Pandemic Preparedness and Response Plan for Nigeria
Transcript Of Pandemic Preparedness and Response Plan for Nigeria
Nigeria National Pandemic Influenza Preparedness and Response Plan
September 2013
EXECUTIVE SUMMARY
Influenza A viruses periodically cause worldwide pandemics with medium to high rates of illness and death and considerable societal disruption. A future influenza pandemic has the potential to infect a very significant percentage of the population and result in a large number of deaths. Unlike other public health emergencies, an influenza pandemic is a disaster and will simultaneously impact all global regions simultaneously. Given the broad geographic scope of a pandemic, the availability of external international support is expected to be very limited. Therefore, each nation must be prepared to respond within this context of limited external assistance, making maximum use of nationally available resources to mitigate the potentially significant impacts of a severe pandemic.
Planning and preparedness is critical to an effective response to a pandemic disaster and requires the involvement of every level of the Government of Nigeria, the healthcare and social services community, and the business community. This document, the National Pandemic Influenza Preparedness and Response Plan of the Federal Republic of Nigeria, serves as a blueprint for a coordinated national strategy to prepare for, and respond to a national pandemic influenza disaster. This plan is intended to be both flexible and dynamic, and includes preparedness and response components that are consistent with the general principles of disaster response.
This plan contains the following sections: 1. Introduction / Objectives / Endstate 2. Situation and Planning Assumptions 3. Nigeria Pandemic Sub-Phases 4. Execution
a. Command and Control b. NEMA Operations Centre Activation c. Concept of Operation (tasks by phase) 5. Functional Instructions (10 key functions) 6. Annexes addressing key areas
The core components of the plan are tasks to be accomplished during each pandemic phase. These tasks provide “trigger” points during each phase to ensure appropriate action is taken. The plan also contains functional instructions which provide more detailed background information concerning ten key functional areas. The annexes included in this plan contain a handbook for civilian population use during a pandemic, glossary and acronyms, bibliography and a number of guidelines and checklists which provide detailed practical information concerning priority populations for vaccination and anti-viral medication; Alternative Medical Treatment Sites; implementation of community containment measures; and hospital preparedness recommendations. It is recommended that all pandemic influenza stakeholders become familiar with the introduction, Situation and Planning Assumptions, Execution and Functional Instructions sections of this plan. Those individuals who are directly involved with the tasks outlined in other sections should acquire in-depth knowledge of the appropriate components.
Last updated draft as of 9/20/2013
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INTRODUCTION
Purpose / Objectives As a component of Nigeria’s comprehensive disaster management system, this pandemic influenza preparedness and response plan addresses issues unique to an influenza pandemic.
The purpose of this plan is to provide a framework for the government of the Federal Republic of Nigeria, pandemic response personnel, and other pandemic stakeholder agencies and organizations to work together to accomplish the following objectives:
1. Contribute to an effective national and local level response to an influenza pandemic
2. Reduce influenza-related morbidity and mortality 3. Minimize disruption of critical social, economic and medical services during a
pandemic 4. Mitigate pandemic-related impacts on critical infrastructure 5. Facilitate post-pandemic recovery operations
Desired Endstate Within the context of the objectives above, the desired post-pandemic endstate is that the Federal Republic of Nigeria and its partners emerge from an influenza pandemic with minimal health and non-health impacts to the local population, government personnel and critical infrastructure and that all private and public sector stakeholders are capable of immediately resuming all aspects of pre-pandemic operations and services.
NOTE: Although this plan provides general guidelines to prepare for and respond to an influenza pandemic, this plan can also be used to prepare for and respond to disaster situations caused by other highly-infectious disease pandemics.
SITUATION AND PLANNING ASSUMPTIONS
Definition of an influenza pandemic
A pandemic is a global disease outbreak. An influenza pandemic occurs when a new influenza virus emerges for which there is little or no immunity in the human population and begins to spread efficiently from person to person, causing serious illness, sometimes resulting in death. Because of its potential to cause significant illness and death worldwide, experts believe that a global influenza pandemic will have a major negative impact on the global economy, including travel, trade, tourism, food, retail consumption and eventually, investment and financial markets.
Last updated draft as of 9/20/2013
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Characteristics and challenges of a pandemic1
Rapid Worldwide Spread
o When a pandemic influenza virus emerges, its global spread is considered inevitable.
o Preparedness activities should assume that the entire world population would be susceptible.
o Countries might, through measures such as border closures and travel restrictions, delay arrival of the virus, but cannot stop it.
