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					        Complied by HA CCID & ICB, CHP                                                                                                  Title: HA Contingency Plan for Influenza Pandemic
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        Revised: 1 July 2006                                                                                                                                                 Page 2 of 50




                        Summary Table for Hong Kong Government Response Systems, Scenarios and HA Response

 Hong Kong
 Government
                                     Alert Response Level                                      Serious Response Level                               Emergency Response Level
  Response
  Systems
                             Confirmation of HPAI outbreaks in poultry              Confirmation of HPAI
                                                                                                               Confirmation of human
                         populations outside HK; Confirmation of HPAI in               outbreaks in the                                      Confirmation of efficient
                                                                                                               case(s) in HK without
                        HK in imported birds in quarantine, in wild birds, in     environment of or among                                         human-to-human            WHO declares
   Scenarios            recreational parks, in pet bird shops or in the natural     poultry population in
                                                                                                                evidence of efficient
                                                                                                                                               transmission of novel         pandemic
                                                                                                                 human-to-human
                       environment; Confirmation of human case(s) of avian        retail markets or farms in                               influenza in HK or overseas
                                                                                                                    transmission
                                        influenza outside HK                                 HK

                                                                                                                                            Enhanced surveillance
                                                                                                               Enhanced surveillance                 +
Key elements of                                                                                                                             Enhanced IC measures          All feasible options
                                      Enhanced surveillance                       Enhanced surveillance                  +
 HA Actions                                                                                                                                          +                   to contain pandemic
                                                                                                               Enhanced IC measures         Manpower & Resources
                                                                                                                                                Deployment

                                                                                                                 Genuine risk of
                                                                                                               transmission due to
                                                                                     Potential risk of
                           Overall risk is low. However, geographic                                            close patient contact
                                                                                    animal-to-human                                            Imminent risk of             High risk in
  Rationale                 proximity to Hong Kong needs to be
                                                                                   transmission due to
                                                                                                                 and evolution of
                                                                                                                                                 pandemic                   transmission
                                           considered.                                                                effective
                                                                                      close contact.
                                                                                                                human-to-human
                                                                                                                   transmission


                                                                                   Serious Response            Serious Response            Emergency Response             Emergency
 HA Response                        Alert Response Level                                 Level                       Level                       Level                   Response Level
                                                                                             (S1)                       (S2)                         (E1)                       (E2)
Complied by HA CCID & ICB, CHP                          Title: HA Contingency Plan for Influenza Pandemic
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                                HA Contingency Plan
                               for Influenza Pandemic
                                          CONTENTS
    I.         Introduction


    II.        Preparedness

          Chapter 1           Command & coordination
          Chapter 2           Risk Assessment
          Chapter 3           Surveillance
          Chapter 4           Epidemiological Investigations
          Chapter 5           Laboratory Support/ diagnostic capacity
          Chapter 6           Infection Control Measures
          Chapter 7           Provision of Essential Services
          Chapter 8           Facilities Management
          Chapter 9           Clinical Management
          Chapter 10          Vaccination / Antivirals
          Chapter 11          Personal Protective Equipments (PPEs) and other supplies
          Chapter 12          Staff Deployment Plan
          Chapter 13          Community Involvement
          Chapter 14          Rehabilitation & Convalescence Services
          Chapter 15          Staff Training
          Chapter 16          External & Internal communications
          Chapter 17          Research

   III.        Outline 概覽


   IV.         Lists of documents posted at HA intranet


   V.          References


   VI.         Membership of CCID & ICB, CHP (as at Dec 2005)
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 I. Introduction
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        Influenza pandemic has a greater potential to cause rapid increases in death and illness
        than virtually any other natural health threat. Planning and preparedness before the next
        pandemic is critical for an effective response.


        Characteristic of an influenza pandemic includes: a) simultaneous impacts territory-wide:
        b) an overwhelming burden of ill persons requiring hospitalization or outpatient medical
        care; c) likely shortages and delays in the availability of vaccines and antiviral drugs; d)
        disruption of community infrastructures including transportation, commerce, utilities and
        public safety, e) global spread of infection, and; f) public fear causing irrational behavior
        which may further overload the health care system..


        Research has identified three prerequisites for the start of a pandemic (WHO):
        1.   A novel virus subtype must emerge to which the general population will have no or
             little immunity
        2.    The new virus must be able to replicate in human and cause serious illness
        3.    The new virus must be efficiently transmitted from one human to another


        HA maintains high vigilance to infectious diseases and has identified priority strategic
        areas in preparation for large-scale infectious disease outbreaks.


        The purposes of the present compiled volume are as follow:
        1.    To provide an overview of keys areas for preparedness and responses in HA
        2.    To list out guidelines and implementation details of various specific response
              components.
        3.    To identify collaborative actions and coordination for interfacing with other
              government departments and agencies.


        This plan is to be read with Hospital Authority’s Response Plan for Infectious Disease
        Outbreaks as well as other relevant documents listed under Section IV. New guidelines
        referred to in this HA Contingency Plan for Influenza Pandemic will be updated and
        posted at HA intranet in due course. This plan is jointly prepared by the Central
        Committee of Infectious Diseases of Hospital Authority and the Infection Control Branch
        of Centre for Health Protection.
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         II. Preparedness
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  Chapter 1                                           Command and Coordination
  1    Introduction
        Clear command structure is essential to the overall response to the control of influenza
        pandemic.


  2    Key objectives
       2.1 To make clear and timely decision and formulate central policies based on the
            latest information
       2.2 To define the responsible parties/ persons for implementation of various
            contingencies
       2.3 To liaise and coordinate with other departments and authorities


  3    Plans in place
       3.1 Command and control structure: Under the Serious Response Level (S2), and
            Emergency Response Level (E1 and E2), the HA Central Command Committee
            (CCC) will be activated and chaired by Chief Executive of Hospital Authority to
            deal with operational issues, human resources policy, infection control and clinical
            management policies.
       3.2    Governance: The Emergency Executive Committee (EEC) delegated by the HA
              Board will be activated when necessary.
       3.3    HA will participate in the overall response actions of the Hong Kong Government.
       3.4    Major Incident Control Centres (MICCs) will be set up in HAHO and 7 clusters.
              There will be linkage with Emergency Command Centre of Centre for Health
              Protection (CHP). Each centre will be adequately staffed and the operation hours
              will depend on the progression of the pandemic.
       3.5    e- Flu will be posted up within 48 hours of activation of Serious Response Level
              (S2), and Emergency Response Level (E1 and E2) in HA to capture patient
              particulars and laboratory results online. The daily situation will be reported to
              CCC and CHP.
       3.6    Other expert groups supporting the CCC are as follows -
                        HA Avian Influenza Collaborative Group (HAICOG) on treatment
                        modalities and research
                        Designated Communication Group convened during Serious Response
                        Level (S2), and Emergency Response Level (E1 and E2)
       3.7    The following functions will in operation under Serious Response Level (S2), and
              Emergency Response Level (E1 and E2)
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                       Business Support subcommand centre under BSSD
                       Public hotline under PA Division
                       Staff hotline and HR Division


4    Operational details
     Please refer to
     4.1 Framework of Government’s preparedness plan for influenza pandemic.
     4.2 Hospital Authority’s Response Plan for Infectious Disease Outbreaks
     4.3 Operational Plan of Hospital Authority Head Office Major Incident Control Centre
           (MICC)
     4.4 AOM Paper P-413 – Terms of reference and membership of the Emergency
           Executive Committee (ECC) and Central Command Committee (CCC)
     4.5 Work plan of HA Dedicated Communication Group (DCG) for Infectious Disease
           Outbreak
     4.6 AOM Paper P-414 – Communication Plan for Influenza Pandemic


     *Full list available under Section IV
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Chapter 2                                                                    Risk Assessment
1    Introduction
      Assessment of pandemic risk and impact of the outbreaks on human health and
      healthcare organization is carried out as part of risk assessment.


