New influenza A (H1N1) virus: WHO guidance on public health measures, 11 June 2009 (WHO WER, June 26, 2009, edited)
Weekly epidemiological record - 26 JUNE 2009, 84th YEAR - No. 26, 2009, 84, 261?268 - http://www.who.int/wer
[Original Document: LINK. EDITED.]
New influenza A (H1N1) virus: WHO guidance on public health measures, 11 June 2009
WHO is providing the following guidance to help countries manage the 2009 influenza pandemic. This guidance reflects current knowledge and experience gained since April 2009, when WHO announced the emergence of the new influenza A (H1N1) virus. Further international spread of the pandemic virus is expected to continue over the coming weeks and months. At this time, however, the epidemiological situation among countries is highly variable, with some countries reporting no or few cases and others experiencing widespread community outbreaks. In past pandemics, the greatest impact on health has occurred in the first year, but excess deaths associated with spread of the pandemic virus have occurred over a 2-year period.
General guidance for all countries
Monitoring the pandemic.
Countries should maintain surveillance(1) during the pandemic period by:
Communicating information to the public.
Countries should make active communication a part of their strategic response by providing accurate and up-to-date information on issues such as pandemic activity and actions being taken by the government.(2)
Adapting plans and interventions to the 2009 pandemic.
Countries should revise pre-existing national pandemic plans to ensure that national actions taken for the 2009 pandemic are sustainable and appropriate to its current level of severity.(3) Specifically:
In addition to the general guidance provided above, WHO also advises countries to note the following guidance that is specific to their current level of disease transmission and local context.
Guidance for countries with widespread community-level transmission
Surveillance
Control measures
Guidance for countries with no reported cases of pandemic infection
Surveillance
Control measures
Guidance for countries in transition
Surveillance
Control measures
(1) Global surveillance during an influenza pandemic [version 1, updated draft April 2009]. Geneva, World Health Organization, 2009 (available at http://www.who.int/csr/disease/swine...ance_apr09.pdf ; accessed June 2009).
(2) For guidance, see WHO Outbreak communication guidelines. Geneva, World Health Organization, 2005 (WHO/CDS/2005.28; available at http://www.who.int/infectious-diseas...ds200528en.pdf ; accessed June 2009).
(3) For further guidance, see Pandemic influenza preparedness and response: a WHO guidance document. Geneva, World Health Organization, 2009 (available at http://www.who.int/csr/disease/influ.../en/index.html ; accessed June 2009).
(4) Resources on clinical care are available from the web site of the WHO Department of Epidemic and Pandemic Alert and Response at http://www.who.int/csr/disease/swine.../en/index.html .
(5) International Health Regulations (2005), 2nd edition. Geneva, World Health Organization, 2005 (available at http://whqlibdoc.who.int/publication...580410_eng.pdf ; accessed June 2009).
(6) See No. 22, 2009, pp. 197?202 (available at http://www.who.int/wer/2009/wer8422.pdf ; accessed June 2009).
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Weekly epidemiological record - 26 JUNE 2009, 84th YEAR - No. 26, 2009, 84, 261?268 - http://www.who.int/wer
[Original Document: LINK. EDITED.]
New influenza A (H1N1) virus: WHO guidance on public health measures, 11 June 2009
WHO is providing the following guidance to help countries manage the 2009 influenza pandemic. This guidance reflects current knowledge and experience gained since April 2009, when WHO announced the emergence of the new influenza A (H1N1) virus. Further international spread of the pandemic virus is expected to continue over the coming weeks and months. At this time, however, the epidemiological situation among countries is highly variable, with some countries reporting no or few cases and others experiencing widespread community outbreaks. In past pandemics, the greatest impact on health has occurred in the first year, but excess deaths associated with spread of the pandemic virus have occurred over a 2-year period.
General guidance for all countries
Monitoring the pandemic.
Countries should maintain surveillance(1) during the pandemic period by:
- monitoring the virus for important genetic, antigenic or functional changes (for example, sensitivity to antiviral drugs);
- monitoring disease and outbreaks to assess whether levels of influenza activity are increasing or decreasing;
- monitoring the functioning of healthcare systems to ensure continuity of services and rapid adjustments;
- identifying and investigating unusual cases, clusters or outbreaks, so that important changes in epidemiology or disease severity are identified quickly;
- characterizing in detail the clinical and epidemiological features of the first >100 cases of pandemic disease in any new settings to ensure that critical information is collected and made available widely;
- reporting surveillance information to WHO frequently and rapidly.
Communicating information to the public.
Countries should make active communication a part of their strategic response by providing accurate and up-to-date information on issues such as pandemic activity and actions being taken by the government.(2)
Adapting plans and interventions to the 2009 pandemic.
