National Prevention Plan
Phases of Global Pandemic
  • The appearance of a viral strain affecting humans.
  • The virus becomes able to reproduce in human bodies, thus developing into a pathological form.
  • The transmission of the virus among humans (becoming highly contagious, through a regular series of viral transmission, ending up with a pandemic outbreak.)
Tracing back the roots of the pandemic, we shall find that, since 1997, the first and second of the aforementioned phases have been realized four times: in Hong Kong (H5N1, 1997), Hong Kong (H5N1, 2003), Netherlands (H7N7, 2003), and Vietnam and Thailand (H5N1, 2004). The H5N1 outbreak is characterized by its severity and big death toll. No other avian virus has ever prevailed so quickly in so many countries.
 
All this taken into consideration, it seems that the world will be facing a global avian pandemic, and could be struggling against this imminent danger for years. Yet, early preparations could be made to diminish and – as much as possible – avoid the potential calamities ahead.
 
Phases of the Global Avian Pandemic:
Phase 1:
In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in (Phase 1) no viruses circulating among animals have been reported to cause infections in humans.
 
Objectives of Phase 1 (Pre-pandemic):
  1. Setting a national plan, concordant with the plan put forward by the World Health Organization (WHO).
  2. Mobilizing the human and financial potential in preparation for the pandemic (in case of occurrence, God forbid!), and directing this potential rapidly and sufficiently to the pandemic-stricken areas.
  3. Forming a committee for right and rapid decision making, as well as taking the necessary precautions in cases of emergency.
  4. Placing emphasis on the preventive and non-curative procedures in this juncture.
  5. Providing antivirals to be used when necessity be.
  6. Coordinating with the mass media as regards the pandemic and the necessary preparations.
Procedures to be taken in Phase 1:
  1. Forming a national committee to take over and follow up the enforcement of the control plan on ground.
  2. Following up the updates introduced to the plan every now and then, in coordination with all the relevant authorities (WHO, Ministry of Agriculture, etc.)
  3. Ensuring the implementation of the plan at all the health and executive levels.
  4. Organizing training courses on the pandemic plans.
  5. Providing all the requirements (antivirals, laboratory solutions and reagents, etc.), and making them easy to obtain when necessity be.
  6. Full coordination and relentless follow-up of the epidemiological situation outside the Kingdom.
  7. Raising the health workers' awareness of the avian pandemic.
  8. Training health staff on correct sampling, and how to handle the samples.
  9. Providing a communications system (local/ international) during the pandemic.
  10. Making the necessary plans and decisions relating to the pandemic known to the various mass media.
 
Phase 2:
In (Phase 2) an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.
 
Objectives of Phase 2:
  1. Affirming the effectiveness of the epidemiological surveillance in detecting any human infections.
  2. Coordinating in the implementation of the preventive procedures with the Animal Health Officers (Ministry of Agriculture).
  3. Diminishing the probability of animal-to-human infection.
  4. Ascertaining that any human infection will be immediately detected, in order for the proper procedures to be taken in due time (immediately reporting any suspected case should be underscored).
  5. Ascertaining that, in case of any human infection, the correct and accurate information will be reported to the responsible health authorities, as well as the public (both citizens and residents).
Procedures to be taken in Phase 2:
  1. Taking a joint decision (in cooperation with the Ministry of Agriculture, the Ministry of Commerce & Industry and the other relevant authorities).
  2. Keeping the proficient and experienced teams in controlling the pandemic on standby.
  3. Being fully ready for providing the affected areas with all the requirements.
  4. Conducting epidemiological surveillance to the human and animal infections, and reporting the result to the World Health Organization (WHO) and Food and Agriculture Organization (FAO).
  5. In case of the appearance of any avian influenza cases, it is recommended to share with the international organizations in the sample analysis, as well as sending the samples to the WHO to identify the viral strain.
  6. Conducting epidemiological investigations on the infected animals and birds, and studying the possibility of viral transmission to humans.
  7. Ascertaining where it would be possible to examine the samples in the national laboratories, and making sure that the necessary laboratory solutions and reagents are available.
  8. In case of any animal infections, all those in direct contact with these animals or poultry should be examined, and given an antiviral (Tamiflu), and those vulnerable to influenza should be given the anti-influenza vaccine as well (as stated in Article 4 [page 14] of the plan).
  9. Taking the necessary action in case of any epidemiological outbreaks among animals or poultry.
  10. Ensuring the availability of antivirals.
 
Phase 3 (current):
In (Phase 3), an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.
Objectives of Phase 3:
  1. Taking the necessary action that diminishes the possibility of the pandemic prevalence.
  2. Managing to know whether human-to-human infection is possible, and making every effort to detect the infected cases as quickly as possible.
  3. Reduction of human-to-human infections, if any.
  4. Reduction of the number of the infected cases (and the death toll caused by the avian influenza).
  5. Reduction of nosocomial transmission, and the infection caused the infected samples in laboratories.
Procedures to be taken in Phase 3:
  1. Proceeding on the epidemiological of the disease.
  2. Giving an antiviral (Tamiflu) and an anti-influenza vaccine to those most vulnerable to influenza (as stated in Article 4 [page 14] of the plan).
  3. Participating with the WHO in its search for a new vaccine
  4. Raising the awareness of health workers, as well as citizens.
Phase 4:
(Phase 4) is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause "community-level outbreaks." The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a foregone conclusion.
 
