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					   Don’t forget! Update disease situations
        before you begin the lecture
• Maps of avian influenza outbreaks in poultry and
  humans
  2003-present: check WHO website: www.who.int ->--
  Health topics >avian influenza-->map OR go directly
  to:
  http://gamapserver.who.int/mapLibrary/app/searchRes
  ults.aspx
• No. of patients and deaths check BOE website:
  http://epid.moph.go.th or BEID website:
  http://beid.ddc.moph.go.th ->-- Disease situations OR
  go directly to:
  http://beid.ddc.moph.go.th/th/index.php?option=com_c
  ontent&task=view&id=36&Itemid=47
       Emerging Infectious Diseases and
Influenza Pandemic Preparedness and Response




     Bureau of Emerging Infectious Diseases,
         Department of Disease Control
             http://beid.ddc.moph.go.th
                     Topics
1. General knowledge – Avian influenza, Influenza
   2009, Emerging infectious diseases (EIDs)
2. Risk – Avian influenza could mutate /re-assort to be
   pandemic influenza and other EIDs could also
   occur.
3. VDO – Hypothetical scenario of influenza pandemic
4. Business continuity plan – For influenza
   pandemic preparedness and response
                     Topic
1. General knowledge – Avian influenza, Pandemic
   (H1N1) 2009, Emerging infectious diseases (EIDs)
    Seasonal Flu                   Avian Flu
(H1N1,H2N2, H3N2)
                                    (H5N1)




                    Pandemic Flu
Hemagglutinin       Influenza virus




                           Neuraminidase

    Hemagglutinin (H) – 16 types
    Neuraminidase (N) – 9 types
              2550
                          2549

                                         2548
                                                2547




Avian flu in poultry and natural birds
     2003-2010 in 63 countries
         2010 in 12 countries
         ( As of 19 May 2010)
   Avian flu patients
498 cases, 294 deaths
    in 15 countries
  (As of 6 May 2010)
 Avian Flu Outbreak and Distribution
             2004 - 2007
Jan-May        Jun-Oct   Jul-Nov   Jun-Aug      Jan-Nov
  2004          2004      2005       2006         2007




                                      อุทัยธานี
                                      พิจิตร
                                      หนองบัวลาภู
    Total        Nakhon Phanom
Vietnam-like       Fujian-like         Patient
  (clade 1)         (clade 2)
                                       Suspected case
                                       Area with H5N1 in animal
  Outbreak in                            Outbreak in
 native chicken,                        native chicken,
   Sukhothai                            Pichit Province
    Province                               (January)
  (November)




                       As of
                    12 May 2010
                   No avian flu in
 Outbreak in           human
native chicken,
 Uthai Thani
   Province
 (November)
                                      Outbreak in
                                     meat chicken,
                                     Nakhon Sawan
                                       Province
                                       (January)
General recommendation on avian influenza
        1. Consume well-cooked chicken and eggs
        2. Avoid exposure to sick or dead poultry
           (particularly for children)
        3. Never use carcasses of poultry that were sick
           and dead to feed other animals
        4. Wear face mask and gloves when exposing to
           poultry during outbreak in the area
        5. Wash hands with water and soap every time
           after exposing to poultry and their secretions
        6. See the doctor immediately and report your
           exposure history and symptoms if you have
           fever and cough (particularly for people
           whose occupations dealing with raising,
           killing, transporting and selling poultry or
           involving poultry carcasses)
               Notification and Recommendation on
                        sick or dead poultry

• Dead natural bird or wildlife, notify Department of National
  Parks, Wildlife and Plant Conservation, Ministry of Natural
  Resources and Environment, hotline Tel. 1362
• Sick or dead poultry: chicken, duck, and other pets
       In provinces, notify livestock volunteer, official at district
       and provincial livestock office, village health volunteer,
       health center official/ leader of village group/village
       headmen/municipality/local government administration
       office
       In Bangkok, notify district office in which dead animal was
       found, or hotline Tel. 1555
       Avian Influenza Control Center, Department of Livestock
       Development, Tel 0 2653 4551-4 (24-hour service)
• Inquire or follow up on avian influenza situation
       Information Center, Department of Disease Control,
       Ministry of Public Health Tel 0 2590 3333 or MOPH
       website at www.moph.go.th
Pandemic (H1N1) 2009




           Department of Disease Control,
                 Ministry of Public Health
Distribution of the new strain of influenza
               (H1N1) 2009
               Report from WHO

                As of 21 May 2010


 Patients confirmed with the new strain of
 Pandemic (H1N1) 2009 in 214 countries

Total confirmed fatal cases = 18,097 deaths


   Disease situations reports are available in MOPH website:
       www.moph.go.th or WHO website: www.who.int
Recommendation on Prevention of Pandemic (H1N1) 2009
How to avoid getting influenza
1. Avoid areas with crowded people. Don’t stay in close proximity with
   influenza patients
2. Wash hands frequently with soap or use alcohol gel. Don’t use the same
   drinking glass, straw, spoon, hand towel and handkerchief with others.
3. Maintain good health by consuming nutritious food, drinking a lot of water,
   getting enough sleep and rest, and exercising regularly.
     When suspecting to get influenza
     1. Take leave from school or work. Get enough sleep and rest. Drink a lot
        of water.
     2. Avoid being in close proximity or sharing the personal belongings with
        others. Wear face mask while being with others. Cover mouth and nose
        with tissue paper when coughing and sneezing
     3. Patients with severe symptoms must go to hospital immediately to get
        treatment and antiviral drug as soon as possible
Emerging Infectious Diseases (EIDs)
EIDs refer to communicable diseases that markedly
increase in humans recently OR tend to increase risk in
near future

