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The clinical impact of influenza in the tropics / subtropics Oh! It’s just the flu Influenza: Seasonal, HPAI, Pandemic Seasonal Influenza Highly Pathogenic Pandemic Influenza Avian Influenza Etiology Influenza A (H3N2, H1N1) Influenza B Pathogenic to humans: H5N1, H7N7 A new subtype mutated H5N1 capable of human- to -human transmission transmission Incubation Period 2 to 3 days 3 days (range 1 to 7 days) (range 2 to 4 days) ? Influenza: Seasonal, HPAI, Pandemic Seasonal Influenza Highly Pathogenic Pandemic Influenza Avian Influenza Exposure from persons infected infected birds with the usual circulating from persons infected with a new virus subtype subtype, strains may vary Clinical manifestations fever, respiratory manifestations, may or may not progress Fever, respiratory manifestations, 5070% fatality, rapid progression Fever, respiratory manifestations, severity to be determined Influenza: Seasonal, HPAI, Pandemic Seasonal Influenza Highly Pathogenic Pandemic Influenza Avian Influenza Who are at risk of complications young children, persons > 50 y/o, with co-morbidities those with contact Uncertain with infected birds Vaccine yearly vaccine strains None none Treatment supportive, antiviral agent supportive, antiviral agent supportive, antiviral agent, if new virus subtype is not resistant What is Avian Influenza? • An infectious disease in chickens, ducks and other birds caused by different subtypes of the influenza A virus – Ranges from mild infection to acute, fatal disease – Two types depending on severity of illness: • Highly Pathogenic Avian Influenza (HPAI) – With mortality in poultry as high as 100% • Low Pathogenic Avian Influenza (LPAI) – Clinical signs much less evident or even absent – Mortality much lower Recent cases of human infection caused by avian influenza viruses 1997 - H5N1 - first human cases seen in Hong Kong in 18 cases, 6 human 1999 – H9N2 - Hongkong, I human case, mild infection 2003 – H5N1 – Hongkong – 2 human cases, 1 death H7N7 – The Netherlands, hundreds with conjunctivitis, ILI , 86 confirmed, 3 cases w/ human-to-human transmission, 1 human death (a veterinarian) H9N2 – Hongkong – 1 human case, mild infection H5N1 - South Korea, Japan – death of chickens, no human case 2004 - H5N1 - human cases and death in Vietnam and Thailand. Spread from one country to another international trade in live poultry – game fowl, breeders migratory waterfowl –wild ducks – - natural reservoir of bird flu viruses - the most resistant to infection - healthy carriers to great distances through their droppings • China • Hong Kong • Vietnam • Thailand • Indonesia • Cambodia • Lao PDR • Pakistan • South Africa • Malaysia • North Korea •Japan **Russia (7/18/05) **Kazakhstan(7/22/05) **Mongolia(8/10/05) Total poultry mortalities / slaughtered fr Jan‘04–Sept 30’05 63.2 million birds Confirmed human cases of avian influenza A(H5N1), 26 Dec ’03 - 13 March ‘06 Cases Deaths Cambodia 4 4 China 15 10 Indonesia 29 22 Iraq Thailand Turkey 2 22 12 2 14 4 Vietnam 93 42 Total 177 98 Reference: WHO CFR = 55% How bird flu spreads within a country • • • • Domestic birds can get the infection when they roam freely and share water supply that that might be contaminated by infected droppings Contaminated equipment, vehicles, feeds, cages, or clothing, especially shoes can carry the virus from farm to farm Wet markets -live chickens and other birds in crowded and often unsanitary conditions Movement of infected birds -trading or smuggling Strait Times, Singapore Website Transmission to humans • Close contact with live infected birds through infected aerosols, discharges and surfaces • Birds excrete the virus in their feces, which dries and becomes pulverized, and is then inhaled • Flapping of wings hastens the transmission Social, economic and political implications – Economic loss in agriculture and the poultry industry – Loss of livelihood of small-scale poultry players – Threat to food security – Widespread public anxiety – Global and national attention on government’s response Human Public Health Implications • High mortality of H5N1 to humans • Emergence of a new influenza virus with pandemic potential - Efficient human to human transmission - Vast