Pandemic influenza

1. Pandemic influenza • Patricia Coward • Principal Adviser (Occupational Health) • Occupational Health Unit • (07) 3247 9400 • Patricia.Coward@qld.gov.au

2. Session overview • What is the difference between seasonal influenza, pandemic influenza and avian influenza (bird flu)? • Infection control practices to protect staff and students in the event of pandemic influenza

3. Seasonal influenza • Occurs each winter in Australia • New strain each winter • It is reasonably predictable because it is similar to previous influenza strains

4. Seasonal influenza • Some groups are at greater risk from seasonal influenza • Persons 65 years of age and over • Aboriginal and Torres Strait Islander persons aged 50 years and over • Chronic disease • Immunosuppression • Residents of long-term care establishments • Pregnant women

5. Pandemic influenza • Pandemic influenza is a severe form of influenza that infects many people around the world at the same time • Occurs when a new strain of influenza virus emerges to which no-one has immunity • Can occur at any time of the year and lasts longer than seasonal influenza

6. Pandemic influenza • Causes more severe illness and death • All people may be at risk, not just the usual ‘at-risk’ groups • The only predictable thing about pandemic influenza is its unpredictability

7. Previous pandemics

8. Avian influenza • Disease of birds caused by an avian (bird) influenza virus • Usually infects aquatic birds • Can also infect domestic birds and some animals

9. Avian influenza • Historically, human infection with avian influenza viruses has been rare and mild • Human infection with the H5N1 strain of avian influenza is rare but it can cause serious human infection with a high death rate • > 60% • WHO 19th June 2008 • 385 confirmed cases • 243 confirmed deaths

10. Avian influenza • Children and young adults are most at risk from H5N1 • 90% of cases are < 40 years of age • 52% of cases are < 20 years of age

11. Avian influenza • H5N1 is circulating in wild and domestic bird flocks in many parts of Asia, Africa and Europe • H5N1 has pandemic potential • There is concern that H5N1 could mutate to cause the next human influenza pandemic

12. Pandemic alert level • The world is on pandemic alert level 3

13. Pandemic planning • Tertiary education facilities are at significant risk for pandemic influenza • Colleges and universities pandemic influenza checklist • http://www.pandemicflu.gov/plan/school/collegeschecklist.html

14. Assumptions • A pandemic is likely to be widespread throughout Queensland • May last up to 12 months • May be 2 or more pandemic waves each lasting about 8 weeks • Healthcare system will be overloaded

15. Pandemic planning • Social distancing within the community • Inadequate supplies • Significant absenteeism for a prolonged period

16. Protecting staff and students • Vaccination • May not be available at the start of a pandemic • Antiviral medications • Availability will be restricted • Infection control • Criticalcontrol for protecting staff and students • Based on influenza’s modes of transmission

17. How is influenza spread? • Contact transmission • Occurs when you have contact with an infected person or a contaminated surface • Transfer influenza virus to your eyes, nose and mouth via your hands

18. How is influenza spread? • Droplet transmission • Occurs when an infected person releases droplets containing influenza virus when they cough, sneeze or talk • The droplets land on your eyes, mouth and nose if you are within about 1 metre distance of the person

19. How is influenza spread? • Airborne transmission • Occurs when you inhale aerosols of influenza virus • Risk for healthcare workers who perform aerosol generating procedures • No evidence that influenza is spread through air-conditioning systems

20. Infection control for pandemic influenza http://www.health.sa.gov.au/infectioncontrol/

21. Hand hygiene • Regularly wash hands with soap and water or apply alcohol-based hand rub

22. Respiratory hygiene and cough etiquette • Cough or sneeze into a disposable tissue • If no tissue available, cough or sneeze into sleeve • Perform hand hygiene after coughing and sneezing X

23. Cleaning programs • Regular cleaning of • Shared surfaces • Surfaces that are frequently touched • Cleaning agents • Water and detergent • Alcohol-based disinfectant