1.Thailand has already experienced the
  outbreaks of avian influenza and influenza
  2009 as previously mentioned
2. Other EIDs outbreaks include chikungunya,
  hand, foot and mouth disease,
  meningococcemia or meningococcal
  meningitis, melioidosis, legionellosis,
  botulism, anthrax, etc.
3. These EIDs can be found in general public or
  obtained from foreign workers inside and
  outside the country
                    Topics
1. General knowledge – Avian influenza, Influenza
   2009, Emerging infectious diseases (EIDs)
2. Risk – Avian influenza could mutate to be pandemic
   influenza and other EIDs could also occur.
3. VDO – Hypothetical scenario of influenza pandemic
4. Business continuity plan – For influenza
   pandemic preparedness and response
       Possibility of viral
                                            Pandemic
    reassortment in humans

       Migratory birds,
         Water birds




                       Domestic chickens,
                          other poultry

Source: WHO / WPRO
       Possibility of viral reassortment in
                     animals
Migratory birds,
  Water birds      Domestic chickens,
                      other poultry




                                         Source: WPRO
         Virus can mutate itself gradually

Migratory birds,   Domestic chickens,
  Water birds        other poultry




                                        Source: WPRO
                    Influenza Pandemics, 20th Century



                            Previous pandemics
                            resulted from the
                           mutations of avian flu

 1918 : Spanish Flu                                                1968 : Hong Kong Flu
         A(H1N1)
                                               1957 : Asian Flu
20-40 million people died                                         1-4 million people died
                                        1-4 million people died
Credit: US National Museum of Health and Medicine                                Source: WHO
               Influenza Outbreaks in Thailand




   1918-1919                  1957                     1968-1975
      A(H1N1)                    A(H2N2)                  A(H3N2)

Thai pop = 8.5 million people    No report system     Thonburi Province
- 2.3 million patients (27.3%)                        ~ 150,000 patients
- 80,000 deaths
(influenza mortality rate = 3.5%)

 Source: WHO    Since 2009, outbreaks of new strain of influenza (H1N1) 2009
                                                      Medical personnel
 Economic collapses       Many people are           overloaded – unable
    occur locally and      sick and die.
                                                               to service
  globally—unable to                                         thoroughly.
  be recovered soon.                                Public health system
                                                       unable to provide
                                                           good support.

Supply, food and
medicine are scarce.        Impacts of
Business and trade                               Clinicians, nurses
are decreased or             pandemic            and medical psick
disrupted.
                             influenza           and die
                                                 ersonnel may be



 Police and soldiers                            Public services
 are sick / die.                                (electricity, tap water,
 Insecurity and                                 gasoline, transport,
 chaos increase.        Political chaos looms   telecommunication, IT)
                        Society is insecure     are disrupted.        7 July 06
              Impacts of EIDs
Risk of mutation: some EIDs, such as the new
influenza strain can cause a more severe pandemic in
humans
Natural history of disease: magnitude of EIDs
problem and occurrence period are normally
unpredictable
Knowledge and information are not clear at the
beginning and easily cause panic in general public
and stakeholders
Public health threats: EIDs can cause tremendous
loss of human health and life, and national economy
                          Cabinet endorsed 10 July 2007

      Cabinet




 Executive Committee
  on Avian Influenza
Prevention and Control
                           The Second National Strategic
 (Chair: Deputy Prime    Plan for Prevention and Control of
   Minister Jaturon)     Avian influenza and Preparedness
                         for Influenza Pandemic 2008-2010
                                                      Antiviral drug
Strategies for                                        Vaccine
influenza pandemic                                    Patient care
preparedness and                                      PPE
response
                                                   Personal hygiene promotion
                                                   Travel restriction
                     Medical/Pharma.               Contact isolation
                                                   Social activity restriction
                                                   Health education
                                                   Public relations
               Pub. Health/ Society
             (Non-med/non-pharma)


           Social and economic                     Security maintenance / laws
                                                   Food and drinking water service
                  systems                          Energy and fuel service
           - to keep the society                   Transport service
                                                   Telecommunication service
                  running                          Financial system / Bank
                                                   management service



                                  Source: David Nabarro at APEC-HMM, Sydney 8 June 2007
Pandemic Preparedness and Response




  Tabletop
                               Drills
  exercise    International
                 Central
                Provincial
             Service centers
         International collaboration
             All-sector collabortion
             Community collaboration
                      YO-YO !
                       อัตตาหิ
                       พึ่งตนเอง
                          อัare
                    You ตโน on
                    ช่วยครอบครัว
                     your own
                     เพื่อนร่วมงาน
                        นาโถ


