INFLUENZA PANDEMIC
and
BEYOND
PHAA 12TH National Immunisation
Conference
ADELAIDE – 17 August 2010
Professor Jim Bishop
Ch...
World Health Organisation
stages of PANDEMIC ALERT
WHO declared: phase 4 on 27 April 2009
phase 5 on 29 April 2009
phase 6...
H1N1 Influenza 09 Pandemic Phases
ALERT (pre 24 April 09)
DELAY (24 April 09)
CONTAIN (22 May 09)
SUSTAIN
Victoria moved t...
Weekly rate of ILI reported from GP ILI surveillance systems from
1 January 2007 to 25 July 2010
0
10
20
30
40
50
60
1 3 5...
Number of respiratory viral presentations to Western Australia EDs from
1 January 2007 to 25 July 2010 by week
0
200
400
6...
ILI presentations to NSW EDs from 2007-2010, by week
0
5
10
15
20
25
30
35
40
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...
Total number of specimens tested by sentinel laboratories, and proportion
positive, 1 January 2010-30 July 2010, by week
0...
Percentage of specimens tested by sentinel laboratories influenza positive
1 January 2010 to 30 July 2010, by subtype
Pand...
Hospitalisations of pandemic (H1N1) 2009,
5 June – 23 October 2009, by week
10
0
100
200
300
400
500
600
700
21 22 23 24 2...
Severe Pandemic
(H1N1) 2009
● Hospitalisations
- Respiratory, diabetes, immuno compromised
obesity, chronic cardiac, renal...
2009 2010
CONFIRMED
PANDEMIC
(H1N1 2009
CASES
HOSPITALISED
CASES
ICU CASES DEATHS CONFIRMED
(H1N1) 2009
CASES
DEATHS
TOTAL...
2009 2010
CONFIRMED
PANDEMIC
(H1N1 2009
CASES
HOSPITALISED
CASES
ICU CASES DEATHS CONFIRMED
(H1N1) 2009
CASES
DEATHS
Vuner...
Age specific rates of hospitalised confirmed cases of pandemic (H1N1) 2009 to 3
October 2009, compared with average annual...
Rate of deaths classified as influenza and pneumonia from the NSW
Registered Death Certificates 2005 to 25 June 2010
ATAGI Modelling of the Impact of Vaccination
Pandemic (H1N1) 2009
Vaccine
• Safety profile good as dose levels recommended
• One injection 15μg protects adults, two fo...
Pandemic H1N1 vaccine distributed (cumulative)
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,0...
Pandemic H1N1 Vaccine - Weekly distribution trends
0
100,000
200,000
300,000
400,000
500,000
600,000
06-Oct19-Oct29-Oct12-...
IMMUNITY
Vaccine Distribution
 9.71 million doses Panvax distributed to 12 August
2010
 6.44 million doses of 2010 seaso...
CURRENT SITUATION – 2010
 Influenza activity low in Australia but showing
signs of increasing
- 1713 Confirmed cases of I...
Weekly consultation rates for influenza-like illness
in New Zealand, 2008-2010
Source: Institute of Environmental Science ...
UK REVIEW
SOME KEY FINDINGS
 Containment phase lasted longer and consumed more
resources than anticipated
 Tension betwe...
1. National governance
and decision making
2. Public communication
3. Public health measures
4. Border measures
5. Primary...
Outcomes of the review will:
further strengthen Australia’s ability to respond;
publicly available 'lessons identified' ...
KEY INDIVIDUALS FOR PANDEMIC RESPONSE
NIR
Ms Mary Murnane
Ms Jenny Bryant
Dr Gary Lum
Ms Fay Holden
Dr Bernie Towler
Dr An...
