FINAL DRAFT INFLUENZA PANDEMIC PREPAREDNESS PLAN

Size: px
Start display at page:

Download "FINAL DRAFT INFLUENZA PANDEMIC PREPAREDNESS PLAN"

Transcription

1 FINAL DRAFT INFLUENZA PANDEMIC PREPAREDNESS PLAN Natinal Department f Health Cmmunicable Disease Cntrl Emerging and Re-Emerging Infectius Diseases Suth Africa February 2006

2 DRAFT INFLUENZA PANDEMIC PREPAREDNESS PLAN 1. Intrductin The Wrld Health Organisatin [WHO] and health authrities thrughut the wrld have recgnised the threat f influenza pandemic, which culd ptentially have serius effects n the health f the human ppulatin. Previusly, majr pandemics have ccurred in 1889, 1918/19, 1957 and Due t the advent f new subtypes f highly pathgenic bird flu, therwise knw as Avian Influenza, health experts anticipate the ccurrence f majr pandemics in the near future. The 1918/19 influenza pandemic was ne f the mst deadly pandemics f cmmunicable diseases t have affected the wrld. This pandemic was directly respnsible fr ver 20 millin deaths wrldwide. In Suth Africa the pandemic killed ver peple, and in turn verwhelmed the ability f the authrities t dispse f the crpses. Furthermre it resulted in ttal paralysis f the health care system, which struggled t manage patients. The main challenge t health authrities is the inadequacy f the tls t predict where and when future pandemics will ccur. It is against this backgrund that the WHO and its Member States are encuraged t prepare cntingency plans t best prevent and cntrl future pandemics. Suth Africa is ne f the cuntries that supprts epidemic/pandemic preparedness and as a result, has develped these plans t safeguard the health f everyne in the cuntry. Management f pandemics requires large stck f antivirals, access t an effective vaccine, human resurces, and a multisectral and multidisciplinary apprach. Suth Africa faces the challenge f cmpeting with first wrld cuntries fr limited supplies f drugs and vaccines. T add t this, such a pandemic wuld ptentially make very serius demands n the healthcare system and create a great deal f public cnsternatin. It is fr these reasns that this pandemic preparedness plan has been develped as a wrking dcument. The WHO has established an Influenza Pandemic Task Frce t Influenza Pandemic Preparedness Plan: Suth Africa 1

3 prepare a blueprint plan t guide gvernments in preparing fr future pandemics. This dcument is adapted frm the WHO blueprint plan and its main bjective is t assist the Suth African Department f Health and its partners best prepare fr ptential pandemics. 1.1 Ptential Flu Pandemic Threats The extent and the impact f a future majr pandemic cannt be predicted with any degree f certainty. Hwever, data frm previus influenza pandemics may be f sme value in cntingency planning. The WHO reprted the 1918/19 Spanish Flu killed ver 40 t 50 millin peple wrldwide. Furthermre, many cuntries experienced serius scial disruptin and ecnmic lsses. Influenza experts predict that if a flu pandemic were t ccur, the wrld wuld face up t 233 millin utpatient visits, 5.2 millin hspitalisatins, and 7.4 millin deaths, within a very shrt perid. Due t imprved health systems, therapeutic care and glbal preparedness strategies; it is unlikely fr the wrld t have the same number f deaths as in 1918/19. Hwever, there are mre risk factrs that may predispse mst peple t infectins. Fr example, increased travel, ppulatin displacements, cnflicts, pverty, vercrwding, pssibly HIV and AIDS and inadequate infrastructure. Suth Africa is nt an exceptin and is likely t be affected at the same time as the first wrld cuntries. In the UK, it has been predicted that new general practitiner cnsultatins wuld exceed 500/ ppulatin in a new majr pandemic. This wuld mean that a practice with a patient base f wuld see at least 50 new patients per week. At the peak f the 1957 pandemic general practitiners recrded seeing cases per day, whereas in the 1969 pandemic these reached up t 1,260/ ppulatin ver a 2 week perid. In the UK at the peak f the 1957 pandemic, between additinal cases f acute respiratry disease were admitted t Natinal Health Service hspitals. In the UK new sickness benefit claims ttaled 2.5 millin ut f 17.5 millin insured. In 1968/69 mre than 1 millin were received ver a 5-mnth perid. It was estimated that 8-10% f the insured ppulatin lst 3 r mre wrking days during the 1957 epidemic. Influenza Pandemic Preparedness Plan: Suth Africa 2

4 Healthcare wrkers were particularly adversely affected with 12.6 t 19.4% f nurses absent in ne district and in ne hspital, nearly a third f nurses were absent. Influenza Pandemic Preparedness Plan: Suth Africa 3

5 2. THE INFLUENZA VIRUS 2.1 Influenza Influenza r 'flu' is a respiratry illness assciated with infectin by influenza virus. Symptms frequently include headache, fever, cugh, sre thrat, aching muscles and jints. There is a wide spectrum f severity f illness ranging frm minr symptms thrugh t pneumnia and death Influenza Virus The influenza virus was first islated in There are three main types that cause infectin: Influenza A, B and C (f respectively imprtance). Influenza A usually causes a mre severe illness than influenza B. The influenza virus, like mst Ribnucleic Acid [RNA] viruses, is genetically highly variable and this variability gives rise t a cnstant changing f the antigenicity f the virus. Hwever, what is characteristic t the virus is that the antigenic changeability cnstantly gives rise t new strains f virus, which are able t escape the immunity, which the ppulatin builds up, t the predecessr strain, which it nw replaces. The epidemilgy f influenza is thus characterised by the cnstant advent f new antigenic strains f the virus resulting in recurring utbreaks r epidemics Classificatin f Influenza Viruses Influenza is classified int 3 types based n the antigenicity f a prtein called nucleprtein, which surrunds the RNA genme f the virus. The 3 types are referred t as type A, type B and type C. Type A influenza virus is further subdivided int subtypes based n the antigenicity f the 2 prteins embedded in the envelpe f the virus, which are used t attach and t penetrate int the hst cell. These are haemagglutinin (HA) and neuraminidase (NA). Sixteen different HA viruses and nine different NAs have been identified in varius cmbinatins in wild aquatic birds, the reservir hst fr influenza viruses. Only 3 subtypes are knwn t infect humans and these are H1N1, H2N2 and H3N2. Presently 2 f the subtypes are circulating in humans, namely H1N1 and H3N Mechanisms f Influenza Virus Variability There are 2 ways in which an influenza virus changes its antigenicity, i.e. antigenic shift and antigenic drift. Influenza Pandemic Preparedness Plan: Suth Africa 4

6 Antigenic Shift Influenza virus is ne f the few viruses where the individual genes ccur n separate and discrete pieces f nucleic acid instead f the mre usual cmplete single strand fr the whle genme. As a result f this if tw different subtypes happen t infect the same cell, genes frm different rigins may be swpped when the prgeny virus is put tgether in the assembly phase f the virus replicatin. The alien gene r genes then prduces hybrid prgeny virus, which usually dies ff. This prcess is called reassrtment and the hybrid ffspring are referred t as reassrtants. The primary mixing bwls where reassrtment is thught t take place in nature are the vast flcks f wild birds, including waterfwl, fund in China and human influenza virus is the pig, which can act as an intermediate hst fr man. In China and the Far East the human ppulatins cme int clse cntact with these animal reservirs that harbur a great variety f influenza subtypes. Nevertheless, reassrtment prducing a new human virus is a rare event, which can give rise t a new pandemic abut nce every years. When reassrtment ccurs, it gives rise t a cmpletely new subtype f virus acquiring a ttally new HA r/and smetimes a new NA prtein. As a result, the human ppulatin becmes susceptible due t dramatic and sudden classical pandemics such as the 1918/19 Spanish Flu, the 1957 Asian Flu, and the 1968 Hng Kng Flu. The sudden and majr change in antigenicity f the virus is hence called antigenic shift. Antigenic Drift This is a mre subtle change in the antigenicity f the HA prtein, which is critical in the attachment f the virus t its receptr n the hst cell. Even subtle changes (i.e. smetimes nly 1 r 2 amin acids) may enable the virus t elude the hst s immunity. These HA mutatins ccur readily and cntinually althugh pint mutatins (i.e. substitutin f 1 amin acid) usually d nt translate n their wn int a significant antigenic change. Hwever, accumulatin f these pint mutatins under the selective pressure f antibdies frmed in innumerable human hsts will eventually prduce meaningful antigenic change resulting in a virus, which can then spread thrughut the human ppulatin, causing widespread epidemic activity. This mre gradual but Influenza Pandemic Preparedness Plan: Suth Africa 5

7 prgressive change is thus called antigenic drift and it gives rise t new antigenic strains f influenza apprximately every 3-5 years. 2.2 Definitin An influenza pandemic r glbal epidemic ccurs when a new influenza virus subtype appears, against which n ne is immune. This may result in several simultaneus epidemics wrldwide with high numbers f cases and deaths. Imprved transprt systems, rapid urbanizatin and increased travel are mre likely t facilitate the spread f new viruses wrldwide. Influenza virus causes utbreaks f influenza every winter seasn. This is seasnal influenza. These utbreaks are f variable intensity but usually affect between 5-30% f the ppulatin resulting in a highly variable degree f mrbidity and sme mrtality, which is virtually cnfined t elderly individuals, especially thse with underlying medical cnditins. When significant antigenic variatin ccurs in the virus s that the ppulatin is largely susceptible, significantly greater epidemic activity ccurs which is ften glbal in extent, with varying intensity in different cuntries ften depending n ppulatin immunity. The widespread epidemics f influenza that affect almst all the cntinents, are smetimes referred t as pandemics. What is very imprtant t understand that there is a difference between seasnal, Avian and human pandemic influenza. The human pandemic influenza invlves a new influenza virus subtype, which is rapidly transmitted between peple and Avian flu is a type f flu diagnsed in birds. This is an animal disease. Influenza Pandemic Preparedness Plan: Suth Africa 6

8 3. PANDEMIC PREPAREDNESS PLAN 3.1 Elements f Preparedness A cmplete pandemic preparedness plan shuld cmprise f all the essential minimum elements aimed at guiding thse invlved in the preventin and cntrl f infectius diseases. The WHO and its Member States recmmend that cuntries use a checklist in rder t ensure smth implementatin f the plans. The plans shuld be prepared in cnsultatin with all gvernment departments, including the public sectrs and cmmunity representatives. Advcacy and cmmitment frm heads f states and department is crucial. Preparedness teams must ensure that the fllwing seven essential elements f the checklist are sufficiently planed and implemented: 1. Preparing fr an Emergency 2. Surveillance 3. Case Investigatin and Treatment 4. Preventin f Spread f Disease 5. Maintaining Essential Services 6. Research and Evaluatin 7. Implementatin, Testing and Revisin f Natinal Plans 3.1 Preparatin fr an Emergency It is f vital imprtance fr bth plitical and bureaucratic prcesses t wrk in harmny with the technical team in case f an emergency. Gvernment must recgnise the ptential human, scial and ecnmic impacts f pandemics at its highest levels f management and gvernance. The fllwing enablers shuld be readily available at varius levels f gvernment, particularly within the health care system: Recgnitin and acknwledgement f preparedness plans Cmmitted funding Respnsible rganizatins, cmmittees and technical expertise Realistic timelines fr cmpletin f preparedness plans Rles and respnsibilities shuld be clearly dcumented Peridic meetings shuld be held and prceedings be dcumented Plitical, gvernment and prfessinal grups shuld be infrmed f the plans Influenza Pandemic Preparedness Plan: Suth Africa 7