Key to
Successful
Preparedness
  เชิญชมวีดีทัศน์จาลองสถานการณ์
      ไข้หวัดใหญ่ระบาดใหญ่
       (ความยาว 12 นาที)


ขอขอบคุณ National Geographic Channel
              เอื้อเฟื้อสารคดีชุดนี้
ทั้งนี้ได้รับอนุญาตจาก National Geographic Channel
ให้เผยแพร่เพื่อประโยชน์ทางวิชาการ มิใช่เพื่อการค้า
                          Topic
1. ความรู้ทั่วไป - ไข้หวัดนก,ไข้หวัดใหญ่ 2009,โรคติดต่ออุบัติใหม่
            ่
2. ความเสียง –ไข้หวัดนกจะกลายพันธุ์เป็นโรคไข้หวัดใหญ่ระบาด
                                 ั
   ใหญ่ และ การเกิดโรคติดต่ออุบติใหม่อื่นๆ
3. วีดีทัศน์ - จาลองสถานการณ์การระบาดใหญ่ของไข้หวัดใหญ่
4. Business continuity plan – For influenza
   pandemic preparedness and response
Business Continuity Plan (BCP)
for Influenza Pandemic Preparedness
1.   Preparedness concepts and principles
2.   Previous BCP activities
3.   Steps in BCP development
4.   BCP examples: Government sector (DDC,
     hospitals and provinces), state enterprise
     agencies, and private sector
1.   Preparedness concepts and principles
2.   การดาเนินงาน BCP ที่ผ่านมา
3.   ขั้นตอนในการจัดทาแผน BCP
4.   ตัวอย่าง : จากจังหวัด โรงพยาบาล และ
     เอกชน
              What is BCP ?

Business Continuity Plan (BCP) is a written plan
that consists of steps and clear operational
processes to support or restore operations back to
                              May be
                           that normal
normal. This will ensure Operational operations
                          in the occurrence of any
can operate continuouslyContinuity Plan
events, such as accidents, natural disasters, fire,
flood, sabotage, or outbreaks of serious infectious
diseases, etc. which disrupt the normal operations.
Why we need a BCP ?

• To manage or minimize the virulence of
  events/disaster
• To reduce impacts on finance, laws, reputations,
  etc.
• Executive administrators can participate in setting
  policy, standard to get operation back to normal
  rapidly
• Agencies can continue to function by using
  existing resources
• Agencies can adapt guideline to suit their roles
  and responsibilities
BCP                 Not only business
Concepts            sector, but also all
                    agencies in government,
                    state enterprise and
                    private sectors !
 • Pre-pandemic : prepare, aware
     Every company has experts who can train, coordinate
      and manage
     Develop a BCP to suit company (plan and procedure)
     Prepare according to the BCP (train/advise; prepare supply,
      work system and information)
     Exercise the BCP periodically
 • During pandemic : not panic, follow the BCP
     Non-essential staff don’t need to show up at office, but work
      from home, submit work via telecommunication; sick personnel
      take leave from work; seek substitute staff to cover the work
     Assist affected staff and families appropriately
     Maintain customer communication and service according to
      situation
 • Post-pandemic : recover rapidly, back to good condition

                                                                29 May 08
Business continuity planning
               BCP: Not only in
                private sector
                                 •Safety of staff
             but also all sectors and owners
                                 •Continuation of
                     Getting      business during
                                  pandemic
                    prepared
                                 •Cooperation with
 Businesses, industries,
markets, department stores,        public sector in
 hotels, travel & tourism,         pandemic response
   communications & IT,          • Rapid recovery
  transportations, power           after pandemic
 plants, gas stations, water
supply, banks, hospitals, etc.
                                                  27 Mar 08
     BCP development for influenza pandemic
          preparedness and response
BCP should cover 6 domains   :
1. Response to pandemic impact on organization /
   business
2. Response to pandemic impact on personnel and
   customers
3. Identification of criteria for implementations during
   the pandemic
4. Resource allocation to protect employees and
   customers during the pandemic
5. Communication and education for personnel
6. Coordination with external organizations and
   assistance for communities
Domain 1 Response to pandemic impact on business (1)

• Identify main coordinator and team responsible
  for pandemic situations
• Identify essential personnel and factors for
  conducting the business
• Train and prepare substituting personnel
• Develop and prepare response plans for
  scenario situations (all pandemic phases) that
  affect demand increase and decrease, and
  basic service disruption
• Estimate impact of pandemic on financial
  status of business by using scenario situations
Domain 1 Response to pandemic impact on business (2)




• Estimate impact of pandemic on domestic and
  international traveling
• Monitor influenza pandemic information from public
  health organizations
• Develop emergency communications plan with key
  contact persons and adjust it constantly
• Test readiness of BCP (tabletop or drill exercises)
Domain 2 Response to pandemic impact on personnel and
                     customers

• Anticipate and allow personnel to take leave from work during
  pandemic
• Establish guideline for personal practice to reduce human-to-
  human transmission
• Personnel at risk should have influenza vaccination annually
• Determine how easy personnel could access health services
  during the pandemic
• Determine how well personnel could easily access public
  health and other social services during the pandemic.
• Prepared list of personnel and important clients that need
  particular services
   Domain 3 Identification of criteria for implementations
   during the pandemic

