0
Pandemic Plan of the Czech Republic
1
Foreword
The knowledge acquired over the course of the 20
th
century pandemics led the Czech government, as
early as 2001, to draw up the first plan for facing an influenza epidemic if such a need arose again.
This document is the 4
th
edition of the pandemic plan and an update of the Pandemic Plan for the
Czech Republic (PP CR) from 2006. The update presented here was instigated, among other reasons,
by the experience gained from the 2009/2010 pandemic. At the same time, it takes into consideration
new findings regarding the spread of the influenza virus, the genesis of new pandemic variants as well
as current recommendations from the World Health Organization (WHO) and the implementation of
International Health Regulations (IHR (2005)). Experience has also shown that the threat of new
infectious diseases (such as SARS) requires the implementation of measures to a large extent
identical to those applied during influenza virus pandemics. Thus, the pandemic plan has been
adapted so that it may be applied as necessary in such situations. The PP CR reflects the current
WHO recommendations – “Pandemic Influenza Preparedness and Response – a WHO guidance
document” (2009), the recommendations of the European Union (EU) for national pandemic planning
– especially the Communication of the Commission to the Council of Europe, the European
Parliament, the European Economic and Social Committee and the Committee of the Regions on
“Pandemic Influenza Preparedness and Response Planning in the European Community” and on
“strengthening coordination on generic preparedness planning for public health emergencies at EU
level”, COM (2005) 607 and COM (2005) 605. At the same time, according to these recommendations
each state is to retain the right to adopt specific measures that will be most effective during a
pandemic in the context of the national legal environment. The PP CR represents the basic document
for resolving pandemic situations in the Czech Republic, while individual pandemic plans are drawn up
to manage the concrete tasks set by the PP CR . The extent of information contained in these plans
corresponds to the need to maintain the basic functions of a given department or administrative
territory during a pandemic. The issue of pandemic preparedness is not the responsibility of a single
department – it should be the responsibility of society as a whole! Nearly all departments, including
their essential public services, are involved in the process of planning strategies to manage a potential
influenza pandemic. It is also necessary, over the long-term, to work on a communication campaign
which, in accordance with WHO and European Commission (EC) recommendations, will also involve
individuals, families and communities and will increase awareness about the pandemic and the
importance of each individual’s behavior in such situations. In this updated version of the pandemic
plan, each ministry specifies the measures within its jurisdiction – this is why this plan is multi-sectoral.
Apart from medical and healthcare challenges, it strives to preserve the continuity of all socioeconomic
life, which must function normally if the damage caused by the pandemic is to remain
minimal. As no country can face the consequences of a pandemic alone, the goal of this plan is also to
stress international coordination. In view of the existence of free movement of persons and goods in
accordance with the IHR (2005) in EU territory as well as worldwide, additional coordination at EU and
worldwide level is necessary.
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1. Introduction
Definition of a pandemic
A pandemic is an epidemic extending over a wide geographic area, affecting whole continents. It
involves the high incidence of a disease over a large territory (continent) over a specific period of time.
According to the WHO definition, an influenza pandemic is characterized by the spread of a pandemic
virus within communities in at least 2 countries of a single WHO region and at least one other country
in another WHO region.
Definition of the new variant of the influenza virus
This is a type A influenza virus with completely new antigenic properties given by the exchange of one
or two of the principle surface antigens (i.e. hemagglutinin and/or neuraminidase) or the reappearance
of a subtype that had already once circulated within a population and then disappeared and for a long
time failed to assert itself as a human pathogen.
Development of an influenza virus with pandemic potential
The influenza virus is represented by the genera A, B and C. Influenza as such represents a unique
type of viral illness, principally characterized by the continuous evolution of its underlying agent. From
an epidemiological aspect, the type A virus is clinically the most significant of these viruses, as it is the
only one to have an animal reservoir. It is no coincidence that the first isolated influenza virus was an
animal virus in 1902. Though it was classified taxonomically only much later, this isolate was labeled
according to the original year of its discovery - A/Chicken/Brescia/1902 H7. The first swine strain was
then isolated in 1930 (A/Iowa/1/30 (Hsw1N1). The human virus was only isolated in 1933 and
subsequently labeled A/Puerto Rico 8/34. Thus, apart from humans, the influenza virus is capable of
infecting other animals. This especially applies to type A influenza, which may rightly be perceived as
a zoonotic infection. The segmented genome of this virus, together with the plentiful reservoir of
further subtypes especially in the population of migrating water birds, is the reason for the great
genetic instability and variability of the influenza virus as such, with all the resulting consequences. It
has been repeatedly and precisely documented that the pandemic strains from 1957 (H2N2 – Asian
flu) and 1968 (H3N2 – Hong Kong flu) developed due to the introduction of an avian virus gene into
the originally circulating human strain. Since 1997, the H5N1 subtype (so-called avian flu) has shown
itself to be a pathogen capable of infecting humans. The clinical forms of infection caused by this virus
are usually very serious and the infection was fatal in more than 50% of recorded cases. In the case of
this virus, no adaptation to humans has occurred as yet. Thus, influenza A (H5N1) fortunately has not
spread and is still not spreading within communities, and human-to-human transmission on close
contact between people has been rare. It is impossible, however, to estimate future development and
it is still absolutely necessary to carefully monitor its incidence. 2003 saw several extensive influenza
H7N7 epizootics at a number of poultry farms in Holland. More than 30 million chickens were affected
or put down. The virus was rapidly transmitted to the staff, in contrast to the H5N1 subtype; both
secondary and tertiary transmissions were also documented, especially in family epicenters.
Conjunctivitis, a characteristic of this subtype, was a typical clinical symptom. In contrast to the H5N1
subtype, only one person succumbed to this infection. The transmissibility of this virus was
significantly higher, though, and its tendency to spread in the human population relatively substantial.
Several clinically very mild ARI were caused in humans by the subtypes H9 and H10. These were
sporadic cases and the virus never spread any further among humans. Its detection was more or less
random, usually as part of enhanced influenza surveillance.
Although the A(H5N1)virus was considered in recent years as the most probable candidate for a
pandemic strain, the first pandemic of the 21
st
century was caused, against all expectations, by a
reassortant strain of a human, swine and avian virus designated as “Pandemic (H1N1) 2009”
influenza.
The pandemic virus may form in two various ways:
• So-called re-assortment, whereby certain RNA segments within the circulating human strain
are exchanged for segments from the animal reservoir (Asian flu 1957, Hong Kong flu 1968
and Pandemic (H1N1) 2009)
• A rarer possibility is the process of so-called adaptive mutations, whereby the original,
usually avian, virus humanizes and gradually acquires the capability to massively spread and
3
infect humans (the most probable example of such viral introduction into the population is the
Spanish flu virus - H1N1 in 1918)
Pandemics characterized by rapid disease spread into all parts of the world and a rapid rise in
morbidity and mortality have been credibly documented since the 16
th
century, appearing at intervals of
10 to 50 years. In view of the genetic instability of the influenza virus and its animal reservoir,
pandemics must be taken as a fact that society must face. The precise timing, severity and impact of
the next influenza pandemic remain great unknowns. Timely planning and preparedness are thus
utterly essential in order to limit the impact and consequences of a global pandemic on society.
Tab. No. 1: Characteristics of pandemics in the 20
th
and 21
st
centuries
Period
of viral
spread
Site of origin of
the pandemic
strain
Virus subtype and
designation of
pandemic
Worldwide deaths Most affected age
group
1918-
1919
Still much
discussed,
probably France,
the Western Front
Spanish flu
H1N1
20-50 million Young adults
1957-
1958
South China
Asian flu
H2N2
1-4 million Children
1968-
1969
South China
Hong Kong flu
H3N2
1-4 million All age groups
2009-
2010
Mexico
Pandemic (H1N1)
2009
Not determined as
yet
Young adults
The spread of a pandemic virus is characterized by:
• Rapid progression of infection with very little time for implementing the necessary measures
ad hoc
• Overload and overwork of healthcare institutions due to the increasing demand for medical
care and the lack of specialized healthcare personnel
• Delayed and limited availability of pandemic influenza vaccines, limited availability of
antivirotics and antibiotics as well as of therapeutic products necessary for the treatment of
other diseases
• Potentially serious shortages of personnel and products because of interruption of key
infrastructure and services as well as the disrupted continuity of all commercial and
government sectors
• Negative impact on the social and economic activities of communities, which may persist long
after the pandemic period has passed
• National preparedness under the constant scrutiny of the public, government agencies and
media
• The global state of emergency limits the potential of international help
“Most experts agree that it is not a question of whether another severe influenza pandemic will occur
but rather of when...”
In the case of seasonal epidemics of common influenza, 5% to 10% of the population is affected.
However, influenza pandemics that occurred in the 20
th
century affected a much greater number of
inhabitants than such seasonal epidemics, namely 30% to 50% of the population. The first pandemic
of the 21
st
century had a milder course and consequences than had been expected at its onset and its
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morbidity was comparable to that of common seasonal influenza. Nonetheless, the course of this
pandemic was associated, in a significant number of persons, with severe course of the infection as
well as death. Within the EU, 80% of deaths were documented in persons younger than 65 years (in
the case of seasonal influenza, 90% of deaths occur in persons over the age of 65 years), with 30% of
these deaths involving completely healthy persons. A significant proportion of deaths and serious
medical conditions was due to acute respiratory distress syndrome (ARDS), which only rarely occurs
in common seasonal influenza. This severe disease course of pandemic influenza highlighted a
fundamental limitation relating to patient care – namely the availability of intensive care in such cases.
This represents a relatively new issue that the preparedness plans for the next pandemic must
adequately take into consideration.
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2. The principal objectives of the Pandemic Plan of the Czech Republic
The Pandemic Plan of the Czech Republic is a document that sets out procedures and the basic
response system of the Czech Republic to an influenza pandemic caused by a new type of influenza
virus. The principal objective of the plan in the case of an influenza pandemic is to mitigate its
expected medical, social and economic consequences. The main objectives of the PP CR include:
• Reinforcing the national early warning and rapid response system for the timely detection of a
disease possibly induced by the pandemic strain,
• Rapid identification of new variants of the influenza virus in poultry, birds or other animals,
• Rapid detection of the genesis of a new subtype of the influenza virus in the population,
• Minimizing the spread of the new virus and precluding the development of a pandemic, if
possible,
• Continuous evaluation of the epidemiological situation, analysis of incidence and
implementation of immediate anti-epidemic measures,
• Ensuring treatment of patients and their complications,
• Ensuring burial of the dead,
• Ensuring that healthcare personnel and the public are kept informed,
• Overseeing the observation of recommended measures,
• Reducing the impact of the pandemic on society,
• Minimizing economic losses.
3. The main principles of the Pandemic Plan of the Czech Republic
a. The role of all sectors of society
The key principles of the PP CR include, in accordance with the recommendations of the
WHO, EC, the European Centre for Disease Prevention and Control (ECDC), a “whole of
society” approach that stresses not only the central role of the healthcare sector, but also the
important roles of all sectors of society.
• The government coordinates; takes decisions regarding human, economic and material
resources for optimal pandemic preparedness and the improvement of capacities; and sets
out measures across all sectors
• The healthcare sector (including medical services providers, health insurance companies
and public health bodies) provides essential epidemiological, clinical and virological
information and information regarding the risk, severity and course of the pandemic that
influences the measures for reducing pandemic virus spread and the associated morbidity and
mortality. It informs about the effectiveness of interventions used in the pandemic. In
cooperation with other sectors and supported by the national inter-sectoral leadership, it plays
a leading role, recommending the necessary steps and increasing awareness regarding the
risk and potential impact of the pandemic on population health. It sets measures for promoting
medical care; it orders steps to be taken to limit spread within communities and healthcare
institutions; and it protects and supports healthcare personnel during the pandemic.
