WHO checklist for

1 WHO checklist forinfluenza pandemicpreparedness planningEPIDEMICALERT &RESPONSEWHO/CDS/CSR/ of Communicable DiseaseSurveillance and ResponseGlobal Influenza Programme World Health Organization 2005 All rights designations employed and the presentation of the material in this publication do not imply the expression of anyopinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, cityor area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps representapproximate border lines for which there may not yet be full mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recom-mended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors andomissions excepted, the names of proprietary products are distinguished by initial capital reasonable precautions have been taken by WHO to verify the information contained in this publication.

2 However, thepublished material is being distributed without warranty of any kind, either express or implied. The responsibility for theinterpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable fordamages arising from its by minimum graphicsPrinted in SwitzerlandContentsPrefacevEssential elements of the checklistix1. Preparing for an Getting Command and Risk Public Communication among those involved in Legal and ethical Legal Ethical Response plan by pandemic phase72. Interpandemic Enhanced surveillance (phase 2 and beyond) Pandemic surveillance113. Case investigation and Diagnostic Local laboratory Reference laboratory Epidemiological investigation and contact management Clinical Case management and Infection control in health-care settings174. Preventing spread of the disease in the Public health General personal Community infection-control Social distancing and Travel and trade Vaccine Routine vaccine Pandemic strain influenza vaccine Antiviral use as a prevention method22iiiCONTENTS5.

3 Maintaining essential Health Health service Health service Health service Excess Other essential Recovery256. Research and Research during phase 2 and From research to action287. Implementation, testing and revision of the national plan29ivWHO checklist FOR INFLUENZA PANDEMIC PREPAREDNESS PLANNINGP refacevPREFACESome time in the futureRumours of an outbreak of unusually severe respiratory illness in two vil-lages in a remote province reach the ministry of health in one of the WorldHealth Organization s (WHO s) Member States. A team is dispatched tothe province and learns that the outbreak started about a month team is able to identify at least 50 cases over the previous month. Allage groups have been affected. Twenty patients are currently in the pro-vincial hospital. Five people have already died of pneumonia and acuterespiratory failure. Surveillance in surrounding areas is increased, and newcases are identified throughout the province.

4 Respiratory specimens col-lected from several patients are tested at the national laboratory and arefound to be positive for type A influenza virus, but they cannot be furthersubtyped. The isolates are sent to the WHO Reference Centre for Influ-enza for further characterization, where they are characterized as influ-enza A(H6N1), a subtype never isolated from humans before. Genesequencing studies further indicate that most of the viral genes are from abird influenza virus, with the remaining genes derived from a human information is immediately transmitted back to the ministry of healthwhere the cases were first identified, and reported throughout the WHOG lobal Influenza Surveillance cases appear in surrounding towns and villages. The new influenzavirus begins to make headlines in every major newspaper, and becomesthe lead story on news networks. Countries are asked by WHO to inten-sify influenza surveillance and control activities.

5 Key government offi-cials throughout the region are briefed on a daily basis, while surveillanceis the next two months, outbreaks begin to take place in neighbouringcountries. Although cases are reported in all age groups, young adults seemto be the most severely affected. One in every 20 patients dies. The rate ofspread is rapid, and countries initiate travel restrictions and quarantinemeasures. Educational institutions are closed. Widespread panic beginsbecause supplies of antiviral drugs are severely limited and a suitable vac-cine is not yet week later, there are reports that the H6N1 virus has been isolatedfrom airline passengers with respiratory symptoms arriving from few weeks later, the first local outbreaks are reported from other conti-nents. Rates of absenteeism in schools and businesses begin to rise. Phonesat health departments ring constantly. The spread of the new virus contin-ues to be the major news item in print and electronic media.