• Develop guideline on compensation for employees with
  influenza who take sick leave and for recovered employees to
  return to work
• Develop guideline on using workplace and work hours or
  alternative work hours
• Develop guideline for preventing the spread of
  influenza virus in workplace
• Develop guideline for operation in case of having employees
  suspected with influenza
• Develop criteria to prohibit domestic and international travel to
  areas with outbreaks
• Appoint persons with authority to command, send disaster
  alarm for response according to BCP, such as temporary
  operation termination
Domain 4 Resource allocation to protect employees and
          customers during the pandemic



• Arrange work place for good health and
  monitor air circulation system
• Provide every unit with sufficient personal
  protection equipment
• Provide communication equipment /
  channels between personnel and clients
• Establish a health consultation unit
   Domain 5 Communication and education for personnel

• Provide personnel with handouts of basic
  knowledge about influenza
• Reduce panic and anxiety of personnel or
  manage about incorrect rumor
• Use simple language that is easy to understand and in
  the context of culture in providing knowledge to personnel
• Provide personnel with information on organization's
  influenza pandemic preparedness and response plan
• Provide employees with knowledge on how to take care
  of themselves and families if any of them get sick at home
• Develop/search websites or hotline centers to communicate
  pandemic situation and coordinating point to seek
  assistance in case of emergency announcement
• Identify information sources in communities that can
  provide information on influenza pandemic
Domain 6 Coordination with external organizations and
            assistance for communities




       • Coordination with social security offices and public
         health facilities in communities
       • Exchange emergency response plan with related
         public health organizations
       • Exchange emergency response plans with related
         business organizations
       • Inform that your organization can support resource
         for communities
Preparedness of
 agencies in all
    sectors



              Maintain business
                          Govern
               to serve society


              Be safe and survive
                   Minimize loss


             Basic service sector
1.   แนวคิด และ หลักการเตรียมความพร้อม
2.   Previous BCP activities
3.   ขั้นตอนในการจัดทาแผน BCP
4.   ตัวอย่าง : จากจังหวัด โรงพยาบาล และ
     เอกชน
          Previous BCP activities
1. Establish a team during 2006- 2007
                 Appointed a working group,
                 consisting of:
                 - Bamrasdaradura Institute (hospital)
                 - Department of Disease Control
                 - Other related organizations
                      Experts from:
                      - Ministry of Public Health
                      - Electricity Generating Authority of
                      Thailand
                      - Thai Bankers’ Association
                      - Board of Trade of Thailand
                      - Federation of Thai Industries
                      - Esso Company
                      - Thai Airlines
                      - Technip Engineering Company
Size of Organization / Business

 Size      Value of       No. Employees
         Fixed Assets         (person)
         (Million Baht)
 Small
             < 50            10 - 50
Medium
           51 - 200         51 - 200
 Large
            > 200            > 200
Preparedness Plan for Business Sector
  2. Developed BCP Guideline for Business Sector




1. Trained 38 facilitators/coordinators
- Staff responsible for personnel development / risk management /
business security maintenance
2. Organized 1st workshop for business sector, 245 participants
- Staff responsible for personnel development/ risk management /
business security maintenance
3. Organized 2nd workshop for business sector, 59 participants
- Staff responsible for personnel development/ risk management /
business security maintenance -- focusing on medium - or small - size
business
        General Recommendation for
     Personnel on Influenza Pandemic (1)

1.   Follow up on disease situation and follow the official
     recommendation
2.   Maintain healthy body by exercising regularly, getting
     enough rest, and stay in well-ventilated area
3.   Consume sufficient amount of nutritious food and use
     serving spoon at meal time
4.   Try not to get influenza virus by avoiding place with
     crowded places, poor-ventilation, or being in close
     proximity with patient
5.   Wash hands frequently, wear face mask when having
     influenza-like illness
6.   Cover mouth with cloth or tissue paper every time
     when coughing or sneezing
               General Recommendation for
                      Personnel on
                 Influenza Pandemic (2)
7.  Seek proper treatment from clinician, take leave from work and stay
    home or stay in hospital when having influenza-like illness, such as high
    fever, muscle pain, cough, sore throat, conjunctivitis
8. Influenza vaccination and antiviral use must be under clinician’s
    supervision only.
9. Avoid traveling to area with outbreak of avian influenza and influenza.
    Use phone or internet instead. Strictly protect yourself if you must make
    that such trip.
10. Reserve basic life support elements, such as food, drinking water,
    common medicine, soaps, flash lights with batteries, toilet tissue paper,
    and others as well as thermometer for body temperature assessment to
    last for at least 2 weeks.
Encourage face
  mask use
    Steps of wearing a face mask

1                                  2




                        3
             2
1




3

    Steps of taking off
    a face mask
    and washing hands
    with water and soap
ภาพแสดงการวิจัยเรื่องการล้างมือ
How do I wash my hands properly?




