United Nations

E G Y P T

Contingency Plan

For a Human Influenza Pandemic

Update: December 2005

coordinated/prepared by:

Name

Designation (UNCT Avian and Human Influenza Focal Point etc.)

Email:

Table of Contents

  1. Introduction……………………………………………………………3

B. Background Information …………………………………………….3

C. Medical Interventions…………………………………………...... 4

1. Vaccines………………………………………………….……4

1.1. Vaccine against Seasonal Influenza………………... 4

1.2. Vaccine against Pandemic Influenza……………….. 4

1.3. Pneumococcal Vaccine……………………………..... 4

2. Antiviral…………………………………………….…...... 5

2.1. Treatment……………………………………………….5

2.2. Stockpiling Tamiflu……………………………………..5

3. Antipyretics, Antibiotics and Medical Supplies…………….. 6

4. Personal Protective Equipment (PPE) and Masks……… 6

5. Medical Care and Medical Evacuation………………..….....7

D. Non-Medical Interventions…………………………………………7

1. Workplace…………………….…………………………...... 7

2. Meetings………………………………………………………..8

3. International Travel……………………………………………8

4. Precautionary Measures and Restricted Movement……....8

5. Relocation of Staff…………………………………….……….8

  1. Communication…………………………………………………….. 9

1. General Communication……………………………….….... 9

2. Emergency Communication……………………………...... 9

F. Implementing the Contingency Plan………………………….. 11

1. The Activation of the Contingency Plan………………..... 11

List of Annexes

Annex 1: The Number of the UNCT Staff and Dependents

Annex 2: Health Care Facilities in Cairo

Annex 3: List of the Essential Staff

Annex 4(a): UN Emergency Contacts

Annex 4(b):Security Wardens in Egypt

Annex 5: Table of Implementation

Annex 6(a):Procurement Needs

Annex 6(b):Non-procurement items

Annex 7:AI Procurement Costs per Agency

A. Introduction

This Contingency Plan uses as a model the WHO Health and Medical Services Contingency Plan for an Influenza Pandemic, dated Dec2005, and has been developed in accordance with its recommendations, which have been adapted to meet the specific needs of the UN Country Team in Egypt.

The United Nations Country Team in Egypt consists of UNDP, UNIDO, FAO, FAO-RNEA, UNHCR, WHO, WHO-WR, ICAO,UNESCO, WFP, WFP-REG, UNFPA, ILO, IOM-REG, UNTSO, UNOPS, ITU, UNODC, WB, UNICEF, UPU, IFC, IMR, UNEP and UNIC. As of Dec2005. The total number of national and international staff, and their dependents is3385(see annex 1) broken down as follows:

  • 335International staff
  • 720 national staff
  • 2330 dependants of both national and international staff.

The purpose of this contingency plan is to ensure advanced preparation for a timely, consistent and coordinated response across the UN Country Team in the event of an Avian Influenza pandemic which could affect Egypt. The overall objective is to minimize the impact of a pandemic on UN staff and their dependents.

The plan sets out specific measures and actions required of the UN Designated Official, UN Security Management Team (SMT), individual agencies and staff members to support an effective response.

The plan was endorsed by the Security Management Team at its meeting on …/…/…….

B. Background Information

It is impossible to predict where and when, or if at all, an outbreak of the Avian Influenza may occur. However, the rising concern over the H5N1 virus requires prevention and preparedness.

If an influenza pandemic occurs, we could expect the following:

  • Given the geographical location of Egypt in a moderate-risk region, the pandemic virus will most probably appear in other countries before it reaches Egypt but then could spread rapidly, leaving little or no time to prepare.
  • Vaccines, antiviral agents and antibiotics to treat secondary infections will be in short supply and will be unequally distributed. It will likely take several months or longer before any effective pandemic vaccine would become widely available.
  • Medical facilities in Egypt will come under very severe strain and have difficulty to respond to the needs of the UN staff and dependents.
  • The window for staff relocation or evacuation, if warranted, will likely be narrow. Borders may close quickly to prevent the spread of the virus.

