A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO,to the PHAA 12th National Immunisation Conference in Adelaide 17 August 2010

1. INFLUENZA PANDEMIC
and
BEYOND
PHAA 12TH National Immunisation
Conference
ADELAIDE – 17 August 2010
Professor Jim Bishop
Chief Medical Officer
Department of Health and Ageing

2. World Health Organisation
stages of PANDEMIC ALERT
WHO declared: phase 4 on 27 April 2009
phase 5 on 29 April 2009
phase 6 on 11 June 2009
post-pandemic 10 August 2010

4. H1N1 Influenza 09 Pandemic Phases
ALERT (pre 24 April 09)
DELAY (24 April 09)
CONTAIN (22 May 09)
SUSTAIN
Victoria moved to a MODIFIED
SUSTAIN on 3 June 2009
CONTROL
RECOVER
PROTECT
17 June 2009
Evidence supports focusing efforts
on protecting the ‘vulnerable’
Australia's response is continual informed
by the emerging evidence around the virus
and effectiveness of control measures
H1N1
Influenza 09,
mild in most
and severe in
some (the
vulnerable)

5. Weekly rate of ILI reported from GP ILI surveillance systems from
1 January 2007 to 25 July 2010
0
10
20
30
40
50
60
1 3 5 7 9 1
1
1
3
1
5
1
7
1
9
2
1
2
3
2
5
2
7
2
9
3
1
3
3
3
5
3
7
3
9
4
1
4
3
4
5
4
7
4
9
5
1
5
3
Week
RateofILIper1,000consultations
ASPREN 2007
ASPREN 2008
ASPREN + NT + VIDRL 2009
ASPREN + VIDRL 2010
First case of
Pandemic
(H1N1) 2009
t d i

6. Number of respiratory viral presentations to Western Australia EDs from
1 January 2007 to 25 July 2010 by week
0
200
400
600
800
1000
1200
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Week
NumberofEmergencyDepartmentILI
PresentationsinWA
2007 Presentations
2008 Presentations
2009 Presentations
2010 Presentations
Child deaths
associated with
influenza

7. ILI presentations to NSW EDs from 2007-2010, by week
0
5
10
15
20
25
30
35
40
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43
Week
RateofEmergencyDepartmentILIPresentationsin
NSW
NSW ED 2007
NSW ED 2008
NSW ED 2009
NSW ED 2010

8. Total number of specimens tested by sentinel laboratories, and proportion
positive, 1 January 2010-30 July 2010, by week
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
8/01/2010
22/01/2010
5/02/2010
19/02/2010
5/03/2010
19/03/2010
2/04/2010
16/04/2010
30/04/2010
14/05/2010
28/05/2010
11/06/2010
25/06/2010
9/07/2010
23/07/2010
6/08/2010
20/08/2010
3/09/2010
17/09/2010
1/10/2010
15/10/2010
29/10/2010
12/11/2010
26/11/2010
10/12/2010
24/12/2010
Week ending (date)
Percentoftestspositiveforinfluenza
0
100
200
300
400
500
600
700
Totalnumberoftests
Percent of tests influenza positive
Total number of tests

9. Percentage of specimens tested by sentinel laboratories influenza positive
1 January 2010 to 30 July 2010, by subtype
Pandemic (H1N1) 2009
67%
Seasonal A/H1N1
0%
Seasonal A/H3N2
24%
Influenza A untyped
4%
Influenza B
5%

10. Hospitalisations of pandemic (H1N1) 2009,
5 June – 23 October 2009, by week
10
0
100
200
300
400
500
600
700
21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43
Week of report
Numberofhospitalistationsassociated
withpandemic(H1N1)2009
Australia

11. Severe Pandemic
(H1N1) 2009
● Hospitalisations
- Respiratory, diabetes, immuno compromised
obesity, chronic cardiac, renal, pregnancy rapid
deteriorating flu patient
● Higher proportion of Indigenous Australians
● Over 50% admitted within 48 hours of onset
● Higher ICU Admissions than expected

12. 2009 2010
CONFIRMED
PANDEMIC
(H1N1 2009
CASES
HOSPITALISED
CASES
ICU CASES DEATHS CONFIRMED
(H1N1) 2009
CASES
DEATHS
TOTAL NUMBER 37,636 13% 14% 191 362 2
CRUDE RATE
PER
100,000
POPULATION
172.1 22.8 3.1 0.9 1.7 n/a
M EDIAN AGE
(YEARS)
21 31 44 53 28 38
FEMALES 51% 51% 53% 44% 48% 100%
SUMMARY of SEVERITY INDICATORS OF
PANDEMIC (H1N1) IN AUSTRALIA,
2009 & 2010 (up to 30 July 2010)
SourceL: Australian Influenza Surveillance Report

13. 2009 2010
CONFIRMED
PANDEMIC
(H1N1 2009
CASES
HOSPITALISED
CASES
ICU CASES DEATHS CONFIRMED
(H1N1) 2009
CASES
DEATHS
Vunerable groups
(Indigenous
persons, pregnant
women&
individuals with
at least 1 co-
morbidity)
n/a 58% 74% 67% n/a n/a
INDIGENOUS
PEOPLE
11% 20% 19% 13% 9% n/a
PREGNANT
WOMEN
n/a 27% 16% 4% n/a 0%
Cases with at
least 1 co-
morbidity
n/a 46% 67% 62% n/a n/a
SUMMARY of SEVERITY INDICATORS OF
PANDEMIC (H1N1) IN AUSTRALIA,
2009 & 2010 (up to 30 July 2010)
SourceL: Australian Influenza Surveillance Report