                                   Source : WHO
  Training personnel on developing a BCP
                             DDC has organized a training
                             workshop and provided
                             support for various agencies
                             to develop their BCPs in
                             accordance with the BCP
                             developing guideline
                               “Self-Learning Guide for
                               Business Continuity Plan
                               (BCP) for Influenza Pandemic
                               Preparedness Plan 2009”

Later, many agencies have developed
their own BCPs as shown in BEID web site at
http://beid.ddc.moph.go.th
1.   แนวคิด และ หลักการเตรียมความพร้อม
2.   การดาเนินงาน BCP ที่ผ่านมา
3.   Steps in BCP development
4.   ตัวอย่าง : จากจังหวัด โรงพยาบาล และ
     เอกชน
7 Steps in BCP development
      Step 1
    Understand
 Your organisation’s              Step 7
      business
                              Test and review
                                 your plan

        Step 2
   Identify the risks
                                  Step 6
                             Communicate your
      Step 3                      plan
   Minimise the
 impact of the risks
                                  Step 5
                            Prepare and implement
                                an action plan
        Step 4
Identify response actions
       if risks occur
                                                     Step 1
                                                Understand
                                             Your organisation’s
                                                  business



                                                                                              
Important                Necessity of activities/services        Could activities be             Support required for
activities/services      during influenza pandemic               conducted outside the           conducting the
of the                                                           organization?                   important
organization             Essential      Non-essential                                            activities/services
List the priorities of   Identify activities/services that are   Identify activities/services,                     for
                                                                                                 List support required
important                essential or non-essential to be        such as home delivery           conducting the important
activities/services of   conducted during influenza pandemic     service of products,            activities, such as information
the organization                                                 original copy delivery via      systems, news, funding, facilities, skilled
                                                                                                 personnel, etc.
                                                                 the Internet, etc. that are
                                                                 conducted outside the
                                                                 organization.
   Step 2 Identify the risks

                                                                                 List the priorities
Identify potential risk          Potential impacts on the     Possibility for the   of risk
                                 organization                 occurrence of
                                                              potential risk
List the risk that could cause   Describe the potential       High, Moderate, Low   List the top 5
the operation interruption in    impacts of pandemic risk,                          highest risk
the occurrence of influenza      such as many employees
pandemic, such as many           are on sick leave,
people are ill, aircrafts stop   transportation of products
their flights.                   is interrupted, etc.




                                                                               Step 2
                                                                          Identify the risks
     Step 3                        Step 3 Minimise the impact of the risks
  Minimise the
impact of the risks               Pre-pandemic During pandemic Post-pandemic


                                                                                       
Specify the     Activities/Problem solving        Time             Documents/              Responsible persons
risk                                                               supporting
                                                                   resource
List the        Specify activities/problem        Specify time     Specify essential       Including persons with
importance      solving that can be prepared      period for       documents, resources    commanding authorities
priorities of   before an outbreak occurs, such   activities       for problem solving,    at lower levels, other
risk            as disease prevention             implementation   such as training plan   related contact persons
(mentioned in   training/knowledge                /problem
Table 2)        dissemination for personnel,      solving
                attainment of additional
                resource in advance
              Step 5
        Prepare and implement                Steps in team operation
            an action plan


                                               Manager:
Team:
                                               Backup manager:
Steps in         Activities
operation
                 Before pandemic –             Responsible persons         Document/resource
                 preparation phase
                 During pandemic –             Responsible   Time spent    Document/resource
                 pandemic phase                persons       (hour/day)
                 After pandemic – recovery     Responsible   Time spent    Document/resource
                 phase                         persons       (day/month)
           Step 4                      Step 4 – Identify response actions if
Identify response actions              risks occur
       if risks occur




                                                                                             
List the risk         Activities/Problem           Time                      Documents/          Responsible
                      solving                                                supporting          persons
                                                                             resource
List the importance   Specify activities/problem   Specify detailed          Specify essential   Including persons
priorities of risk    solving that cannot be       timeline for the          documents,          with commanding
(mentioned in         managed or prepared in       completion of             resources for       authorities at lower
Table 2)              advance, but need to be      activities/problem        problem solving     levels, other related
                      managed to minimize risk     solving, such as day 1,                       contact persons
                      impact during an outbreak    day 3, week 2, month
                                                   1 of an outbreak, etc.




        Standard Operating Procedure (SOP) could be added here
      Step 6
   Communicate
     your plan


                                                                                                                
          Objectives                Target groups         Key messages                    tools                   Remark
Specify objectives for releasing   Specify persons      Specify information    Specify publicizing tools,    Specify time,
the BCP, such as personnel         that need to be      to publicize in each   such as manual for            responsible
needs essential information        informed, such as    pandemic phase to      administrators, brochure,     persons,
during and after outbreak,         clients, managers,   ensure the             posters, meeting plan, etc.   publicizing tools,
managers can inform personnel      volunteers,          achievements                                         as well as evaluate
to adapt operation guideline       providers of                                                              achievements
under emergency situation          substances/raw
                                   materials,
                                   stakeholders
      Step 7                                 Step 7 Test & review your plan
Test & review your
       plan
                                             7.1- Check list
       No.                                 Questions                                Yes   No

       1     Is there any document specifying the responsible operation and
             essential services of organization?

       2     Is there any document specifying impact of disease outbreak on
             organization and its services?

       3     Is there any list of personnel and their roles and responsibilities?


       4     Is there any document specifying the skills required for operations
             and essential services to be continued?

