Non-Pharmaceutical Interventions to Face the Pandemic

1. INTERCOUNTRY MEETING ON AVIAN INFLUENZA AND PREPAREDNESS FOR HUMAN PANDEMIC INFLUENZA EMRO, CAIRO, EGYPT, 28-30 NOVEMBER 2005 Non-Pharmaceutical Interventions to Face the Pandemic Dr John J. Jabbour Senior Epidemiologist IHR/CSR/DCD WHO/EMRO

2. Outline • Why non-pharmaceutical interventions? • What are the non-pharmaceutical interventions? • Limitations • Challenges Communicable Disease Surveillance, Forecast & Response Unit

3. Why non-pharmaceutical intervention? • Given the problems of : • inadequate vaccine supplies and • the uncertain role of antiviral drugs, • Several efforts have been made to determine whether non-pharmaceutical interventions could mitigate the initial impact of a pandemic Communicable Disease Surveillance, Forecast & Response Unit

4. Why non-pharmaceutical intervention? • the principal protective tools pending the augmentation of vaccine supplies. • In resource-poor settings, non-pharmaceutical interventions may be the main line of defense throughout the first wave of a pandemic. • The effectiveness of most of these interventions has not, however, been tested under the unique conditions of a pandemic. Communicable Disease Surveillance, Forecast & Response Unit

5. The effectiveness of many interventions • depends on: • the behavior of the virus as determined by its: • pathogenicity, • principal mode of transmission (droplet or aerosol), • concentration in different age groups, • duration of virus shedding • susceptibility to antiviral drugs. Communicable Disease Surveillance, Forecast & Response Unit

6. Example • If children are the most severely affected age group, or play a major role in transmission, then health authorities should make decisions about: • the effectiveness of school closure, • travel measures (children travel less frequently than adults) and • quarantine (children cannot be separated from their parents). Communicable Disease Surveillance, Forecast & Response Unit

7. Selection of appropriate measures • Driven by questions of feasibility, which are closely linked to: • costs, • ease of implementation within existing infrastructures, • likely acceptability to the public, and • potential to cause social and economic disruption. Communicable Disease Surveillance, Forecast & Response Unit

8. Non-pharmaceutical Interventions

9. Public health information, communication • Information for public on risks and risk avoidance (tailored to target population) • Information for professionals (Guidelines) • Advice on universal hygiene behavior • Preparatory information on next phase Communicable Disease Surveillance, Forecast & Response Unit

10. Measures to reduce risk that cases transmit infection • Confinement: • Confine cases (mild and severe) as appropriate to local situation (provide medical and social care, face masks): • Severity of illness depends on prior experience with related variants • symptomatic persons • exposed person: undertake risk assessment considering: evidence of human-to-human transmission; closeness of contact; frequencyof exposure • persons seeking care (respiratory illness) in risk Communicable Disease Surveillance, Forecast & Response Unit

11. Measures to reduce risk that contacts transmit infection • Tracing and follow-up of contacts (Not feasible once pandemic starts) • Self-health monitoring and reporting if ill • Voluntary quarantine (home confinement) of healthy contacts; provide medical and social care • Advise contacts to reduce social interaction • Advise contacts to defer travel to unaffected areas • Provide contacts with antiviral prophylaxis Communicable Disease Surveillance, Forecast & Response Unit

12. Measures to increase social distance • Voluntary home confinement of symptomatic persons • Closure of schools (including pre-school, higher education) in conjunction with other measures (limiting after-school activities) to reduce mixing of children • Population-wide measures to reduce mixingof adults (furlough non-essential workers, close workplaces, discourage mass gatherings) • Masks in public places Communicable Disease Surveillance, Forecast & Response Unit

13. Disinfection measures • Hand-washing • Household disinfection of potentially contaminated surfaces • Widespread environmental disinfection • Air disinfection Communicable Disease Surveillance, Forecast & Response Unit

14. Measures for persons entering or exiting an infected area within the country • Advise to avoid contact with high-risk environments (infected poultry farms, live poultry markets) • Recommended deference of non-essential travel to affected areas • Restrict travel to and from affected areas • Disinfection of clothing, shoes, or other objects of persons exiting affected areas Communicable Disease Surveillance, Forecast & Response Unit

15. Influenza Surveillance • Influenza surveillance network with NAMRU-3 (Expansion and guidelines) • Active search surveillance for persons coming from affected areas • Distribute proper information to travelers for self reporting • Facilitate the installation of proper communication means for data reporting • Health facilities • Laboratories • Build analytical capacities at national levels capable of producing reports quickly Communicable Disease Surveillance, Forecast & Response Unit

16. Laboratory Skills • Guidelines: sample collection, biosafety, etc. • Building capacities: • Consultants • Training of national staff • Link to reference laboratory for virus isolation and information-sharing • Laboratory surveillance networking Communicable Disease Surveillance, Forecast & Response Unit

17. Limitations • Pandemic influenza is considered far more difficult to control than SARS: • Influenza A viruses are much more contagious than the SARS corona virus • The incubation period is shorter and the virus can be spread prior to the onset of symptoms • Fever checks and border screenings will not be able to detect people in the incubation period who have no symptoms • While SARS remained largely confined to hospital settings, pandemic influenza will rapidly and widely spread within the community Communicable Disease Surveillance, Forecast & Response Unit

18. Challenges • Select the appropriate non-pharmaceutical measure • Strengthen human and animal health surveillance systems • Enhance inter-sectoral collaboration • Improve laboratory capacities for detecting and isolating the virus • Ability to produce and disseminate guidelines and educational material to the health professionals and the public • Ability to share and update information quickly among all concerned parties Communicable Disease Surveillance, Forecast & Response Unit