May 2006
United Nations in Barbados
CONTINGENCY PLAN
FOR AN INFLUENZA PANDEMIC
for
Barbados and Member Countries of he Organization of Eastern Caribbean States (OECS)
DRAFT
May 2006
1
UN Contingency Plan for an Influenza Pandemic - Barbados
May 2006
Table of Contents
/ Page /A. / Introduction ...... / 2
B. / Background information...... / 2
C. / Contingency Planning Arrangements / 3
D. / Pandemic Preparedness Plan...... / 4
Phase 3 ......
/ 5Phase 4 ......
/ 8Phase 5 ......
/ 10Phase 6 ......
/ 11Annex I
A. / Medical Interventions...... / 12
B. /
Non-Medical Interventions ......
/ 18C. /
Communication ......
/ 20Annex II
Template for the Contingency Plan for Pandemic – Procurement ......
/ 21Annex III
Personal Protective Equipment kit (PPE)......
/ 23Annex IV
Health Advisory on Self Protection for travel to/through or living in outbreak regions . .
/ 24Annex V
Protecting yourself and others against respiratory illness ......
/ 26Annex VI
Proposed priority groups for pandemic vaccine ......
/ 27Annex VII
Psychosocial aspects of the predicted influenza pandemic ......
/ 28Annex VIII
Guidelines for Managers: Communicating with staff about the UN Contingency Plan for an Influenza Pandemic ......
/ 30A. Introduction
The overall objective of this UN Contingency Plan for an Influenza Pandemic in Barbados is to protect the health and safety of all United Nations staff and their dependants[1] in the event of an Influenza pandemic, while at the same time and to the extent possible, maintain essential UN functions and services. The purpose of the Plan is to ensure advanced preparation for a timely, consistent and coordinated response to a possible Influenza pandemic across the UN System in Barbados.
To facilitate the initial stages of planning, an ad hoc Working Group was established represented by PAHO/WHO, UNICEF, FAO, UNIFEM and the UNDP under the leadership of PAHO/WHO.nb
This Contingency Plan sets out specific measures and actions required of the UN Resident Coordinator, UN Security Management Team (SMT), Medical Service, individual UN agencies, and staff members to support an effective response. While this Contingency Plan provides detailed guidelines for action at various stages of an Influenza pandemic, it is important to stress that any course of action at the time of an actual emergency will depend on specific circumstances and a wide range of factors that are impossible to predict. Flexibility in implementing this Plan is essential and the most appropriate course of action will be decided on by the Designated Official, in consultation with the Crisis Management Task Force ( to be formed) and as per WHO recommendations.
All persons, and their dependants, working for the UN in Barbados are covered by this plan, regardless of contractual status, but provided they are registered with the Safety and Security Section.
B. Background Information
Influenza is a viral respiratory disease affecting humans and certain animals. Normally, people are infected only by human influenza viruses and not animal influenza viruses. Clinical disease ranges from infection with no symptoms to mild non-specific illness to many different life threatening complications, including pneumonia.
On occasion, animal influenza viruses, or influenza viruses containing genes from animal influenza viruses can begin infecting people. When a completely new strain of influenza virus emerges among human populations, and has the ability to spread easily from person to person, the virus can spread world-wide within months (and perhaps weeks) leading to higher levels than usual of mortality and severe illness. In this situation, all age groups are vulnerable to infection, and there can be disruption of all sectors of the society. Such a situation is called an influenza “pandemic’’. Pandemics are different from usual influenza seasons and happen relatively infrequently.
There is currently rising concern that an avian or bird influenza virus, known as influenza A (H5N1) or simply as "H5N1," which is circulating widely among birds primarily in Asia but now parts of Europe, may gain the ability to spread easily from person to person and lead to the first influenza pandemic of the 21st Century. Many of the prerequisites for the start of an influenza pandemic appear to be in place but the virus still has not gained the ability to conduct efficient and sustained human-to-human transmission. The possibility that the H5N1 virus will gain this ability must be considered quite "real" but also is not certain.
If an influenza pandemic appears, the following additional considerations will be important to understand and incorporate into additional local planning efforts:
§ Given the high level of global travel, the pandemic virus may spread to much of the world within weeks to months, leaving little or no time to prepare.