       5     Is there any document publicize the roles and responsibilities of
             volunteers on their operations?

       6     Is there any document specifying time period for organize a
             meeting of key personnel who are not volunteers?

       7     Is there any special information, technology, and/or
             materials/devices to be used in the operation?

       8     Is there any list of logistic organizations which transport
             substances/raw materials and list of essential companies under
             contract for the operation to be continued without any interruption?
       9     Besides the list in #8, is there any alternative?
Exercise the
plan                   Develop     Preparedness
                    Preparedness
                        Plan       Cycle


       Adjust
      the plan                       Prepare
     periodically                   as planned




                      Exercise
                        the
                    preparedness
           Type of Exercises
1. Orientation

2. Table-top exercise : TTX

3. Drill

4. Functional Exercise

5. Full - scale exercise
Tabletop Exercise
                                       Drill Exercise


                                      Photo Courtesy Kevin Cooper NSW DPI




Photo Courtesy Kevin Cooper NSW DPI
                            Functional Exercise




NSW LDCC, Exercise Minotaur, September 2002
                       Type of Exercises
Level of capacity required for preparation

        Practice-oriented exercise
                                                        Full –scale exercise
        Discussion-oriented exercise


                                               Functional exercise




                                       Drill




                       Table-top exercise




         Orientation

                                 Amount of preparation for planning and training
To monitor if the BCP covers all
 related agencies and has a
 practice guideline, better
 conduct an orientation or
 tabletop exercise


To monitor if the practice
 guideline is accurate, up to date
 and practical, better conduct a
 drill
1. แนวคิด และ หลักการเตรียมความพร้อม
2. การดาเนินงาน BCP ที่ผ่านมา
3. ขั้นตอนในการจัดทาแผน BCP
4. BCP examples from : government sector
   (Department of Disease Control, hospitals and
   provinces), state enterprise agencies and private
   sector
1. Bank of Thailand has endorsed a BCP
   guideline for outbreak of severe
   communicable disease, effective on 4
   August 2008 onward, for various banks to
   follow by emphasizing work system
   management for outbreak response and
   post-outbreak recovery.
2. Thai Bankers’ Association has provide
   support and driven the preparedness of
   banking sector.
3. Thai Military Bank (TMB) has set a good
   example in initiating a BCP development
   and served as facilitator/coordinator for
   other banks too.
1. Organized training workshop for
   central and provincial agencies
   under DDC
2. Provided support and advice on
   BCP development to various
   organizations
3. Agency under DDC has
   developed BCP by specifying
   essential activities and
   operational steps as shown in
   BEID website
Has developed a BCP by:
1. Managing essential work system in case
   of pandemic by using experiences from
   SARS, avian influenza, influenza and
   other communicable diseases
2. Managing the rotation and substitution
   of personnel
3. Reviewing information system,
   managing disease prevention
   knowledge, public relations and
   coordination by clearly specifying
   activities and operation guideline
1. In 2009, agencies in all sectors developed their
   own provincial BCPs
2. Adapted DDC’s 7 steps of BCP
3. Divided groups for BCP development
   according to their missions (provincial health
   office / hospitals / livestock development office
   / state enterprise agencies / district health
   offices / academic institutes / private sector /
   border check points
4. Specified essential activities and operational
   processes to continue these activities
5. Plan to revise and improve BCP
  BCP example from State Enterprise :
Electricity Generating Authority of Thailand
                    1. Has constantly developed a BCP since 2004
                       in parallel with Preparedness Plan and
                       collaborated with Ministry of Public Health
                       in developing BCP guideline for business
                       sector.
                    2. Emphasizes domains of raw materials and
                       transport, internal and external
                       communications, and health education for
                       personnel and work promotion.
                    3. Regularly exercises and revises the BCP.
                    4. Transfers BCP guideline and manual to
                       provincial offices to adapt as needed.
 During 2008-2009, BEP developed
 preparedness plan and conducted ICS
 exercise for influenza pandemic response in
 accordance with the national plan, with
 support and participation from senior
 administrators.
In 2009, BEP also initiated BCP
 development plan.
 In 2010, BEP developed a complete BCP
 by adapting 7 steps of BCP development
 as this process is easy to understand.
Ministry of Labour (MOL) has collaborated with
International Labour Organization (ILO)
1. Since avian influenza outbreak occurred, Ministry of Labour has
   collaborated with ILO in developing preparedness plan for business
   facilities, SMEs (small and medium-size enterprises) in 18 provinces /
   500 companies / 2,500 employees by training employees, managing
   work system and environment to prevent viral transmission as well
   as monitored and evaluated the program according to manual and
   survey form.

2. Organized knowledge exchange forum between government sector /
   labour union and employees / employers organizations / farmers /
   United Nations / international organizations / experts on occupational
   health and safety in workplace / operational staff from 4 countries
   (Cambodia, Laos, Malaysia and Vietnam).

