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Influenza Pandemic Information

Introducing This Page

Find out here what you can do to stay protected from infections from the influenza virus.

Influenza Pandemic Alert Codes

Current Alert Status Pandemic Influenza

Code: WHITE

White Yellow Red Green
     

Summary about what the Alert Status Codes are

The Influenza Pandemic Alert codes define the planning escalation steps for action in the event of a pandemic.

For planning purposes the different stages of an influenza pandemic have been grouped and defined with colour codes ... Code White, Code Yellow, Code Red and Code Green.

When we know there is a pandemic we go to Code Red.

Code White
is information/advisory only, used in the planning stages of pandemic preparedness.

Code Yellow
is a standby phase, used to alert the health sector when there has been a significant development in the virus overseas, or single isolated cases in New Zealand.

Code Red
is the response phase, encompassing the 'keep it out', 'stamp it out' and 'manage it' stages.

Code Green
is to notify standdown and recovery phase.

Changes in alert codes will be widely publicised.

Apart from alerting government agencies to action, the alert codes may provide businesses with triggers to activate their own pandemic plans.

MoH advises that the potential impacts of an influenza pandemic in New Zealand include:

  • Morbidity and mortality are unknown, but may be very high;
  • Full community mobilisation needed all government and many community agencies are likely to be involved in whole-of-society response;
  • Health services may be unable to provide direct care (the orientation of health care may be to co-ordinate and support community mobilisation); and
  • Very high staff absence rates may be likely, for some periods during the pandemic.

For more information, see the MOH Influenza section.

 

Influenza Explained

Influenza (Seasonal Influenza)

Influenza (the flu) is a highly infectious illness caused by a virus. It is much more serious than a common cold and will leave you ill for up to 10 days.  Symptoms of the flu start suddenly and include:

  • a high fever
  • headache
  • muscle aches and pains
  • fatigue
  • cough
  • sore throat, or
  • a runny nose

Influenza can be a mild or severe illness depending on the type of influenza virus causing it, and the age and general health of the person affected. It may take up to three days to show symptoms when you catch the flu. Anyone can get influenza - being fit, active and healthy does not protect you from getting this virus.

Anyone can die from influenza - it kills at least 100 New Zealanders every year, including some young, fit people.

Can I do anything to prevent myself getting it?

Every year you can ask your doctor to vaccinate you against the flu. As the influenza virus changes frequently, new vaccine against the new virus is made every year. To get your immunity to the new virus you will need to get the new vaccine. The flu is very easily spread by sick people who cough and sneeze.

Vaccination is free for people aged 65 years and over, and adults and children with certain long-term (chronic) conditions. Your doctor will know if you are eligible for a free vaccination.

Find out more about Seasonal Influenza including who is currently eligible for free vaccinations here
(http://influenza.org.nz/?t=884).

Some employers also subsidise or pay for flu vaccinations to maximise employees immunities.

To reduce the chances of getting the flu there are also things you can do, such as ensuring good health hygiene habits.

If you have the flu, you should stay home from work, avoid public places and close contact with others. If you have the flu, you should always cough and sneeze into a disposable tissue and wash your hands afterwards.

Avian Influenza (Bird Flu)

What causes the Avian Influenza?

There are many types of influenza virus, some of which infect other animals including birds. The viruses that infect birds are avian influenza viruses. Very rarely, an avian influenza virus can also infect people. One of these viruses - H5N1- has infected some people who have caught it from having close contact with infected birds.

What are the symptoms of Avian Influenza?

Avian influenza can cause severe flu-like symptoms in people and may result in death. It has not been shown for sure that anyone has caught avian influenza from another person. If this has happened it has been very rare.

Can I protect myself from Avian Influenza?

There are currently no commercially available vaccines that will protect people against disease caused by H5N1.

Is Avian Influenza transmissible to humans?

Yes, very rarely, an avian influenza virus can also infect people. The current avian influenza virus H5N1 has infected some people who have caught it from having close contact with infected birds.

Why are Health Authorities concerned about Avian Influenza?

