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HBDHB Pandemic Influenza Plans Gear Up a Notch

12 October 2005

HBDHB Pandemic Influenza Plans Gear Up a Notch

Hawke’s Bay District Health Board chief operating officer, Ray Lind, updated Board members at today’s Board meeting, on the international, national and local planning for a potential influenza pandemic.

Mr Lind is a member of New Zealand’s Pandemic Influenza Reference Committee.

Ray Lind said a pandemic (worldwide) influenza outbreak would have serious effects on the Hawke’s Bay community. “This wouldn’t be a problem just for health services…it would be a community problem and everyone in Hawke’s Bay would have to change their day-to-day activities to help stop the spread of influenza, contain and control the outbreak, and eventually return to ‘business as usual’.

He said over a six to eight week period, a possible scenario is that between 25% and 50% of Hawke’s Bay people would have severe influenza. 53,000 people would be sick; 25,000 would visit the doctor; 600 would be seriously ill and admitted to hospital and 150 people would die.

“As this would be a novel (new) virus, no one would have immunity and even fit, healthy people could die. In the 1918 Spanish flu pandemic, otherwise fit and healthy young soldiers made up a high number of the casualties.

“During an influenza pandemic schools would be closed, businesses and industry would temporarily close. There would be no public gatherings, and of course all health services would be under extreme pressure. GPs would be treating more complex cases, with only the sickest people being admitted to hospital. Families would become caregivers for their loved ones at home.

“Everyone would have to play their part in a community response. Hawke’s Bay District Health Board and the Ministry of Health would provide health education and information to the public.

“It would take time for a vaccine to be developed, so in the interim it would be a case of treating symptoms and complications of influenza. Current vaccines don’t provide protection against Asian bird flu H5N1,” he said.

Mr Lind said it wasn’t all doom and gloom. “There are some simple, practical things people can do to protect themselves and their families…hand washing is still the single most important measure to reduce the risks of transmitting influenza from person to person. Because influenza virus is easily spread by droplets from sneezing or coughing hand washing with soap and water and thoroughly drying (preferably on disposable towels) will reduce the spread of the virus.

People with flu or cold-like respiratory symptoms should:

- avoid close contact (less than 1 metre) with other people

- cover their nose and mouth when coughing or sneezing

- use disposable tissues

- immediately dispose of used tissues

- immediately wash and dry hands after sneezing

- use a disposable mask to help prevent exposing others to their respiratory secretions

Mr Lind said a briefing had been held earlier today on ‘Operation Flubuggers’ an interagency desktop exercise designed to test the community’s capability for managing an Influenza Pandemic.

“The exercise involves representatives from across the health sector and government agencies. Various scenarios will be played out over three weeks in November, and each participating agency will be given 48 hours to come up with their response to the various phases of the pandemic.

“The purpose of the exercise is to test our plans as they stand, and in the process, identify any gaps and devise strategies to ensure we are as well prepared as possible,” Ray Lind said.

Detailed information on Pandemic Influenza is available on the Ministry of Health website
www.moh.govt.nz This includes very specific information for health professionals.

ENDS

Background information

Interim guidelines for personal protection during an influenza pandemic
(Edited from Ministry of Health Information issued 15 September 2005)

Concern for personal protection is greater during a pandemic influenza as it is caused by a virus that is markedly different from recently circulating strains such as found in a seasonal influenza, which is a familiar infection, especially during winter. A pandemic influenza causes illness in a large number of the people infected; it spreads widely and quickly because the population will have no immunity.
How is pandemic influenza transmitted?

Primarily, human influenza is transmitted from person to person via virus-laden large droplets (particles >5 µm in diameter), which are generated when an infected person coughs or sneezes. These large droplets can then be directly deposited onto the mucosal surfaces of the upper respiratory tract of susceptible people who are near the infected person (ie, within 1 metre). Transmission may also occur through direct contact with infectious (wet) respiratory secretions, such as by touching door handles, taps, lift buttons, stairwell railings, keyboards, etc that have deposits of the infected secretions on their surfaces, and then hand-to-face contact.

