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«© World Health Organization 2009. Reprinted 2010. All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, ...»

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WHO Library Cataloguing-in-Publication Data

Pandemic influenza preparedness and response: a WHO guidance document.

1.Influenza, Human - epidemiology. 2.Influenza, Human - prevention and

control. 3.Disease outbreaks - prevention and control. 4.Epidemiologic

surveillance. 5.Health planning. 6.Guidelines. I.WHO Global Influenza

Programme. II.World Health Organization.

ISBN 978 92 4 154768 0 (NLM classification: WC 515)

© World Health Organization 2009. Reprinted 2010.

All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e- mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications - whether for sale or for noncommercial distribution - should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e- mail: permissions@who.int).

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.

Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

Printed in France 02 This guidance is an update of WHO global influenza preparedness plan, the role of WHO and recommendations for national measures before and during pandemics, published by WHO March 2005.1

FOREWORD

These guidelines were edited by Jum Kanokporn Coninx, Keiji Fukuda, Hande Harmanci, Kidong Park, Mary Chamberland, Tamara Curtin Niemi, Elisabeth (Isis) Pluut and Claudia Vivas of the Global Influenza Programme in the Health Security and Environment Cluster of the World Health Organization.

This guidance is an update of WHO global influenza preparedness plan, the role of WHO and recommendations for national measures before and during pandemics, published by WHO in March 2005.1 The information and recommendations contained in this guidance document are the product of expert opinion obtained in thecourse of international consultations which began in 2007. During the meeting held between 27 and 29 November 2007, five task forces were created to prepare draft guidance documents which were discussed in subsequent meetings. All task force members and other experts invited to participate in the subsequent meetings were asked to complete, sign and submit the Declaration of Interest for WHO Experts form.

During the revision process, the task forces reviewed and consolidated existing WHO guidance;

examined available information and modeling studies; sought input from public health experts on lessons learned from SARS; and reviewed studies and analyses of both animal and human influenza responses. All the external experts that participated in the substantive elaboration of this guidance document are listed and acknowledged in the following section. In accordance with WHO policy, participating experts were requested to submit a duly completed and signed Declaration of Interest for WHO Experts form. Representatives of industry attending the meeting of 5-9 May 2008 participated as observers and, in accordance with WHO rules, were not therefore required to submit a Declaration of Interest. Further information on the declarations of interests by individual experts is summarized in Annex 2.

The Global Influenza Programme will revise this guidance in 2014, or sooner in the event of significant developments which impact pandemic preparedness and response planning.

1. WHO Global Influenza Preparedness Plan. The role of WHO and recommendations for national measures before and during pandemics, World Health Organization. 2005 (WHO/CDS/CSR/GIP/2005.5)

