Table of Content of the Preparedness Plan for the Influenza Pandemic

Table of content of the Preparedness Plan for the Influenza Pandemic

Page

1Introduction

1.1Global situation

1.2Objectives of the Plan

1.3Definition of the pandemic phases

1.4Coordination mechanisms (Multisectoral coordination)

1.5Structure of the National Disaster Plan

2Situation analysis and risk assessment

2.1Birds migration pattern in Seychelles

2.2Islands and birds distribution

2.3Previous Influenza outbreaks in Seychelles

2.4Farmers distribution and live stocks

2.5Current surveillance system in place for poultry and birds movements and deads

2.6Human and veterinary laboratory facilities available

3Health Interventions

3.1Surveillance system

3.2Laboratory

3.3Treatment

3.4Isolation facilities and transportation of suspected/probable cases

3.5Protection equipment available and needed

3.6Prevention

3.7Vaccination strategy

3.8Deads management

4Veterinary Interventions

4.1Surveillance system

4.2Laboratory

4.3Protection equipment available and needed

4.4Disinfection and culling procedures

4.5Prevention......

5Time frame and allocation of responsibilities

6Budget requirements

7Monitoring and evaluation

1

1Introduction

Since 1997 when the avian flu was found in south East Asia there has been over 120 cases with a high mortality rate of over 50 %. So far there has not been any documented cases of human to human transmission. However in view of H5N1 high mutagenicity, (potential to mutate), scientists have warned that the possibility of H5N1 developing capability for human to human transmission is high. This reality has lead WHO to sound warning alerts to all countries to put a preparedness plan in place to deal with a potential pandemic.

The next flu pandemic has been described as a matter of when and not if. Scientists have postulated that the most likely agent will originate from the avian flu (H5N1).

1.1Global situation

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 nonspecific 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 virusemerges 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.

Influenza A(H1N1), A(H3N2) and B viruses co-circulated and caused outbreaks. While most of the outbreaks (regional or widespread) were associated with influenza A(H3N2) viruses, influenza B viruses circulated widely and caused outbreaks in some countries in Africa, Asia, eastern Europe, Oceania and South America. Influenza A(H1) viruses circulated to a lesser extend and caused outbreaks in a few countries in Africa, central Asia and eastern Europe.

A total of 84 countries/areas, including 8 in Africa, 17 in the Americas, 18 in Asia, 37 in Europe and 4 in Oceania, reported influenza activity during September 2004 and August 2005. Of the 84 countries/areas, 39 reported outbreaks associated with Influenza A(H1N1), A(H3N2) or B viruses.

Outbreaks caused by influenza A(H1N1) viruses were reported in Africa (South Africa and Tunisia), Asia (Oman) and Europe (Bulgaria, Greece, Kazakhstan and the Russian Federation).

Outbreaks associated with influenza A(H3N2) viruses were reported in Africa (Egypt, Seychelles), the Americas, Asia, Europe and Oceania. Between 16 December 2004 and 10 October 2005, 73 patients with influenza A(H5N1), of whom 28 died, were reported from Cambodia, Indonesia and Viet Nam. To date accordingly to WHO, there has been no evidence of sustained human-to-human transmission, and the WHO influenza pandemic preparedness level remains at Phase 3 (see 1.3).

1.2Objectives of the Plan

The main objectives of the current plan are:

(a)To provide a time-bound framework for emergency response to the influenza pandemic based on national priorities in Seychelles;

(b)To ensure that resources are mobilized and used most efficiently;

(c)To facilitate coordination among various sectors, particularly those dealing with human and animal health.

1.3Definition of the pandemic phases

The following pandemic phases were formulated by the Ministry of Health and Social Services, taking into account the WHO's revised global influenza preparedness plan and based on the concept of pandemic phases. Although activity levels are expected to vary from region to region at any point in time, a pandemic phase will be designated for the world by the World Health Organization.

1. 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

1. 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.

• 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 phase 4 and 5.

III. PANDEMIC

• Phase 6: increased and sustained transmission in general population.

The Principal Secretary for the department of health at the Ministry of Health and Social Services, under the advice of the Director General for Community Health and taking into account the recommendations made by the Influenza multi-sectoral committee and in close coordination with the National Disaster Committee will make the necessary announcements of any change in the phases of the epidemic, via the appropriate dissemination channels.

1.4Coordination mechanisms (Multisectoral coordination)

Seychelles on its part has embarked on a flu preparedness. A team of mostly technical people has been put together as the core working group. The team meets once a week every Friday at the moment. The frequency of meeting is subject to change based on needs.

