NHS Grampian Influenza Pandemic Plan

Title: /

NHS Grampian Influenza Pandemic Plan

Identifier: /

NHSG/XXX/PLAN/XXX

Across NHS
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/ Clinical Service / Specialty
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This controlled document shall not be copied in part or whole without the express permission of the author or the author’s representative.
Review date: / December 2006
Author: / Dr. Helen Howie CPHM & Pandemic Influenza Co-ordinator
Policy application: / NHS Grampian
Purpose: / This document describes the NHS Grampian response to a pandemic of influenza and will assist NHS Grampian and other partner agencies to respond effectively and in an integrated manner. The prime objectives are to save lives, reduce the health impact and minimise disruption to essential services whilst maintaining business continuity and reducing disruption to society.
Responsibilities for implementation:
Organisational: / Chief Executive
Sector: / General Managers & Clinical Leads
Clinical Service: / Management Team
Policy statement: / It is the responsibility of all staff at all levels to ensure that they are working to the most up to date and relevant policies and procedures. By doing so, the quality of the services offered will be maintained, and the likelihood of staff making erroneous decisions that may adversely affect the care, safety or comfort of patients, staff or visitors will be reduced.
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NHS Grampian Pandemic Influenza Plan

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Table of Contents

Glossary

Schedule of amendments
Section 1 - Introduction
Section 2 - Aim and Objectives
Section 3 - Planning Assumptions and Impact Assessment
Section 4 - Phases of the Pandemic
Section 5 - The Inter-Pandemic Period – Influenza Prevention and Surveillance in Grampian
Section 6 - Scottish Response to an Influenza Pandemic
Section 7 - The Local Response to an Influenza Pandemic
Section 8 - Prevention and Infection Control
Section 9 - Public and Media Information
Section 10 - End of the Outbreak
Appendices
Appendix 1 - Contact Information for SCG and PIMT
Appendix 2 - Responsibilities & Tasks of SCG Members
Appendix 3 - NHS Grampian PIMT – Individual Roles
Appendix 4 - NHS Grampian PIMT – Draft Agenda

Appendix 5 - CHP Operational Team – Individual Roles

Appendix 6 - Acute Sector Operational Team – Individual Roles
Appendix 7 - Priority Groups for vaccination
Appendix 8 - Numbers for Vaccination
Appendix 9 - Operational plan for immunisation of essential workers

Appendix 10 - Operational plan for distribution of anti-virals

Appendix 11 - Prioritised list of services – Acute

Appendix 12 - Prioritised list of services – City CHP

Appendix 13 - Prioritised list of services – Shire CHP

Appendix 14 - Prioritised list of services - Moray CHSCP

Appendix 15 - Succession planning arrangements Acute

Appendix 16 - Succession planning arrangements – City CHP
Appendix 17 - Succession planning arrangements – Shire CHP
Appendix 18 - Succession planning arrangements – Moray CHP
Appendix 19 - Actions related to WHO Pandemic Phases
Appendix 20 a/b/c - NHSG modelling data ( CAR 10%,25% 50%)
Appendix 21 - Estimated burden of illness
Appendix 22 – Staffing Impact
Appendix 23 - NHSG Pandemic Influenza Plan (Summary Annex A)

