Presentation in MTE on 4 August 2015 at Furama Hotel Bukit Bintang KL

By

DR WAN NORAINI WAN MOHAMED NOOR

Dr. Wan Noraini Wan Mohamed Noor Public Health Physician Disease Control Division

Ministry of Health Malaysia 4 August 2015

Source: Morens DM et al. 2004. The challenge of emerging and re-emerging infectious diseases. Nature. 430: 242-249

GLOBAL DISTRIBUTION OF EMERGING AND REEMERGING INFECTIOUS DISEASES

SARS

H5N1

Nipah Virus Pandemic (H1N1) 2009

MERS-CoV Ebola (2014)

H7N9

The Threats Continue

• Populations grow and move …

Microbes adapt …

Changing climates …

Increasing global interconnectedness …

WHO Briefing Notes: Pandemic (H1N1) 2009

“…. The 2009 influenza pandemic has spread internationally with unprecedented speed. In past pandemics, influenza viruses have needed more than six months to spread as widely as the new H1N1 virus has spread in less

than six weeks ….”

WHO , Geneva (16 July 2009)

Emerging Infectious Diseases (EIDs): Our Fair Share

Global burden largely unknown

Data available mainly from temperate climate

WHO estimation of illness & deaths due to seasonal

influenza: Annual illness: 3 – 5 million

Annual deaths: 250,000 – 500,000

In the US (per year): > 200,000 hospitalizations and ~ 35,000 deaths

USD 37.5 billion in economic cost

Pandemic influenza – an ever present threat

Seasonal Influenza: Influenza that occurs every year with gradual variations in the previous year’s virus surface proteins (antigenic drift)

Avian Influenza: A disease of birds that occasionally jumps species and infects humans. Ultimately is the source of new viruses in humans causing pandemics

Pandemic Influenza: A worldwide surge in cases caused by the introduction of a new type A surface protein (antigenic shift)

Influenza is an acute respiratory disease

Transmission of influenza viruses:

Person-to-person transmission through close contact

Primarily through contact with respiratory droplets

Transmission from objects (fomites) possible

Viral shedding can begin 1 day before symptom onset

Peak shedding first 3 days of illness

Subsides usually by 5th to 7th day in adults

Infants, children and the immunosuppressed may shed virus longer

Clinical symptoms non-specific Symptoms overlap with many pathogens Coupling with lab data to verify diagnosis

Abrupt onset

Fever, chills, body aches, sore throat, non-productive cough, runny nose, headache

Gastrointestinal symptoms and muscle inflammation more common in young children

Influenza infection is not a direct cause of deaths in many influenza associated deaths (bacterial pneumonia, heart failure etc.)

Elderly > 65 years

Young children (<2 years)

Persons with chronic medical conditions Immunosuppression Conditions that can compromise respiratory function or the

handling of respiratory secretions

Pregnant women

Nursing home residents

Children on long-term aspirin therapy

Annual vaccination

Best way to prevent seasonal influenza

Contains antigens representing three (trivalent vaccine) or four (quadrivalent vaccine) influenza virus strain

- Trivalent vaccine: influenza A(H1N1) + influenza A(H3N2) + either one of the two influenza type B virus strain

- Quadrivalent vaccine: influenza A(H1N1) + influenza A(H3N3) + influenza B (Victoria lineage) + influenza B (Yamagata lineage)

Will not work on pandemic strains

A new influenza A subtype emerges that can infect humans (antigenic shift); AND

Ability to cause serious illness; AND

Ability to spread easily from human-to-human (i.e. sustained human-to-human transmission)

The occurrence: on average three times each century (based from past history)

The Pandemic (Common Name)

Timeframe Mortality Virus Subtype

Asiatic (Russian) Flu 1889 – 1890 ≈ 1 million H2N2 (possibility)

Spanish Flu 1918 – 1920 20 – 100 million H1N1

Asian Flu 1957 – 1958 1 – 1.5 million H2N2

Hong Kong Flu 1968 – 1969 0.75 – 1 million H3N2

Pandemic H1N1/09 2009 – Aug. 2010 18,000 H1N1

The impact has increased dramatically as the world becomes ever more interconnected

Spanish Flu 1918 caused a form of viral pneumonia that could kill the perfectly fit within 48 hours or less

Potential Impacts on Non-Health Sectors (Pandemic influenza could infect >35% of world’s population)

Breakdown of Services Economic and Social Disruption

• Changed of demands • Lack of BCP

ABSENTEEISM

Death / Illness Quarantine

Care Fear

Decreased Demand

• Retail trade • Transportation • Leisure travel • Gastronomy

Decreased Supply Increased Supply

• Reduced production • Disrupted transportation • International trade of

commodities • Cross-sectoral

interdependencies

• Military support for logistics etc.

• Mortuary & burial services • Water & sanitation • Telecommunication (phone

& internet) • ATM, online banking • Health & life insurance • Protection against

insecurity • Electricity / power supply • Healthcare

The Global Approach

WHOLE-OF-SOCIETY PANDEMIC READINESS

Source: WHO (2009). Whole-Of-Society Pandemic Readiness: WHO Guidelines for Pandemic Preparedness and Response in the Non-Health Sector. Geneva.

