Planning assumptions for pandemic influenza a(h1n1) 09 in new zealand

[Sally Furniss]

Note: These documents are based on best estimates at the time of publication. Because of the changing situation the updates provided will be reviewed (and updated if required) once weekly, or more frequently if there is a marked change in the situation requiring a change in response

PLANNING ASSUMPTIONS FOR PANDEMIC INFLUENZA A(H1N1) 09​

IN NEW ZEALAND​

The Foundations
The New Zealand Pandemic Action Plan 2006 (NZIPAP) remains the core document to inform planning and response by all agencies, and sets out planning scenarios, agency responsibilities, and details of functions, policies and guidelines (eg, on antivirals) that remain in force unless the Ministry of Health announces otherwise.


This Planning Assumptions document provides background for agency planning utilising the new NZIPAP scenario 6.2.1 ?Manage It? as described in the current NHCC Action Plan (version 04). This must be read together with these Assumptions. This will help agencies customise their action to the influenza A (H1N1) 09 pandemic.


The Ministry of Health website (www.moh.govt.nz/influenza-a-h1n1) is the main source of information on the evolving situation for all organisations and the public.


Note that the Planning Assumptions are based on current international information on the nature and impact of this virus. Should the virus mutate, the situation could change for the better or the worse. Further information will become available as the impact of the virus internationally becomes better understood.


The NHCC Action Plan and its key Planning Assumptions will be updated weekly commencing Monday 29^th June, or more frequently should the situation change. The latest version can be accessed on the Ministry website from that date.


Emerging information on the nature of this virus and its ramifications for planning

• The influenza A (H1N1) 09 virus is a new strain of influenza. So far it has tended to affect infants, children and young adults more than other age groups. Illness associated with the virus is mostly mild to moderate, although some people experience a more severe illness.
• Epidemiologists estimate that just under half of the population could be infected by the virus throughout the course of the pandemic, resulting in about a third of the population becoming symptomatic over time.
• There are no indications of this level of infection in the population of any country at present, but the event is still in its early days, and even without control measures, it will take months for the epidemic to peak, as noted below.
• The peak of the current pandemic wave is difficult to predict, but it is anticipated that this will be three months or more away.
• Few deaths worldwide have been associated with this virus. Based on the information to date, and the above assumptions, New Zealand will have less than two hundred deaths, and quite possibly less than 100.
• One of the response aims is to slow transmission in order to delay and spread out the impact on communities and health services, especially during the peak winter incidence of seasonal influenza. This will minimise impact on health services, and enable society to operate much as normal.
• The impact on workplace attendance is difficult at predict, but it is anticipated that absenteeism due to sickness will be spread over a period of several months but should not exceed a total of 35% across that period. Additional workforce absenteeism will occur if employees have to care for sick family members at home. There may be higher peaks in some workplaces at certain times, especially if infected staff come to work. It is therefore important to reinforce the messages noted in How to protect yourself and others below. Workplaces must have plans for above average staff absenteeism.
• Second (and even third) wave(s) are likely over the next 12 months. Such wave(s) may be more or less virulent, and have higher or lower death rates than the first wave.
• Better data will become available as experts study the clinical and epidemiological characteristics of the virus and review and adapt response measures.

What public health controls/containment programmes may be put in place, and how will these impact on my family, organisation, sector and business?




The NHCC Action Plan outlines such programmes.


Some specific containment actions may continue to be considered, but will be focused in areas where community transmission is not well established in an effort to interrupt and delay virus transmission.


In areas with established community transmission, many of these actions will not be appropriate. However, containment programmes will still be selectively considered in higher risk settings, such as residential facilities and educational establishments, and to protect higher risk groups.


Temporary Closure of educational establishments and other institutions
Taking into account the current situation and its possible development, partial or full closure of some establishments in unaffected and affected areas remains a potential intervention strategy. Any such closures will be highly selective and targeted to individual establishments or sections of those establishments. For example:

• initially an establishment, school, or class with a case or cluster may be required to close for a period of up to a week to interrupt transmission
• depending on the local situation, other establishments in the affected area may need to close if there is evidence of contact with the case(s) within those establishments in an otherwise unaffected area
• no national school closures are planned.

Compulsory restriction of public gatherings and venues and the closure of workplaces
Based on current information, this is highly unlikely, other than in exceptional circumstances. For example, should an area or workplace be badly affected in comparison with its neighbours, this intervention may be considered.


The Ministry of Health will continue to rely on providing information to the public on how to protect themselves, including social distancing measures as required. Other agencies will be expected to transmit this information to their sectors.


