Mass gatherings and pandemic Flashcards
What is a pandemic?
An epidemic of infectious disease spreading through human populations across a large region.
Give four examples of pandemics throughout history.
- Smallpox
- Tuberculosis
- HIV
- Influenza (2009)
True or false: influenza is usually more severe than other respiratory viral infections
Influenza involves a combination of respiratory and constitutional symptoms; list five.
- Respiratory
- Cough
- Sore throat
- Constitutional
- Fever
- Headache
- Muscle aches
Name four population subgroups who are more at risk of complications from influenza infections.
- Elderly
- Young
- Poor immune systems
- Pre-existing respiratory/cardiac/endocrine conditions
What is viral shedding?
Successful reproduction, expulsion, and host-cell infection caused by virus progeny.
When do adults shed the influenza virus?
Before symptoms begin through 5 to 10 days after illness onset.
True or false: there are three types of influenza viruses.
True or false: Influenza type A is responsible for epidemics.
Influenza type A is responsible for pandemics.
True or false: Influenza type B is responsible for epidemics.
What organisms are the natural hosts of influenza type A?
Wild birds
Influenza A has a natural host, but can also infect other organisms - give some examples.
- Humans
- Birds
- Pigs
- Horses
- Seals
- Whales
- Others
Influenza type B viruses are normally found in which species?
Humans.
True or false: influenza type C viruses cause mild illness in humans, and don’t cause pandemics or epidemics.
True or false: influenza types B and C are not classified according to subtype.
Influenza A viruses are divided into subtypes based on what feature?
Two proteins on the virus surface: hemagglutinin and neuraminidase.
What are the two subtypes of influenza A found in humans?
- Influenza A (H1N1)
- Influenza A (H3N2)
What is antigenic drift?
Small changes in the virus that happen continually over time, producing new virus strains that may not be recognised by antibodies of earlier strains.
What is antigenic shift?
Antigenic shift is an abrupt, major change in the influenza virus from re-assortment or adaptive mutation, resulting in a new influenza virus that can infect humans.
Is influenza A capable of antigenic drift, antigenic shift, or both?
Both.
Is influenza B capable of antigenic drift, antigenic shift, or both?
Antigenic drift.
List the naming convention components for influenza viruses.
- Antigenic type (A, B, C)
- Host of origin (swine, equine, etc. Human-origin viruses have no host of origin designation)
- Geographical origin
- Strain number
- Year of isolation
- Hemagglutinin and neuraminidase antigen description in parentheses (influenza A viruses only)
How do pandemics begin according to the WHO?
- An influenza virus develops the ability to infect humans and cause serious disease (unable to transmit efficiently between humans)
- Following further genetic change, the virus may become more efficient at passing from human to human, first within small groups or clusters (families or community networks)
- The virus is able to transmit readily between humans. It spreads rapidly because of the short incubation period and the infectious nature of influenza. Rapid global spread is aided by international travel
TL;DR: virus is able to infect humans, virus becomes more efficient at infection, virus is easily transmitted and spreads rapidly.
What is the meaning of ‘attack rate’?
The proportion of susceptible individuals exposed to a particular pathogen who become infected.
Name three current pandemics.
- AIDS (1980 - now)
- Malaria
- Tuberculosis
What three criteria must be met for an influenza pandemic to occur?
- A new influenza virus emerges to which humans have little or no immunity
- The new virus must be virulent enough to cause disease in humans
- The new virus must have capacity to spread efficiently from person to person
Attack rate and fatality rate depend on what two factors?
- Type of mutation and how quickly it evolves to become weaker
- The population at risk
Note: understand concept, not memorise
List some likely impacts of an influenza pandemic.
- People sick with pandemic influenza or who have been in close contact with sick people may be asked to stay at home
- Many people unable to work due to changes in work practices/temporary work closures
- Many people needing to stay home to care for others
- Public services such as power, water, and transport and other services may be disrupted
- Schools may need to be closed for up to 6 months
- Loss of productivity
- Health care costs
- Impact on travel and retail sectors
- Civil unrest, looting, etc
- Economic collapse
- Potential disruption to food production and distribution
List some key government strategies for epidemic prevention, response, and recovery.