C. Medical Interventions

1. Vaccines

1.1. Vaccine against Seasonal Influenza

There is a vaccine available to protect against seasonal human influenza. This vaccine will not protect against a pandemic strain but it will protect against seasonal influenza which, at a time of pandemic, could be mistaken as being caused by the pandemic virus. Such a situation would create unnecessary concern and misuse of limited antiviral medications.

The UN Country Team has procured seasonal influenza vaccines and will offer vaccination to all UN staff. Some agencies have already covered dependents. The same locations arrangements will be valid for future needs. All authorized recognized dependants and staff should be encouraged to be immunized urgently.

1.2 Vaccine against Pandemic Influenza

There is no vaccine available for human H5N1 for the anticipated pandemic and vaccines will not be ready for possibly six months after virus isolation.

WHO will closely monitor the development of any new pandemic vaccine and will make recommendations as soon as the product is available. The UN Country Team will follow these recommendations.

It is expected that any new pandemic vaccine will initially be in short supply as the demand will far outstrip availability. Recognizing the reality of not being able to vaccinate everyone and following the WHO Health and Medical Services Contingency Plan recommendations, each agency will be requested to develop a priority list of pandemic vaccine recipients. Priority recipients will include those involved with direct clinical contact with patients, those staff required to maintain essential functions and those at particularly high risk of serious complications, such as the elderly and those with chronic diseases.

1.3. Pneumococcal Vaccines

Pneumococcal vaccine will be considered for people at particular risk of bacterial pneumonia complication of influenza, including those 65 years of age or older, those over the age of two with chronic diseases such as congestive heart failure, emphysema, diabetes mellitus, alcoholism, or chronic liver disease, and those who are otherwise immune compromised.

The UN Country Team will procure pneumococcal vaccines with a single dose syringe for 10% of staff and dependents. Each agency will draw up a list of pneumococcal vaccine recipients.

1.4.Education materials for families will be developed for home care by families. Draft will be available by 15 January 2006.

1.5.Information sharing with all UN agencies will be regularly distributed by WHO.

2. Antivirals

In recent years, new anti-viral agents to prevent or treat influenza infections have been developed. An antiviral drug called oseltamivir, or Tamiflu, is widely used to treat the flu. Tamiflu is used for treating patients one year of age and older whose flu symptoms started within the last day or two. Tamiflu can also be used to reduce the chance of getting the flu if there is a flu outbreak in the community.

The efficiency of antiviral drugs in an Avian Influenza pandemic cannot be known with any certainty until the pandemic is under way.

During a widespread pandemic, it will not be feasible to give post-exposure treatment to non-ill contacts. Non-medical interventions and isolation will be the principal means of control. In persons with febrile or respiratory illnesses, Tamiflu is used for treatment rather than prophylaxis.

2.1. Treatment

In symptomatic patients suspected of having pandemic influenza, Tamiflu should be administered in a dose of two 75 mg. capsules a day (total of 150 mg. per day) for 5 days.

For maximum effect, the drug should be started within 48 hours of onset of symptoms. During a pandemic situation, anyone with a fever or respiratory illness should be presumed to have influenza and treated immediately, if possible.

2.2. Stockpiling Tami flu

If a pandemic is declared it is very likely that stocks of medicine useful against influenza, particularly Tami flu, will be rapidly exhausted.

Taking into account a number of elements such as the epidemiology of previous pandemics, the likely attack rate, and WHO recommendations, the UN Country Team will procure a basic stockpile allowing for a 5-day course of Tamiflu treatment for 40 % of all their staff and their dependants.

Individual purchase of Tamiflu for preventive use is a personal choice of each staff member. The quality and origin should be scrutinized.

Because antivirals will become valuable commodities during a pandemic, they should be stored in a secure place. Stocks of medications will be under the responsibility of the WHO office in Cairo.

Each agency will procure Tamiflu separately through UNICEF, as agreed by the Working Group on Avian Influenza (New York, 30 August 2005). It should be noted that Tamiflu new orders will not be delivered before September 2006, based on Roche’s priorities. Agencies deciding to self purchase should inform the SMT by end of December.

