Pandemic stuff (preparedness) IPC stuff and outbreaks

Question 1

What is GISRS

Answer 1

Global Influenza Surviellance and and response system

WHO initiative

The mission of GISRS is to protect people from the threat of influenza by continuously functioning as a:

• global mechanism of surveillance, preparedness and response for seasonal, pandemic and zoonotic influenza;
  -global platform for monitoring influenza epidemiology and disease; and
  -global alert for novel influenza viruses and other respiratory pathogens.

Question 2

Which genetic groups of H1N1 pdm2009 have been most common

Answer 2

5a2a clade and 5a2a1

Question 3

Describe which flu viruses have had zoonotic spread to humans in UK in the last yer

Answer 3

(H1N2)v
-75 y/o man who live close to a pig farm (no direct contact)
- swine influenza virus genetic clade 1B.1.1.
-November 2023

H5N1
-2 cases in poultry workers
-May 2022

https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON468

Question 4

Which flus have had zoonotic tramsmission to humans, which animals

Answer 4

Five subtypes of avian influenza A viruses are known to have caused human infections (H5, H6, H7, H9, and H10 viruses). The most frequently identified subtypes of avian influenza A viruses that have caused human infections are H5, H7 and H9 viruses. Specifically, A(H5N1) and A(H7N9) viruses have caused the majority of avian influenza A virus infections reported in people, with HPAI A(H5N6) and LPAI A(H9N2) viruses also causing human infections in recent years. Human infections with other subtypes, such as A(H6N1), A(H10N3), A(H10N7), and A(H10N8), have been detected in small numbers of people.

H1N2v (pigs)
H3N2 (different in humans and pigs
H5N1 (birds)
H7N9
H3N8 (birds)

Question 5

Describe a significant zoonotic flu not in UK

Answer 5

2 cases of H5N1 in Cambodia Dec 2023

Case of H10N1 + H3N2 co-infection in china (women who bought a duck), in Jan 2024

(To be completed_)

Question 6

T/F
Influenza B and C have a non human resevoir

Answer 6

FALSE

Question 7

Names of avian influenza vaccines

Answer 7

Celldemic and

Question 8

List 5 routed of transmission of viruses

Answer 8

Resp (droplets and aerosols)
Vector
Sexual or blood (includ mother to child)
Oral (food and water)
Contact

Question 9

Features of a CL3 lab

Answer 9

CL2 +
Sealable for fumigation
Negative pressure
HEPA (High efficiency Particulate Air) filitered
Single-pass air- typically 10-12 air changes/hour
Alarm systems for air leaks

Question 10

Features of CL2 Lab

Answer 10

Restricted entry
Not positive airflow
MSC class 1 and 2 cabinets
Disinfection policy
Codes of practice
Waste policy
Accident policy

Question 11

What are the 3 main threats as per national security risk assessment (UKHSA)

Answer 11

Emerging infectious diseases- pathogen with high mortality or those with upto 2000 cases
Pandemic infectious diseases- may arise as as an emerging disease,
AMR

Question 12

List 7 characteristics for a pathogenic organism to consider for pandemic prepardeness

Answer 12

1) Transmissibility
2) Incubation period and serial intervention time- harder to control infections with shorter incubation and second interval times
3) Severity
4) Prolonged asymptomatic phase
5) Lack of native population immunity
6) Ability to mutate
7) Abilty to survive outside of a host

Question 13

UKHSA preparedness strategies

Answer 13

Surveillance
Laboratory detection
-pan genus or pan-family PCR
-Novel serology and neutralisation assays for assessment of population immunity and effectiveness of vaccines
-metagenomics for emerging pathogens
Healthcare capacity: diagnostic labs, PPE, clarity on roles

Respond
vaccine development and delivery
generate public health interventions
Rapid research (study protocols)

Question 14

One case of diarrhoea on ward

1) what do you do

2) 3 more cases on ward, what do you do (answer from micro)

Answer 14

Answer from micro exam

1) Isolate/barrier nurse symptomatic patients,
Cohort if required
Close bay or ward
Stool culture/C diff/noro testing on symptomatic patients
Ribotype if C diff positive
Cleaning/environmental audit
Environmental screening
Independent hand hygiene audit
Antibiotic audit
RCAs for cases

I would add
-call outbreak meeting, ?who to invite

Question 15

What do HIS guidelines recommend for one case of norovirus

Answer 15

If a sporadic case of norovirus is identified, consider introducing control measures (including transmission-based precautions) to prevent an outbreak (for the next 72 h).

Question 16

When can a norovirus outbreak be declared over?

Answer 16

Whenever possible, maintain the control measures in place for 72 h after the last episode of vomiting or diarrhoea in the last known case before declaring the end of an outbreak

Question 17

Other IPC actions for noro outbreak as per the HIS norovirus guidelines

Answer 17

Test all symptomatic patients to establish whether their symptoms are due to norovirus infection

Risk assess whether visitors can come on to ward

Re environmental screening: Do not screen the environment routinely during an outbreak. Consider environmental sampling for norovirus to inform IPC measures during prolonged, unusual or uncontrolled outbreaks.

If the patient with norovirus infection is discharged to another facility sooner than 48 h after symptoms cease, inform the receiving facilities so that appropriate arrangements can be made.

Question 18

Cleaning post norovirus

Answer 18

appropriate cleaning, including the removal of organic soiling, precedes disinfection

Use 0.1% (1000 ppm) hypochlorite for disinfection

Consider using automated room decontamination devices for norovirus outbreaks when, despite the standard IPC measures being in place, there is evidence of ongoing transmission from the environment

Question 19

Following a norovirus outbreak should affected staff be allowed to return to work and how should their return be managed to ensure patient safety

Answer 19

Consider excluding symptomatic staff with norovirus infection for a minimum of 48 h after symptom resolution

In outbreaks where staff exclusion policy is not feasible (i.e. when it is not possible to replace skilled members of staff), conduct a local risk assessment that takes into account skills and staffing levels before allowing staff to return within 48 h of symptomatic norovirus infection.

Question 20

Describe method of terminal cleaning in noro outbreak

Answer 20

For occupied single rooms, delay terminal cleaning until at least 48 h after the patient’s symptoms of norovirus have resolved.

For occupied, shared patient areas or multi-occupancy rooms, undertake terminal cleaning a minimum of 72 h after symptoms in the last case of norovirus have resolved.

Question 21

Describe Mpox des-escalation from
1) hospitlisation
2) Isolation at home

Answer 21

https://www.gov.uk/guidance/de-isolation-and-discharge-of-monkeypox-infected-patients-interim-guidance

Question 22

Describe Mpox ppe- Clade 1 and clade 2

Question 23

PPE for query VHF

Answer 23

Double gloves
Grown and water proof arpove
hood
Eye protection

Other considerations: exposed staff

Question 24

IPC for measles

Answer 24

Negative pressure room
Single use disposable gloves
Apron (gown if doing AGP)
RPE
Eye protection

Patient should wear surgical face mask if transfering