- Policy and capability development
- Health sector preparedness
- Border control and quarantine measures
- Disaster mx system preparedness
- Assisting industry preparedness
- Social and community issues
- Exercising and reviewing plans
List four rapid containment measures
- Rapid field investigations
- Increasing social isolation
- Closure of schools
- Border control
- Restricted movement
- Stringent infection control
- Strategic use of antiviral rx
- Challenges of sufficient quantities and rapid development
The physical handover of pts, pt records, and other pt care equipment must be done in a manner that will limit what risk?
Cross-infection.
List three elements of the general guide that should be used for pt handover protocols.
- Continue to wear PPE until all contact with the pt is ceased and the pt is successfully handed over to QH staff and vehicle decontamination is completed
- Paramedics must not enter the assessment centre unless directed to do so by the receiving QH staff
- Remove PPE according to the approved procedures
List and describe three extra precautions in the event of an influenza pandemic.
- Limit use of nebuliser to severe cases
- Extra care when pt is intubated or has LMA
- Mandatory that hair remains covered to avoid droplet infection
Describe the decontamination of PPE
- Washed at end of shift with warm soapy water using liquid dishwashing detergent
- Wiping down the respiratory and filter with a disinfectant
Describe the decontamination of uniforms.
- During the later stages of pandemic operations, staff will attend all cases in full PPE including APR, surgical gown, and gloves
- Uniforms removed and bagged prior to leaving work
- Boots worn during shift should be wiped over with a disinfectant wipe or solution and left to dry
- Before leaving the station to return home, officers must shower and change into a fresh set of clothing and footwear
Discuss issues with vaccines with regard to pandemics
- Hard to produce right vaccine in advance
- Process takes 3 months minimum
- Vaccines have been produced to the current strain of H5N1, but what if the next pandemic isn’t H5N1 or a different strain?
- Legal/ethical issues regarding side effects and safety
Discuss issues with antivirals with regard to pandemics.
- Need to be given early in course of illness (within 24-48 hours) to be effective
- Development of drug resistant strains
- Who should get prophylaxis?
- Speed of deployment to source of outbreak
- How to distribute quickly enough
- Potential for rioting, theft, black market sales, and fake drugs
What is the National Medical Stockpile (NMS)?
A national strategic reserve of essential vaccines, antibiotics, antiviral drugs, chemical and radiological antidotes, and personal protective equipment.
The NMS is initially deployed for what purpose?
To ensure essential community and health services (police, ambulance, public hospital) can continue to operate effectively
Aside from emergency services, who also has priority of the NMS, and for what purpose?
Australian border protection officers and public health workers, so the entry of the pandemic into Australia can be delayed for as long as possible
What is the definition of a mass gathering according to the WHO?
Events attended by a sufficient number of people to strain the planning and response resources of a community, state, or nation.
What are the risks of mass gatherings?
- The normal health risks of large numbers of people amplified in a single location
- The transportation and other risks associated with the accumulation of a large number of people
- The amplified risks of food, water, and waste disposal in an environment in which infrastructure is inadequate
- The specific risks of particular events
- The risks of mass crown movement
- Failure of infrastructure
- Large crowds are highly visible targets
What are the five key areas of concern for mass gatherings?
- Overcrowding and crowd control
- Event access points
- Fire safety measures
- Medical preparedness
- Emergency response
Name four mx strategies for overcrowding and crowd control.
- Venue capacities (once full, it’s full)
- Training of stewards and security staff in crowd control
- All-seater venues
- Mosh pit safety
What is a mx strategy for event access points?
Provision of adequate site access for participants and emergency services
List four elements that promote medical preparedness.
- Provision of on-site medical care
- Local hospitals involved with emergency planning and preparation
- Major incident systems at local health services
- Medical teams organised to prioritise mass casualty care
List some factors of mass gathering event management that facilitate the emergency response.
- Having a mass gathering major incident plan available will improve response
- Tested communication systems and back-up
- Ongoing monitoring of weather and other hazards
- Early warning systems to alert participants and organisers of dangers
- Enhanced site management, prehospital, and hospital systems for emergency response
- Site access for emergency vehicles
List seven of the most common casualty conditions at mass gatherings.
- Heatstroke/dehydration/respiratory distress
- Blistered feet
- Fainting/exhaustion from a combination of hysteria, heat, and alcohol
- Cuts from broken glass and drink can ring pulls
- Illicit drug and alcohol abuse
- Trampling/crushing from crown pressure at barriers
- Epilepsy attacks brought about from strobe lighting
What does history show are leading causes of mortality during mass gatherings?
Human stampedes and heat-related illnesses
