Progress with Implementation of the Recommendations of Thereport by Dr Nigel

Attachment

Progress with Implementation of the Recommendations of theReport by Dr Nigel Perkins,Independent review of Hendra virus cases at Redlands and Proserpine in July and August 2008

No / Recommendation Detail / Government position / Implementation status
1 / It is recommended that efforts continue to be directed to effectively communicate exposure risk to all people who work with horses and to incorporate this information into various guidelines and other documents with a focus on early adoption of precautionary measures designed to minimise exposure risk at all times when interacting with horses. / Accepted / FINALISED (noting there will be ongoing review as part of Biosecurity Queensland’s core business).

The language of the Guidelines for Veterinarians (the Guidelines) and the Important Information for Horse Owners has been amended to facilitate communication and understanding. A focus on precautionary measures has been included in the Guidelines, including the application of the most recent research from the Australian Animal Health Laboratory (AAHL) on precautionary infection control measures. The updated Guidelines and Horse Owner Information have been published on the Queensland Primary Industries and Fisheries (QPIF) website.
A review of the QPIF horse web pages has been completedas part of the continuous improvement approach. The layout and information available is aimed to facilitate user access to horse biosecurity information. Updates to the website will continue as part of the continuous improvement approach.
A specific Horse Biosecurity Communications Plan has been developed, and includes the following elements:
A Direct[1]e-mail communication pathway for horse owners is under developmentusing contact databases developed during the Equine Influenza community engagement exercise.
Development of a web ‘portal’ for horse owners (in association with the Queensland Horse Council) was launched in May 2009.
Development of an emergency contact database (in association with Queensland Horse Council) known as HOSS (Horse Owners Signal System) was launched in May 2009 -
Development of ‘Horse Event Guidelines’ with biosecurity messages for horse-related event organisers is nearing completion for publishing on the QPIF website.
A Horse Industry emergency response plan (in association with Queensland Horse Council) has been developed and is available at
The Communication Plan covers the period January 2009 – August 2009 when it will be reviewed and evaluated prior to planning for 2009-2010.

2 / It is recommended that specifications be developed for post mortem preparation of suspect or positive Hendra cases for transport and disposal, for safe transportation of a prepared carcass from the site of death or euthanasia to the site of disposal and for disposal of the carcass. These specifications can then be used in discussions with waste removal services to agree on arrangements that can be rapidly implemented during a response. It is recognised that some commercial providers of waste removal services may request that a body be cut into small pieces to facilitate transport and disposal. This approach presents additional exposure risk to people and other animals and it is suggested that specifications for transport and disposal involve the whole body where possible. / Accepted / IN PROGRESS

Anoperationalprocedure is under development and will be added to the Guidelines for Veterinariansto provide guidance and options for the handling and safe transport of suspect or positive Hendra virus carcasses.
The use of horse ‘body bags’ as a disposal option has been promoted to the veterinary industry through the Horse Biosecurity and Market Access Liaison group (a Government and horse industry information sharing forum).This group has indicated its support for the use of body bags.

3 / It is recommended that appropriate DPI&F (now QPIF) operating procedures are completed or reviewed, identified in manuals and plans, and implemented right from the beginning of an emergency response, acknowledging that these will depend on the scale and activities of the response and the nature of the risks being encountered. / Accepted / FINALISED (noting there will be ongoing review as part of Biosecurity Queensland’s core business).

Biosecurity Queensland’sBiosecurity Emergency Operations Manualhas been updated and endorsed.
The Guidelines for Veterinarians have undergone a significant update and rewrite, including review of operational procedures (infection control, sampling, and necropsy techniques).
A specific community engagement plan is under development for future Hendra virus incidents.
The Respiratory management program has been updated and training undertaken for frontline Biosecurity Queensland responders.

