Current Challenges in Infectious Diseases Essay Example

Introduction

The Border plan control measure of HINI 2009 Influenza

According to Australian Government Department of Health and ageing (AHMPPI) 2010, a1 pandemic is an epidemic that has been acknowledged to have spread to vast regions and countries. An epidemic is an infectious contagious disease that has thrived over many people exhibiting hardcore characteristics in the prevention and treatment. The bacteria or the influenza virus generate genes that eventually survives immunization proving them ineffective. At the instance of emergence, an antibiotic for the disease is developed and proves some effectiveness. However, according to WHO in 20092, the virus reproduces and copies its genetic material becoming antibiotic resistance. Cooper et al in 20063 observed that the antibiotic resistance consequently poses a predicament in the treatment of such infectious diseases since the morbidity and the mortality rate increases, the hospitalization period increases and the disease becomes enormous for control spreading over vast regions and countries consequently being declared as a pandemic.

It is the government’s responsibility over the public’s health welfare. Consequently, the Australian government through its department of health has identified the ways to protect the public in events of epidemic and emergence. In reference to the pandemic (HINI) Influenza 2009, the Department of Health and Ageing in Australia developed various measures that have been in implementation since then. The measures were directed or aimed towards delaying the pandemic invasion in Australia, slowing the spreading of the disease and decrease the number of the pandemic victims in the community. Among other measures developed in the AHMPPI by the Australian Commonwealth Department of Health and Ageing in reference to the Australian Government Department of Health and Ageing report in 20094, border measure and border restrictions at airports and seaports were put in place.

The border plan measure is directed towards protecting the country from receiving the infectious diseases from outside their boundaries. Consequently the border measures are in reference to air and sea entries. In the recommendations of WHO in 20095, one measure in the border plan is the screening of infectious diseases or those suffering from any acute respiratory illness. When identified, the passengers are not allowed to board the vessel or the plane. The policy is complimented by the Quarantine department where it retains authority to detain and keep away any person who is ailing from a contagious disease or an acute respiratory illness (ARI) until declared free of the diseases’ symptoms. Duncan et al in his literature in 20096 directs that the same precaution method is used prior to arrival in Australia where the flight commander is supposed to confirm that they have or they don’t have any ill passenger on board prior to alighting. If the response is positive: there is an ill passenger, the personnel at the airport report the case to the Australian Quarantine and Inspection Service which consequently handles the case medically.

Concurrent with the measures, the border plan requires that there be made an in-flight announcement in reference to a pandemic influenza which is targeted to encourage self-reporting of individuals and provide information in regard to one own health status if experiencing any symptom following the recommendations as stated in the WHO report in 2009. On the other hand, vessel and plane passengers are required to fill health declaration cards (HDCs). The cards have spaces that should be filled by passenger’s personal information in regard to the influenza symptoms, and any contact had with an ARI patient. According to the Australian Government Department of Health and Ageing response report in 2009, the cards7 are produced in a number of languages to ensure that there is full enquiry to get correct answers.

Thermal imaging scanners are also used in the border plan against the factious disease as implemented in the AHMPPI border plan in reference to the Australian Government Department of Health and Ageing response report. Cooper et al in 2006 describes that8 the hand held devices are used to check on the arriving passengers’ skin’s temperature providing a means to identify an elevated temperature hence the need for further clinical assessment in regard to the influenza traces. In case of occurrences of delay in the formal border plan elements, an immediate deployment of a clinical presence in designated air and sea ports are made. The clinical assessment is directed towards assessing arriving travellers who have signs and symptoms of influenza. The thermal scanners and the clinical assessment are complemented by screening for further analysis.

Other elements of the border plan are disembarking of confirmed patients of the in the influenza, purification of the Aircrafts and the Airports in regard to the pandemic’s virus and the vessels too and also continued training of the quarantine and the clinical assessors.

History of the Border Control

In reference to the WHO literature in 20099, the border measures through the authority of AHMPPI and the Quarantine department has been implemented and has been in use as from the early years of 1918 in the period when there was the emergence of the Spanish flu that was spread across the world causing the death of millions of people. However, Australia escaped the traces of the infectious disease due its border restrictions. As stated by Duncan et al in 200910, the border measures implemented at the international airports and at the sea ports were first implemented in Victoria and later to New South Wales after which the whole it was adopted in the whole of Australia.

The border plan has had continued use and emphasis mostly after the emergence of the HINI. The Marine Quarantine conferred that the changes of mass travellers in the cruise ships’ closed environment was a leading factor to the spread of the infectious respiratory disease. Since communications remains a cornerstone of pandemic influenza response as acknowledged by the Australian Government Department of Health and Ageing in 200911, the border plan has since been into effect even in times of non-pandemic to improve and confer preparedness as a national pandemic outbreak protocol.