• The sector of essential public services must provide essential activities and services during
the pandemic in order to minimize the impact on the population’s health, and social and
economic consequences. If society is not effectively prepared, there is a risk of social and
economic disruption; the continuity of essential public services is threatened; production falls;
there are problems with distribution and basic products become scarce. Power cuts, for
example, may lead to the inability of the healthcare sector to provide standard care.
Commercial outages may significantly contribute to the economic consequences of a
pandemic. Certain commercial sectors are more vulnerable and, similarly, certain groups of
inhabitants may also be more affected than others. Other measures include planning the
allocation of resources for protecting employees and customers; communication with
employees regarding their protection and the measures that will be implemented and
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contributing towards these plans, thus promoting the continued functioning of society.
Essential public services in the power industry, water industry, food industry and agriculture,
the healthcare sector, transportation sector, communication and information systems sector,
financial and monetary markets, emergency and social services and public administration, as
well as internal and external state security and foreign policy will be factually set out by the
corresponding departments and regions in their respective pandemic plans.
• The media play an important role in communicating not only with the lay public but also with
experts. The regular presentation of news regarding the pandemic, the risks of pandemic
influenza, the current epidemiological situation, the national and international measures and
other news are crucial for how the lay and expert public will approach the given situation and
subsequently behave. Adequate awareness of the public and panic prevention require the use
of credible sources.
• Civilian organizations and associations with close relations to communities may often
increase awareness about the given issue, transmit the necessary information, rebut false and
untrue information, provide necessary services and cooperate with the government during the
crisis. Such groups should assess their strength and potential and plan their roles during the
pandemic in collaboration with local authorities or other organizations. They may, for example,
reinforce organizations in other sectors such as by providing support to family members of
patients being cared for at home.
• Families and individuals may help limit the spread of the pandemic virus by adhering to nonpharmacological
measures– using handkerchiefs when coughing or blowing their noses,
washing their hands and voluntarily isolating themselves in the event of symptoms of
respiratory illness. During a pandemic it is important for family members to ensure that they
have access to the correct information, food, water and medication. Information from local and
national authorities is essential. Individuals, especially those who have already recovered from
pandemic influenza, may consider working as volunteers for organized groups helping other
members of the community.
b. Ensuring the ethicalness of pandemic preparedness and response
An influenza pandemic, similarly to any emergency situation in the field of public health, requires
making decisions that imply a balancing act between potential conflicts of interest involving individuals
on the one hand and the community on the other. The persons responsible for this process may use
ethical principles as tools for evaluating and balancing this conflict between interests and values. The
ethical approach does not provide a previously set procedure. Rather, it applies principles such as
equality, benefit/efficacy, freedom, reciprocity and solidarity. These principles may be used as the
basic framework for evaluating and balancing the range of interests in order to achieve the set goal
(such as the protection of human rights and the specific needs of vulnerable and minority groups).
c. Integration of pandemic preparedness within crisis management
The activities of pandemic preparedness rank among national as well as international priorities.
Financial as well as human resources are, however, limited. In view of the fundamental uncertainty
regarding the timing of the next pandemic, steps ensuring the long-term sustainability of pandemic
preparedness are absolutely necessary and should include:
- Integrating pandemic preparedness in crisis management plans and crisis preparedness plans
- Applying pandemic preparedness activities in order to reinforce basic and emergency
capacities associated with health (such as the primary care system, the surveillance of
respiratory diseases and laboratory diagnostic capacities)
- Applying pandemic preparedness activities in the active building of communication channels
between sectors and communities
- Developing or modifying plans specifically drawn up for cases of pandemic influenza and
- Periodically re-evaluating and updating existing plans on the basis of developments and new
findings acquired e.g. through exercises or real situations.
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4. Influenza
4.1. Characteristics of influenza as a disease
4.1.1. Clinical symptoms of influenza
Influenza is an acute viral infection of the respiratory tract with a short incubation period (18 to 48
hours). Transmission of this infection is mainly airborne via small droplets. Indirect transmission via the
hands is also frequent. Transmission via contaminated objects is possible but less frequent. Typically,
the onset of systemic signs is sudden and swift (fever 38 to 41 °C, chills, diffuse pain around the whole
body, joints and muscles, weakness, lassitude, anorexia, headache, dry irritating cough).
According to data from pandemics that have occurred in the past, in the case of pandemic influenza
we must also expect clinical symptoms and complications outside the respiratory tract (CNS,
cardiovascular system, GIT, etc.) as well as a frequent incidence of attendant bacterial complications
(Streptococcus pneumoniae, Staphylococus aureus, Haemophilus influenzae etc.), which is not usual
in the case of common influenza epidemics.
The clinical course depends on many variables: the virulence of the infectious agent, patient age,
immunity status, any potential underlying chronic diseases, especially those involving the heart and
lungs. Type A influenza cannot be distinguished from type B without laboratory tests. The disease
course tends to be especially severe in pregnant women and significantly overweight persons .
• Uncomplicated influenza in adults. A fever not lasting more than 5 days. A non-productive
cough is an early symptom along with nasal congestion, throat pain and retro-sternal pain
associated with coughing. The symptoms recede within 3 to 5 days, although the cough,
weakness and fatigue may persist for as long as several weeks.
• Influenza in children. Acute stenosing laryngotracheobronchitis is especially dangerous for
infants and toddlers. This is characterized by a typical inspiratory stridor, irritating cough,
dysphonia or even aphonia. In small children up to the age of 4, insomnia comes as no surprise.
Compared to adult patients, children more frequently experience GIT symptoms (nausea,
vomiting, abdominal pain, diarrhea). Acute otitis media represents the most common complication
(Streptococcus pneumoniae, Haemophilus influenzae).
• Influenza in old age. This always carries a more serious prognosis, including a worse survival
prognosis. It is associated with the more frequent incidence of bacterial super-infections, a higher
incidence of lower respiratory tract symptoms (sputum production, cough, chest pain). One
complication that must always be kept in mind is pneumonia, both primary- interstitial and
secondary- bacterial (Streptococcus pneumoniae, Staphylococcus aureus). GIT symptoms are
present more often than in younger patients (abdominal pain, constipation or diarrhea).
The danger of influenza lies on the one hand in its more severe course and on the other in its
complications, both primarily induced by the influenza virus itself (laryngotracheobronchitis,
bronchiolitis, and influenza induced interstitial pneumonia) and secondarily by bacteria (pulmonary
inflammation, sometimes associated with pleural effusion, and lung abscess). Complications also
include exacerbation of COPD, chronic bronchitis, and bronchial asthma as well as non-respiratory
complications.
4.1.2. Complications of influenza
• Primary influenza-induced pneumonia. The typical onset of influenza is followed on the 2
nd
to
3
rd
day by a worsening cough, chest pain and respiratory distress. The minimal auscultatory
findings are associated with dyspnea, tachypnea, cyanosis and sometimes hemoptysis. This state
rapidly evolves into terminal pulmonary edema. The chest X-ray demonstrates diffuse interstitial
infiltrates, present either independently or as signs of respiratory distress syndrome (RDS).
Oxygen saturation is usually lower. Patients with heart disease, especially mitral stenosis, are
most susceptible to this type of pneumonia. Primary influenza-induced pneumonia is less common
but is clinically a more severe complication compared to secondary bacterial pneumonia.
• Secondary bacterial bronchopneumonia. This most often manifests during the period when
general symptoms are receding. In the early convalescence period, on the 7
th
to 10
th
day from the
onset of influenza, fever returns, associated with a productive cough and physical signs of
8
pneumonia. The usual pathogens are Streptococcus pneumoniae, Staphylococcus aureus, and
Haemophilus influenzae. Pneumococcal pneumonias are most frequent, while staphylococcal
pneumonias are rarer, but their course is more severe with a tendency to form abscesses.
Haemophilus pneumonias can usually be treated in the outpatient setting. Persons with chronic
lung or cardiac disease are most at risk.
There also exist mixed pneumonias that demonstrate the signs and clinical symptoms of both these
distinctive types of pneumonia.
Experience from the Pandemic (H1N1)2009 has confirmed that pregnant women in the second and
third trimester as well as significantly overweight persons are much more susceptible to severe
pulmonary complications.
Patients receiving immunosuppressive therapy or, generally, patients with significantly impaired
immunity including patients with HIV/AIDS are more susceptible to a possible severe course of the
infection. These groups of persons run a high risk of fatal viral pneumonia. Immunocompromised
patients may transmit the influenza virus for more than 5 months!
Reye’s syndrome (hepato-cerebral syndrome) has been observed in 2- to 16-year-old patients as a
serious, life-threatening complication of type B influenza and, rarely, of type A influenza. An
epidemiological association has been observed between Reye’s syndrome and the use of
acetylsalicylic acid as an antipyretic. The syndrome develops over one to two days with nausea,
vomiting, possibly loss of consciousness, seizures, and cerebral edema. Increased liver
aminotransferase and serum ammoniac levels are present and hepatomegaly is common. Bilirubin
values are usually normal.
4.1.3. Other manifestations
• Neurological and psychiatric manifestations. Fever, hypoxia, and pH abnormalities associated
with influenza are usually responsible for toxic encephalopathy in certain patients, while others
develop viral encephalitis, sometimes of a hemorrhagic character. Acute psychotic states with
auditory or visual hallucinations have also been described. Hyperthermia may induce seizures,
especially in children (toxo-infectious encephalopathy).
• Myocardium involvement. Most infected persons, including those without cardiac symptoms,
may have changes on the ECG. These abnormalities are usually transitory and only exceptionally
last more than 24 hours. If they persist for months or years, they may be the cause of fatal
arrhythmias or cardiomyopathy. Influenza-associated myocarditis is usually asymptomatic.
• Myositis with subsequent rhabdomyolysis and myoglobinemia and acute renal failure
represents a rare complication in young persons with type A influenza.
• Disseminated intravascular coagulation (DIC) may occur in both influenza type A and B.
Patients may have the following manifestations: hemoptysis, hematemesis, melena, hematuria,
vaginal bleeding, purpura, renal failure and jaundice.
• In transplant recipients, both influenza type A and B lead to graft rejection.
• Toxic shock syndrome. This is an unusual complication of influenza (more often of type B) due
to a secondary staphylococcal infection, and is associated with high mortality.
Tab. No. 2: Overview of the most frequent complications of influenza
OVERVIEW OF THE MOST FREQUENT COMPLICATIONS OF INFLUENZA
PRIMARY (viral) SECONDARY (bacterial)
Interstitial pneumonia Bronchopneumonia
Acute laryngotracheobronchitis Otitis media, sinusitis
Myocarditis Acute exacerbation of chronic bronchitis
Encephalitis Acute bronchitis associated with COPD
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4.2. Treatment of patients suffering from influenza
4.2.1. Symptomatic treatment
Uncomplicated influenza is treated symptomatically. Bed rest is important. Antipyretics are
administered in the case of fever exceeding 38.5 °C. Paracetamol or non-steroidal anti-inflammatory
drugs are administered to children, as acetylsalicylic acid presents a risk of Reye’s syndrome. Fever
may also be reduced with the help of physical methods, e.g. cold packs. High temperatures also
present a significant loss of fluids, which is why adequate hydration must be maintained.
Primary viral infection is not treated with antibiotics. The clinical manifestations of influenza often
include acute tracheitis or tracheobronchitis and the drugs of choice are only anti-tussic or mucolytic
agents.