9 3.1.1 Cmmand and Cntrl In rder t make clear and timely decisin and implementatin f unifrm plicies endrsed by all rle players, it is essential t knw wh is respnsible fr varius activities within cmmunicable disease cntrl. Wh and when t enfrce key elements f respnse like travel r trade bans and quarantine shuld be clearly stipulated, e.g. President, Ministers, Directr Generals, etc. These shuld be instituted in all rganisatins participating in the develpment f the plans. In additin t high level cmmand and cntrl plans, technical experts frm varius sectrs and disciplines shuld knw their rles and respnsibilities in rder t avid cnfusin. Wherever necessary, standard perating prcedures like utbreak investigatin, labratry cnfirmatin, case management, plitical decisin-making, infrmatin t be disseminated and any ther relevant guidelines need t be develped and implemented Risk Assessment Suth Africa is classified by WHO,UN and IOE as a lw risk cuntry. The risk f a pandemic is great and will persist, but the timing and severity are unknwn. Risks need t be defined immediately. Varius sectrs that are mre likely t be affected are encuraged t cnduct studies n expected impact f the pandemic. Mdelling studies n the impact f the pandemic n varying attack rates shuld be dne as well as systems fr early detectin, testing and reprting. Impact measures shuld include health facility attendance, admissins, and deaths. The scial and ecnmic impact shuld als be assessed. An estimatin f the effects f ptential interventins with antiviral medicatin and/r vaccines in varius grups shuld be cmputed Cmmunicatin Cmmunicatin strategies are an imprtant cmpnent in the management f any infectius disease utbreak risk and especially management cmmunicatin. Cmmunicatins that address varius target grups, e.g. cmmunity, press, pliticians, health wrkers, shuld be develped. Disseminatin strategies, e.g. website, leaflets, newspapers, radi, televisin and languages t be used shuld be well planned and executed. Cmmunicatin als invlves regular meetings between varius stakehlders, cuntries, including reprting t the WHO. Sci-cultural aspects f the Influenza Pandemic Preparedness Plan: Suth Africa 8

10 cuntry shuld be well understd, e.g. religin and language. Suth Africa endrses and will use the WHO Cmmunicatin During Outbreaks dcument. Cmmunicatin shuld be clear and bjective t prevent cnfusin. Messages shuld be cnsistent within the cuntry, but als in acrss barder cuntries Legal and Ethical Issues During pandemics it may be necessary fr gvernment t verrule existing legislatins and rights, e.g. schl, sprting and prt clsure, quarantine r travel ban. Any decisins shuld cmply with the Internatinal Health Regulatins Respnse Plan The WHO recmmends that different stages f respnding t the epidemic be instituted. This includes varius triggers that will be activated at varius levels f the respnse. The applicable sectins are equally imprtant fr animal flu utbreaks, e.g. Avain flu. Influenza Pandemic Preparedness Plan: Suth Africa 9

11 4. SURVEILLANCE 4.1 Natinal Surveillance Prgrammes Within the Department f Health, bth clinical and labratry surveillance systems shuld be sensitive enugh t detect any suspected human cases. The Department f Agriculture is respnsible fr surveillance in pultry and ther animals. The surveillance systems shuld: Be cmprehensive and cver the whle cuntry Facilitate rapid respnse Allw that labratry and epidemilgical data be integrated Ensure natinal security Cntribute t capacity and imprvement f the system Fit in with the glbal infrmatin netwrk system NB: What is said here fr human flu viruses and surveillance is equally imprtant fr animal viruses and surveillance Labratry Surveillance The influenza labratry f the Natinal Institute fr Cmmunicable Diseases [NICD] is the majr surveillance site fr influenza in Suth Africa. There are smaller sites situated in the Department f Micrbilgy, University f Cape Twn and Department f Virlgy, University f Natal. Bth active and passive surveillance is carried ut at the NICD. The active surveillance prgramme cnsists f a netwrk f sentinel sampling sites; at present sme 80 general practitiners, clinics and staff health centers, which prvide rutine upper respiratry tract specimens frm patients with acute respiratry disease fr virus islatin. On average between 50 and 100 virus islates are made annually. These islates are antigenically typed at the NICD using reagents supplied by the WHO. In additin, mlecular studies are carried ut at the NICD t determine the plypeptide sequence f the surface prteins f new islates in rder t determine subtle sequence changes. Supplementing this acute surveillance prgramme is the resurce f clinical material sent t the NICD fr rutine diagnstic purpses. Virus islatin data is cupled Influenza Pandemic Preparedness Plan: Suth Africa 10

12 with investigatin f schl and wrk absenteeism, which is used as a rugh determinant f the extent and impact f influenza. The NICD influenza labratry is part f the internatinal glbal netwrk f sme 116 reference centers thrughut the wrld. Clse ties are maintained with these centers as well as with the fur WHO Cllabrating Centers fr Reference and Research n Influenza: The Cmmnwealth Serum Labratries, Melburne, Australia Natinal Institute fr Medical Research, Mill Hill, Lndn Natinal Institute f Infectius Diseases, Tky, Japan Influenza Branch, Natinal Center fr Infectius Diseases, CDC, Atlanta, Gergia. Links are maintained thrugh the internet via a prgramme called FluNet. All participating labratries supply infrmatin regarding influenza activity and characteristics f virus islates. Three influenza cllabrating labratries have been established in China t act as internatinal early warning sentinel labratries t warn f the appearance f new strains f influenza virus Mnitring Antigen Drifts The regular mnitring f human influenza virus islates fr the mre regular antigenic drifts is carried ut by sme 125 natinal influenza centers thrughut the wrld. These labratries btain influenza virus islates either frm rutine patient diagnstic material sent int clinical virlgy labratries r, alternately, specimens are actively recruited frm sentinel medical practitiners r clinics wh purpse-fully take thrat swabs frm patients with upper respiratry tract infectins. A successful viral watch prgramme with a netwrk f sentinel practitiners has been perating successfully n the Witwatersrand since Preliminary characterizatin f influenza islates is carried ut by the NICD and a representative number f virus islates are then sent t the WHO Cllabrative Centres fr Reference and Research n Influenza, in Lndn and Melburne, Australia; fr detailed antigen and genetic characterisatin. Influenza Pandemic Preparedness Plan: Suth Africa 11

13 5. Ptential Cntrl Measures fr Human Infectin T reduce the pprtunity r risk f transmissin, the fllwing shuld be dne: Use the best available infrmatin t act and t infrm cuntries Cntrl the flu in animals and cntain the surce f infectin Cntain seasnal flu utbreaks thrugh an effective flu immunisatin prgramme t surge capacity fr pandemics Avid high risk behaviur, e.g. eating f raw pultry, big gatherings, wet slaughtering, c-habitatin Imprve persnal hygiene, e.g. washing hands with sap, cvering muth and nse if cughing r sneezing Vluntary quarantine/islatin Imprve infectin cntrl Immediate investigatin in suspected subtype cases Imprve diagnsis, treatment and verall service prvisin Imprve human and animal surveillance systems Influenza Pandemic Preparedness Plan: Suth Africa 12

14 6. CASE INVESTIGATION AND TREATMENT Gd diagnstic capacity is pssible where the clinical staff is well supprted by labratry cnfirmatin f causative agents. It is therefre very critical that health facilities and labratry services maintain gd cmmunicatin. Mrever, utbreak respnse teams shuld have necessary skills and knwledge n case investigatin. Labratry and case investigatin shuld infrm case management in terms f prcurement and use f vaccines, prphylaxis and ther drugs. 6.1 Case Management T ensure effective and safe treatment f cases, clinical guidelines shuld be readily available and if nt, WHO guidelines shuld be adapted and implemented. All prvinces in Suth Africa are expected t identify designated health facilities where treatment prtcls will be well implemented. In case f large epidemics, additinal facilities shuld be identified after assessment, and supprt shuld be prvided t such facilities. The chice f interventin depends n the virus, severity, age grup, etc 6.2 Vaccine Frmulatin Twice a year, twards the end f the nrthern and suthern hemisphere influenza seasn, a meeting is cnvened by the WHO cnsisting f representatives f the Influenza Cllabratin Centers and ther influenza experts, t review the past influenza seasn and t examine labratry data n the antigenicity f new islates. On this basis an estimate is made as t which strains in each f the subtype viruses are likely t circulate in the ppulatin the fllwing influenza seasn. Prttype influenza strains are then selected and used fr preparing seed virus strains fr vaccine manufacturers t prcess int vaccines. Influenza vaccines are inactivated (killed) vaccines made by inculating fertilized chicken eggs with influenza virus, harvesting the fluid and then extensively purifying ut the virus which is then chemically inactivated, usually with frmaldehyde. The frmulatin f the vaccine is annunced biannually in February and Octber in the WHO publicatin, the Weekly Epidemilgical Recrd. This then allws fr Influenza Pandemic Preparedness Plan: Suth Africa 13

15 apprximately 4-5 mnths fr manufacturers t prduce and package vaccine in time t vaccinate the nrthern hemisphere ppulatin befre the nset f their winter. 6.3 Antiviral Chemprphylaxis Influenza vaccines are, by far, the mst imprtant means f preventing influenza. On ccasin, hwever, it may be necessary t supplement vaccine prphylaxis with chemprphylaxis using seltamivar [Tamiflu], r zanamavir [Relenza], which inhibits influenza virus replicatin. Chemprphylaxis shuld be administered under the fllwing circumstances: a. In very high-risk situatins t subjects wh may already have been vaccinated r, if nt, tgether with influenza vaccine, fr example t frail, elderly inmates f an institutin befre a threatening utbreak. b. In an emergency situatin where vaccine has been mitted in a high-risk patient. As the prtective effects f vaccinatin nly cmmence after 14 days. c. Where vaccine is cntraindicated - in persns wh have a histry f severe hypersensitivity t egg prtein. d. Where vaccine is nt available r vaccines cntaining the crrect strains are nt prcurable, e.g. travellers ging frm summer t winter seasn. 6.4 Antiviral Chemtherapy Oseltamivar r zanamavir may als be used as a therapy fr influenza prvided it is administered early in the curse f the illness, i.e. within 48 hurs after nset f influenza. Therapeutic respnses have been demnstrated in the treatment f influenza pneumnia. NB: Oseltamivar is the drug f chice but zanamavir [relenza] is als available. Influenza Pandemic Preparedness Plan: Suth Africa 14