Composition of the working group are as follows ;

1

Dr Jude Gedeon- Health- Chair

Dr Rui Gamma Vaz- WLO

Dr Shobha Harjarnis- Health

Mr Nicholas Shamlaye-Health

Mrs Kathleen Adrienne-Health

Dr Henry Telemaque-Health

Mr Danny Poiret- Health

Dr Bernard Moulinee-Veterinary

Dr Jimmy Melanie-Veterinary

Mr Roland Hoareau-Agriculture

Mr Nirmal Jivan Shah-Bird life Int

Mr Selby Remie-Environment

Mrs Anselmine Cafrine-Health

Mrs Gina Michel-Health

Mr Antoine Moustache-Agriculture

Dr Malulu-Vetterinary

1

Mr Philip Palmyre- HealthMrs. M Andre Asba-Health

Dr Ponmudi - HealthMr. Leon Biscornet-Health

1.5Structure of the National Disaster Plan

See plan

2Situation analysis and risk assessment

Influenza A viruses infects many different animals, including ducks, pigs, whales, human etc. Birds are however the only group of animals that can host all known subtypes of influenza A viruses, with most other animals having strains that are host specific. Furthermore the mixing of human and animals especially in Asia has allowed various virus strains to mix and form potentially lethal combinations. The H5N1 virus which is currently affecting various parts of the world and has been found to pass from birds to human has been mostly recorded in the Anatidae family (ducks, geese and swans). There are also reports of the virus being recorded in other species such as crows, pigs and recently a parrot (refer to table 1). Outbreaks of the viruses have been recorded both in the wild and in artificial systems such as Parks and zoos.

Seychelles is not considered as a group of islands that are intensively used by migrating species. The islands especially the outlying Coralline islands are however part of the Eastern African/ West Asia bird migratory pathway (Annex 1 FAO) and therefore tend to receive a few migrants. Most migrating birds that reached the Seychelles however are considered as vagrants, meaning that their records are rather unusual.

Because the flu virus is changing so rapidly and also changing species (recent find in a parrot in the UK) it is important that a number of precautions are taken with regards to the disease. Monitoring of wild birds should be carried out in a systematic fashion and also all anecdotal reports of bird kill or sick birds should be investigated. Wild geese, ducks and swans can be considered as vagrants in the Seychelles but they should be the main focus of any monitoring programme even if they are rarely encountered.

The life style of the Seychellois people offers some protections against the eventual spread of the H1N5 virus if it was to reach the island. Ducks are rarely kept as free range and then again the areas where this is done will not be used by wild migrating birds. The risk to free range animals is of some concerns but for the time being is considered very low. The presence of stray animals may also be of potential concern as well since it is know that animal/ animal transfer may occur. Though the risk is again small a good level of hygiene and the discouragement of stray animals should be exerted.

The legislation of Seychelles in terms of bird importation is considered as strict. It is therefore unlikely that the disease will be introduced through an approved application of import.

Of particular concerns are islands that have a lot of wild birds, notably some of the Nature Reserves. These islands are at risk and information dissemination remains a priority

2.1Birds migration pattern in Seychelles / Islands and birds distribution

An assessment was made of birds recorded in Seychelles. This analysis was compared to the species that have been known to carry the H5N1 virus (Annex2) and a tentative attempt was made to try and quantify the risk using the following criteria (island the bird was found, number of records etc.)

Species / Status / Risk to introduce the virus / Risk of Spreading the virus
Grey Heron
(Ardea cinerea) / Breeds in Seychelles. Is a migratory bird common to Asia and Europe / Low. The Grey heron is Seychelles are likely resident populations / Medium. If the disease is transferred between species. Mixes with especially the Cattle Egret
Greater Flamingo
(Phoenceps rubber) / Seems to be resident on Aldabra, with a few vagrants. / Low / Meduim. Only if the disease is seen to transfer to other species. Risk restricted to mainly Aldabra
Great black-headed gull
(Larus ichytyaetus) / Findings in Seychelles unconfirmed. Common vagrant to Kenya / Low / Low
Peregrine Falcon
(Falco peregrinus) / Vagrant to granitic Seychelles / Low-medium. Known to feed on other birds including carrier of the virus / Low
House sparrow
(Passer domesticus) / Resident on some islands of the Amirantes group / Low / Medium. If the disease reach the Amirantes island, since the sparrows are found in close proximity to people
Crow
(corvus bracyrhynchos) / Resident on Aldabra. Eradicated on granitic islands / Low / Low, restricted to Aldabra
Feral Pigeon / Common on all main islands. Introduced resident bird / Low / Medium –high. This specie interact intensively with human, and occasionally nest in houses or other buildings.
Other species
Cats
(Felis domestica) / Domestic pet but feral as well. / low / Low. The disease is not common in cats. There are no transfers recorded from cats to human.
Pig
(sus domesticus) / Only kept by registered farmers / low / Low.