§ In all three 20th Century pandemic, substantially more young people died from pandemic influenza than normal when compared with regular influenza seasons. In the 1918 pandemic, the highest death rates and the largest total numbers of deaths occurred in previously healthy young adults. These patterns suggest that the next pandemic could have a substantial impact on the workforce.
§ Vaccines and antiviral agents for pandemic influenza, and antibiotics to treat secondary infections will be in short supply initially, while distribution of available supplies is likely to be unequal. It will take several months or longer before any effective pandemic vaccine becomes widely available.
§ Many if not most medical facilities will be overwhelmed by patients. Moreover, the health care workforce is likely to be reduced because health care workers also will become ill and will also stay home to care for ill family members.
§ For weeks at a time, significant shortages of personnel may occur disrupting essential community services.
§ For UN staff, the window period for relocation or evacuation is likely to be narrow. Borders may close quickly to prevent the spread of the virus, and available airplane seats may be taken up quickly.
§ Once the virus has gained the ability to spread easily among people, then no country or region can be considered a low risk area for infection. In essence, there will be no "safe havens" from potential exposure to the virus.
More background information on influenza is available on WHO web site at:
http://www.who.int/csr/disease/influenza/
C. Contingency Planning Arrangements
The Crisis Management Task Force (CMTF) (to be shortly formed in a special UNCT meeting) will have the following responsibilities:
§ Agree on this UN Barbadian Contingency Plan for an influenza Pandemic to safeguard the safety of UN staff in Barbados,
§ Make recommendations to the DO on actions needed for the timely implementation the UN-wide contingency plan for Barbados,
§ On a continuous basis advise the DO on necessary actions and decisions for the preparations for, and during a possible influenza pandemic in Barbados,
§ Organize/coordinate briefings for all UN staff in Barbados as appropriate in order to ensure transparency and open lines of communication on the risks and safety precautions relating to the influenza pandemic,
§ Liaise with the Barbadian Authorities to ensure access to the latest information on the risk of an influenza pandemic outbreak and to make necessary arrangements for the protection of UN staff.
The Task Force will report to the DO on a regular basis and as needed. It will also communicate directly with the UN Agencies based in Bridgetown to provide regular updates about the implementation of this Contingency Plan. The Task Force will also communicate directly with UN staff, through a series of briefings to be led by PAHO/WHO, and through other means.
D. Pandemic Preparedness Plan
WHO's revised global influenza preparedness plan of 2004 and related national plans are based on the concept of pandemic phases, which facilitates preparedness planning. Psychosocial support to staff is an important issue and is developed in Annex. The psychosocial needs of UN staff should be addressed at all stages of the pandemic.
I. INTER-PANDEMIC PHASES:
· Phase 1: no novel influenza A virus subtypes have been detected in
humans. An influenza A virus subtype that has caused human infection
may be present in animals. If present in animals, the risk of human
infection or disease is considered to be low.
· Phase 2: no novel influenza A virus subtypes have been detected in
humans; however, a circulating animal influenza A virus subtype poses
a substantial risk of human disease
II. PANDEMIC ALERT:
· Phase 3: human infection(s) with a novel subtype, but no human to human spread, or at most rare instances of spread to a close contact.
We are currently in Phase 3 (December 2005).
· Phase 4: small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.
· Phase 5: larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).
Depending on the available information at the time, it may be difficult to make a rapid and meaningful distinction between phases 4 and 5.
III. PANDEMIC
· Phase 6: increased and sustained transmission in general population
The following table shows the implementation of the UN Medical Services contingency plan for an influenza pandemic.
· Actions are intended to continue through progressive phases unless they are superseded by actions in the higher phase. If an up-scaling designation skips a phase, actions in the skipped phase should also be implemented, unless they are superseded by actions in the higher phase.
· For each phase, actions have been grouped within 4 areas: Planning and Coordination/ Medical Interventions/ Non Medical Interventions/ Communication.
· UN Agencies will continuously monitor the development and availability of a specific pandemic influenza vaccine and will procure vaccine for staff and dependents as soon as possible.
Medical Actions recommended independent of Pandemic Phase- Recommend seasonal influenza vaccination for all staff and dependants.