The World Health Organization is worried that an avian influenza virus might change so that it has the ability to easily spread from person to person, or mix with a human influenza virus resulting in a new strain of influenza virus that can do this. This could trigger an influenza pandemic, which could cause many deaths and could occur at any time. It would not necessarily be a winter illness.

 

Pandemic Influenza

What does 'Influenza Pandemic' mean?

Health experts and governments round the world are worried that the flu virus H5N1 affecting birds(avian influenza or bird flu) could change into a virus that easily affects people. If this happens, and the new virus enters New Zealand, many of us could become very sick.

When a new flu virus infects many people around the world, it is called an influenza pandemic.

What causes Influenza Pandemics

An influenza pandemic occurs when a new strain of influenza virus emerges, spreading around the world and infecting many people in a very short time. An influenza virus capable of causing a pandemic is one that people have no natural immunity to and can easily spread from person to person. It may cause severe disease. An influenza pandemic could cause many deaths and could occur at any time. It could happen at any time of the year, not just winter.

How is pandemic influenza transmitted?

Primarily, human influenza is transmitted from person to person via virus-laden large droplets (particles >5 m in diameter), which are generated when an infected person coughs or sneezes.

These large droplets can then be directly deposited onto the mucosal surfaces of the upper respiratory tract of susceptible people who are near the infected person (ie, within 1 metre).

Transmission may also occur through direct contact with infectious (wet) respiratory secretions, such as by touching door handles, taps, lift buttons, stairwell railings, keyboards, etc that have deposits of the infected secretions on their surfaces, and then hand-to-face contact.

There were three influenza pandemics last century, in 1918, 1956-57 and 1968. What caused them? All three pandemics last century were caused by different types of bird flu viruses.

 

Symptoms

What are the symptoms of an influenza pandemic?

The symptoms of pandemic influenza are the same as seasonal influenza.

This includes:

  • The sudden start of a high fever headache
  • muscle aches and pains
  • fatigue
  • cough
  • sore throat or
  • a runny nose

The virus can cause a mild or severe illness depending on the type of influenza virus and the age and general health of the person affected. It may take up to three days to show symptoms.

 

How likely is an Influenza Pandemic?

It is certain an influenza pandemic will happen one day.

There are many bird flu viruses circulating in some countries at present

One of these, the H5N1, could become a pandemic influenza virus at any time if it changes so it can be easily spread from human to human.

Concern for Personal Protection

Concern for personal protection is greater during a pandemic influenza as it is caused by a virus that is markedly different from recently circulating strains such as found in a seasonal influenza, which is a familiar infection, especially during winter. A pandemic influenza causes illness in a large number of the people infected; it spreads widely and quickly because the population will have no immunity.

Who will decide if the world is having a pandemic?

The World Health Organization (WHO) will determine when a virus such as the avian flu virus is spreading from human to human in sufficient numbers to constitute a pandemic. Many governments and the WHO have intensive surveillance programmes to track the spread of avian flu. This programme will provide global early warning of human infections so Governments can begin implementing "pandemic alert" phases designed to track the progress of the disease spread nationally.

Can a pandemic be averted?

No one knows for sure. Influenza viruses are highly unstable and difficult to predict.

However, health authorities such as the World Health Organization remain optimistic that if the right actions are taken quickly, an influenza pandemic can be averted.

For more information, see the WHO website
www.who.int/countries/nzl/en/

 

Influenza in New Zealand

Import of Influenza

Could migratory birds "import" the avian influenza virus to New Zealand?

Migratory waterfowl (such as ducks and geese) are carriers of the avian influenza virus. It generally does not make them sick, but they excrete the virus. The virus they leave in fields or water can then infect domestic birds. Fortunately New Zealand is not on the regular migratory pathways of any waterfowl. The small number which do reach New Zealand mostly originate from southern Australia.

Other migratory birds such as shorebirds including the bar-tailed godwit, lesser knot, ruddy turnstone, Pacific golden plover etc, visit estuaries along the Asian coastline, Philippines and Australia on their annual migrations south from arctic Russia . They are not "waterfowl" and are not regarded as a high risk for introducing avian viruses into New Zealand. The Ministry of Agriculture and Forestry (MAF) is currently undertaking surveillance in wild birds to assess the influenza status of waterfowl and shore birds.