Glossary

AMH
ARI
ASOMT
CCU
CEO
CGC
CHP
CMO
CPHM
CDEH
DEFRA
DH
DPH
DMO
EHO
EISS
EPO
FOC
GIBU
GPICC
HAC
HCW
HEPO
HDU
HPA
HPNS
HPS
ICD
ICN
ITU
NICE
NHS
NHSG
NIBSC
HPT
OHS
PCO
PGD
PIMT
NHSQIS
RACH
RCH
RVL
SAS
SECC
SEERAD
SEHD
SPICG
SCG
UKNIPC
WHO / Aberdeen Maternity Hospital, Aberdeen Royal Infirmary
Aberdeen Royal Infirmary
Acute Sector Operational Management Team
Coronary Care Unit
Chief Executive Officer
Clinical Group Co-ordinator
Community Health Partnership
Chief Medical Officer
Consultant in Public Health Medicine
Communicable Disease and Environmental Health
Department for Environment, Food and Rural Affairs
Department of Health
Director of Public Health
Designated Medical Officer
Environmental Health Officer
European Influenza Surveillance System
Emergency Planning Officer
Force Operations Centre
Gastrointestinal Bleeding Unit
Grampian Pandemic Influenza Co-ordinating Committee
Health Advisory Cell
Health Care Worker
Health Emergency Planning Officer
High Dependency Unit
Health Protection Agency
Health Protection Nurse Specialist
Health Protection Scotland
Infection Control Doctor
Infection Control Nurse
Intensive Therapy Unit
National Institute for Clinical Effectiveness
National Health Service
NHS Grampian (Grampian NHS Board)
National Institute for Biological Standards and Control
Health Protection Team
Occupational Health Service
Primary Care Organisation
Patient Group Direction
Pandemic Incident Management Team
NHS Quality Improvement Scotland
Royal Aberdeen Children’s Hospital
Royal Cornhill Hospital
Regional Virus Laboratory, Gartnavel Hospital, Glasgow
Scottish Ambulance Service
Scottish Emergencies Co-ordinating Committee
Scottish Executive Environment and Rural Affairs Department
Scottish Executive Health Department
Scottish Pandemic Influenza Co-ordinating Group
Strategic Co-ordinating Group
UK National Influenza Pandemic Committee
World Health Organisation

Schedule of amendments

Version / Date / Author / Reason
Draft 1 / October 2005 / Dr H Howie / SEHD guidance
Draft 2 / November 2005 / Dr H Howie / Comments from Emergency Planning Steering Group
Draft 3 / November 2005 / Dr H Howie / Pandemic Influenza Co-ordinators meeting
Draft 4 / November 2005 / Dr H Howie / Mr R W Abel / Internally generated non conformances listing
Draft 5 / December 2005 / Dr H Howie / Mr R W Abel / Revised SEHD guidance
Draft 6 / January 2006 / Mr R W Abel / Downsizing and succession planning information (AS & Deeside)
Draft 7 / January 2006 / Mr R W Abel / PICC meeting and comments from Dir. Pharmacy and Medicine Management
Draft 8 / January 2006 / Mr R W Abel / Scaling Down & succession planning details

1. Introduction

1.1 Purpose

This document describes the NHS Grampian response to a pandemic of influenza and it will assist NHS Grampian and other partner agencies to respond effectively and in an integrated manner.

The prime objectives of integrated planning for a pandemic are to save lives, reduce the health impact and minimise disruption to essential services, whilst maintaining business continuity and reducing disruption to society.

This plan should be read in conjunction with associated supporting documents

• UK Health Department’s UK Influenza Pandemic Contingency Plan (Scottish Executive Health Department (SEHD) October 2005)

• NHS Pandemic Flu - Infection Control Guidelines for use in hospitals and primary care settings.

• Scottish Operational Framework for stockpiling, distributing and using antiviral medicines for patient treatment in the event of Pandemic Influenza

• Dealing with Disasters Together

• Managing Incidents Presenting Actual or Potential Risks to Heath SEHD 2003

The plan makes reference to the NHS Acute Sector Escalation Plan and the Community Health Partnership Contingency Pans. Sectors are responsible for developing and maintaining their own contingency plans taking into consideration articulation with the NHS Grampian Influenza Pandemic Plan and the Infection Control Guidelines.

This document does not describe other agency’s internal contingency plans as these are for each organisation to develop and maintain.

1.2Plan Activation

This plan will be activated by the Director of Public Health, or his/her deputy at WHO Phase 6 when a pandemic is imminent in the UK, or as advised by the SEHD if the risk in the UK is assessed as high. See [check paging] for WHO phases and UK alert levels.

At Phase 6 the Grampian Pandemic Incident Management Team (PIMT -Tactical) will be convened by the DPH or his/her deputy to co-ordinate the response. Members of the PIMT will brief their own Chief Executives and advise when the Grampian Strategic Co-ordinating Group (SCG) needs to be convened.

The NHS Grampian Chief Executive (CEO) and the Chief Constable will discuss and agree who convenes and chairs the SCG, which will be located at the Force Operations Centre (FOC), Operational Planning Department, King Street.