2    Key Objectives
     2.1 To assess the risk of outbreaks in HK
     2.2 To estimate impact of the outbreaks on the healthcare sector and other patient care
          services


3    Plans in place
     3.1 Joint HA/CHP risk assessment template: Experts from HA and CHP have
          developed a comprehensive system of risk assessment by continuous situation
          update and literature review regarding the latest scientific evidence on the
          epidemiology, clinical features and virology of the avian influenza virus.
     3.2        Overall situation assessment by CHP & its Scientific Committees: HA will take
                reference to the latest situation assessment by CHP and the evaluation by the
                Scientific Committees and the Government’s decision to activate the different
                avian influenza response levels.
     3.3        Under Serious Response Level (S2), and Emergency Response Level (E1 and
                E2): Central Command Committee will assess service impact of the pandemic,
                special needs of certain patient groups, concerns of staff groups, public responses
                and sentiment as well as effect of potential interventions. The “state of
                emergency” may be declared by the Chief Executive of HA when necessary.


4    Operational details
     Please refer to
     4.1 Risk Assessment of Avian Influenza (predisposition for an influenza pandemic) on
           circulation (accessible through http://ha.home)
     4.2 Hong Kong Government Response System & HA’s Response of Infectious Disease
           Outbreaks. Slide 2-14 of Training Kit for Pandemic Influenza for Healthcare
           Workers. By IDCTC, HA & ICB, CHP.


     *Full list available under Section IV
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Chapter 3                                                                        Surveillance
1    Introduction
      Surveillance consists of ongoing collection, interpretation and dissemination of data to
      enable the development of evidence based interventions.


2    Key objectives
     2.1 To establish surveillance system and network to cater for influenza outbreaks at
          different time frame, in different geographic areas
     2.2 To improve and streamline reporting system
     2.3 To ensure and improve linkage of surveillance information between HA and CHP


3    Plans in place
     3.1 During inter-pandemic period
                   Sentinel surveillance conducted by GOPCs and private doctors to monitor
                   influenza activity
                   Notification system for statutory notifiable diseases to CENO including
                   H5, H7, H9 influenza
                   Staff early sickness alert system to monitor specific syndromes in HA staff
                   Investigation and reporting of hospital outbreaks / unusual clustering by
                   hospital infection control team
                   Co-operation with SEB and ICB of CHP on monitoring of outbreaks in
                   hospitals, extended care facilities, and old aged homes.
                   Co-operation with SEB on epidemiological investigation of community
                   outbreaks
                   Online reporting of suspected avian influenza/ influenza with
                   epidemiological link
                   Enhanced surveillance and triage of influenza-like-illness (ILI) patients
                   with epidemiological link


     3.2        Under Serious Response Level (S1)
                       Enhanced surveillance of laboratory workers handling clinical specimens
                       Symptoms surveillance program during Serious Response Level (S1) for
                       staffs involved in poultry culling


     3.3        Under Serious Response Level (S2) , and Emergency Response Level (E1 and E2),
                the following systems will be activated
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                       Designated Accident & Emergency Departments, General OPDs coding
                       monitoring program for ILI
                       e-Flu for surveillance, contact tracing, communication and administrative
                       purpose
                       Monitoring mechanism for antiviral usage and stock level in HA hospitals
                       Ad hoc surveillance programs as advised by CHP as the pandemic evolves


4    Operational details
     Please refer to
     4.1 Guideline on the Management of Outbreaks in HA Extended Care Facilities
     4.2 Reporting Mechanism for Notifiable Diseases and other Communicable Diseases
     4.3 Guidance Notes on Staff Early Sickness Alert System (SESAS)
     4.4 Operational plan of e-Flu


     *Full list available under Section IV
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  Chapter 4                                        Epidemiological Investigations
  1    Introduction
       Epidemiological investigations are carried out to identify how suspected human
        cases of a new influenza strain become infected, to determine the risk that infected
       persons, or their environment, may pose to others. Based on this assessment, control
       measures and preventive actions may be started.


  2    Key objectives
       2.1 Rapid detection and timely report of clustering of illness with epidemiological
            links or outbreaks
       2.2 To carry out appropriate investigations to delineate nature of outbreak
       2.3 To implement infection control measures to curtail spread of illness


  3    Plan in place
       3.1 Investigation and reporting of hospital outbreaks/ unusual clustering are conducted
             by hospital infection control teams.
       3.2 Staff early sickness alert system (SESAS) to monitor syndromes in HA staff is in
             operation.
       3.3 Regional public health teams from CHP will work closely with hospital infection
             control teams on hospitals and community outbreaks.
       3.4 Under Serious Response Level (S2), and Emergency Response Level (E1 and E2),
             e-Flu will be activated in HA hospitals to aid epidemiological investigations.


  4    Operational details
       Please refer to
       4.1 Outbreak investigation and control in HA Hospitals (HAHO Operations Circular)
       4.2 Reporting Mechanism for Notifiable Diseases and other Communicable Diseases
             (HAHO Operations Circular)
       4.3 Guidance Notes on Staff Early Sickness Alert System (SESAS)


       *Full list available under Section IV
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Chapter 5                             Laboratory Support / Diagnostic Capacity
1    Introduction
     To enable rapid confirmation of suspected human cases of avian influenza or a new
     influenza strain, it is essential to ensure access to diagnostic capacity and subsequent
     confirmation by reference laboratory. Laboratory investigations and support of various
     diagnostic tests will facilitate proper risk assessment and provide clinical management
     guide.


2    Key Objectives
     2.1 To provide rapid and reliable laboratory results
     2.2 To prepare for surge in demand and formulate testing strategies during pandemic
     2.3 To collaborate with Public Health Laboratory Services Branch (PHLSB) of CHP
          for confirmation all positive specimens
     2.4 To ensure safety in collecting, transporting and handling infectious materials


3    Plan in place
     3.1 Hospital influenza testing strategies- baseline level, no alert in HA and CHP
           3.1.1 Rapid antigen tests for influenza, mainly by commercial immunoassays, are
                  performed in hospital laboratories based on indications.
           3.1.2 Rapid tests for a panel of respiratory pathogens by immunofluorescence on
                  respiratory specimens are performed on a daily routine basis in designated
                  laboratories.
           3.1.3 RT-PCR testing for influenza H5 if indicated will be performed at PHLSB
                  of CHP.
           3.1.4 Viral culture and serology studies are done at PHLSB of CHP.


     3.2        Under Alert Response Level, and Serious Response Level (S1) in HA
                3.2.1 Continue rapid tests for the respiratory panel under Hospital Based
                      Virology Service.
                3.2.2 Review and revise if necessary the strategy on laboratory testing, such as
                      extending rapid antigen test for influenza to more hospital laboratories;
                      stockpile of testing reagents; mobilization of manpower to enhance
                      diagnostic capacity; enhance service accessibility through inter-cluster
                      support.
                3.2.3 RT-PCR testing for influenza H5 if indicated is done at University
                      laboratories and PHLSB.
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             3.2.4 Viral culture and serological test are done at PHLSB and the two
                   universities.


       3.3   Under Serious Response Level (S2), Emergency Response Level (E1 and E2)
             3.3.1 Strategy on laboratory testing and safety requirements will be reviewed
                   based on the latest epidemiological and research findings.
             3.3.2 There is central coordination stockpile of testing reagents to streamline
                   supplies.
             3.3.3 RT-PCR tests for influenza H5 will be performed in designated HA
                   laboratories (i.e. QEH, PMH and TMH) if needed; in addition to the two
                   universities (i.e. PWH & QMH) and PHLSB.
             3.3.4 Enhancement in local laboratory capacity for RT- PCR for influenza H5 to
                   assist diagnosis will be planned.


       3.4   Laboratory Safety
             3.4.1 Guidelines and audit on guiding transport and handling of clinical
                   specimens are promulgated to all laboratories.
             3.4.2 Mechanism for reporting of unprotected exposure to infectious specimens/
                   cultures is established.


4      Operative details
       Please refer to:
       4.1 HA Operational Plan on Laboratory Testing for Human Influenza A (H5N1)
             Infection
       4.2 Guideline on Management Approach of Influenza-like Illness (ILI) and
             Community-acquired Pneumonia (CAP) Suspected of Avian Influenza .
       4.3 Supplementary Guidelines for Handling of Clinical Specimen in the Laboratory
       4.4 Guideline on Transport of Clinical Specimens and Infectious Substances


       *Full list available under Section IV
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Chapter 6                                               Infection Control Measures
1      Introduction
        Infection control is an essential part of patient management. Guidance to staff is
        important to clarify routes of transmission and ways to interrupt transmission through
        infection control measures.