Health Care Systems Overloaded
o Most people have little or no immunity to a pandemic virus. Infection and illness rates soar. A substantial percentage of the world’s population will require some form of medical care.
o Nations are unlikely to have the staff, facilities, equipment and hospital beds needed to cope with large numbers of people who suddenly fall ill.
o Death rates are high, largely determined by four factors: the number of people who become infected, the virulence of the virus, the underlying characteristics and vulnerability of affected populations and the effectiveness of preventive measures.
o Past pandemics have spread globally in two and sometimes three waves.
Medical Supplies Inadequate
o The need for vaccine is likely to outstrip supply.
o The need for antiviral drugs is also likely to be inadequate early in a pandemic.
o A pandemic can create a shortage of hospital beds, ventilators and other supplies. Surge capacity at non-traditional Alternative Medical Treatment Sites such as schools may be created to cope with demand
o Difficult decisions will need to be made regarding who gets antiviral drugs and vaccines.
Economic and Social Disruption
o Travel bans, closings of schools and businesses and cancellations of events could have major impact on communities and citizens.
o Care for sick family members and fear of exposure can result in significant worker absenteeism.
1 http://www.pandemicflu.gov/general/whatis.html
Last updated draft as of 9/20/2013
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Clinical Attack Rates for Nigeria
The table below illustrates the estimated number of symptomatic cases expected during a pandemic, based on either a 15% or 35% attack rate.
Estimated Number of Symptomatic Cases by Outcome for Federal Republic of Nigeria
Estimated Number of Symptomatic Cases by Outcome Nigeria – Population 162,470,7372
Outcome
15% Attack Rate 35% Attack Rate
Sick
24,370,611
56,864,758
Deaths (2.5%)
609,265
1,421,619
Hospitalizations (10%)
2,437,061
5,686,476
ICU (15% of Hospitalized)
365,559
852,971
Mechanical Ventilation (7.5% of Hospitalized)
182,780
426,486
Planning Assumptions
1) An influenza pandemic will affect multiple communities across Nigeria simultaneously.
2) Susceptibility to the pandemic influenza virus will be universal among all population groups.
3) Efficient and sustained person-to-person transmission of a “novel” virus signals an imminent pandemic. (Note: a novel virus is one that has not been previously found in the human population and therefore one for which humans have little or no inherent immunity.)
4) The typical incubation period (interval between infection and onset of symptoms) for influenza is approximately 2 days.
5) Persons who become ill may “shed” virus and can transmit infection for up to one day before the onset of symptoms. Viral shedding and the risk of transmission will be greatest during the first 2 days of illness. Children usually shed the greatest
2 World Bank, World Development Indicators,
http://www.google.com/search?q=nigeria+population&sugexp=chrome,mod=19&sourceid=chrome&ie=UTF-8
Last updated draft as of 9/20/2013
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amount of virus and therefore are likely to post the greatest risk for transmission to others.
6) On average, infected persons will transmit infection to approximately two other people.
7) The clinical disease attack rate will be 30% or higher in the overall population during the pandemic. Illness rates will be highest among school-aged children (about 40%) and decline with age. Among working adults, an average of 25% will become ill during a community outbreak.
8) Some persons will become infected but not develop clinically significant symptoms. Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection.
9) Of those who become ill with a pandemic influenza virus, 50-60% will seek outpatient medical care, but due to the enormous demand for health resources, most infected persons will be treated at home. This will require families to provide inhome care for ill family members.
10) Pandemic-related anxiety will cause increased psychogenic and stress-related illness, compounding the strain on healthcare facilities.
11) The number of hospitalizations and deaths will depend on the virulence of the pandemic virus. (Note: Estimates of pandemic casualties differ significantly between more and less severe scenarios.)
12) Risk groups for severe and fatal infection will include infants, the elderly, pregnant women, and persons with compromised immune systems and/or chronic medical conditions.
13) Access to anti-viral medications will be very limited.
14) Once a pandemic influenza virus is identified, it will take from three to six months to produce an initial vaccine, and significantly longer to produce and distribute sufficient quantities of this vaccine to effectively impact the pandemic.
15) Once produced, vaccine will be distributed in accordance with priorities established by the World Health Organization.
16) Lack of access to anti-viral medications and vaccines and perceptions about inequitable distribution is a potential cause of public concern, and even social unrest.