3. Antipyretics, antibiotics and medical supplies

Antipyretic (such as paracetamol/panadol, but not aspirin) will be indicated as in most febrile diseases to relieve pain and control fever. Antipyretics are widely available and the staff is advised to stockpile their own.

Monitoring one’s own body temperature is essential during an influenza pandemic. UN staff is advised to purchase individual thermometers.

As influenza is often complicated by secondary bacterial infection of the lungs, antibiotics could be life saving in the case of late-onset pneumonia. Therefore the UN Country Team will procure through WHO/UNICEF (select one) three types of antibiotics: Augmentin, Levofloxacin and Azithromycin.

Since syringes and needles may be in short supply and are necessary for administration of any vaccine, UNCT will procure and stockpile two sets of syringes and needles for 40% of all staff and dependents

4. Personal protective equipment (PPE) and masks

Personal protective equipment (PPE) is primarily for health care workers who are trained how to use it, and will be stockpiled for this category of staff.

Suspected cases should wear a simple surgical mask in order to limit the spread of the virus through cough, speech, and fomites. Persons who have confirmed exposure to patients with fever or clinical respiratory disease should also wear a mask as they may be infectious a few days before symptoms develop.

In the event of a pandemic, it is anticipated that many staff will request masks as they may provide some sense of security although no guaranteed protection. As a result, masks may be in short supply.

For this purpose, the UN Country Team will stockpile 2 masks per person for 6 days, i.e. a total of40,620 surgical masks. N95 masks would be provided to those required to go to work (essential staff). In that case the quantity ofN95 masks will be10,380 (2 per essential staff (519) for 10 days.

5. Medical care and medical evacuation

Health care facilities in Egypt in case of an influenza pandemic will be evaluated. However, recognizing that such facilities will be strained, a practical guideline for homecare will be developed by WHO.

Medical evacuation of severe cases that cannot be dealt with locally will be assessed on a case-by-case basis according to the realities at the time.

It is further recognized that in case of an Avian Influenza pandemic people posted in the provinces may need to stay where they are and receive their medical care in site, in accordance with the existing UN security plan guidelines applicable to their particular province (see Annex2).

Adequate amounts of relevant medication and medical supplies will be stockpiled in each province where a presence of UN staff exists. These stocks will be under the responsibility of a designated staff member.

D. Non-Medical Interventions

All UN staff and their dependants will be required to comply with the public health measures taken by the national authorities, particularly those relevant to social gatherings (e.g. schools, cinemas, public transportation, etc).

The general recommendations regarding "respiratory etiquette" (put your hand before your mouth when you cough) and hand washing should be emphasized. Educational material and information materials will be given to all staff members both in English and Arabic.

1. Workplace

The individual agencies have identified their essential and non-essential staff members for the purposes of possible relocation. This identification will guide plans for use of drugs, vaccines (when available in a limited amounts) and need for staff to ensure that certain work is completed (administrative responsibility). Should work attendance be suspended (corresponding roughly to Phase Three (or Four) of the UN Security Plan, all technical staff from FAO and WHO involved in outbreak control should be considered as essential staff.

Voluntary quarantine must apply to staff or dependents having suspect symptoms or having been in contact with cases. If a staff member has a relative or someone else at home suspected to be affected by pandemic influenza, he/she should refrain from going to work and inform his/her respective agency of the situation. In addition, upon confirmation of suspect symptoms he/she should as soon as possible start a course of Tami flu and wear a mask when meeting with other people.

2. Meetings

If a pandemic is declared, all face-to-face meetings will be reconsidered in line with WHO public health measures recommended at the time. Teleconferences, teleworking and the Internet will be used as an alternative to face-to-face meetings.

3. International Travel

WHO recommendations on international travel will be followed. Influenza is readily transmissible by droplets and air and virus excretion may already occur during the incubation period. It has a relatively short incubation period (1-3 days). Therefore it is unlikely that restrictions of travel, and other social distancing efforts, can stop spread of influenza, however, these steps may help slow down the spread of an influenza pandemic. Early in the pandemic, slowing down the spread of influenza pandemic could buy precious time for vaccine development and access to other essential supplies. UN Offices are required to strictly follow WHO recommendations at the time of the outbreak.