2      Key objectives
       2.1 To provide clear instructions to staff on infection control measures under different
            response system levels
       2.2 To familiarize staff with the required interventions to control the outbreak


3      Plans in place
       3.1 HA Infection Control Plan for Avian Influenza: the guidelines takes into
            consideration the following areas as applied to hospital and ambulatory care
            settings:
                      precautionary principles,
                      infection control infrastructure,
                      surveillance and notification mechanism,
                      laboratory support,
                      patient care practices,
                      use of personal protection equipment,
                      infection control measures in various health settings,
                      visiting policy,
                      cleaning and disinfection,
                      waste management.
                      linen management
                      infection control training
                      preparation for preparation of negative pressure isolation rooms
                      general principles of use for PPEs
                      non-emergency patient transfers of avian flu patients / patients at risk of
                      avian flu
                      infection control measures of outreach care


       3.2   Guideline on the Management of Outbreak in HA Extended Care Facilities
             describes measures to be implemented in extended care facilities in case of
             infectious disease outbreaks.
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       3.3    Laboratory Biosafety Guidelines available on transport and handling of
              infectious samples in the laboratory.


4      Operational details
       Please refer to
       4.1 HA infection Control Plan for Avian Influenza
       4.2 Guideline on the Management of Outbreak in HA Extended Care Facilities
       4.3 Guideline on Transport of Clinical Specimens and Infectious Substances
       4.4 Supplementary guidelines for Handling of Clinical Specimens in the Laboratory


       *Full list available under Section IV
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Chapter 7                                                   Essential Medical Services
1    Introduction
      It is crucial that essential health services are maintained in operation as long as possible
      by ensuring an optimal use of facilities and sensible personnel management.


2    Key objectives
     2.1 To stock take available facilities and human resources during pre-pandemic phase
     2.2 To closely monitor territory wide utilization of public hospitals.
     2.3 To meet surge in workload due to influenza by re-organising or reducing
          non-urgent and non-emergency services.
     2.4 To identify triggers for implementation of health services emergency plans.


3    Plans in place
     3.1 During the Alert Response Level, and Serious Response Level (S1) period, the
          following areas are reviewed
                     Beds and healthcare workers deployment plans on cluster basis for
                     surge in medical admissions
                     HA Hospitals and Beds Mobilization Plan for Avian Influenza (AI)
                     patients (adult and paediatric)
                     Stocktaking isolation facilities in HA hospitals
                     Stocktaking ventilators and mobile X-ray machines in HA
                     Registry of doctors and nurses with ICU rotations
                     Training package and refresher courses for staff


     3.2        During Serious Response Level (S2) and Emergency Response Level (E1 and
                E2), Central Command Committee will assess and decide on the followings:
                       HA wide service impact and prioritization of non-emergency and
                       non-essential services
                       Activation in stages of hospital mobilization plan for AI patients
                       Activation of staff deployment plans of seven clusters
                       Activation of Designated Clinics
                       Activation of collaboration plans with private hospitals, other NGOs
                       and/or other personnel to assist in maintaining services for non-AI patients
                        Recruitment of additional doctors, nurses and other health care workers
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4    Operational details
     Please refer to
     4.1 Beds and staff deployment plans of the seven clusters
     4.2 Operational Plan of Designated Clinics
     4.3 Training Kit for Pandemic Influenza for Healthcare Workers by Infectious Disease
           Control Training Center, Hospital Authority & Infection Control Branch, Centre
           for Health Protection
     4.4 Scenarios for Hospitals and Beds Mobilization
     4.5 Operational plans on Public-Private Collaboration during Influenza Pandemic
     4.6 List of cluster liaison person for private sector
     4.7 Guideline on segregation policy for high risk patients at AEDs and GOPCs


     Full list available under Section IV
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Chapter 8                                                     Facilities Management
1    Introduction
      The increase in patient admissions during influenza pandemic will cause strain on
      capacity of various facilities such as outpatient clinics, Accident & Emergency
      Departments, isolation wards, intensive care units, laboratory testing and hospitals
      mortuaries. Staff may request to stay in hospital quarters voluntarily. Hence planning for
      alternatives and re-deployment /re-designation of use of facilities is essential in the
      pre-pandemic phase and should be reviewed continuously during the progression of the
      outbreak.


2    Key objectives
     2.1 To plan for reserved and additional capacity of various facilities
     2.2 To make plans for delivering medical care in non-traditional/ alternative settings.
     2.3 To identify triggers for implementation of health services emergency plans


3    Plans in place
     3.1 HA has 18 Designated Clinics to manage suspected patients with fever and defined
          symptoms during Serious Response Level (S2), and Emergency Response Level
          (E1 and E2).
     3.2 There is ICU contingency plan for deployment of additional capacities for
          intensive care during crisis
     3.3 Cluster management regularly monitors beds (including isolation facilities)
          utilization and will re-designate the use of beds to meet surge admissions when
          necessary.
     3.4 A two-tiers laboratories network has been established on sharing of expertise and
          clinical specimens and enhance diagnostic capacity
     3.5 There is a plan for temporary mortuary under Emergency Response Level (E1 and
          E2) to enhance storage capacity of bodies.
     3.6 HA keeps an inventory of hospital quarters.
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4     Operational details
      Please refer to
      4.1 Hospitals beds and staff deployment plan of seven clusters
      4.2 Scenarios for Hospitals and Beds Mobilization
      4.3 HA Operation Plan on Laboratory Testing for Human Influenza A (H5N1)
            Infection
      4.4 CHP/ HA plan for temporary mortuary and arrangement for cremation during
             influenza pandemic (under preparation)
      4.5    Administrative Guidelines - Temporary Accommodation for Frontline Staff during
             Pandemic (under preparation)
      4.6    Guidelines on the Use of Isolation Rooms/Beds

       Full list available under Section IV
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Chapter 9                                                        Clinical Management
1      Introduction
       Experience sharing, research and expertise transfer among clinicians are important in
       ensuring effective and safe treatment of (suspected) human cases of a novel influenza
       strain. The spectrum of illness associated with influenza virus infections could be wide.
       Current guidelines are derived from the review of latest literatures and require further
       modification when more data are collected at different phases of a pandemic.


2      Key objectives
       2.1 To review & update diagnosis, treatment and management protocols
       2.2 To develop and review admission and discharge criteria
       2.3 To provide guidance on social and psychological support for patients, families and
            staff


3      Plan in place
       3.1 Clinical Management overview: Guidelines on management and therapeutics of
             influenza are issued by HA & CHP
       3.2   Initial approach to Influenza-Like-Illness (ILI) at out-patient: Management
             algorithms for patients with ILI and community acquired pneumonia presented
             clinics and Accident & Emergency Departments are issued by HA
       3.3   Initial approach for hospitalized suspected avian influenza patient: Detailed
             charts showing approach to hospitalized suspected patients and, guidance table on
             risk stratification of admitted cases are issued by HA
       3.4   Triage of Patients: Triage assessment for febrile patient for Avian Flu (H5N1)
             infection is issued by HA for use at AEDs & outpatient clinics.


4      Operational details
       Please refer to
       4.1 Guideline on Management Approach of influenza-like Illness (ILI) and
             Community-acquired Pneumonia (CAP) Suspected of Avian Influenza
       4.2 Guideline on Management of Seasonal Influenza in Hong Kong
       4.3 A&E and GOPC Triage Assessment for Febrile Patient for SARS / Avian Flu (H5)
             infection
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   4.4   Operational Plan of Designated Clinics
   4.5   Fact sheet on Avian Influenza
   4.6   Fact sheet on antiviral therapy against influenza
   4.7   General Guide to Doctors: Antiviral use For Novel Influenza Treatment and
         Prophylaxis by Centre for Health Protection Scientific Committee on Emerging
         and Zoonotic Diseases


   Full list available under Section IV
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Chapter 10                                                             Antiviral Therapies
1      Introduction
       The use of antiviral agents for treatment and prophylaxis of human influenza may reduce
       mortality and morbidity. However, clinical outcomes of the application of antiviral
       agents to avian influenza are still uncertain. As there is constrain in stockpile of currently
       available antiviral drugs, it is necessary to formulate a strategy for setting priorities for
       treatment and prophylaxis during the pandemic.


