Expert answer:Public health plan Pandemic Flu Case Analysis
Solved by verified expert:Peruse the Pennsylvania Pandemic Flu Plan. No disaster plan is without flaws or weaknesses. Based on your knowledge of disaster mitigation and response, as well as your knowledge of public health, design a tool which could be used by the PA Department Of Health (DOH) as an instructional guide to their county offices on how they plan to handle an influenza pandemic. As part of this guide, present at least 5 weaknesses or potential weaknesses that you find here. Additionally, comment on how and why personnel in county public health offices may be overwhelmed during a pandemic and what tasks they would have to address to assist in response to and mitigation of the disaster.Please first read the Influenza pandemic response plan in the PAP fluplan document, then read the other three articles to expand your thoughts about pandemics. Important notes: 1- You can use FEMA.gov materials to emphasize your understanding of disaster mitigation and response. 2- It should be 3-4 pages. 3- Please carefully read the requirements of this assignment and comprehensively read the materials that I attached. 4- Use APA format for citation.
papandemicfluplan.pdf
sars.pdf
swine_flu.pdf
bird_flu.pdf
Unformatted Attachment Preview
Table of Contents
Page
Preface…………………………………………………………………………………………………………………….. . i
List of Attachments …………………………………………………………………………………………………… . ii
Abbreviations Used in This Document ………………………………………………………………………… .iii
I.
Purpose……………………………………………………………………………………………………………………. .1
II.
Authority and Responsibilities ……………………………………………………………………………………. .1
III.
Situation and Assumptions…………………………………………………………………………………………. .2
IV.
Concept of Operations……………………………………………………………………………………………….. .4
Command Management
Roles and Responsibilities
V.
Influenza Pandemic Response Actions ………………………………………………………………………… .6
Interpandemic Period
Pandemic Alert Period
Pandemic Period
Post-Pandemic Period
VI.
Pandemic Influenza Surveillance ………………………………………………………………………………… .7
VII. Laboratory Diagnostics ……………………………………………………………………………………………… 17
VIII. Emergency Response ………………………………………………………………………………………………… 21
Health care Planning
IX.
Community Disease Control and Prevention ………………………………………………………………… 27
Isolation and Quarantine/Community Containment
Travel Management
X.
Distribution of Vaccines and Antivirals……………………………………………………………………….. 35
Clinical Guidelines
XI.
Public Health Communications………………………………………………..………. ……… 41
XII. Workforce Support………………………………………………..………. ………………………. 46
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Preface
Pandemic is defined as a disease affecting or attacking the population of an extensive region,
including several countries, and/or continent(s). It is further described as extensively epidemic.
Before the advent of Severe Acute Respiratory Syndrome (SARS), influenza viruses were
considered to be unique in their ability to cause sudden, pervasive illness in all age groups on a
global scale. While the World Health Organization (WHO) and the Centers for Disease Control
and Prevention (CDC) have not characterized SARS as a pandemic, its potential has been clearly
established, adding a new dimension to the pandemic threat.
Three influenza “pandemics” occurred during the last century, one of which, the infamous
“Spanish flu” of 1918, was responsible for more than 20 million deaths worldwide, including an
estimated 450,000 in the United States. Many of those affected were healthy young adults. The
development of vaccines, antiviral drugs and other medical advances has provided new tools in
the fight against emerging diseases, but only provides limited impact. Existing influenza vaccine
only protects against previously circulating strains of the disease. About six to nine months are
required to develop a vaccine in response to a newly identified strain, a period during which the
entire population is vulnerable. Experience with SARS (for which no effective treatment has
been discovered) has reminded us of the speed at which disease can be spread throughout the
world. It is generally acknowledged that production capacity for antiviral medications will not
be adequate to meet worldwide demand. On the positive side, the available pneumococcal
vaccine can reduce the incidence of some complications that can result from influenza.
The response to, and mitigation of, the health and social consequences of a pandemic will take
place at both the state and local levels, with the Pennsylvania Department of Health
(Department) assuming the lead for the public health response. The Influenza Pandemic
Response Plan (IPRP) addresses the unique challenges that could rapidly unfold. The IPRP will
be integrated into the Department’s Emergency Preparedness and Response Plan.
The IPRP details the phases of a pandemic; identifies the roles and responsibilities of key public
health responders for the operational components to include surveillance; medical/emergency
response; vaccine/pharmaceutical procurement, distribution and administration; and
communications and education. It also identifies command and control, policy, legal authorities
and organizational structures that facilitate pandemic response activities. The plan is based on
the influenza model but could be adapted for use in response to other pandemic situations.
