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Overview of the current situation for H1N1 Influenza in Australia & Internationally

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A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO, to the MISMS Oceania Influenza Meeting. 16 March 2010 …

A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO, to the MISMS Oceania Influenza Meeting. 16 March 2010

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  • 1. Overview of the currentsituation for H1N1 Influenza in Australia & Internationally MISMS Oceania Influenza Meeting MELBOURNE - 16 March 2010 Professor Jim Bishop AO Chief Medical Officer
  • 2. The Australian Health Management Plan for Pandemic Influenza (AHMPPI)• The AHMPPI (2008): third edition of the national health management plan• Revised as a result of Exercise Cumpston 06 – Addressing policy gaps – Streamlined decision making – More flexible policy
  • 3. Australian Health Protection Committee (AHPC) Aileen Plant National Incident Room• The key decision-making body for health emergencies – Chaired by DoHA Deputy Secretary – Commonwealth CMO, S/T Chief Health Officers – Experts in mental health, emergency medicine, communicable diseases• Preparedness role• Response role in health emergencies
  • 4. PANDEMIC (H1N1) 2009 TIMELINE24 Apr WHO announces health emergency27 Apr WHO moves to Pandemic phase 428 Apr Australia moves to Pandemic DELAY29 Apr WHO moves to Pandemic phase 522 May Australia moves to Pandemic CONTAIN 3 Jun Victoria moves to MODIFIED SUSTAIN11 Jun WHO moves to Pandemic phase 617 Jun Australia moves to Pandemic PROTECT18 Sept TGA Approves pandemic (H1N1) vaccine. WHO Donation30 Sept Adult Vaccination Program commences5 Dec TGA Approves and registers pandemic vaccine for children 4
  • 5. DELAY PHASE
  • 6. CONTAIN PHASEActions taken during CONTAIN included: • Contact tracing and home quarantine • Anti-virals for contacts • Increased public messaging • Some school closures • Continuation of the measures commenced in DELAY
  • 7. H1N1 Influenza 09 Pandemic Phases ALERT (pre 24 April 09) Australias response is continual informed by the emerging evidence around the virus DELAY (24 April 09) and effectiveness of control measures H1N1 CONTAIN (22 May 09) Influenza 09, mild in most and severe in PROTECT some (the vulnerable) SUSTAIN 17 June 2009Victoria moved to a MODIFIED Evidence supports focusing efforts SUSTAIN on 3 June 2009 on protecting the ‘vulnerable’ CONTROL RECOVER
  • 8. Key Elements of PROTECT• Re-focus of testing and treatment• Identification and early treatment for those at risk• Voluntary home isolation, no treatment, mild disease• Controlling outbreaks in special settings• Limited school closures early in the Pandemic• Communications• Re-focus surveillance
  • 9. PANDEMIC (H1N1) 2009 SURVEILLANCE, AUSTRALIAOffice of Health Protection, Surveillance Branch, Department of Health and Ageing
  • 10. Laboratory Confirmed Cases Of Pandemic (H1N1) in Australia to 26 February 2010 1600 ACT NSW NT Qld 1400 SA Tas Vic WANumber of confirmed cases of pandemic (H1N1) 2009 1200 AUS phase PROTECT 1000 VIC moved to modified 800 SUSTAIN phase Vaccination commenced 600 400 200 0 22/05/2009 19/06/2009 17/07/2009 31/07/2009 14/08/2009 28/08/2009 11/09/2009 25/09/2009 23/10/2009 20/11/2009 18/12/2009 15/01/2010 29/01/2010 12/02/2010 26/02/2010 8/05/2009 5/06/2009 3/07/2009 9/10/2009 6/11/2009 4/12/2009 1/01/2010 Source: NetEPI database Date of onset / notification Source: NetEPI database
  • 11. Sentinel General Practice Surveillance 1 January 2007 to 21 February 2010* 60 ASPREN 2007 ASPREN 2008Rate of ILI per 1,000 consultations 50 ASPREN + NT + VIDRL 2009 ASPREN + NT 2010 40 First case of Pandemic (H1N1) 2009 30 reported in Australia 20 10 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 Week •Delays in the reporting of data may cause data to change retrospectively. As data from the NT surveillance system is combined with ASPREN data for 2010, rates may not be directly comparable across 2007, 2008 and 2009. SOURCE: ASPREN, and NT GP surveillance system.
