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Managing pandemic influenza in general practice

Part C - Response

Proportional response

Last revised: 16 Dec 2019

Response occurs at the onset of an emergency. The level of response is likely to vary during the pandemic. Initially, pandemic cases may be sporadic, whereas during a peak, general practices may be inundated with patients with pandemic influenza.

Practices should implement their response strategies just prior to and during the pandemic. The action(s) required will depend on the current pandemic stage as determined by the Australian Government. These four stages are aligned with the Department of Health’s AHMPPI:

Responding to a pandemic means activating the plans made in the preparedness phase – in a manner and to a degree appropriate for the severity and intensity of the outbreak.

The quality of planning will affect the ability to respond. Strategies for implementation of pandemic plans are considered effective if they:3

  • are flexible
  • include a range of pandemic preparedness approaches applicable to different situations
  • include communication aspects and are transparent
  • include advance stockpiling (eg for drugs and equipment).

In the early stages of a pandemic, information about the risks and severity will be minimal. The best source of upto-date and relevant information for general practices will be the Department of Health, the RACGP, and state and territory health departments. They will provide information about:

  • what is known about the virus early in the pandemic – this is likely to include mode of transmission, broad incubation period, broad clinical presentation and case definition, and preventive measures to reduce transmission
  • what is unknown early in the pandemic – this may include age and clinical groups most affected, age groups with most transmission, ‘severity’ and case-fatality rates, precise case definition, complicating conditions, effectiveness of antivirals and other medications, and safety of any pharmaceutical interventions
  • what GPs should do early in the pandemic – as more information becomes available it will be easier to tailor your response according to the pandemic, your patients and your practice.

To continue to provide locally relevant information, health authorities will need to be informed about frontline pandemic situations, including patient feedback and effectiveness of any interventions.11