17) Workplace absenteeism will depend on the severity of the pandemic. In a severe pandemic, absenteeism attributable to illness, the need to care for ill family members, and fear of infection may reach 40% during the peak weeks of a community outbreak. Certain public health measures (closing schools and childcare facilities, quarantining household contacts of infected individuals, etc.) are likely to increase rates of absenteeism.
18) In an affected community, a pandemic outbreak “wave” will last about 6 to 8 weeks. These outbreaks will reoccur multiple times within a community.
19) Multiple waves (periods during which community outbreaks occur across the country) of illness will occur, with each wave lasting 2-3 months.
Last updated draft as of 9/20/2013
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20) Government agencies may recommend changes in business workplace rules, such as increased telecommuting, but government action to close businesses or involuntarily mandate business work policies is unlikely to be effective.
21) Most national governments will not close their borders or severely limit travel, although significant entrance and exit screening will be mandated at border entry and exit locations and will cause significant travel delays.
22) Commercial air transportation will be limited by flight cancellations due to airline crew availability, pandemic-related infrastructure limitations and fiscal challenges. Flights to some countries may be completely unavailable.
23) Isolation and quarantine at international ports-of-entry (POE) is a national responsibility, with some local government support and follow-up.
24) During a severe “pandemic wave”, local availability of food, health, fuel, and other “everyday” items will be limited by hoarding and pandemic-related impacts on distribution and transportation systems.
NATIONAL PANDEMIC PHASES
The Federal Republic of Nigeria has established pandemic alert phases which are modelled on the World Health Organization (WHO) Pandemic Alert phasing protocols and have also been designed to coincide with various stages of the “pandemic curve.”
These phases also include unique “Nigeria-specific sub-phasing” during phase 4-6. This sub-phasing will be initiated upon the WHO’s declaration of Phase 4, which occurs once a novel virus with the potential to cause community outbreaks has been identified. The purpose of this sub-phasing is to provide a more accurate assessment of regional and national pandemic risk to facilitate decision-making during national pandemic response operations. The President’s Office will determine and declare the current phase using information and recommendations provided by the Ministry of Health. It should be noted that while this phasing protocol has specific standards identified for declaration of each phase, other unique factors may be present which might warrant variation from these standards in determining the appropriate phase.
These phases consider the possibility that Nigeria may experience a severe pandemic prior to the World Health Organization declaring either Phase 5 or Phase 6 to indicate a global pandemic. This would be especially likely if a pandemic virus were to begin in Nigeria, or in close proximity to Nigeria, thus causing the region to experience a pandemic disaster prior to the advent of a global pandemic.
Last updated draft as of 9/20/2013
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WHO Phase 1: No viruses circulating among animals have been reported to cause infections in humans. WHO will normally declare Phase 1.
Nigeria Sub-Phasing: Phase 1-3: Preparation: No significant human pandemic virus identified globally.
WHO 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. WHO will normally declare Phase 2.
Nigeria Sub-Phasing: Phase 1-3: Preparation: No significant human pandemic virus identified globally.
WHO Phase 3: An animal or human-animal influenza 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. WHO will normally declare Phase 3.
Nigeria Sub-Phasing: Phase 1-3: Preparation: No significant human pandemic virus identified globally.
WHO Phase 4: Characterized by verified human-to-human transmission of an animal or human-animal influenza virus able to cause “community-level outbreaks.” WHO will normally declare Phase 4.
Nigeria Sub-Phasing: Phase 4a: No confirmed or suspected cases within Africa, Nigeria or neighbouring countries (Benin, Niger, Chad, Cameroon). Phase 4b: Confirmed or suspected cases in Africa, but no cases within Nigeria or any of the countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon). Phase 4c: Local Outbreak: First confirmed or suspected case in Nigeria or one of the countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon). Phase 4d: Regional Outbreak: Confirmed or suspected cases in Nigeria and at least one country bordering Nigeria (Benin, Niger, Chad, Cameroon). Phase 4e: Widespread Regional Outbreak: Confirmed or suspected cases in Nigeria and at least three countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon). Phase 4f: High Risk Regional Outbreak: Confirmed or suspected cases in Nigeria and at least three countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon) and widespread confirmed cases in schools. Phase 4g: Deceleration/Resolution: Weekly incidence rates of pandemic influenza decline by at least 10% per week for at least two weeks.
Last updated draft as of 9/20/2013
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WHO Phase 5: Characterized by human-to-human spread of the virus into at least two countries in one WHO region. WHO will normally declare Phase 5.