It is not known why some strains of influenza become virulent in some species under certain circumstances while others do not, but it is thought that inter-species mixing (i.e. quails, geese, ducks and chickens) and high population densities, such as occur in intensive poultry farming and bird markets in China and other Asian countries, may favour interspecies transmission of the viruses.

How can avian influenza be controlled in birds?

The most important control measures are surveillance, identification and rapid destruction (culling) of all infected or exposed birds, proper disposal of carcasses, and the quarantining and rigorous disinfection of farms.

Restrictions on the movement of live poultry, both within and between countries, are another important control measure.

I have chickens. How will I know if my flock has got avian influenza?

The disease can be variable, depending on species, age, virus type and other factors like concurrent bacterial infections.

The main symptoms to look for in poultry are:

  • Sudden and unexplained deaths
  • Rapid spread of disease throughout the flock
  • Depression and loss of appetite
  • Drop in egg production
  • Nervous signs
  • Swelling and blue combs and wattles
  • Coughing, sneezing and diarrhoea

To report suspected cases of avian influenza in birds or exotic diseases call 0800 809 966.

Who will be in charge?

Who will be in charge if there is a pandemic in New Zealand?

The Government will ensure there is an appropriate response from all agencies involved. The Ministry of Health will take the lead in all national health-related matters.

How does New Zealand Prepare?

What is New Zealand doing to prepare for an influenza pandemic?

New Zealand has been planning for this for some time.

The Ministry of Health has a national pandemic plan, and District Health Boards have local plans. The New Zealand Government, following the advice of the World Health Organization, is stockpiling anti-viral medicine to help reduce the impact of a pandemic on New Zealanders.

By the end of 2005 there will be enough anti-viral medicine for about 21 percent of the population.

Will New Zealand stop travellers?

Will New Zealand stop travellers from coming into the country in an effort to stop the spread of disease?

The details of how New Zealand would manage its borders in the event of a pandemic are still being worked through.

Because we are an island nation, active management of the border - ranging from partial restrictions to full closure - needs to be considered among the range of options as we plan our response.

Other countries are also considering this issue. Any final decision on border management will be made by the Government with input from a range of government departments.

What could happen?

What could happen in New Zealand if there is an influenza pandemic?

A pandemic could mean so many people are sick that it will affect workplaces, schools, hospitals and many other services.

There would be public announcements on TV, the radio and through other media channels that there is an influenza pandemic and information about what to do and where to go for help.

Some workplaces and schools may close. Normal health and other services may not be available for several weeks. You may be asked to care for yourself and others at home.

Illness and Death

How many people could get sick or die if a pandemic virus reaches New Zealand?

This is difficult to say because it depends on many factors, such as the severity of the pandemic and who it affects most. However research published in the New Zealand Medical Journal earlier this year suggested a flu pandemic could result in the deaths of up to 3700 New Zealanders, with as many as 20,000 people requiring hospital care and just over one million people needing to see a health professional.

How will the New Zealand health system cope?

How will the New Zealand health system cope with a pandemic?

There is no doubt that in a severe pandemic, hospitals and primary care practitioners such as GPs will find it difficult to deal with large numbers of people with the flu. The Ministry of Health is considering and planning for other possible options such as community assessment centres for people with the flu. People may also be asked to look after each other at home and given information about how best to do so.

What about Hospital Services?

What is likely to happen to elective services offered by hospitals?

Individual District Health Boards will decide whether they are able to continue offering elective services.

Treatment or Health advice

How will New Zealanders get treatment or health advice in a pandemic?

This will depend on the severity of the pandemic and how many people it affects.

If you are sick you may be asked to phone your local doctor or nurse for advice, rather than visiting a waiting room and potentially spreading germs.

The Ministry of Health is also investigating the possibility of setting up community assessment centres, where people who are sick with influenza go to be assessed.

You will also be able to ring the national free 24-hour health advice number, Healthline (0800 611 116). This line is staffed by registered nurses.

Many people may be asked to care for themselves and their family members at home.

Who is at Risk?

Health Care Workers

Health care workers are at a greater risk of pandemic influenza than the general public because they will often be caring for infected people who might be hospitalized or seeking primary health care services.