Influenza Pandemic and Beyond
Influenza Pandemic and Beyond
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Influenza Pandemic and Beyond

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A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO,to the PHAA 12th National Immunisation Conference in Adelaide 17 August 2010

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Influenza Pandemic and Beyond

  1. 1. INFLUENZA PANDEMIC and BEYOND PHAA 12TH National Immunisation Conference ADELAIDE – 17 August 2010 Professor Jim Bishop Chief Medical Officer Department of Health and Ageing
  2. 2. World Health Organisation stages of PANDEMIC ALERT WHO declared: phase 4 on 27 April 2009 phase 5 on 29 April 2009 phase 6 on 11 June 2009 post-pandemic 10 August 2010
  3. 3. H1N1 Influenza 09 Pandemic Phases ALERT (pre 24 April 09) DELAY (24 April 09) CONTAIN (22 May 09) SUSTAIN Victoria moved to a MODIFIED SUSTAIN on 3 June 2009 CONTROL RECOVER PROTECT 17 June 2009 Evidence supports focusing efforts on protecting the ‘vulnerable’ Australia's response is continual informed by the emerging evidence around the virus and effectiveness of control measures H1N1 Influenza 09, mild in most and severe in some (the vulnerable)
  4. 4. Weekly rate of ILI reported from GP ILI surveillance systems from 1 January 2007 to 25 July 2010 0 10 20 30 40 50 60 1 3 5 7 9 1 1 1 3 1 5 1 7 1 9 2 1 2 3 2 5 2 7 2 9 3 1 3 3 3 5 3 7 3 9 4 1 4 3 4 5 4 7 4 9 5 1 5 3 Week RateofILIper1,000consultations ASPREN 2007 ASPREN 2008 ASPREN + NT + VIDRL 2009 ASPREN + VIDRL 2010 First case of Pandemic (H1N1) 2009 t d i
  5. 5. Number of respiratory viral presentations to Western Australia EDs from 1 January 2007 to 25 July 2010 by week 0 200 400 600 800 1000 1200 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 NumberofEmergencyDepartmentILI PresentationsinWA 2007 Presentations 2008 Presentations 2009 Presentations 2010 Presentations Child deaths associated with influenza
  6. 6. ILI presentations to NSW EDs from 2007-2010, by week 0 5 10 15 20 25 30 35 40 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 Week RateofEmergencyDepartmentILIPresentationsin NSW NSW ED 2007 NSW ED 2008 NSW ED 2009 NSW ED 2010
  7. 7. Total number of specimens tested by sentinel laboratories, and proportion positive, 1 January 2010-30 July 2010, by week 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45 0.5 8/01/2010 22/01/2010 5/02/2010 19/02/2010 5/03/2010 19/03/2010 2/04/2010 16/04/2010 30/04/2010 14/05/2010 28/05/2010 11/06/2010 25/06/2010 9/07/2010 23/07/2010 6/08/2010 20/08/2010 3/09/2010 17/09/2010 1/10/2010 15/10/2010 29/10/2010 12/11/2010 26/11/2010 10/12/2010 24/12/2010 Week ending (date) Percentoftestspositiveforinfluenza 0 100 200 300 400 500 600 700 Totalnumberoftests Percent of tests influenza positive Total number of tests
  8. 8. Percentage of specimens tested by sentinel laboratories influenza positive 1 January 2010 to 30 July 2010, by subtype Pandemic (H1N1) 2009 67% Seasonal A/H1N1 0% Seasonal A/H3N2 24% Influenza A untyped 4% Influenza B 5%
  9. 9. Hospitalisations of pandemic (H1N1) 2009, 5 June – 23 October 2009, by week 10 0 100 200 300 400 500 600 700 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 Numberofhospitalistationsassociated withpandemic(H1N1)2009 Australia
  10. 10. 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
  11. 11. 2009 2010 CONFIRMED PANDEMIC (H1N1 2009 CASES HOSPITALISED CASES ICU CASES DEATHS CONFIRMED (H1N1) 2009 CASES DEATHS TOTAL NUMBER 37,636 13% 14% 191 362 2 CRUDE RATE PER 100,000 POPULATION 172.1 22.8 3.1 0.9 1.7 n/a M EDIAN AGE (YEARS) 21 31 44 53 28 38 FEMALES 51% 51% 53% 44% 48% 100% SUMMARY of SEVERITY INDICATORS OF PANDEMIC (H1N1) IN AUSTRALIA, 2009 & 2010 (up to 30 July 2010) SourceL: Australian Influenza Surveillance Report
  12. 12. 2009 2010 CONFIRMED PANDEMIC (H1N1 2009 CASES HOSPITALISED CASES ICU CASES DEATHS CONFIRMED (H1N1) 2009 CASES DEATHS Vunerable groups (Indigenous persons, pregnant women& individuals with at least 1 co- morbidity) n/a 58% 74% 67% n/a n/a INDIGENOUS PEOPLE 11% 20% 19% 13% 9% n/a PREGNANT WOMEN n/a 27% 16% 4% n/a 0% Cases with at least 1 co- morbidity n/a 46% 67% 62% n/a n/a SUMMARY of SEVERITY INDICATORS OF PANDEMIC (H1N1) IN AUSTRALIA, 2009 & 2010 (up to 30 July 2010) SourceL: Australian Influenza Surveillance Report