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List of Attachments
Attachment A
Department of Health’s Organizational Chart
Attachment B
Statutory Authority
Attachment C
Pandemic Alert & Pandemic Period Flow Chart
Attachment D
Interim Guidance for the Implementation of CDC and OSHA
Avian Influenza Public Health Recommendations (DRAFT)
Attachment E
Bureau of Epidemiology Response Tasks
Attachment F
Influenza Testing at the Bureau of Laboratories
Attachment G
Emergency Medical Services Emergency Response Plan
Attachment H
Points of Dispensing (POD) Template Plan
Attachment I
Emergency Medical Services Infection Control Guidelines
Attachment J
Command Center Organizational Chart
Attachment K
Notice to Assist Pennsylvania Hospitals to Accommodate
Increased Inpatient Demands Related to Influenza 2004-05
Attachment L
Priority Vaccination Distribution
Attachment M
Priority Antiviral Distribution
Attachment N
Office of Communications – Chain of Command
Attachment O
Office of Communications – Communication Strategies
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Abbreviations Used in This Document
BCHS
Bureau of Community Health Systems
BOE
Bureau of Epidemiology
BOL
Bureau of Laboratories
CDC
Centers for Disease Control and Prevention
CENIC
Commonwealth Emergency Network Information Center
CISM
Critical Incident Stress Management
CMHD
County and Municipal Health Departments
CPPR
Counterterrorism Planning Preparedness and Response Act
DAAC/DNCF
Division of Acute and Ambulatory Care/Division of Nursing Care
Facilities
DCORT
Disaster Crisis Outreach and Referral Teams
Department
Pennsylvania Department of Health
DPCL
Disease Prevention and Control Law
DPW
Department of Public Welfare
ED
Emergency Department
EMS
Emergency Medical Services
EpiX
Epidemic Information Exchange
EPRP
Emergency Preparedness and Response Plan
FEOC
Forward Emergency Operations Center
HRSA
Health Resources Services Administration
ICP
Infection Control Practitioner
ICS
Incident Command System
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Abbreviations Used in This Document (cont’d)
IDE
Infectious Disease Epidemiology
ILI
Influenza-Like Illness
IPRP
Influenza Pandemic Response Plan
ISPN
Influenza Sentinel Provider Surveillance Network
LMS
Learning Management System
NIMS
National Incident Management System
OMHSAS
Office of Mental Health and Substance Abuse Services
OTC
Over-the-Counter
PA HAN
Pennsylvania Health Alert Network
PA-NEDSS
Pennsylvania National Electronic Disease Surveillance System
PA SNS
Pennsylvania Strategic National Stockpile
PCR
Polymerase Chain Reaction
PEMA
Pennsylvania Emergency Management Agency
POD
Point of Dispensing
PPE
Personal Protective Equipment
ProMed
Program for Monitoring Diseases
RODS
Real-time Outbreak and Disease Surveillance System
SARS
Severe Acute Respiratory Syndrome
Secretary
Secretary of Health
SEOC
State Emergency Operations Center
SIIS
Statewide Immunization Information System
SNS
Strategic National Stockpile
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Abbreviations Used in This Document (cont’d)
UCS/ICS
Unified Command System/Incidence Command System
VAERS
Vaccine Adverse Events Reporting System
VFC
Vaccines For Children
VIS
Vaccine Information Statements
WHO
World Health Organization
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I.
PURPOSE
A.
The purpose of Pennsylvania’s Influenza Pandemic Response Plan (IPRP) is to
provide a framework, methodology and recommendations for pandemic
preparedness actions at the federal, state and local levels and is intended to
provide pandemic disease prevention strategies.
B.
The IPRP uses the terms “Federal,” “State” and “Local” as headings to
distinguish between responsibilities carried out by various agencies during an
influenza pandemic:
1.
2.
3.
C.
II.
Federal: Activities carried out by any federal government agency that
possesses a role in the planning, response or recovery phases of an
influenza pandemic.
State:
Activities carried out by the Pennsylvania Department of Health
(hereinafter “the Department”) during the phases of the influenza
pandemic.
Local:
Activities carried out by local health jurisdictions during the
phases of the influenza pandemic.
For purposes of the IPRP, “local health jurisdiction” means the Department’s six
district Offices, the State Health Centers, and the six County and four Municipal
Health Departments.