–  –  –

P Abi-Hanna (Lebanon), L Ahadzie (Ghana), S Al Awaidy (Oman), T Asikainen (ECDC), Azimal (Indonesia), N Bakirci (Turkey), D Bell (USA), Y Berhane (Ethiopia), M Betancourt-Cravioto (Mexico), F Binam (Cameroon), D Boakye (Ghana), M Bökkerink (Netherlands), S Borroto-Gutierrez (Cuba), H Branswell (Canada), JS Bresee (USA), P Calvi-Parisetti (IFRC), D Camus (France), O Carlino (Argentina), E Carmo (Brazil), M de Carvalho (Brazil), M Cetron (USA), P Chappe (France), É Chatigny (Canada), P-H Chung (China), S Chunsuttiwat (Thailand), E Coker (Nigeria), T Colgate (IFPMA), J Cutter (Singapore), J Dabanch (Chile), V Davidyants (Armenia), B Duncan (ECDC), P Duplessis (IFRC), R El-Aouad (Morroco), O Ergonul (Turkey), B Eshaya-Chauvin (IFRC), M Esveld (Netherlands), R Fasce (Chile), M Fawzi (Egypt), N Fergusson (UK), L Finelli (USA), A Fiore (USA), G Foliot (WFP), A Fry (USA), J Gale (Singapore), M Gastellu-Etchegorry (France), N Gay (UK), U Go (Republic of Korea), P Grove (UK), MM Gouya (Iran), W Haas (Germany), J Hall (Australia), N Hehme (IFPMA), M Henkens (Belgium), N-T Hien (Vietnam), P Hung (Vietnam), P Imnadze (Georgia), M Jacobs (New Zealand), S Jadhav (DCVMN), A Kandeel (Egypt), M Kaku (Japan), G Kamenov (Bulgaria), F Karcher (EC), R Kirby (UK), O Kiselev (Russia), P Kreidl (ECDC), J-W Kwon (Republic of Korea), H-S Lee (Republic of Korea), W Lum (Panama), J Macey (Canada), J Mackenzie (Australia), H Mambu-ma-Disu (Congo), O Mansoor (UNICEF), M Mapatano (DR Congo), A Marx (OCHA), M Meltzer (USA), Z Memish (Saudi Arabia), Z Mohamed (Sudan), A Monto (USA), J Moran (Kazakhstan), M Mosselmans (OCHA), A Mounts (USA), Y Ndao (Senegal), H Needham (ECDC), J Newstead (UK), J Nguyen van Tam (UK), A Nicoll (ECDC), T Omori (Japan), H Oshitani (Japan), J O'Toole (ECDC), J Paget (Netherlands), E Palacios-Zavala (Mexico), B Paton (OCHA), C Patterson (Australia), W Peerapatanapokin (Thailand), E Perez (France), N Phin (UK), S Plotkin (USA), N Pshenichnaya (Russia), G Ramirez-Prada (Peru), P Ravindran (India), B Rawal (IFPMA), S Redd (USA), A Reynolds (UK), A Ricol-Solernou (EC), B Rodriques (UNICEF), C Russell (UK), G Saour (France), C Schuyler (NATO), J Sciberras (Canada), P Scott-Bowden (WFP), P Seukap (Cameroon), H Shirley-Quirk (UK), Y Shu (China), L Simonssen (USA), M Smolinski (USA), R Snacken (Belgium), S Strickland (UK), N Sunderland (USA), K Taniguchi (Japan), M Tashiro (Japan), J Toessi (Benin), B Toussaint (EC), P Tull (Sweden), M Vanderford (USA), M Van der Sande (Netherlands), S Vaux (France), L Vedrasco (OCHA), S Venkatesh (India), R Vivarie (UNHCR), S Vong (Cambodia), R Waldman (USA), W Wang (China), J Watson (UK), D Xiao (China), P Yosephine (Indonesia), H Yu (China), S Zaidi (Pakistan), H Zhao (UK), D Zoutman (Canada).





04 The following WHO staff were involved in the development and review of this document and their

contribution is gratefully acknowledged:

B Abela-Ridder, W Alemu, C Alfonso, M Almiron, R Andraghetti, P Andrea, N Asgari, J Azé, M Barbeschi, P Ben-Embarek, I Bott, B Brennan, S Briand, C Brown, R Brown, P Carrasco, L Castellanos, M Chamberland, C Chauvin, M Chu, S Chungong, M Coly, P Cox, A Croisier, T Curtin-Niemi, A Dabbagh, T dos Santos, H El Bushra, N Eltantawys, N Emiroglu, S Eremin, D Featherstone, J Fitzner, M Friede, K Fukuda, B Ganter, M Gayer, P Ghimire, A Gilsdorf, T Grein, M Guardo, P Gully, M Hardiman, H Harmanci, G Hartl, F Hayden, M Hegermann-Lindencrone, D Heymann, H Hollmeyer, A Huvos, J Kanokporn Coninx, T Kasai, S Kirori, D Lavanchy, R Lee, D Legros, A Li, K Limpakarnjanarat, J Lopez-Macedo, Q Lui, C Maher, S Martin, D Menucci, A Merianos, C Mukoya, L Mumford, A Odugleh-Kolev, K O'Neill, S Otsu, L Palkonyay, K Park, C Pessoa Da Silva, O Pinheiro de Oliva, B Plotkin, S Pooransingh, G Poumerol, E Pluut, K Prosenc, J Rainford, A Reis, G Rodier, J Rovira, M Ryan, D Scales, N Shindo, C Toscano, K Vandemaele, C Vivas, J Watson, S Westman, E Whelan, S Wilburn, L Wolfson, A Yada, A Yeneabat, W Zhang, W Zhou, P Zuber.