4. Precautionary Measures and Restricted Movement

The phases for security (0 to 5) are ill fit to cover the pandemic situation. Therefore security phases will have to be interpreted with flexibility, e.g. For evacuation or relocation of non-essential staff and dependants, this may be voluntary.

At an early stage, in case of localized outbreaks of influenza with pandemic potential, the Designated Official will convene a meeting of the Security Management Team (SMT) with the objective of reviewing the situation and declaring security phase similar to security phase I or II as appropriate. Advance planning for the relocation of non-essential recruited staff members and their dependents should be considered and this should be conveyed to the Secretary General as a preparation for the declaration of security phase III or IV.

Symptomatic (e.g. feverish) persons should not travel unless under special circumstances (see medical evacuation).

In case of localized outbreaks of influenza with limited human to human transmission (phase IV of epidemic): families & national staff and international staff that would have remained in Egypt, should remain at home and keep themselves updated on the current situation using different public sources (such as the media) and the UN information system, except for those essential staff required to go to work. They should follow the guidelines laid down by WHO and be aware that isolation is likely to be the best course of action during this stage. Preparation for teleworking should be made by staff and organizations.

5. Relocation of Staff

In case of increasing pandemic risk in a region, it is likely that neighboring countries will be affected quickly and disruption of travel and health services is to be expected.

As soon as WHO Pandemic Phase 4 is declared (see section F below), with cases confirmed in the country or in a neighbouring country, the Designated Official will recommend to the Secretary-General that quasi/adopted Phase Three of the UN Security Plan be declared (with possible voluntary repatriation/relocation). As indicated under Phase Three of the UN Security Plan, those non-essential international staff and dependents, who are not ill and have no exposure to a known case will be advised to relocate directly to their country of origin where health services are less congested, providing this is the case, using existing repatriation/home leave entitlements.

Ultimately, relocation will probably not protect against exposure to a pandemic strain (it might either delay it or increase chances of infectious contact through travel) but it could ensure access to better quality of care in case of infection depending on the quality & availability of care in their home country of relocation.

Staff and/or dependants about to be relocated will be screened by UN-designated physician before their departure to decrease the risk of spread of the disease through their movement.

All national staff should receive an advance payment of their salary to a maximum of three months. In addition the costs of relocation transport should be paid to those members of the national staff who would wish to relocate themselves and their recognized dependents to a more isolated part of the country. It should be noted, that the medical facilities available in the rural areas may not be as well developed as those in the capital. It is important to avoid large transport vehicles such as buses and pick-up trucks. Hiring of private transport may be the best course of action. National staff who would plan to relocate at this stage should inform their agency administrative office wellin advance so that adequate relocation funds can be made available.

The remains of deceased international staff and their dependents as a result of the pandemic influenza may not be allowed to be repatriated and will be subject to WHO guidelines for disposal. As the repatriation of bodies may be an unlikely option under the pandemic realities, the bodies may have to be buried/cremated Egypt following WHO advise.

In preparation for the prospect of staff casualties, the UN Country Team will stockpile 30 mortuary bags.

As from WHO Pandemic Phase 5 and until the pandemic alert has been officially declared over, all UN staff remaining in the country should check their body temperature at least once daily and notify the WHO or UN physician on duty of any respiratory symptoms, such as cough or any fever (temperature above or equal to 38°C) by phone. They should be thoroughly examined by a medical doctor. The UN should make arrangement for appropriate medical care of that person.

E. Communication

1. General communication

The threat of a pandemic will create a high demand for information both within the UN and from external partners. It will be vital to coordinate the information that is circulated by headquarters, regional and country offices. A country communication plan will be prepared to rapidly provide proper information to all UN staff. This should identify who is responsible for coordinating UN information and communications. Clear internal and external communication will be essential to rapidly deal with rumors and anxieties.