4 / It is recommended that procedures be reviewed to ensure that quarantine notices served on properties for the purposes of Hendra virus provide sufficient detail to cover expected activities and movements, the conditions under which they may be permitted or not permitted to occur and the role of DPI&F (now QPIF) staff in performing, supervising, checking and approving activities related to the management of quarantine on the site. / Accepted in principle / YET TO BE PROGRESSED

A review of the quarantine procedure is planned, and it is intended that a biosecurity plan will be provided in addition to quarantine notices to assist property owners understand their quarantine and biosecurity obligations.
Biosecurity Queenslandwill also consider whether the quarantine notification procedures in the provisions of the new Biosecurity Bill can be framed to clarify procedures and obligations for quarantined properties.

5 / It is recommended that consideration be given to the implementation of a form of review or audit of DPI&F (now QPIF) procedures that may be performed by an individual independent of the response activities, with appropriate skills in response activities and procedures (such as EMU staff), and completed early in the operational phase of a response. / Accepted / FINALISED (noting there will be ongoing review as part of Biosecurity Queensland’s core business).

The Emergency Management Unit (EMU) of Biosecurity Queensland Control Centre (BQCC) is the responsible unit for development and review of response procedures and has a plan to review existing Standard Operating Procedures (SOP’s) in addition to development of new SOP’s. The EMU is Biosecurity Queensland’s preparedness unit, and is therefore independent of the operational aspectsof biosecurity responses. It performs an audit role during responses to ensure they are run according to response plans.
After Action Review (AAR) is an established and nationally recognised process for review and audit following a biosecurity incident. Biosecurity Queensland routinely undertakes these reviews after an incident to inform continuous learning, including review and refinement of operational policy and Standard Operating Procedures.

6 / It is recommended that the guidelines for veterinarians continue to be the subject of review as required by a working group that includes representation from relevant industry bodies and in particular the Australian Veterinary Association (AVA) including the relevant AVA special interest group, Equine Veterinarians Australia (EVA). / Accepted / FINALISED (noting there will be ongoing review of the guidelines as part of Biosecurity Queensland’s core business).

The Guidelines for Veterinarians have undergone a significant update and rewrite, including review of operational procedures (infection control, sampling and necropsy techniques). The Guidelines are available on the QPIF website. Both theAustralian Veterinary Association (AVA) and the Equine Veterinary Association (EVA)had input into the rewrite and they have advised that they are satisfied with the revised Guidelines.
A formal review procedure of the Guidelines will form part of Biosecurity Queensland’s continuous improvement procedure. This will involve input from the peak professional bodies, including the AVA and the EVA.

7 / It is recommended that changes suggested in this review document in relation to the guidelines for veterinarians be considered for implementation in the guidelines for veterinarians. / Accepted / FINALISED (noting there will be ongoing review of the guidelines as part of Biosecurity Queensland’s core business).

The Hendra Review made a number of recommendations regarding the information to be included in the Guidelines. All of these recommendations have been considered for incorporation in the review and update of the Guidelines. New and emerging information relevant to the Guidelines has also been included.
The formal review procedure noted in recommendation 6 will ensure that any new or emerging information will be included in future updates to the Guidelines.

8 / It is recommended that procedures relevant to liaison officers appointed by DPI&F (now QPIF) be reviewed and more information provided on the roles of liaison officers as conduits of information flow to and from relevant stakeholders. This should include review of induction and training, and information and other material they should have either available to them or access to during the response. Consideration should be given to the early appointment of liaison officers with communication roles that are independent of response activities. / Accepted in principle subject to feasibility in the time frame / IN PROGRESS

Liaison officers will be appointed for all significant biosecurity response. ‘Just-in-time’ training for liaison officers is under discussion at the national level. These discussions include input from the Animal Health Australia as the peak industry/government body with responsibility for facilitating industry liaison officer training.
The Horse Biosecurity and Market Access Liaison group (an initiative between government and the horse industry) provides an active forum for the development of the liaison officer role and the issue is under ongoing discussion through this forum.
Biosecurity Queensland will review its appointment, induction and training procedures for industry liaison officers as informed by these processes, and learning’s from After Action Reviews.