24. Social distancing • Restrict non-essential face-to-face contact • Conduct business by alternative ways that minimise face-to-face contact • Ensure supporting communications systems • Staff and students able to work from home

25. Social distancing • Where essential face-to-face contact is required • Sit > 1 metre apart • Hold the meeting outdoors if practicable • Stagger start, finish and break times so that fewer people are using workplace facilities and public transport at the same time • Postpone work recreational activities

26. Social distancing • Promote spatial separation at the office • Arrange work stations >1 metre apart • Transparent screens at face-to-face customer service areas

27. Personal protective equipment • Disposable gloves for tasks that involve contact with potentially contaminated surfaces • Vinyl, nitrile or powder-free latex gloves • Perform hand hygiene after glove removal

28. PPE • Surgical masks for • Staff who develop influenza illness at work • Contain their coughs and sneezes • Staff who have face-to-face contact with others

30. Work restrictions • Restrict workplace entry • Display notices at workplace entry points advising people not to enter if they have influenza symptoms

31. Work restrictions • Exclude sick family members from the workplace • Exclude infected children from family rooms • Exclude staff who are contacts of infected people • Should be in quarantine for 7 days from the time that their contact became ill

32. Managing sickness at work • If a person develops pandemic influenza symptoms at work • Separate the person from other workers • First aid or family room

33. Managing sickness at work • Provide the person with • Surgical mask and tissues • Alcohol-based hand gel to sanitise their hands and prevent contamination of their work surfaces • Influenza kit for managing sick workers • Surgical masks, alcohol-based hand gel, tissues, disinfectant, disposable gloves, garbage bags

34. Managing sickness at work • Send the person home promptly • Most contagious at the onset of symptoms • Clean and disinfect the sick person’s workstation once they have left • Identify recent close work contacts and advise them of the situation • May require isolation • Train first aid personnel

35. Vaccination • Maintain annual seasonal influenza vaccination • Seasonal influenza strains may continue to circulate during a pandemic • Encourage vaccination once a pandemic influenza vaccine becomes available

36. Stockpiling • “The decision made now not to stockpile means that you have made the decision not to protect your workers during a pandemic”

37. Campus health services • May be the first to see cases of suspected pandemic influenza • May have to provide care to sick students and staff if hospitals, GPs and community influenza clinics are overwhelmed • International students • Students residing in student housing

38. Campus health services • Medical offices and clinics pandemic influenza planning checklist http://www.pandemicflu.gov/plan/healthcare/medical.html • Stockpile medical consumables, including hand hygiene products, PPE and antivirals

39. Campus health services • Triage system to identify and separate persons presenting with influenza symptoms from others • Single room with ventilation that is not recirculated to other rooms within the facility • Shaded outdoor area • Provide infected persons with a surgical mask to contain coughs and sneezes

40. Campus health services • P2 respirators for healthcare workers, clinic administrative staff and others • Respirator fit test • AS 1715:1994 Selection, use and maintenance of respiratory protective devices • “In order for the designed performance to be achieved by a respirator, it is essential the respirator be properly fitted to the individual to whom it is assigned”

41. Campus health services • Fit check • User seal check performed each time the respirator is donned • Respirator ready • Clean shaven

42. Campus health services • Clinic security • Infection control training • Staff fatigue and work overload • Clinic staff who may be at high risk from acquiring pandemic influenza • Pregnant staff • Monitor clinic staff for influenza illness

43. Campus health services • Commonwealth Department of Health & Ageingwww.health.gov.au • Interim Infection Control Guidelines for Pandemic Influenza in Healthcare and Community Settings • Prepared and protected DVD • Queensland Healthwww.health.qld.gov.au • Pandemic Influenza – Infection Control for Healthcare Workers DVD • Available from the Communicable Diseases branch of Queensland Health (07) 3234 1155 • Royal Australian College of General Practitioners