3. Revised guide for BCP development of business facilities by adapting
   7 steps of BCP development
Collaboration among APEC Members -- 21 Countries (1)
                                         APEC SMEWG Meeting
                  Pandemic Influenza Train the Trainers Workshop
                                 Hong Kong, China - 8 June 2010
1. Trained member countries on how to develop a BCP for influenza
   pandemic response in SMEs, by emphasizing measures in business
   facilities, such as educating personnel on how to protect themselves at
   home and at work, arranging work system in an event of influenza
   pandemic
2. Recommendation: To adapt 7 steps of BCP development as shown in
   Thailand BCP Guideline
3. Presentation : Collaboration between ILO and Thailand Ministry of
   Labour during 2006 – 2015 –To develop preparedness of SMEs
Collaboration among APEC Members -- 21 Countries (2)
                                           APEC SMEWG Meeting
                   Pandemic Influenza Train the Trainers Workshop
                                  Hong Kong, China - 8 June 2010
 4. Presentations : “Guidance for Businesses and Employers To Plan and
    Respond to the 2009 – 2010” and “Influenza Season” by US CDC
 5. Presentations : example documents from
     1. World Health Organization (Reduction of Infection in Schools)
     2. CIDRAP (Center for Infectious Disease Research & Policy)
     3. Checklist of Business Pandemic Influenza Planning : Homeland Security,
         Department of Health & Human Services
     4. Hypothetical Scenarios of Preparedness Activities by Business Agencies
         “Lee Electronics” and “Bank Tech Team”
 6. Participants from Thailand: Representatives from 3 Ministries : Industry,
    Labour, and Public Health
                                              Hot Hit Q & A
1.   Would an influenza pandemic really occur ?
2.   How do business facilities and workplaces prevent viral transmission ?
3.   How does the Ministry of Public Health assist other organizations ?
4.   Does Thailand have sufficient stockpile of antiviral drug – Oseltamivir ?
     How is such stockpile managed ?
5.   Does business sector need to have its own stockpile of antiviral drug ?
     How large should it be ?
6.   Does business sector need to have its own stockpile of other drugs,
     medical supply and equipment ? How large should it be ?
7.   Is there any vaccine to prevent avian influenza infection in humans ?
8.   Does business sector need to provide influenza vaccine to every employee ?
9.   Where could business sector get influenza vaccine for it own use?
            1. Would an influenza pandemic
                       really occur ?


 It is possible that pandemic may occur after influenza 2009
  outbreak.
 There might be the reassortment of influenza 2009 virus and
  avian influenza and produces a new influenza strain that
  may cause more severe outbreak than influenza 2009 has.
 No one can confirms when a pandemic will occur.
 No one can estimate magnitude of problem and virulence.

Therefore, we must prepare for it in advance !
2. How do business facilities and workplaces
        prevent viral transmission ?



   Recommend employees on personal hygiene. Take
    leave from work when getting sick and stay home.
   Disinfect equipment and substances used by many
    people.
   Provide enough sinks, water and soap for hand wash
   Open windows to get good ventilation and let the
    sunlight in thoroughly and often if not every day.
   Develop a BCP for work system management so that
    the business can be constantly operated (see BEID
    website).
3. How does the Ministry of Public Health
      assist other organizations ?



         Disseminates knowledge and provides support to all sectors
          on preparedness plan development
         In event of pandemic, MOPH has the following roles:
        • Coordinate with Flu Manager of business sector
        • Enhance knowledge and awareness about pandemic influenza; provide
          information on outbreak situation and government measures
        • Provide consultation on screening of employees/clients and on health
          care for patients
        • Coordinate on information about surveillance and monitoring patients
          and contacts
        • Control outbreak in business facilities
        • Provide assistance in event of outbreak in business facilities
4. Does Thailand have sufficient stockpile of antiviral
        drug – Oseltamivir ? How is such stockpile
                      managed ?

             • Currently, Thailand has to import raw
               materials for manufacturing Oseltamivir and
               packaged drug into individual portions to use
               in the country.
             • If pandemic occurs, Thailand would increase
               its production capacity appropriately.
             • Meanwhile, Thailand is in the research
               phase to produce the raw materials.
             • Public hospitals will be supported by DDC
               and the GPO.
             • Support for private hospitals will be
               considered based on necessity and
               suitability.
5. Does business sector need to
    have its own stockpile of
        antiviral drug ?
      How large should it be ?



           MOPH has a policy to encourage private sector to
            participate in antiviral stockpile (Oseltamivir).
           This specially controlled substance must be used in
            health facilities with beds for patients to stay over night
            and require medical prescription.
           Business facilities could reserve or donate drugs via
            private hospitals approved by MOPH. Drug import needs
            to be approved by Food and Drug Administration.
6. Does business sector need to have its own
     stockpiles of other drugs, medical supply
       equipment ? How large should it be ?




      • Antipyratic drugs, common cold drugs,
        antiviral drugs, sterilizing alcohol, alcohol-
        based hand gel, saline powder, normal
        saline solution, antibiotics, disinfectants,
        gloves, face masks, thermometers, etc.

