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.