Antibiotics are indicated only in bacterial complications of influenza. The most frequent agents
inducing bacterial pulmonary inflammation are Streptococcus pneumoniae, Staphylococcus aureus
and Haemophilus influenzae. In the case of diagnosed, confirmed as well as suspected pneumonia, it
is imperative to start antibiotic treatment, optimally according to the results of bacteriological
examinations including antibiotic susceptibility testing. In the case of COPD, which is often
exacerbated by influenza, the rule should be that antibiotics are started if at least one of the following
three conditions is met: worsening of dyspnea, increased sputum volume and viscosity, purulent
sputum.
Patients with a more severe clinical course or with more serious complications, especially high risk
patients, are referred for hospitalization.
4.2.2. Causal treatment
Currently, the antivirotics available are the neuraminidase inhibitors zanamivir and oseltamivir. Both
are effective against influenza A and B. Amantadine and rimantadine are effective only against
influenza A, but resistance of the influenza virus to these preparations has been reported. The
intravenous virostatics peramivir and zanamivir are currently undergoing clinical testing. This
application form is absolutely necessary for patients in intensive care.
Treatment with virostatics must be started no later than 48 hours from the onset of the first symptoms.
They shorten the symptomatic period as well as the viral shedding period and thus infection
transmission. Virostatics do not interfere with vaccine antibody response; they are specific and safe.
Administration of these preparations must be in accordance with the package information leaflet,
especially the information regarding dosage and patient age, which may change as the preparation is
used in clinical practice and new preparations or new commercial names appear.
4.3. Laboratory diagnosis of the influenza virus in respiratory and extra-respiratory disease
4.3.1. Laboratory diagnosis of the influenza virus in respiratory disease
Laboratory diagnosis of the influenza virus from samples of clinical material is performed in virological
laboratories using standard procedures - see Table No. 3. The optimal specimen is a nasopharyngeal
swab or aspirate in the acute phase of infection, i.e. in the first three days following the development of
clinical symptoms. In patients with lower respiratory tract symptoms and suspected pneumonia, testing
requires either a sample of sputum or optimally of bronchoalveolar lavage. In deceased persons,
sections of the trachea with hemorrhagic foci or from the bifurcation site or sections of lung tissue from
the edge of the pneumonic focus are taken post mortem during the autopsy. It is also possible to
perform a serological examination of acute (together with the swab) and convalescent blood samples
(at an interval of 14 to 21 days).
4.3.2. Laboratory diagnosis of the influenza virus in extra-respiratory disease
10
The antigen may be detected in vascular endothelium, in the heart muscle (myocardium) and
pericardial fluid (in the case of cardiovascular system involvement, myocarditis, pericarditis); in
ependymal cells, the cerebrospinal fluid, the brain (in the case of CNS involvement, encephalopathy,
encephalitis); in muscle biopsies and post mortem muscle samples (in the case of myopathy and renal
dysfunctions; myositis, myoglobinuria); and in stools (in the case of GIT symptoms). Serological tests
may be performed in the case of extra-respiratory disease if both acute and convalescent phase sera
are available.
In all these cases of influenza complications, samples of similar clinical material may also be taken
concurrently as in the case of common respiratory diseases, if this coincides with the acute phase of
influenza.
Tab. No. 3: Laboratory methods suitable for detection of the influenza virus in respiratory and extrarespiratory
systems
LABORATORY METHODS:
a) RETROSPECTIVE (classical
virological methods)
Virus isolation – use chicken embryo, cell lines
Serology – CFR (applicable in all virological laboratories in
the Czech Republic), VNT, HIT (NRL for influenza)
b) RAPID NOT DISTINGUISHING
SUBTYPE (in clinical material,
during first passages of isolation,
partially in autopsy material)
ELISA, IF, IPT, bedside tests* (minimally one of these
methods is available in every virological laboratory in the
Czech Republic)
Electron microscopy (only in specialized laboratories)
c) RAPID DISTINGUISHING SUBTYPE
direct detection in clinical
material:
PCR in a suitable modification
Sequential analysis
* suitable for the outpatient setting or field work - rapid confirmation of influenza during a pandemic
The type of laboratory test is determined by the appropriate virological laboratory according to the type
of sample collected, the data on the request form and, potentially, based on agreement with the
attending physician. In cases of illness with an atypical clinical course or in exceptional
epidemiological situations, differential diagnosis of other respiratory diseases of a presumed viral or
other etiology must start immediately.
The optimal diagnostic procedure is recommended by the National Reference Laboratory for Influenza
(NRL) on the basis of World Health Organization instructions.
4.4. Surveillance of influenza in the Czech Republic and worldwide
Influenza occurs worldwide and causes epidemics of various extent, ranging from small local
epidemics in schools and groups of children to nationwide epidemics. More than 1 million cases of
influenza and influenza-like illnesses are recorded annually in the Czech Republic. When epidemics
occur they usually affect the whole country. The beginnings of influenza surveillance date back to
1954, when the then Czechoslovak Republic was among the first states to begin cooperation with the
worldwide influenza program coordinated by the WHO. In 1957, the NRL for Influenza was set up as
part of the National Institute of Public Health in Prague.
Surveillance of influenza in the Czech Republic involves the monitoring of both virological and
epidemiological or if need be epizootological data. A number of institutions outside Prague as well as
medical outpatient clinics are involved in the collection of data and material for the virological and
epidemiological program. Virological surveillance involves sending, in accordance with the instructions
of the Czech Chief Public Health Officer, samples to the NRL for Influenza from each region over a
defined period of time - usually from the 40
th
calendar week to the 20
th
calendar week. These samples
always include 2 samples of nasopharyngeal secretions weekly from patients with defined diagnoses.
This material, together with a wide range of material collected directly by the NRL for Influenza, helps
monitor the circulating respiratory viruses. The reporting of the number of patients with ARI and ILI
(epidemiological program) then forms the basis for evaluating the trend of morbidity.
11
Surveillance of influenza and influenza-like illnesses is conducted throughout the year. In the climatic
zone where the Czech Republic lies, influenza has a seasonal character. The influenza season in the
northern hemisphere is usually denoted by the period of cold months from the 40
th
calendar week of
the current year to the 18
th
calendar week of the following year. Based on long-standing monitoring
and observation, the first, usually mild increase in disease incidence is expected in December. This is
usually interrupted by the Christmas holidays, then the number of recorded illnesses gradually
increases in the course of January, usually peaks at the end of January and culminates into an
epidemic at the beginning of February, gradually involving the whole territory of the Czech Republic. In
the past ten years, between 1.5 and 3.5 million persons have annually suffered from influenza or
influenza-like illnesses (see Graph No. 1).
Graph No.1: Weekly morbidity of influenza and other acute respiratory infections in the Czech
Republic, 2000 to 2010
National surveillance results are regularly submitted to the ECDC (TESSy) and WHO (FLU-NET).
4.5. Prevention of influenza
4.5.1. Pharmacological measures
As the potential pandemic strain of the influenza virus always differs from the seasonal influenza virus
strain that commonly circulates in the population, it is necessary to manufacture a pandemic vaccine
against the new viral subtype during a pandemic. This is only possible, though, once thus subtype has
been identified. The WHO then selects the pandemic vaccine strain and recommends the timing of
pandemic vaccine production. Though work on the manufacture of a “mock-up” pandemic vaccine has
been underway for a number of years, it must be kept in mind that a period of up to several months
(minimally 3 but more likely 6 months) may elapse between the appearance of a new pandemic
influenza virus and the manufacture of the first doses of a vaccine. This means that vaccinations might
not be available for the first wave of the pandemic.
4.5.2. Non-pharmacological measures
In view of the possibly restricted capacity and problematic timely availability of the aforementioned
pharmacological measures during a pandemic, strict and thorough adherence to non-pharmacological
measures must be vehemently stressed. These measures include, for example, the thorough washing
of hands, voluntary isolation of patients, effective location of contacts, restriction of public
transportation use and mass gatherings, all of which in the initial phases of a pandemic outbreak help
gain the time necessary for acquiring more data regarding the course of the disease caused by the
pandemic virus and for the pandemic vaccine to become available.
5. Pandemic
12
5.1. Possible impact of influenza pandemics
5.1.1. Possible impact of influenza pandemics on health
The effects of a pandemic on society are unavoidable. Nonetheless, effective preparedness and
response planning may contribute towards reducing a pandemic’s extent and impact. Planning for a
potential pandemic is a complex issue, as only limited data regarding its probable impact exists: the
information available is uncertain and lacks common features. Using information from previous
pandemics, consultations with experts and theoretical modeling, most national preparedness plans are
based on the following assumptions:
Clinical disease attack rate: i.e. the proportion of inhabitants who will develop the clinical stage of
influenza during the pandemic. It is presumed that in the Czech Republic up to 30% of the population
could become ill between 9 to 15 weeks from the onset of the pandemic, i.e. more than 3 million
persons. The disease attack rate and severity may possibly differ in individual age groups. A more
severe course and higher mortality rate is expected than in the case of common “seasonal” influenza,
as the whole population will not be immune to the new influenza virus.
Influenza mortality: this is the ratio between the number of deaths as a consequence of influenza
and the total number of patients. Most national plans base their assumptions on an estimate that takes
into consideration experience from the 1957/58 pandemic. Thus, it is estimated that 0.37% of the
population could die during the pandemic period, which in the Czech Republic represents almost
12 000 persons.
Outpatient visits: it is expected that 50% of those who will fall ill will seek professional medical care,
primarily from general practitioners.
Number of hospitalized persons: it is moreover expected that 1% of those who will fall ill will be
hospitalized for acute respiratory and related complaints, i.e. approx. 30 000 persons.
ICU care: it is expected that 15% of patients hospitalized as a consequence of an influenza-like illness
will require intensive care and that 50% of these may require mechanical ventilation.
Absenteeism from work: for planning purposes it should be presumed that during the three months
from the onset of the pandemic a total of 30% of the workforce will not be present at work because of
illness for a period of five to eight working days. Influenza transmission will accelerate in schools and
other closed communities, so that it may become necessary to close such institutions. This, together
with disruption of transport and the need for the employed to care for family members and other
persons, will further increase absenteeism.
Two key methods of medical intervention are capable of significantly ameliorating the impact on
health: vaccination and the correct administration of antivirotics. Both must be conducted in the most
effective manner possible and in accordance with EC/ECDC/WHO recommendations, taking into
consideration national conditions.
Fortunately, the estimated impact on health did not come to pass during the 2009 pandemic.
Nonetheless, pandemic preparedness must be generally designed in such a way as to ensure
sufficient flexibility of the system in every situation.
5.1.2. Estimates of possible economic impact of the pandemic
From the aspect of employment in individual branches of the national economy, various degrees of
contagiousness (50%, 45%, 40%, 35%) as well as various degrees of importance from the aspect of
the functioning of the economy and state security must be differentiated. With parameters thus set, up
to 40% of employees in the group at highest risk (first-line physicians, public transport) could fall ill
within 10 days. Similarly, up to 27% in the group at risk and those important for the functioning of the
economy and state security (physicians, transport employees, employees in the commercial sector,
state administration and defense sector), 12% in the group at less risk (other production branches of
the national economy - even strategically important ones but with lower concentrations of people, e.g.
13
the energy sector) and 4% in the groups at lowest risk (other public services, financial services,
agriculture, forestry) could be affected. Overall, this represents up to 10 days of morbidity in around
10% of the employed. If we were also to project the lowest level of contagiousness for the rest of the
population, around 7% of the population could fall ill within 10 days. Economic losses due to
absenteeism correspond not only to the number of persons who are actually ill, but also include e.g.
absences when people are taking care of ill family members.
From a macroeconomic aspect, we estimate that a pandemic which can be expected to subside after
around 90 days could lead to a fall in economic productivity (measured as the annual gross domestic
product) by 1.5% to 2.0%. In the event of insufficient planning and a prepared effective response to
the pandemic, the fall in annual GDP as a consequence of morbidity could be at least 2.5% to 3.0%.