To support the protection of health care workers in their workplace in the event of a pandemic influenza, and to ensure that there is a supply of PPE in DHBs beyond that required for everyday use, Cabinet approved funding in February 2005 for DHBs to buy PPE for health care workers and support staff in the secondary/tertiary and primary health care sector.

Organisations

How does an Influenza Pandemic affect Organisations?

You need to think about how to keep your business running. You will find some very useful suggestions on how to do this in the Business Continuity Planning Guide at: www.med.govt.nz/templates/MultipageDocument
TOC____14455.aspx

The Department of Labour also has a great website for Workplaces to inform themselves - titled: Workplace Policy, Pandemic Planning Information. Just click on the following link to get you there:
www.dol.govt.nz/initiatives/workplace/pandemic

Questions and Answers Log of Issues Raised by Infrastructure Providers

The Ministry of Economic Development website collected frequently asked questions and answers that might interest you. To read these please follow the following link: www.med.govt.nz/templates/MultipageDocument
TOC____19878.aspx#P98_10533

 

Before the Influenza Pandemic Strikes

Can I do anything to prepare for a pandemic?

The Ministry of Health recommends the general public follow the appropriate general infection prevention and control measures described below to decrease influenza transmission.

Talk to your family and friends

Talk to your family and friends about health hygiene, hand washing and safe coughing and sneezing.

  • Include paracetamol (for fever) in your home emergency survival kit.
  • Have a plan for what you and your family would do if you had to stay at home during a pandemic.

Have a plan

  • Have a plan if you and your family have to stay at home for several weeks during a pandemic. Talk to your family and friends about their plans.
  • Your plan needs to include who could help you with food and supplies if you and your family are ill. One way of doing this is by having a telephone network for you and the people who live close by.
  • Have the phone number for your family doctor in a prominent place (eg, the fridge door)
  • Think about an expanded emergency supplies kit. You can find a list of basic emergency kit contents on the inside back cover of the Yellow Pages. Or you could check the Ministry of Civil Defence and Emergency Management website on What To Do in a disaster.

Build up your emergency supplies kit

Make sure you have an emergency survival kit. Plan for having about a week's worth of essential supplies such as non-perishable food, as well as plenty of fluids. For further information see the Ministry of Civil Defence and Emergency Management website on What to do in a disaster.

What should I put in the Kit?

  • Have a supply of food and drinks to last for at least a week. Choose non-perishable foods like canned foods, soup sachets and dried foods.
  • Have extra paracetamol for all the family to help relieve aches and pains, and high temperatures. Remember not to give aspirin to children under 12. If you have prescription medicines (eg, for blood pressure), dont wait until you run out to get more. Consider putting some in your emergency supplies kit.
  • Have tissues (or toilet paper) and plastic bags supermarket bags are good to put the used tissues into.
  • You might want to include some masks, like some standard surgical masks from a pharmacy or the sort you get in a hardware store to protect yourself when sanding or using solvents. Clear advice on how best to use any masks safely and appropriately will be given at the beginning of a future pandemic. For example you might be advised to wear a mask if you get sick at work and need to travel home via public places. Masks should only be worn for short periods. They must be changed if they get wet from sneezing or coughing.
  • Think about things to do if you and your family have to stay home for a couple of weeks (eg, books, games and videos).

Vaccine available?

Is there a vaccine available for a flu pandemic?

The Ministry of Health has a formal arrangement with Australia's CSL Ltd - the only influenza vaccine manufacturer in the Southern Hemisphere - which gives us a guaranteed supply if we need a pandemic vaccine.

However, manufacture of such a vaccine can only start once we know the strain of the virus causing the pandemic, and so a vaccine is not currently available.

How can Organisations prepare for an Influenza Pandemic?

Respiratory Disease Policies

Organisations of all kinds should have effective policies and processes in place to ensure people with symptoms of respiratory disease do not place others at risk of infection. For workplaces, such policies can include sending ill people home and enabling staff to work in more isolated settings, such as from home, during times of influenza outbreak.