The SCG will be convened on the advice of the PIMT or on instruction from the Scottish Executive. The SCG will ensure an integrated response and report to the Scottish Executive Emergency Support Team (SE-EST). See page [check paging] for organograms of UK, Scottish and Grampian organisational structures.

1.3 Planning Partners

This plan has been prepared by NHS Grampian in consultation with the

• Grampian Emergency Planning Unit on behalf of Aberdeen City, Aberdeenshire and The Moray Councils

• Grampian Fire & Rescue Service

• Grampian Police

• NHS 24

• Scottish Ambulance Service

2. Aim & Objectives

2.1Aim

The aim of this plan is to assist health, emergency services and other planning partners in Grampian to respond effectively to a pandemic of influenza.

2.2Objectives

• The prime objectives are to save lives, reduce the health impact and minimise disruption to essential services whilst maintaining business continuity and reducing disruption to society.

• Prevent infection by using vaccines and anti-viral treatments, if available.

• Minimise transmission by optimum infection control and other public health measures.

• Reduce morbidity and mortality from influenza.

• Provide treatment and care for large numbers of people ill with influenza and its complications, both at home and in hospital.

• Cope with the anticipated large number of deaths.

• Minimise the impact on health and social services including the consequences for other patients as a result of re-prioritisation of services.

• Provide accurate, consistent, timely, authoritative and up-to-date information to professionals, the public and the media.

• Ensure that essential services are maintained.

• Minimise the impact on daily life and business and the consequent economic losses.

2.3Principles underlying the response

The following principles underlie the UK contingency plan:

• The priority in an influenza pandemic is to reduce the impact on public health; i.e. to reduce illness and save lives. Interventions will therefore be applied where they will achieve maximum health benefit. However they may also be needed to help maintain essential services. Should there be a conflict between these two aims, political decisions will need to be made about priorities for the use of interventions.

• With or without medical interventions to protect or treat large numbers of the population measures aimed at slowing the spread of a pandemic may buy valuable time and help services to cope even if this prolongs the overall duration of the pandemic

• The overall response to pandemic influenza in the UK will require collaboration between the UK Government, Devolved Administrations, the Health Protection Agency, Health Protection Scotland, Wales National Public Health Service and NHS infrastructures at all levels, together with many partner organisations and the public.

• Scottish Ministers are accountable for the Scottish response to pandemic influenza, but an effective response in Scotland will require a coherent approach across the UK and the Scottish response will fit in the framework of the overall UK response. The response in Scotland will require partnership between the Scottish Executive, Health Protection Scotland, NHS Scotland and partner organisations and the public in Scotland.

3.Planning Assumptions and Impact Assessment

The World Health Organisation advises that plans should anticipate illness in at least 25% of the population withillness lasting 1-2 weeks in those who recover.

In the 1918/19 pandemic an estimated 250,000 people died in the UK with 20-40 million worldwide. It is estimated that there could be over 50,000 deaths in the UK.

If the pandemic starts in the South East Asia it could reach the UK in less than a month, spread throughout the UK in 2-4 weeks. Thereafter activity could last 3-5 months with peak activity about week 6. There are likely to be subsequent waves, weeks or months later.

3.1Influenza – The Threat

Influenza is a viral infection caused by three types of influenza virus A, B and C.

Influenza A is the most common cause of influenza and its various sub-types cause epidemics and pandemics.

Influenza B causes sporadic infections and periodic epidemics, usually affecting mainly the young and the elderly.

Influenza C usually causes mild upper respiratory illness and is of relatively little importance.

Influenza is a very infectious illness and is mainly spread by the respiratory route through droplets of infected respiratory secretions produced when an infected person talks, coughs or sneezes. It may also spread by hand/face contact after touching a person or surface contaminated with infectious respiratory droplets. Finer respiratory aerosols (which stay in the air for longer and are therefore more effective at spreading infection) may occur in some circumstances.

People are highly infectious from the onset of symptoms for 4-5 days (longer in children and people who are immunocompromised). People are likely to be infectious just before the onset of symptoms. Children have been shown to shed virus for longer (and at higher levels) than adults.

People with asymptomatic infection shed virus and are therefore also likely to be infectious to some extent and pass the infection on.