16 7. ROLES AND RESPONSIBILITIES Department f Health The Deputy-Directr General shuld prvide leadership t the multidisciplinary teams invlved in develping preparedness strategies. The Natinal, Prvincial and Lcal Departments f Health tgether with the Natinal Institute fr Cmmunicable Diseases and health partners frm the private sectr need t establish and sustain a wellcnstituted and well-functining utbreak respnse team. The verall aim f the utbreak respnse team is t: Prvide leadership and identify infectius disease utbreaks by ensuring the existence f a functinal surveillance system Investigate utbreaks, prepare adequately and timeusly fr emergencies Ensure rapid respnse and systematic management f utbreaks, in rder t reduce mrbidity, and mrtality Enhance crdinatin at each level, e.g. establish a Jint Operatins Center [JOC] General Respnsibilities f the Outbreak Respnse Team at ALL Levels The activities f the utbreak respnse team shuld be underscred by the cmmn understanding f reducing mrbidity and mrtality due t infectius diseases. Hwever, this bjective can be realised by the fllwing general respnsibilities f the team: T prepare plans f actin fr epidemic preparedness and respnse T mbilise human, material and financial resurces fr epidemic preventin and cntrl lcally T prvide infrmatin and educatin t the public befre, during and after utbreaks/epidemics T mnitr the implementatin f utbreak/epidemic cntrl actins T crdinate assistance fr epidemic preventin and cntrl frm varius partners T mnitr resurce utilisatin (drugs, vaccines, supplies, disinfectants, lgistics and financial resurces) T verify any rumur f disease utbreak and carry ut utbreak investigatin T recmmend apprpriate strategies and measures fr the rapid cntainment f epidemics t the lcal utbreak respnse teams T crdinate the implementatin f the plan f actin and participate actively in the implementatin f epidemic preventin and cntrl strategies T prvide technical supprt t the health facilities during utbreaks/epidemics T mnitr and evaluate verall preparedness, investigatin and respnse t ensure dcumentatin f all utbreaks T crdinate cmmunicatin and activities Influenza Pandemic Preparedness Plan: Suth Africa 15

17 Directrate: Cmmunicable Disease Cntrl (CDC) [Natinal and Prvincial] Crdinate Epidemic Preparedness and Respnse (EPR) and epidemilgical investigatin at apprpriate level [s] f the health care systems Develp guidelines n cntrl, preventin and management f influenza Crdinate activities e.g. rumur verificatin, early detectin, utbreak investigatin, case management and epidemic preparedness and respnse Prvide technical supprt t apprpriate level[s] n the cntrl, preventin and treatment f epidemic-prne infectius diseases Facilitate and supprt labratry surveillance activities fr early detectin f utbreaks and mnitring f circulating pathgenic strains Develp mechanisms fr systematic mnitring and evaluatin f strategic plans f EPR n influenza at apprpriate level[s] and feedback Liaise with ther prgrammes, gvernment departments and ther partners Participate in inter-cuntry epidemic preparedness and respnse activities, e.g. SADC EPR Initiatives Facilitate resurce mbilisatin (human, financial, infrastructure, etc) fr rapid respnse and timely preparedness Facilitate cperatin with internatinal agencies at apprpriate levels Develp and disseminate infrmatin f disease utbreaks t the public, managers, and apprpriate level[s] Prepare and submit reprts/infrmatin t strategic managers and plitical heads and structures such as the Directrs General, Minister, parliament, cabinet, etc. Directrate: Epidemilgy with NICD Surveillance (data cllectin, capturing, cleaning, analysis and presentatin) fr rapid respnse and systematic investigatin and management f the pandemic. Ensure that an Early Warning System fr ptential utbreaks is established and functinal fr early detectin f ptential epidemics. Disseminate data fr prmpt and apprpriate respnse, t all levels f the health system and internatinal rganisatins, in the frm f reprts, website, etc. timeusly Cllect and disseminate data, n a daily basis during an utbreak, fr preventin and cntrl purpses Cnduct epidemilgical investigatins, and develp reprts n the epidemilgy f the disease utbreak Develp mechanisms fr systematic mnitring and evaluatin f strategic surveillance plans fr influenza in the regin and prvide feedback Prvide technical supprt t prvincial and district health infrmatin managers Influenza Pandemic Preparedness Plan: Suth Africa 16

18 Supprt in epidemic intelligence (rumur verificatin, clinical surveillance f suspected cases, labratry surveillance fr cnfirmed cases, investigatin, cntrl and preventin) Directrate: Health Prmtin [Natinal and Prvince] Crdinate health prmtin messages at natinal level Develp and distribute infrmatin, educatin and cmmunicatin [IEC] materials, e.g. pster, pamphlets and audi-visuals, fr public awareness in all relevant settings including brdering cmmunities. Increase public awareness n risk f influenza and pandemic thrugh electrnic media, televisin, radi, and internet Develp active cmmunity participatin strategies [excluding large gatherings], and ensure cmmunity invlvement during utbreaks Train health prmtin practitiners n the varius techniques useful fr attitude and behaviural change, healthy life styles and disease preventin Invlve cmmunity-based rganisatins [CBOs], nn-gvernmental rganisatins [NGOs] and cmmunity health wrkers in utbreak respnse Prmte vluntary islatin Infrm wrkers at prts f entry Directrate: Envirnmental Health [Natinal and Prvince] Cnduct envirnmental assessment and management f risk factrs predispsing individuals t influenza Crdinate prt health activities, e.g. islate suspected cases and infrm masters f vessels, pilts and ther relevant persns at grund crsses n preventin and best management practices f suspected cases Directrate: Fd Cntrl [Natinal and Prvincial] Play a central rle in the implementatin f Fd Cntrl Regulatins t prevent fdbrne diseases and prvide technical and legal supprt in case f fd brne r related utbreaks Crdinate fd recall activities during fd-brne utbreaks Cllabrate with the Department f Agriculture n fd-related issues Cluster: Cmmunicatin [Natinal and Prvincial] Wrk tgether with the Department f Cmmunicatins as media liaisn between Departments [especially the Department f Turism], health partners and the public in a crdinated way Influenza Pandemic Preparedness Plan: Suth Africa 17

19 Develp cmmunicatin prtcls and rutines: patients cnfidentiality, press releases and briefings and clear miscnceptins Manage freign and internatinal cmmunicatins in rder t prtect and maintain diplmatic ties with ther cuntries Develp strategies in case f an utbreak, epidemic r pandemic Develp a cmmunicatin strategy fr bth gvernment and private sectr Directrate: Human Resurces [All Levels and Sectrs] Facilitate capacity develpment f members f the team and relevant emplyees Facilitate technical supprt and training n epidemic preparedness and respnse t utbreak respnse teams Mtivate fr availability f human resurces [cntingency plan] during an utbreak Directrate: Health Infrmatin Systems [Natinal and Prvincial] Ensure that health infrmatin systems fr infrmatin flw, during and in the absence f epidemics, are implemented Publish infrmatin n disease utbreaks daily n the Departmental Website and Intranet Health infrmatin shuld be transparent ands accessible t allw rapid respnse Directrate: Pharmaceutical Plicy and Planning [Natinal Prvincial] Ensure the prvisin f medical supplies befre and during utbreaks, e.g. drugs, vaccines, Ensure that influenza vaccine is n the primary level Essential Drug List [EDL] and available at that level Encurage seasnal influenza vaccinatin Develp strategies fr securing f drugs and deplyment f antivirals and vaccines as part f preparedness, if s required Implement, mnitr and evaluate drug levels and deplyment f antivirals, vaccines and ther related resurces Negtiate with industry n capacity, availability and equity issues Directrate: Emergency Medical Services and Disaster Management [All Levels] Crdinate transprtatin f patients and crdinatin f designated facilities Crdinatin f all EMS activities, bth private and public Play a rle in incident management Assist ther disciplines with planning and implementatin f preventive, peratinal and cntingency plans Audit f health facilities, bth private and public Influenza Pandemic Preparedness Plan: Suth Africa 18

20 Directrate: Hspital Management [Natinal and Prvince] Prepare a list f designated hspitals with islatin facilities, and determine capacity per facility Prepare cntingency plans and ensure capacity fr ventilatrs and ther tertiary requirements fr severe acute respiratry patients Ensure infectin cntrl in designated facilities tgether with Quality Assurance Directrate Prepare a list f mrtuary [nt frensic] capacity per prvince Directrate: Financial Management [Natinal] Prvide additinal and emergency financial supprt Suth African Military Health Services Prvide technical assistance, infrastructure and human resurces during and in the absence f utbreaks n request Department f Finance [Natinal Treasury] Make available emergency funding in case f an epidemic r a pandemic Department f Prvincial and Lcal Gvernment Finalise Disaster Management Plan and versee implementatin Participate in utbreak cntrl Prvide a list f all private burial services per lcal gvernment and their capacity Prvide safe drinking water tgether the Department f Water Affairs and Frestry Department f Agriculture Prvide legal framewrk fr ntificatin f animal diseases Prvide surveillance and infrmatin sharing n zntic diseases Crdinate the investigatin and cntrl f utbreaks related t animals Investigate cmpensatin pssibilities fr lss f infected stck by culling Develp risk cmmunicatin strategy Ensure stck mvement and cntrl Department f Scial Develpment Ensure the availability f basic scial needs during utbreaks Cmmunity mbilisatin and supprt Department f Safety and Security Ensure safety and rder in the case f unrest due t utbreaks Influenza Pandemic Preparedness Plan: Suth Africa 19

21 Department f Hme Affairs Manage mvements acrss the brders Department f Educatin Scial mbilisatin and invlvement in health prmtin activities Manage clsure f educatinal facilities, if required Department f Freign Affairs Ensure diplmatic relatins Mbilisatin f internatinal assistance Disseminatin f infrmatin t embassies /missins abrad and freign missins in Suth Africa Assist with crss-brder cmmunicatin and cntrl Establish call center fr Suth Africans abrad and freign natinals Department f Crrectinal Services Infrm prisners and visitrs regarding the risk f the pandemic Imprve health prmtin activities Arrange fr case management, and hspital admissins and islatin Private Health Sectr Prvide a plan fr relevant supprt (labratries, specialists, infrastructure, etc) t the Department f Health t ensure Public Private Partnership and multisectral initiatives are well implemented and crdinated Internatinal Organisatins [WHO, CDC, etc] Prvide supprt (labratries, specialists, infrastructure, funds, etc) t Suth Africa Suthern African Develpment Cmmunity (SADC) Participate in SADC EPR activities t strengthen crss-brder and inter-cuntry epidemic preparedness and respnse strategies. Strengthen mechanisms fr increasing scial mbilisatin and ensure active cuntry participatin in the regin ALL DEPARTMENTS SHOULD HAVE THEIR OWN CONTIGENCY PLAN These terms f reference are expected t be dynamic in nature and shuld be cntinuusly reviewed, given the nature f the disease and methds t manage it. The Influenza Pandemic Preparedness Plan: Suth Africa 20

