Role of health care providers in responding to pandemic influenza

Last updated: 06 November 2006

What is pandemic influenza?

Pandemic influenza is a global outbreak of a new strain of human influenza. This influenza can spread rapidly between people, because there is little or no immunity to the new strain. There is currently no pandemic influenza anywhere in the world, but there is thought to be an increased risk of a pandemic strain of influenza developing because of the recent global outbreak of H5N1 avian influenza. Avian influenza is a disease primarily of birds, and human cases of avian influenza are rare. However, if the current H5N1 avian influenza strain mutates to become easily transmissible between humans, a pandemic strain of influenza could result.

Who should be considered a suspected case?

As pandemic influenza does not exist, it is difficult to determine an exact case definition at this stage. In the meantime, an interim case definition for pandemic influenza has been agreed on. This interim pandemic influenza case definition is:

Fever ≥ 38°C (or history of fever), cough and fatigue of acute onset
AND any one of:

• Returned from a pandemic influenza affected area* within the last 7 days, OR
• Contact with a person with pandemic influenza, or a person with an undiagnosed influenza-like illness returned from an affected area* within the last 7 days, OR
• Worked in a laboratory with exposure to clinical samples contaminated with pandemic influenza virus within the last 7 days.

* A list of pandemic affected areas will be found on World Health Organisation website and this website as soon as a new human strain of influenza with pandemic potential is identified anywhere in the world. A revised case definition will also become available at that stage. This case definition may be revised and updated repeatedly as more information about the new strain of influenza becomes available.

What is the role of primary health care providers?

In general, the role of primary health care providers will be to ensure that they are able to continue with the provision of primary health care. However, some rural and remote General Practitioners and Aboriginal Medical Service providers may be asked to be involved in the assessment and management of suspected cases of pandemic influenza at hospitals and influenza clinics. Your local Area Health Service will contact you to discuss your involvement in the response if this is the case.

What to do if a patient meets the case definition?

If you are a primary health care provider (e.g., General Practitioner, Aboriginal Medical Service provider, Community Nurse or Community Pharmacist), you should provide the patient with a surgical mask and send the patient to the nearest hospital Emergency Department or Multi Purpose Service for assessment and management, preferably by private car or taxi. You should also notify the Emergency Department that you are referring a suspected case of pandemic influenza. We advise you not to try to isolate and manage the patient yourself, as you may place yourself and other health care staff at risk. If you are a hospital or multi purpose service health care provider, you should screen, isolate, assess and manage the patient according the information provided in the Hospital Response to Pandemic Influenza Part 1: Emergency Department Response policy. The best way to make sure that you and your facility are prepared is to make isolating and providing masks to patients with infectious respiratory illnesses a routine part of your practice.

What is the public health response to pandemic influenza?

The public health response to pandemic influenza will be principally to contain the spread of the infection in the community.

What is containment?

Containment refers to all activities aimed at limiting the spread of infection in the community. This includes identification and isolation of cases, and tracing and quarantining of contacts, treatment and prophylaxis with anti-influenza medication, promotion of good hygiene practices and appropriate infection control procedures, including use of personal protective equipment and hand-washing, and border control and screening activities.

How is pandemic influenza diagnosed?

In order to diagnose pandemic influenza, you will need to obtain two nose swabs and one throat swab using appropriate viral swabs (not bacterial swabs), or two nasopharyngeal aspirates from young children. You need to wear full personal protective equipment (P2 mask, disposable gown, protective eyewear, gloves) while taking these swabs or aspirates, and the swabs should be taken with the patient in isolation in a single room if at all possible. These swabs or aspirates should be sent to either ICPMR at Westmead, Sydney or SEALS, Prince of Wales Hospital, Sydney for URGENT pandemic influenza testing.

How is it treated?

If pandemic influenza is suspected, the patient can be commenced on an appropriate dose of antiinfluenza medication - oseltamivir (Tamiflu), or zanamivir (Relenza), while you are waiting for the result of the influenza tests and other pathology tests. The patient should be kept in isolation either in hospital or at home, depending on their clinical condition, while waiting for the results of the test.

Related Links

• Medications to treat or prevent influenza  http://www.health.nsw.gov.au/factsheets/environmental/med_pandemic_flu.html