  • 12. WA Emergency DepartmentsNumber of Emergency Department ILI 1 January 2007 to 14 February 2010 1200 2007 Presentations 2008 Presentations 2009 Presentations 1000 2010 Presentations Presentations in WA 800 Child deaths associated with influenza infection in 2007 600 400 200 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Week Source: WA ‘Virus Watch’ Report
  • 13. Deaths Associated with Influenza and Pneumonia, 2005 - 2010 Source: NSW ‘Influenza Monthly Epidemiology Report’
  • 14. ABSENTEEISM 28 Jan 2007 to 17 Feb 2010 Rates of absenteeism (greater than 3 days absent), national employer, from 28 January 2007 to 17 February 2010, by week. 1.6 2007 Absenteeism 1.4 2008 Absenteeism 2009 AbsenteeismPercent of Staff Absent 1.2 2010 Absenteeism 1 0.8 0.6 0.4 0.2 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 Week SOURCE: Absenteeism data
  • 15. Overview of pandemic (H1N1) 2009 severity – to 26 February 2010 2009 2010Pandemic (H1N1) 2009 Confirmed Hospitalised ICU cases Deaths Confirmed Hospitalised ICU Deaths cases cases cases cases cases Total number 37,636 13% of 14% of 191 44 11 1 0 Confirmed Hospitalised +186 cases cases Influenza Type A Crude rate per 172.1 22.8 3.1 0.9 0.2 100,000 population Median age (years) 21 31 44 53 30 Females 51% 51% 53% 44% 29% Vulnerable groups n/a 58% 74% 67% Indigenous people 11% 20% 19% 13% Pregnant women n/a 27% 16% 4% Hospitalised Hospitalised females aged Pregnant 15-44 years womenCases with at least 1 n/a 46% 67% 62% co-morbidity
  • 16. Severe Pandemic (H1N1) 2009● Hospitalisations - Respiratory, diabetes, immuno compromised obesity, chronic cardiac, renal, pregnancy rapid deteriorating flu patient● Higher proportion of Indigenous Australians● Over 50% admitted within 48 hours of onset● Higher ICU Admissions than expected
  • 17. Hospitalisations of pandemic (H1N1) 2009, 5 June – 23 October 2009, by week 700Number of hospitalistations associated 600 with pandemic (H1N1) 2009 500 Australia 400 300 200 100 0 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 Week of report 17
  • 18. Age specific rates of hospitalised confirmed cases of pandemic (H1N1) 2009 to 3October 2009, compared with average annual age specific rates of hospitalisations from seasonal influenza 2004-05 to 2006-07*, Australia 80.0 Males pandemic (H1N1) 2009 te e 0 ,0 0 o u tio ) A e s e ific ra (p r 1 0 0 p p la n 70.0 Females pandemic (H1N1) 2009 60.0 2004-07 seasonal influenza 50.0 40.0 30.0 20.0 g pc 10.0 0.0 9 9 4 9 4 4 9 9 4 4 4 9 4 4 9 4 9 + -5 -5 -8 -1 -1 -6 -2 -3 -2 -3 -4 -4 -6 -7 -7 0- 5- 85 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 Age group (5 Years) 18
  • 19. Comparison of hospitalisations, ICU admissions and deaths, by age group, to 2 October 2009 Hos p 1400 ICU 60Total number of hospitalisations Numbers of deaths of confirmed Deaths 1200 50 and ICU admissions of 1000 confirmed cases 40 800 cases 30 600 20 400 200 10 0 0 0-9 10-19 20-29 30-39 40-49 50-59 60+ Age groups (10 ye a rs)