9 / It is recommended that management of the DPI&F (now QPIF) web site consider the implementation of display of document tracking information on the web, flags or alerts to inform viewers when information has changed and for longer documents such as the guidelines for veterinarians, summary information to indicate the nature of the changes. Consideration should also be given to adding further information to the web site including for example FAQs, links to information on bats, and descriptive summaries of past cases. Other recommendations relating to flow of information to stakeholders are also relevant to the web site. / Accepted in principle subject to technical feasibility of document tracking.
Accepted need for further information on website / IN PROGRESS

QPIF web pages for horses have been updated to highlight changes made to key documents, specifically the Guidelines to facilitate identification of significant changes made to content.
New and relevant information is added to the QPIF web site as it becomes available, an example being the Australian Animal Health Laboratory research paper “Initial experimental characterisation of HeV (Redland Bay 2008) infection in horses” (Middleton, D).
The review of the QPIF horse web information underway includes an assessment of appropriate links to relevant sites, including bat carer sites
The web pages have been designed to provide a broad approach to horse biosecurity, rather than focussing on specific disease issues. All relevant information of diseases is available, including Hendra virus, in addition to information on biosecurity associated with movement of horses and conduct of horse events.

10 / It is recommended that DPI&F (QPIF) work with the Australian Veterinary Association (AVA) to review and agree on procedures for timely reporting during a response of clinical signs, progression of disease and results of additional procedures such as post mortem examinations. / Accepted / FINALISED (noting that procedures will be subject to ongoing review as part of Biosecurity Queensland’s core business)

Procedures have been established with the AVA Queensland to enable timely reporting to AVA members, including disease notification and circulation of updates and relevant reports. This system was recently used to advise members of the updates to the Guidelines, and the availability of new Hendra research information on the QPIF website.
The procedures are subject to ongoing review with a view to continuous improvement in partnership with AVA.

11 / It is recommended that DPI&F (now QPIF) and the Veterinary Surgeons Board of Queensland (VSB–QLD) work together to develop procedures to ensure that a current list of email addresses for those veterinarians that have consented to have their email addresses used for emergency animal disease information, is provided to the DPI&F either as early as possible after confirmation of an emergency disease case to facilitate communication or on an annual basis after renewals have concluded. / Accepted / IN PROGRESS

Procedures have been established with theVeterinary Surgeons Board(VSB) to allow rapid contact with registered veterinarians in Queensland, including disease notification and circulation of updates and relevant reports. This utilises the electronic notification system available to members. This system has been utilised recently to advise veterinarians of the updated Guidelines and newly available Hendra research publications.
The VSB is giving further consideration to how they can disseminate information to those veterinarians that have not signed up for electronic notifications. The Board has advised it will further consider the notification procedures at its June 2009 meeting with appropriate recommendations to follow.
This notification procedure is subject to ongoing review with the intention of continuously improving the system in partnership with the VSB.

12 / It is recommended that DPI&F (now QPIF) and appropriate peak bodies consider options for improving the coverage rate to veterinarians and allowing sign-up for emergency animal disease information at any time. The VSB–QLD option only allows veterinarians to sign-on for communications on an annual basis. There may be an alternative option that allows veterinarians to sign-on at any time or to provide updates of changes in contact information. This could be achieved by adding functionality to a web site to allow individuals to sign-up for information. / Accepted / IN PROGRESS

Consultation between Biosecurity Queensland and VSB continues to explore alternate notification systems, including anelectronic alert system, subject to privacy considerations. This is in addition to the notification procedures already established in response to Recommendations 10 and 11.
One option being considered by the VSB is establishing sign up procedures requiring the provision of mandatory contact details for Queensland veterinarians. The VSB needs to consider privacy issues with respect to this.

13 / It is recommended that the AVA as the peak body representing member veterinarians, continue to work with DPI&F (now QPIF) to ensure effective communication with veterinarians and to explore options for further development and improvement of communication. / Accepted / FINALISED (noting there will be ongoing review of the guidelines as part of Biosecurity Queensland’s core business).