AUTHORITY AND RESPONSIBILITIES
A.
The Governor is responsible for addressing threats to this Commonwealth and its
citizens presented by disasters. Responsibilities and authority of the Governor
include:
1.
2.
3.
4.
5.
6.
B.
Declaration of disaster emergency;
Activation of disaster response;
Suspension of certain regulatory statutes;
Utilization and redirection of state and local government resources;
Requisition or utilization of any public, quasi-public or private property, if
necessary to cope with the disaster; and
Direction and requirements for evacuations and access control to disaster
areas.
The Department (Attachment A) is responsible for the health of the
Commonwealth’s entire population. The Secretary of Health (hereinafter
“Secretary”) has the authority to determine and employ the most efficient and
practical means necessary for the prevention and control of the spread of disease.
(See 71 P.S. §§ 532(a) and 1403(a)). Responsibilities and authority for the
Secretary include:
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III.
1.
Coordinated activation of the response and recovery aspects of any and all
applicable state, county and local response plans with the Pennsylvania
Emergency Management Agency (hereinafter “PEMA”); and
2.
Authorization of the furnishing of aid and assistance as detailed in
Attachment B.
C.
Authorities relevant to Emergency Medical Services (hereinafter “EMS”) are
detailed in the Department’s Emergency Preparedness Response Plan.
D.
The Department of Public Welfare is responsible for the coordination of mental
health services in the event of an emergency.
E.
Specific authorities in support of Commonwealth agencies, with a role in
responding to an influenza pandemic, are provided in the Commonwealth
Emergency Operations Plan.
SITUATION AND ASSUMPTIONS
A.
Background
1. Influenza, also known as “the flu,” is a contagious disease that is caused by
the influenza virus and most commonly attacks the respiratory tract in
humans. The flu is not a cold. Flu usually comes on suddenly, starting with a
sore throat, fever, headache, and profound fatigue, followed by dry cough,
body aches, prostration, and possibly nausea/vomiting. There are three main
types of influenza viruses: A, B, and C. Influenza Type C causes only mild
disease and has not been associated with widespread outbreaks. Influenza
Type A, however, causes epidemics yearly. InfluenzaType B infrequently
causes widespread flu epidemics.
2. Influenza pandemic is most likely when the Influenza Type A virus makes a
dramatic change (i.e., antigenic “shift”). This shift results in a new or “novel”
virus to which the general population has no immunity. The appearance of a
novel virus is the first step toward a pandemic. Influenza Type B viruses do
not undergo shift and do not cause influenza pandemics.
B.
Situation
1. The estimated morbidity and mortality during an influenza pandemic within
12-16 weeks, nationwide, and in Pennsylvania is as shown below:
Require Outpatient Care
Hospitalizations
Deaths
United States
50 million
2 million
500,000
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Pennsylvania
1.6 million
37,800
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2. To some extent, everyone will be affected by an influenza pandemic.
3. It will take six to eight months after the novel virus is identified and begins to
spread among humans before a specific vaccine would likely be available for
distribution.
4. The Department will depend on local, community, state, and federal services
to provide the public health response necessary for, and appropriate response
to, annual influenza epidemics.
5. Federal, state and local collaboration will be essential to appropriately respond
to the next pandemic.
6. Regardless of the availability of a vaccine that protects against the influenza
pandemic strain, pneumococcal vaccine will reduce the risk of complications
that can result from influenza infections.
C.
Assumptions
1. An influenza pandemic is inevitable and will probably give little warning. To
some extent, everyone will be affected by a pandemic.
2. An influenza pandemic will cause simultaneous outbreaks across the United
States limiting the ability to transfer assistance from one jurisdiction to
another.
3. Effective preventive and therapeutic measures, including vaccines, antiviral
agents and other antibiotics, will likely be in short supply or not available.
Supplies that are available will most likely be managed by the state and
distributed using the Pennsylvania SNS Implementation Plan.
4. Two doses of influenza vaccine, administered 30 days apart, may be needed to
develop full immunity to the novel influenza virus.
5. The Department may need to identify funds to purchase the vaccine for
Pennsylvania’s citizens.
6. Widespread illness in communities may increase the likelihood of significant
shortages of personnel who provide other essential community services.
7. An influenza pandemic may exhaust availability of assistance from the federal
government.
8. The first wave of pandemic influenza will be followed by a second wave
arriving three to nine months after the first wave.
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IV.
CONCEPT OF OPERATIONS
A.