  1. World Health Organization. Pandemic influenza risk management: WHO interim guidance. Geneva: WHO, 2013.
  2. Department of Health and Ageing. Review of Australia’s health sector response to pandemic (H1N1) 2009: Lessons identified. Canberra: Commonwealth of Australia, 2011.
  3. Jean-Gilles L, Hegermann-Lindencrone M, Brown C. Recommendations for good practice in pandemic preparedness: Identified through evaluation of the response to pandemic (H1N1) 2009. Copenhagen: WHO Regional Office for Europe, 2010.
  4. Moen A, Kennedy PJ, Cheng PY, MacDonald G. National inventory of core capabilities for pandemic influenza preparedness and response: Results from 36 countries with reviews in 2008 and 2010. Influenza Other Respir Viruses 2014;8:201–08.
  5. Kunin M, Engelhard D, Thomas S, Ashworth M, Piterman L. Influenza pandemic 2009/A/H1N1 management policies in primary care: A comparative analysis of three countries. Aust Health Rev 2013;37:291–99.
  6. Simonsen KA, Hunskaar S, Sandvik H, Rortveit G. Capacity and adaptations of general practice during an influenza pandemic. PLoS One 2013;8:e69408.
  7. World Health Organization. Influenza (seasonal) fact sheet. Geneva: WHO Media Centre, 2016. mediacentre/factsheets/fs211/en [Accessed 21 March 2017].
  8. Simonsen L, Spreeuwenberg P, Lustig R, et al. Global mortality estimates for the 2009 influenza pandemic from the GLaMOR project: A modeling study. PLoS Med 2013;10:e1001558. [Accessed 21 March 2017].
  9. Muscatello DJ, Newall AT, Dwyer DE, Macintyre CR. Mortality attributable to seasonal and pandemic influenza, Australia, 2003 to 2009, using a novel time series smoothing approach. PLoS One 2013;8:e64734. [Accessed 21 March 2017].
  10. Quiñones-Parra S, Grant E, Loh L, et al. Pre-existing CD8+ T-cell immunity to the H7N9 influenza A virus varies across ethnicities. Proc Nat Acad Sci USA 2014;111:1049–54. [Accessed 21 March 2017].
  11. Collins N, Litt J, Winzenberg T, Shaw K, Moore M. Plan your pandemic – A guide for GPs. Aust Fam Physician 2008;37:794–99, 802–04. [Accessed 21 March 2017].
  12. Patel MS, Phillips CB, Pearce C, Kljakovic M, Dugdale P, Glasgow N. General practice and pandemic influenza: A framework for planning and comparison of plans in five countries. PLoS One 2008;3:e2269. [Accessed 21 March 2017].
  13. Larsen EL, Liverman CT (eds). Preventing transmission of pandemic influenza and other viral respiratory disease: Personal protective equipment for healthcare personnel. Update 2010. Washington: National Academies Press, 2011. [Accessed 21 March 2017].
  14. Dominguez A, Castilla J, Godoy P, et al. Effectiveness of pandemic and seasonal influenza vaccines in preventing pandemic influenza-associated hospitalization. Vaccine 2012;30:5644–50. [Accessed 21 March 2017].
  15. Valenciano M, Ciancio B, I-MOVE study team. I-MOVE: A European network to measure the effectiveness of influenza vaccines. Euro Surveill 2012;17(39). pii:20281. [Accessed 21 March 2017].
  16. Kissling E, Valenciano M, I-MOVE Case-Control Studies Team. Early estimates of seasonal influenza vaccine effectiveness in Europe among target groups for vaccination: Results from the I-MOVE multicentre case-control study, 2011/12. Euro Surveill 2012;17(15). pii: 20146. [Accessed 21 March 2017].
  17. Barberis I, Martini M, Iavarone F, Orsi A. Available influenza vaccines: Immunization strategies, history and new tools for fighting the disease. J Prev Med Hyg 2016 57(1): E41-E46. [Accessed 21 March 2017].
  18. Garten RJ, Davis CT, Russell CA, et al. Antigenic and genetic characteristics of swine-origin 2009 A(H1N1) influenza viruses circulating in humans. Science 2009;325:197–201. [Accessed 21 March 2017].
  19. York I, Donis RO. The 2009 pandemic influenza virus: Where did it come from, where is it now, and where is it going? Curr Top Microbiol Immunol 2013;370:241–57. [Accessed 21 March 2017].
  20. Milne GJ, Halder N, Kelso JK. The cost effectiveness of pandemic influenza interventions: A pandemic severity based analysis. PLoS One 2013;8:e61504. [Accessed 21 March 2017].
  21. Nelson C, Lurie N, Wasserman J, Zakowski S. Conceptualizing and defining public health emergency preparedness. Am J Public Health 2007;97(1):S9–11. [Accessed 21 March 2017].
  22. Nori A, Williams MA. Pandemic preparedness – Risk management and infection control for all respiratory infection outbreaks. Aust Fam Physician 2009;38:891–95. [Accessed 21 March 2017].
  23. La Torre G, Semyonov L, Mannocci A, Boccia A. Knowledge, attitude, and behaviour of public health doctors towards pandemic influenza compared to the general population in Italy. Scand J Public Health 2012;40:69–75. [Accessed 21 March 2017].
  24. Godoy P, Castilla J, Delgado-Rodríguez M, et al. Effectiveness of hand hygiene and provision of information in preventing influenza cases requiring hospitalization. Prev Med 2012;54:434–39. [Accessed 21 March 2017].
  25. World Health Organization. Vaccines against influenza. WHO position paper. Geneva: WHO, 2012. [Accessed 21 March 2017].
  26. Department of Health. The Australian immunisation handbook. 10th edn. Canberra: NHMRC, Commonwealth of Australia, 2015. [Accessed 21 March 2017].
  27. Blank PR, Bonnelye G, Ducastel A, Szucs TD. Attitudes of the general public and general practitioners in five countries towards pandemic and seasonal influenza vaccines during season 2009/2010. PLoS One 2012;7:e45450. [Accessed 21 March 2017].