majority of people have no immunity - No protective vaccine/ Inadequate quantity of developed vaccines for the world -High number of cases and deaths worldwide (pandemic) Avian Flu and Influenza Pandemic, Impact • • • During the current H5N1 > 150 million birds culled or died: direct economic cost to affected countries $8-12billion Next pandemic may cause very high morbidity and mortality in few weeks. It could cause 1 billion cases and 2-7 million deaths A modest pandemic lasting over one year might cause losses as high as 3% of Asia GDP and 0.5% of world GDP. Presently equivalent to a loss of $ 150-200 billion in GDP The SARS experience and the influenza pandemic •Economic impact of the six-month SARS epidemic: Asia-Pacific region at about $40 billion. Canadian tourism- $419 million. Ontario health-care system -$763 million, Flights in the Asia-Pacific area decreased by 45 % from the year before, the number of flights between Hong Kong and the United States fell 69 % •The impact of SARS would pale in comparison to that of a 12- to 36-month worldwide influenza pandemic. Influenza Pandemics in 20th Century Credit: US National Museum of Health and Medicine 1918: “Spanish Flu” 20-40 million deaths, 20-50 y/o A(H1N1) Avian source 1957: “Asian Flu” 1-4 million deaths, infants and children A(H2N2) 1968: “Hong Kong Flu” 1-4 million deaths A(H3N2) Recombination of human and avian influenza viruses Influenza Pandemics: Why are we concerned now? 3 pre-requisites to start an influenza pandemic: 1. Emergence of a new virus to which all are susceptible; 2. Virus is able to replicate and cause disease in human; 3. New virus is transmitted efficiently from human-to-human H5N1 virus, is the potential candidate, but 3. not fulfilled yet Geographical extent of the problem Reservoirs of infection expanding (range of wild birds and ducks) and virus changing Number of human infections increasing (c/f last year) Past Influenza Pandemics 1847 1850 42 yrs 1889 1900 29 yrs 1918 H1N1 30 – 40 years cycle 39 yrs 1950 H2N2 H3N2 2000 1957 1968 11 yrs No Pandemic for > 38 years Signs and symptoms in humans • A (H5N1) infection very similar to other influenza viruses, most are self-limiting • Initial symptoms are fever, malaise, myalgia, sore throat and cough. • Conjunctivitis in some patients • Persistently high fever • Complications and death due to severe pneumonia, respiratory distress syndrome and multi-organ failure. Individuals at risk In areas where H5N1 has been reported or is suspected Poultry handlers/workers People living near poultry farms Sellers/people involved in live chicken sale Aviary workers Ornithologists Cullers involved in destruction of poultry Diagnosis • If the patient has had direct or indirect contact through handling or having taken care or getting near sick chickens or other birds. • A laboratory confirmation of the bird flu infection and epidemiologic link with unusual death or epidemics of chickens will support the diagnosis of bird flu. Prevention • • • • • Hand hygiene Cleaning and disinfection Avoiding contact with wild birds Safe food practices Practice of proper hand washing and cleaning and disinfection procedures in poultries Vaccination No vaccine developed against H5N1 Routine influenza vaccine – to prevent humans as mixing vessel for re-assortment into a new virus subtype Selected groups for vaccination: • cullers involved in destruction of poultry • people living and working in poultry farms • health care workers involved in the daily care of H5N1 human cases • health care workers in emergency care facilities in areas where there is confirmed occurrence of influenza H5N1 in birds. Emergence of Pandemic Strain Reassortment in Humans or Pigs Migratory water birds Reassortment in human Reassortment in pig Reference: WHO Treatment • Treatment for H5N1, infection is essentially the same as for other influenza viruses. • Antiviral drugs for both treatment and prevention, but have some limitations • OSELTAMIVIR: 1 tab BID x 5 days; Prophylactic: 1 tab OD x7 days Phases of Pandemic Influenza Preparedness and Response - 1 PANDEMIC PHASES (WHO) DESCRIPTION PHILIPPINES Interpandemic Phase Phase 1- No new influenza virus subtypes detected in humans, but may be present in animals and the risk of human