The Risk Strategy for Responding to an Influenza Outbreak - Literature review Example

Introduction A risk strategy plays a critical role in pandemic and epidemic control. It has been suggested that a risk strategy which includes crisis communication should be given prominence in response to outbreaks (Gamhewage, 2014). Risk strategies in high-concern situations are responsible for assembling information that motivates public health interventions during health outbreaks and emergencies. One thing stands in support of developing a working risk strategy: it is the driving force for an effective response (Fred Garcia, 2006). It accomplishes this by replacing single-directional communication among stakeholders with a multi-directional one. Painful and important lessons about risk strategy for health outbreaks have been learnt and effective models have evolved from past epidemics. Among these were the severe acute respiratory syndrome (SARS) outbreaks of 2003, the outbreaks of Middle East respiratory syndrome coronavirus (MERSCoV), the influenza A (HINI) pandemic of 2009, the 2014-15 outbreaks of Ebola in West Africa, and lately the Zika outbreak (Tambyah, 2016). This study selects influenza outbreak for framing a risk strategy. This is because influenza remains to be a notable health outbreak in the region. The Australian Department of Health (2015) observes that 62% of all notifications in 2015 were attributed to the influenza B season. The most affected were children in the school going age bracket. The number of patients hospitalized with influenza was the same as the previous year with 7% of the hospitalized being taken to the ICU. Corbellini et al. (2011) suggest a number of strategies for responding to influenza as a risk. Some of the strategies are incorporated in the framing of the risk strategy this paper discusses. The Risk Strategy for responding to influenza outbreak In framing a risk strategy model, a lot could be borrowed from Huddox Matrix which was designed to be used in injury intervention (Runyan, 1998). Public health researcher as and experts have applied the same model for guiding response to the pandemic influenza (Barnett et al., 2005a) and other public health concerns like SARS and bioterrorism (Barnett et al., 2005b). The matrix has a grid comprising four columns for four factors namely the human, the agent, the physical environment and the organizational environment (Runyan, 1998). These factors are present whenever any event occurs. If influenza pandemic is understood as a massive kind of injury, Huddox Matrix would help analyse the complex nature of the outbreak and the attendant challenges (Patel et al., 2008). The matrix is applicable in framing an influenza risk response strategy in the sense that it identifies the contribution of each of the four factors in the grid towards the provision of primary healthcare services, surveillance and control in the public health sector. Against this background, this study adopts a strategy developed by the Communicable Diseases Network Australia and New Zealand (1999). The agency identifies intervention steps that are important in developing a risk strategy for Influenza. It borrows greatly for the World Health Organization guidelines for responding to influenza (WHO, 2015). The first step is to enhance surveillance by keeping the track of the virus spread through sampling patients and conducting routine laboratory check-ups (Seid et al., 2007). This stage implies direct funding allocation and taking preventive measures. The second stage is notification. This stage happens in case there is a confirmation of a human-to-human transmission of the virus. The public is notified of influenza outbreak or what may be called influenza-like outbreak in case there is no certainty. This step implies policy or legislative actions. The third step is to involve a response agency. In case of Australia, the team to be informed and involved is the Australian Medical Disaster Coordination Group (AMDCG). The agency advises its members to be on high alert. It also sets in motion plans for medical emergencies. Vaccination is the third stage of response to influenza outbreak. Upon the advice of WHO, the Communicable Diseases Network Australia New Zealand (CDNANZ) identifies the high-risk and priority groups to be vaccinated. Ranking may be done according to the factors like vulnerability, predisposition, and exposure. Children, for instance could more vulnerable than adults, groups that could be considered to be traditionally at high-risk include over 50 year-old indigenous Australians, over 65 year-old indigenous and non-indigenous Australians, and people suffering from chronic illnesses. Those at high-risk exposure comprise providers of essential services. They include the police, the health-workers and other emergency service providers. The last response strategy is treatment and/or hospitalization. This entails different diagnosis of the patients, different modes of treatment or therapies and admission in hospitals. Considerations are made between providing home or hospital care, the capacity of the health and nursing facilities in the community. Institutions like the Red Cross and St. John Ambulance are also involved in such emergencies. An important component of a risk strategy is the timeframe. If the emergence of a new sub-type of influenza is reported in the Northern Hemisphere before it reaches Australia, the country has ample time to activate the earlier stages of preparation. From the history of previous pandemics, a new wave of transmissions is expected to occur 3-9 months after the first outbreak. According to WHO (2015), it takes an interval of 2-3 years between the end of an influenza outbreak and a new wave of outbreaks. Another component of the strategy is to consider remote and rural populations. In most cases, access to proper health services is limited in rural and remote settings (Abeysinghe & White, 2011). Since these populations do have a right to good healthcare, they should be included in planning and executing interventions for influenza pandemic in an equitable and fair manner. A risk strategy testing is an important facet of its framing. There is need to conduct field tests for draft pandemic response strategies (Sullivan, 2009). This aids in identifying strengths and weaknesses and addressing the accordingly. Test drills in the field are good for determining the efficacy and gaps in a risk strategy. Another way to test the response plans is by using scenarios. The response teams could use table-top and field activities to identify the “what if” situations which would be form bases for discussions. The scenarios may yield a number of options for different possible cases. Conceptual framework A risk strategy for health emergency is best understood to revolve around five major functions identified by the WHO (2012). These functions include Event detection, Risk assessment, Risk communication, Control measures, and evaluation. The event in this sense refers to the outbreak of a health emergency, in this case, influenza outbreak. A well developed risk strategy should have features for detecting this event. As