Based on the fact that Seychelles is slightly outside the main migratory route and also that most species are vagrants the immediate risk of introduction of the H5N1 virus especially on the main granitic islands can considered as low, but this risk will increase slightly on some other islands such as Aldabra. The risk of the disease spreading if it reaches the Seychelles is higher since feral animals such as pigeons are known to come into close contact with human. These feral animals have the potential to mix with wild birds.

Risks of animals to animals transfer.

Though considered low this risk is present pigeons, cats and even rats are of primary concerns since they have all been shown to be able to host the virus. It is important that feral animals are discouraged around homes, work places and public areas. The risk of animal to animal transfer will increase if the disease reaches the Seychelles. Additional measures such as culling may subsequently be required but at this moment not recommended. Hygiene remains a must and this might be good opportunity to further sensitise the public and also animal Welfare movements about some of the dangers/risks associated with stray animals.

Proposed immediate measures

• Stop all imports of unnecessary live birds and poultry meat from affected countries

• Sensitise all staff form responsible organisations and public.
• Caging of free range animals may become necessary but currently considered unnecessary.
• Prepare specific guidelines for islands with a lot of Wild birds

2.2Previous Influenza outbreaks in Seychelles

Avian Influenza (AI) disease outbreaks have never been reported in the Seychelles. No records of HPAIV available and we do not know if reservoirs of infection exist in the country. Birds (layers and broilers) screened in 1990 were all negative for AIV (please check)

2.3Farmers distribution and live stocks

There are altogether 47 licensed poultry farmers in Seychelles. See annex 3 for details.

2.4Current surveillance system in place for poultry and birds movements and deads

Actually Seychelles is only importing hatching eggs and frozen broiler, duck and turkey and none of these commercial imports are from countries being currently affected by the H5N1 virus. By law the only bird besides poultry authorized to enter the country is the African Grey Parrot but still is has to be licensed by the Director of Veterinary Services.

Mortality is recorded every day on poultry farms and the dead and culled birds are buried/incinerated on the farm. Usually framers contact Livestock / Veterinary Services when in doubt.

Hatchery – farm – abattoir is the main poultry movement in their production cycle. All commercial poultry farmers operate under license and cross farm movement of stock is prohibited. Eggs are sold on the free market and spent chicken (layers) are sold on farm and at times at the market.

2.4.1Guidelines for staff and General public

The staffs of the Department of Environment have already been briefed about the dangers of the bird Flu and also how to attend to site visits with precaution.

The following guidelines in annex 2 are to be followed by staff. It must be noted that the Ministry already have a manual (draft) to deal with bird kill, these guidelines provide further additions to this manual to make the response more specific to Bird Flue responses.

Furthermore the key in annex 3 gives an indication of particular bird form that staff should particularly look out for.

2.4.2 Public

• Members of the public are advised to report any strange birds they might see, particularly the life forms in appendix3.
• Members of the public are advised not to touch any dead or sick birds. If mass mortality is seen in domestic animals, members of the public are advised not to touch these animals.
• The Greenline (722111) must be used to report any of the points above.

2.4.3 Material Required

MATERIALS / Quantity / STATUS
Bird identification manuals / 1 on each island / Available
Monitoring equipment / Binoculars / Lacking on La Digue
Heavy duty tongs for collection of carcass / 5 sets of 5 / Not available. Need to purchase
Sharp shooter with pellet guns / 1 Shooter with am / Available when required. Will only be used if culling is deemed necessary
Dedicated vehicle / 2 Truck s / Available
Stockpile of lime / 1 ton / Not available. Not required by WHO and FAO but should be used as a precaution
Camera / 1 on each site / Available
Face Masks type N951 / 200 / Not available need to purchase (URGENT)
Aprons / 50 / Not available, needs urgent purchasing
Goggles / 50 / Needs purchasing
Recommended disinfectant (e.g Cidex) / 50 litres minimum / Not available, needs purchasing
Sample bags / 200 / Available
Gloves. Disposable lightweight nitrile or vinile or Heavy duty rubber work gloves that can be disinfected. / 50 / Not available, needs purchasing
Medication / For all exposed staff (10 doses) / Only if the disease if reported to have arrived in Seychelles

2.5Human and veterinary laboratory facilities available

The Veterinary Services has no laboratory facilities of its own. Attempt was made early 90s to set up a laboratory but due to limited financial resources the basic activities of the laboratory could not be sustained.

Arrangements are being made to have samples sent to South Africa or UK for testing. FAO has also pledge to assist in that domain. Contact has been made.

The public health lab at the MOHSS is responsible for organizing all human samplings and expediting to overseas reference lab. Seychelles has been designated an influenza surveillance site by NICD (National Institute of Communicable disease) in Johanesburg. All samples are processed for Seychelles at the cost of the NICD lab.