Countries should revise pre-existing national pandemic plans to ensure that national actions taken for the 2009 pandemic are sustainable and appropriate to its current level of severity.(3) Specifically:
- national efforts should focus primarily on mitigating the impacts on health and society of the virus through appropriate care of ill people rather than on attempts to contain transmission of the disease;
- health-care systems should be prepared to manage a higher volume of cases and, potentially, more serious cases of illness;
- countries should implement plans for obtaining essential medicines and equipment, as well as antiviral medicines and vaccines.
In addition to the general guidance provided above, WHO also advises countries to note the following guidance that is specific to their current level of disease transmission and local context.
Guidance for countries with widespread community-level transmission
Surveillance
- As a baseline, national surveillance should track
- (i) the spread of, and increases or decreases in, the number of cases, deaths and outbreaks associated with the pandemic virus;
- (ii) the functioning of the health-care system; and
- (iii) any changes in the viruses.
- During the remaining pandemic period, the collection of clinical samples for virus testing should be limited to selected samples of cases only, rather than laboratory-testing of all cases, to save on resources while allowing critical information to be collected.
Control measures
- The primary focus should be the appropriate management of patients, either at home or in health-care facilities.
- The health-care system should be protected and supported so that it can continue to operate.
- Most people with pandemic infection can be diagnosed clinically without the need for laboratory testing.
- Community-level measures such as school closures and cancellations of mass gatherings should be considered on a case-by-case basis to slow increases in infection and to try and reduce pressure on the health-care system. In implementing such measures, consideration should be given to the disruption they may cause, and the feasibility and sustainability of their implementation.
Guidance for countries with no reported cases of pandemic infection
Surveillance
- Countries should identify any national disease and virus surveillance capacity that can be used to detect and monitor cases of disease, including laboratories with the capacity to test influenza viruses. If no capacity is available within a country, WHO can help with shipment of clinical specimens to another laboratory.
- Surveillance should focus on settings such as closed communities (for example, schools, military camps, health institutions) particularly in urban settings, since these are locations where new cases are likely to occur.
- Baseline surveillance for influenza or severe respiratory illness should be maintained.
- Entry or exit screening at airports and contact tracing can be considered, but such actions are resourceintensive and will provide decreasing benefi ts as infections become more widespread. Such screening may detect cases but may not prevent the spread of the disease because asymptomatic or sub-clinical infections will not be detected.
Control measures
- Incoming travellers who are sick should be provided with the information needed to obtain medical attention.
- The health-care sector should
- (i) be ready to manage increasing numbers of patients with respiratory disease;
- (ii) ensure the availability of essential medicines and supplies for the treatment of pneumonia as well as other common life-threatening illnesses in the community; and
- (iv) provide training to health-care workers on the diagnosis and treatment of influenza patients.(4)
- WHO does not recommend border closures or travel restrictions because such measures will not prevent the spread of the disease and may have a negative economic impact.
Guidance for countries in transition
Surveillance
- Countries should notify laboratory-confirmed cases to WHO in accordance with the International Health Regulations (2005).(5)
- Detailed epidemiological, clinical and virological information should be collected on the fi rst 100 cases, or as many as is possible.
- Information to assess the severity of the disease at the national level6 should be collected.
- Highly resource-intensive efforts such as contact tracing should be phased out once the value of the collected information drops.
Control measures
- Countries in transition should be prepared to move towards implementing the control measures recommended to countries with sustained communitylevel transmission, as described above.
- Antiviral prophylaxis generally should be limited, and antiviral medicines should be reserved for treating patients, particularly those who have, or are at high risk for, severe disease.
(1) Global surveillance during an influenza pandemic [version 1, updated draft April 2009]. Geneva, World Health Organization, 2009 (available at http://www.who.int/csr/disease/swine...ance_apr09.pdf ; accessed June 2009).
(2) For guidance, see WHO Outbreak communication guidelines. Geneva, World Health Organization, 2005 (WHO/CDS/2005.28; available at http://www.who.int/infectious-diseas...ds200528en.pdf ; accessed June 2009).
(3) For further guidance, see Pandemic influenza preparedness and response: a WHO guidance document. Geneva, World Health Organization, 2009 (available at http://www.who.int/csr/disease/influ.../en/index.html ; accessed June 2009).
(4) Resources on clinical care are available from the web site of the WHO Department of Epidemic and Pandemic Alert and Response at http://www.who.int/csr/disease/swine.../en/index.html .
(5) International Health Regulations (2005), 2nd edition. Geneva, World Health Organization, 2005 (available at http://whqlibdoc.who.int/publication...580410_eng.pdf ; accessed June 2009).
(6) See No. 22, 2009, pp. 197?202 (available at http://www.who.int/wer/2009/wer8422.pdf ; accessed June 2009).
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