• The national government

• The health sector

• The diverse array of non-health sectors

• Civil society organizations

• Families and individuals

Adopting A Whole-of-Society Approach

A whole-of-society approach to pandemic influenza preparedness emphasizes the significant roles played by all sectors in the society:

Source: WHO (2009). Pandemic influenza preparedness and response – A WHO guidance document. Geneva: Global Influenza Programme

An international law which helps countries work together to save lives and livelihoods caused by the international spread of diseases and other health risks

Entered into force on 15 June 2007

Aim to prevent, protect against, control and respond to the international spread of disease while avoiding unnecessary interference with international traffic and trade

Are also designed to reduce the risk of disease spread at international airports, ports and ground crossings

Revision took place due to limitations of the IHR (1969) their narrow scope (i.e. cholera, yellow fever and plague)

dependence on official country notification

lack of a formal internationally coordinated mechanism to contain international disease spread

Addressing the growing and varied public health risks that resulted from increased travel and trade in the last quarter of the 20th century

Some countries were reluctant to promptly report outbreaks of these diseases for fear of unwarranted and damaging travel and trade restrictions

The IHR (2005)’s reporting procedures are aimed at expediting the flow of timely and accurate information

The Local Approach

MOH Malaysia: The Preparedness

• The preparedness plans:

– 2006: The National Influenza Pandemic Preparedness Plan (NIPPP)

– 2006: The National Crisis and Preparedness Response Centre (CPRC)

– 2008: The Risk Communication Work Plan

• The National Influenza Pandemic Preparedness Plan (NIPPP):

– Preparation started in 2003

– Drafted by the National Influenza Pandemic Planning (Technical) Committee and endorsed by the Cabinet

– Launched on 9 January 2006

• Organization of regular simulation exercises involving various levels and players / agencies

Pandemic Influenza: The Organizational Response

Multi-sectoral coordination operates through various organizational responses both at national and state levels:

i. National level:

• The National Inter-Ministerial Influenza Pandemic Committee (NIIPC) - Chairman: The Honourable Deputy Prime Minister

• The National Influenza Pandemic Planning (Technical) Committee (NIPPC) - Chairman: The Director General of Health

• The National Influenza Pandemic Committee (NIPC) - Chairman: The Deputy Director General of Health (Public Health)

ii. State & District Levels:

• State & District Influenza Pandemic Committee

The Multi-Sectoral Approach

• The National Security Council (NSC) of PMO: the highest government agency with a mechanism to coordinate disaster management (including pandemic influenza) and response involving various sectors

• The NSC Directive No. 20 (NSC No. 20): an integrated emergency management policy, which includes the responsibilities and functions of various related agencies

• Continuity of Operations Planning was developed by the Malaysian Administrative Modernization and

Management Planning Unit (MAMPU) of PMO – Directive was given to all public sector agencies for internal establishment of the planning by 2015

How a Severe Pandemic Influenza Could Affect Workplaces?

ABSENTEEISM

SICKNESS

CARE

FEAR

DEATH

A pandemic could affect as many as 40 percent of the

workforce during periods of peak influenza illness

During an influenza pandemic, the most realistic way to minimize absenteeism is to combine a mix strategies

• Reduce workforce exposure to the virus

• Encourage employees to get immunized when the vaccine is available

• Support their efforts to recover if they do become ill

A Quick Guide To Pandemic Response & Human Resource Issues

A. Protecting Employees

• Set the expectation that sick employees must stay at home

• Allow flexible work arrangements for employees who are at highest risk of developing severe complications if they become ill

• Promote hygiene practices

• Explore options for antiviral medications

• Stay current on vaccine availability

• Consider respiratory protection

A Quick Guide To Pandemic Response & Human Resource Issues

B. Making Good Decisions During Rapidly Changing Conditions

• Focus on sources of information and news

• Narrow the scope of work to what is possible

• Arrange daily (or more frequent) meetings or conference calls

• Use the principle of proportion response

• Involve legal counsel

A Quick Guide To Pandemic Response & Human Resource Issues

C. Managing Sick Employees • Temporarily suspend the requirement for a doctor’s note • Send sick employees home • Review policies on sick-leave and pay • Explore telework option

D. Communicating • Help employees understand that conditions can change

quickly • Communicate with accuracy, timeliness and commonality • Communicate with employees’ families • Contact local and state health department

Measuring The Progress – A Checklist (Use the checklist to assess the organization’s level of preparedness, identify gaps

and benchmark the effort)

STEPS TO TAKE IMMEDIATELY

Items The Status

Sick employees should stay home

Sick employees at work should be sent home

Encourage employees to wash their hands often

Encourage employees to cover their coughs and sneezes

Clean surfaces and items that are more likely to have frequent hand contact

Encourage employees to get vaccinated

Protected employees at higher risk for complications of flu

Prepare for increased numbers of employee absences due to illness in employees and their family members and plan ways for essential business functions to continue

Prepare for possibility od school dismissals or temporary closure of child care programs

Advise employees before traveling to take certain precautionary measures

Measuring The Progress – A Checklist (Use the checklist to assess the organization’s level of preparedness, identify gaps

and benchmark the effort)

STEPS TO WHEN SEVERITY INCREASES

Items The Status

Consider active screening of employees who report to work

Consider alternative work environments for employees at higher risk for complications of flu during periods of increased flu activity in the community

Increase social distancing

Advise employees about possible disruptions and special considerations while travelling abroad

Prepare for school dismissal or closure of child care programs

Thank You