These estimates do not allow for damage to health or death that would have a long-term effect on the
fall in economic activity. These would be naturally more significant in the absence of effective
measures.
5.2. Description of the pandemic phases according to the WHO
In Stockholm in September 2006, the ECDC working party issued recommendations for EU Member
States to redefine and adapt pandemic plans to the WHO global plan so as to avoid
misunderstandings when declaring the individual phases of a pandemic. This would also enable the
transmission of correct information within a given country and between Member States and institutions
set up by the EU and WHO and the transmission of undistorted information via the media. The
individual phases of a pandemic alert are declared by the WHO.
Tab. No. 4: Description of pandemic phases according to the WHO
Phase Description
1 No viruses circulating among animals have been reported to cause infections in
humans.
2 An animal influenza virus circulating among domesticated or wild animals is
known to have caused infection in humans, and is therefore considered a
potential pandemic threat.
3 An animal or human-animal influenza reassortant virus has caused sporadic
cases or small clusters of disease in people, but has not resulted in human-tohuman
transmission sufficient to sustain community-level outbreaks.
4 Verified human-to-human transmission of an animal or human-animal influenza
reassortant virus able to cause "community-level outbreaks"
5 Community-level epidemics in at least two countries in one WHO region
6 Community-level epidemics in at least two countries in one WHO region and
moreover in at least one country in another WHO region.
Post-peak
phase
Pandemic disease levels in most countries with adequate surveillance have
dropped below peak observed levels.
Possible new
wave
Pandemic disease levels in most countries with adequate surveillance have
returned to peak observed levels.
Post-
pandemic
phase
Pandemic disease levels in most countries with adequate surveillance have
returned to the levels of seasonal influenza.
5.3. Reaction of the state to a pandemic
Pandemic alertness is declared by the WHO. In view of the fact that Member States may experience
different threat levels according to the period and extent of involvement the PP CR divides the
individual phases into variant A - the country is not affected, and variant B - the country is affected.
In general, the state’s reaction to a pandemic is divided into individual phases that copy the
aforementioned WHO phases, with each phase further divided into 6 basic groups that are then further
developed:
1) Planning and coordination
2) Monitoring and assessment of the situation
14
3) Reducing the spread of disease
4) Ensuring continued functioning of the healthcare system
5) Communication
6) Inter-sectoral cooperation
The transition between individual phases is declared by the WHO based on the evaluation of the
situation and, last but not least, on information from individual Member States (MS). The WHO
evaluates key epidemiological, virological and clinical factors and the seriousness of the pandemic and
helps national authorities take decisions regarding the optimal response to the given situation. It
provides recommendations and, potentially, technical assistance. A similar role within the EU is played
by the EC/ECDC, which enables the sharing of information and coordination on the narrower European
scale, which is of key importance for the conduct of individual EU MS.
The state’s reaction begins with measures that must be implemented before the onset of the
pandemic. It subsequently designates the necessary steps to be taken during the main pandemic
wave and does not forget to designate subsequent measures intended for the convalescence of
society and the economy as a whole. The primary objective of these preparations is to reduce the loss
of human lives associated with the pandemic, to minimize the impact on the population’s health as a
whole, to reduce the possible financial impact in all sectors of the national economy and, last but not
least, to renew human and material resources.
5.4. Containment and mitigation measures
As soon as it is possible, the EC/ECDC/WHO provides an evaluation of the impact of the pandemic on
the population’s health in order to help MS governments determine the appropriate level of response
to the pandemic. Previous pandemics have been characterized by various rates of morbidity and
mortality. The evaluation may be based on medical or economic factors. As economic factors may
differ dramatically in individual countries, the WHO plans to evaluate the impact of the pandemic on
the basis of its consequences with regard to the population’s health, as these may be monitored.
This evaluation will help MS:
- Decide whether to implement containment measures (restricting or rather slowing the spread
of the pandemic virus)/mitigation measures (limiting the impact of the pandemic),
- Take decisions regarding the use of antivirotics, vaccines and other medical intervention
- Manage the impact on healthcare provision,
- Communicate with the media and public when answering their queries.
Pandemic phase 4-5 according to the WHO is of essential importance, whereby rapidly coordinated
local and global actions may stop or limit the spread of a new variant of the virus. For national
authorities, the aim of rapid containment measures during a pandemic is to limit or rather slow the
spread of a virus with pandemic potential as fast as possible once it has been detected – this is done
with the support of the WHO and EC/ECDC. This involves unique measures in the field of public
health protection that basically do not differ from the routine response to infectious diseases, yet which
exceed this in their extent. Rapid containment is an important challenge for planning, organization and
coordination. Emphasis is placed on systematically conducting the program of surveillance, as the
success of planned measures depends on it to a great extent. If it is decided to apply containment
measures, the WHO and EC/ECDC provide, if necessary, support to the affected countries in the area
of management and technical factors.
To activate containment measures the national authority, the WHO and EC/ECDC require the
common and rapid evaluation of technical, operational and medical factors in order to determine
whether:
• It is reasonable to believe that an influenza virus with pandemic potential is capable of
effective human-to-human transmission at community level,
• There are persuasive reasons why containment measures should not be envisaged. Rapid
containment measures are not applied if it has been demonstrated that a virus with pandemic
potential is too widespread or that it is no longer possible to slow its spread. In this phase,
measures are re-directed to mitigation with the aim of limiting the pandemic’s impact on
society.
15
EC/ECDC/WHO recommendations depend on the evaluation of the situation by experts, on scientific
sources and feasibility factors. The final decision as to whether to implement concrete measures,
though, depends on the MS. Continuous communication and a flexible approach to developments by
both the MS and EC/ECDC/WHO are essential.
5.5. Lessons learnt from the last influenza pandemic in 2009/2010
The worldwide experience with the 2009/2010 pandemic has provided invaluable information for
planning the national and global response to pandemics and has concurrently confirmed the
unpredictability of influenza virus behavior, as at the moment when the world was preparing itself for
the threat of avian influenza (H5N1), a new pandemic virus unexpectedly appeared. This showed that
vigilance must not be relaxed and pandemic preparedness must continue. Thanks to such continual
preparations, the world has been well prepared in recent years. Nonetheless, it was shown that certain
critical areas of pandemic preparedness must be reinforced. These especially include:
- Communication, not only with the public but also with experts and the media (the need to
provide clear, precise information regarding measures and to clearly formulate the set
recommendations),
- The multi-sectorial conception of the fight against the pandemic,
- The effective and meaningful planning of antivirotic and pandemic vaccine use from an
international aspect, cooperation of EU MS in this area and cooperation with the WHO.
6. Contact persons who will provide information during an influenza pandemic in the Czech
Republic:
The Minister of Health of the Czech Republic
The Chief Public Health Officer of the Czech Republic or his/her statutory representative from the
public health protection section of the Czech Ministry of Health
The Press Secretary of the Czech Ministry of Health (MH) in cooperation with the press secretaries of
the other departments and ministries
The press secretaries of Regional Public Health Offices and inpatient healthcare institutions
The representatives of the NRL for Influenza, the NIPH, and the State Institute for Drug Control
Experts designated by the Ministry of Health
7. The Commission for dealing with the incidence of serious infectious diseases in the Czech
Republic
The Commission for dealing with the incidence of serious infectious diseases in the Czech Republic
(“The Central Epidemiology Commission”, hereinafter the “CEC”) is a working body of the Czech
government, which approves its statute. Its principle tasks include:
a) Informing the government about the course and consequences of serious infectious diseases,
including the incidence of influenza caused by a new variant of the influenza virus in the event of
an influenza pandemic,
b) Coordinating and managing the activities of Regional Commissions for resolving the incidence of
serious infectious diseases, including the incidence of influenza caused by a new variant of the
influenza virus in the event of an influenza pandemic,
c) Evaluating developments in the epidemiological situation,
d) Recommending to the government the approval of appropriate anti-epidemic measures with
nationwide authority.
As part of its activities, it submits reports to the government regarding developments in the
epidemiological situation and proposes essential measures in the area of public health protection in
order to ensure the readiness of various departments and the public services under their authority to
take action.
16
Regional council presidents establish, at regional level, a similar commission for resolving the
incidence of serious infectious diseases, including the incidence of influenza caused by a new variant
of the influenza virus in the event of an influenza pandemic. At the same time, they set the statute of
such commissions taking into consideration the specificities of the individual regions of the Czech
Republic.
If necessary, the CEC initiates the convening of team of selected experts, whereby the representation
of individual departments depends on the current situation and needs.
8. Detailed description of the pandemic phases according to the WHO
INTERPANDEMIC PERIOD – uncertain probability of a pandemic
PHASE 1
No viruses circulating among animals have been reported to cause infections in humans. In
this phase, no new subtypes of the influenza virus in humans have been detected.
The principle aim in the field of public health in this phase is to reinforce influenza pandemic
preparedness at all levels - global, national and regional.
INTERPANDEMIC PERIOD – uncertain probability of a pandemic
PHASE 2
An animal influenza virus circulating among domesticated or wild animals is known to have
caused infection in humans, and is therefore considered a potential pandemic threat.
The main aim in the field of public health in this phase is to reinforce influenza pandemic
preparedness at all levels - global, national and regional.
PHASE 2A – the country is not affected
PHASE 2B – the country is affected
INTERPANDEMIC PERIOD – uncertain probability of a pandemic
PHASE 3
An animal or human-animal influenza reassortant virus has caused sporadic cases or small
clusters of disease in people, but has not resulted in human-to-human transmission sufficient
to sustain community-level outbreaks.
The main aim in the field of public health in this phase is to reinforce influenza pandemic
preparedness at all levels - global, national and regional; to rapidly uncover the characteristics
of the new agent and to ensure early detection, reporting and reaction to other cases of the
disease.
PHASE 3A – the country is not affected
PHASE 3B – the country is affected
PERIOD OF PANDEMIC ALERT – intermediate to high probability of a pandemic
PHASE 4
Verified human-to-human transmission of an animal or human-animal influenza reassortant
virus able to cause "community-level outbreaks"
Small foci with restricted human-to-human transmission, but spread is highly localized, which
indicates that the virus is not sufficiently adapted to human-to-human transmission.
17
The main aim in the field of public health is to maintain the new virus in restricted foci or to
delay its spread in order to gain time for implementing preparedness measures, including the
development of a vaccine.
PHASE 4A – the country is not affected
PHASE 4B – the country is affected
PERIOD OF PANDEMIC ALERT – high probability of a pandemic
PHASE 5
Community-level epidemics in at least two countries in one WHO region
Larger foci of infection appear, but human-to-human spread of the infection is thus far
localized.
The main aim in the field of public health (especially in phase 5A) is to exert maximal efforts to
limit or delay the spread of the infection and to gain time in order to implement measures in
reaction to the pandemic, including the development of a vaccine.
Activities are re-directed (especially in phase 5B) from preparedness to response at a global
level in order to maximally reduce the pandemic’s impact on society.
PHASE 5A – the country is not affected
PHASE 5B – the country is affected
PANDEMIC PERIOD
PHASE 6
Community-level epidemics in at least two countries in one WHO region and moreover in at
least one country in another WHO region
The main aim in the field of public health is to reduce as much as possible the pandemic’s
impact on society.
A pandemic is an extensive epidemic affecting whole continents. It thus involves the high
incidence of a disease in a large territory (continent) over a specific period of time. This level
does not designate the level of the disease’s clinical severity. Rather, it means that the disease
(infection) has already affected a number of continents. Activities focus on reducing the
pandemic’s impact on society.