Command and Management
1. Command and Management functions are outlined in the Command Center
Manual. The purpose of this Command Center Manual is to provide
management guidance to users in order to establish, operate, and evaluate the
Department’s response to public health threats. The Command Center
Manual is intended to be a companion to the Department’s “all hazard”
Disaster EPRP and all associated plans.
2. The Command Center serves as the most efficient and coordinated approach
for the Department to coordinate with PEMA and public health entities on all
health-related emergency preparedness, response and recovery activities.
3. Command and Control are based upon three guiding principles:
a. While PEMA coordinates the overall response, the Department has the
lead role in ensuring the health of Commonwealth citizens during any
emergency event.
b. When responding to a large event, using a focused organizational structure
ensures that all issues are considered and addressed in proper prospective.
The Secretary is responsible for the activities of the Department. The use
of the National Incident Management System (NIMS) in areas such as the
Unified Command System/Incidence Command System (UCS/ICS) to
organize a large multi-faceted response ensures that all issues are
addressed and appropriate actions are taken.
c. Communication and coordination are essential. Many of the activities
accomplished by the Department are done in conjunction with
county/municipal health departments, other state agencies, the federal
government, private and public health organizations and professional
associations.
4. The Command Center manual includes a basic plan, Command Center
Position Checklists, and forms. It describes how strategic policy is
determined and how it differs from emergency operations and coordination;
three levels of activation of the Command Center; and infrastructure required
to operate the Command Center.
B.
Roles and Responsibilities
1. Federal:
a. Coordinate national influenza pandemic response planning.
b. Develop a national information database/exchange clearinghouse.
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c. Develop generic guidelines and information templates for modification
and adaptation of pandemic response planning, as needed.
2. State:
a. Maintain data management systems, such as the National Electronic
Disease Surveillance System (NEDSS), the Real-time Outbreak and
Disease Surveillance System (RODS) and the Statewide Immunization
Information System (SIIS) to implement the IPRP.
b. Incorporate the IPRP with the Commonwealth’s and the Department’s
existing emergency response plans.
c. Review and exercise the IPRP on an annual basis.
d. Develop and maintain legal documents for volunteer resources,
quarantine, etc.
e. Coordinate agreements with the State Police.
f. Develop a plan to close and reopen schools, businesses and other public
places/events.
g. Prepare to activate operations for a pandemic appropriate for the occurring
infectious disease.
3. Local:
a. Coordinate security provisions for vaccine, human resources and clinic
locations.
b. Identify local administrative and medical decision makers.
c. Develop local preparedness plans that correspond to statewide plans.
d. Identify local surveillance teams.
e. Meet with local stakeholders and review major elements of local
emergency response preparedness.
f. Modify local Points of Dispensing (PODs) to account for updates on
recommended target groups, projected vaccine supply and available
human resources.
g. Secure written agreements from hospitals, pharmacies and other identified
community properties that will be utilized to establish storage, security
and transport for bulk amounts of vaccines/antivirals.
h. Elicit written commitments from agencies and institutions that will
provide volunteers.
i. Maintain a current plan for local surveillance, medical/emergency
response, vaccine/ antiviral administration and communications.
j. Develop a plan utilizing communication templates, in languages common
for the area, to educate the public.
k. Communicate with schools, businesses and other venue for potential
closures.
l. Develop collaborations with adjoining counties/districts/states.
m. Conduct local and county exercises/drills annually for an emergency
influenza pandemic response.
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V.
INFLUENZA PANDEMIC RESPONSE ACTIONS
Influenza pandemic response activities are delineated by periods within the following
components: Pandemic Influenza Surveillance, Laboratory Diagnostics, Emergency
Response, Community Disease Control and Prevention, Distribution of Vaccines and
Antivirals, Public Health Communications and Workforce Support. For each component,
the pandemic phases are categorized as Interpandemic Period, Pandemic Alert Period, Pandemic
Period and Post- Pandemic Period.
Phase 1: No new influenza virus
subtypes have been detected in
humans. An influenza virus subtype
that has caused human infection may
be present in animals. If present in
animals, the risk of human infection or
disease is considered to be low.
Phase 2: No new influenza virus
subtypes have been detected in
humans. However, a circulating
animal influenza virus subtype poses a
substantial risk of human disease.
Phase 3: Human infection(s) with a
new subtype, but no human-to-human
spread, or at most rare instances of
spread to a close contact.
Phase 4: Small cluster(s) with limite …
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