Literature Review in regard to the border plan

1. Appuhamy R, Beard F, Phung H, Selvey C, Birrell F & Culleton T. The changing phases of pandemic of pandemic (H1N1) 2009 in Queensland: an overview of public health actions and epidemiology, 2009, Med J Aust; 192 (2): 94-97 retrieved from https://www.mja.com.au/journal/2010/192/2/changing-phases-pandemic-h1n1-2009-queensland-overview-public-health-actions-and

In reference to the article12, the border plan was implemented as a response measure in the control of the (HINI) 2009 pandemic in Queensland by a number of agencies including AMHPPI. The border control measure is along with other measures of quarantine and antiviral, compulsory school closings and educating the public. In regard to the border control measure, the first case was noted in a passenger a citizen of Australia returning from the United States.

The border measures include positive pratique, use of health cards and self declaration along thermal scanners at the airports. The border plan proved successful with identification of hundreds of people with the disease’s symptoms. The border plan is also implemented in the seaports. A cruise ship was reported to with several similar cases of the infectious disease with over five passengers.

It is also reviewed that the H1N1 2009 border control measure was still in use during the emergence of Severe Acute Respiratory Syndrome (SARS). It is consequently recommended that there should be a periodical strict review on the effectiveness of the measure. The border plan currently exists in the protect phase and in the control phase along other measures having prevented the expected impact. However, there should be some an improvement in the measures at large to decrease the impact of such infectious diseases.

2. Cowling B, Lincoln L, Peng Wu, Wong H, Fang V, Riley S & Nishiura H. Entry screening to delay local transmission of 2009 pandemic influenza A (H1N1), pub med central, BMC Infect dis V.10;2010, retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152767/?tool=pubmed

The border plan13 was a recommendation from the WHO. It was consequently adopted by many countries by May 2009 at the airports, ports and other border crossings consequently separating the suspected victims and those confirmed of the influenza. Confidence was laid in the plan with a 95% delay as compared to countries that didn’t implement the plan. The border screening is divided to four major approaches the first one being the temperature check prior to disembarkation, followed by the self declaration health cards, observation for influenza symptoms and finally the thermal check for elevated temperatures. It was unfortunate that the emergence countries like Mexico didn’t check for the exiting travellers. A 7-12 days delay was acknowledged with an upper limit of about 20-30 days in the confirmation of imported influenza cases and the confirmation of the local cases.

The border plan could have performed poorly if implemented on its own. Consequently, many countries implemented the other mitigation measures such as the quarantine measures of separation and detention of suspected and confirmed cases, public education on hygiene, school closures and enhanced surveillance. However, it is negatively subjected that the border plan element of screening at the Australian sea and airports could only delay the spread of the pandemic rather than prevent the emergence of the local epidemics. In addition, most international journeys are shorter as compared to the H1N1 influenza incubation period of 1.5 to 2 days consequently rendering the border plan not being 100% effective to identify ill travellers with Hong Kong being a good example where only a third of the imported influenza was identified by the border screening while the other majority was identified through the local health care system.

It is summarized that14 substantial resources need be employed in order for the border screening to effectively operate though the WHO has been in subjectivity that the screening shortly reduces the entry bearing in mind that most journeys are shorter than the incubation period. However, resources employed should be in reference to the benefits obtained while other measure on influenza emergence and control should be applied and be awarded the respective resources.

The border measures use in the influenza control

The use of border measures and border restrictions in the control of the spread of a pandemic such as the H1N1 pandemic of 2009 in Australia had various implications. Aside from the benefits of influenza delay, it had various challenges as well as disadvantages.

Benefits of border measures and restrictions

Faster means of travel such as air travel were easy to monitor as the monitoring of air traffic can be combined with real time news reports of infectious disease outbreaks to help monitor passengers coming in from areas where there have been recent reports of disease detection. Thermal screening, health declaration cards, positive pratique, clinical were used to effectively delay the entry influenza into the country (WHO, 2009).

Border screening and quarantine can delay transmission of disease by a few days if effectively done. The Australian authorities reported the first case on 9th may and this remained the only case until 20th may. The delay phase was thus effective managing to delay the entry and spread for almost a month.

The border restrictions put in place enjoyed a significant amount of success as the entry of the virus into Australia was delayed by a few weeks. The morbidity and the mortality of the pandemic in Australia was also low and this can be attributed to the border measures and restrictions that were in place, though other measures such as those implemented under the CONTAIN and PROTECT phases also contributed to this high rate of success. According to government news bulletin reports on 21st October 200915 the deaths from the influenza were 186 out of 36,991 infections and 4886 hospitalizations.