Objectives of Phase 4:
  1. Ensuring the availability of an outbreak detection system, so as to control the pandemic in due time.
  2. Activating the preventive procedures meant to control the infection.
  3. Evaluating the scope of human-to-human infection.
  4. Detecting the new cases and epicenters of the disease, as well as investigating the potentiality of prevalence.
  5. Evaluating the infection cases, and identifying the proper preventive procedures.
  6. Making every effort to prevent human-to-human infection, or put it off, as much as possible.
  7. Reduction of the number of the infected cases (and the death toll caused by the avian influenza).
  8. Making it clear to all the relevant authorities, as well as citizens and residents, that the situation is very likely to rapidly develop, to the effect that the world might be stricken with the pandemic outbreaks in many of its spots.
  9. Endeavoring to put the outbreak off.
Procedures to be taken in Phase 4:
  1. Identifying the targeted groups, as well as preparing the necessary guidance material dedicated for every targeted group.
  2. Activating the preventive procedures meant to control the infection.
  3. Activating epidemiological surveillance (‎stringency and control).
  4. Monitoring the production of a new vaccine (specific).
  5. Enlisting all the capabilities and requirements to the fight against the pandemic.
Phase 5:
(Phase 5) is characterized by human-to-human spread of the virus into at least two countries in one WHO region (Figure 4). While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.
 
Objectives of Phase 5:
  1. Identifying the areas stricken with the pandemic outbreak, and preventing it from transmission to other areas, and cooperating with the relevant international organizations regarding the available information on the disease incidence and the death toll.
  2. Following up the epidemiological situation closely.
  3. Ensuring the readiness of health workers for the incidence/ prevalence of pandemic outbreaks.
  4. Reduction of nosocomial transmission, and the infection caused the infected samples in laboratories.
Procedures to be taken in Phase 5:
  1. Reconsidering the use of antivirals.
  2. Making good use of the studies conducted on both the drug and the disease in the pandemic-stricken countries, as they become more experienced in the effectiveness of the drug.
  3. In case of the production of a specific vaccine, it is highly recommended to vaccinate all the targeted groups immediately (the aim of vaccination would be limiting the disease in a certain geographical spot), as well as the people of the affected area.
  4. Activating the Scientific Committee so as to coordinate with the Assistant Agency for Preventive Medicine in taking the proper action in due time.
  5. Updating the information related to the disease, and making it known to the public as well as health workers.
  6. Testing the preventive procedures to ensure their effectiveness.
  7. Raising the citizens' awareness of the procedures to be taken by the Ministry of Health and the other relevant authorities in pursuit of putting an end the disease prevalence.
 
Phase 6 (the pandemic phase):
(Phase 6), the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is underway.
 
Objective of Phase 6:
  1. Establishing an operations room to take the necessary actions meant to reduce the infection and death rates, in addition to diminishing material losses as well (coordinating the distribution of health facilities and medical requirements, etc.)
  2. Evaluating and studying the procedures taken in the affected countries, so as to make use of their experience in the field of pandemic control.
  3. Building confidence between the Ministry (the Coordinating Committee for Disease Control) and the medical staff on one hand, and between medical staff and citizens on the other hand.
  4. Controlling or delaying the pandemic, by preventing the occurrence of human agglomerations in schools and universities, for example.
  5. Launching channels aiming to raise citizens' awareness, and to guide them about how to handle the pandemic.
  6. Updating the Leadership with all the relevant information.
Procedures to be taken in Phase 6:
  1. Setting the operations room intended for the pandemic control to work.
  2. Coordinating with the authorities and executive officers on the procedures intended to be taken (closing schools, avoiding congestion, preventing the arrivals of pandemic-stricken countries from getting into the Kingdom, or quarantining them, and so on.)
  3. Applying all the precautionary measures as planned.
  4. Proceeding on the epidemiological surveillance, just like (Phase 5).
  5. Keeping an eye on the global pandemic situation (the vaccine and antivirals as well as their effectiveness).
  6. Reducing the infection and death rates by using the available vaccines and antivirals.
  7. Applying viable preventive procedures, along with following up and considering the proposals put forward by the WHO experts, by virtue of their experience in this domain.
  8. Being cautious while diagnosing any cases, and immediately reporting them to the competent authorities, so as to take the right action, in accordance with the circulars issued in this field.
  9. Endeavoring to provide the necessary medications for all the members of society, thus prompting them to report and detect the infected cases.
  10. Being ready for comprehensive immunization, starting with the Hajj sites, and then extending to all the Kingdom's regions.
  11. Adhering to the precautionary measures in the hospitals including infected cases, and working to prevent the transmission of the virus among other patients, or outside the hospital.
  12. Updating the mass media, as well as the public, with information on the global pandemic situation.
 
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