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Grampian Health Advisory Group (HAG) This report provides a summary of public health advice provided by the HAG to the Grampian Strategic Coordinating Group (SCG), NHSG Strategic Group and NHSG Pandemic Influenza Management Team (PIMT); and will be updated on a regular basis. HAG provides advice to the SCG, NHS Strategic Group and PIMT on the management of public health aspects of the outbreak and coordinates the risk assessment, risk management and risk communication Actions Recipients should - check the “Actions” column and ensure that those they are responsible for are undertaken and reported back to HAG ([email protected]) - cascade the information in this document, as appropriate, within their area of responsibility - always check HPS website for latest guidance - List of additional information/planning guidance at end of document Changes since Version 12 (Issued 10 September ) Infection control -Checklist of Infection Control Precautions to minimise transmission of Influenza A H1N1v in the General Dental Practice setting Schools -Preventing and controlling the spread of swine flu: Advice for schools and nurseries Universities & colleges - Guidance on planning: influenza pandemic - revised Offshore -Guidance for Management of Suspected Cases of Influenza A H1N1v on Offshore Installations (Draft) Issue Current Position at WHO phase 6 Action Public Health From July 6 2009 the UK moved from containment to treatment. For further Public Health advice Tel: 01224 558520 during office hours and 0845-456-6000 out of hours (ask for Public Health on call). See SGHD letter 2 July 2009. In summary GP diagnosis of Influenza A (H1N1)v is on the basis of clinical assessment. Routine swabbing and serology from all suspected cases will no longer be required Hospitalised cases should be swabbed as part of normal investigations All contact tracing has ceased and post exposure prophylaxis should only be given to close contacts in exceptional circumstances – HPS guidance awaited. Case Definitions Confirmed case: Any person with laboratory confirmation of influenza A(H1N1)v Clinical diagnostic criteria (suspected case): Clinicians are now encouraged to diagnose influenza A(H1N1)v cases on the basis of symptoms. The clinical diagnostic criteria are: Fever [pyrexia ≥ 38°C] or a history of fever AND Influenza-like illness (two or more of the following symptoms: cough, sore throat, rhinorrhea, limb or joint pain, headache)* OR Severe and/or life-threatening illness suggestive of an infective process *vomiting and diarrhoea has been a feature of some of the confirmed US cases Antivirals Patients clinically assessed as suffering from Influenza A (H1N1)v should be offered anti-viral medication if clinically appropriate. For information When a GP authorises an anti-viral they should use a GP10 form, but endorsed below 2 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health Issue Current Position at WHO phase 6 Action the drug description with the word “FLU” in capitals and underlined. Local community pharmacies and dispensing practices will hold anti-viral supplies ready to dispense on presentation of GP prescription. A small amount of anti-viral stock will be distributed to all practices for use in GP bags. This will be accompanied by advice regarding the most appropriate use of this small amount of stock. A summary of prescribing guidance for Oseltamivir (Tamiflu®) has been produced by HPS http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/antiviralprescribing-2009-05-12.pdf Oseltamivir suspension is only available for children under 1yr Vaccination The UK seasonal flu programme will go ahead as normal this year A vaccine against Influenza A(H1N1) will be available in October 2009 For information Plans are being developed to deliver the pandemic influenza vaccine See Scottish Vaccine update for details http://www.documents.hps.scot.nhs.uk/immunisation/scottish-vaccine-update/issue72009-08.pdf In summary Key planning assumptions The vaccines will be supplied by two manufacturers (GlaxoSmithKline and Baxter). The programme will start at the same time across the UK. The programme will only start when the vaccines have been licensed by the European Medicines Agency and licensed stock has been distributed across the country. The earliest date for the programme to start in late October 2009. Each person will need two doses of H1N1v vaccine. The doses need to given at least three weeks apart. The different brands of vaccine are not interchangeable. Meaning that each 3 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health Issue Current Position at WHO phase 6 Action person should receive two doses of either the GSK or the Baxter brand vaccine. The HPV immunisation programme, routine childhood immunisation and seasonal influenza immunisation programmes will proceed as planned. H1N1v vaccine will be suitable for co-administration with HPV, seasonal influenza and childhood immunisations. Deliveries of vaccine will be made into NHS Board Vaccine Holding Centres on a weekly basis, staged over several months. Priority groups The latest scientific advice on priority groups has been considered by the Joint Committee on Vaccination and Immunisation (JVCI) and Scientific Advisory Group on Emergencies (SAGE). The following groups will be given first priority once the vaccine is licenced: Individuals aged six months and up to 65 years in the current seasonal flu vaccine clinical at-risk groups. Pregnant women, subject to licensing considerations . Household contacts of immunocompromised individuals. People aged 65 and over in the current seasonal flu vaccine clinical at-risk groups. Frontline health and social care workers will be vaccinated alongside the first priority groups as they are at increased risk of infection and of transmitting that infection to susceptible patients. It has now been agreed that GPs will support the programme A