–  –  –

07

EXECUTIVE SUMMARY

Influenza pandemics are unpredictable but recurring events that can have severe consequences on human health and economic well being worldwide. Advance planning and preparedness are critical to help mitigate the impact of a global pandemic. This WHO Guidance document Pandemic influenza preparedness and response significantly updates and replaces WHO global influenza preparedness plan: the role of WHO and recommendations for national measures before and during pandemics which was published in 2005.

Why update the 2005 guidance?

The global response to the spread of avian influenza A (H5N1) that began in 2003 has helped shape a number of significant public health advances. First, avian and pandemic influenza initiatives have led to substantial gains in strengthening national and global capacities and building partnerships between animal and human health sectors. Extensive practical experience in dealing with outbreaks of avian influenza (H5N1) virus in poultry and humans, in addition to pandemic preparedness and response exercises carried out in various countries, has led to a greater understanding of the issues that need to be addressed in pandemic preparedness. Second, there is increased understanding of past pandemics, strengthened outbreak communications, greater insight into disease spread and approaches to control, and development of increasingly sophisticated statistical modeling techniques.

Third, there has been growing attention to global health security following the adoption of the revised International Health Regulations (IHR) in 2005, which provide a framework to address international public health concerns. Finally, stockpiles of antiviral drugs and other essential supplies are now a reality, new approaches to influenza vaccine development are under way and a Global Vaccine Action Plan2 has been devised to increase the supply of pandemic vaccine.

Overview of the major changes

The revised guidance:

1. retains the six-phase structure but regroups and redefines the phases to more accurately reflect pandemic risk and the epidemiological situation based upon observable phenomena

2. highlights key principles when undertaking pandemic planning including:

a) application of ethical principles to assist policymakers in balancing a range of interests and protecting human rights;

b) integration of pandemic preparedness and response into national emergency frameworks to encourage sustainable preparedness;

c) incorporation of a “whole of society” approach that emphasizes not only the central role played by the health sector, but also the significant roles of other sectors such as businesses, families, communities and individuals;

3. harmonizes the recommended measures with the IHR 2005 and the concurrent development/revision of WHO guidance in related areas such as pandemic influenza surveillance, disease control measures, rapid containment and communications;

4. includes suggested planning assumptions, their implications and a selected evidence base to aide planning efforts on a national level.

2. Global pandemic influenza action plan to increase vaccine supply (WHO/CDS/EPR/GIP/2006.1) World Health Organization, 2006.

(http://www.who.int/csr/resources/publications/influenza/WHO_CDS_EPR_GIP_2006_1/en/index.html, accessed 23 March 2009).

08How to use this guidance

This document should be used as a guide to inform and harmonize national and international preparedness and response before, during and after an influenza pandemic. Countries should develop or update national influenza preparedness and response plans that address the recommendations in this guidance. This document is not intended to replace national plans which should be developed by each country.

This guidance serves as the core strategic document in a suite of materials. It is supported by a complement of pandemic preparedness materials and tools (Figure 1). These documents and tools provide detailed information on a broad range of specific recommendations and activities, as well as clear guidance on their implementation. The individual elements of the guidance package will be made available as they are finalized.

FIGURE 1

THE WHO GUIDANCE PACKAGE FOR PANDEMIC INFLUENZA PREPAREDNESS AND RESPONSE

–  –  –

A “whole-of-society” approach to pandemic influenza preparedness emphasizes the significant roles played by all sectors of society.

• The national government is the natural leader for communication and overall coordination efforts. Central governments should work to put in place the necessary legislation, policies and resources for pandemic preparedness, capacity development and anticipated response efforts across all sectors.

• The health sector (including public health and health-care services) provides critical epidemiological, clinical and virological information which, in turn, informs measures to reduce spread of the pandemic virus and its attendant morbidity and mortality.

• The diverse array of non-health sectors must provide essential operations and services during a pandemic to mitigate health, economic and social impacts.

• Civil society organizations are often well placed to raise awareness, communicate accurate information, counter rumours, provide needed services, and liaise with the government during an emergency.

• Families and individuals can help reduce the spread of pandemic influenza through adoption of measures such as covering coughs and sneezes, hand washing, and the voluntary isolation of persons with respiratory illness.



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