2      Key objectives
       2.1 To secure supply and stockpiling of appropriate antiviral drugs in accordance with
            government’s policy
       2.2 To formulate strategy and priority for antiviral prophylaxis for health care workers
            in HA during pandemic
       2.3 To monitor side effects, utilization pattern and stockpiling of antiviral agents used
            during avian influenza outbreaks and influenza pandemic


3      Plan in place
       3.1 CHP’s recommendations on antiviral drug stockpile for various population groups
       3.2 Inventory of antiviral drug at HA


4      Operational details
       Please refer to
       4.1 General Guide to Doctors: Antiviral use For Novel Influenza Treatment and
             Prophylaxis by Centre for Health Protection Scientific Committee on Emerging
             and Zoonotic Diseases
       4.2 Fact sheet on antiviral therapy against influenza
       4.3 Guideline on Management of Seasonal Influenza in Hong Kong
       4.4 Summary of Recommendations on Antiviral Stockpiling for Influenza Pandemic
             by Centre for Health Protection Scientific Committee on Emerging and Zoonotic
             Diseases
       4.5 Operational Plan on supply and distribution logistics of Tamiflu


Full list available under Section IV
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Chapter 11                                                       PPEs and other supplies
1    Introduction
      Appropriate and adequate PPEs (Personal Protective Equipments) form an essential
      part of infection control measures.


2    Key objectives
     2.1 To provide clear instructions to staff on use of PPEs to be used under different
          settings
     2.2 To ensure adequate supply of PPEs and other supplies
     2.3 To ensure compliance and proper use of PPEs


3    Plans in place
     3.1 HA Infection Control Guidelines for Avian Influenza: the guidelines define
          recommendation of PPEs at high-risk patient areas, other hospital areas,
          ambulatory care settings and during high risk procedures.
     3.2        PPE: PPEs are stockpiled for HA hospitals and clinics with an average of 3
                months of assumed peak use capacity during the SARS epidemics. The stockpile
                strategy will be reviewed periodically.
     3.3        Medication and vaccines supply: Availability and diversification of supplies and
                stockpiling of medications and consumables, in addition to antiviral drugs, for use
                during the pandemic is reviewed periodically by Chief Pharmacist’s Office (CPO).
                HA will collaborate with CHP when vaccines for avian influenza / pandemic
                influenza become available.
     3.4        Ventilators and patient care monitoring equipments: their supplies will be
                periodically reviewed and coordinated jointly by COC (ICU), COC (Respiratory
                Medicine), COC (Paediatrics) and BSSD, HAHO
     3.5        N95 Fit tests records: All healthcare workers requiring to wear N95 masks are
                tested for suitable models of N95 masks and the records are kept by
                clusters/hospitals management.
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4      Operational details
       Please refer to
       4.1 HA infection Control Guidelines for Avian Influenza
       4.2 Scenarios for Hospitals and Beds Mobilization
       4.3 Operational plan of Business Support Sub-command Centre
       4.4 Records of models of N95 masks and results of fit tests of HA healthcare workers
            (kept at hospitals)


       Full list available under Section IV
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    Revised: 1 July 2006                                                            Page 26 of 50




Chapter 12                                                               Staff Deployment
1      Introduction
       During an influenza pandemic there will be an increased need for doctors, nurses and
       allied health professionals to deal with increased demands on health care system
       especially in the specialties of medicine, pediatrics, infection control, intensive care,
       respiratory care, accident and emergency, family medicine and clinical psychology.


2      Key objectives
       2.1 To provide adequate and just-in-time specialty relevant training and refresher
            courses to HA staff
       2.2 To formulate plans to recruit additional workforce as well as optimize deployment
            of existing health care workers
       2.3 To offer supports and be caring to staff
       2.4 To deliberate on concerned HR issues before and during pandemic


3      Plan in place
       3.1 Each cluster/hospital/department has established internal staff mobilization plans
             to prepare for the surge in patient service (in-patient, out-patient & community
             based)
       3.2 A registry of professional and trained staff with rotation/experience in ICU is
             maintained
       3.3 Guideline on the HR Policies and arrangements during Serious Response Level
             and Emergency Response Level has been promulgated. .
       3.4 Hospitals will maintain a list of external personnel and contact those who can be
             contacted and recruited as additional workforce during Emergency Response Level
             (E1 and E2).


4      Operational details
       Please refer to
       4.1 Bed and staff deployment plans of the seven clusters
       4.2 Contingency Plan of Major Incident Psychological Services for HA Staff
       4.3 Guideline on the HR policies and arrangements during Serious Response Level
             and Emergency Response Level


Full list available under Section IV
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    Revised: 1 July 2006                                                                Page 27 of 50



Chapter 13                                                   Community Involvement
1      Introduction
       The community has two roles during a pandemic: as a backend resource, and as
       end-receiver of supports.


      Community as backend resource:

      In the previous chapters, we have identified ways to optimize facilities management and
      human resource management within Hospital Authority. However, during a pandemic,
      such resources would likely be overwhelmed. The best use of resources during crisis shall
      be achieved through territory-wide prioritization with the inclusion of both private and
      public sectors and the community outside of the health care system, including various
      NGOs.


      Human resources outside the conventional health care system should be considered for
      mobilization as part of community resources during pandemic. They include, but are not
      limited to: a) retired doctors/nurses; b) doctors/nurses currently not working in clinical
      health care (i.e. in education, administration, research, private industry); c) trainees (i.e.
      medical students and nursing students); d) veterinarians; e) experienced staff working in
      community pharmacies; f) allied heath professionals in various walks of life (especially
      those with occupational therapy, physiotherapy, radiology and laboratory background); g)
      social workers.


      Community as support receiver:

      During a pandemic, the bereavements of victims’ families, the continuous media
      coverage on case fatalities and tragic news would have a significant negative impact on
      the general public. Confusions and misconceptions may also arise due to possible
      inaccurate reporting which could lead to panic, chaos and social disruption.


2      Key objectives

       2.1   To solicit public actions and support as well as maintain public confidence through
             effective communication programs
       2.2   To mobilize community resources through sharing of expertise and workload
             between public medical sector, private medical sector and the Community
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       2.3   To extend the coverage of psychosocial care through collaboration among various
             sectors.


3      Plan in place
       3.1 Existing networks and on-going communication channels between HA and private
             sector & various NGOs
       3.2 Existing HA volunteer network


4      Operational details
       Please refer to
       4.1 Work plan of HA Dedicated Communication Group (DCG) for Infectious Disease
             Outbreak
       4.2 Operational Plans on Public-Private Collaboration during Influenza Pandemic
       4.3 CHP’s letter to doctors: Volunteer service in public health during influenza
             pandemic


       Full list available under Section IV
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    Revised: 1 July 2006                                                                Page 29 of 50




Chapter 14                           Convalescent and Rehabilitation Services
1      Introduction
        Recovering patients shall benefit from well-planned convalescence and rehabilitation
        services. The psychological, social, financial and physical concerns of recovered
        patients and affected families have to be addressed by various parties concerned.


2      Key objectives
      2.1 To identify and establish essential convalescent and rehabilitation services for avian
           influenza / pandemic influenza patients


3      Plan in place
      3.1 Each hospitals/departments have established internal staff mobilisation plan to
            provide      physical     and      psychological    rehabilitation  services    at
            hospitals/ambulatory/community settings
      3.2 To work with Social Welfare Department to provide and mobilize tangible services,
            such as material assistance, financial assistance, emergency placement to meet the
            immediate welfare needs of the patients and their family members
      3.3 To work with Social Welfare Department, NGOs and private AH practitioners for
            referral of appropriate patients and families


4. Operational details
    Please refer to
   4.1 Cluster/Hospital AH service plans during influenza pandemic
   4.2 Operational guidelines on disaster management for Medical Social Services Units


       Full list available under Section IV
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    Revised: 1 July 2006                                                                Page 30 of 50



Chapter 15                                                                    Staff training
1      Introduction
       Healthcare workers, both in public and private sector and volunteers will benefit from
       various levels of training on avian influenza as well as the on-going communication on
       preparation for pandemic.