infection or disease is low New influenza virus subtype in animals, no poultry outbreaks, no human cases Stage 1 Philippines - Avian influenza-free Phase 2 - New influenza virus subtypes detected in animals and substantial risk of human infection or disease New influenza virus subtype in animals, there are poultry outbreaks, no human cases Stage 2 - Avian influenza in domestic fowl in the Philippines • >1 unlinked human cases with clear history of exposure to an animal source/non-human source Independent clusters of human cases from a common source/ spread from case to close household or unprotected health-care contacts, no sustained human-to-human transmission •Cases with source of exposure which cannot be determined, no clusters or outbreaks of human cases Stage 3 - Confirmation of avian influenza from poultry to humans in the Philippines Pandemic Alert Period Phase 3 – Human infections with a new sub-type, but no human-tohuman spread, or at most, rare instances of spread to a close contact Phases of Pandemic Influenza Preparedness and Response - 2 PANDEMIC PHASES (WHO) DESCRIPTION PHILIPPINES >1 clusters involving a small number of human cases, e.g. a cluster of <25cases lasting <2 weeks Stage 4 - Avian Influenza with humanto-human transmission of pandemic influenza causing outbreaks in the country. Pandemic Alert Period Phase 4 – Small clusters with limited human-to-human transmission but spread is highly localized Small number of human cases in one of several geographically linked areas without a clear history of a non-human source of exposure Phase 5 – Larger clusters but human-to-human spread is still localized •Ongoing cluster-related transmission, but total number of cases is not rapidly increasing, e.g. cluster of 25-50 cases and lasting for 2 to 4 weeks Ongoing transmission, but cases appear to be localized (remote village, university, military base, island) Stage 4 - Avian Influenza with humanto-human transmission of pandemic influenza causing outbreaks in the country. Phase 6 – Pandemic phase: increased and sustained transmission in general population Sustained transmission, increasing number of cases Stage 4 - Avian Influenza with humanto-human transmission of pandemic influenza causing outbreaks in the country. Post-pandemic phase Return to interpandemic period Post-pandemic phase Return to inter-pandemic period Early Signals • Bird/animal death (unexplained/unusual) • Human respiratory infections assoc. with bird/animal deaths • Unusual respiratory disease/deaths-cluster of cases among - Travelers - Cullers - Poultry Handlers - Health care worker - Laboratory workers • Rumor surveillance in the early warning phase to identify possible cases of pandemic strain influenza that might not be notified by routine or enhanced surveillance Keeping the Philippines Bird Flu Free Preparedness from the National to the Local Level AI National Task Force Executive Committee Secretariat Logistics Policy Communications Committee on Human Health Protection Committee on Animal Health Protection Surveillance / Lab Surveillance / Lab Clinical Mgt / Hospitals Containment Resource Mobilization Resource Mobilization Public Health Response Quarantine Quarantine • Secretary of Agriculture • Secretary of Health • DA USec for Livestock and Fisheries • DOH Usec for Health Operations • BAI Director • NMIS Director • DOH Program Director for Emerging & Re-emerging Infections • Private Sector Representatives • Broilers • Layers • Gamefowl • Poultry Veterinarians Keeping the Philippines Bird Flu Free Preparedness from the National to the Local Level AI Regional/ Provincial Task Force AI TASK FORCE Rapid Action Team Surveillance Team Committee Quarantine Team Census Team • DA Regional Director • DOH Regional Director • DA Provincial Officer • DILG RegionalOfficer Director • DOH Provincial • PNP RegionalDirector Director • PNP Provincial • RegionalDisaster Disaster • Provincial Coordinating Council Coordinating Council • Private Sector • Private Sector Representative/s Representative/s IEC Team Stage 1: Keeping the Philippines Bird Flu Free • • • • • • • • Ban of all poultry and poultry products from AI-infected countries Border control Ban on sale, keeping in captivity of wild birds Biosecurity measures Standardized