22 invlvement f varius stakehlders will als be determined by the nature f the utbreak, epidemic r pandemic. Influenza Pandemic Preparedness Plan: Suth Africa 21

23 8 NEW PHASES AND OVERARCHING PUBLIC HEALTH GOALS 8.1 Pandemic Perids Fr internatinal planning purpses, the WHO has defined phases in the prgressin f an influenza pandemic frm the first emergence f a nvel influenza virus, t wide internatinal spread. These phases allw a step-wise escalating apprach t preparedness planning and respnse. They are glbal classificatins based n the verall internatinal situatin and are used internatinally fr planning purpses. A. Interpandemic perid Phase 1 N new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infectin may be present in animals. If present in animals, the risk f human infectin r disease is cnsidered t be lw. Strengthen influenza pandemic preparedness at the glbal, reginal, natinal and sub-natinal levels. Phase 2 N new influenza virus subtypes have been detected in humans. Hwever, a circulating animal influenza virus subtype pses a substantial risk f human disease. Minimize the risk f transmissin t humans; detect and reprt such transmissin rapidly if it ccurs. B. Pandemic Alert Perid Phase 3 Human infectin(s) with a new subtype, but n human-t-human spread, r at mst rare instances f spread t a clse cntact. Ensure rapid characterizatin f the new virus subtype and early detectin, ntificatin and respnse t additinal cases. Phase 4 Small cluster(s) with limited human-t-human transmissin but spread is highly lcalized, suggesting that the virus is nt well adapted t humans. Influenza Pandemic Preparedness Plan: Suth Africa 22

24 Cntain the new virus within limited fci r delay spread t gain time t implement preparedness measures, including vaccine develpment Phase 5 Larger cluster(s) but human-t-human spread still lcalized, suggesting that the virus is becming increasingly better adapted t humans, but may nt yet be fully transmissible (substantial pandemic risk). Maximize effrts t cntain r delay spread, t pssibly avert a pandemic, and t gain time t implement pandemic respnse measures. C. Pandemic Perid Phase 6 Pandemic: increased and sustained transmissin in general ppulatin Minimize the impact f the pandemic. a. The distinctin between phase 1 and phase 2 is based n the risk f human infectin r disease resulting frm circulating strains in animals. The distinctin is based n varius factrs and their relative imprtance accrding t current scientific knwledge. Factrs may include pathgenicity in animals and humans, ccurrence in dmesticated animals and livestck r nly in wildlife, whether the virus is enztic r epiztic, gegraphically lcalized r widespread, and/r ther scientific parameters. b. The distinctin between phase 3, phase 4 and phase 5 is based n an assessment f the risk f a pandemic. Varius factrs and their relative imprtance accrding t current scientific knwledge may be cnsidered. Factrs may include rate f transmissin, gegraphical lcatin and spread, severity f illness, presence f genes frm human strains (if derived frm an animal strain), and/r ther scientific parameters. NB: Annexure A gives detailed bjectives and activities during the different phases f the pandemic. Influenza Pandemic Preparedness Plan: Suth Africa 23

25 ANNEXURE A: OVERARCHING GOALS, OBJECTIVES AND ACTIVITIES BY PHASES Interpandemic Perid: Phase 1 Overarching Gal: Strengthen Influenza Pandemic Preparedness Planning and Crdinatin Objectives Activities Respnsible Cst [Rand] Develp and maintain natinal pandemic cntingency plans Establish and strengthen multisectral influenza pandemic cmmittees at all levels f care NORT and Prvinces Prmte early reprting f new influenza viruses, mbilise, and develp effective resurce mbilisatin mechanisms fr early respnse Advcate preparedness plans t tp decisin-makers in gvernment and with relevant partners in and utside the health sectr NORT Develp mechanisms fr decisin-making fr rapid respnse thrugh intersectral and multidisciplinary cllabratin Identify and train key persnnel t be mbilised in case f emergency Ensure gd labratry and clinical surveillance f nvel strains f influenza Cnsider the develpment f dmestic stckpile (antivirals, vaccines, prtective clthing, labratry diagnstics and ther technical supprt) fr rapid deplyment, including a management and distributin plan Cnsider prviding supprt t resurce-pr cuntries with fci f influenza activity Develp a risk cmmunicatin plan NORT, EMS and Prvinces and Lcal Gv NICD Pharm Plicy Planning, NHLS and EMS Cabinet GCIS and Cmmunicatins Situatin Mnitring and Assessment Objectives Activities Respnsible Cst [Rand] Maintain updated infrmatin n trends in human infectin with seasnal strains f influenza Identify ptential human and animal surces f infectin and assess risk Develp generic surveillance systems fr detectin, characterisatin and assessment f influenza-like illnesses r respiratry deaths Reprt rutine and unusual surveillance findings t relevant natinal and internatinal authrities Develp cntingency plans fr mnitring infrmatin, assessment f impact and resurce needs, e.g. mrbidity, mrtality, human resurces, facilities, admissins, number f beds, alternative facilities, mrtuary capacity, etc Epidemilgy, NICD, Agric (Animal Health) Epidemilgy, NICD and Agric Epidemilgy, NICD and Prvinces Assess burden f seasnal influenza t help estimate additinal needs during a pandemic NICDl Influenza Pandemic Preparedness Plan: Suth Africa 23

26 Preventin and Cntainment Objectives Activities Respnsible Cst [Rand] Agree in advance n a range f strategies based n nn-pharmaceutical public health actins Develp strategies fr stckpiling f antivirals and vaccines, deplyment strategies/criteria Develp natinal guidelines fr public health interventins, and discuss them with authrities/decisin-makers in and utside the health sectrs Develp table-tp exercises and use plans t imprve strategies/plans, e.g. stckpiling NORT, CDC Pharm Planning Plicy Set pririties and criteria fr deplyment and use f antivirals and vaccines during pandemic alert and pandemic perids Pharm Planning Plicy Cnsider participating in research fr antiviral resistance and vaccine prductin Explre strategies fr vaccine access frm prducing cuntries, thrugh bilateral agreements Pharm Planning Plicy Pham Plan Plicy Negtiate with industry t increase capacity Pharm Plan Plicy Health System respnse Objectives Activities Respnsible Cst [Rand] Ensure up-t-date cntingency plans and strategies are Invlve the WHO in develpment f preparedness strategies NORT and Freign Affairs in place fr pandemic respnse in the health-care sectr and address deficiencies Ensure that authrities, respnsibilities and pathways are clearly identified fr cmmand and cntrl f health systems Identify pririties and respnse strategies fr each stage, e.g. triage system, human and material resurces Prduce interim case finding, treatment and management prtcls and algrithms, infectin cntrl guidelines, capacity management and staffing strategies Ensure labratry safety, specimen testing and characterisatin prtcls Increase awareness and strengthen training f health-care wrkers n pandemic influenza Dedicated facilities list made available Prvince, Private Sectr Prvince, Private Sectr NORT, CDC NHLS ORT s Facilities Plan, Prvince, Private Sectr Influenza Pandemic Preparedness Plan: Suth Africa 24

27 Cmmunicatin Objectives Activities Respnsible Cst [Rand] Develp cmmunicatin strategies between health authrities, partners and public Ensure cllabratin between gvernment, partners and public and develp clear rles and respnsibility Establish cmmunicatin strategy and infrastructure Establish cmmunicatin netwrks amng stakehlders Familiarise media with preparedness and respnse measures NORT, Cmmunicatins ORT s, Cmmunicatin Cmmunicatins Develp feedback mechanisms fr public, address rumurs and crrect misinfrmatin NORT, Cmmunicatins NORT Natinal Outbreak Respnse Team, ORT Outbreak Respnse Team, NICD - Natinal Institute fr Cmmunicable Diseases, NHLS Natinal Health Labratry Service, JOC Jint Operatins Cmmittee Influenza Pandemic Preparedness Plan: Suth Africa 25

28 Interpandemic Perid: Phase 2 Overarching Gal: Minimise Risk f Transmissin t Humans, Early Detectin and Reprting Planning and Crdinatin Objectives Activities Respnsible Cst [Rand] Ensure a heightened respnse capacity t address pssible human cases Crdinate implementatin f measures in clse cllabratin with animal health authrities t minimise risk f human infectin Activate jint mechanisms f actin with animal health authrities and ther relevant stakehlders Assess preparedness status and identify immediate actins t address gaps [use WHO checklist] Ensure ability t mbilise and rapidly deply multisectral expert respnse team NORT, CDC NORT, CDC NORT, CDC Ensure ability t rapidly deply stckpile resurces frm natinal r internatinal surces, accrding t risk assessment NORT, Pharm Plan Plicy Situatin Mnitring and Assessment Objectives Activities Respnsible Cst [Rand] Identify interspecies transmissin at an early stage and reprt t WHO and ther authrities Implement human and animal health surveillance and reprt t natinal and internatinal authrities Health [All Facilities], NICD, Agric Prvide nging risk assessment fr transmissin f viruses with pandemic ptential t humans Transmit representative islates t natinal and internatinal reference labratries fr cnfirmatin, characterisatin, reagent and vaccine develpment Cnduct labratry/epidemilgical field investigatin in the affected areas Health [All Levels], Agric NICD, Epid and Agric Participate actively in assessment f risk f transmissin Ensure expertise and virlgical surveillance in natinal labratries accrding t internatinal standards [WHO standards] Epid, NICD, CDC, agric NICD, Epid and Agric Cntinue t cllect and exchange virus islates and ther scientific infrmatin with partner rganisatin Cnduct serlgical surveillance f farmers and their families, animal wrkers and selected family members invlved in animal influenza utbreak NICD, Epid and Agric NICD, Epid and Agric Influenza Pandemic Preparedness Plan: Suth Africa 26