2      Key objectives
       2.1 To develop specific skills and knowledge related to avian influenza and influenza
            pandemic preparedness
       2.2 To familiarize staff with specific contingency plans (including corporate and
            hospital based plans)
       2.3 To plan and revise the training package on avian influenza and pandemic influenza


3      Plans in place
       3.1 Infectious Disease Control Training Centre is responsible for coordinating
            overall training activities and various topics related to avian influenza and
            influenza pandemic. A webpage dedicated to avian influenza has been created for
            rapid dissemination of information related to avian influenza and serves as
            resources of training material. An e-learning courseware on infection control has
            also been developed. Training kit for Pandemic Influenza for Healthcare Workers
            had been developed. Hardcopies, CD ROM and online versions are available for
            use by individuals, healthcare workers, or hospital infection control teams.
       3.2 All staff will go through relevant courses (intensive care, infection control and
             other refresher courses).
       3.3   Infection Control Teams of respective hospitals are responsible for on-going
             training and familiarization on the implementation of infection control policies for
             frontline staff.


4      Operational details
       Please refer to
       4.1 Training Kit for Pandemic Influenza for Healthcare Workers by Infectious Disease
             Control Training Center, Hospital Authority & Infection Control Branch, Centre
             for Health Protection (revised edition July 06).
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   4.2   Infectious Disease Control Training Centre (IDCTC) webpage on avian influenza.
         Accessible through HA intranet: http://ha.home/idctc/avianflupage; and internet:
         http://www3.ha.org.hk/idctc/avianflupage
   4.3   Hospital Authority webpage on Avian Influenza. Accessible through HA intranet:
         http://ha.home


   Full list available under Section IV
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    Revised: 1 July 2006                                                               Page 32 of 50



Chapter 16                            Communications (Internal and External)
1      Introduction
       Communication strategies are an important component in managing influenza pandemic.
       Accurate and timely information at all levels is critical in order to maximize the effective
       outcome of response and to minimize unnecessary worries and socio-economical
       impacts.


2      Key objectives
       2.1 To ensure timely and accurate communication with staff, patients and public on
            progress of disease and the status of the outbreak
       2.2 To share essential information with private healthcare sector and other
            governmental departments
       2.3 To ensure staff are aware of the contingency plans and address their concerns
            before pandemic outbreaks


3      Plan in place
       3.1 Under Alert Response Level, and Serious Response Level (S1), HA will:
             3.1.1 Promulgate health advice to the public
             3.1.2 Share information with private healthcare sector, medical professionals and
                    other health care providers groups
             3.1.3 Regular review and update situations assessment on the threat of a local
                    outbreak and timely dissemination of relevant information to public and
                    media
             3.1.4 Organize cluster forums to update staff on corporate policies, latest
                    situation of the outbreak/pandemic, guidance on disease management and
                    infection control, management action and the contingency measures


       3.2   Under Serious Response Level (S2), and Emergency Response Level (E1 and
             E2), in addition to measures during Alert Response Level, and Serious
             Response Level (S1 ), HA will:
             3.2.1 Provide support to and liaise with SEB and ICB, CHP on implementation
                    of public health measures, enhanced surveillance and contact tracing and
                    exchange of relevant clinical information
             3.2.2 Brief to District Councils and other community groups
             3.2.3 Promulgate health advice to clients and formulate a public communication
                    strategy on effective use of health resources
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             3.2.4 Streamline communication strategy in the dissemination of situation
                   updates and guidelines to all staff


4      Operational details
       Please refer to
       4.1 Work plan of HA Dedicated Communication Group (DCG) for Infectious Disease
             Outbreak
       4.2 AOM Paper P-414 - Communication plan for influenza pandemic


     Full list available under Section IV
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    Revised: 1 July 2006                                                               Page 34 of 50




Chapter 17                                                                             Research
1      Introduction
       Research is essential to increase the understanding of the disease or the impact of
       proposed measures. Coordinated research strategies among the universities, Department
       of Health and HA are needed during pandemic for optimal outcomes.


2      Key Objectives
       2.1 To conduct researches on various topics on avian influenza / novel influenza such
            as
                   study to determine risk factors for human infection and the likelihood of
                   human-to-human transmission
                   impact assessment of pandemic
                       Studies on the pandemic strain virus
                       evaluation of the effectiveness of antivirals and other therapies for the
                       treatment and prophylaxis protocols
                       study on the effectiveness of public health measures to control the
                       pandemic


3      Plan in Place


4      Operational details
       Please refer to
       4.1 Discussions and recommendations of various CHP Scientific committees
       4.2 Discussions and recommendations of the HA Influenza Collaborative Group
             (HAICOG)


       Full list available under Section IV
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Revised: 1 July 2006                                                Page 35 of 50




III. Outline of Hospital Authority Contingency
      Plan for Influenza Pandemic
      醫院管理局流感大流行應變計劃概覽
       Complied by HA CCID & ICB, CHP                                                                                         Title: HA Contingency Plan for Influenza Pandemic
       Revised: 1st July 2006                                                                                                                                       Page 36 of 50




      The table below summarizes the HA responses under different scenarios of the Government’s Alert, Serious and Emergency
      Response Levels.

Hong Kong Government
                                         Alert Response Level                              Serious Response Level                              Emergency Response Level
  Response Systems

                                Confirmation of HPAI outbreaks in poultry
                                                                               Confirmation of HPAI
                                populations outside HK; Confirmation of                                   Confirmation of human
                                                                               outbreaks     in     the                               Confirmation of efficient
                                HPAI in HK in imported birds in quarantine,                               case(s) in HK without
                                                                               environment of or                                      human-to-human                WHO             declares
      Scenarios                 in wild birds, in recreational parks, in pet
                                                                               among            poultry
                                                                                                          evidence of efficient
                                                                                                                                      transmission    of    novel   pandemic
                                bird shops or in the natural environment;                                 human-to-human
                                                                               population in retail                                   influenza in HK or overseas
                                Confirmation of human case(s) of avian                                    transmission
                                                                               markets or farms in HK
                                influenza outside HK

                                                                                                                                        Enhanced surveillance
                                                                                                           Enhanced surveillance                 +
 Key elements of HA                                                                                                                     Enhanced IC measures         All feasible options
                                           Enhanced surveillance               Enhanced surveillance                 +
       Actions                                                                                                                                   +                   to contain pandemic
                                                                                                           Enhanced IC measures         Manpower & Resources
                                                                                                                                            Deployment

                                                                                                               Genuine risk of
                                                                                   Potential risk of      transmission due to close
                                 Overall risk is low. However, geographic
                                                                                  animal-to-human            patient contact and                                        High risk in
      Rationale                   proximity to Hong Kong needs to be
                                                                                 transmission due to        evolution of effective
                                                                                                                                      Imminent risk of pandemic
                                                                                                                                                                        transmission
                                                 considered.
                                                                                    close contact.            human-to-human
                                                                                                                transmission


                                                                                Serious Response            Serious Response           Emergency Response              Emergency
     HA Response                         Alert Response Level                         Level                       Level                      Level                    Response Level
                                                                                        (S1)                        (S2)                         (E1)                       (E2)
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Hong Kong Government
                                                Alert Response Level                                         Serious Response Level                                          Emergency Response Level
  Response Systems

         HA Response                                                                              Serious Response                Serious Response Level             Emergency Response                    Emergency
                                                  Alert Response Level                                  Level                                                              Level                          Response Level
                                                                                                                                             (S2)
                                                                                                           (S1)                                                                 (E1)                             (E2)

                                                                                                                                          EEC, CCC                          EEC, CCC                         EEC, CCC
a) Command and coordination                                  CCID                                         CCID
                                                                                                                                         HAHO MICC                         HAHO MICC                        HAHO MICC

                                                                                                                                                                                                        Additional assessments
                                                                                                                                                                     Additional assessments on
                                                                                                                                                                                                       on service impact, special
                                                                                                                                                                  service impact, special needs of
                                                                                              Latest virology, clinical and       Latest virology, clinical and                                         needs of patient groups,
b) Risk assessment                       Latest virology, clinical and epidemiological                                                                            patient groups, concerns of staff,
                                                                                               epidemiological evidence            epidemiological evidence                                             concerns of staff, public
                                                            evidence                                                                                                 public responses, effect of
                                                                                                                                                                                                          responses, effect of
                                                                                                                                                                             intervention
                                                                                                                                                                                                              intervention