Nigeria Sub-Phasing:
Phase 5a: No confirmed or suspected cases within Africa, Nigeria or neighbouring countries (Benin, Niger, Chad, Cameroon).
Phase 5b: Confirmed or suspected cases in Africa, but no cases within Nigeria or any of the countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 5c: Local Outbreak: First confirmed or suspected case in Nigeria or one of the countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 5d: Regional Outbreak: Confirmed or suspected cases in Nigeria and at least one country bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 5e: Widespread Regional Outbreak: Confirmed or suspected cases in Nigeria and at least three countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 5f: High Risk Regional Outbreak: Confirmed or suspected cases in Nigeria and at least three countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon) and widespread confirmed cases in schools.
Phase 5g: Deceleration/Resolution: Weekly incidence rates of pandemic influenza decline by at least 10% per week for at least two weeks.
WHO Phase 6: This 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 under way. WHO will normally declare Phase 6.
Nigeria Sub-Phasing:
Phase 6a: No confirmed or suspected cases within Africa, Nigeria or neighbouring countries (Benin, Niger, Chad, Cameroon).
Phase 6b: Confirmed or suspected cases in Africa, but no cases within Nigeria or any of the countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 6c: Local Outbreak: First confirmed or suspected case in Nigeria or one of the countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 6d: Regional Outbreak: Confirmed or suspected cases in Nigeria and at least one country bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 6e: Widespread Regional Outbreak: Confirmed or suspected cases in Nigeria and at least three countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 6f: High Risk Regional Outbreak: Confirmed or suspected cases in Nigeria and at least three countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon) and widespread confirmed cases in schools.
Phase 6g: Deceleration/Resolution: Weekly incidence rates of pandemic influenza decline by at least 10% per week for at least two weeks.
Last updated draft as of 9/20/2013
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EXECUTION
Command and Control for Pandemic Response Operations Nigeria has developed a comprehensive national approach to disaster management applicable at all jurisdictional levels and across functional disciplines. This system allows national, state and local governments to work effectively and efficiently together to prepare for, respond to, and recover from domestic incidents, regardless of cause, size, or complexity. Current national disaster policies and plans discuss the roles and responsibilities to various disaster stakeholders at the national, state and local levels. In addition, these policies and plans outline the fundamental concept of operations for disaster response and define the functional roles and responsibilities of various government entities, including the Armed Forces of Nigeria (AFN). The Command and Control structure of this National Pandemic Influenza Preparedness and Response Plan coincides with the command and control structure outlined in these other policies and plans. During a pandemic, the Federal Ministry of Health (FMoH) will operate as the “lead agency” for governmental response, although all national response will be coordinated and directed by the National Emergency Management Agency (NEMA) in full cooperation with applicable ministries and national committees. Although the FMoH will operate as the lead agency, it should be emphasized that an influenza pandemic is not solely a public health emergency. The non-health impacts of a pandemic may be more problematic than potential health impacts. Therefore, it is critical that the national government respond to any severe influenza pandemic as it would in any other national disaster and that all available resources are committed to pandemic response.
Activation of the Nigeria National Emergency Management Agency (NEMA) Operations Centre: The trigger point for partial NEMA Operations Centre activation is declaration of the Nigerian sub-phase 4b, 5b, or 6b, which occurs when cases of confirmed pandemic influenza are present in Africa, but not in Nigeria or its neighbouring countries. The Full NEMA Operations Centre activation trigger point is the declaration of the Nigeria subphase of 4c, 5c, or 6c, which occurs when a confirmed case of pandemic influenza occurs within Nigeria or a neighbouring country. Although these trigger points will be utilized for NEMA partial and full activation, other factors will be considered (i.e. viral virulence, etc.) prior to activation of the NEMA Operations Centre and may cause acceleration or delay of NEMA Operations Centre activation. At the appropriate trigger point, the President’s Office, with recommendations from the FMoH and NEMA, will draft an Executive Order declaring that a State of Emergency exists and specifying the emergency powers that are necessary or appropriate to cope with the pandemic disaster. Existing disaster management policies and plans outline the procedures for activation of various government ministries and agencies to address the specific needs of a pandemic and the procedures to coordinate the efforts between various government ministries, the AFN, and other disaster stakeholders. To facilitate a coordinated response, NEMA will maintain contact with the State Emergency Management Agencies. Depending on characteristics of an influenza pandemic, regional ECOWAS response actions may be warranted, involving various regional and international stakeholders.