In the past there have been e.g. pandemics of the plague, cholera, smallpox, diphtheria,
pertussis, influenza, poliomyelitis and other diseases.
PHASE 6A – the country is not affected
PHASE 6B – the country is affected
POST – PEAK PERIOD
Pandemic disease levels in most countries with adequate surveillance have dropped below
peak observed levels.
The main aim in the field of public health is to concentrate all activities on the medical and
social consequences of the pandemic and on preparing for a potential new wave of the
pandemic.
POSSIBLE NEW WAVE
Pandemic disease levels in most countries with adequate surveillance have returned to peak
observed levels.
POST-PANDEMIC PERIOD
Pandemic disease levels in most countries with adequate surveillance have returned to the
levels of seasonal influenza.
The main aim in the field of public health is to concentrate all activities on the long-term
medical and social consequences of the epidemic and on restoring the normal functioning of
the healthcare and social system.
18
PHASE 1-3 MEASURES JURISDICTION
PLANNING AND
COORDINATION
• Regular meetings of the CEC; cooperation and
mutual exchange of information with the
Central Administrative Authorities (CAA) and
regions
MH, CAA, regions
• Conducting exercises focusing on verifying the
quality of pandemic preparedness at all levels
Crisis
management
bodies, essential
public services
• Periodic revision of the pandemic plan at least
1x every 2 years or as necessary –
assessment of capacities and identification of
the priorities of pandemic preparedness and
response planning at national and regional
level in cooperation will all partners involved
Crisis
management
bodies
• Selecting essential public services to ensure
their activities in relation to the declaration of
phases 4 – 6
CAA, regions
• Updating legislation with regard to the needs
for pandemic preparedness for all proposed
measures
CAA
• Integrating pandemic plans into existing crisis
plans and crisis preparedness plans
Crisis
management
bodies, affected
subjects
• Evaluating needs and finding financial as well
as human resources necessary for
implementing the proposed measures at
national and regional level and their integration
within pandemic plans
Crisis
management
bodies, affected
subjects
• Cooperation with the WHO and EC/ECDC,
NATO and potentially other international
institutions
MH
• Estimating and planning the purchase and
distribution of personal protective equipment
for protecting employees
Affected subjects
• Estimating and planning the purchase and
distribution of pre-pandemic or pandemic
vaccine for selected target groups of patients
MH
• Estimating and planning the purchase and
distribution of pre-pandemic or pandemic
vaccine for the protection of employees
essential for public services
MH and CAA
• Estimating and planning the purchase and
distribution of medicinal products (antivirotics)
- coordination of accessibility and possibility of
rapid use
MH
• Planning the implementation of containment
measures
MH, affected
departments and
subjects
MONITORING AND
ASSESSMENT OF THE
• Support and development of the national
surveillance system (cooperation especially of
MH/NIPH,
MA/SVA, rPHO,
19
SITUATION the healthcare and veterinary sector) enabling
the acquisition of current clinical, virological
and epidemiological data regarding the trends
in the incidence of human infections with
seasonal influenza viruses, which may also
help estimate potential needs during the
pandemic.
HF
• Detecting and investigating unusual clusters of
influenza-like respiratory diseases or deaths
and assessment of human-to-human
transmission
MH/NIPH, rPHO
• Detection of animal influenza virus infections,
potential sources of human infection, preparing
documentation for the collection, storage and
transport of samples and result reporting
MA/SVA
• Detecting and reporting suspected or
laboratory-confirmed human cases of these
diseases on the territory of the Czech Republic
and sharing this information with the WHO and
EC via the IHR and EWRS respectively;
preparing documentation for the collection,
storage and transport of samples and result
reporting
MH/NIPH, rPHO
• Cooperation between the PHPB and veterinary
authority; regular reporting to the CEC
MH, MA, MI, MD
• Information regarding evaluation of the risk of
transmission of an animal virus to the human
population
MH/NIPH
• Reinforcing the national capacity of laboratory
diagnosis and analysis in the fields of both
animal and human infections induced by
influenza and influenza-like viruses, including
the securing of sufficient human and financial
resources
MH/NIPH, MA/SVA
• Cooperation and mutual exchange of
information with the WHO and EU/ECDC
(support of international institutions when
drawing up case definition for the purpose of
reporting to the MS; and when investigating
disease cases and epidemiological
circumstances and determining risk groups)
MH/NIPH
• Characterizing and sharing animal and human
influenza virus isolates and informing relevant
international agencies (WHO, EC/ECDC) with
the aim of developing diagnostic reagents,
candidate vaccine viruses and monitoring
antiviral resistance
MH/NIPH, MA/SVA
REDUCING THE
SPREAD OF DISEASE
• Selecting multi-sectoral experts in order to
prepare for an epidemic of influenza with
pandemic potential; activating the said team of
multi-sectoral experts from phase 3
MH, CAA
• Preventing virus transmission from animals to
humans – veterinary measures
MA/SVA, affected
subjects
• Promoting preventive anti-epidemic measures
as prevention against infection spread within
the population
MH/NIPH, rPHO
• Defining social-hygienic measures (closing MH, affected
20
schools, banning visitors in hospitals etc.) departments,
regions, rPHO
• Cooperation with international organizations
(WHO, EC/ECDC) and the MS on the issue of
effective vaccine availability
MH/NIPH
• Monitoring WHO and EC/ECDC
recommendations
MH/NIPH
• Discussing potential measures relating to the
International Health Regulations
MH, affected
departments
In the event of phase
2B, 3B
• Epidemiological investigation of disease cases
and epidemiological circumstances of
infection, determining risk groups within the
population and immediate reporting of results
to the WHO, EC/ECDC
MH, rPHO
ENSURING CONTINUED
FUNCTIONING OF THE
HEALTHCARE SYSTEM
• Reviewing and updating the readiness of the
healthcare system to take action at nationwide
and regional level in the event of
increased demands on the volume of medical
care
MH, affected
departments,
regions, HF
(preparedness of the
healthcare system for the
increased demand for
medical care)
• Promoting common principles for diagnosis
and treatment, measures restricting infection
spread and relating to the safe handling of
biological material samples and hazardous
waste
MH/NIPH, affected
departments,
regions, HF
• Preparing healthcare documentation and
algorithms relating to patient examination and
medical care provision
MH/NIPH, HF,
regions
• Verifying the functionality of the Pandemie IS
at both national and regional level
MH, HF, rPHO
• Reinforcing good laboratory practice including
laboratory safety and safe sample storage and
transport as well as safe waste disposal
MH/NIPH, MA/SVA
• Ensuring the reinforcement of rapid reporting
and treatment of human cases of infections
with pandemic potential
MH/NIPH, rPHO,
regions, HF
• Developing the capacity of rapid disease
diagnostics as soon as relevant tests are
available
MH/NIPH
• Monitoring WHO, EC/ECDC, NATO
recommendations
MH/ NIPH
COMMUNICATION • Initiating communication activities with the
media, professional and lay public regarding
the potential and real risks of pandemic
influenza
MH, affected
departments,
rPHO, regions
• Monitoring WHO, EC/ECDC recommendations MH/NIPH
• Determining the principles and goals of the
communication strategy
MH, affected
departments
• Appointing a working party for communication;
activation of the said working party from phase
3
MH, affected
departments
• Building long-term cooperation with the media
at national and regional level with the aim of
ensuring they are sufficiently informed on the
issue of the pandemic
MH, regions,
rPHO
• Developing an effective dialogue with the MH, regions,
21
public with the aim of ensuring it is sufficiently
informed on the issue of the pandemic
rPHO
• Increasing public awareness regarding the
measures that may be available in order to
reduce the risk of pandemic influenza spread;
promoting personal hygiene as a means of
protection against infection
MH/NIPH, regions,
HF, rPHO
• Creating special channels of information for
hard to reach groups of the population
MH, regions
• Conducting exercises to test communication
capabilities at least once per year or more
often if necessary
MH, Crisis
management
bodies
• Updating communication strategies in
accordance with feedback from the public and
partner organizations - collecting and
analyzing information
MH, regions
From phase 2B also: • Using the disease case definitions as agreed
by the WHO/EU for reporting purposes
MH, MA
• Exchanging information relating to the efficacy
of recommended measures at international
level (WHO, EC/ECDC, MS)
MH, MA
• Exchanging information relating to the efficacy
of recommended measures at national level
MH, MA, regions
• Ensuring that information regarding the
infection of persons with a new strain of the
influenza virus is provided rapidly at both
national and international level using IHR,
EWRS
MH
• Monitoring the worldwide epidemiological
situation and disease characteristics according
to WHO, EC/ECDC reports
MH/NIPH
• Cooperation with the WHO, EC/ECDC and the
MS on the enforcement of unified and precise
reporting on the disease and epidemiological
situation
MH
INTER-SECTORAL
COOPERATION
• Defining the responsibilities of individual
Central Administrative Authorities (CAA),
regions and other affected subjects
CAA, regions,
affected subjects
• Planning measures to be implemented at
consulates and embassies abroad
MFA, MH
• Preparing information for Czech citizens
abroad and the means of providing state aid
during the pandemic; informing the public in
the Czech Republic about the situation of
Czech citizens in the affected country
MFA, MH
• Preparing and planning aid provided by the
state to Czech citizens abroad in order to
protect their lives and health (providing
information)
MFA, MH
• Preparing conditions for ensuring the
organization of emergency supplies to the
population
MI, regions
• Preparing measures for supervising that public
order and security are upheld
MI
• Preparing measures for adapting procedures
at entry points in accordance with the IHR
(2005)
MH, affected CAA,
rPHO
22
• Drawing up plans for the reaction of
international transportation to events that may
represent a threat of international significance
to public health
MT, affected
subjects
• Preparing measures relating to international
transport for persons, baggage, freight,
containers and transportation means in order
to forestall or limit disease spread in the
international context and to avoid unnecessary
disruption of international operations, applied
in accordance with the IHR (2005) and
recommendations issued by the WHO and
international transportation organizations
MT, affected
subjects
• Preparing the deployment of 5
th
and 6
th
year
medical students studying general medicine as
assistants at healthcare facilities
MH, MEYS, MLSA,
regions, HF
• Preparing the deployment of students studying
general medicine from the 3
rd
year onward in a
nursing capacity
MH, MEYS, MLSA,
regions, HF
• Implementing CEC recommendations
regarding the reimbursement of costs that will
impact the state budget and that are
associated with the influenza pandemic in the
Czech Republic
Government, MF
• Preparing measures in facilities providing
social and social-medical services
MH, MLSA,
regions, affected
subjects
• Preparing non-governmental organizations to
help in the process of providing medical care
and social services to the population
MH, regions, HF,
NGOs
• Preparing measures to ensure the continued
functioning of essential public services
Essential public
services
• Preparing volunteers who will help provide
care in inpatient healthcare facilities, where
patients will be hospitalized
MH, regions,
NGOs, HF
• Preparing procedures for resolving critical
situations associated with burial of the dead
MRD, MH, regions
• Preparing procedures for applying regulatory
measures when a state of crisis is declared
ASMR, CAA,
regions
• Preparing measures for changing the
operation of educational institutions that fall
under the jurisdiction of regions
MEYS, regions
• Preparing measures for changing the
operation of inpatient healthcare facilities and
outpatient general practitioner clinics (adult
and pediatric)
MH, regions, HF,
GP, GP (AC)
• Preparing measures to ensure the operation of
public transportation
MT, regions
23
PHASE 4A MEASURES JURISDICTION
PLANNING AND
COORDINATION
• Regular meetings of the CEC; cooperation
and mutual exchange of information with the
Central Administrative Authorities (CAA) and
regions
MH, CAA, regions
• Defining concrete posts and positions in the