training resource for vaccinators is available at http://www.nes.scot.nhs.uk/hai/pandemic%5Fflu/ this will be updated regularly. The content is abased on http://www.hps.scot.nhs.uk/training/education.aspx which is already available to those undertaking routine vaccinations Staff should review the resource regularly for updated information 4 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health Issue Current Position at WHO phase 6 Infection Control General information on Influenza A(H1N1) The general information contained within this document is for the use of clinical and public health colleagues. It sets the scene for more specific guidance on transmissionbased precautions and infection control in defined clinical settings. Its aim is to facilitate the implementation of measures to interrupt transmission on Influenza A(H1N1)v. Action For further infection control advice for healthcare premises please contact: 08:30-17:00 Mon-Fri http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vgeneral-information-2009-08-17.pdf Tel: 01224 552 118 Modes of Transmission of Influenza A H1N1v and Transmission Based Precautions (TBPs) Tel: 07500 033 688 This document describes the modes of transmission of Influenza A H1N1v and the Transmission-Based Precautions (TBPs) required to prevent the spread of Influenza A H1N1v. http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vtransmission.pdf Checklist of Infection Control Precautions to Minimise Transmission of Influenza A H1N1v in the Hospital Setting Includes information on healthcare workers, personal protective equipment, patient placement and transfers, respiratory hygiene, the environment, equipment, linen and waste. 08:30-17:00 Weekends Out with these hours contact 0845-456-6000 (ask for Microbiologist on call). For further infection control advice in community settings please contact Public Health Tel: 01224 558520 during office hours and 0845-4566000 out of hours (ask for Public Health on call). http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vic-precautions-hospitals.pdf Checklist of Infection Control Precautions to Minimise Transmission of Influenza 5 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health Issue Current Position at WHO phase 6 Action A H1N1v in the Primary Care Practice Setting Includes information on healthcare workers, personal protective equipment, patient advice and segregation, respiratory hygiene, hand hygiene, the environment, equipment and waste. http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vchecklist-primary-care-2009-09-02.pdf Checklist of Infection Control Precautions to minimise transmission of Influenza A H1N1v in the General Dental Practice setting Includes information on patient advice and segregation, healthcare workers, personal protective equipment, respiratory hygiene, hand hygiene, the environment, equipment and waste. http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vchecklist-dental-2009-09-10.pdf Checklist of Infection Control Precautions to Minimise Transmission of Influenza A H1N1v when Providing Care in the Patient’s/Client’s Home Includes information on health/social workers, personal protective equipment, patient advice and segregation, respiratory hygiene, hand hygiene, the environment, equipment, linen and waste. http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vchecklist-social-care-2009-09-02.pdf influenza A(H1N1)v is a category 2 pathogen and FFP3 masks are only required for aerosol generating procedures with suspected or confirmed cases. 6 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health Issue Current Position at WHO phase 6 Action British Thoracic Society and British Paediatric Respiratory Society statement on the use of nebulisers in patients where influenza A/H1N1v infection is suspected http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/bts-bprs-statementnebuliser-use-2009-08.pdf NHS Grampian Pharmacy supports the statement in principle and CHP Lead pharmacists have had discussions with community hospitals and GPs regarding the use of and stock of spacers and inhalers. A Patient Group Directive (PGD) is being prepared to allow staff to administer inhalers in this way where clinically appropriate and this has been sent to respiratory consultants for approval. The PGD will go to the Medicines Guidelines and Policies Group on 24 September for approval and sign off. Pandemic Flu: Guidance for infection control in hospitals and primary care settings This guidance provides specific recommendations, planning strategies, and tools for local public health and healthcare officials who are the front line for managing and containing an influenza pandemic. http://www.documents.hps.scot.nhs.uk/respiratory/pandemic-influenza/ic-guidancehospitals.pdf Health care workers (HCWs) caring for suspected (clinically diagnosed) or confirmed cases of Influenza A(H1N1)v: Frequently Asked Questions http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/hcw-faqs-pandemicflu-v0.4-2009-09-08.pdf FFP3 Respirators: Frequently Asked Questions 7 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health Issue Current Position at WHO phase 6 Action FFP3 Respirators are designed to prevent infectious aerosols being inhaled, or landing directly on the vulnerable mucous membranes of the upper respiratory tract. These questions and answers explain the use of FFP3 respirators. http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/ffp3-faqs-2009-v0.42009-09-08.pdf General advice on respiratory and hand hygiene. All front line health professionals, including those working within social care and schools, should take the opportunity to educate members of the public on good respiratory and hand hygiene. General guidance recommends that individuals should wash hands frequently with soap and water; cover the nose and mouth with a tissue when coughing or sneezing and dispose of tissues promptly; ensure that hands are washed after