Disadvantages of border measures

Border restrictions and measures had a wide range of scenarios, some of which had not been forecast before outbreak of the pandemic. Specific scenarios such as on board cruise ships required that strategic communication be established in order to monitor the situation more effectively. Cruise ships have numerous stopovers coupled with the fact that they spend a considerable amount of time between destinations meant that extra precaution had to be taken in monitoring such situation. Reports of Cruise flu lockdown for 200016 reported that 36 cruise ship passengers were feared to have contracted the virus. Further out of the 2000 passengers on board, 172 of them reported to have flu-like symptoms. The plan in place included screening of passengers and seclusion of infected or vulnerable passengers and staff. Plans were put in place to monitor the medical condition of staff members so that those with symptoms were allowed to quarantine at home while seeking medical help. The government 17 also recommended to all patients aboard ships that had been at risk of infection to quarantine themselves for 7 days while also seeking treatment.

Government decision making is a lengthy process that requires optimum coordination between the concerned bodies of the government for effective border restriction and control. If the decision making is slow the disease will have passed through the borders before the border restriction protocols are put in place. The government’s health and ageing department18 is well aware of this and as such has stipulated that border measures may be activated way before an epidemic is declared in order to remain flexible and provide spontaneous response to developing situations.

Border restrictions may also stipulate the imposition of travel bans on passengers travelling out of a country. Such a measure would have serious social and economic implications on such travellers. Such restrictions would also work between states in cases where different states have different prevalence rates.

Recommendations

The border restrictions that were put in place were only meant for the delay stage of the epidemic response protocol of Australia. Once the disease was confirmed to have gotten past the borders, there was a general relaxation on the stringent measures such as thermal screening, health declaration cards, positive pratique, and clinical presence as the government sought to redirect their efforts to contain the local cases now that the pandemic had spread. Further the previous response plan put in place was set out to deal with a severe pandemic which the H1N1 was clearly not. There was therefore a need to re evaluate the previous response as the disease was generally moderate with only a few severe cases and mild in the majority of cases. However stringent measures19 as specified by the positive pratique arrangements were still applicable to cruise ships arriving at ports.

The Australian government shifted to PROTECT stage which stipulated new border measures and restrictions. These new measures geared towards treating new patients identified at border screening points while also providing information to healthy patients on how to stay healthy. Even though this shift was effective, it highlighted the inability of the country’s disaster preparedness teams in the health sector to forecast all possible scenarios. The plan in place to deal with the influenza pandemic was designed with a more severe, Spanish flu- like pandemic in mind. However the H1N1 pandemic was observed to be mild in most severe in some. This meant that there was a need to come up with a new plan. Such occurrences should be avoided in the future as perfect planning should be able to account for all possible occurrences. Future courses of action should be diverse enough to handle any form of pandemic, whether severe or mild.

Despite this apparent fortune there is need for caution as medical practitioners have warned that border screening would have been rendered useless in detecting some other severe forms of influenza pandemic. The fact that the H1N1 influenza was mild meant that the pandemic plans were not fully put to the test. Prodormal or asymptomatic cases of infection20 were undetectable by the border screening processes that were put in place even with some of the infections of the influenza being asymptomatic.

Eastwood et al21, (2009) in their post pandemic case study review the idea that due to the perception among Australians that the disease was mild, most of them opted to not giving up information concerning the measures they undertook to stay healthy while the pandemic was still a threat. There was a reduced level of compliance to health measures that may be deemed necessary in the event of severe pandemics. This might negatively affect the collection of information in the future as was the case with border measures that required the filling in of health declaration cards at airports, if the perception among the population is that the pandemic is mild at its worst just like the past occurrence of the 2009 H1N1 influenza. Future dissemination of information regarding the pandemic to the general population should lay emphasis on ensuring the public understand the severity of the disease while also urging them not to be complacent in cases where the pandemic is mild.

References

Appuhamy R, Beard F, Phung H, Selvey C, Birrell F & Culleton T. The changing phases of pandemic of pandemic (H1N1) 2009 in Queensland: an overview of public health actions and epidemiology, 2009 Med J Aust; 192 (2): 94-97 retrieved from https://www.mja.com.au/journal/2010/192/2/changing-phases-pandemic-h1n1-2009-queensland-overview-public-health-actions-and
on 1st May, 2012. Pagebox.net/airtransport.html

Australian Bureau of Statistics. Assessment of the 2009 influenza pandemic. [Internet] 2009 [Cited 1st 2012]. Available from http://www.flu.gov/pandemic/global/southhemisphere.html

Australian Government Department of Health and Ageing. Government activates thermal scanners and health declaration cards at airports [Internet] 2009 [Cited 1st 2012]. Available from http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/news-008 on 1st May, 2012.

Australian government Department of Health and Ageing. Fluborderplan: National pandemic influenza airport border operations plan. [Internet] February 2009 [Cited 1st May 2012]. Available from: http://www.flupandemic.gov.au/internet/panflu/publishing.nsf/Content/B89

Cooper B, Pitman R, Edmunds W & Gay N. Delaying the international spread of pandemic influenza, PLos Med Jun 3(6):e212, 2006. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16640458 on 30th April, 2012.