      • Size of stockpiles should be based on risk of
        disease and number of employees
7. Is there any vaccine to prevent avian influenza
                 infection in humans ?



      • Presently, food and drug
        administrations in some countries,
        such as USA, European countries,
        have already approved the use of
        avian influenza (H5N1) vaccine in
        humans, but the vaccine has not yet
        been used widely.
      • Some other countries are still in the
        phase of research and development
        of such vaccine.
8. Does business sector need to provide influenza
             vaccine to every employee ?




                           Depend on each agency’s
                           policy by considering risk
                           to each employee and
                           other factors, such as
                           budget
 9. Where could business sector get
influenza vaccine for its own use?



     • Seasonal influenza vaccine
       Could be obtained from public or
       private hospitals that have the
       vaccine available for services, OR
       purchased from vaccine companies
       via hospitals in contract with
       business sector

     • Pandemic influenza vaccine
       Already available on the market
    Conclusions

   Avian influenza, Pandemic (H1N1) 2009, and zoonotic diseases
    have potential to cause more severe influenza pandemic in
    humans.
   Preparedness and response plans are in place globally.
   Thailand encourages collaboration on preparedness development
    under national strategy plan.
   State enterprise/private sectors have good preparedness
    coordination and collaboration w/ government & public sectors
   Previous preparedness emphasized knowledge dissemination,
    awareness & BCP development according to guideline, for
    employee safety maintenance & business continuity.
   Develop preparedness plans of all sectors network and clear
    coordinating mechanism of private sector network so they can
    assist each other.
Thank you
Backup slides
Transmission of Influenza Virus (1)
Influenza A(H1N1) virus in a
    patient’s nose and throat
    excretion is passed to other
    persons directly through
    coughing and sneezing.


Another person within 1 metre in
  distance can also be exposed
  to the virus by breathing in
  contaminated air.
  Transmission of Influenza Virus (2)
       A person can be infected by touching
contaminated hands, surfaces and utensils such
as glasses, telephone and door knob etc. The
virus infects a person while they touch their nose,
eyes and mouth.
   Transmission of Influenza Virus (3)
      A patient can even transmit the virus 1 day
before symptom appears. The most contagious
period is the first 3 days of illness. The longest
contagious period normally does not exceed 7
days.
           Signs and Symptoms (1)
In a very rare case that incubation
   period approaches 7 days. After
   getting infected, a person will have
   fever greater than 37.5 Celsius.
   Symptoms of this new influenza
   A(H1N1) is quite similar to
   seasonal influenza starting with
   fever, headache, body aches,
   chills, fatigue, cough, sore throat,
   and in some cases, nausea,
   vomiting and diarrhea.
          Signs and Symptoms (2)

Most patients have only mild
 symptoms and do not require
 any hospitalization. A patient
 will gradually recover within 5
 – 7 days. However some ill
 individuals might have severe
 complications such as
 pneumonia which can be
 observed through rapid and
 trouble breathing.
                 Treatment (1)
       Patients with severe illness should seek medical
care at a nearby hospital immediately. Antiviral drug
such as oseltamivir prescribed within 48 hours after
onset on illness under care of a physician usually gives
good treatment result.
                    Treatment (2)
        Patients with mild sickness i.e. low grade fever and
appetite should seek care at a private clinic or consult a
pharmacist for proper medicine and advice. Home care of
a sick person are as follows :
• Take prescribed medicine for
   relief of symptoms such as
   paracetamol etc. Wipe the
   patients’ skin gently and
   intermittently using towel soaked
   with clean water to help relief
   fever.
• Drink plenty of clean water and
  fruit juice. Avoid drinking cold
  water.
                 Treatment (3)

•   Eat soft nutritious food including eggs,
    vegetables and fruits. In case of low appetite,
    supplement vitamins will be helpful.

•   As the disease is caused by a virus, there is
    no need to take any antibiotics. Only in case
    of bacterial complications, antibiotics will be
    prescribed and a patient must take all of the
    medicine to prevent drug resistance problem.
       Prevention from Infection (1)
• Avoid close contact with influenza
  ill persons.
• if you have to care for an ill
  person, you should wear a mask.
  Wash your hands with soap and
  water thoroughly after each
  contact with the ill person.
• Avoid sharing the same glasses,
  straw, spoon, handkerchief etc.
  with other persons especially
  influenza ill persons.
           Prevention from Infection (2)
• Use serving spoon when eating with
  other persons.
• Wash hands with soap and water
  thoroughly and often especially after
  coughing and sneezing. Alcohol-
  based gel hand cleaners are also
  effective disinfectants.
• take actions to stay healthy
  including nutritious food, proper and
  regular exercises, adequate safe
  water and sleep and avoidance of
  cigarettes and alcoholic drink.
   Prevention of Virus Spreading (1)

• Ill persons should stay
  at home or seek
  medical care for 3 - 7
  days. This will prevent
  spreading of influenza.


• Avoid close contact
  with others.
 Prevention of Virus Spreading (2)
    Wear mask when happen to be with others or cover
nose and mouth with tissues after coughing and sneezing.
Throw used tissues in a trash can. Clean hands with soap
and water right after.

				
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