sector of essential public services in order to
ensure the continuity of their activities
Essential public
services
• Reviewing and updating the pandemic plan in
accordance with developments relating to
cases of infection
Crisis
management
bodies, affected
subjects
• Setting necessary protection levels and
conditions for using personal protective
equipment for the protection of employees
MH/NIPH, rPHO
• Specifying requirements for the purchase of
personal protective equipment for the
protection of employees
Affected subjects
• Specifying the requirements for the purchase
and distribution of pre-pandemic or pandemic
vaccine for selected target patient groups
MH
• Specifying the requirements for the purchase
and distribution of pre-pandemic or pandemic
vaccine for the protection of employees of
essential public services
MH, CAA, regions
• Specifying the requirements for the purchase
and distribution of medicinal products
(antivirotics) - coordination of availability and
possible rapid use
MH
• Finalizing preparations for the pandemic activating
internal measures
Affected subjects
MONITORING AND
ASSESSMENT OF THE
SITUATION
• Support and development of the national
surveillance system enabling the acquisition
of current clinical, virological and
epidemiological data regarding the trends in
the incidence of human infections with
seasonal influenza viruses, which may also
help estimate potential needs during the
pandemic
MH/NIPH, rPHO,
HF
• Reinforcing surveillance and monitoring of
measures designated to limit the spread of
infection
MH/NIPH, rPHO,
HF
• Reinforcing virological and epidemiological
surveillance for the detection of possible
cases and clusters of infection, especially in
the case of travel or commercial contacts with
affected countries
MH/NIPH, rPHO,
HF
• Monitoring WHO and ECDC/EC reports
regarding measures taken in the area of
increased surveillance and evaluation of the
efficacy of these measures
MH/NIPH
• International exchange of information
regarding tighter control of the incidence of
infection in high risk groups of the population
MH/NIPH
24
and regarding the efficacy of the measures
introduced to limit the spread of infection
• Detecting and reporting suspected or
laboratory-confirmed cases of the disease on
the territory of the Czech Republic and
sharing this information with the WHO,
EC/ECDC via IHR, respectively the EWRS
MH/NIPH, rPHO
• Verifying the documentation prepared for the
collection, storage and transport of samples
and for the reporting of results
MH/NIPH
• Detecting and investigating any unusual
incidence of influenza-like respiratory
illnesses or deaths due to these and
assessing the transmission of the respiratory
infections in the population
MH/NIPH, rPHO,
HF
• Cooperation and mutual exchange of
information with the WHO and EU/ECDC
(support of international institutions when
drawing up definitions of disease cases for the
purpose of reporting to the MS; when
investigating cases of disease and
epidemiological circumstances and
determining risk groups within the population)
MH/NIPH
• Reinforcing the national capacity of laboratory
diagnosis and analysis both in the field of
animal and human infections induced by
influenza and influenza viruses, including the
securing of sufficient human and financial
resources
MH/NIPH, MA/SVA
• Characterizing and sharing animal and human
influenza virus isolates and informing relevant
international agencies (WHO, EC/ECDC) with
the aim of developing diagnostic reagents,
candidate vaccine viruses and monitoring
antiviral resistance
MH/NIPH, MA/SVA
REDUCING THE SPREAD
OF DISEASE
• Convening a team of multi-sectoral experts in
order to prepare for an epidemic of influenza
with pandemic potential
MH/NIPH, CAA,
selected experts
• Implementing containment measures (to limit
the spread of infection or to at least delay the
spread of infection), taking into consideration
WHO, EC/ECDC recommendations and the
current epidemiological situation
MH/NIPH, affected
departments and
subjects, rPHO
• Promoting personal hygiene as a means of
protection against infection
MH, regions, HF,
rPHO
• Preparing social-hygienic measures (closing
schools, banning visitors in hospitals etc.)
MH, MEYS, MLSA,
regions, rPHO, HF
• Cooperation with international organizations
(WHO, EC/ECDC) and the MS on the issue of
effective vaccine availability
MH
• Monitoring WHO and EC/ECDC
recommendations
MH/NIPH
• Discussing potential measures in relation to
International Health Regulations
MH, affected
departments
• Consulting with other MS or WHO MS
regarding the potential planning of other
MH, MFA
25
measures to limit the spread of infection
ENSURING CONTINUED
FUNCTIONING OF THE
HEALTHCARE SYSTEM
• Reviewing and updating the readiness of the
healthcare system to take action at nationwide
and regional level in the event of
increased demands on the volume of medical
care and laboratory diagnostics
MH, affected
departments,
regions, HF
(preparedness of the
healthcare system for the
increased demand for
medical care)
• Promoting common principles for diagnosis
and treatment, measures restricting infection
spread and relating to the safe handling of
biological material samples and hazardous
waste
MH, HF, rPHO
• Finalizing protocols and algorithms for
infection localization, clinical care and
treatment of cases
MH, HF
• Verifying the functionality of the Pandemie IS
at national level
MH, rPHO
• Reinforcing routine laboratory safety and safe
sample storage and transport as well as safe
waste disposal
MH/NIPH
• Ensuring the reinforcement of rapid reporting
and treatment of human cases of infection
with pandemic potential
MH, HF, rPHO,
MH/NIPH
• Developing the capacity of rapid disease
diagnostics as soon as relevant tests are
available
MH/NIPH
• Checking the capacity of the healthcare
system with regard to the detection and
management of influenza incidence at
inpatient healthcare facilities
MH, regions, HF
• Recommendation for healthcare personnel to
consider the diagnosis of influenza in cases of
ARI, especially if the patient has returned from
affected regions or has been in contact with
persons from affected regions
MH/NIPH
• Infection control (barrier measures) at
healthcare facilities
MH, rPHO, HF
• Monitoring WHO, EC/ECDC, NATO
recommendations
MH/NIPH
COMMUNICATION • Initiating communication activities with the
media, professional and lay public regarding
the potential and real risks of pandemic
influenza
MH, affected
departments,
regions, rPHO
• Monitoring WHO and EC/ECDC
recommendations
MH/NIPH
• Finalized communication strategy MH
• Active working party for communication MH
• Building long-term cooperation with the media
at national and regional level with the aim of
ensuring that they are sufficiently informed on
the issue of the pandemic
MH, regions,
rPHO
• Developing an effective dialogue with the
public with the aim of ensuring it is sufficiently
informed on the issue of the pandemic
MH, regions,
rPHO
• Creating special channels of information for
hard to reach groups of the population
MH, regions
26
• Increasing public awareness regarding the
measures that may be available in order to
reduce the risk of pandemic influenza spread;
promoting personal hygiene as a means of
protection against infection
MH/NIPH, regions,
rPHO
• Conducting exercises to test communication
capabilities at least once per year or more
often if necessary
MH, Crisis
management
bodies
• Updating communication strategies in
accordance with feedback from the public and
partner organizations - collecting and
analyzing information
MH, regions
• Using disease case definitions as agreed by
the WHO/EU for reporting purposes
MH, MA
• Exchanging information relating to the efficacy
of recommended measures at international
level (WHO, EC/ECDC, MS)
MH, MA
• Exchanging information relating to the efficacy
of recommended measures at national level
MH, MA, regions
• Monitoring the worldwide epidemiological
situation and disease characteristics
according to WHO, EC/ECDC reports
MH
• Cooperation with the WHO, EC/ECDC and
the MS on the enforcement of unified and
precise reporting on the disease and
epidemiological situation
MH
• Holding frequent and previously announced
briefings via the popular media - web, TV,
radio as well as press conferences, with the
aim of containing panic and dispelling rumors
MH
• Exchanging reports intended for the public
and educational materials with other MS,
EC/ECDC
MH
INTER-SECTORAL
COOPERATION
• Detailing the planned measures to ensure the
activities of individual CAA, and other affected
subjects and regions within the scope of their
authority and reflecting developments in the
epidemiological situation within the relevant
pandemic plans
Crisis
management
bodies
• Updating planned measures to ensure the
continuity of essential public services
Essential public
services
• Updating planned measures to ensure the
continuity of activities of inpatient healthcare
facilities
HF
• Updating planned measures to ensure the
continuity of social and social-medical
services
Regions, affected
subjects
27
PHASE 4B MEASURES JURISDICTION
PLANNING AND
COORDINATION
• Regular meetings of the CEC; cooperation
and mutual exchange of information with CAA
and regions
MH, CAA, regions
• Defining concrete posts and positions in the
sector of essential public services in order to
ensure the continuity of their activities
Essential public
services
• Reviewing and updating the pandemic plan in
accordance with developments relating to
cases and the course of the infection in
humans
Crisis
management
bodies, affected
subjects
• Considering the declaration of a state of crisis
according to needs and the situation,
including the implementation of crisis
measures
regions,
government
• Commencing activities in accordance with the
pandemic plan, focusing on ensuring essential
public services
Crisis
management
bodies, essential
public services
• Finalizing preparations for a possible
pandemic – activating internal measures,
mobilizing and reinforcing the workforce in
essential public services
CAA, regions,
essential public
services
• Specifying necessary protection levels and
conditions for using personal protective
equipment for the protection of employees
MH/NIPH, rPHO
• Finalizing preparations for a possible
pandemic, including finalizing the purchase of
supplies of protective equipment set out in the
pandemic plan for the protection of employees
Affected subjects
• Finalizing preparations for a possible
pandemic, including finalizing the purchase of
medicinal product supplies
MH
• Finalizing preparations for a pandemic,
including finalizing the distribution of medicinal
product supplies- coordination of availability
and possible rapid use
MH
• Specifying the requirements for the purchase
and distribution of pre-pandemic or pandemic
vaccine for selected target patient groups
MH
• Specifying the requirements for the purchase
and distribution of pre-pandemic or pandemic
vaccine for the protection of employees of
essential public services
MH, CAA, regions
MONITORING AND
ASSESSMENT OF THE
SITUATION
• Support and development of the national
surveillance system (cooperation especially
with the healthcare and veterinary sector)
enabling the acquisition of current clinical,
virological and epidemiological data regarding
the trends in the incidence of human
infections with seasonal influenza viruses,
MH/NIPH, HF,
rPHO
28
which may also help estimate potential needs
during the pandemic
• Reinforcing surveillance – rapid detection and
reporting of new cases in the population
MH/NIPH, rPHO,
HF
• Reinforcing virological and epidemiological
surveillance for the detection of possible
cases and clusters of infection– collection of
clinical and epidemiological data in the
greatest extent possible
MH/NIPH, rPHO,
HF
• Monitoring of measures implemented to limit
the spread of infection in the population
MH
• Monitoring WHO and ECDC/EC reports
regarding measures taken in the area of
increased surveillance and evaluation of the
efficacy of these measures
MH/NIPH
• International exchange of information
regarding increased epidemiological
surveillance of high risk groups of the
population and regarding the efficacy of the
measures introduced to limit the spread of
infection
MH/NIPH
• Detecting and reporting suspected or
laboratory-confirmed cases of the disease on
the territory of the Czech Republic and
sharing this information with the WHO,
EC/ECDC via IHR respectively EWRS
MH/NIPH, rPHO
• Collection, storage and transport of samples
in accordance with the prepared
documentation
HF
• Detecting and investigating any unusual
incidence of influenza-like respiratory
illnesses or deaths due to these and
assessment of transmission among humans
MH/NIPH, rPHO,
HF
• Cooperation and mutual exchange of
information with the WHO and EC/ECDC
(support of international institutions when
drawing up definitions of disease cases for the
purpose of reporting to the MS; and when
investigating cases of disease and
epidemiological circumstances and
determining risk groups within the population)
MH/NIPH
• Reinforcing the national capacity of laboratory
diagnosis and analysis both in the field of
animal and human infections, including the