                                     FTOCC if there is confirmation of human case(s) of
                                         avian influenza outside mainland China
                                                                                                                                                                                                        Depending on situation
c ) Surveillance & Epidemiological                            OR                                  Risk-based surveillance          Risk-based surveillance        Additional surveillance program,
                                                                                                                                                                                                         assessments, e-Flu
     investigations                                                                                      program                   program, e-flu activated               e-flu activated
                                     Additional risk-based surveillance program if there is                                                                                                                   activated
                                      confirmation of human case(s) of avian influenza
                                                    within mainland China


                                                                                              -    See IC plan for avian                                          Additional recommendations to
                                                                                                                              -     See IC plan for avian                                               Strategy on IC measures
d) Infection control measures and    - See IC plan for avian influenza                             influenza                                                        IC plan according to latest
                                                                                                                                    influenza                                                               will be reviewed
    PPE                              - Stockpile appropriate PPE                              -    Stockpile  appropriate                                          epidemiological and research
                                                                                                                              -     Stockpile appropriate PPE                                              according to WHO
                                                                                                   PPE                                                                       findings


                                                                                                                                                                   Clinical protocols are in place.      On-going review of
                                                                                                   Risk based clinical               Risk based clinical            Enhance medical support to          guidelines & protocols
e) Clinical management                    Risk based clinical management guidelines
                                                                                                  management guidelines             management guidelines         residential institutions and Long       according to latest
                                                                                                                                                                        Term Care Facilities                 information
                                                                                                                                                              Title: HA Contingency Plan for Influenza Pandemic
             Complied by HA CCID & ICB, CHP
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             Revised: 1st July 2006




Hong Kong Government
                                                   Alert Response Level                                        Serious Response Level                                            Emergency Response Level
  Response Systems

          HA Response                                                                               Serious Response                 Serious Response Level               Emergency Response                 Emergency
                                                     Alert Response Level                                 Level                                                                 Level                       Response Level
                                                                                                                                                (S2)
                                                                                                            (S1)                                                                    (E1)                           (E2)

                                                                                               -    According to CHP and         -     According to CHP and
                                                                                                                                                                    -     According to CHP and           - According to CHP
f) Antiviral therapy                  According to CHP and HAICOG's recommendations                 HAICOG's                           HAICOG's
                                                                                                                                                                          HAICOG's recommendations         and      HAICOG's
                                                                                                    recommendations                    recommendations
                                                                                                                                                                                                           recommendations

                                                                                               -    On-going update on           -     Ensure staff are well                                             - Ensure staff are well
                                                                                                    avian influenza and                equipped          before     -     Ensure    staff   are  well      equipped       before
                                      -     On-going update on avian influenza and infection
                                                                                                    infection          control         deployment                         equipped before deployment       deployment
g) Staff training and research              control training for staff
                                                                                                    training for staff           -     Plan for research project    -     Plan for research project      - Plan for research
                                      -     Plan for research project where indicated
                                                                                               -    Plan for research project          where indicated                    where indicated                  project        where
                                                                                                    where indicated                                                                                        indicated


                                                                                               Share information with staff          Share information with staff       Enhanced internal and external    Enhanced internal and
h) Communications                         Share information with staff and concerned parties
                                                                                                  and concerned parties                 and concerned parties                 communications             external communications


                                                                                                                                  Normal service maintained.         Implement prioritization of non
                                                                                                                                 Consider designated clinics for      emergency and non essential        Further review on service
I) Surge Capacity
                                                                                                                                      triage. Sharing of              services, activate designated      provision and collaborate
                                                     Normal service maintained                 Normal service maintained
                                                                                                                                 information and updates with          clinics to manage demand,         with private hospitals for
   1.Essential medical services
                                                                                                                                 private sectors and concerned      collaborate with private hospitals     additional capacities
                                                                                                                                             parties                         when necessary


                                                                                                                                                                         - Activate hospital and bed      Additional measures to
                                                                                                                                                                                mobilization plans;       be considered, such as
                                                                                                                                      Activate hospital and bed
                                                                                                   Stock taking of isolation                                                - ICU contingency plan.       provision of healthcare
   2 Facilities management                               Normal operations                                                            mobilization plan for avian
                                                                                                           facilities                                                   - Designation of more beds in            service in
                                                                                                                                          influenza patients
                                                                                                                                                                           each cluster to meet surge       non-conventional,
                                                                                                                                                                                   admission               non-hospital settings
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Hong Kong Government
                                    Alert Response Level                      Serious Response Level                                  Emergency Response Level
  Response Systems

       HA Response                                                   Serious Response     Serious Response Level               Emergency Response                   Emergency
                                      Alert Response Level                 Level                                                     Level                         Response Level
                                                                                                      (S2)
                                                                            (S1)                                                         (E1)                             (E2)

                                                                                          Activate the network of 3 labs.
                                                                                            Consider activation of the       Activate the network of 6 labs       Strategy on lab testing
 3.Lab support     /   diagnostic                                     Normal laboratory
                                    Normal laboratory arrangements                         network of 6 labs if needed       and mobilize central reagents           will be reviewed
 capacity                                                               arrangements
                                                                                          and mobilize central reagents                 stockpile                   according to WHO
                                                                                                     stockpile


                                                                                           Implement staff deployment       Implement staff deployment plan           Strategy of staff
                                                                       Normal staffing     plan and corresponding HR        and corresponding HR policies to         deployment to be
 4.Staff deployment                  Normal staffing arrangements
                                                                        arrangements        policies to support hospital        support hospital and bed          reviewed according to
                                                                                            and bed mobilization plans             mobilization plans              situation assessment


                                                                                                                                                                   Manpower outside
                                                                                                                            Manpower outside conventional
                                                                                                                                                                 conventional health care
 5.Community involvement                       Normal                     Normal                     Normal                  health care system should be
                                                                                                                                                                    system should be
                                                                                                                                      considered
                                                                                                                                                                       considered


                                                                                                                                                                     Allied health and
                                                                                                                            Allied health and psycho-social
 6.Convalescent & rehabilitation               Normal                     Normal                     Normal                                                      psycho-social support for
                                                                                                                               support for those in need
                                                                                                                                                                      those in need
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      Revised: 1 July 2006                                                                                            Page 40 of 50



     醫院管理局流感大流行應變計劃概覽
     以下表格概述醫管局於不同警示級別下的應變措施

香港政府的應變級別系統                      戒備應變級別                       嚴重應變級別                                     緊急應變級別


                      香港境外證實在家禽中爆發高致病性禽流感;香        香港境內證實在家禽所處環
                      港境內證實在檢疫中的入口禽鳥、野生禽鳥、休        境或在零售市場、批發市場   香港境內證實出現人類感染
                                                                                   有證據確定外地或本港出現容易在人與
      概要              憩公園、寵物店或自然環境中出現高致病性禽流        或農場家禽中爆發對人類健   禽流感的個案,但無證據顯示
                                                                                       人之間傳播的新型流感
                                                                                                                       世衛宣告流感大流行發生
                      感個案;在香港境外證實出現人類感染禽流感的        康造成影響的高致病性會流   病毒容易在人與人之間傳播。
                               個案。                      感。


                                                                                            加强監察
                                                                      加强監察                    +
 醫管局主要事項處理                         加强監察               加强監察              +                加强傳染病控制措施                  所有流感大流行下可實行的措施
                                                                   加强傳染病控制措施                  +
                                                                                         制定員工調配計劃


                                                     因緊密接觸而潛在     因緊密接觸及有人傳人之間       存有即時發生『流感大流行』的
      基礎                整體風險較低,需考慮個案發生的地域範圍
                                                    動物傳人的風險危機       傳播的真確風險                風險
                                                                                                                           有高風險的傳播



  醫管局應變級別                       戒備應變級別             嚴重應變級別(S1)      嚴重應變級別(S2)          緊急應變級別(E1)                       緊急應變級別(E2)