Last updated draft as of 9/20/2013
Page 10
September 2013
EXECUTIVE SUMMARY
Influenza A viruses periodically cause worldwide pandemics with medium to high rates of illness and death and considerable societal disruption. A future influenza pandemic has the potential to infect a very significant percentage of the population and result in a large number of deaths. Unlike other public health emergencies, an influenza pandemic is a disaster and will simultaneously impact all global regions simultaneously. Given the broad geographic scope of a pandemic, the availability of external international support is expected to be very limited. Therefore, each nation must be prepared to respond within this context of limited external assistance, making maximum use of nationally available resources to mitigate the potentially significant impacts of a severe pandemic.
Planning and preparedness is critical to an effective response to a pandemic disaster and requires the involvement of every level of the Government of Nigeria, the healthcare and social services community, and the business community. This document, the National Pandemic Influenza Preparedness and Response Plan of the Federal Republic of Nigeria, serves as a blueprint for a coordinated national strategy to prepare for, and respond to a national pandemic influenza disaster. This plan is intended to be both flexible and dynamic, and includes preparedness and response components that are consistent with the general principles of disaster response.
This plan contains the following sections: 1. Introduction / Objectives / Endstate 2. Situation and Planning Assumptions 3. Nigeria Pandemic Sub-Phases 4. Execution
a. Command and Control b. NEMA Operations Centre Activation c. Concept of Operation (tasks by phase) 5. Functional Instructions (10 key functions) 6. Annexes addressing key areas
The core components of the plan are tasks to be accomplished during each pandemic phase. These tasks provide “trigger” points during each phase to ensure appropriate action is taken. The plan also contains functional instructions which provide more detailed background information concerning ten key functional areas. The annexes included in this plan contain a handbook for civilian population use during a pandemic, glossary and acronyms, bibliography and a number of guidelines and checklists which provide detailed practical information concerning priority populations for vaccination and anti-viral medication; Alternative Medical Treatment Sites; implementation of community containment measures; and hospital preparedness recommendations. It is recommended that all pandemic influenza stakeholders become familiar with the introduction, Situation and Planning Assumptions, Execution and Functional Instructions sections of this plan. Those individuals who are directly involved with the tasks outlined in other sections should acquire in-depth knowledge of the appropriate components.
Last updated draft as of 9/20/2013
Page 2
INTRODUCTION
Purpose / Objectives As a component of Nigeria’s comprehensive disaster management system, this pandemic influenza preparedness and response plan addresses issues unique to an influenza pandemic.
The purpose of this plan is to provide a framework for the government of the Federal Republic of Nigeria, pandemic response personnel, and other pandemic stakeholder agencies and organizations to work together to accomplish the following objectives:
1. Contribute to an effective national and local level response to an influenza pandemic
2. Reduce influenza-related morbidity and mortality 3. Minimize disruption of critical social, economic and medical services during a
pandemic 4. Mitigate pandemic-related impacts on critical infrastructure 5. Facilitate post-pandemic recovery operations
Desired Endstate Within the context of the objectives above, the desired post-pandemic endstate is that the Federal Republic of Nigeria and its partners emerge from an influenza pandemic with minimal health and non-health impacts to the local population, government personnel and critical infrastructure and that all private and public sector stakeholders are capable of immediately resuming all aspects of pre-pandemic operations and services.
NOTE: Although this plan provides general guidelines to prepare for and respond to an influenza pandemic, this plan can also be used to prepare for and respond to disaster situations caused by other highly-infectious disease pandemics.
SITUATION AND PLANNING ASSUMPTIONS
Definition of an influenza pandemic
A pandemic is a global disease outbreak. An influenza pandemic occurs when a new influenza virus emerges for which there is little or no immunity in the human population and begins to spread efficiently from person to person, causing serious illness, sometimes resulting in death. Because of its potential to cause significant illness and death worldwide, experts believe that a global influenza pandemic will have a major negative impact on the global economy, including travel, trade, tourism, food, retail consumption and eventually, investment and financial markets.
Last updated draft as of 9/20/2013
Page 3
Characteristics and challenges of a pandemic1
Rapid Worldwide Spread
o When a pandemic influenza virus emerges, its global spread is considered inevitable.
o Preparedness activities should assume that the entire world population would be susceptible.
o Countries might, through measures such as border closures and travel restrictions, delay arrival of the virus, but cannot stop it.