The incubation period is 1-3 days.

Without intervention, and with no significant immunity in the population, the historical evidence suggests that one person infects on average about 1.4 to 1.8 people (the Ro or ‘basic reproduction number’). This number is however likely to be higher in closed communities.

Influenza is usually a self-limiting disease of 2 - 7 days duration. The symptoms include fever, headache, muscle pains, sore throat, cold symptoms and cough. Serious complications of influenza can occur, especially in people with underlying illness and immunosuppression. These include primary viral pneumonia and secondary bacterial pneumonia (e.g. pneumococcal and staphylococcal pneumonias) septicaemia and cardiovascular disease (myocardial infarction and heart failure). These can give rise to severe morbidity and mortality in any age and the role these complications will play in each outbreak is initially unpredictable.

Some influenza occurs every year due to antigenic drift and loss of immunity. Mild to moderate epidemics cause significant morbidity and mortality every few years.

Table 1. Definitions normal influenza activity in Scotland

Activity / Primary care consultations /100,000
Normal seasonal activity / 50-599
Higher than expected seasonal activity / 600 –1000
Epidemic / >1000

3.2 Pandemic Influenza

Pandemics, or world-wide epidemics, of influenza are rare and occur only when a radically new or changed strain (due to antigenic shift) of the virus emerges that can spread easily from person to person, and against which the population has no immunity from past exposure or immunisation.

Previous pandemics, in 1918, 1957 and 1968, were accompanied by high levels of morbidity and mortality and caused widespread disruption to health and other services. The huge increase in international travel means that pandemic influenza may appear in Scotland with little warning and may occur at any time of year.

A pandemic

• is a global epidemic

• exhibits more than one wave, each lasting about 12 weeks

• results from a major viral change (antigenic shift) against which an effective vaccine may not be available

• will be heralded by the identification of a new strain leading to investigation and declaration of the potential problem by the WHO
• spreads easily from person to person

• occurs over a very wide area

• affects most people, but not all will develop clinical illness (may be equal number with asymptomatic infection)

• usually affects a higher proportion of the population (estimate 25%, versus 5-10% for seasonal influenza)

• may lead to severe symptoms and death in groups outside the normal high risk groups

• affects a higher number of people, who develop severe prostration and rapidly fatal overwhelming viraemia, viral pneumonia, or secondary complications.

• usually kills a higher proportion of cases (1% of the population in 1918)

• may disproportionately affect younger people rather than the elderly

• occurs infrequently, but unpredictably

• may occur at any time of year, not just during the winter season

The age-specific differential attack rate will affect the overall impact. If working age adults are predominantly affected this will impact more seriously on provision of services and business continuity. However illness in the very young and the elderly is likely to present a greater burden on health services, especially, for the former, paediatric intensive care

3.3 Deaths

Excess mortality due to influenza is expected to be higher than in inter-pandemic years, when 12,000 excess deaths are estimated to occur in England and Wales. (By extrapolation from Interpandemic years around 1,200 excess deaths would be expected in Scotland). The impact of overall case fatality rates between 0.37% (based on inter-pandemic and 1957 experience) and 2.5% has been considered.

Table 2: Range of possible excess deaths based on various permutations of case fatality and clinical attack rates, based on UK population

Overall case fatality rate / Clinical attack rate
10% / 25% / 50%
0.37% / 21,500 / 53,700* / 107,500
1.00% / 56,700 / 141,800 / 283,700
1.5% / 85,100 / 212,800 / 425,500
2.5% / 141,800 / 354,600 / 709,300

*Value used for planning purposes

Average deaths from all causes in the UK normally run at around 12,000 per week. In a pandemic, deaths resulting from influenza are likely to gradually rise to 50% higher than normal at the peak of a pandemic wave, and then gradually decline. However there is the potential, based on the worst case scenario modelled, for as many deaths in 12 weeks of a pandemic as there would be over the course of a whole year.

Mortality rates are likely to vary considerable between different age groups. At least a third of the total excess deaths are likely in people under 65 years compared with less than 5% in inter-pandemic years.

3.4Implications for the Health Service and Other Agencies

A large number of people will be affected in an influenza pandemic and this will have implications for both primary and secondary care, as well as other essential services.