footbath Confiscation and destruction of unlicensed cargo Surveillance of Poultry in Critical Areas Influenza vaccination for all poultry workers, handlers Keeping the Philippines Bird Flu Free Minimum Biosecurity Measures • • • • • • • Biosecurity control points e.g.gates, shower rooms, footbaths, fumigation boxes Proper rest period and disinfection between flocks Inaccessible to stray animals and free-flying birds Proper disposal of mortalities No domestic ducks and freerange poultry in migratory bird areas, especially wetlands No mixing of poultry and swine in same holding facility Record all movement to and from the facility e.g. visitors, vehicles, deliveries Keeping the Bird Flu Free Areas Surveillance ofPhilippines Poultry in Critical • • 20 critical sites identified Target poultry are not wildlife, but native chickens, ducks, gamefowl, etc. in the vicinity • 6 barangays per location to be selected for sample collection Keeping the Philippines Bird Flu Free Priority Areas for Surveillance • • • • • • • • • • Zamboanga del Norte Zamboanga del Sur Zamboanga City Zamboanga Sibugay Palawan near Quezon and Narra Towns Pampanga – Candaba Swamp Ilocos Norte – Pagudpud Cagayan – Aparri Cebu – Olanggo Island Negros Occidental – Himamaylan • Isabela – Magat Dam, Ramon • CARAGA – Lake Mainit, Agusan del Sur • Agusan del Norte • Surigao del Norte • Surigao del Sur • Panay Island – Roxas, Capiz • Sorsogon – Bulan and Matnog • General Santos City • Mindoro Oriental – Naujan • Cotabato – Cabacan, Liguasan Marsh Keeping the Philippines Bird Flu Free Enforcement of Wildlife Act • • • To be led by PAWB-DENR, in coordination with the LGUs and local PNP No permits for poultry wildlife or exotic poultry species from AI-affected countries No collection of migratory birds, regardless of purpose or collection technique Preventive Measures in Humans • Influenza vaccination for all poultry workers, handlers STAGE 2: Avian Influenza in Domestic Fowl in the Philippines • Prevention of spread from birds-to birds: early recognition and reporting, mass culling, quarantine of affected area • Prevention of spread from birds to humans: human protection through proper handling of infected birds, use of protective gear by residents, poultry handlers, and response teams Establishment of Compartmentalized Poultry Keeping the Philippines Bird Flu Free Zones • Compartment 1 Objectives Establish boundaries to prevent entry and limit or stop spread of AI Facilitate surveillance, detection and control Ensure availability of disease free production areas for export and local markets Compartment 2 Compartment 3 Compartment 7 Compartment 4 Compartment 6 Compartment 5 Compartment 8 STAGE 2: Avian Influenza in Domestic Fowl in the Philippines Community Response to sick or dead birds • Protection of exposed residents – gloves/ plastic material in handling sick or dead birds, hand washing • Personal protective equipment for cullers – caps, masks, goggles, gowns • Slowly remove clothing and take a bath immediately after handling birds • Identification of exposed individuals and quarantine for 10 days • Inform the local health and agricultural officers Stage 2: Controlling and Eradicating Bird Flu in Domestic Fowl In case of an outbreak, a 3-kilometer quarantine zone shall be established and all birds within this area shall be stamped out. Moreover, a 7–kilometer control zone shall be secured so that intensive surveillance can be conducted to detect further outbreaks. 3 km 3 km SUSPECT PREMISES CONTROL ZONE QUARANTINE ZONE Level 1 INFECTED PREMISES 7 km QUARANTINE ZONE Level 2 STAGE 3- Avian Influenza in Humans Prevention of cases and deaths • Protection of exposed individuals • Isolation and management of cases • Judicious use of antiviral agents • Infection control • Quarantine of contacts • Mobilization of the BHERTs What should be done when there is a suspected case of avian influenza? Protection of caregiver : face mask and goggles or eye glasses, hand washing, self-monitoring for signs and symptoms Patient: face mask, in a separate area or at least 1 meter distance from other people Monitoring of contacts of the case Immediate transfer to the Referral Hospital Protection of the transporting team and disinfection of vehicle What should