securing of sufficient human and financial
resources
MH/NIPH, MA/SVA
• Characterizing and sharing animal and human
influenza virus isolates and informing relevant
international agencies (WHO, EC/ECDC) with
the aim of developing diagnostic reagents,
candidate vaccine viruses and monitoring
antiviral resistance
MH/NIPH, MA/SVA
REDUCING THE SPREAD
OF DISEASE
• Direct and coordinated steps taken by the
team of multi-sectoral experts when finalizing
preparations for the epidemic of influenza with
pandemic potential, focusing on limiting the
MH/NIPH, CAA,
selected experts
29
spread of infection (or at least delaying it)
• Promoting personal hygiene as a means of
protection against infection
MH/NIPH, regions,
HF, rPHO
• Implementing social-hygienic measures
(closing schools, banning visitors in hospitals
etc.) on the basis of developments in the
epidemiological situation
MH/NIPH, MEYS,
MLSA, regions,
rPHO, HF
• Cooperation with international organizations
(WHO, EC/ECDC) and the MS on the issue of
effective vaccine availability
MH
• Monitoring WHO and EC/ECDC
recommendations
MH/NIPH
• Implementing potential measures relating to
international travel – IHR
MH, affected
departments,
affected subjects
• Investigating disease cases and the
epidemiological circumstances of infection
and determining the groups at risk as well as
immediate reporting of results to the WHO,
EC/ECDC
MH/NIPH, rPHO
• Implementing containment measures (to limit
the spread of infection or at least delay the
spread of infection), taking into consideration
WHO, EC/ECDC recommendations and the
current epidemiological situation
MH, affected
departments and
subjects, rPHO
• Increasing stocks of medication and medical
materials in accordance with the pandemic
plan based on the current developments in
the epidemiological situation
HF
• Ensuring the accessibility and possible rapid
use of medicinal products (antivirotics) from
state stocks
MH, ASMR, MF
• Planning the use of vaccines – assessing the
advantages and disadvantages of vaccinating
persons who are at risk of infection at work or
during other activities using vaccines against
seasonal influenza and potential planning of
the vaccination program
MH, SIDC
• Consultations with other EU MS and EC
regarding the potential planning of other
measures to limit the spread of infection
MH
• Regular reporting of the current
epidemiological status and number of cases
to the WHO, EC/ECDC
MH
ENSURING CONTINUED
FUNCTIONING OF THE
HEALTHCARE SYSTEM
• Readiness of the healthcare system at nationwide
and regional level to face increased
demands on medical services, including
laboratory services
MH/NIPH, regions
, HF
(preparedness of the
healthcare system for the
increased demand for
medical care)
• Promoting common principles for diagnosis
and treatment, measures restricting infection
spread and relating to the safe handling of
biological material samples and hazardous
waste
MH/NIPH, HF,
rPHO
• Applying protocols and algorithms for infection
localization, care and treatment of cases
rPHO, NIPH, HF
• Activating the Pandemie IS at national level MH
• Operating the Pandemie IS and data analysis MH/NIPH, rPHO
30
• Applying the principles of laboratory safety
and safe sample storage and transport as well
as safe waste disposal
HF, rPHO
• Ensuring the rapid reporting and treatment of
human cases of infections with pandemic
potential
MH/NIPH, rPHO,
HF
• Ensuring sufficient capacities for rapid
disease diagnostics as soon as relevant tests
are available
MH/NIPH
• Readiness of the healthcare system with
regard to the detection and management of
influenza incidence in inpatient healthcare
facilities
MH, regions, HF
• Recommendation for healthcare personnel to
consider the diagnosis of influenza in cases of
ARI, especially if the patient has returned from
affected regions or has been in contact with
persons from affected regions
MH/NIPH, rPHO
• Implementing infection control measures
(barrier measures) at healthcare facilities
HF, rPHO
• Monitoring WHO, EC/ECDC
recommendations
MH/NIPH
• Information and consultations regarding
preparations for the next phase of the
pandemic
MH, regions,
selected experts
• Activating alternative plans for ensuring
isolation and providing medical care, if
developments so require
HF
COMMUNICATION • Actively developing communication activities
with the media, professional and lay public
regarding the potential and real risks of
pandemic influenza. Activating communication
mechanisms to ensure the widest possible
dissemination of information
MH, affected
departments,
regions, rPHO
• Monitoring WHO and EC/ECDC
recommendations
MH/NIPH
• Applying the communication strategy MH
• Regular meetings of the working party for
communication
MH
• Evaluating the global and national pandemic
risk
MH, selected
experts
• Building long-term cooperation with the media
at national and regional level with the aim of
ensuring they are sufficiently informed on the
issue of the pandemic
MH, regions,
rPHO
• Developing an effective dialogue with the
public with the aim of ensuring it is sufficiently
informed on the issue of the pandemic
MH, regions,
rPHO
• Increasing public awareness regarding the
measures that may be available in order to
reduce the risk of pandemic influenza spread;
the promotion of personal hygiene as a
means of protection against infection
MH/NIPH, regions,
rPHO
• Applying special channels of information for
hard to reach groups of the population
MH, regions
• Updating communication strategies in MH, regions
31
accordance with feedback from the public and
partner organizations - collection and analysis
of information
• Using the disease case definitions as agreed
by the WHO/EU for reporting purposes
MH, MA
• Exchanging information relating to the efficacy
of recommended measures at international
level
MH, MA
• Exchanging information relating to the efficacy
of recommended measures at national level
MH, MA
• Ensuring the rapid transmission of information
regarding human infection with a new strain of
the influenza virus at national and
international level using the IHR, EWRS
MH, rPHO
• Monitoring the worldwide epidemiological
situation and disease characteristics
according to WHO, EC/ECDC reports
MH
• Cooperation with the WHO, EC/ECDC and
the MS on the enforcement of unified and
precise reporting on the disease and
epidemiological situation
MH
• Holding frequent and previously announced
briefings via the popular media - web, TV,
radio as well as press conferences, with the
aim of containing panic and dispelling rumors
MH
• Exchanging reports intended for the public
and educational materials with other MS,
EC/ECDC
MH
• Ensuring rapid transmission of information
regarding laboratory-confirmed human
infection via a network of reference
laboratories
MH, rPHO
• Setting up procedures to be followed by all
spokespersons to provide consistent
information
MH, CAA, regions
• Regular communication using set
mechanisms
What we know or do not know about the virus,
the epidemiological situation, the
implementation and efficacy of measures and
the probable subsequent steps
The importance of restricting the non-essential
movement of persons to and from a
designated region where containment
measures are in force and of the relevant
screening procedures at transit sites
The importance of compliance with
recommended measures in order to limit
further spread of the disease
How to access drugs, basic services and
supplies in the containment region
MH, regions, HF,
rPHO
INTER-SECTORAL
COOPERATION
• Finalizing the responsibilities of individual
CAA, and other affected subjects and regions
within the scope of their authority, reflecting
developments in the epidemiological situation
within the relevant pandemic plans.
Crisis
management
bodies, affected
subjects
• Updating planned measures to ensure the Essential public
32
continuity of essential public services services
• Updating planned measures to ensure the
continuity of activities of inpatient healthcare
facilities
HF
• Updating planned measures to ensure the
continuity of social and social-medical
services
Regions, affected
subjects
33
PHASES 5A a 6A MEASURES JURISDICTION
PLANNING AND
COORDINATION
• Regular meetings of the CEC; cooperation
and mutual exchange of information with CAA
and regions
MH, CAA, regions
• If necessary, updating recommendations for
the public, taking into account the situation
regarding the incidence of infection and
information coming from abroad (especially
from affected regions)
MH/NIPH
• Finalizing preparations for a pandemic –
activating internal measures, mobilizing and
reinforcing the workforce in essential public
services
Crisis
management
bodies, essential
public services
• Considering the declaration of a state of crisis
according to needs and the situation, including
the implementation of crisis measures
regions,
government
• Continued activities in accordance with the
pandemic plan, focusing on ensuring essential
public services
Crisis
management
bodies, essential
public services
• Supporting and maintaining confidence across
all agencies, organizations and the public via
the transparency and credibility of the steps
taken
Government, MH,
selected experts
• Finalizing preparations for a pandemic,
including the purchase and distribution of
medicinal products - coordination of
availability and possible rapid use
MH
• Specifying the required level of protection and
conditions for the use of personal protective
equipment for the protection of employees
MH/NIPH, rPHO
• Finalizing preparations for a pandemic,
including the purchase and distribution of
protective equipment for the protection of
employees as set out in the pandemic plan
Affected subjects
• Finalizing requirements for the purchase and
distribution of pre-pandemic or pandemic
vaccine for selected target patient groups
MH, government
• Finalizing requirements for the purchase and
distribution of pre-pandemic or pandemic
vaccine for the protection of employees of
essential public services
MH, CAA,
government
From phase 6 • Purchase, distribution and application of prepandemic
or pandemic vaccine for the
protection of employees of essential public
services
MH, CAA,
government, MF
From phase 6 • Purchase, distribution and application of prepandemic
or pandemic vaccine for selected
target patient groups
MH, government,
MF
MONITORING AND
ASSESSMENT OF THE
SITUATION
• Readiness of the national surveillance system
enabling the acquisition of current clinical,
virological and epidemiological data regarding
the trends in the incidence of human infections
with seasonal influenza viruses, which may
MH/NIPH, rPHO,
HF
34
also help estimate potential needs during the
pandemic
• Surveillance and monitoring measures
implemented to limit the spread of infection in
the population
MH/NIPH, rPHO
• Virological and epidemiological surveillance
for the detection of possible cases and
clusters of infection, especially in the case of
travel or commercial contacts with affected
countries
MH/NIPH, rPHO,
HF
• Monitoring WHO and ECDC/EC reports
regarding measures taken in the area of
increased surveillance and evaluation of the
efficacy of these measures
MH/NIPH
• International exchange of information
regarding increased surveillance of high risk
groups and regarding the efficacy of the
measures introduced to limit the spread of
infection
MH/NIPH
• Detecting and reporting suspected or
laboratory-confirmed cases of the disease on
the territory of the Czech Republic and sharing
this information with the WHO, EC/ECDC via
the IHR, respectively EWRS
MH/NIPH, rPHO
• Collection, storage and transport of samples in
accordance with the prepared documentation
HF
• Detecting and investigating any unusual
incidence of influenza-like respiratory
diseases or deaths due to these and
assessment of transmission among humans
MH/NIPH, rPHO,
HF
• Cooperation and mutual exchange of
information with the WHO and EC/ECDC
(when investigating disease cases and
epidemiological circumstances of the infection,
when determining risk groups, and in the
development of disease characteristics and
severity); monitoring their recommendations
MH/NIPH
• Ensuring the sufficient capacity of laboratory
diagnosis and analysis, including securing
sufficient human and financial resources
MH/NIPH
• Characterizing and sharing animal and human
influenza virus isolates and informing relevant
international agencies (WHO, EC/ECDC) with
the aim of developing diagnostic reagents,
candidate vaccine viruses and monitoring
antiviral resistance
MH/NIPH, MA/SVA
REDUCING THE
SPREAD OF DISEASE
• Direct and coordinated steps taken by the
team of multi-sectoral experts to resolve the
epidemic of influenza with pandemic potential,
focusing on limiting the spread of infection (or
at least delaying it)
MH/NIPH, CAA,
selected experts
• Promoting personal hygiene as a means of
protection against infection
MH/NIPH, regions,
HF, rPHO
• Implementing social-hygienic measures
(closing schools, banning visitors in hospitals
etc.) on the basis of developments in the
epidemiological situation
MH/NIPH, MEYS,
MLSA, regions,
rPHO, HF
35
• Cooperation with international organizations
(WHO, EC/ECDC) and the MS on the issue of