coughing or sneezing. Supervising adults should make sure that children follow this advice. NHS Education for Scotland (NES) infection control measures - training programme NES training programme Education Guidance for schools and early years or group childcare settings Guidance for childminders Guidance for further education colleges and higher education institutions Guidance in residential settings for children and vulnerable young people Justice 8 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health Issue Current Position at WHO phase 6 Action Guidance for fire and rescue services Guidance for funeral directors Guidance for the Scottish Prison Service Guidance for the Police Service Environment Guidance for cleaning staff and refuse collectors in non-health care settings Tourism Guidance for infection control for the Hospitality Industry 9 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health Issue Current Position at WHO phase 6 Action Occupational Health Where an individual has concerns about their own health or that of a colleague then advice can be sought from [email protected] in the usual manner. Individuals can self refer or line managers can refer. Local risk assessments may require adjustment during a pandemic and updated advice will be sought from Health Protection Scotland and other experts. For further information on occupational health issues please contact [email protected] Healthcare workers who are at high risk of complications of influenza (eg immunocompromised workers and pregnant women) should be considered for alternate work assignments, away from the direct care of patients, for the duration of the pandemic or until they have been vaccinated, if it is clinically appropriate for them to be vaccinated. At the very least they should not provide care to patients with confirmed influenza A(H1N1), and neither should they enter parts of the facility segregated for the treatment of patients with confirmed influenza A(H1N1). For information SG advice to employers' on swine flu has been circulated to all HR Directors. This advice is available online on the NHS24 website. Waste There is no change to current waste disposal practices. Guidance included in advice issued to service 30/04/09 Self Care There is no change to current self care flu guidance. Staff should continue to promote good hand hygiene practice, cough etiquette and tissue disposal to patients and their visitors. Social Distancing For information Encourage good hygiene All suspected flu cases are being asked to remain at home whilst symptomatic Stay at home until antiviral medication completed and symptoms resolved. For information If necessary to go out stay away from crowded places and buildings where there are large groups of people like schools, nurseries and hospitals. Exclusions Health and social care staff who are clinically diagnosed with Influenza A(H1N1)v 10 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health Issue Current Position at WHO phase 6 Action should be excluded from work for 7 days, regardless of whether they have been prescribed with antivirals or not. (Draft HPS guidance 27 July 2009) For information Staff who are asymptomatic do not need to be excluded from work. Schools, Further and Higher Education Preventing and controlling the spread of swine flu: Advice for schools and nurseries For information Advice for schools and nurseries on preventing and controlling the spread of swine flu. This includes information on: the symptoms of swine flu how it is spread how to prevent the spread action to be taken if children become unwell whilst at school or nursery action to be taken if staff become unwell whilst at school or nursery specific advice for special schools specific advice for boarding schools http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vadvice-for-schools-2009-09-10.pdf Please read in conjunction with general guidance in the Infection control section Universities & colleges Guidance on planning: influenza pandemic http://www.scotland.gov.uk/Topics/Education/UniversitiesColleges/16640/pandemicflu 11 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health Issue Current Position at WHO phase 6 Action Social Care and Care Homes Checklist of Infection Control Precautions to Minimise Transmission of Influenza A H1N1v when Providing Care in the Patient’s/Client’s Home For information Includes information on health/social workers, personal protective equipment, patient advice and segregation, respiratory hygiene, hand hygiene, the environment, equipment, linen and waste. http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1vchecklist-social-care-2009-09-02.pdf Please read in conjunction with general guidance in the Infection control section Public gatherings No restrictions in place For information Travel and Port Health The current UK government travel advice can be viewed at http://www.fco.gov.uk/en/. For information Influenza A(H1N1)v – travel advice from HPS weekly 05 August 2009 Some authorities have introduced medical screening for influenza A(H1N1)v at several airports for passengers arriving on international flights. Travellers who show flu-like symptoms may be required to undergo further tests and some countries have put quarantine measures in place for people travelling from affected countries. The Foreign and Commonwealth Office (http://www.fco.gov.uk/en/travelling-and-livingoverseas/swine-flu) is posting information on individual country records where this is taking place. British nationals who find themselves quarantined overseas should contact their nearest British Embassy who will be able to offer consular assistance. The Association of British Insurers (ABI) has issued a News Release (http://www.abi.org.uk/Media/Releases/2009/07/) providing influenza A(H1N1)v insurance information for travellers. Influenza A(H1N1)v is treated the same as any other illness by travel insurers. Travel insurance will generally cover the