Health Care Systems Overloaded
o Most people have little or no immunity to a pandemic virus. Infection and illness rates soar. A substantial percentage of the world’s population will require some form of medical care.
o Nations are unlikely to have the staff, facilities, equipment and hospital beds needed to cope with large numbers of people who suddenly fall ill.
o Death rates are high, largely determined by four factors: the number of people who become infected, the virulence of the virus, the underlying characteristics and vulnerability of affected populations and the effectiveness of preventive measures.
o Past pandemics have spread globally in two and sometimes three waves.
Medical Supplies Inadequate
o The need for vaccine is likely to outstrip supply.
o The need for antiviral drugs is also likely to be inadequate early in a pandemic.
o A pandemic can create a shortage of hospital beds, ventilators and other supplies. Surge capacity at non-traditional Alternative Medical Treatment Sites such as schools may be created to cope with demand
o Difficult decisions will need to be made regarding who gets antiviral drugs and vaccines.
Economic and Social Disruption
o Travel bans, closings of schools and businesses and cancellations of events could have major impact on communities and citizens.
o Care for sick family members and fear of exposure can result in significant worker absenteeism.
1 http://www.pandemicflu.gov/general/whatis.html
Last updated draft as of 9/20/2013
Page 4
Clinical Attack Rates for Nigeria
The table below illustrates the estimated number of symptomatic cases expected during a pandemic, based on either a 15% or 35% attack rate.
Estimated Number of Symptomatic Cases by Outcome for Federal Republic of Nigeria
Estimated Number of Symptomatic Cases by Outcome Nigeria – Population 162,470,7372
Outcome
15% Attack Rate 35% Attack Rate
Sick
24,370,611
56,864,758
Deaths (2.5%)
609,265
1,421,619
Hospitalizations (10%)
2,437,061
5,686,476
ICU (15% of Hospitalized)
365,559
852,971
Mechanical Ventilation (7.5% of Hospitalized)
182,780
426,486
Planning Assumptions
1) An influenza pandemic will affect multiple communities across Nigeria simultaneously.
2) Susceptibility to the pandemic influenza virus will be universal among all population groups.
3) Efficient and sustained person-to-person transmission of a “novel” virus signals an imminent pandemic. (Note: a novel virus is one that has not been previously found in the human population and therefore one for which humans have little or no inherent immunity.)
4) The typical incubation period (interval between infection and onset of symptoms) for influenza is approximately 2 days.
5) Persons who become ill may “shed” virus and can transmit infection for up to one day before the onset of symptoms. Viral shedding and the risk of transmission will be greatest during the first 2 days of illness. Children usually shed the greatest
2 World Bank, World Development Indicators,
http://www.google.com/search?q=nigeria+population&sugexp=chrome,mod=19&sourceid=chrome&ie=UTF-8
Last updated draft as of 9/20/2013
Page 5
amount of virus and therefore are likely to post the greatest risk for transmission to others.
6) On average, infected persons will transmit infection to approximately two other people.
7) The clinical disease attack rate will be 30% or higher in the overall population during the pandemic. Illness rates will be highest among school-aged children (about 40%) and decline with age. Among working adults, an average of 25% will become ill during a community outbreak.
8) Some persons will become infected but not develop clinically significant symptoms. Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection.
9) Of those who become ill with a pandemic influenza virus, 50-60% will seek outpatient medical care, but due to the enormous demand for health resources, most infected persons will be treated at home. This will require families to provide inhome care for ill family members.
10) Pandemic-related anxiety will cause increased psychogenic and stress-related illness, compounding the strain on healthcare facilities.
11) The number of hospitalizations and deaths will depend on the virulence of the pandemic virus. (Note: Estimates of pandemic casualties differ significantly between more and less severe scenarios.)
12) Risk groups for severe and fatal infection will include infants, the elderly, pregnant women, and persons with compromised immune systems and/or chronic medical conditions.
13) Access to anti-viral medications will be very limited.
14) Once a pandemic influenza virus is identified, it will take from three to six months to produce an initial vaccine, and significantly longer to produce and distribute sufficient quantities of this vaccine to effectively impact the pandemic.
15) Once produced, vaccine will be distributed in accordance with priorities established by the World Health Organization.
16) Lack of access to anti-viral medications and vaccines and perceptions about inequitable distribution is a potential cause of public concern, and even social unrest.
17) Workplace absenteeism will depend on the severity of the pandemic. In a severe pandemic, absenteeism attributable to illness, the need to care for ill family members, and fear of infection may reach 40% during the peak weeks of a community outbreak. Certain public health measures (closing schools and childcare facilities, quarantining household contacts of infected individuals, etc.) are likely to increase rates of absenteeism.
