RKI – Scientific part Summary
DEsign to Harm especially for the Vulnerable and produce unsafe und ineffective Measures and mandatory Treatments. This is criminal!
Summary of the scientific part of the German Influenza Pandemic Preparedness Plan (chapter 13)
The scientific part of the German Influenza Pandemic Preparedness Plan (Part II) describes the current scientific knowledge on pandemic influenza preparedness planning and response to pandemic influenza and thus serves as a technical basis for decisions on measures to prepare for the event of a pandemic, as well as measures in the event of a pandemic.
Erscheinungsdatum 4. April 2016 PDF (67 KB, Datei ist nicht barrierefrei)
The scientific part of the preparedness plan 2007 was updated under the direction of the Robert Koch Institute (RKI), supported by the RKI Expert Advisory Board on Influenza which was founded in November 2012. It advises the RKI prior to and during an influenza pandemic with regard to scientific questions concerning influenza. The experiences from the 2009 pandemic as well as the content of the Pandemic Influenza Risk Management – WHO Interim Guidance 2013 have been incorporated.
Essential changes compared to the 2007 scientific part were:
Preparing a flexible response to different pandemic scenarios
A fundamental lesson learned in the 2009 pande- mic was that pandemics can greatly vary in their levels of severity. Neither the timing nor the impact of a pandemic triggered by an emerging influenza virus can be predicted and there may well be regional variations. Therefore, greater flexibility in planning is required to get national pandemic preparedness planning and management ready for different potential pandemic situations.
13.5. Concept for risk assessment during a pandemic
The overall aim of a risk assessment during an influenza pandemic is the description and assess- ment of the pandemic situation. Three basic criteria can be used for the ongoing, differentiated in the risk assessment: The epidemic potential within the population, the epidemiological (severity) profile of influenza diseases and the impact on health care resources. This virological, epidemiological and clinical information is collected through surveillance systems and studies.
The primary purpose of a risk assessment is that appropriate measures can be recommended by decision-makers to respond to the pandemic. One particular challenge is that the virological, epide- miological and clinical information for the most part does not or does not reliably exist at the time when risk assessments are required and decisions on measures to be taken need to be made. There- fore, it is necessary that the risk assessment is con- tinually updated with any available information and re-conducted.
This chapter describes the criteria and required information that allow for a risk assessment during a pandemic und delineates the international con- cepts for a pandemic influenza severity assessment.
13.6. Clinical presentation of influenza
The clinical presentation of influenza regarding symptoms as well as the frequency and type of complications is highly variable. Differences in the clinical presentation are determined by (a) the pathogenicity and virulence of influenza virus types and subtypes and (b) the age of the patient and whe- ther the patient belongs to a risk group.
When a new influenza A subtype emerges (as in previous pandemics), many aspects of the influenza disease can differ from what is considered to be typical in seasonal epidemics where most influenza viruses are circulating on population level for years. In previous pandemics, younger age groups and a higher proportion of persons without underlying medical conditions were affected by severe illness than in seasonal epidemics. A higher proportion of primary viral pneumonia was also observed and new risk factors for severe illness were identified. Therefore, scientific knowledge needs to be rapidly gained, primarily at the start of a pandemic, in order to provide prophylaxis and treatment to persons with a high risk for severe course of illness.
13.7. Non-pharmacological interventions
Non-pharmacological interventions are implemen- ted to reduce the probability of or inhibit transmis- sion of the influenza virus. In general, non-pharma- cological interventions can be implemented in the medical setting (ambulatory care or hospital) and in the general population. The latter can be differenti- ated in individual interventions or group interven- tions, where a intervention is decided by someone for a group of persons such as school closures or compulsory interventions in the occupational field.
This chapter aims to answer the following questi- ons: (a) which non-pharmacological interventions are available in response to an influenza pandemic, (b) what evidence is available for specific interven-tions to reduce the transmission of influenza (or other less specific end points), (c) what aspects (in addition to the effectiveness) are important to con- sider in the recommendation process for certain interventions.
The literature research was carried out in two steps. First, a systematic literature search was performed primarily to identify randomised controlled trials (RCTs) and systematic reviews of RCTs with the end point “laboratory confirmed influenza”. Because of the low number of identified literature, further studies such as observational studies and studies with other end points were included.
In the medical setting, particularly the hospital setting, structural and organisational interventions are important. Furthermore, there are individual interventions such as wearing a gown, a mask or hand hygiene. In this chapter, the interventions “wearing a mask” and “performing hand hygiene” are presented regarding their effectiveness to reduce the transmission of laboratory confirmed influenza (or other end points as indicator of influenza) in the medical setting.
The term “masks” usually refers to surgical masks and respiratory masks FFP (Filtering Face Piece) that are available as FFP1, FFP2 and FFP3 masks. There is only a small number of studies availa- ble that investigated the effectiveness of wearing a mask to prevent influenza transmission in the hospital setting. The identified studies showed that transmission of influenza is reduced when wearing a mask compared to not wearing a mask. There is limited evidence that wearing a FFP2 respirator is more effective than wearing a surgical mask. Case-control-studies from the SARS epidemic reported the effectiveness of hand hygiene in preventing the transmission of SARS and suggest that this is also true for influenza. During a pandemic different factors for wearing a mask need to be considered: (1) the risk group of biological agent that is assigned to the pandemic influenza virus, (2) the occupational tasks performed i.e. performing aerosol producing procedures and if the patient wears a surgical mask and (3) the availability of different types of masks.
Studies in households with one influenza posi- tive household member provide results regarding individual interventions in the general popula- tion. There is little evidence for the effectiveness of wearing a mask without additional intensified hand hygiene. For intensified hand hygiene wit- hout additionally wearing a mask the evidence for effectiveness is even weaker. Moderate evidence ..,
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