6 Citizens startto clamour for vaccines, but they are still not available. Antiviral drugscannot be obtained. Police departments, local utility companies and masstransit authorities experience significant personnel shortages thatresult in severe disruption of routine services. Soon, hospitals and outpa-tient clinics are critically short-staffed as doctors, nurses and other health-care workers themselves become ill or are afraid to come to work. Fearinginfection, elderly patients with chronic medical conditions do not dare toleave home. Intensive care units at local hospitals are overwhelmed, andsoon there are insufficient ventilators for the treatment of pneumonia pa-tients. Parents are distraught when their healthy young adult sons anddaughters die within days of first becoming ill. Several major airports closebecause of high absenteeism among air traffic controllers. Over the next6 8 weeks, health and other essential community services deterioratefurther as the pandemic sweeps across the you prepared?

7 Are you prepared to prevent or minimize the human morbidity and mor-tality, the social disruption and the economic consequences caused by aninfluenza pandemic?An influenza pandemicAn influenza pandemic (or global epidemic) occurs when a new influenzavirus subtype appears, against which no one is immune. This may resultin several simultaneous epidemics worldwide with high numbers of casesand deaths. With the increase in global transport and urbanization, epi-demics caused by the new influenza virus are likely to occur rapidly aroundthe new influenza virus: how it could cause a pandemicAnnual outbreaks and epidemics of influenza are caused by influenza Aand B viruses. They are the result of minor changes in the influenza vi-ruses that enable them to evade the immunity we have developed afterprevious infections with the viruses, or in response to the influenza A virus can cause pandemics.

8 When a major change ineither one or both surface proteins of the influenza A virus occurs, no onewill be immune, as this represents a completely new virus. When thevirus also has the capacity to spread from person to person, a pandemicmay pandemics have been reported for many hundreds of years. Thebest documented pandemics occurred in 1918 (H1N1, the Spanish flu),1957 (H2N2, the Asian flu) and 1968 (H3N2, the Hong Kong flu).Consequences of an influenza pandemicDuring the 20th century, influenza pandemics caused millions of deaths,social disruption and profound economic losses worldwide. Influenza ex-perts agree that another pandemic is likely to happen but are unable to sayviWHO checklist FOR INFLUENZA PANDEMIC PREPAREDNESS planning when. The specific characteristics of a future pandemic virus cannot bepredicted. Nobody knows how pathogenic a new virus would be, and whichage groups it would affect.

9 The impact of improved nutrition and healthcare needs to be weighed against the effect of increased international travelor simultaneous health threats that weaken the immune system, such asHIV/AIDS. The level of preparedness will also influence the final deathtoll. However, even in one of the more conservative scenarios, it has beencalculated that the world will face up to 233 million outpatient visits, hospital admissions and million deaths globally, within a veryshort addition to their human toll, epidemics can have enormous social andeconomic consequences in a closely interconnected and interdependentworld. For example, in 2003 the outbreak of severe acute respiratory syn-drome (SARS) caused economic losses and social disruption far beyondthe affected countries and far out of proportion to the number of cases anddeaths. While influenza is distinctly different from SARS, it can be antici-pated that a pandemic would have a similarly disruptive effect on socie-ties and do not occur frequently.

10 The last major influenza pandemicwas in 1968. Since then, however, highly pathogenic avian influenza (HPAI),which has previously infected only birds, has caused illness in humansseveral times. HPAI outbreaks remind us that the next pandemic couldoccur at any time if an influenza virus were to combine the high case-fatality rate associated with HPAI infections in humans and the high trans-missibility of seasonal influenza. Governments and their partners need todevelop strategies and programmes to prepare for a prepare?The objective of pandemic planning is to enable countries to be preparedto recognize and manage an influenza pandemic. planning may help toreduce transmission of the pandemic virus strain, to decrease cases,hospitalizations and deaths, to maintain essential services and to reducethe economic and social impact of a addition, blueprints for an influenza pandemic preparedness plan caneasily be used for broader contingency plans encompassing other disasterscaused by the emergence of new, highly transmissible and/or severe com-municable to use the pandemic preparedness checklistThe capacity of countries for influenza pandemic planning varies, and theymay be at different stages of the planning process.