanners purchased
• Development of border protocols
• International Aid

Slide 12: 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 13: 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 14: Preparedness 2003-2006

Stockpile $342.7m

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

Slide 15: 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 16: What will we do if it happens?

Slide 17: 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 18

[Graph: Pandemic Influenza Cases in Sydney 1919]

Slide 19

[Graph: Personal infection control and distancing]

Slide 20

[Graph: Quarantining households]

Slide 21

[Graph: Effect of combining interventions on delay]

Slide 22: 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 23: 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 24: 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 25: Maintenance of social function

Keep society functioning

• Continuous antivirals
  • for health care workers managing cases
• 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 26: Whole of Government approach: Interdepartmental committees

Prime Minister and Cabinet

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

Slide 27: 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 28: Thank you.