  28. Aguilar-Diaz Fdel C, Jimenez-Corona ME, Ponce-de-Leon-Rosales S. Influenza vaccine and healthcare workers. Arch Med Res 2011;42:652–57. [Accessed 21 March 2017].
  29. Carlson AL, Budd AP, Perl TM. Control of influenza in healthcare settings: Early lessons from the 2009 pandemic. Curr Opin Infect Dis 2010;23:293–99. [Accessed 21 March 2017].
  30. Bellia C, Setbon M, Zylberman P, Flahault A. Healthcare worker compliance with seasonal and pandemic influenza vaccination. Influenza Other Respir Viruses 2013;7 Suppl 2:97–104. [Accessed 21 March 2017].
  31. van der Sande MA, Jacobi A, Meijer A, Wallinga J, van der Hoek W, van der Lubben M. The 2009 influenza A (H1N1) pandemic. Management and vaccination strategies in The Netherlands. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013;56:67–75. [Accessed 21 March 2017].
  32. Devnani M. Factors associated with the willingness of health care personnel to work during an influenza public health emergency: An integrative review. Prehosp Disaster Med 2012;27:551–66. [Accessed 21 March 2017].
  33. Seale H, Ward KF, Zwar N, Van D, Leask J, Macintyre CR. Examining the knowledge of and attitudes to pandemic influenza among general practice staff. Med J Aust 2010;192:378–80. [Accessed 21 March 2017].
  34. Martin SD, Brown LM, Reid WM. Predictors of nurses’ intentions to work during the 2009 influenza A (H1N1) pandemic. Am J Nurs 2013;113:24–31. [Accessed 21 March 2017].
  35. Council of Australian Governments. National action plan for human influenza pandemic. Canberra: Department of the Prime Minister and Cabinet, 2009. [Accessed 19 April 2017].
  36. Bocquet J, Winzenberg T, Shaw KA. Epicentre of influenza – The primary care experience in Melbourne, Victoria. Aust Fam Physician 2010;39:313–16. [Accessed 19 April 2017].
  37. Fleming DM, Durnall H. Ten lessons for the next influenza pandemic – An English perspective: A personal reflection based on community surveillance data. Hum Vaccin Immunother 2012;8:138–45. [Accessed 19 April 2017].
  38. Sherlaw W, Raude J. Why the French did not choose to panic: A dynamic analysis of the public response to the influenza pandemic. Sociol Health Illn 2013;35:332–44. [Accessed 19 April 2017].
  39. State Emergency Management Committee Western Australia. Emergency preparedness report 2012. Government of Western Australia. West Leederville: SEMC, 2012. [Accessed 19 April 2017].
  40. Angione SL, Inde Z, Beck CM, Artenstein AW, Opal SM, Tripathi A. Microdroplet sandwich real-time rt-PCR for detection of pandemic and seasonal influenza subtypes. PLoS One 2013;8:e73497. [Accessed 19 April 2017].
  41. Jimenez-Garcia R, Hernández-Barrera V, Rodríguez-Rieiro C, et al. Hospitalizations from pandemic influenza [A(H1N1) pdm09] infections among type 1 and 2 diabetes patients in Spain. Influenza Other Respir Viruses 2013;7:439–47. [Accessed 19 April 2017].
  42. Paich HA, Sheridan PA, Handy J, et al. Overweight and obese adult humans have a defective cellular immune response to pandemic H1N1 Influenza A virus. Obesity (Silver Spring) 2013;21:2377–86. [Accessed 19 April 2017].
  43. Weeramanthri TS, Robertson AG, Dowse GK, et al. Response to pandemic (H1N1) 2009 influenza in Australia – Lessons from a state health department perspective. Aust Health Rev 2010;34:477–86. [Accessed 19 April 2017].
  44. World Health Organization. Avian influenza, including influenza A (H5N1), in humans: WHO interim infection control guideline for health care facilities. Geneva: WHO, 2006. [Accessed 19 April 2017].
  45. Lee A, Chuh AA. Facing the threat of influenza pandemic – Roles of and implications to general practitioners. BMC Public Health 2010;10:661. [Accessed 19 April 2017].
  46. Anikeeva O, Braunack-Mayer AJ, Street JM. How will Australian general practitioners respond to an influenza pandemic? A qualitative study of ethical values. Med J Aust 2008;189:148–50. [Accessed 19 April 2017].
  47. Apolloni A, Poletto C, Colizza V. Age-specific contacts and travel patterns in the spatial spread of 2009 H1N1 influenza pandemic. BMC Infect Dis 2013;13:176. [Accessed 19 April 2017].
  48. National Health and Medical Research Council. Australian guidelines for the prevention and control of infection in healthcare. Canberra: NHMRC, 2010. healthcare_140616.pdf [Accessed 1 May 2017].
  49. Hall GG, Perry AG, vanDijk A, Moore KM. Influenza assessment centres: A case study of pandemic preparedness to alleviate excess emergency department volume. CJEM 2013;15:1–8. [Accessed 1 May 2017].
  50. Pearce C, Shearer M, Phillips C, et al. Views of GPs and practice nurses on support needed to respond to pandemic influenza: A qualitative study. Aust Health Rev 2011;35:111–15. [Accessed 1 May 2017].
  51. Etingen B, LaVela SL, Miskevics S, Goldstein B. Health information during the H1N1 influenza pandemic: Did the amount received influence infection prevention behaviors? J Community Health 2013;38:443–50. [Accessed 1 May 2017].
  52. Tooher R, Collins JE, Street JM, Braunack-Mayer A, Marshall H. Community knowledge, behaviours and attitudes about the 2009 H1N1 Influenza pandemic: A systematic review. Influenza Other Respir Viruses 2013;7:1316–27. [Accessed 1 May 2017].
  53. Earnshaw VA, Quinn DM. Influenza stigma during the 2009 H1N1 pandemic. J Appl Soc Psychol 2013;43:e109–14. [Accessed 1 May 2017].