Ventilation of internal spaces

There is scientific and medical evidence that influenza can spread in inadequately ventilated internal spaces. All internal spaces should be well ventilated, preferably with fresh air, by opening windows, or with properly designed and maintained air-conditioning systems. See www.health.govt.nz/our-work/diseases-and-conditions/influenza for specific Ministry of Health advice on air conditioning and influenza.

Personal Protective Equipment (PPE)

Personal protection equipment (PPE) includes masks, goggles, eye/face shields, gloves, gowns and aprons. Varying levels and types of PPE are required, depending on the level of exposure and the risk of transmission.

Whatever the level of PPE to be used, education and training is necessary to ensure the equipment is used and disposed of correctly, to maintain the equipments effectiveness.

First Responders

It is important to provide PPE to first 'responders', and to educate and train them in appropriate PPE use, as well as ensuring they know how to use general infection prevention and control strategies. First responders include ambulance, police and fire staff, as well as other workers responding to emergencies as part of their work and coming into close contact with cases of pandemic influenza.

 

During an Influenza Pandemic

Personal Protection Guidelines

Interim Guidelines for Personal Protection and Using Personal Protective Equipment During an Influenza Pandemic

These interim guidelines for personal protection have been developed as part of the national health emergency planning for a potential influenza pandemic.

The recommended personal protective equipment (PPE) and general infection prevention and control measures apply to health care workers and first responders such as ambulance, police, fire and other frontline services. The general infection prevention and control measures also apply to the general public.

Minimising the Spreading of Infection

Social Distancing

Try to keep well people and sick people apart. Stay home if you are sick and keep away from other people. Avoid visitors and avoid visiting other people.

Crowded places and large gatherings of people should be avoided at times of an influenza pandemic, whether such gatherings are in internal or external spaces.

A distance of at least 1 metre should be maintained between persons wherever possible. Greater distances are more effective.

Any form of contact with people who are unwell with pandemic influenza, including visiting, should be avoided wherever practicable.

Keep coughs and sneezes covered

Keep coughs and sneezes covered. Tissues are best. Put the tissue in a rubbish bin. Wash and dry your hands after you cough, sneeze, wipe or blow your nose (or your child's nose), use the bathroom or toilet.

Give plenty to drink

Give people who have a fever and/or diarrhoea plenty to drink.

Keep and use your home emergency survival kit

Give Paracetamol for fever. Do not give aspirin to children under 12.

Hand Hygiene

Wash and dry your hands before you prepare food and eat, and when you are looking after sick people.

Hand washing is still the single most important measure to reduce the risks of transmitting infectious organisms from one person to another. Hands should be washed regularly with soap and water, an alcohol-based hand rub or an antiseptic hand wash and then thoroughly dried, preferably using disposable tissues or towels.

Hands should always be washed and dried after contact with respiratory secretions or after touching surfaces that have been contaminated with respiratory secretions. Health care workers dealing with respiratory secretions should be wearing gloves as per the Standard Precautions. See Standard Precautions: www.cdc.gov/ncidod/dhqp/gl_isolation_standard.html

Hand-to-face contact, which occurs during such activities as eating, normal grooming or smoking, presents significant risks because of the potential for transmitting influenza from surfaces contaminated with respiratory secretions, and for this reason, hands should always be washed and dried before any activity that involves hand-to-face contact.

Other Hygiene (including: Washing and Cleaning)

Sharing bedding, clothing and utensils may spread infection, but you do not need to wash a sick persons bedding, clothing and utensils separately from the rest of the family's.

Respiratory Hygiene/cough Etiquette

People with respiratory infection symptoms should practise the following cough/sneeze etiquette whenever they are in the presence of another person.

All symptomatic people should:

  • Avoid close contact (less than 1 metre) with other people
  • Cover their nose and mouth when coughing or sneezing
  • Use disposable tissues to contain respiratory secretions
  • Immediately dispose of used tissues in the nearest waste receptacle
  • Immediately wash and dry their hands

Protective Barriers

Protective barriers in the form of perspex or glass may provide useful protection for people such as front-counter staff, supermarket operators or public transport drivers, whose duties require them to have frequent face-to-face contact with members of the public where social distancing is either not possible or not practical.