Domestic travel restrictions
Isolating of affected areas within NZ is also very unlikely to occur, given the relatively mild to moderate illness experienced by most affected people to date. Given the practical difficulties with this approach and the consequential social and economic impacts, this strategy is unlikely to be of value in all but more remote areas with limited access. Should an isolated area be badly affected in comparison to neighbouring areas, this intervention may be considered.


Vaccine
The introduction of vaccination programmes is affected by the availability of vaccine, and associated trials of its efficacy and safety. This takes time: Influenza A(H1N1) 09 is a new virus and vaccine is currently being developed. Vaccine will not be available for some months. The Ministry is currently reviewing options concerning the purchase and prioritisation of the use of vaccine, and further updates will be provided. Given the mild to moderate nature of the virus and the low death rates, population vaccination campaigns are highly unlikely.


Emergency declarations
The declaration of states of emergency is not contemplated at this time. However, the use of the special powers under the Health Act 1956 may be authorised if needed to support any of the measures described above.


So what does my agency/organisation/business do now?


Taking account of the above, implement plans for your organisation and your sector to respond to the current situation.


Note that responses in different areas will be affected by the situation in that area: for example, in areas where community transmission is not confirmed, greater emphasis will be placed on containment measures, whereas areas with extensive community transmission will focus on providing services for people with moderate to severe illness.


Government agencies are responsible for leading responses in their relevant sectors. They are responsible for developing information for their sector, based on information provided by the Ministry of Health on its website.


Respond to queries for your sector. The Ministry of Health will pass on any queries it receives from your sector for your agency to action.


Agencies are responsible for implementing control mechanisms within their organisations, including the procurement of their own supplies for protection of staff and others in their premises.


If you are the local branch of a national agency, follow national directions/guidance from your agency, and ensure you liaise with your local district health board emergency manager and/or emergency operations centre to plan for and participate in a local response as and when required.


Utilise current resources to help you prepare yourself, your family and your organisation. The Ministry of Health web-site is the prime source.


Regularly check this website (www.moh.govt.nz/influenza-a-h1n1) for updates, and for existing policies, publications and resources. This web site contains useful links to other government department web sites providing information to their sectors.


For example,

• employers and employees may wish to access advice on human resource issues from the Department of Labour
• the education sector can obtain advice from the Ministry of Education web-site.

How to protect yourself and others

• Signs and symptoms of influenza include fever, cough, sore throat, stuffy nose, body aches, headache, chills and fatigue. Some people also experience diarrhoea and vomiting.
• Anyone who is ill with influenza-like symptoms is advised to phone Healthline (0800 611 116) or their GP.

• [FONT=Arial M?ori, Arial, sans-serif]Stay away from work or school until essentially well, that is not sneezing and coughing as this is how the virus spreads. This is usually around 3 to 4 days after symptoms start, but may be up to a week.[/FONT]
• This is to keep you from infecting others. Most people will be able to safely recover at home.
• You should seek medical advice if necessary (by phone first), for example if your condition worsens. This is particularly important for people with underlying medical conditions who are at greater risk of developing complications from influenza. If you need medical advice, please phone Healthline 0800 611 116 in the first instance, or your GP. Do not turn up at a hospital or medical centre before doing this, as you might spread infection to other people.
• If you are caring for someone with influenza, watch for signs that they may need further medical attention, including: difficulty breathing, chest pain, blueness around the lips, inability to keep fluids down, becoming less alert or developing confusion.
• Try to avoid contact with sick people and reduce time spent in crowded settings.
• Be prepared - This is the time for people to make sure they are prepared to be self-sufficient for a period of time, should they need to. This means you should have enough food, water and basic medical supplies, including paracetamol or ibuprofen, as well as regular medications, nappies for babies, cleaning products, tissues and bathroom supplies for at least a week.
• Hand hygiene is still the single most effective measure in protecting yourself. Regularly wash your hands with soap and water and dry them thoroughly.
• Alcohol-based cleaners are also effective. Avoid touching your eyes, nose or mouth as germs spread this way.
• Practise good cough and sneeze etiquette. This means covering your nose and mouth with a tissue when you cough or sneeze, and disposing of the tissue in a lined rubbish bin with a lid or plastic bag. If tissues are not available, cough into your elbow.

For further general information on how you can plan for emergencies, visit www.getthru.govt.nz




http://www.moh.govt.nz/moh.nsf/indexmh/influenza-a-h1n1-situation-nhccplan