General and specific infection prevention and control measures

Organisational respiratory disease policies

Organisations of all kinds should have effective policies and processes in place to ensure people with symptoms of respiratory disease do not place others at risk of infection. For workplaces, such policies can include sending ill people home and enabling staff to work in more isolated settings, such as from home, during times of influenza outbreak.

Ventilation of internal spaces

There is scientific and medical evidence that influenza can spread in inadequately ventilated internal spaces. All internal spaces should be well ventilated, preferably with fresh air, by opening windows, or with properly designed and maintained air-conditioning systems. See www.moh.govt.nz/pandemicinfluenza for specific Ministry of Health advice on air conditioning and influenza.

Hand hygiene

Hand washing is still the single most important measure to reduce the risks of transmitting infectious organisms from one person to another.

Hands should be washed regularly with soap and water, an alcohol-based hand rub or an antiseptic hand wash and then thoroughly dried, preferably using disposable tissues or towels.

Hands should always be washed and dried after contact with respiratory secretions or after touching surfaces that have been contaminated with respiratory secretions. Health care workers dealing with respiratory secretions should be wearing gloves as per the Standard Precautions. See Standard Precautions: www.cdc.gov/ncidod/hip/ISOLAT/std_prec_excerpt.htm

Hand-to-face contact, which occurs during such activities as eating, normal grooming or smoking, presents significant risks because of the potential for transmitting influenza from surfaces contaminated with respiratory secretions, and for this reason, hands should always be washed and dried before any activity that involves hand-to-face contact.

Respiratory hygiene/cough etiquette

People with respiratory infection symptoms should practise the following cough/sneeze etiquette whenever they are in the presence of another person.

All symptomatic people should:

- avoid close contact (less than 1 metre) with other people

- cover their nose and mouth when coughing or sneezing

- use disposable tissues to contain respiratory secretions

- immediately dispose of used tissues in the nearest waste receptacle

- immediately wash and dry their hands.
-
Social distancing

Crowded places and large gatherings of people should be avoided at times of an influenza pandemic, whether such gatherings are in internal or external spaces.

A distance of at least 1 metre should be maintained between persons wherever possible. Greater distances are more effective.

Any form of contact with people who are unwell with pandemic influenza, including visiting, should be avoided wherever practicable.

Protective barriers

Protective barriers in the form of perspex or glass may provide useful protection for people such as front-counter staff, supermarket operators or public transport drivers, whose duties require them to have frequent face-to-face contact with members of the public where social distancing is either not possible or not practical.

Using masks

People with respiratory infection symptoms should consider using a disposable surgical mask to help prevent exposing others to their respiratory secretions.

Any mask must be disposed of as soon as it becomes moist or after any cough or sneeze, in an appropriate waste receptacle, and hands must be thoroughly washed and dried after the used mask has been discarded.

Patients with respiratory infection symptoms in health care institutions should be masked to contain respiratory secretions at any time they present a potential risk to unprotected people.

Recommendations for Personal Protective Equipment use

Personal protection equipment (PPE) includes masks, goggles, eye/face shields, gloves, gowns and aprons. Varying levels and types of PPE are required, depending on the level of exposure and the risk of transmission.

Whatever the level of PPE to be used, education and training is necessary to ensure the equipment is used and disposed of correctly, to maintain the equipment’s effectiveness.

Summary of protection measures

Protection measure Where applicable
Hand hygiene, cough etiquette, ventilation Everyone, all the time
Organisational policies Every organisation, all the time
Social distancing Everyone, whenever practical
Protective barriers In situations where regular work practice requires unavoidable, relatively close contact with the public
Disposable surgical mask Workers in any community or health care setting who are caring for the sick (this includes first responders) Also as a possible adjunct to protective barriers
Disposable particulate respirator mask, eye protection, gloves, gown/apron Health care workers participating directly in close contact patient care when there is a high risk of contact with respiratory secretions, particularly via aerosols (mostly inpatient settings).

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