Meet-the-Expert Seminar on 4th August 2015 at Furama Hotel Bukit Bintang Kuala Lumpur by BCM Institute Malaysia.

1. Presentation in MTE on 4 August 2015
at Furama Hotel Bukit Bintang KL
By
DRWAN NORAINI WAN MOHAMED NOOR

2. Dr.Wan Noraini Wan Mohamed Noor
Public Health Physician
Disease Control Division
Ministry of Health Malaysia
4August 2015

3. 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-CoVEbola (2014)
H7N9

4. 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)

5. Emerging Infectious Diseases (EIDs):
Our Fair Share

8.  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

9.  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)

11.  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

12.  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

13.  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.)

14.  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

15.  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

16.  A new influenzaA 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)

17.  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

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

19. 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

20. The Global Approach

21. 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.

22. • 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

23.  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

24.  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

25. The Local Approach

26. 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

27. 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

28. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. Thank You