Australian Health Management Plan for Pandemic Influenza

2.3 Slowing the spread in the community

No matter how effective Australia’s border measures are, it is very likely that at some time the pandemic strain will make its way into Australia. A number of measures will be needed to minimise the spread of the pandemic.

Measures at the individual level include:

• Widespread, concerted adoption by individuals of good infection control at all times, such as:
  • keeping at least one metre away from people with obvious flu symptoms
  • adopting good hygiene practices
  • wearing a surgical mask (or other appropriate nose and mouth covering) when instructed by health authorities.

Part 2, Section B provides further information on these infection control measures.

• Identifying and isolating cases, and providing antiviral treatment. Part 2, Section C.2 provides further guidance on how infectious individuals can help slow the spread of the pandemic.
• Identifying and quarantining people who have been in close contact with an infectious case, and providing antiviral prophylaxis. Part 2, Section D provides further guidance on how those in contact with infectious individuals can help slow the spread of the pandemic.

Measures at the community level (often referred to as ‘social distancing measures’) include:

• closure of schools and childcare centres
• workplace measures
• cancellation of mass gatherings
• changing public transport arrangements to limit crowding
• movement restrictions.

Top of page

Identification and management of people infected (cases) with the pandemic influenza virus

Public health authorities will start to actively look for people potentially infected with the pandemic influenza virus as soon as we reach the DELAY phase (this is referred to as active surveillance). Depending on local requirements, state and territory health departments may establish flu clinics to assist with the early detection of people who may have pandemic influenza (see Part 1, Section C3.2 for more details).

The definitions used by public health authorities and clinicians to identify cases of pandemic influenza may change at different phases of the pandemic, as knowledge about the disease increases (see Box 5).

Box 5: Confirming the diagnosis During the DELAY and CONTAIN phases, people under investigation for pandemic influenza are likely to require a laboratory test to confirm the diagnosis. Confirming the diagnosis using a laboratory test will allow public health authorities to assess the situation accurately. Later in the pandemic, in SUSTAIN and CONTROL phases, when case numbers will be higher and when health professionals will be experienced in identifying pandemic influenza cases, an influenza like illness (ILI) may be sufficient for diagnosis and commencement of treatment. Community announcements will encourage those who are ill to remain in home isolation. During RECOVER, laboratory diagnosis will once again be important to assess the situation and confirm the diagnosis when very few, if any cases, are occurring in Australia. Details of laboratory testing are provided in the Pathology Annex.

If clinically indicated, cases may be offered a course of antiviral medicine and will be provided with information on how to access medical care if they become severely unwell.

In accordance with appropriate public health legislation all people with pandemic influenza will be required to stay at home (referred to as ‘home isolation’) until they are no longer infectious. If severely ill and requiring hospital care, they would be isolated from people without influenza in a hospital room, or in an alternative facility, until they are no longer infectious or no longer requiring hospital care.

It is likely that adults will be infectious for up to seven days after the onset of illness. Children and the elderly may take longer to clear the virus from their system and hence could be infectious and need to be in isolation for longer periods. Clear guidance on how long cases should be asked to remain in isolation will be issued in the DELAY phase. The length of isolation may be adjusted during the pandemic in light of increased knowledge about the behaviour of the pandemic virus and a better understanding of the effectiveness of antiviral medication in reducing the amount of virus a person sheds.

The patient, and those caring for them in the home, will need to adopt strict hygiene practices to avoid the spread of infection in the household (see Part 2). Wearing a surgical mask while in close contact with other people is one of the main measures an infectious person can take to help stop the spread of infection.
Top of page

Phase snapshot: Case identification and management

PHASE	HEALTH ACTION
ALERT	Prepare policy, infrastructure, processes Implement passive surveillance for cases of avian influenza in humans (imported from overseas)
DELAY	Implement active surveillance for possible cases of pandemic influenza, manage and isolate cases under investigation until diagnosis of pandemic influenza is excluded
CONTAIN	Depending on sustainability of resources continue active or passive surveillance Continue to manage and isolate cases
SUSTAIN
CONTROL	Continue, but consider downscaling surveillance of cases as appropriate. Continue to manage and isolate cases manage cases Evaluate effectiveness of case identification and isolation measures
RECOVER	Get ready to re-implement effective measures if a subsequent wave is imminent
Linked document	Guidelines for the Public Health Management of Pandemic Influenza (under development)

Top of page

Identification and management of people exposed to pandemic influenza: quarantine of contacts

From DELAY onwards, authorities will try to identify people who have been in recent close contact with patients confirmed to have the pandemic strain (‘contacts’). The definition of a contact will be determined at the time and may change during the different phases (see Box 6).

Box 6: Scope of contact definition

CONTAIN	Likely to include household, school, workplace and other close contacts.
SUSTAIN onwards	Likely to include household contacts only

Top of page In the CONTAIN phase efforts will be made to identify and quarantine people who have had contact with infectious cases at school and/or workplace as well as at home. All contacts will be directed to stay at home in ‘home quarantine’. During the SUSTAIN phase, quarantine may be limited to people who share a home with an infected case. These contacts may be given post-exposure prophylaxis antivirals (preventative medication) to reduce their chances of becoming infected. Contacts in quarantine will be asked to take their body temperature every day and report by telephone to a specified jurisdictional health service if symptoms occur. Contacts in home quarantine should wear a surgical mask if they can (or other appropriate covering of mouth and nose) for at least 48 hours from the time they were identified as a contact. Contacts should practice appropriate personal hygiene throughout the quarantine period. If a contact becomes unwell with any influenza like symptoms, they should wear a surgical mask while in contact with others. They should discuss their symptoms with the health authorities. If confirmed as a case, their post-exposure prophylaxis may be changed to a treatment regime. The infected person would then be managed in isolation as stated above (case management). For those who do not become ill, home quarantine will end after a specified period of time. This is likely to be around seven days from last possible exposure. Clear guidance on how long contacts should be asked to remain in quarantine will be issued at the beginning of the DELAY phase. The length of the quarantine period may be adjusted during the pandemic in light of increased knowledge about the behaviour of the pandemic virus. [Top of page