18) In an affected community, a pandemic outbreak “wave” will last about 6 to 8 weeks. These outbreaks will reoccur multiple times within a community.
19) Multiple waves (periods during which community outbreaks occur across the country) of illness will occur, with each wave lasting 2-3 months.
Last updated draft as of 9/20/2013
Page 6
20) Government agencies may recommend changes in business workplace rules, such as increased telecommuting, but government action to close businesses or involuntarily mandate business work policies is unlikely to be effective.
21) Most national governments will not close their borders or severely limit travel, although significant entrance and exit screening will be mandated at border entry and exit locations and will cause significant travel delays.
22) Commercial air transportation will be limited by flight cancellations due to airline crew availability, pandemic-related infrastructure limitations and fiscal challenges. Flights to some countries may be completely unavailable.
23) Isolation and quarantine at international ports-of-entry (POE) is a national responsibility, with some local government support and follow-up.
24) During a severe “pandemic wave”, local availability of food, health, fuel, and other “everyday” items will be limited by hoarding and pandemic-related impacts on distribution and transportation systems.
NATIONAL PANDEMIC PHASES
The Federal Republic of Nigeria has established pandemic alert phases which are modelled on the World Health Organization (WHO) Pandemic Alert phasing protocols and have also been designed to coincide with various stages of the “pandemic curve.”
These phases also include unique “Nigeria-specific sub-phasing” during phase 4-6. This sub-phasing will be initiated upon the WHO’s declaration of Phase 4, which occurs once a novel virus with the potential to cause community outbreaks has been identified. The purpose of this sub-phasing is to provide a more accurate assessment of regional and national pandemic risk to facilitate decision-making during national pandemic response operations. The President’s Office will determine and declare the current phase using information and recommendations provided by the Ministry of Health. It should be noted that while this phasing protocol has specific standards identified for declaration of each phase, other unique factors may be present which might warrant variation from these standards in determining the appropriate phase.
These phases consider the possibility that Nigeria may experience a severe pandemic prior to the World Health Organization declaring either Phase 5 or Phase 6 to indicate a global pandemic. This would be especially likely if a pandemic virus were to begin in Nigeria, or in close proximity to Nigeria, thus causing the region to experience a pandemic disaster prior to the advent of a global pandemic.
Last updated draft as of 9/20/2013
Page 7
WHO Phase 1: No viruses circulating among animals have been reported to cause infections in humans. WHO will normally declare Phase 1.
Nigeria Sub-Phasing: Phase 1-3: Preparation: No significant human pandemic virus identified globally.
WHO 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. WHO will normally declare Phase 2.
Nigeria Sub-Phasing: Phase 1-3: Preparation: No significant human pandemic virus identified globally.
WHO Phase 3: An animal or human-animal influenza 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. WHO will normally declare Phase 3.
Nigeria Sub-Phasing: Phase 1-3: Preparation: No significant human pandemic virus identified globally.
WHO Phase 4: Characterized by verified human-to-human transmission of an animal or human-animal influenza virus able to cause “community-level outbreaks.” WHO will normally declare Phase 4.
Nigeria Sub-Phasing: Phase 4a: No confirmed or suspected cases within Africa, Nigeria or neighbouring countries (Benin, Niger, Chad, Cameroon). Phase 4b: Confirmed or suspected cases in Africa, but no cases within Nigeria or any of the countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon). Phase 4c: Local Outbreak: First confirmed or suspected case in Nigeria or one of the countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon). Phase 4d: Regional Outbreak: Confirmed or suspected cases in Nigeria and at least one country bordering Nigeria (Benin, Niger, Chad, Cameroon). Phase 4e: Widespread Regional Outbreak: Confirmed or suspected cases in Nigeria and at least three countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon). Phase 4f: High Risk Regional Outbreak: Confirmed or suspected cases in Nigeria and at least three countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon) and widespread confirmed cases in schools. Phase 4g: Deceleration/Resolution: Weekly incidence rates of pandemic influenza decline by at least 10% per week for at least two weeks.
Last updated draft as of 9/20/2013
Page 8
WHO Phase 5: Characterized by human-to-human spread of the virus into at least two countries in one WHO region. WHO will normally declare Phase 5.
Nigeria Sub-Phasing:
Phase 5a: No confirmed or suspected cases within Africa, Nigeria or neighbouring countries (Benin, Niger, Chad, Cameroon).