                                                                  啓動『緊急應變策導委員會』、   啓動『緊急應變策導委員會』『中央指
                                                                                                、                   啓動           、
                                                                                                                                 『
                                                                                                                      『緊急應變策導委員會』 中
                                   啓動                   啓動
a) 指揮及協調                       『中央傳染病委員會』           『中央傳染病委員會』
                                                                   『中央指揮委員會』及            揮委員會』及                         央指揮委員會』及
                                                                   醫管局重大事故控制中心        醫管局重大事故控制中心                     醫管局重大事故控制中心


                                                   更新及檢討有關禽流感病毒   更新及檢討有關禽流感病毒                                      附加評核在服務影响方面,病人
                                                                                   附加評核在服務影响方面,病人團體需
b) 風險評估               更新及檢討有關禽流感病毒的病毒學、臨床特徵        的病毒學、臨床特徵及流行   的病毒學、臨床特徵及流行病
                                                                                   求、員工關注,社會回應及有關方面。
                                                                                                                    團體需求、員工關注,社會回應
                           及流行病學的科學証據。               病學的科學証據。        學的科學証據。                                            及有關方面。

                             發生在中國大陸境外 – FTOCC 或
                                                                  加强監察及啓動電子流感系                                      按情况評核,啓動電子流感系统
c) 監察及流行病學                   發生在中國大陸境內 -加强監察
                                                       加强監察
                                                                      统 (e-Flu)
                                                                                   加强監察及啓動電子流感系统 (e-Flu)
                                                                                                                          (e-Flu)
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            Revised: 1 July 2006                                                                                                   Page 41 of 50



香港政府的應變級別系統                          戒備應變級別                          嚴重應變級別                                         緊急應變級別


      醫管局應變級別                       戒備應變級別                嚴重應變級別(S1)        嚴重應變級別(S2)            緊急應變級別(E1)                        緊急應變級別(E2)

                                                      -   按『醫管局禽流感感染控   -   按『醫管局禽流感感染控
 d)    感染控制措施及個人           -   按『醫管局禽流感感染控制計劃』指引                                          跟據最新流行病學研究報告,附加感染                    跟據世衛指引,檢討感染控制措
                                                          制計劃』指引            制計劃』指引
       保護裝備                -   貯備個人保護裝備                                                        控制計劃建議。                              施策略。
                                                      -   貯備個人保護裝備      -   貯備個人保護裝備


                                                                                          公佈、更新及修訂有關臨床指引,加强
 e)    臨床管理                    制訂以風險評估為基礎的流感相關疾病指引    制訂以風險評估為基礎的流      制訂以風險評估為基礎的流      對住宿院舍及長期護理服務設施的醫療                        跟據最新訊息檢討有關指引
                                                         感相關疾病指引           感相關疾病指引               支援。


                           按衛生防護中心及『醫管局大流感協作(治療)小     按衛生防護中心及『醫管局      按衛生防護中心及  『醫管局大   按衛生防護中心及『醫管局大流感協作                    按衛生防護中心及『醫管局大流
 f)    抗病毒預防及治療
                                   組』建議               大流感協作(治療)小組』建議     流感協作(治療)小組』建議         (治療)小組』建議                         感協作(治療)小組』建議



                                                      -   為員工提供禽流感及流
                           -   為員工提供禽流感及流感大流行的新知識及        感大流行的新知識及感    -   確保員工適當地使用個人                                        -   確保員工適當地使用個人保
                                                                                          -    確保員工適當地使用個人保護裝備
                               感染控制措施                     染控制措施             保護裝備                                                   護裝備
 g)    員工訓練及研究                                                                            -    與本地及國際的學術界合作,進行有
                           -               ,
                               與本地及國際的學術界合作 進行有關疫潮的   -   與本地及國際的學術界    -   與本地及國際的學術界合                                        -   與本地及國際的學術界合
                                                                                               關疫潮的研究
                               研究                           ,
                                                          合作 進行有關疫潮的研       作,進行有關疫潮的研究                                            作,進行有關疫潮的研究
                                                          究



 h)    溝通                          向員工發放有關資訊              向員工發放有關資訊         向員工發放有關資訊               加强內部及對外溝通                        加强內部及對外溝通


                                                                        維持正常服務,考慮啟動指定
 i)    應付重大事故的能力
                                                                        診所及制訂分流程序,並向私     順優先次序執行非緊急及非迫切服務;                    按情況作檢討,並與私家診所合
                                      維持正常服務                維持正常服務
                                                                        家診所及其他社區組別提供       啓動指定診所及與私家診所合作。                        作,增加額外效能。
       1. 基本醫療服務
                                                                             簡報。

                                                                                          - 啓動 『醫院及病床調配計劃』
                                                                        啓動應禽流感病人而設的『醫     - 啟動 『深切治療部應變計劃』                     考慮實施輔加措施,例如:在非
       2. 設施管理                        維持正常運作               進行隔離設施點算
                                                                          院及病床調配計劃』
                                                                                  。       - 在每個聯網劃定更多可用的病床作疫                    醫院醫設施下的醫療服務。
                                                                                            潮收症之用
     Complied by HA CCID & ICB, CHP                                   Title: HA Contingency Plan for Influenza Pandemic
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香港政府的應變級別系統                   戒備應變級別               嚴重應變級別                                   緊急應變級別


 醫管局應變級別                     戒備應變級別     嚴重應變級別(S1)     嚴重應變級別(S2)         緊急應變級別(E1)                       緊急應變級別(E2)

                                                       啓動三間化驗室網絡
                                        維持正常化驗室運作                     啓動六間化驗室網絡及調配中央測試劑                依據世衛指引,檢討化驗測試策
  3. 化驗室支援                  維持正常化驗室運作                 如有需要,可考慮啓動六間化
                                                                              貯備                             略。
                                                      驗室網絡及調配中央測試劑
                                                            貯備


                                                       啓動三間化驗室網絡
                                        維持正常化驗室運作                     啓動六間化驗室網絡及調配中央測試劑                依據世衛指引,檢討化驗測試策
  4. 化驗室支援                  維持正常化驗室運作                 如有需要,可考慮啓動六間化
                                                                              貯備                             略。
                                                      驗室網絡及調配中央測試劑
                                                            貯備


                                                                      考慮採用傳统醫療護理制度以外的人手                考慮採用傳统醫療護理制度以外
  5. 社區參與                      維持正常服務     維持正常服務         維持正常服務
                                                                              安排                            的人手安排


  6. 療養及康復                     維持正常服務     維持正常服務         維持正常服務         安排專職治療及社會心理輔導                   安排專職治療及社會心理輔導
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IV. List of Documents

      List of Documents posted at HA intranet
      (Infectious Disease Control Training Centre – Avian Influenza
      webpage: Contingency & Related Plan Page

