Document by NDMA, Govt. of India, 01-5-2009
Introduction
Mexican Flu also named as Influenza A detected first time in Mexico is caused by
H1N1 virus. WHO has already declared the disease as alert level to phase 5, one
step short of full fledged pandemic. With current movements of the population,
our country may not remain free from the disease. Therefore preventive measures
are required in place so that virus does not reach to our country, through carrier or
patient. Even if it reaches preventive measures for the containment will be taken
against the spread of virus. Following guidelines are prepared on the basis of
best practices being followed in the affected countries on the advice of WHO and
CDC Atlanta. These guidelines also include recommendations of “International
Workshop on Pandemic Preparedness beyond Health” held on 21 and 22 Apr
2008 organized by NDMA.
I. Prevention
a. Active surveillance by medical screening at Air ports, Sea ports and
International land entry points is required.
b. All persons coming from affected countries and showing symptoms of
influenza will be screened. Teams of trained doctors and para medical
staff need to be placed at air port, sea ports and at land entry points of our
neighboring countries for medical screening of passengers arriving from
the influenza affected countries.
c. A standard format will be used for the screening purposes across the
country. During the screening doctors must look for the symptoms of
fever, cough, sore throat, head-ache, nasal discharge, sneezing, chills and
fatigue. Some cases may have diarrhea and vomiting as well. Passengers
having these symptoms must be quarantined and their nasopharyngeal
swab should be taken. Passengers having possible symptoms indicating
flu need to be quarantined at least for three days, their samples will be
taken and sent for virus identification to the designated bio-safety
laboratories (BSL). Adequate sample collection kit and Personal
Protective Equipments (PPE) will be placed for the sampling. All medical
teams will observe universal safety measures.
d. Nasal and Throat swab taking: Both nose and throat swabs will be taken
and placed into a bottle of viral transport medium, using swabs preferably
with a plastic shaft. The staff members taking the swabs should wear a face mask, plastic apron and gloves. All lab staff taking swab must be
trained for correct procedures of sample taking.
e. Strict Quarantine: Passengers travelling from affected countries and
those showing flu like symptoms will be placed under strict quarantine for
a period of minimum three days and will only be cleared after receiving a
negative report for H1N1 virus.
II. Hospital Preparedness:
a. All hospital in the major cities will be earmarked to create capacities to
isolate these patients during quarantine period. All doctors, para-medical
staffs, nurses, laboratory technicians and other staff likely to come in
contact with suspected person will use personal protective equipment
(PPE). Adequate stock of PPE consisting of face masks, gloves and
protective disposable suits with goggles will be kept for the use of hospital
staff. Similar measures shall also be taken for international air ports, major
hospitals in major cities and laboratories. Plans should also be prepared to
cater for large number of patients that may come at the pandemic phase.
Such capacity can be surged by discharging cold surgery and chronic
cases. Wards for H1N1 influenza patients will be isolated to prevent the
infection to the other patients. Medical team treating H1N1 influenza cases
in hospital are required to use FFP3 standard mask (International
Standard).
b. Chemoprophylaxis: Those in close
contact of person showing symptoms
will be given antiviral drug TamiFlu. A stock of ten million doses of
Oseltamivir (TamiFlu) to be procured and distributed. The TamiFlu
should be stocked at international air ports and designated hospitals. Drugs
can be given for prophylaxis to medical and para medial staff and for the
treatment of affected cases and people who have come in contact with
affected cases.
c. Laboratory backup: Adequate laboratory back up of BSL3 and BSL4
labs is required to be activated to support the hospital and the screening
team.
III. Logistics support:
a. Adequate amount of TamiFlu to be procured and stocked at the location
decided by the nodal ministry.
b. Pharmaceutical companies will be advised to keep themselves ready to
manufacture larger quantities of TamiFlu at a short notice.IV. Public Awareness: Press and Electronic Media will be used for this
purpose Do’s and Dont’s will be regularly relayed to the community. Public
should be specifically advised not to hide the disease and advised to report the
nearest medical authority in case of Flu symptoms. Do’s and Dont’s are attached
as annexure-A.
V. Communication:
a. Control rooms will be established at airports, sea ports, hospitals, director
health services of states, to be linked with state crisis management groups,
ministry of health and family welfare, and ministry of home affairs,
National Crisis Management Committee and National Disaster
Management Authority.
b. Regular updates on development across the country must be monitored by
the nodal officer so appointed by Ministry of Health and Family Welfare
and Department of Health.
c. Crisis Management Group must meet every day to review the status and
apprise NCMC and NDMA on day to day basis.
VI. Business continuity plan:
a. Plan for Maintenance of Essential Services and Continuity of Operations
should be prepared for full fledged pandemic. Such plans will be
applicable both for government and private sectors through awareness
strategies, monitoring and regulation mechanisms for compliance.
b. Sub-committees need to be constituted for handling issues related to civil
continuity with working groups for concerned ministries. For pandemic
preparedness and planning refer annexure-D of proceedings of
“International Workshop on Pandemic Preparedness beyond Health”
(attached).
VII. Recommendation for coordination and ensuring
implementation
a. It is proposed to constitute teams which will have representative from
Ministry of Health and Family Welfare, State Health departments of
affected states and NDMA.
b. The teams will visit airports and hospitals to coordinate and over see the
proper functioning. Annexure-A
Do’s and Dont’s for the public:
Do’s
· Cover your mouth and nose with a handkerchief or tissue while coughing or
sneezing.
· Wash your hands every time after coughing or sneezing, thoroughly with soap
and water, before and after touching your nose, eyes or mouth.
· Avoid crowded places.
· Stay at home if infected with flu like illness.
· Keep at least an arm’s distance from people affected with symptoms of influenza
like cough, running nose, sneezing and fever.
· Sleep well, stay physically active and effectively manage stress.
· Drink plenty of water and eat nutritious food.
Dont’s
· Shake hands, hug and kiss socially, or use other contact greetings.
· Take medicines without consulting the physician.
· Spit outdoors.
· Aspirin not to be used in children.
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