Phase snapshot: Contact identification and management

PHASE	HEALTH ACTION
ALERT	Prepare policy, infrastructure, processes
DELAY	Implement contact tracing (all contacts) and quarantine
CONTAIN
SUSTAIN	Depending on impact and sustainability of resources continue contact tracing (household contacts) and quarantine
CONTROL	Continue contact tracing (household contacts) and quarantine if feasible, but consider downscaling services as appropriate to complement vaccine distribution Evaluate effectiveness of control measures
RECOVER	Get ready to re-implement effective measures if a subsequent wave is imminent Implement measures to recover
Linked document	Guidelines for the Public Health Management of Pandemic Influenza (under development)

Top of page

Community measures—social distancing

While it is not feasible for everyone in the community to stop all social contact, we can reduce the likelihood of infection in some settings.

Some people will be infectious without knowing it and they will continue to move around in the community. In settings where there are large numbers of people who have close contact, infections can spread easily. The aim of social distancing is to decrease the opportunity for this to happen.

Social distancing measures complement individual measures outlined earlier.

Disease modelling has shown that some of these interventions, for example school and childcare closures, need to be in place early to ensure they are fully effective. The choice of measures will depend on the epidemiology of the pandemic.

Implementation of the social distancing measures outlined below will be a whole of government decision because of their broader social and economic impact (see Box 7). Health may advise consideration of the following.

Box 7: Social and community impacts of social distancing The Australian Government is working with the community sector to enhance its ability to manage better the social and community impacts of a pandemic and to be in the best position to continue providing essential community services in the event of a pandemic in Australia. This includes providing information and planning tools, pandemic business continuity workshops, training for social workers, arrangement to ensure continuity of income support payments, more flexible contractual arrangements for service providers and other assistance should it be needed.

Top of page

Schools and childcare closures

Disease modelling has shown that the early introduction of school or childcare closures may reduce the rate at which pandemic influenza spreads in the community. It is known from seasonal influenza and from previous pandemics that:

• children typically have higher rates of infection than adults
• they may be infectious but not showing signs of infection for longer than adults
• infected children shed more virus and for longer periods of time than adults (that is, are more infectious to others than adults)
• children are less able to comply with hygiene measures than adults.

Reducing transmission in children by closing schools could therefore potentially reduce the rate at which children become infected and reduce transmission in the community.

Decisions relating to school or childcare closures will be made at the time, once the epidemiological characteristics of the virus are known. If schools or childcare centres are to be closed, administrators and employers will be advised by their state or territory government.

Workplace measures

All businesses should have business continuity plans in place to prepare for an influenza pandemic and protocols for infection control and general hygiene in the workplace.

In addition to good infection control and general hygiene in the workplace, employers can prevent transmission by:

• Encouraging people who are potentially infected with pandemic influenza, and their contacts, to keep away from the workplace. Staff should be actively encouraged to stay away from work if they or someone in their household has a fever, or other signs of respiratory illness.
• Ensuring staff who develop influenza like illness (ILI) while at work leave immediately and seek medical attention at the nearest influenza service.
• Providing opportunities for staff to work from home, particularly during the SUSTAIN phase.
• Providing flexible working hours to reduce crowding at peak times.

Business or community organisation managers should consider providing the following:

• Facilities for people to wash their hands frequently. This means sinks with warm and cold running water, plain, liquid or antimicrobial soap, or alcohol-based disinfectants and disposable paper towels.
• Tissues and no‑touch waste bins.
• Signs about cough and sneeze etiquette. Posters and other materials are available from www.flupandemic.gov.au.

Further guidance for workplaces and business continuity planning is available at Appendix B.

Cancelling mass gatherings in the SUSTAIN phase: for example, places of worship, sports events.

If the pandemic is widespread in the community well people may be encouraged to avoid mass gatherings, and certain events may even be cancelled. Specific local advice on events and gatherings will be provided at the time.
If well people must enter a crowded environment in an area where there is widespread community transmission they will be advised to apply individual infection control measures.

Public transport in the SUSTAIN phase

If the pandemic is widespread in the community, transport schedules may be changed to limit crowding. If people must use public transport they will be advised to apply individual infection control measures.

Movement restrictions

Movement restrictions are likely to be an extraordinary measure and utilised only under certain circumstances in the CONTAIN phase. The decision will be made at a whole of government level.

In the CONTAIN phase, if an outbreak of the pandemic virus is confined to a well‑defined area, that area may be quarantined. If so, people will not be allowed to travel to or from the area. Authorities will ensure that necessary services continue to be supplied to people in the area.
Top of page

Phase snapshot: Community measures — social distancing

PHASE	HEALTH ACTION
ALERT	Prepare health policy advice
DELAY	Advise whole of government that social distancing measure should be anticipated
CONTAIN	Advise whole of government that social distancing measure should be implemented Implement social distancing measures
SUSTAIN	Evaluate social distancing measures depending on impact and sustainability of resources
CONTROL	Advise whole of government if social distancing measure should be continued but consider downscaling services as appropriate to complement vaccine distribution Evaluate effectiveness of control measures
RECOVER	Get ready to re-implement effective measures if a subsequent wave is imminent Implement measures to recover
Linked document	National Action Plan for Human Influenza Pandemic

Top of page

|TOC|next page

This information is current for 03 September, 2010
This information was issued on 05 December, 2008