14. Age specific rates of hospitalised confirmed cases of pandemic (H1N1) 2009 to 3
October 2009, compared with average annual age specific rates of hospitalisations
from seasonal influenza 2004-05 to 2006-07*, Australia
14
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
0-4
5-9
10
-14
15
-19
20
-24
25
-29
30
-34
35
-39
40
-44
45
-49
50
-54
55
-59
60
-64
65
-69
70
-74
75
-79
80
-84
85
+
Age group (5 Years)
Agespecificrate(per100,000population)
Males pandemic (H1N1) 2009
Females pandemic (H1N1) 2009
2004-07 seasonal influenza

15. Rate of deaths classified as influenza and pneumonia from the NSW
Registered Death Certificates 2005 to 25 June 2010

16. ATAGI Modelling of the Impact of Vaccination

17. Pandemic (H1N1) 2009
Vaccine
• Safety profile good as dose levels recommended
• One injection 15μg protects adults, two for young
children
• FDA licence/TGA registration
• Emphasis on priority groups but available to ALL
• Widespread uptake by the Population (over 9
Million doses)
Source: New England Journal of Medicine: 2009: 361, September 10

18. Pandemic H1N1 vaccine distributed (cumulative)
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
9,000,000
10,000,000
06-Oct
22-Oct
12-N
ov
03-Dec
07-Jan
27-Jan
18-Feb
11-M
ar
08-Apr
29-Apr
20-M
ay
10-Jun
01-Jul
22-Jul
Cumulative total

19. Pandemic H1N1 Vaccine - Weekly distribution trends
0
100,000
200,000
300,000
400,000
500,000
600,000
06-Oct19-Oct29-Oct12-N
ov26-N
ov10-Dec07-Jan21-Jan03-Feb18-Feb04-M
ar18-M
ar08-Apr22-Apr06-M
ay20-M
ay03-Jun17-Jun01-Jul15-Jul29-Jul
Doses

20. IMMUNITY
Vaccine Distribution
 9.71 million doses Panvax distributed to 12 August
2010
 6.44 million doses of 2010 seasonal vaccine
released by TGA
National Serosurvey (healthy adults)
 May 2009 - Pre-pandemic: 5-15%
 October 2009 - Post pandemic, pre Panvax: 22%
 March 2010 - Post Panvax, pre Seasonal: 43%

21. CURRENT SITUATION – 2010
 Influenza activity low in Australia but showing
signs of increasing
- 1713 Confirmed cases of Influenza in 2010, 362 pandemic
(H1N1)
 Pandemic strain predominant in Australia
- 68% pandemic (H1N1) 2009 of specimens isolated
 Pandemic (H1N1) 2009 predominant in most
countries, low activity except NZ, India
 Type B predominant in China (55.5%) with 46% the
same strain as 2010 Southern Hemisphere vaccine

22. Weekly consultation rates for influenza-like illness
in New Zealand, 2008-2010
Source: Institute of Environmental Science and Research, Influenza Weekly Update 2010/30

24. UK REVIEW
SOME KEY FINDINGS
 Containment phase lasted longer and consumed more
resources than anticipated
 Tension between common phased approach to
pandemic planning and flexibility
 Vaccine availability during the pandemic – a significant
achievement
 Flexible arrangements needed for purchasing vaccine
 Need for vaccination implementation plans prior to a
pandemic
 Communications – important to generate public
awareness and understanding
 Coordinated media briefings

25. 1. National governance
and decision making
2. Public communication
3. Public health measures
4. Border measures
5. Primary and secondary
health care
6. National Medical
Stockpile deployment
7. Surveillance
8. Laboratories
9. Vaccination
10. Indigenous Australians
AUSTRALIAN PANDEMIC
RESPONSE REVIEW

26. Outcomes of the review will:
further strengthen Australia’s ability to respond;
publicly available 'lessons identified' report, at the
end of the 2010; and
Revise the Australian Health Management Plan
for Pandemic Influenza (AHMPPI)

27. KEY INDIVIDUALS FOR PANDEMIC RESPONSE
NIR
Ms Mary Murnane
Ms Jenny Bryant
Dr Gary Lum
Ms Fay Holden
Dr Bernie Towler
Dr Andrew Singer
Dr Andrea Forde
Ms Kay McNiece
Dr Jenean Spencer
Prof Terry Nolan ATAGI
Dr Chris Mitchell RACGP
Dr Vicki Krause CDNA
NSW Dr Kerry Chant
Dr Jeremy McAnulty
VIC Dr John Carnie
Dr Rosemary Lester
QLD Dr Jeanette Young
Dr Christine Selvey
TAS Dr Craig White
Dr Chrissie Pickin
WA Dr Tarun Weeramanthri
Dr Andy Robertson
SA Dr Stephen Christley
ACT Dr Charles Guest
NT Dr Barbara Paterson