  13. 13. Age specific rates of hospitalised confirmed cases of pandemic (H1N1) 2009 to 3 October 2009, compared with average annual age specific rates of hospitalisations from seasonal influenza 2004-05 to 2006-07*, Australia 14 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 0-4 5-9 10 -14 15 -19 20 -24 25 -29 30 -34 35 -39 40 -44 45 -49 50 -54 55 -59 60 -64 65 -69 70 -74 75 -79 80 -84 85 + Age group (5 Years) Agespecificrate(per100,000population) Males pandemic (H1N1) 2009 Females pandemic (H1N1) 2009 2004-07 seasonal influenza
  14. 14. Rate of deaths classified as influenza and pneumonia from the NSW Registered Death Certificates 2005 to 25 June 2010
  15. 15. ATAGI Modelling of the Impact of Vaccination
  16. 16. Pandemic (H1N1) 2009 Vaccine • Safety profile good as dose levels recommended • One injection 15μg protects adults, two for young children • FDA licence/TGA registration • Emphasis on priority groups but available to ALL • Widespread uptake by the Population (over 9 Million doses) Source: New England Journal of Medicine: 2009: 361, September 10
  17. 17. Pandemic H1N1 vaccine distributed (cumulative) 0 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000 7,000,000 8,000,000 9,000,000 10,000,000 06-Oct 22-Oct 12-N ov 03-Dec 07-Jan 27-Jan 18-Feb 11-M ar 08-Apr 29-Apr 20-M ay 10-Jun 01-Jul 22-Jul Cumulative total
  18. 18. Pandemic H1N1 Vaccine - Weekly distribution trends 0 100,000 200,000 300,000 400,000 500,000 600,000 06-Oct19-Oct29-Oct12-N ov26-N ov10-Dec07-Jan21-Jan03-Feb18-Feb04-M ar18-M ar08-Apr22-Apr06-M ay20-M ay03-Jun17-Jun01-Jul15-Jul29-Jul Doses
  19. 19. IMMUNITY Vaccine Distribution  9.71 million doses Panvax distributed to 12 August 2010  6.44 million doses of 2010 seasonal vaccine released by TGA National Serosurvey (healthy adults)  May 2009 - Pre-pandemic: 5-15%  October 2009 - Post pandemic, pre Panvax: 22%  March 2010 - Post Panvax, pre Seasonal: 43%
  20. 20. CURRENT SITUATION – 2010  Influenza activity low in Australia but showing signs of increasing - 1713 Confirmed cases of Influenza in 2010, 362 pandemic (H1N1)  Pandemic strain predominant in Australia - 68% pandemic (H1N1) 2009 of specimens isolated  Pandemic (H1N1) 2009 predominant in most countries, low activity except NZ, India  Type B predominant in China (55.5%) with 46% the same strain as 2010 Southern Hemisphere vaccine
  21. 21. Weekly consultation rates for influenza-like illness in New Zealand, 2008-2010 Source: Institute of Environmental Science and Research, Influenza Weekly Update 2010/30
  22. 22. UK REVIEW SOME KEY FINDINGS  Containment phase lasted longer and consumed more resources than anticipated  Tension between common phased approach to pandemic planning and flexibility  Vaccine availability during the pandemic – a significant achievement  Flexible arrangements needed for purchasing vaccine  Need for vaccination implementation plans prior to a pandemic  Communications – important to generate public awareness and understanding  Coordinated media briefings
  23. 23. 1. National governance and decision making 2. Public communication 3. Public health measures 4. Border measures 5. Primary and secondary health care 6. National Medical Stockpile deployment 7. Surveillance 8. Laboratories 9. Vaccination 10. Indigenous Australians AUSTRALIAN PANDEMIC RESPONSE REVIEW
  24. 24. Outcomes of the review will: further strengthen Australia’s ability to respond; publicly available 'lessons identified' report, at the end of the 2010; and Revise the Australian Health Management Plan for Pandemic Influenza (AHMPPI)
  25. 25. KEY INDIVIDUALS FOR PANDEMIC RESPONSE NIR Ms Mary Murnane Ms Jenny Bryant Dr Gary Lum Ms Fay Holden Dr Bernie Towler Dr Andrew Singer Dr Andrea Forde Ms Kay McNiece Dr Jenean Spencer Prof Terry Nolan ATAGI Dr Chris Mitchell RACGP Dr Vicki Krause CDNA NSW Dr Kerry Chant Dr Jeremy McAnulty VIC Dr John Carnie Dr Rosemary Lester QLD Dr Jeanette Young Dr Christine Selvey TAS Dr Craig White Dr Chrissie Pickin WA Dr Tarun Weeramanthri Dr Andy Robertson SA Dr Stephen Christley ACT Dr Charles Guest NT Dr Barbara Paterson

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