29 Preventin and Cntainment Objectives Activities Respnsible Cst [Rand] T minimise risk f human infectin frm cntact with infected animals Assess natinal availability f antiviral drugs Reduce risk f c-infectin in humans t minimise virus reassrtment Ensure ptimal respnse t animal utbreaks and ensure minimum infectin f respnse team Recmmend measures t reduce human cntact with ptentially infected animals, and prepare use f further interventin if humans are infected Update infrmatin n available supplies f antivirals, prphylaxis and vaccines Health Prm and Agric Health Prm, Agric, Lcal Gv Pharm Plan Plicy Ensure natinal stckpile strategy fr deplyment at prvincial, district and municipal level Develp cntingency plans fr prcuring seasnal/specific vaccines fr distributin Pharm Plan Plicy, NORT Pharm Plan Plicy Establish mechanisms fr exchange f epidemilgical and virlgical data Epid, NORT, NICD, Agric Health System Respnse Objectives Activities Respnsible Cst [Rand] Ensure that if human infectins ccur, they will be quickly recgnised and that health systems will respnsed apprpriately Alert lcal health care prviders t cnsider new influenza infectin in ill patients with epidemilgical link t affected animals Implement infectin cntrl measures, reprt cases immediately and prvide algrithms t assist in case-finding and management NORT, NICD, CDC NORT, Prv/District ORT Verify availability and distributin prcedures fr persnal prtective equipment, antivirals and vaccines Prv/District ORT Ensure rapid deplyment f diagnstic tests r transprtatin f specimen t labratries Alert health system t review preparedness plans and prepare fr small numbers f patients fr islatin NHLS NORT, CDC Assess health system capacity t detect and cntain utbreak f human disease in hspital setting Prv ORT Influenza Pandemic Preparedness Plan: Suth Africa 27

30 Cmmunicatin Objectives Activities Respnsible Cst [Rand] Ensure that apprpriate infrmatin is shared rapidly amng health authrities and ther partners Ensure that messages are crdinated and standardised Establish rapid cmmunicatins t answer questins frm health care prviders and the public Cmmunicate infrmatin n risk and preventin [risk f infectin, safe fd, animal handling] based n WHO recmmendatins Health Prmtin, Cmmunicatin Health Prmtin, Cmmunicatin, Agric Address pssible stigmatisatin f individuals/ppulatins in cntact with animal strain Health Prmtin, Cmmunicatin, Agric Update natinal authrities, ther partners and stakehlders, including at-risk grups and public, with current infrmatin n virus spread and risk t humans Health Prmtin, Cmmunicatin Influenza Pandemic Preparedness Plan: Suth Africa 28

31 Pandemic Alert Perid: Phase 3 Overarching Gal: Ensure rapid characterisatin f the New Virus Subtype and Early Detectin, Ntificatin and Rapid Respnse Planning and Crdinatin Objectives Activities Respnsible Cst [Rand] Crdinate timely interventins t reduce the risk f nset f pandemic Ensure that mechanisms exist s that imminent ptential human health threats can be recgnised and dealt with Activate natinal pandemic cntingency planning arrangements Implement interventins t reduce burden in the initial fci and cntain r delay the spread f infectin NORT, CDC NORT, Prv/District ORT Brief apprpriate fficials in all relevant gvernment departments (e.g. health, agriculture, legislative) at all levels f gvernance Prvide assistance t prvincial and district authrities in implementing interventins NORT, Cmmunicatins NORT, CDC Situatin Mnitring and Assessment Objectives Activities Respnsible Cst [Rand] Early detectin and reprting f human-t-human transmissin and identificatin f risk factrs Cnfirm and reprt cases prmptly, excluding labratry incidents and intentinally released cases Determine the epidemilgy f human cases [surces, incubatin perids, infectin f cntacts, perid f cmmunicability] Establish natinal case definitin based n WHO guidelines Epidemilgy, NICD NICD, Epidemilgy NORT, NICD Assess clinical characterisatin f infectins in humans and share with relevant authrities/partners Ensure rapid characterisatin f viruses respnsible fr human infectin, and share infrmatin with partners CDC, NICD, ORTs NICD Enhance human/animal surveillance and cllabrate with internatinal partners in assessing the pathgenicity in humans Epidemilgy, Agric, NICD Identify gegraphical areas and risk grups fr targeting with preventive measures CDC, ORTs, Agric Assess effectiveness f treatment prtcls and infectin cntrl measures and cnduct ser-prevalence studies in risk grups and expand t general ppulatin [symptmatic/asymptmatic] Health care Wrkers, QA, Hsp services Influenza Pandemic Preparedness Plan: Suth Africa 29

32 Health Systems Respnse Objectives Activities Respnsible Cst [Rand] Prevent nscmial transmissin and labratry infectin Heighten awareness amng health care prviders regarding islated cases r clusters Activate JOC s and ORT s Train health wrkers t detect/identify cases Implement infectin cntrl and ensure labratry bisafety Explre strategies t fast-track deplyment f vaccines and prphylaxis JOC s, ORT s CDC, NICD NICD, QA, Hsp serv Pharm Plan Plicy Prvide case definitins, prtcls and algrithms Activate infectin cntrl cmmittees CDC, Hsp Serv Hsp Serv, QA, NICD Preventin and Cntainment Objectives Activities Respnsible Cst [Rand] Cntain r reduce human-t-human virus transmissin Limit mrbidity and mrtality assciated with current human infectins Increase readiness fr pssible pandemic develpment Activate Jint Operatins Cmmittees (natinal, prvincial and district) Explre ways t prvide drugs and medical care t patients in rder t encurage prmpt reprting f new cases Train health care wrkers t detect/identify clusters f cases CDC, ORTs, Pharm Plan Plicy ORT s Ensure implementatin f infectin cntrl prcedures t prevent nscmial transmissin Ensure cmpliance with standards fr bisafety in labratries and fr safe specimen handling CEOs f Hspitals NICD Prvide public and private health care with updated case definitins, prtcls and algrithms t assist with case finding, management, infectin cntrl and surveillance Assess capacity fr implementing infectin cntrl prcedures NORT Health Facil, QA, CEO Influenza Pandemic Preparedness Plan: Suth Africa 30

Hospital Preparedness Checklist

Hospital Preparedness Checklist Hspital Preparedness Checklist http://pandemicflu.gv Preparedness Subject 1. Structure fr planning and decisin making An internal, multidisciplinary planning cmmittee fr influenza preparedness has been

More information

H1N1 Influenza 09 Guidance for Residential Aged Care

H1N1 Influenza 09 Guidance for Residential Aged Care H1N1 Influenza 09 Guidance fr Residential Aged Care 11 June 2009 As knwledge abut H1N1 Influenza 09 develps, further advice will be prvided. Please check www.healthemergency.gv.au fr the latest infrmatin.

More information

CDC Influenza Division Key Points MMWR Updates February 20, 2014

CDC Influenza Division Key Points MMWR Updates February 20, 2014 CDC Influenza Divisin Key Pints MMWR Updates In this dcument: Summary Key Messages Seasnal Influenza Vaccine Effectiveness: Interim Adjusted Estimates Influenza Surveillance Update: September 29, 2013-February

More information

Pandemic H1N1 2009: DrillSafe Update. David Blizzard BD Manager, Energy Mining and Infrastructure

Pandemic H1N1 2009: DrillSafe Update. David Blizzard BD Manager, Energy Mining and Infrastructure Pandemic H1N1 2009: DrillSafe Update David Blizzard BD Manager, Energy Mining and Infrastructure Pandemic H1N1 Update CDC.Gv USA Pandemic H1N1 Summary Pints Virus cntinues t spread with nearly all WHO

More information

Swindon Joint Strategic Needs Assessment Bulletin

Swindon Joint Strategic Needs Assessment Bulletin Swindn Jint Strategic Needs Assessment Bulletin Swindn Diabetes 2017 Key Pints: This JSNA gives health facts abut peple with diabetes r peple wh might get diabetes in Swindn. This helps us t plan fr medical

More information

Improving Surveillance and Monitoring of Self-harm in Irish Prisons

Improving Surveillance and Monitoring of Self-harm in Irish Prisons HSE Mental Health Divisin Stewart s Hspital, Palmerstwn, Dublin 20 Tel: 01 6201670 Email: inf@nsp.ie www.nsp.ie Imprving Surveillance and Mnitring f Self-harm in Irish Prisns Prject Scpe Dcument 8 th June

More information

Response to. type 2 vaccine-derived polioviruses. prior to global topv withdrawal. Interim Guidelines

Response to. type 2 vaccine-derived polioviruses. prior to global topv withdrawal. Interim Guidelines Respnse t type 2 vaccine-derived pliviruses prir t glbal topv withdrawal Interim Guidelines August 2015 GPEI peratinal guidance nte August 2015 Summary Prepare fr prmpt actin fr any area r ppulatin at

More information

Recommendations for Risk Management at Swine Exhibitions and for Show Pigs August 2012

Recommendations for Risk Management at Swine Exhibitions and for Show Pigs August 2012 Recmmendatins fr Risk Management at Swine Exhibitins and fr Shw Pigs August 2012 Backgrund: The Natinal Prk Bard facilitated in develping this dcument. These recmmendatins were develped by a wrking grup

More information

UNIT 6. DEVELOPING THREAT/HAZARD-SPECIFIC ANNEXES

UNIT 6. DEVELOPING THREAT/HAZARD-SPECIFIC ANNEXES UNIT 6. DEVELOPING THREAT/HAZARD-SPECIFIC ANNEXES This page intentinally left blank. UNIT INTRODUCTION Visual 6.1 This unit presents infrmatin n annexes that shuld be included in a schl emergency peratins

More information

77 WHO/IPA workshop on Immunisation

77 WHO/IPA workshop on Immunisation 77 WHO/IPA wrkshp n Immunisatin cst/efficacy f either f them des nt justify their rutine use. Cntents f such diseases shuld be within the respnsibilities f the Epidemilgy Department. XVII INTERNATIONAL

More information

Full-time or part-time to a minimum of 0.8FTE (30 hours per week) Job Reference: CLS00161

Full-time or part-time to a minimum of 0.8FTE (30 hours per week) Job Reference: CLS00161 Jb Title: Medical Statistician Grade: 8 Salary: 42,418 t 47,722 per annum Department: Research Design Service (RDS) and Leicester Clinical Trials Unit (LCTU) Cntract: Open ended cntract subject t fixed

More information

CDC Influenza Division Key Points November 7, 2014

CDC Influenza Division Key Points November 7, 2014 In this dcument: Summary Key Messages FluView Activity Update LAIV Effectiveness and Vaccinatin f Children H3N2 Match and Vaccinatin Vaccine Supply Summary Key Messages This week s FluView reprt indicates

More information

CDC Influenza Technical Key Points February 15, 2018

CDC Influenza Technical Key Points February 15, 2018 CDC Influenza Technical Key Pints In this dcument: Summary Key Pints U.S. Vaccine Effectiveness U.S. Flu Activity Update Summary Key Pints On Thursday, tw influenza-related reprts appeared in the Mrbidity

More information

Key Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red.