be done when there is a suspected case of avian influenza? • Through the Local Health Officer, immediately notify the Provincial Health Office and the Regional Epidemiology and Surveillance Unit regarding a suspected case of HPAI. • A holding area in the community or in the health center will be set aside while awaiting transport. Personal Protective Equipment Who should use PPE? • • Cullers and animal husbandry/veterinary staff and all those who are handling infected or suspected poultry and poultry products. • All doctors, nurses and health care workers who provide direct patient care to avian influenza cases • All support staff including medical aides, X-ray technicians, cleaners, transport staff, laundry staff • All laboratory staff who handle patient specimens from suspect cases • Family members who care for avian influenza patients (no visits) • The patient(s) should wear a mask (N95 preferable) when other people are in the isolation area. • Contacts and international travellers during home isolation/quarantine must wear a mask (N95 preferable). Cullers and transporters should be provided with appropriate PPE •Coveralls plus an impermeable apron or surgical gowns with long cuffed sleeves plus an impermeable apron •Heavy duty rubber gloves that may be disinfected •N95 respirator masks or standard well-fitted masks •Goggles •Rubber or polyurethane boots or disposable protective foot covers Hand washing • single most important and effective component for preventing the transmission of infection. • Running water and soap with friction should be ideally used for 15 to 20 seconds. • It is important to dry hands after washing • A 70% alcohol-based hand rub solution after hand washing can be used. Respiratory Etiquette • Cover your nose and mouth with tissue or handkerchief every time you sneeze, cough or blow your nose. If you don’t have tissue, cough into your sleeve. • Wash your hands with soap and water. – Before touching your eyes, nose or mouth. – Before shaking hands with other people. If water is not available, use an alcohol-based hand sanitizer. • Don’t be offended if someone offers you tissue. Thank the person for the kind act. • Don’t spit on the floor or on the road. Spit on a trash bin or on a small plastic bag. • • Put used tissues or plastic bags in the trash bin. Wash used handkerchiefs separately from clothing. • As much as possible, stay at home when you are sick. • Maintain a safe distance of 1 meter from other people when you are sick. • Do not share eating utensils, drinking glasses, towels or other personal items. Exposed persons Exposure: During the 7 days before the onset of symptoms, contact (within 1 meter) with live or dead domestic fowl or wild birds or with persons suspected to have bird flu Quarantine exposed persons for 10 days and monitor for signs and symptoms of illness. Quarantine of contacts • Stay at home for 10 days • Monitor self for fever, cough or difficulty of breathing or any sign and symptoms of illness. • Refer sick persons to the Referral Hospital for SARS and other severe emerging infections. Referral of Avian Influenza Cases A. Satellite Referral Hospitals – Regional Hospitals/ Medical Centers of 16 Regions B. Sub-national Referral Centers San Lazaro Hospital Lung Center of the Philippines Vicente Sotto Memorial Medical Center Davao Medical Center C. National Referral Hospital Research Institute for Tropical Medicine STAGE 4: Human-to-human transmission of influenza (pandemic influenza) Challenges • High morbidity and mortality • Increased demand for health services • Maintaining essential services – disaster response team, security, peace and order, transportation, communication and utilities • Public anxiety – epidemic of fear CRISIS MITIGATION MEASURES FOR STAGE IV Coping with increased demand for health services and goods Primary care • manpower augmentation • antipyretics, analgesics, liniments and antibiotics Secondary care • • • • Shortage of beds, equipment and supplies Only serious and urgent cases will be admitted Back-up / buddy system Supplies of relevant drugs (e.g. antibiotics) and equipment (e.g. Ventilator) Maintaining essential services In an explosive spread, efforts and resources will be shifted to maintenance of essential services