- Pneumococcal vaccination is also recommended for all staff and dependents, particularly those who are at high risk (very young, very old and the immune-compromised[2] )
Phase 3:
Human infection(s) with a novel subtype, but no human to human spread, or at most rare instances of spread to a close contact.
Phase 3 ACTION / RESPONSIBILITY /Planning and Coordination
· Brief relevant officials of the UN organizations on present situation, possible outcomes and related resource requirements / UNDP, PAHO/WHO
· Convene regular meetings of UN Agencies participating in UN Working Group / UNDP
· Identify members and functions for a Crisis Management Task Force (CMTF-Formed at Phase 4 ) at the country level / UNDP, PAHO/WHO, UNICEF, FAO, UNIFEM, ..
· Assess preparedness status and identify gaps and develop plans to address these gaps / UN Working Group at country level
· Identify essential functions and the associated staff needed to maintain those functions. The defined essential functions will vary to some extent among Organizations due to differences in mission, but include the following:
- Physical security of staff
- Medical care of staff. Identify facilities and actions to take
- Maintenance of computers and telephone services
- Ability to communicate with other organizations and governments
- Ability to make important operational and policy decisions related to the pandemic
- Ability to make important operational and policy decisions related to critical operations and programs continuity / Security Management Team (Heads of Agencies) & Field Security Coordinating Assistant - FSCA.
PAHO/WHO
Heads of Agencies
UNDP Resident Representative
Medical Interventions
· Vaccines / Prioritize and identify the groups who will be receiving the vaccine, if a vaccine becomes available.
Encourage staff to access pneumococcal vaccine for themselves and dependents.
Encourage staff to access seasonal influenza vaccine for themselves and dependents. / SMT
· Antivirals / Stockpile Oseltamivir (Tamiflu) to treat 40% of staff and dependants.
In addition, stockpile enough Oseltamivir to provide prophylaxis for 6 weeks for all staff needed and identified to maintain essential functions. / PAHO/WHO/UN Headquarters
· Antipyretics / Paracetamol or Ibuprofen are usually readily available; staff members should be encouraged to stock enough for their needs. / Staff - Family Medical Kit
· Antibiotics / Stockpile antibiotics to treat secondary bacterial infections on an out-patient basis in 10% or more of UN staff and their dependents (Annex2). / PAHO/WHO/UN Physicians.
· Medical Supplies / Implement stock of:
- Family Medical Kit
- Staff Medical/First Aid Kit:
1. Surgical masks in numbers sufficient to provide essential staff with 2 masks per day for 6 weeks.
2. Antipyretics
3. Medical thermometer
4. Enough Personal Protective Equipment (PPE) for two changes per day for 6 weeks for medical and paramedical staff who will have direct contact with ill patients (Annex3).
- Order and distribute antiseptic liquid hand soap for office use
- Purchase antiseptic liquid hand soap / Each staff member to implement.
See Family Medical Kit (Annex 1).
PAHO/WHO/Heads of UN Agencies
For UN medical and paramedical staff. Responsibility of the Ministry of Health.
Non Medical Interventions
· Familiarize with national preparedness plan
· Familiarize with national public health plan / Heads of UN Agencies
Heads of UN Agencies
· Familiarize with UN Medical Services Contingency Plan for Influenza Pandemic / SMT, UN Physicians
· Identify hospitals in the country and region where critically ill staff may be sent and develop specific plans for facilitating their rapid hospitalization / PAHO/WHO at the country level
UN designated Physicians
· Prepare agreements with outpatient and hospital-based health care providers who will agree to care for ill UN staff / PAHO/WHO at country level
UN designated Physicians
Develop plans
· for creating local auxiliary outpatient care clinics for UN staff and their dependents that are designed to reduce the risk of nosocomial influenza infection (fever clinics)
· Distributing masks
· Distributing PPE
· Distributing antibiotics / PAHO/WHO at country level
Undesignated Physicians
Communication
· Communicate the UN preparedness plan to all UN Offices in the Country. / UNDP/UNICEF
· Provide health travel advisory (Annex4) / UN Medical Directors in consultation with WHO
UN Country Representatives
· Disseminate periodic advice on personal hygiene (Annex 5). / PAHO/WHO/UNICEF
· Provide information on case management to Health Care Worker (HCW) / PAHO/WHO/UNICEF
Phase 4: