Risk Communication Table-top Exercise on novel influenza. Module E2

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1 Risk Communication Table-top Exercise on novel influenza Module E2 1

2 Module objective This is a resource package for those interested in organising a table top exercise to practice communication skills for a scenario on an outbreak of novel influenza This module comprises of 3 main parts: 1. Introduction 2. The scenario 3. Resources for exercise managers 2

3 1. INTRODUCTION This module is a table top exercise on emergency risk communication with a fictional scenario on an outbreak of a novel influenza This table top exercise is designed for health professionals, emergency responders and communicators to practice communication skills to deal with an outbreak of a novel influenza It is for teams to work separately to plan and develop response procedures and then report back to a larger group The exercise is designed to be carried out in 3-8 hours, depending on the number and types of tasks 3

4 Disclaimer This is a fictional scenario intended to serve as the basis for training discussions. The contents of this scenario do not represent the views of any organizations or WHO. 4

5 2. SCENARIO Map of Sohara 5

6 Background -1 Sohara country profile Basic information The country has an estimated population of 30,500,000 There are over 30 ethnic groups - each with its own unique language. English and Arabic however, are the official languages. The principal religions are Islam, Christianity and Traditional beliefs. State of the Economy The World's Fastest Growing Economy in 2013 (Banker Magazine, July 2014; Economy Watch, August 2014) Sohara s Labor force is 11.5 million people Now a Middle Income Economy endowed with natural resources Major oil discovery off the coast of Sohara in 2007 has led to significant international commercial interest in the country Oil accounted for 6% of the revenue for

7 Background 2 Sohara state of the economy Sohara trade with the world 7

8 Background 3 Sohara import-export Commodity Exports Commodity Exports Commodity Imports 8

9 Background 4 Sohara health profile 9

10 Background 5 Children health profile 10

11 Background 6 Millennium development goals (MDGs) 11

12 Background 7 Health services and expenditure 12

13 Background 7 Adult health risks 13

14 Background 9 Top 10 causes of death 14

15 Background 10 Sohara epidemiological records Disease trends Malaria accounts for about 30-40% of outpatient visits and about 20% of all deaths in the country Outbreaks of Cholera, cerebraspinal meningitis and yellow fever are among the top causes of deaths and disability each year. Challenges The poor hygiene and sanitation conditions Low quality of air, water and soil No infrastructure for waste management 3 in 5 people have access to potable water 15

16 Inject -1 Influenza caused by a new subtype has been identified in humans in your neighbouring country WHO confirms that a novel strain of influenza is circulating in your neighbouring country - Bamboka. Your country shares a land border with Bamboka and people from the two countries travel through three main (road) border crossings, but many informal border crossings exist. Your country generally enjoys good relations with Bamboka and trade and travel between the two countries has been booming in the last three years. Trade with Bamboka is an important part of your country s economy and a major source of income from agricultural exports. There are at least 12,000 citizens of your country who are migrant workers in Bamboka. WHO has facilitated shipment of samples from Bamboka to the WHO reference laboratory which has identified the new influenza strain as A(H5N10). This strain has been circulating among avian populations for some time killing especially baby chickens. WHO is monitoring human cases of A(H5N10) closely to see if other countries, including in other continents, are being affected as this would trigger the announcement of a global pandemic influenza. Most of the cases are in the capital city of Samura, with a small number of cases in two of three four main suburbs. Today health authorities reported 155 hospitalized patients including 19 deaths. The Bamboka authorities have just made a public statement about the New Flu in capital suburban area. 16

17 Inject 2- Media article from Shasha news agency Tackling resurgence of bird flu in Sohara Currently, the biggest threat that bird flu poses to Sohara is an economic one. If the situation turns out that people become irrationally afraid and stop consuming chicken like in 2007 is repeated, it can cause doom for poultry farming. Just as the animal health component of the Avian Influenza Control Project has been reactivated, it is better to also reactivate the communication component now as information is key to disease control. Communication component needs to start working simultaneously as animal health workers go about passive and active surveillance of farms to collect samples and other needful. Accurate and effective dissemination of information is quite vital, especially now that the situation is manageable and containable. At this stage, it is important that Soharans understand that bird flu is currently a low risk health threat and that one cannot get the flu from properly cooked chicken. There is need to reactivate public campaigns on practices that pre-dispose people to bird flu. It is important for people to know that some birds such as ducks can actually get and spread the disease without ever showing signs of illness. People need to be reminded about signs and symptoms of bird flu. There is need to harp on need for behavioural change from harmful traditional practices that involve the use of birds and their blood. Public education should commence for the public to be conscious of the fact that it is only infected birds, their feathers, faeces and other wastes that pose risk, to avoid needless fear. Appropriate authority should do the needful on importation of frozen chickens and illegal routes of poultry production importation. It is bad enough that importation of the products impact negatively on local farmers, but it would be a disaster if we import bird flu to add to the myriad of issues competing for attention in the country. 17

Continued - Inject 2 Since the majority of poultry farmers are backyard farmers with low level of poultry disease management, surveillance and education should now be a daily affair.

18 Continued - Inject 2 Since the majority of poultry farmers are backyard farmers with low level of poultry disease management, surveillance and education should now be a daily affair. Mentality of an average farmer, as we can infer from the experience, is to sell at lower price when they experience sudden sickness and death of chickens rather than report strange signs of sickness in birds to appropriate authority. Bird flu, just like other poultry disease management, involves taking steps to ensure good hygiene and increasing the standards of cleanliness as well as containment to reduce the risk of introducing disease into a flock. For poultry farmers, application of standard security measures is vital in protecting poultry birds from the disease. The focus on security is to maintain and improve the health status of animal and prevent the introduction of new disease pathogens by assessing all possible risks to animal health. It is a standard disease prevention practice to ensure that poultry farms are distanced from public roads, from pond or lake and has a gate that restricts vehicle access. If a vehicle must enter a farm, it should be ensured that such vehicle is disinfected. Photo caption: Workers from the Animal Protection Ministry cull chickens to contain an outbreak of bird flu in Sohara. Photo: REUTERS/Luc Gnago 18

19 Continued - Inject 2 Also, it is recommended that government should train poultry farmers on regular basis based on biosecurity, disease prevention and the adoption of modern husbandry practices. Mitigation option through the use of livestock insurance policy is very low among poultry farmers in Sohara. Government should formulate a policy that will make livestock insurance more affordable to poultry farmers by increasing the present level of subsidy granted for livestock insurance cover. Also, there should be adequate dissemination of knowledge on the benefits of livestock insurance to increase the level of participation of poultry farmers in the use of livestock insurance to militate against disease outbreak in poultry enterprise. Now that the disease is still under control the best drug we can administer right now is information, education, enlightenment and communication. A healthy bird is safe and good to eat. Egg and chicken could help boost the life expectancy of Soharans. But family, restaurants, hotels and super markets in the country noted for fast food business that involve the sale of products like chicken, burger, egg bonce among others should be on alert. 19

20 Inject 3 Fact sheet on avian influenza key facts Avian influenza (AI), commonly called bird flu, is an infectious viral disease of birds. Most avian influenza viruses do not infect humans; however some, such as A(H5N1) and A(H7N9), have caused serious infections in people. Outbreaks of AI in poultry may raise global public health concerns due to their effect on poultry populations, their potential to cause serious disease in people, and their pandemic potential. Reports of highly pathogenic AI epidemics in poultry, such as A(H5N1), can seriously impact local and global economies and international trade. The majority of human cases of A(H5N1) and A(H7N9) infection have been associated with direct or indirect contact with infected live or dead poultry. There is no evidence that the disease can be spread to people through properly cooked food. Controlling the disease in animals is the first step in decreasing risks to humans. Avian influenza (AI) is an infectious viral disease of birds (especially wild water fowl such as ducks and geese), often causing no apparent signs of illness. AI viruses can sometimes spread to domestic poultry and cause large-scale outbreaks of serious disease. Some of these AI viruses have also been reported to cross the species barrier and cause disease or subclinical infections in humans and other mammals. AI viruses are divided into 2 groups based on their ability to cause disease in poultry: high pathogenicity or low pathogenicity. Highly pathogenic viruses result in high death rates (up to 100% mortality within 48 hours) in some poultry species. Low pathogenicity viruses also cause outbreaks in poultry but are not generally associated with severe disease. 20

21 Inject 4 Fact sheet Avian influenza A(H5N1) and A(H7N9) The A(H5N1) virus subtype, a highly pathogenic AI virus, first infected humans in 1997 during a poultry outbreak in Hong Kong SAR, China. Since its widespread re-emergence in 2003 and 2004, this avian virus has spread from Asia to Europe and Africa and has become entrenched in poultry in some countries, resulting in millions of poultry infections, several hundred human cases, and many human deaths. Outbreaks in poultry have seriously impacted livelihoods, the economy and international trade in affected countries. The A(H7N9) virus subtype, a low pathogenic AI virus, first infected 3 humans 2 residents of the city of Shanghai and 1 resident of Anhui province - in March No cases of A(H7N9) outside of China have been reported. Containment measures, including the closure of live bird markets for several months, have impacted the agriculture sectors of affected countries and international trade. Continued surveillance for A(H7N9) will be necessary to detect and control the spread of the virus. Ongoing circulation of A(H5N1) and A(H7N9) viruses in poultry, especially where endemic, continues to pose threats to public health, as these viruses have both the potential to cause serious disease in people and may have the potential to change into a form that is more transmissible among humans. Other influenza virus subtypes also circulate in poultry and other animals, and may also pose potential threats to public health. 21

22 Inject 5 Avian influenza A(H5N1) and A(H7N9) infections and clinical features in humans The case fatality rate for A(H5N1) and A(H7N9) virus infections in people is much higher compared to that of seasonal influenza infections. The A(H7N9) virus particularly affects people with underlying medical conditions. In many patients, the disease caused by the A(H5N1) virus follows an unusually aggressive clinical course, with rapid deterioration and high fatality. Like most emerging disease, A(H5N1) influenza in humans is not well understood. The incubation period for A(H5N1) avian influenza may be longer than that for normal seasonal influenza, which is around 2 to 3 days. Current data for A(H5N1) infection indicate an incubation period ranging from 2 to 8 days and possibly as long as 17 days. Current data for A(H7N9) infection indicate an incubation period ranging from 2 to 8 days, with an average of five days. 1 WHO currently recommends that an incubation period of 7 days be used for field investigations and the monitoring of patient contacts. Initial symptoms include high fever, usually with a temperature higher than 38 C, and other influenza-like symptoms (cough or sore throat). Diarrhea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums have also been reported as early symptoms in some patients. One feature seen in many patients is the development of lower respiratory tract early in the illness. Respiratory distress, a hoarse voice, and a crackling sound when inhaling are commonly seen. Sputum production is variable and sometimes bloody. 2 Complications of A(H5N1) and A(H7N9) infection include hypoxemia, multiple organ dysfunction, and secondary bacterial and fungal infections. 3 22

23 Inject 6 Antiviral treatment Evidence suggests that some antiviral drugs, notably oseltamivir, can reduce the duration of viral replication and improve prospects of survival. In suspected cases, oseltamivir should be prescribed as soon as possible (ideally, within 48 hours following symptom onset) to maximize its therapeutic benefits. However, given the significant mortality currently associated with A(H5N1) and A(H7N9) infection and evidence of prolonged viral replication in this disease, administration of the drug should also be considered in patients presenting later in the course of illness. The use of corticosteroids is not recommended. In cases of severe infection with the A(H5N1) or A(H7N9) virus, clinicians may need to consider increasing the recommended daily dose or/and the duration of treatment. In severely ill A(H5N1) or A(H7N9) patients or in patients with severe gastrointestinal symptoms, drug absorption may be impaired. This possibility should be considered when managing these patients. 4 Moreover, most A(H5N1) and A(H7N9) viruses are predicated to be resistant to adamantine antiviral drugs, which are therefore not recommended for use. 23

24 Inject 7 Risk factors for human infection The primary risk factor for human infection appears to be direct or indirect exposure to infected live or dead poultry or contaminated environments, such as live bird markets. Controlling circulation of the A(H5N1) and A(H7N9) viruses in poultry is essential to reducing the risk of human infection. Given the persistence of the A(H5N1) and A(H7N9) viruses in some poultry populations, control will require long-term commitments from countries and strong coordination between animal and public health authorities. There is no evidence to suggest that the A(H5N1)and A(H7N9) viruses can be transmitted to humans through properly prepared poultry or eggs. A few A(H5N1) human cases have been linked to consumption of dishes made of raw, contaminated poultry blood. However, slaughter, defeathering, handling carcasses of infected poultry, and preparing poultry for consumption, especially in household settings, are likely to be risk factors. 24

Inject 8 Human pandemic potential Influenza pandemics (outbreaks that affect a large proportion of the world due to a novel virus) are unpredictable but recurring events that can have health,

25 Inject 8 Human pandemic potential Influenza pandemics (outbreaks that affect a large proportion of the world due to a novel virus) are unpredictable but recurring events that can have health, economic and social consequences worldwide. An influenza pandemic occurs when key factors converge: an influenza virus emerges with the ability to cause sustained human-to-human transmission, and the human population has little to no immunity against the virus. With the growth of global trade and travel, a localized epidemic can transform into a pandemic rapidly, with little time to prepare a public health response. The A(H5N1) and A(H7N9) AI viruses remain two of the influenza viruses with pandemic potential, because they continue to circulate widely in some poultry populations, most humans likely have no immunity to them, and they can cause severe disease and death in humans. However, whether the influenza A(H7N9) virus could actually cause a pandemic is unknown. Experience has shown that some animal influenza viruses that have been found to occasionally infect people have not gone on to cause a pandemic while others have done so. Surveillance and the investigations now underway will provide some of the information needed to make this determination. In addition to A(H5N1) and A(H7N9), other animal influenza virus subtypes reported to have infected people include avian H9, and swine H1 and H3 viruses. H2 viruses may also pose a pandemic threat. Therefore, pandemic planning should consider risks of emergence of a variety of influenza subtypes from a variety of sources. 25

26 Task 1 Based on the developments in the neighbouring country, your Ministry of Health has set up an internal task force to plan and prepare for a potential human case in your country. Your team has been asked to take responsibility of the ministry's work in emergency risk communication. Your task is to outline a plan for emergency risk communication and present it to the task force in tomorrow's meeting. Here are some guiding questions for you to consider for your preparation: What is the core risk communication objective for this work What is your key advice to the minister and the task force on best risk communication practices? Who are your key stakeholders, partners? How and when should you involve them? What should you do to obtain information from and address concerns of the population? 26

27 Inject 9 Concern about avian influenza is growing in your country. Rumours are spreading that there are human cases with the new flu but not officials are not reporting them due to concerns over its implications on the economic impact to the food export. The Ministry of Health is working hard to set up a surveillance system which includes an early warning system and hospital based surveillance. The Ministry of Health is also working closely with the animal health officials to obtain information on animal surveillance in a timely manner. The Ministry of Health has also put out advice to cook poultry well before consumption 27

28 Inject 10 Examples of posters used in other countries Source: UN Pakistan 28

29 Continued Inject 10 Source: Source: nzaresources/files/mm-re pdf 29

30 Task 2 Your minister has asked you to prepare 3 sets of key messages: For the minister's press briefing with the media For developing communication materials for the public For a joint meeting with other sectors of the government, including animal health, trade and education Use the template on the next slide to work on your key messages 30

31 KEY MESSAGES Press briefing General public Coordination meeting with other sectors

Inject 11 BREAKING NEWS Suhara reports 5 suspected human cases with novel flu Suhara Three people, all of whom are young healthy men have died after being in contact with poultry in a farm in the

Additionally, two people, including a man and a woman are hospitalised, on suspicion of similar infection.

32 Inject 11 BREAKING NEWS Suhara reports 5 suspected human cases with novel flu Suhara Three people, all of whom are young healthy men have died after being in contact with poultry in a farm in the town bordering Barry, which also has its borders with Bamboka where the new strain of bird flu is spreading. Additionally, two people, including a man and a woman are hospitalised, on suspicion of similar infection. WHO earlier announced that Bamboka has confirmed cases of human infection with the novel influenza virus identified as A(H5N10). A local health authority who have asked not be identified revealed that the suspicion has been building up since the last two weeks, when the local community noted deaths among chickens in several farms in the towns neighbouring Barry. The local health authority has also warned people with weakened immunity, such as the elderly, children and pregnant women, not to visit wet markets where live poultry is sold. A(H5N10) is a bird flu strain first reported to have infected humans in Bamboka since the last 6 months. It is most likely to strike in winter and spring. The world's first human A(H5N10) infection was reported last year Chazegen, a populated country with high poultry export. The infection occurred in a 26-year-old housewife who died. 32

33 Task 3 Based on the rapidly evolving situation, the Minister of Health has asked you to: 1. Prepare talking points on the latest update on the situation and on the health advice the government is giving to the public 2. The minister has asked you to be on standby to represent him in either a press conference or a meeting with key partners, including donors 3. Draft a statement to be shared with the media and partners 33

34 Debriefing & wrapping up of the scenario Reconvene in the large group. Discuss the experiences and skills practiced by the participants in the following areas: Risk communication priorities and objectives Stakeholder analysis Message development Social media Engaging with communities Working with the media / Press conference 34

35 3. RESOURCES FOR EXERCISE MANAGERS Some background on table top exercise (TTX) This is a discussion-based session Based on a fictional emergency scenario Run in an informal, stress-free environment The situation develops through injects in the scenario The facilitator guides the participants to discuss their role in the scenario and their responses to the evolving situation Participants examine discuss the problems; identify various areas where plans should be refined; and produce solutions Discuss the produces for evaluation, validation and updating of preparedness and response plans 35

36 Benefits of a TTX 1. TTX can facilitate training, evaluate tools and processes, look at decisionmaking and overall teamwork in the emergency response team 2. It is run in a safe environment to practice where participants are able to apply what they know and what they have learnt 3. It is a tool for participants to assess how they work under pressure with little or no information with multiple demands 4. It is an opportunity for the participants to learn from eachother, learn about themselves and about ways to improve their risk communication skills in a crisis situation 36

37 Hand-outs and injects The scenario, background and injects should be handed out in print to the participants Allow sufficient time for the participants to go through the information and discussion Mark 'Exercise-Exercise-Exercise' on all materials used for the table top exercise 37

For more information on WHO risk communication simulation exercise WHO Risk Communication Simulation Exercises www.who.

38 For more information on WHO risk communication simulation exercise WHO Risk Communication Simulation Exercises Comments and suggestions for improvement are welcome! 38

AVIAN FLU BACKGROUND ABOUT THE CAUSE. 2. Is this a form of SARS? No. SARS is caused by a Coronavirus, not an influenza virus.

AVIAN FLU BACKGROUND ABOUT THE CAUSE. 2. Is this a form of SARS? No. SARS is caused by a Coronavirus, not an influenza virus. AVIAN FLU BACKGROUND 1. What is Avian Influenza? Is there only one type of avian flu? Avian influenza, or "bird flu", is a contagious disease of animals caused by Type A flu viruses that normally infect