Cowling B, Lincoln L, Peng Wu, Wong H, Fang V, Riley S & Nishiura H. Entry screening to delay local transmission of 2009 pandemic influenza A (H1N1), pub med central, BMC Infect dis V.10;2010, retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152767/?tool=pubmed
on 1st May, 2012.

Duncan A, Priest P, Jennings L, Brunton C & Baker M. Screening for influenza infection in international airline travellers, 2009. Am J Public Health Oct; 99, retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19797749 on 30th April, 2012.

Eastwood. K, Durheim. D, Butler. M & Jones. A. Responses to pandemic (H1N1) 2009, Australia [Internet]. 2010 August 8 [Cited 1st May 2012]. Available from http://wwwnc.cdc.gov/eid/article/16/8/pdfs/10-0132.pdf

Harvey E. & Hall L. Cruise flu lockdown for 2000. Sydney Morning Herald [Internet]. 2009 15th May.[cited 1st may 2012] Available from: http://www.smh.com.au/national/cruise-flu-lockdown-for-2000-20090526-bkvx.html

Government news bulletin. Pandemic update bulletin [Internet].21st October 2009[Cited 1st may 2012]. Available from: http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/1E D28E00C7CE66CBCA257654007538F5/$File/211009.pdf

Kelly H. We should not be complacent about our population based public health [Internet]. 2011 [Cited 1st May] Available from: http://www.biomedcentral.com/1471-2458/11/78

WHO. Pandemic (H1N1) 2009 briefing note 9: Preparing for the second wave: lessons from current outbreaks, 2009. Retrieved from http://www.who.int/csr/disease/swineflu/notes/h1n1_second_wave_20090828/en/index.html on 1st May, 2012.

WHO. Pandemic influenza preparedness and response (25 April 2009), Geneva, 2009, retrieved from http://www.who.int/csr/disease/influenza/pipguidance2009/en/index.html
on 1st May, 2012.

WHO. New influenza A (H1N1) virus: WHO guidance on public health measures, 2009, retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19797749 on 29th April, 2012.

1
Australian Government Department of Health and Ageing. Current status: Pandemic phases, 2010.

2
WHO. New influenza A (H1N1) virus: WHO guidance on public health measures, 2009.

3
Cooper B, Pitman R, Edmunds W & Gay N. Delaying the international spread of pandemic influenza, PLos Med Jun 3(6):e212, 2006.

4
Australian government department of health and ageing. Fluborderplan: National pandemic influenza airport border operations plan, 2009.

5
WHO. Pandemic influenza preparedness and response (25 April 2009), Geneva, 2009.

6
Duncan A, Priest P, Jennings L, Brunton C & Baker M. Screening for influenza infection in international airline travellers, 2009.

7
Australian Government Department of Health and Ageing. Current status: Pandemic phases, 2010 n 1.

8
Cooper B, Pitman R, Edmunds W & Gay N. Delaying the international spread of pandemic influenza, PLos Med Jun 3(6):e212, 2006, n 2.

9
WHO. Pandemic (H1N1) 2009 briefing note 9: Preparing for the second wave: lessons from current outbreaks, 2009.

10
Duncan A, Priest P, Jennings L, Brunton C & Baker M. Screening for influenza infection in international airline travellers, 2009, n 5.

11
Australian Government Department of Health and Ageing, Government activates thermal scanners and health declaration cards at airports, 2009.

12
Appuhamy R, Beard F, Phung H, Selvey C, Birrell F & Culleton T. The changing phases of pandemic of pandemic (H1N1) 2009 in Queensland: an overview of public health actions and epidemiology, 2009.

13
Cowling B, Lincoln L, Peng Wu, Wong H, Fang V, Riley S & Nishiura H. Entry screening to delay local transmission of 2009 pandemic influenza A (H1N1), pub med central, BMC Infect dis V.10;2010

14
Cowling B, Lincoln L, Peng Wu, Wong H, Fang V, Riley S & Nishiura H. Entry screening to delay local transmission of 2009 pandemic influenza A (H1N1), n 12.

15
Government news bulletin. Pandemic update bulletin, 2009.

16
http://www.smh.com.au/national/cruise-flu-lockdown-for-2000-20090526-bkvx.html

17
http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/news-008[february2009].[1st May 2012].

18
http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/phases[2009], [May 1st 2012]

19
http://www.who.int/csr/disease/influenza/pipguidance2009/en/index.html

20
http://www.biomedcentral.com/1471-2458/11/78.[2011]May 1st 2012 ]

21
http://wwwnc.cdc.gov/eid/article/16/8/pdfs/10-0132.pdf.[august 2010][1st May 2012]