Persons providing – Emergency and disaster response – Maintenance of peace and order – Transportation, including air traffic controllers – Utilities – water, electricity • Arrange ahead places of duties and schedule to cover the required duties during the pandemic • Back up Slowing the spread of infection Personal hygiene – cough etiquette, handwashing Social Distancing • Quarantine of persons/ areas Reduction of unnecessary travel Staying at home when sick Isolation at home (separate room) Closure of schools Suspension of public events • Closure or limitation of people in public places or establishments • • • • • What is the government doing Organization/ Coordination • Management Committee on Prevention and Control of Emerging and Re-emerging Infectious Diseases (DOHMC– PCEREID) • National AI Task Force for Avian Influenza Protection Program (NATF-AIPP) • Formulated structure for Regional and Local TF-AIPP Moving forward: •Monitor Organization of Regional and Local Task Forces -AIPP •Identification of Team Leaders for each critical area What is the government doing Planning Policy/ Technical Guidelines Development • Preparedness and Response Plan for Avian and Pandemic Influenza • Work and Financial Plan • Guidelines: Consensus on the Prevention and Management of Influenza (with medical specialties) Clinical Management of HPAI Infection Control • Planning workshops • Mobilization of DOH-Management Committee for PCEREID • Interagency Avian Influenza Task Force Meeting • Table top exercises Moving Forward: Assist in Preparedness and Response Planning for Avian and Pandemic Influenza - LGUs - Hospitals - DepEd and other agencies - Regional offices What is the government doing Orientation on Avian Influenza and Pandemic Influenza Preparedness • • • • Regional Directors and Chiefs of Hospitals in the National Staff Meeting Regional Coordinators and Epidemiology and Surveillance Units Rural Health MidwivesOlongapo City, Cebu City Ongoing Regional Meetings Training on Infection Control (NCHFD) • NCR Hospitals Moving forward: •Speakers’ Bureau •Provincial, City and Municipal Health Officers and private practitioners •Joint Agriculture-Health Officers Training •Training on Infection Control Other regions – Hospital Staff (Luzon, Visayas and Mindanao What is the government doing Advocacy • Legislators : Committee on Health, Lower House • National Anti-Poverty Commission National Disaster Coordinating Council Medical specialty organizations PPS, PSMID, PIDSP Diplomatic Corps American Chamber of Commerce Asian Development Bank Japanese Consuls to Asian Countries Business Sector Moving Forward: Continuing advocacy to: Health sector Business sector Funding organizations Non-government organizations Other stakeholders/ support groups What is the government doing Advocacy and Information Dissemination • • • • • • Regional Summits (Joint DOHDA activity)– 6 regions –Regions 3, 4, 9, 10, 11 and Palawan Development of IEC Materials – Target audience-based, Cough manners, proper handwashing Quadri-media DOH website for bird flu Lectures to other agencies, offices Planning with UP-CPH for Training on Risk Communication Moving forward: • Local Bird Flu Summits in 40 provinces DOH, DA, DILG, poultry industry • Reproduction of IEC Materials – Target audience-based, cough manners, proper handwashing • Tri-media bird flu features/ updates/ advisories What is the government doing Resource Mobilization • Request Million to PCSO for P30 • Request to PS-DBM for PPE (P8.5M) • Procurement through WHO: 700 bottles of suspension, 10,000 capsules of Oseltamivir • Project development – SARS Project to dovetail Avian and Pandemic Influenza, Meeting with CIDA, USAID (Pledge of $50,000) Moving forward: • Procurement of additional 100,000 capsules of Oseltamivir for 10,000 treatments (to source out P8.5M) • Resource generation AVIAN & PANDEMIC INFLUENZA BUDGET as of 2/22/06 ACTIVITY DONOR AMOUNT GOP-DOH Unilab 10.2 M 60 M Allocated/Released Pledged AusAID 1.77 M Requested Procurement of PPEs GOP-DOH AusAID 20M 1.55M Allocated Requested Workshops and Trainings GOP-DOH ADB WB AusAID 0.5 M 3M 0.5 M 2.0 M Available (2006 budget) Allocated (dovetailed with SARS funds) Requested Requested AusAID 5.52 Requested GOP-DOH USAID UNICEF Spent