      (Intranet) - http://ha.home/idctc/avianflupage/resources_conplan.asp


      (Internet) - http://www3.ha.org.hk/idctc/avianflupage/resources_conplan.asp
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1.     A&E and GOPC Triage Assessment for Febrile Patient for SARS / Avian Flu (H5) infection
2.     AOM Paper P-305 Establishment of the Emergency Executive Committee (EEC)
3.     AOM Paper P-413 – Terms of reference and membership of the Emergency Executive
       Committee (ECC) and Central Command Committee (CCC)
4.     AOM Paper P-414 - Communication plan for influenza pandemic
5.     CHP’s letter to doctors: Volunteer service in public health during influenza pandemic
6.     Cluster/Hospital AH service plans during influenza pandemic
7.     Communication plan for Avian influenza
8.     Contingency Plan of Major Incident Psychological Services for HA Staff
9.     Fact sheet on antiviral therapy against influenza
10.    Fact sheet on Avian Influenza
11.    Framework of Government’s preparedness plan for influenza pandemic
12.    General Guide to Doctors: Antiviral use For Novel Influenza Treatment and Prophylaxis by
       Centre for Health Protection Scientific Committee on Emerging and Zoonotic Diseases
13.    Guidance Notes on Staff Early Sickness Alert System (SESAS)
14.    Guidelines for volunteers service
15.    Guideline on Management Approach of Influenza-like Illness (ILI) and Community-acquired
       Pneumonia (CAP) Suspected of Influenza A (H5)       (Eng and Chi Version)
16.    Guideline on Management of Seasonal Influenza in Hong Kong
17.    Guidelines on Human Resources Policies and Arrangements during Alert Response Level,
       Serious Response Level and Emergency Response Level (戒備/嚴重/緊急應變級別下人
       力資源政策及安排的指引)
18.    Guideline on the Management of Outbreaks in HA Extended Care Facilities
19.    Guidelines on the Use of Isolation Rooms/ Beds
20.    Guideline on Transport of Clinical Specimens and Infectious Substances
21.    HA Operational Plan on Laboratory Testing for Human Influenza A (H5N1) infection
22.    HA Infection Control Guidelines for Avian Influenza (2nd Edition)
23.    HA Staff Influenza Vaccination Program (current year)
24.    Hospital Authority’s Response Plan for Infectious Disease Outbreaks
25.    Operational guidelines on disaster management for Medical Social Services Units
26.    Operational Plan of Business Support Sub-command Center
27.    Operational Plan of Designated Clinics
28.    Operational Plan of e-Flu
29.    Operational Plan of Hospital Authority Head Office Major Incident Control Centre (MICC)
30.    Operational Plans on Public-Private Collaboration during Influenza Pandemic
31.    Outbreak investigation and control in HA Hospitals (HAHO Operations Circular)
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32.    Records of models of N95 masks and results of fit tests of HA healthcare workers – Records
       kept by respective hospital clusters / hospitals
33.    Referrals from Private Sector to HA Hospitals on Avian Influenza / Suspected Avian
       Influenza Patients
34.    Reporting Mechanism for Notifiable Diseases and Other Communicable Diseases
35.    Risk Assessment of Avian Influenza (predisposition for an influenza pandemic) on circulation
       -          Accessible     through     http://ha.home     →      “ID/IC      website”     →       “Fact
       Sheets/Guidelines/Training Materials” → “A-Z Search” → “A – Avian Influenza”.
36.    Roles of Community Geriatric Assessment Team (CGAT) during ID outbreak
37.    Scenarios for Hospitals & Beds Mobilization
38.    Summary of Recommendations on Antiviral Stockpiling for Influenza Pandemic by Centre
       for Health Protection Scientific Committee on Emerging and Zoonotic Diseases
39.    Supplementary Guidelines on Handling of Clinical Specimens in the Laboratory
40.    Training kit for Pandemic Influenza for Healthcare Workers by Infectious Diseases Control
       Training Center, Hospital Authority & Infection Control Branch, Centre for Health Protection,
       2nd         Edition,    July   2006    -   Accessible     through     the   website     of    IDCTC:
       http://ha.home/idctc/avianflupage/training_kit_pandemic_flu.asp
41.    Work plan of HA Dedicated Communication Group (DCG) for Infectious Disease Outbreak
       (Chinese version: 醫管局的傳染病爆發專責溝通小組)
42.    Operational Plan on supply and distribution logistics of Tamiflu
43.    Guideline on segregation policy for high risk patients at AEDs and GOPCs


Listed in alphabetical order
* New guidelines referred in this HA Contingency Plan for Influenza Pandemic will be
updated and posted at HA intranet in due course
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V. References
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1.   World Health Organization. Influenza pandemic preparedness and response. Report by
     the Secretariat at the Executive Board 115th session. Agenda item 4.17 on 20th January
     2005. Accessed online http://www.who.int/gb/ebwha/pdf_files/EB115/B115_44-en.pdf
2.   World Health Organization. WHO checklist for influenza pandemic preparedness
     planning.                   2005.                    Accessed            online
     http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_
     4/en/
3.   World Health Organization. Avian influenza: assessing the pandemic threat. 2005.
     Accessed online http://www.who.int/csr/disease/influenza/en/H5N1-9reduit.pdf
4.   Public Health Agency of Canada. Canadian Pandemic Influenza Plan September 2004.
     Accessed online http://www.phac-aspc.gc.ca/cpip-pclcpi/index.html
5.   Department of Health and Human Services, USA. HHS Pandemic Influenza Plan.
     November 2005. Accessed online http://www.hhs.gov/pandemicflu/plan/
6.   Monto AS. The threat of an avian influenza pandemic. N Engl J Med 2005;352: 323-325
7.   UK Health Departments Influenza Pandemic Contingency Plan October 2005. Accessed
     online http://www.dh.gov.uk/assetRoot/04/12/17/44/04121744.pdf
8.   RIVM report. Scenario analysis of the expected number of hospitalizations and deaths
     due to pandemic influenza in the Netherlands.2002. Accessed online
     http://www.rivm.nl/bibliotheek/rapporten/282701002.html
9.   World Health Organization Global Influenza Preparedness Plan. Accessed online
     http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_
     5/en/index.html
10. Australian Government Department of Health & Ageing. Australian Management Plan
    for      Pandemic        Influenza.      June       2005.       Accessed      online
    http://www.health.gov.au/internet/wcms/publishing.nsf/Content/phd-pandemic-plan.htm
11. World Health Organization. Responding to the avian influenza pandemic threat.
    Recommended              strategic         actions.        Accessed      online
    http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_
     8/en/index.html
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VI. Membership of CCID & ICB, CHP (as at Dec 05)
    Complied by HA CCID & ICB, CHP            Title: HA Contingency Plan for Influenza Pandemic
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    Revised: 1 July 2006                                                         Page 49 of 50




Membership of CCID, HA

Dr SH LIU, Deputy Director (PS), Chairman
Cluster Representatives
•  HKEC
Dr Rodney Allen LEE, Associate Consultant, PYNEH
Dr Loletta So, Associate Consultant (Med), PYNEH
•  HKWC
Dr WH SETO, Consultant, QMH
Ms Patricia CHING, Senior Nursing Officer, QMH
•   KCC
Dr Dominic TSANG, Consultant (Path), QEH ( Also Vice Chairman of CCID)
Dr Johnny WM CHAN, Senior Medical Officer (Med), QEH
•  KEC
Dr Kitty SC FUNG, Senior Medical Officer (Path), UCH
Dr WK LUK, Senior Medical Officer (Path), TKOH
•  KWC
Dr TK NG Consultant (Path) PMH
Dr WK TO, Senior Medical Officer (Path), YCH/PMH
•  NTEC
Dr Raymond LAI, Consultant (Micro) PWH
Dr KW Choi, Associate Consultant (Med), AHNH
•  NTWC
Dr TL QUE, Consultant (Micro), TMH
Dr ML Szeto, Consultant (Med & Geri), TMH


A&E - Dr CC LAU, Consultant (A&E), PYNEH
       Dr Beatrice Cheng. SEM (PS & O), HAHO
Family Med - Dr Daniel CHU, Consultant (Family Med), RHTSK
              Dr Aylwin Chan, SEM (PS & PC)
Medicine & Geriatrics - Dr SY AU, Consultant (Geri), TMH
                         Dr Daisy Dai, SEM (MSD), HAHO
Medicine & Infectious Diseases - Dr ST LAI, Consultant (Med), PMH


ICU - Dr. KL LEE, Senior Medical Officer (ICU), UCH
       Dr. M Y Cheng DD(PS& FM), HAHO
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 Revised: 1 July 2006                                                          Page 50 of 50




Paediatrics - Dr Barbara LAM, Consultant (Paed), QMH
              Dr CW Leung, Consultant (Paed), PMH456+0


Respiratory Medicine - Dr Thomas MOK, Chief of Service (RMD), KH
                       Dr PC WONG, Chief of Service (TBCU), GH


Nursing - Mr Alan WONG, General Manager (Nursing), QMH


HKU -Prof Malik Peris, Professor (Micro), HKU/QMH
CU - Prof Margaret IP, Associate Professor (Micro), CUHK/PWH


DH/CHP Representative
Dr Thomas TSANG, Consultant (CM), CHP, DH
Dr Wilina LIM, Head, PHLSB, CHP, DH
Dr Raymond Yung, Head, ICB, CHP,DH ( Also vice-chairman of CCID)


Membership of ICB, CHP
Dr Raymond YUNG, Infection Control Branch Head & Cons i/c IDCTC, HAHO
Dr TY WONG, Associate Consultant, ICB
Dr Lawrence WONG, Senior Medical Officer, ICB
Dr KC LAI, Medical Officer, ICB


(December 2005)

				
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