Using Masks

People with respiratory infection symptoms should consider using a disposable surgical mask to help prevent exposing others to their respiratory secretions.

Any mask must be disposed of as soon as it becomes moist or after any cough or sneeze, in an appropriate waste receptacle, and hands must be thoroughly washed and dried after the used mask has been discarded.

Patients with respiratory infection symptoms in health care institutions should be masked to contain respiratory secretions at any time they present a potential risk to unprotected people.

Using Personal Protection Equipment (PPE)

Personal protection equipment (PPE) includes masks, goggles, eye/face shields, gloves, gowns and aprons. Varying levels and types of PPE are required, depending on the level of exposure and the risk of transmission.

Whatever the level of PPE to be used, education and training is necessary to ensure the equipment is used and disposed of correctly, to maintain the equipments effectiveness.

Using disposable surgical masks, gloves and gowns/aprons

Disposable surgical masks are recommended for first responders and health care/support workers in a health care setting who are at risk from droplet transmission.

Disposable gloves are recommended as a means of reducing the likelihood of influenza transmission when handling objects contaminated with respiratory secretions. Apart from health care settings, the use of gloves is less important than careful hand washing. The use of gloves does not replace the need for hand washing.

Disposable gowns or splash resistant aprons may also reduce opportunities for transmitting influenza. However, it may not always be practical to use gowns/aprons outside the health care setting.

Using particulate respirator masks, eye protection, gloves and gowns/aprons (full PPE)

Health care workers should wear particulate respirator masks, eye protection, gloves and gowns/aprons (i.e. full PPE) when there is a high risk of direct contact with respiratory secretions, particularly via aerosols. This will apply mostly in inpatient settings during some invasive procedures.

In most other settings a disposable surgical mask (with or without eye protection and disposable gloves) will provide sufficient protection from droplet transmission for health care workers in close contact and/or providing direct personal care to patients with pandemic influenza.

Summary of Protection Measures

Protection measure Where applicable
Hand hygiene, cough etiquette, ventilation Everyone, all the time
Organisational policies Every organisation, all the time
Social distancing Everyone, whenever practical
Protective barriers In situations where regular work practice requires unavoidable, relatively close contact with the public
Disposable surgical mask Workers in any community or health care setting who are caring for the sick (this includes first responders)
Also as a possible adjunct to protective barriers
Disposable particulate respirator mask, eye protection, gloves, gown/apron Health care workers participating directly in close contact patient care when there is a high risk of contact with respiratory secretions, particularly via aerosols (mostly inpatient settings).

For more information visit www.cdc.gov/flu

See also:

Standard Precautions:
www.cdc.gov/ncidod/dhqp/gl_isolation_standard.html
Droplet Precautions:
www.cdc.gov/ncidod/dhqp/gl_isolation_droplet.html

Using these measures helps comply with the Health and Safety in Employment Act 1992

The Health and Safety in Employment Act 1992 requires the following measures to be taken.

Section 6: All practicable steps

Every employer shall take all practicable steps to ensure the safety of employees while at work; and in particular shall take all practicable steps to:

  • provide and maintain for employees a safe working environment
  • provide and maintain for employees while they are at work facilities for their safety and health ...

Section 28: Employees may refuse to perform work likely to cause serious harm

  • An employee may refuse to do work if the employee believes that the work that the employee is required to perform is likely to cause serious harm to him or her ...."

Employers must take all practicable steps to mitigate the risk and protect employees, especially those at high risk, such as health care personnel, support staff and first responders (fire/police/ambulance/other emergency workers) from pandemic influenza.

These workers should be educated in hand hygiene, cough etiquette, social distancing and the use of appropriate PPE and should be provided with the supplies required to carry out these techniques. Employers need to actively plan to cover their risks and the risks to their workers and the public.

For more information, see www.health.govt.nz/our-work/diseases-and-conditions/influenza

 

Disclaimer

The information in these documents is not intended to cover every situation. Details which may be relevant to a user's particular circumstances may have been omitted. Users are advised to seek professional advice before applying any information contained in this document to their own particular circumstances. Users should always obtain appropriate professional advice on the medical issues involved.

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