Phase 5b: Confirmed or suspected cases in Africa, but no cases within Nigeria or any of the countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 5c: Local Outbreak: First confirmed or suspected case in Nigeria or one of the countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 5d: Regional Outbreak: Confirmed or suspected cases in Nigeria and at least one country bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 5e: Widespread Regional Outbreak: Confirmed or suspected cases in Nigeria and at least three countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 5f: High Risk Regional Outbreak: Confirmed or suspected cases in Nigeria and at least three countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon) and widespread confirmed cases in schools.
Phase 5g: Deceleration/Resolution: Weekly incidence rates of pandemic influenza decline by at least 10% per week for at least two weeks.
WHO Phase 6: This 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 under way. WHO will normally declare Phase 6.
Nigeria Sub-Phasing:
Phase 6a: No confirmed or suspected cases within Africa, Nigeria or neighbouring countries (Benin, Niger, Chad, Cameroon).
Phase 6b: Confirmed or suspected cases in Africa, but no cases within Nigeria or any of the countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 6c: Local Outbreak: First confirmed or suspected case in Nigeria or one of the countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 6d: Regional Outbreak: Confirmed or suspected cases in Nigeria and at least one country bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 6e: Widespread Regional Outbreak: Confirmed or suspected cases in Nigeria and at least three countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon).
Phase 6f: High Risk Regional Outbreak: Confirmed or suspected cases in Nigeria and at least three countries immediately bordering Nigeria (Benin, Niger, Chad, Cameroon) and widespread confirmed cases in schools.
Phase 6g: Deceleration/Resolution: Weekly incidence rates of pandemic influenza decline by at least 10% per week for at least two weeks.
Last updated draft as of 9/20/2013
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EXECUTION
Command and Control for Pandemic Response Operations Nigeria has developed a comprehensive national approach to disaster management applicable at all jurisdictional levels and across functional disciplines. This system allows national, state and local governments to work effectively and efficiently together to prepare for, respond to, and recover from domestic incidents, regardless of cause, size, or complexity. Current national disaster policies and plans discuss the roles and responsibilities to various disaster stakeholders at the national, state and local levels. In addition, these policies and plans outline the fundamental concept of operations for disaster response and define the functional roles and responsibilities of various government entities, including the Armed Forces of Nigeria (AFN). The Command and Control structure of this National Pandemic Influenza Preparedness and Response Plan coincides with the command and control structure outlined in these other policies and plans. During a pandemic, the Federal Ministry of Health (FMoH) will operate as the “lead agency” for governmental response, although all national response will be coordinated and directed by the National Emergency Management Agency (NEMA) in full cooperation with applicable ministries and national committees. Although the FMoH will operate as the lead agency, it should be emphasized that an influenza pandemic is not solely a public health emergency. The non-health impacts of a pandemic may be more problematic than potential health impacts. Therefore, it is critical that the national government respond to any severe influenza pandemic as it would in any other national disaster and that all available resources are committed to pandemic response.
Activation of the Nigeria National Emergency Management Agency (NEMA) Operations Centre: The trigger point for partial NEMA Operations Centre activation is declaration of the Nigerian sub-phase 4b, 5b, or 6b, which occurs when cases of confirmed pandemic influenza are present in Africa, but not in Nigeria or its neighbouring countries. The Full NEMA Operations Centre activation trigger point is the declaration of the Nigeria subphase of 4c, 5c, or 6c, which occurs when a confirmed case of pandemic influenza occurs within Nigeria or a neighbouring country. Although these trigger points will be utilized for NEMA partial and full activation, other factors will be considered (i.e. viral virulence, etc.) prior to activation of the NEMA Operations Centre and may cause acceleration or delay of NEMA Operations Centre activation. At the appropriate trigger point, the President’s Office, with recommendations from the FMoH and NEMA, will draft an Executive Order declaring that a State of Emergency exists and specifying the emergency powers that are necessary or appropriate to cope with the pandemic disaster. Existing disaster management policies and plans outline the procedures for activation of various government ministries and agencies to address the specific needs of a pandemic and the procedures to coordinate the efforts between various government ministries, the AFN, and other disaster stakeholders. To facilitate a coordinated response, NEMA will maintain contact with the State Emergency Management Agencies. Depending on characteristics of an influenza pandemic, regional ECOWAS response actions may be warranted, involving various regional and international stakeholders.
Last updated draft as of 9/20/2013
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