  • 20. Notification rates for pandemic (H1N1) 2009 in a selection of affected countries Country Population Confirmed cases Crude rate per Hospitalisation rate Deaths Trends 100,000 per 100,000 population* population Southern Hemisphere Australia 21,262,641 37,636 172.1 22.8 191 Low influenza activityNew Zealand 4,319,932 3,233 73.0 22.7 18 Low levels of ILI, decreasing trend Argentina 40,482,000 11,234 27.8 33.7 613 Low ILI activity, decreasing trend Chile 16,454,143 12,276 74.6 9.8 150 Low ILI activity, decreasing trend Northern Hemisphere Canada 33,212,696 N/A 23.5 4.4 336 Low influenza activity UK 60,943,912 26,110 42.8 N/A 265 Decreasing influenza activity Mexico 109,955,400 66,070 60.1 n/a 671 n/a USA 304,059,724 50,768 16.5 10.3 1,336 Low influenza activity
  • 21. Pandemic (H1N1) 2009 Vaccine• Safety profile as with seasonal flu• One injection 15μg protects adults• FDA licence/TGA registration• Emphasis on priority groups but available to ALLSource: New England Journal of Medicine: 2009: 361, September 10
  • 22. Clinical Trials of Pandemic (H1N1) 2009 VaccineSystemic Side effects: · Headache · Fever · Myalgia · MalaiseImmune Response: 15mcg 97 % 30mcg 93 %Source: New England Journal of Medicine: 2009: 361, September 10
  • 23. VACCINE ROLL OUT• Around 7.6 million doses distributed (35% population)• Available for this Influenza season• Trivalent vaccine for seasonal influenza available to targeted groups
  • 24. Key lessons so far1. Value of detailed planning2. Leadership and co-ordination • AHPC • NPEC3. Flexibility4. Medical innovation5. CommunicationNEJM on line publication – Dec 2009
  • 25. Current Situation – 2010• Influenza activity low in Australia but showing some signs of increasing earlier than usual – <2% respiratory tests positive for influenza – 55 confirmed cases influenza per week• Pandemic strain predominant in Australia – 3/5 pandemic (H1N1) 2009• Pandemic (H1N1) 2009 predominant in most countries• Type B predominant in China (83%) and Hong Kong (56%)
  • 26. Current Situation - 2010 Laboratory confirmed cases of influenza (pandemic (H1N1) 2009 and seasonal) in Australia, 2010 to 26 February, by week and type A/Mexico/223/2009(H1N1) A/H1N1 strain unknown A not subtyped A/H1N1/Brisbane/59/2007 A/H3N2; A/H3n2/Brisbane/10/2007 B Untyped A&B 60 50N ber of confirm influenza cases 40 ed 30 20 um 10 0 2/01/2010 9/01/2010 16/01/2010 23/01/2010 30/01/2010 6/02/2010 13/02/2010 20/02/2010 We e k of onse t/notification - start date
  • 27. KEY INDIVIDUALS FOR PANDEMIC RESPONSENIR NSW Dr Kerry ChantMs Mary Murnane Dr Jeremy McAnultyMs Jenny Bryant VIC Dr John CarnieDr Gary Lum Dr Rosemary LesterMs Fay Gardner QLD Dr Jeanette YoungDr Bernie Towler Dr Christine SelveyDr Andrew Singer TAS Dr Chrissie PickinDr Andrea Forde WA Dr Tarun WeeramanthriMs Kay McNiece Dr Andy RobertsonDr Jenean Spencer SA Dr Stephen ChristleyProf Terry Nolan ATAGI ACT Dr Charles GuestDr Chris Mitchell RACGP NT Dr Barbara PatersonDr Vicki Krause CDNA