Key Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red. Key Pints Entervirus D68 in the United States, 2014 Nte: Newly added infrmatin is in red. The United States is currently experiencing a natinwide utbreak f entervirus D68 (EV-D68) assciated with severe

More information

State Health Improvement Plan Choosing Priorities, Creating a Plan. DHHS DPH - SHIP Priorities (Sept2016) 1

State Health Improvement Plan Choosing Priorities, Creating a Plan. DHHS DPH - SHIP Priorities (Sept2016) 1 State Health Imprvement Plan 2017-2021 Chsing Pririties, Creating a Plan DHHS DPH - SHIP Pririties (Sept2016) 1 Creating a Plan: 2017-2021 SHIP Welcme! Wh s here? What is the State Health Imprvement Plan

More information

World Confederation for Physical Therapy Congress , May Singapore

World Confederation for Physical Therapy Congress , May Singapore Wrld Cnfederatin fr Physical Therapy Cngress 2015 1-4, May Singapre Call fr applicatins fr Chair f the Internatinal Scientific Cmmittee The Executive Cmmittee f WCPT invites applicatins and suggestins

More information

Palliative Medicine Specialist

Palliative Medicine Specialist Date: June 2017 Jb Title : Palliative Medicine Specialist Department : Palliative Care Services, Specialty Medicine & Health f Older Peple Divisin Lcatin : Nrth Shre Hspital primarily, althugh there may

More information

VCCC Research and Education Lead for Breast Cancer

VCCC Research and Education Lead for Breast Cancer VCCC Research & Educatin Lead VCCC Research and Educatin Lead fr VCCC Visin The Victrian Cmprehensive Cancer Centre (VCCC) will save lives thrugh the integratin f cancer research, educatin and clinical

More information

AUTHORISED BY: CEO. Introduction. Whistle Blowing

AUTHORISED BY: CEO. Introduction. Whistle Blowing GUIDELINE NAME: Field Cmplaints Disclsure Guidelines SECTION : Refer t Excel Guidelines list Dcument N: DISTRIBUTION: All Emplyees FIRST ISSUED: April 2013 DATE UPDATED: Dec 2014 ISSUED/UPDATED BY: Peple

More information

Strategic Plan Publication No: EO-SP

Strategic Plan Publication No: EO-SP Strategic Plan 2017-2019 Publicatin N: EO-SP-170223 +61 2 9036 5002 www.pcg.rg.au pcg.ffice@sydney.edu.au This dcument was prepared by the PCG Executive Office PCG Publicatin number: EO-SP-170223 Psych-nclgy

More information

Key Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red.

Key Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red. Key Pints Entervirus D68 in the United States, 2014 Nte: Newly added infrmatin is in red. Over the last several mnths, the United States has experienced a natinwide utbreak f entervirus D68 (EV- D68) assciated

More information

Commissioning Policy: South Warwickshire CCG (SWCCG)

Commissioning Policy: South Warwickshire CCG (SWCCG) Cmmissining Plicy: Suth Warwickshire CCG (SWCCG) Treatment Indicatin Criteria FreeStyle Libre Flash Cntinuus Glucse Mnitring System Type I Diabetes Prir apprval must be requested frm the Individual Funding

More information

Breast Cancer Awareness Month 2018 Key Messages (as of June 6, 2018)

Breast Cancer Awareness Month 2018 Key Messages (as of June 6, 2018) Breast Cancer Awareness Mnth 2018 Key Messages (as f June 6, 2018) In this dcument there are tw sectins f messages in supprt f Cancer Care Ontari s Breast Cancer Awareness Mnth 2018: 1. Campaign key messages

More information

Frequently asked questions: Influenza A (H1N1)v

Frequently asked questions: Influenza A (H1N1)v July 30 th 2009 V1.0 Frequently asked questins: Influenza A (H1N1)v (Swine Flu) infrmatin fr parents The fllwing advice is fr parents f children in all educatinal institutins, including crèches, childcare,

More information

The estimator, X, is unbiased and, if one assumes that the variance of X7 is constant from week to week, then the variance of X7 is given by

The estimator, X, is unbiased and, if one assumes that the variance of X7 is constant from week to week, then the variance of X7 is given by ESTIMATION PROCEDURES USED TO PRODUCE WEEKLY FLU STATISTICS FROM THE HEALTH INTERVIEW SURVEY James T. Massey, Gail S. Pe, Walt R. Simmns Natinal Center fr Health Statistics. INTRODUCTION In April 97, the

More information

Corporate Governance Code for Funds: What Will it Mean?

Corporate Governance Code for Funds: What Will it Mean? Crprate Gvernance Cde fr Funds: What Will it Mean? The Irish Funds Industry Assciatin has circulated a draft Vluntary Crprate Gvernance Cde fr the Funds Industry in Ireland. 1. Backgrund On 13 June 2011,

More information

STAKEHOLDER IN-DEPTH INTERVIEW GUIDE

STAKEHOLDER IN-DEPTH INTERVIEW GUIDE STAKEHOLDER IN-DEPTH INTERVIEW GUIDE PURPOSE The Stakehlder In-Depth Interview Guide cntributes t understanding the scale-up prcess by asking key stakehlders t evaluate what has been achieved in scaleup,

More information

WCPT awards programme 2015

WCPT awards programme 2015 WCPT awards prgramme 2015 The WCPT awards prgramme recgnises utstanding cntributins and leadership by individual physical therapists and grups t the prfessin and/r glbal health at an internatinal level.

More information

A fake medicine that passes itself off as a real, authorised medicine. (1)

A fake medicine that passes itself off as a real, authorised medicine. (1) Falsified medicines Index 1 Intrductin 2 Types f falsified medicines 3 Eurpean regulatin n falsified medicines 4 Risks f falsified medicines 5 Buying medicine nline safely 6 References 7 Further resurces

More information

Preventing and Responding to Emerging IDs the role of WHO

Preventing and Responding to Emerging IDs the role of WHO Preventing and Respnding t Emerging IDs the rle f WHO Mark Jacbs Directr, Divisin f Cmmunicable Diseases WHO Respnding t Emerging Infectius Diseases Sympsium 21st Public Health Summer Schl University f

More information

Chapter 6: Impact Indicators

Chapter 6: Impact Indicators Overview Chapter 6: Impact Indicatrs The best measure f the lng-term impact f all HIV preventin activities is the HIV incidence rate, namely the number f new cases f HIV infectin per year divided by the

More information

Ministry of Health and Long-Term Care

Ministry of Health and Long-Term Care Ministry f Health and Lng-Term Care Infrmatin n Nvel H1N1 Influenza A - Frequently Asked Questins fr Primary Care Practitiners May 7, 2009 This infrmatin is subject t change based n evlving infrmatin n

More information

Health action in crisis

Health action in crisis Health actin in crisis WHO Emergency Health Prgramme fr the Fd Crisis in Niger Situatin Reprt # 10 11 t 17 Octber 2005 Highlights Training f healthcare trainers and healthcare wrkers n the treatment f

More information

Health Screening Record: Entry Level Due: August 1st MWF 150 Entry Year

Health Screening Record: Entry Level Due: August 1st MWF 150 Entry Year Health Screening Recrd: Entry Level MIDWIFERY EDUCATION PROGRAM HEALTH SCREENING REQUIREMENTS (Rev. June 2017) 1. Hepatitis B: Primary vaccinatin series (3 vaccines 0, 1 and 6 mnths apart), plus serlgic

More information

FOUNDATIONS OF DECISION-MAKING...

FOUNDATIONS OF DECISION-MAKING... Table f Cntents FOUNDATIONS OF DECISION-MAKING... Errr! Bkmark nt Describe the decisin-making prcess pp.62-66... Errr! Bkmark nt Explain the three appraches managers can use t make decisins pp.67-70 Errr!

More information

ACSQHC National Consensus Statement: Essential Elements for High Quality End-oflife Care in Acute Hospitals.

ACSQHC National Consensus Statement: Essential Elements for High Quality End-oflife Care in Acute Hospitals. 27 March 2014 Prfessr Debra Picne Chief Executive Officer Australian Cmmissin n Safety and Quality in Health Care c/ Ms Jennifer Hill, Senir Prject Officer Level 5, 255 Elizabeth Street SYDNEY NSW 2000

More information

Assessment criteria for Primary Health Disciplines Eligibility for Recognition as Credentialled Diabetes Educator. December 2015 ADEA

Assessment criteria for Primary Health Disciplines Eligibility for Recognition as Credentialled Diabetes Educator. December 2015 ADEA Assessment criteria fr Primary Health Disciplines Eligibility fr Recgnitin as Credentialled Diabetes Educatr December 2015 ADEA ASSESSMENT CRITERIA FOR PRIMARY HEALTH DICIPLINES ELIGIBILITY FOR RECOGNITION

More information

Immunisation and Disease Prevention Policy

Immunisation and Disease Prevention Policy Immunisatin and Disease Preventin Plicy Quality Area 2: Children s Health and Safety 2.1 Each child s health is prmted 2.1.4 Steps are taken t cntrl the spread f infectius diseases and t manage injuries

More information

Building Community Resiliency: Ensuring Emergency Preparedness Medical Library Association Marriott Inner Harbor October 10, 2007 Baltimore, MD

Building Community Resiliency: Ensuring Emergency Preparedness Medical Library Association Marriott Inner Harbor October 10, 2007 Baltimore, MD Building Cmmunity Resiliency: Ensuring Emergency Preparedness Medical Library Assciatin Marritt Inner Harbr Octber 10, 2007 Baltimre, MD Gerges C. Benjamin, MD, FACP, FACEP (Emeritus) Executive Directr

More information

Medical Director of Palliative Care INFORMATION PACK

Medical Director of Palliative Care INFORMATION PACK Medical Directr f Palliative Care INFORMATION PACK CONTENTS: Selectin Criteria (please address in a cver letter) & Hw T Apply Cntext and Scpe HammndCare s Mtivatin, Missin and Missin in Actin (ur cre values)

More information

International Experts Meeting on Severe Accident Management in the Light of the Accident at the Fukushima Daiichi Nuclear Power Plant

International Experts Meeting on Severe Accident Management in the Light of the Accident at the Fukushima Daiichi Nuclear Power Plant IAEA-CN-233 Internatinal Experts Meeting n Severe Accident Management in the Light f the Accident at the Fukushima Daiichi Nuclear Pwer Plant Organized in cnnectin with the implementatin f the IAEA Actin

More information

CFS Private Sector modalities

CFS Private Sector modalities CFS Private Sectr mdalities APPROVED September 8, 2011 A. BACKGROUND 1. Fd security exists when all peple at all times have physical and ecnmic access t sufficient, safe and nutritius fd t meet their dietary

More information

This standard operating procedure applies to stop smoking services provided by North 51.