explained in the previous section this component is equated to the Surveillance. Good surveillance systems are able to detect threats and initial incidents of the breakout before they spread to significant levels. The risk can be easily eliminated at the initial stages before they gain epidemic status or cause serious damages. Once the event has been detected, other risk strategy components are activated at once. Fig 1.1 Risk strategic framework Communication is made to the technical members of the system and not the entire system. In the case of influenza outbreak, experts like medics, laboratory technicians and security organs of the systems gain from the process of Notification. Once laboratory and diagnostic tests have been conclusive, control measures can be taken to eliminate the transmission before it spreads. Measures like quarantine, routine screening, vaccinations and treatment take effect immediately assessment provides actionable results. As the control measures go on, evaluation is done at every stage and changes to verify their appropriateness and efficacy. Modifications are made on the basis of the evidence provided by the evaluators. In case of influenza outbreak or other epidemic, the effect may be massive and control and evaluation issues may face bottlenecks. Campaign The Australian Department of Health and Ageing (2006) outlines four main goals for setting up a risk strategy for influenza. The first goal is to, prevent as much as possible, influenza pandemic from occurring. The second goal is to ensure preparedness to meet the community needs in the event of a pandemic. The third goal is to readiness for prompt and effective response that would minimize the impact of the pandemic. The last goal is for the stakeholders to develop quick recovery mechanisms for individuals, communities and services. Communications is very crucial in risk strategy formulation as a campaign organ. In the case of influenza, proper communication would stem cases of public anxiety, confusion and panic. Moore, Mawji, Shiell and Noseworthy (2007) note that this could happen even if the response strategy is robust. Risk communication does not stop at notifying the relevant stakeholders and the general public of influenza outbreak. It has been noted that public alarm could come as a result of some measures like restricting movement, screening, closing public facilities and rationing vaccinations (Corbellini et al., 2011). It follows that information disseminated to the public and how it is done matters a lot. Therefore, an effective communication strategy is inevitable. In Australia, the National Emergency Media Relations Network (NEMRN) is responsible for coordinating media services in times of emergencies. It is charged with ensuring that the media is given proper briefing in an emergency. It also facilitates rapid information dissemination to the members. Jacobs et al. (2010) observe that the media strategy begins with preparing the public beforehand on what is expected if a new wave or influenza transmission reaches Australia. This may be done through a brochure assuring the public that CDNANZ is well prepared to handle the outbreak. A fact sheet could also be used to outlines measures to be taken and why they should be taken. For, example sheet may specify who should be included or excluded in the vaccination programme, or why patient isolation is done. During emergencies it is recommended that all health facilities and offices should have the fact sheet and priority should be given to the health workers (WHO, 2015). To complement this regular briefs by way of bulletins should be sent to hospitals, health colleges nurses and the health caregivers associations. The media is recognized as the most important in a risk strategy as it links the public and the health authorities during pandemics – vital information can be disseminated within a minute around Australia (Department of Health, 2015). Media should therefore view themselves as part of the emergency nad they need to be assisted by the medical practitioners to comprehend and pass vital medical information to the public. They should also buy in the measures taken by the authorities so that they may report from a position of partners rather than observers of the emergency response. The key stakeholders Players in health outbreak response include health practitioners, decision-makers, communities, scientists, partners, response teams, communities, nongovernmental organizations, technical experts and individuals. The stakeholders in Australia for influenza response include the following: Australian Nursing Council, Australia and New Zealand State/Territory Chief Health Officers State/Territory Chief Quarantine Officers, Australasian College for Emergency Medicine Australia Post. Australian Animal Health Laboratory Australian College of Paediatricians, Australian Faculty of Public Health Medicine, Australian Healthcare Association, Australian Lung Foundation, Australian Medical Council Federation, Australian Pharmaceutical Manufacturers Association, Australian Private Hospitals Association, Australian Society for Infectious Diseases, Australian Society for Microbiologists, Australian Medical Association, Carers Health Forum of Australia, CSL Ltd, Department of Foreign Affairs and Trade Emergency Management, Australia Glaxo Wellcome Australia Ltd, Medeva Pharma Ltd (UK), Novartis Pharmaceuticals Australia Pty Ltd, Rhone-Poulenc Rorer, Australia Pharmaceutical Society of Australia , Australian Association of Consultant Physicians Ltd, Australian Chinese Medical Association Inc. , Proprietary Medicine Association of Australia Public Health , Association of Australia Public Health Laboratory Network, Royal Australasian College of Physicians, Royal Australian College of General Practitioners, Pharmacy Guild of Australia, Australian Medical Disaster Coordination Group, Royal Australian College of Medical Administrators, Royal College of Nursing , Royal College of Pathologists of Australasia, SmithKline Beecham State Reference Laboratories, Thoracic Society of Roche Products Pty Ltd and the National Aboriginal Community Controlled Health Organization. Conclusion A risk strategy in responding to influenza is multi-structural. It contains several functions from different stakeholders doing different functions. Risk communications, however, is the most important tool in the risk strategy since it facilitates and coordinates every process. Media campaigns during an epidemic are sensitive and should be coordinated well so that confusion and panic associated with outbreaks could be forestalled. NEMRN ensures that all media players are given the correct information to rapidly transmit to national and community stakeholders. The other components of the strategy include the stakeholders and operations. References Abeysinghe, S., & White, K. (2011). The avian influenza pandemic: Discourses of risk, contagion and preparation in Australia. Health, Risk & Society, 13(4), 311-326. http://dx.doi.org/10.1080/13698575.2011.575457 Australia. (2006). Australian health management plan for pandemic influenza. 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