As outlined in response to Recommendation 10, Biosecurity Queensland has established procedures with the AVA for notification and communication with their members. This is subject to ongoing review with the intention of continuously improving communication arrangements in partnership with the peak professional body for veterinarians.
QPIF and AVA will continue to work in partnership to explore all options to improve communication channels with respect to biosecurity matters.

14 / It is recommended that consideration be given to the benefits and costs of offering Hendra diagnostic testing at a laboratory in north Queensland such as the Oonoomba laboratory at Townsville, acknowledging that primary focus on risk management should be directed at the early implementation of precautionary biosecurity measures appropriate for the assessed level of risk for all interactions with horses. / Accept subject to feasibility study. / IN PROGRESS

The feasibility of transferring Hendra Virus Polymerase Chain Reaction (HeV-PCR) diagnostic capability to Biosecurity Queensland laboratory facilities in Townsville has been assessed. It has been determined that the transfer is not able to be progressed at this stage until Physical Containment Level 3 (PC3) technology is available in Townsville (Oonoonba) – anticipated in 2011 (with the relocation of the Biosecurity Queensland Tropical and Aquatic Animal Health laboratory to James Cook University campus)
The HeV-PCR exclusion diagnostic capability has however been successfully transferred to the Biosecurity Sciences Laboratory (Yeerongpilly) from Queensland Health (CoopersPlains) providing Biosecurity Queensland with direct access to the diagnostic capability. This PCR capacity in the Biosecurity Sciences Laboratory was recently put to the test when a sample from a sick horse was submitted. The sample was received, tested and a negative diagnosis confirmed on the same day.
An ongoing review of Hendra sample submissions (or diagnoses) from north Queensland is underway to determine the most appropriate submission pathway for timely sample receipt. It may be quicker to send samples from Cairns to Brisbane now that the diagnostic capacity resides within Biosecurity Queensland.

15 / It is recommended that initiatives be progressed through the joint involvement of DPI&F (now QPIF) and a range of industry bodies such as the AVA and Animal Health Australia (AHA), and accredited providers of safety training for the development of training and preparedness programs for veterinarians and that similar initiatives be progressed with appropriate industry bodies for all people who interact with horses. It is considered important that training is tailored to the needs of the relevant user, available to all relevant people, and that training may incorporate information relevant to biosecurity measures for other diseases in addition to Hendra virus. / Accepted in principle, Government will not be responsible for the training of private veterinarians and others. / IN PROGRESS

Infection Control in Veterinary Practice Workshops have commenced in partnership with AVA (Qld) and Workplace Health and Safety Queensland (Department of Justice and Attorney-General).
The workshops include presentations on general Infection Control Principles for practising veterinarians, Zoonoses and Workplace Health and Safety Requirements, and Personal Protective Equipment (PPE) from relevant experts and service providers. The purpose of these workshops is to improve awareness of veterinarians and encourage them to obtain the appropriate PPE training through accredited organisations.
Workshops have been held as follows:
15 February 2009 (Malanda)
19 April 2009 (Toowoomba)
14 June 2009 (Rockhampton)
26 July 2009 (Brisbane)
Future workshops are planned for:
Townsville, Friday 28 August 2009.
A presentation on ‘Risk management approach to on-farm biosecurity – developing a biosecurity plan with farmers’ and ‘Decontamination when visiting farms with and without suspected infectious disease’ was made to the AVA national conference (May 2009) by a Biosecurity Queensland response specialist.
Information regarding infection control and Personal Protective Equipment has also been provided to horse industry groups (i.e. through their representation on the Horse Biosecurity Market Access Working Group), for dissemination to members.
Biosecurity Queensland is not an accredited training provider, and cannot therefore provide formal training to veterinarians or horse owners in the use of PPE for example. Biosecurity Queensland, through the workshops and industry information, has actively encouraged stakeholders to obtain such training through accredited providers.