This standard operating procedure applies to stop smoking services provided by North 51. Authr Name/Title Melanie McIlvar, Bid Develpment Manager Authr Signature Date: 4 th September 2017 Apprver Name/Title Jasn Shelley, Grup Directr f QA/RA Apprver Signature Date: 4 th September 2017 Issue

More information

Position Title Diabetes Educator Program / Funding Stream Primary Health Care

Position Title Diabetes Educator Program / Funding Stream Primary Health Care P O S I T I O N P R O F I L E POSITION TITLE: Diabetes Educatr Psitin Title Diabetes Educatr Prgram / Funding Stream Primary Health Care Psitin Classificatin RAHP Leve 4 - Level 5 r NUR Level 3 - Level

More information

Campus Climate Survey

Campus Climate Survey Campus Climate Survey Executive Summary www.ecu.edu/ecyu 2016 A prject spnsred by the Office fr Equity and Diversity Executive Summary Prject Backgrund In FY 2013-2014, the Campus Climate Cmmissin prpsed

More information

MGPR Training Courses Guide

MGPR Training Courses Guide MGPR Training Curses Guide fiscal cde 92107050921 1. Descriptin The training prgram supprted by MGPR is prpsed by a grup f excellent mentrs/educatrs, accmplished in Pesticides Management and Analysis,

More information

Vaccine Information Statement: PNEUMOCOCCAL CONJUGATE VACCINE

Vaccine Information Statement: PNEUMOCOCCAL CONJUGATE VACCINE Vaccine Infrmatin Statement: PNEUMOCOCCAL CONJUGATE VACCINE Many Vaccine Infrmatin Statements are available in Spanish and ther languages. See www.immunize.rg/vis. Hjas de Infrmacián Sbre Vacunas están

More information

WHAT IS HEAD AND NECK CANCER FACT SHEET

WHAT IS HEAD AND NECK CANCER FACT SHEET WHAT IS HEAD AND NECK CANCER FACT SHEET This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice

More information

Completing the NPA online Patient Safety Incident Report form: 2016

Completing the NPA online Patient Safety Incident Report form: 2016 Cmpleting the NPA nline Patient Safety Incident Reprt frm: 2016 The infrmatin cntained within this dcument is in line with the current Data Prtectin Act (DPA) requirements. This infrmatin may be subject

More information

FIGHT DEMENTIA ACTION PLAN

FIGHT DEMENTIA ACTION PLAN FIGHT DEMENTIA ACTION PLAN DEMENTIA IS A HEALTH PRIORITY Dementia will be the majr health prblem f this century. Over ne millin Australians are already affected by the disease themselves r are caring fr

More information

Annual Assembly Abstract Review Process

Annual Assembly Abstract Review Process Annual Assembly Abstract Review Prcess AAHPM and HPNA cllabrate t review and select abstracts fr Annual Assembly. The cmmittees meet prir t the calls t review and update the Assembly bjectives (Planning

More information

Call Summary. The following conference events focused on female condoms:

Call Summary. The following conference events focused on female condoms: Call Summary Presentatin: Serra Sippel, president, Center fr Health and Gender Equity (CHANGE): Debriefing n Female Cndm Activities at the XVII Internatinal AIDS Cnference The attentin and activities devted

More information

Code of employment practice on infant feeding

Code of employment practice on infant feeding Cde f emplyment practice n infant feeding An Emplyer s guide t: Sectin 69Y f the Emplyment Relatins Act 2000 Frewrd As Minister f Labur, I am pleased t publish the Cde f Emplyment Practice n Infant Feeding.

More information

TASKFORCE REPORT AIMS TO BOOST CANCER SURVIVAL AND TRANSFORM PATIENT EXPERIENCE

TASKFORCE REPORT AIMS TO BOOST CANCER SURVIVAL AND TRANSFORM PATIENT EXPERIENCE Sunday 19 July, 2015 TASKFORCE REPORT AIMS TO BOOST CANCER SURVIVAL AND TRANSFORM PATIENT EXPERIENCE SIX STRATEGIC pririties have tday (Sunday) been recmmended by the Independent Cancer Taskfrce t help

More information

Frequently Asked Questions: IS RT-Q-PCR Testing

Frequently Asked Questions: IS RT-Q-PCR Testing Questins 1. What is chrnic myelid leukemia (CML)? 2. Hw des smene knw if they have CML? 3. Hw is smene diagnsed with CML? Frequently Asked Questins: IS RT-Q-PCR Testing Answers CML is a cancer f the bld

More information

Ontario 2018 provincial election issues backgrounder

Ontario 2018 provincial election issues backgrounder Ontari 2018 prvincial electin issues backgrunder Dietitians f Canada Pririties May 2018 Access t dietitians in Ontari s health system Diet is the #1 risk factr fr chrnic diseases that cst Ontari $90 billin

More information

DISCUSSION DRAFT DEVENTER, OCTOBER 2006 Consolidation of documents due for revision

DISCUSSION DRAFT DEVENTER, OCTOBER 2006 Consolidation of documents due for revision UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES DISCUSSION DRAFT DEVENTER, OCTOBER 2006 Cnslidatin f dcuments due fr revisin ARCHIVED: GENEVA, OCTOBER 2007 REPORT OF THE UEMS SECTION OF PSYCHIATRY Quality Assurance

More information

FDA Dietary Supplement cgmp

FDA Dietary Supplement cgmp FDA Dietary Supplement cgmp FEBRUARY 2009 OVERVIEW Summary The Fd and Drug Administratin (FDA) has issued a final rule regarding current gd manufacturing practices (cgmp) fr dietary supplements that establishes

More information

Recommendations for good practice in pandemic preparedness for National Influenza Centres

Recommendations for good practice in pandemic preparedness for National Influenza Centres Recmmendatins fr gd practice in pandemic preparedness fr Natinal Influenza Centres Evaluatin f hw pandemic preparedness activities aided Natinal Influenza Centres in the WHO Eurpean Regin in the respnse

More information

Lyme Disease Surveillance in North Carolina

Lyme Disease Surveillance in North Carolina Lyme Disease Surveillance in Nrth Carlina 2008-2014 Carl Williams DVM Megan Sanza MPH Cmmunicable Disease Branch Divisin f Nrth Carlina Public Health Lyme Disease Surveillance in Nrth Carlina 2008-2014

More information

Human papillomavirus (HPV) refers to a group of more than 150 related viruses.

Human papillomavirus (HPV) refers to a group of more than 150 related viruses. HUMAN PAPILLOMAVIRUS This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between

More information

PANDERIA: WHEN PANDEMIC LEADS TO PANIC

PANDERIA: WHEN PANDEMIC LEADS TO PANIC INGSA CASE STUDIES PANDERIA: WHEN PANDEMIC LEADS TO PANIC Tatjana Buklijas (INGSA/University f Auckland). 1 PANDERIA WHEN PANDEMIC LEADS TO PANIC A new highly cntagius viral disease, labelled Frest Respiratry

More information

Guidance for Applicants to the Global fund to Fight AIDS, TB and Malaria Round 8 Call for proposals 28 February 2008

Guidance for Applicants to the Global fund to Fight AIDS, TB and Malaria Round 8 Call for proposals 28 February 2008 Guidance fr Applicants t the Glbal fund t Fight AIDS, TB and Malaria Rund 8 Call fr prpsals 28 February 2008 Sexual Minrities Backgrund: The bard f the Glbal Fund t Fight AIDS, TB and Malaria at its 16

More information

Practicum Evaluation Form - Formative Assessment

Practicum Evaluation Form - Formative Assessment Practicum Evaluatin Frm - Frmative Assessment Candidate Name: Candidate ID#: Mentr/Principal Name: LEA/District: Cllege/University: Prgram Crdinatr: This frm is t be cmpleted and frmally shared with the

More information

Vaccine Information Statement: LIVE INTRANASAL INFLUENZA VACCINE

Vaccine Information Statement: LIVE INTRANASAL INFLUENZA VACCINE Vaccine Infrmatin Statement: LIVE INTRANASAL INFLUENZA VACCINE Many Vaccine Infrmatin Statements are available in Spanish and ther languages. See www.immunize.rg/vis. Hjas de Infrmacián Sbre Vacunas están

More information

Athabasca Health Authority Keewatin Yatthé Health Region Mamawetan Churchill River Health Region

Athabasca Health Authority Keewatin Yatthé Health Region Mamawetan Churchill River Health Region Athabasca Health Authrity Keewatin Yatthé Health Regin Mamawetan Churchill River Health Regin Nrthern Saskatchewan Health Indicatrs Reprt 2011 Summary Athabasca Health Authrity Keewatin Yatthé Health Regin

More information

Strategy and Action Plan for Engagement of Local Communities in Nature Conservation, Kemeri National Park

Strategy and Action Plan for Engagement of Local Communities in Nature Conservation, Kemeri National Park Strategy and Actin Plan fr Engagement f Lcal Cmmunities in Nature Cnservatin, Kemeri Natinal Park Jūrmala, 2014 1 Cntents Intrductin... 3 1. Backgrund fr the strategy... 3 2. Our cmmunities... 4 3 SWOT

More information

STANDARD OPERATING PROCEDURES (SOP) EXPANDING THE CONTINUUM OF CARE SATELLITE SITES

STANDARD OPERATING PROCEDURES (SOP) EXPANDING THE CONTINUUM OF CARE SATELLITE SITES STANDARD OPERATING PROCEDURES (SOP) EXPANDING THE CONTINUUM OF CARE SATELLITE SITES 1. Intrductin t Cntinuum f Care In 2003, the Ministry f Health f the Ryal Kingdm f Cambdia apprved the Cntinuum f Care

More information

The U.S. & The Global Fund to Fight AIDS, Tuberculosis and Malaria

The U.S. & The Global Fund to Fight AIDS, Tuberculosis and Malaria The U.S. & The Glbal Fund t Fight AIDS, Tuberculsis and Malaria The Glbal Fund t Fight AIDS, Tuberculsis and Malaria (Glbal Fund) is an independent, multilateral, financing entity designed t raise significant

More information

A. Catalonia World Health Organization Demonstration Project

A. Catalonia World Health Organization Demonstration Project A. Catalnia Wrld Health Organizatin Demnstratin Prject In 1989, the Health Department f Catalnia (Spain) and the Cancer Unit at the WHO (Geneva) designed and planned a demnstratin prject fr implementatin

More information

Cancer Association of South Africa (CANSA)

Cancer Association of South Africa (CANSA) Cancer Assciatin f Suth Africa (CANSA) Fact Sheet and Psitin Statement n Cannabis in Suth Africa Intrductin Cannabis is a drug that cmes frm Indian hemp plants such as Cannabis sativa and Cannabis indica.

More information

Exclusion of Key Populations and People Living with HIV from implementation of programmes 10 June To: CC:

Exclusion of Key Populations and People Living with HIV from implementation of programmes 10 June To: CC: Exclusin f Key Ppulatins and Peple Living with HIV frm implementatin f prgrammes 10 June 2016 T: CC: Mr. Nrbert Hauser, Chair f the Bard f the Glbal Fund t fight AIDS, TB and Malaria Ms. Aida Kurtvic,

More information

Measures to Minimize Influenza Transmission at Swine Exhibitions

Measures to Minimize Influenza Transmission at Swine Exhibitions Measures t Minimize Influenza Transmissin at Swine Exhibitins It is estimated that 150 millin peple visit agricultural fairs each year in Nrth America. Agricultural exhibitins prvide valuable educatinal

More information

British Sign Language (BSL) Plan October 2018 Scottish Charity Regulator

British Sign Language (BSL) Plan October 2018 Scottish Charity Regulator British Sign Language (BSL) Plan 2018-2024 Octber 2018 Scttish Charity Regulatr Cntents Sectin 1: Intrductin and cntext 1.1 Intrductin 1.2 Our wrk and what we d Sectin 2: Our BSL Plan 2.1 Scttish Public

More information

Assessment Field Activity Collaborative Assessment, Planning, and Support: Safety and Risk in Teams

Assessment Field Activity Collaborative Assessment, Planning, and Support: Safety and Risk in Teams Assessment Field Activity Cllabrative Assessment, Planning, and Supprt: Safety and Risk in Teams OBSERVATION Identify a case fr which a team meeting t discuss safety and/r safety planning is needed r scheduled.