Pledged Pledged WB AusAID 2.0 M 2.75 M Amount unspecified 3.0 M 5.0M GOP CDC(RITM) 1.0 M 5.0 M Allocated Allocated PCSO 30M Requested Procurement of Oseltamivir Vaccine for health workers Hospital Equipment IEC Survey/ Materials Surveillance Package of Trainings, equipment, supplies STATUS Allocated ( with SARS funds) Requested Elements of the Preparedness Plan 1. Management structure, planning and policy formulation 2. Surveillance system for HPAI and pandemic influenza 3. Antiviral agents and pandemic influenza vaccine 4. Readiness of health facilities, service, manpower and supplies 5. Maintaining non-health essential services 6. Public health interventions 7. Information, education and communication 8. Networking Business Pandemic Influenza Planning - 1 1. Strengthen management structure a. Identify a pandemic coordinator &/or team for preparedness and response planning Planning Considerations: a. Determine processes & services most essential to maintain; affected most by high absenteeism b. Identify essential employees & other critical inputs (e.g. raw materials, sub-contractor services/products, logistics) required to maintain business operations c. Plan for scenarios - or in demand for your products/ services; impact of pandemic on business-related local & international travel d. How to minimize illness among staff, customers e. Labor representatives should be part of process Business Pandemic Influenza Planning - 2 1. Strengthen management structure b. Develop policies, standards & guidelines Sickness & absenteeism policy Set up authorities, triggers, procedures for activating terminating company’s response plan, altering operations Inc. social distancing (e.g. frequency & type of faceto-face contact) Flexible worksite, work-hours Annual Influenza vaccination Prevention of Influenza spread at worksite Travel to affected areas Infectious Control Measures 1. Respiratory etiquette 2. Handwashing 3. Avoid touching the eyes, nose, mouth 4. Stay home when sick, check w/ health provider when needed 5. Practice other good health habits Business Pandemic Influenza Planning - 3 2. Operationalizing a Surveillance system Strengthen coordination & partnership with DA, DOH Monitoring workforce absenteeism Support for surveillance – reporting network, communication 3. Enhancing capabilities of health & nonhealth key personnel Funds to support trainings of Municipal Health and Agriculture Officers, BHERTs Funds to reproduction of training modules Business Pandemic Influenza Planning - 4 4. Providing antiviral agents and pandemic influenza vaccines Stockpile of antivirals for own company; Influenza vaccination for workers Employee access to healthcare services Infection control supplies 5. Ensuring readiness of health facilities, service, workforce & supplies Ensure health workers are knowledgeable on infection control & 1st response Private hospitals to accept patients during a pandemic (Hospital checklist) Non-traditional sites & workers: schools, hotels, etc. as clinics, triage centers Provision of food, supplies, other provisions Business Pandemic Influenza Planning - 5 6. Ensuring preparedness of agencies delivering non-health essential services Preparation of contingency plans Back-up system for personnel to maintain services during a pandemic Temporary permits to volunteers and workers 7. Public Health Interventions Infection control measures; use of masks Suspension of public events; closure or limitation of people in public places (e.g. schools) Limitation of movement from one area with outbreaks to area with no or few cases; suspension of travel to a country w/ outbreaks Transportation: curtains in buses, shut off airconditions Business Pandemic Influenza Planning - 6 8. Strengthening IEC campaign Establish emergency communication plan – directory of contact persons; IT structures (for employee, customer) Training of company speakers Provide funds for the reproduction of IEC materials, conduct of for a, etc. Provide IEC (incl. Preparedness plan) materials to employees 9. Soliciting support & networking W/ government agencies, other business groups, NGOs, healthcare facilities, LGUs Resource Mobilization Self-monitoring against price increases Plan ahead – it wasn’t raining when Noah built the ark.