1. Pandemic Influenza

2. Guidance for Pandemic Influenza: Infection Control in Hospitals and Primary Care Settings UK Pandemic Influenza Contingency Plan Operational Guidance for Health Service Planners UK Operational Framework for Stockpiling, Distributing and Using Antiviral Medicines in the Event of Pandemic Influenza Department of Health, England Health Protection Agency

3. Pandemic flu: clinical management of patients with an influenza-like illness during an influenza pandemic. Provisional guidelines from the British Infection Society, British Thoracic Society and Health Protection Agency in collaboration with the Department of Health Thorax January 2007

4. Influenza A

5. 1918 - H1N1 ‘Spanish flu’ 40 million deaths 1957 - H2N2 ‘Asian flu’ 2 million deaths 1968 - H3N2 ‘Hong Kong flu’ 1 million deaths Recent epidemiological and virological changes from outbreaks of flu in Asia indicate that a pandemic is a definite possibility. ‘Avian flu’ - H5N1 - Endemic amongst birds in Asia. Since December 2003, 100 cases in humans ? adapting towards human transmission Anxiety about H5

6. Pandemic New influenza A virus infects humans Spreads efficiently from human to human Causes significant illness in a high proportion of those infected No immunity in susceptible population - the disease spreads widely and rapidly

7. International phases Inter-pandemic phases 1.No new influenza viruses detected in humans 2. Animal influenza virus sub-type poses substantial risk

8. International phases Pandemic alert period 3. Human infections with a new sub-type but no human to human spread to a close contact 4. Small clusters with limited human to human transmission but spread is highly localised, suggesting that the virus is not well adapted to humans 5. Large clusters but human to human spread is still localised, suggesting that the virus is becoming increasingly better adapted to humans

9. International phases Pandemic period 6. Increased and sustained transmission in general population Post-pandemic period 7. Return to inter-pandemic period

10. International phases Pandemic alert period 3. Human infections with a new sub-type but no human to human spread to a close contact 4. Small clusters with limited human to human transmission but spread is highly localised, suggesting that the virus is not well adapted to humans 5. Large clusters but human to human spread is still localised, suggesting that the virus is becoming increasingly better adapted to humans

11. UK Alert levels 1.Virus/cases only outside UK 2.Virus isolated in UK 3.Outbreaks in the UK 4.Widespread activity across the UK

12. Epidemiology Mortality globally 2.4 - 7 million Mortality UK - 50,000, possibly higher Elderly, children and young adults One month for virus to arrive in UK Widespread cases within 2 weeks, peak 6 weeks Possibly more than one epidemic wave Clinical and Serological attack rates of 25% and 50% respectively

13. Clinically Incubation 2-4 days Abrupt onset of fever

14. Clinically Cough Malaise Chills Headache Anorexia Coryzal symptoms Myalgia Sore throat

15. Clinical case definition The presence of fever and new (or, in those with chronic lung disease, worsening) cough of acute onset in the context of influenza circulating in the community

16. Complications Usually uncomplicated with acute symptoms resolving within 7 days Pneumonia Myocarditis Encephalitis/Myelitis/Guillaine-Barre Otitis media

17. Provision of care in the event of a Pandemic Significant changes to usual practice in order to cater for the excess caseload over a period of a few weeks, perhaps encompassing; Treatment of patients in the community by healthcare professionals other than their usual GP Treatment of patients in their own homes or intermediate care settings by their GP who, under usual circumstances, would have been admitted to hospital Treatment of severely ill cases in hospital by medical and nursing teams in areas of the hospital not normally used for providing such care.

18. Planning in Secondary Care Vaccination Anti-viral therapy for healthcare workers Infection control Capacity planning

19. Anti-virals Neuraminadase inhibitors – Oseltamivir, Zanamavir M2 Ion channel inhibitors – Amantadine Ribavirin

20. Infection control Timely recognition of cases Preparedness, good stocks of disposables/equipment Hand hygiene Personal protection equipment Containment of respiratory secretions Triage and separation of cases

21. Infection control Restriction on health care workers Restrictions on Patients Restrictions on Visitors Education of patients/visitors and staff Occupational health, screening symptomatic workers Non-clinical areas – laundry/linen

22. Infection control Separation Dedicated wards, adopting surgical beds Reception areas Visiting areas Laboratory and X ray areas

23. Capacity Overall co-ordinator of hospital management during pandemic Supported by multi-disciplinary committee Early discharge schemes Triage Cancellation of elective activity