More information

during Last Days of Life

during Last Days of Life Unit 36: Supprting Individuals during Last Days f Life Unit reference number: F/616/7374 Level: 3 Unit type: Optinal Credit value: 4 Guided learning hurs: 32 Unit summary Prmting respnsive care in the

More information

Alcohol & Substance Misuse Policy. St Mary s CE Academy Trading Company. Date: Spring 2017 Date of Next Review: Summer 2018

Alcohol & Substance Misuse Policy. St Mary s CE Academy Trading Company. Date: Spring 2017 Date of Next Review: Summer 2018 St Mary s CE Academy Trading Cmpany Alchl & Substance Misuse Plicy Date: Spring 2017 Date f Next Review: Summer 2018 Signed by: Family Supprt Crdinatr Signed by: Grup Manager Alchl and Substance Misuse

More information

What You Need to Know About ZIKA VIRUS

What You Need to Know About ZIKA VIRUS What Yu Need t Knw Abut ZIKA VIRUS Refugee and Immigrant Health Seminar Tuesday, Nvember 1, 2016 Malaya Fletcher, MPH Glbal Migratin & Mnitring Crdinatr PDPH Divisin f Disease Cntrl 1 Backgrund n Zika

More information

PANDEMIC INFLUENZA ANNEX L

PANDEMIC INFLUENZA ANNEX L THE SOUTHERN NEVADA HEALTH DISTRICT EMERGENCY OPERATIONS PLAN PANDEMIC INFLUENZA ANNEX L May 2009 1 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09 This page intentinally left blank. 2 Pandemic

More information

Castilion Primary School. Spiritual Moral Social and Cultural Education Policy

Castilion Primary School. Spiritual Moral Social and Cultural Education Policy Spiritual Mral Scial and Cultural Educatin Plicy Intrductin recgnises that the persnal develpment f pupils, spiritually, mrally, scially and culturally, plays a significant part in their ability t learn

More information

Submitted to the World Health Organisation. Date: 8 th March Contact:

Submitted to the World Health Organisation. Date: 8 th March Contact: Wrld Cancer Research Fund Internatinal input t the third rund f infrmal cnsultatins n the revised draft WHO glbal actin plan fr the preventin and cntrl f NCDs cvering the perid 2013 t 2020 Submitted t

More information

Structured Assessment using Multiple Patient. Scenarios (StAMPS) Exam Information

Structured Assessment using Multiple Patient. Scenarios (StAMPS) Exam Information Structured Assessment using Multiple Patient Scenaris (StAMPS) Exam Infrmatin 1. Preparing fr the StAMPS assessment prcess StAMPS is an assessment mdality that is designed t test higher rder functins in

More information

US Public Health Service Clinical Practice Guidelines for PrEP

US Public Health Service Clinical Practice Guidelines for PrEP Webcast 1.3 US Public Health Service Clinical Practice Guidelines fr PrEP P R E S ENTED BY: M A R K T H R U N, M D A S S O C I AT E P R O F E S S O R, U N I V E R S I T Y O F C O L O R A D O, D I V I S

More information

Continuous Quality Improvement: Treatment Record Reviews. Third Thursday Provider Call (August 20, 2015) Wendy Bowlin, QM Administrator

Continuous Quality Improvement: Treatment Record Reviews. Third Thursday Provider Call (August 20, 2015) Wendy Bowlin, QM Administrator Cntinuus Quality Imprvement: Treatment Recrd Reviews Third Thursday Prvider Call (August 20, 2015) Wendy Bwlin, QM Administratr Gals f the Presentatin Review the findings f Treatment Recrd Review results

More information

Meeting the Nutritional Requirements of Individuals with Dementia

Meeting the Nutritional Requirements of Individuals with Dementia Unit 15: Understanding and Meeting the Nutritinal Requirements f Individuals with Dementia Unit reference number: D/616/7124 Level: 3 Unit type: Optinal Credit value: 3 Guided learning hurs: 26 Unit summary

More information

PMI End Use Verification (EUV) Survey Uganda 31 May 2016

PMI End Use Verification (EUV) Survey Uganda 31 May 2016 PMI End Use Verificatin (EUV) Survey Uganda 31 May 2016 Date f cllectin: 25 th -30 th April 2016 # f facilities: 75 Regins: 4 Rainy seasn: (Nt applicable) Intrductin Malaria is the leading cause f mrtality

More information

Disaster relief emergency fund (DREF) Senegal: Yellow Fever Outbreak in Kedougou

Disaster relief emergency fund (DREF) Senegal: Yellow Fever Outbreak in Kedougou Disaster relief emergency fund (DREF) Senegal: Yellw Fever Outbreak in Kedugu DREF Operatin n MDRSN006 19 December, 2011 The Internatinal Federatin f Red Crss and Red Crescent (IFRC) Disaster Relief Emergency

More information

Statement of Work for Linked Data Consulting Services

Statement of Work for Linked Data Consulting Services A. Backgrund Infrmatin Statement f Wrk fr Linked Data Cnsulting Services The Natinal Library f Medicine (NLM), in Bethesda, Maryland, is a part f the Natinal Institutes f Health, US Department f Health

More information

Vaccine Impact Modelling Consortium

Vaccine Impact Modelling Consortium Vaccine Impact Mdelling Cnsrtium Annual meeting 2017 - Summary meeting reprt Windsr, UK February 28 March 2, 2017 Objectives f the Vaccine Impact Mdelling Cnsrtium The Vaccine Impact Mdelling Cnsrtium

More information

CHAPTER 2. HEALTH SERVICES

CHAPTER 2. HEALTH SERVICES CHAPTER 2. HEALTH SERVICES 2.1 Treatment f substance use disrders within health services Thmas F Babr and Kerstin Stenius Overview Since the end f the Secnd Wrld War there has been a cnsistent grwth f

More information

MSF Alert! 5 epidemics to watch in 2016

MSF Alert! 5 epidemics to watch in 2016 Geneva, 25 January 2016 MSF Alert! 5 epidemics t watch in 2016 Outbreaks f chlera, measles and meningitis are cmmn in resurce-pr settings, despite affrdable and efficient vaccinatins being available; high

More information

HOSA 105 EMERGENCY PREPAREDNESS

HOSA 105 EMERGENCY PREPAREDNESS HOSA 105 EMERGENCY PREPAREDNESS MODULE 2: MEDICAL RESERVE CORPS (MRC) PURPOSE The Medical Reserve Crps (MRC) is an imprtant part f the Citizen Crps. The prgram reprts directly t Surgen General f the U.S.

More information

A Phase I Study of CEP-701 in Patients with Refractory Neuroblastoma NANT (01-03) A New Approaches to Neuroblastoma Therapy (NANT) treatment protocol.

A Phase I Study of CEP-701 in Patients with Refractory Neuroblastoma NANT (01-03) A New Approaches to Neuroblastoma Therapy (NANT) treatment protocol. SAMPLE INFORMED CONSENT A Phase I Study f CEP-701 in Patients with Refractry Neurblastma NANT (01-03) A New Appraches t Neurblastma Therapy (NANT) treatment prtcl. The wrd yu used thrughut this dcument

More information

Code of Conduct for Employees

Code of Conduct for Employees Crprate Human Resurces Plicy Cntent Updated: 2016-06-22 Wrk Envirnment Plicy N: HR-01-09 Page 1 f 5 Apprval: 2014-09-24 Cde f Cnduct fr Emplyees POLICY STATEMENT The residents and businesses f the City

More information

Independent Charitable Patient Assistance Program (IPAP) Code of Ethics

Independent Charitable Patient Assistance Program (IPAP) Code of Ethics Independent Charitable Patient Assistance Prgram (IPAP) Cde f Ethics Independent charitable patient assistance prgrams (IPAPs) fcus n the needs f patients wh are insured, meet certain financial limitatin

More information

The data refer to persons aged between 15 and 54.

The data refer to persons aged between 15 and 54. Drug-related hspital stays in Australia 1993-2005 Prepared by Amanda Rxburgh and Luisa Degenhardt, Natinal Drug and Alchl Research Centre Funded by the Australian Gvernment Department f Health and Ageing

More information

Building Code 101 OWMC November 20, Ministry of Municipal Affairs and Housing

Building Code 101 OWMC November 20, Ministry of Municipal Affairs and Housing Building Cde 101 OWMC Nvember 20, 2015 Ministry f Municipal Affairs and Husing Disclaimer These slides are prvided by the Ministry f Municipal Affairs and Husing fr cnvenience nly The slides shuld nt be

More information

True Patient & Partner Engagement How is it done? How can I do it?

True Patient & Partner Engagement How is it done? How can I do it? True Patient & Partner Engagement Hw is it dne? Hw can I d it? GROUP TECHNICAL ASSISTANCE JANUARY 18, 2017 COLORADO FOUNDATION FOR PUBLIC HEALTH AND THE ENVIRONMENT Webinar Objectives 1. Describe patient

More information

Primary Health Networks Greater Choice for At Home Palliative Care Central Queensland Wide Bay Sunshine Coast PHN

Primary Health Networks Greater Choice for At Home Palliative Care Central Queensland Wide Bay Sunshine Coast PHN Primary Health Netwrks Greater Chice fr At Hme Palliative Care Central Queensland Wide Bay Sunshine Cast PHN Dcument cntrl 1 1. Planned activities funded under the Activity Primary Health Netwrks Greater

More information

EXECUTIVE SUMMARY INNOVATION IS THE KEY TO CHANGING THE PARADIGM FOR THE TREATMENT OF PAIN AND ADDICTION TO CREATE AN AMERICA FREE OF OPIOID ADDICTION

EXECUTIVE SUMMARY INNOVATION IS THE KEY TO CHANGING THE PARADIGM FOR THE TREATMENT OF PAIN AND ADDICTION TO CREATE AN AMERICA FREE OF OPIOID ADDICTION EXECUTIVE SUMMARY INNOVATION IS THE KEY TO CHANGING THE PARADIGM FOR THE TREATMENT OF PAIN AND ADDICTION TO CREATE AN AMERICA FREE OF OPIOID ADDICTION The Bitechnlgy Innvatin Organizatin (BIO) and ur member

More information