cost of medical treatment if people contract the infection while on holiday. It will also cover the 12 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health Issue Current Position at WHO phase 6 Action cost of rearranged flights and accommodation for anyone covered by the policy. People diagnosed with influenza A(H1N1)v before they are due to travel abroad, and any immediate family members due to travel with them, will be covered for the cost of holiday cancellation. ABTA - the Travel Association also provides useful information for travellers (at http://www.abta.com/about/news/view/157). The Muslim Council of Britain (MCB) has issued new guidance for those planning to travel to Hajj/Umrah through the ongoing A(H1N1)v pandemic (http://www.mcb.org.uk/uploads/MCBSwineFluAdvice1.pdf). It is advised that pregnant women, the elderly, those with chronic illnesses and children postpone their participation in Hajj and Umrah for this year. Further advice is also available on the Travax and Fitfortravel websites (http://www.travax.nhs.uk and http://www.fitfortravel.nhs.uk/home.aspx). TPH2 - HPS Guidance on action at airports for the Treatment Phase during an Influenza A (H1N1)v Pandemic with TPH6 as Annex http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/tph2-hps-guidanceon-action-at-airports-treatment-phase-v2-2009-08-06.pdf TPH3 - HPS Guidance on action at sea ports for the Treatment Phase during an Influenza A (H1N1v) Pandemic with TPH6 as Annex http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/tph3-hps-guidanceon-action-at-sea-ports-treatment-phase-v2-2009-08-06.pdf TPH6 - HPS Guidance (Treatment Phase) - onward travel of passengers arriving at air or sea ports http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/tph6-hps-guidance13 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health Issue Current Position at WHO phase 6 Action passengers-at-ports-diagnosed-as-possible-cases-v2-2009-08-06.pdf Aircraft cleaning - HPS have issued interim guidance for aircraft cleaning when swine influenza is suspected in a passenger or crew member http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/tph7-hps-guidanceon-cleaning-aircraft-2009-07-01.pdf Interim local guidance agreed with Local Authorities Red Cross protocol for transport in exceptional circumstances – agreed. Offshore Installations Guidance for Management of Suspected Cases of Influenza A H1N1v on Offshore Installations (Draft) For information The first version of this guidance was produced at a time when it was feared the Influenza A H1N1v virus might represent a virulent mutation of flu, causing a potentially serious clinical condition, and when public and industry anxiety reflected this, causing potential difficulties for the movement of personnel onshore and around the UK. It is now shown that to date, the Influenza A H1N1v infection has been generally mild, with fever, sore throat and clinical recovery in a few days. In early July 2009, UK government policy on management of the Influenza A H1N1v pandemic transitioned from 'containment' to 'treatment'. This means that, onshore, Influenza A H1N1v is now diagnosed clinically rather than using laboratory diagnosis, and patients who have a clinical diagnosis of Influenza A H1N1v receive antiviral medication, either where specifically clinically indicated (for example, in the presence of existing conditions) or where a strong preference for treatment is expressed by the patient. Contacts are no longer being traced and antivirals are not being given to these asymptomatic individuals as prophylaxis. However, for the time being this guidance will continue to reflect the tactics necessary 14 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health Issue Current Position at WHO phase 6 Action to implement a strategy of localised containment for offshore installations. To facilitate this, the Scottish government has agreed to release a proportion of the national stockpile of oseltamivir to offshore installations. http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/influenza-a-h1n1voffshore-installations-draft-2009-09-18.pdf HPS/Oil and Gas UK Statement on Transportation of H1N1 Flu patients by helicopter in the UK North Sea. Available from Public Health Further information: http://www.hps.scot.nhs.uk/ http://www.scotland.gov.uk/Topics/Health/health/AvianInfluenza Scottish framework Maternity Guidance Health workforce guidance Health Workforce Terms and Conditions Issues Mental health services Adult community care - Operational and strategic framework Adult community care - Guidelines for community care staff Provision of healthcare in a community setting Acute care checklists Death certification Ethics framework Scientific evidence base Clinical guidelines Good Medical Practice 15 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health Vulnerable groups planning guidance The Cabinet Office has produced the guidance document, 'Identifying People who are Vulnerable in a Crisis'. Although originally developed for responders in England and Wales, the principles and methods for identifying vulnerable groups are equally applicable across the UK so the document is also relevant for responders in Scotland. Planning for vulnerable groups Schools, childcare and children's services Guidance for schools, childcare and children's services Schools, Nurseries and children's services: Information for parents Summary guidance for Scottish schools Guidance to group childcare providers in Scotland Further and Higher Education Guidance for colleges and universities Business Workplace Guidance Introductory advice for staff on planning for pandemic influenza Distribution: for onward distribution as appropriate within each organisation SCG, HAG, PIMT, OMT and Operational leads NHS G Control Room for Public Health on call and Tactical CPHM folder GP practices, NES and SNBTS 16 Advisory Group advice - Version 13 Issued 23 September 2009 NHS Grampian Health