effective vaccine availability
MH
• Monitoring WHO and EC/ECDC
recommendations
MH/NIPH
• Implementing containment measures (to limit
the spread of infection or at least delay the
spread of infection), taking into consideration
WHO, EC/ECDC recommendations;
cooperation with the WHO and EC/ECDC
MH, affected
departments and
subjects, rPHO
• Considering screening at international border
entry points
MH, affected
departments
• Consultations with other EU MS and EC
regarding the potential planning of other
measures to limit the spread of infection
MH
• Incorporating WHO recommendations and
information when designing travel
recommendations and health warnings
MH, affected
departments
• Discussing potential measures relating to
international travel – IHR
MH, affected
departments and
subjects
• Updating recommendations regarding the
planning of interventions on the basis of
experience and information from affected
countries
MH, MFA, affected
departments
• Ensuring the accessibility and possible rapid
use of medicinal products (antivirotics) from
state stocks
MH, ASMR, MF
• Planning the use of vaccines – assessing the
advantages and disadvantages of vaccinating
persons who are at risk of infection at work or
during other activities using vaccines against
seasonal influenza and the potential planning
of the vaccination program
MH, SIDC
ENSURING CONTINUED
FUNCTIONING OF THE
HEALTHCARE SYSTEM
• Readiness of the healthcare system at nationwide
and regional level to face increased
demands for medical and laboratory services
MH/NIPH, regions,
HF
(preparedness of the
healthcare system for the
increased demand for
medical care)
• Promoting common principles for diagnosis
and treatment, measures restricting infection
spread and relating to the safe handling of
biological material samples and hazardous
waste
MH, HF, rPHO
• Applying protocols and algorithms for infection
localization, care and treatment of cases
rPHO, NIPH, HF
• Activating the Pandemie IS at national level MH
• Applying the principles of laboratory safety
and safe sample storage and transport to
laboratories as well as safe waste disposal
NIPH, rPHO, HF
• Ensuring the rapid reporting and treatment of
human cases of infection with pandemic
potential
MH/NIPH, rPHO,
HF
• Ensuring sufficient capacities for rapid disease
diagnostics as soon as relevant tests are
available
MH/NIPH
• Readiness of the healthcare system with
regard to the detection and management of
influenza incidence in inpatient healthcare
MH, regions, HF
36
facilities
• Recommendation for healthcare personnel to
consider the diagnosis of influenza in cases of
ARI, especially if the patient has returned from
affected regions or has been in contact with
persons from affected regions
MH/NIPH, rPHO
• Implementing infection control measures
(barrier measures) at healthcare facilities
HF, rPHO
• Monitoring WHO, EC/ECDC
recommendations
MH/NIPH
• Monitoring updated WHO, EC/ECDC
recommendations regarding the clinical
course, diagnosis and reporting of cases
MH
COMMUNICATION • Active development of communication
activities with the media, professional and lay
public regarding the potential and real risks of
pandemic influenza
MH, affected
departments,
regions, rPHO
• Monitoring WHO and EC/ECDC
recommendations
MH/NIPH
• Applying the communication strategy MH
• Regular meetings of the working party for
communication
MH
• Evaluating the global and national pandemic
risk
MH, selected
experts
• Building long-term cooperation with the media
at national and regional level with the aim of
ensuring they are sufficiently informed on the
issue of the pandemic
MH, regions,
rPHO
• Developing an effective dialogue with the
public with the aim of ensuring it is sufficiently
informed on the issue of the pandemic
MH, regions,
rPHO
• Increasing public awareness regarding the
measures that may be available in order to
reduce the risk of pandemic influenza spread;
promotion of personal hygiene as a means of
protection against infection
MH/NIPH, regions,
rPHO
• Applying special channels of information for
hard to reach groups of the population
MH, regions
• Updating communication strategies in
accordance with feedback from the public and
partner organizations - collecting and
analyzing information
MH, regions
• Using disease case definitions agreed on by
the WHO / EU for reporting purposes
MH, MA
• Exchange of information relating to the
efficacy of recommended measures at
international level (WHO, EC/ECDC, MS)
MH, MA
• Exchange of information relating to the
efficacy of recommended measures at
national level
MH, MA
• Ensuring rapid transmission of information
regarding human infection with a new strain of
the influenza virus at national and international
level using the IHR, EWRS
MH, rPHO
• Monitoring the worldwide epidemiological
situation and disease characteristics
MH
37
according to WHO, EC/ECDC reports
• Cooperation with the WHO, EC/ECDC and the
MS on the enforcement of unified and precise
reporting on the disease and epidemiological
situation
MH
• Holding frequent and previously announced
briefings via the popular media - web, TV,
radio as well as press conferences, with the
aim of containing panic and dispelling rumors
MH
• Exchanging reports intended for the public
and educational materials with other MS,
EC/ECDC
MH
• Regularly updating and informing the public
about what is known and not known about the
pandemic disease, including routes of
transmission, clinical severity, treatment and
possibilities of prophylaxis
MH, rPHO,
selected experts
• Providing regular information targeting social
issues such as travel alerts, closure of borders
etc.
MH, selected
experts, affected
departments
• Setting up procedures to be followed by all
spokespersons to provide consistent
information regarding developments
MH, CAA, regions
• Regular communication using set
mechanisms
What we know or do not know about the virus,
the epidemiological situation, the application
and efficacy of measures and the probable
subsequent steps
The importance of restricting the non-essential
movement of persons to and from a
designated region where containment
measures are in force and of the relevant
screening procedures at transit sites
The importance of compliance with
recommended measures in order to limit
further spread of the disease
How to access drugs, basic services and
supplies in the containment region
MH, regions,
affected
departments
INTER-SECTORAL
COOPERATION
• Implementing the duties of individual CAA,
other affected subjects and regions within the
scope of their authority, reflecting
developments in the epidemiological situation
as per the pandemic plans
Crisis
management
bodies, affected
subjects
• Implementing planned measures to ensure the
continuity of essential public services
Essential public
services
• Implementing planned measures to ensure the
continuity of activities of inpatient healthcare
facilities
HF
• Implementing planned measures to ensure the
continuity of social and social-medical
services
Regions, affected
subjects
38
PHASE 5 B and 6 B MEASURES
JURISDICTION
PLANNING AND
COORDINATION
• Regular meetings of the CEC; cooperation
and mutual exchange of information with CAA
and regions
MH, CAA, regions
• If necessary, updating recommendations for
the public, taking into account the situation
regarding the incidence of infection and
information coming from abroad (especially
from the most affected regions)
MH/NIPH
• Finalizing preparations for a pandemic –
activating internal measures, mobilizing and
reinforcing the workforce in essential public
services
Crisis
management
bodies, essential
public services
• Considering the declaration of a state of crisis
according to needs and the situation,
including the implementation of necessary
measures
regions,
government
• Maintaining confidence across all agencies,
organizations and the public via the
transparency and credibility of the steps taken
Government, MH,
selected experts
• Setting procedures and targets aiming at a
rational, ethical and transparent approach to
human, material and economic resources
MH, CAA, regions,
selected experts
• Evaluating the need of international help MH, MFA,
government
• Defining the required level of protection and
conditions for the use of personal protective
equipment for the protection of employees
MH/NIPH, rPHO
• Distributing protective equipment supplies in
accordance with the pandemic plan for the
protection of employees
Affected subjects
• Distributing medicinal products (antivirotics) coordination
of availability and possible rapid
use
MH
In phase 5 B • Finalizing requirements for the purchase and
distribution of pre-pandemic or pandemic
vaccine for selected target patient groups
Government, MF,
MH
In phase 5 B • Finalizing requirements for the purchase and
distribution of pre-pandemic or pandemic
vaccine for the protection of employees of
essential public services
Government, MF,
MH, CAA
From phase 6 • Purchase, distribution and application of prepandemic
or pandemic vaccine to the target
group of patients
Government, MF,
MH
From phase 6 • Purchase, distribution and application of prepandemic
or pandemic vaccine to the
employees of essential public services
Government, MF,
MH, CAA
MONITORING AND
ASSESSMENT OF THE
SITUATION
• Reporting the number of cases on the territory
of the Czech Republic and sharing this
information with the WHO and EC/ECDC via
the IHR, respectively EWRS
MH/NIPH, rPHO
• Collection, storage and transport of samples
and reporting results in accordance with the
prepared documentation
HF
39
• Detecting and investigating any unusual
incidence of influenza-like respiratory
diseases or deaths from these and evaluation
of human-to-human transmission
MH, rPHO, HF
In the area of surveillance
• Evaluating the efficacy of implemented
measures
MH/NIPH, rPHO
• Monitoring morbidity and mortality MH/NIPH, rPHO
• Comprehensibly evaluating the earliest cases
of pandemic influenza
MH/NIPH, rPHO
• Documenting the developing pandemic,
including its geographic spread, trends and
impact
MH/NIPH, rPHO
• Documenting every change in the
epidemiological and clinical characteristics of
the virus
MH/NIPH, rPHO
• Maintaining adequate virological surveillance
for the detection of antigenic and genetic
changes as well as changes in viral sensitivity
to antivirotics and pathogenicity
MH/NIPH, rPHO
• Modifying the case definition and updating
clinical and laboratory algorithms for
diagnosis, as necessary
MH/NIPH, rPHO
In the area of monitoring
• Monitoring essential resources such as: the
supply of medical materials, antivirotics,
vaccines and other drugs; the availability of
healthcare workers; bed occupancy in
inpatient healthcare facilities; the utilization of
alternative healthcare facilities; the supplies of
laboratory materials; and the capacities of
funeral services
MH, MRD,
regions, HF
• Monitoring and evaluating the national impact
using criteria such as absenteeism (work,
school), affected regions, the most affected
groups and the availability of essential
workers
CAA, regions,
essential public
services
• Evaluating the effect and impact of
implemented motivational measures
CAA, regions,
essential public
services
• Estimating the pandemic’s economic impact,
if possible
MF, MH, CAA,
regions,
government
REDUCING THE SPREAD
OF DISEASE
• Direct and coordinated steps taken by the
team of multi-sectoral experts to deal with the
influenza pandemic, focusing on limiting the
impact of the pandemic
MH, CAA,
selected experts
• Consultations with other EU MS and EC
regarding the potential planning of other
measures to limit the spread of infection
MH
• Transition from containment to mitigation
measures in accordance with WHO and
EC/ECDC recommendations; cooperation
with the WHO and EC/ECDC
MH, affected
departments, HF
• Active approach to personal hygiene as a MH/NIPH, regions,
40
means of protection against infection HF, rPHO
• Implementing social-hygienic measures
(closing schools, banning visitors in hospitals
etc.) on the basis of developments in the
epidemiological situation
MH/NIPH, MEYS,
MLSA, regions,
HF, rPHO
• Cooperation with international organizations
(WHO, EC/ECDC) and the MS on the issue of
effective vaccine availability
MH
• Monitoring WHO and EC/ECDC
recommendations
MH/NIPH
• Applying potential measures related to
international travel – IHR
MH, affected
departments and
subjects
• Investigating atypical cases of the disease
and the epidemiological circumstances of
infection; determining risk groups and
immediate reporting of results to the WHO,
EC/ECDC
MH/NIPH, rPHO
• Ensuring a sufficient supply of drugs and
other materials for providing medical care in
accordance with the pandemic plan on the
basis of developments in the epidemiological
situation
MH, regions, HF
• Consultations with other EU MS and EC
regarding potential other measures
MH
• Incorporating WHO recommendations and
information when preparing international
recommendations for travel and health
warnings
MH, affected
departments
• Updating recommendations regarding the
planning of interventions on the basis of
experience and information from affected
countries
MH, MFA,
selected experts
• Recommending that persons suffering from
ARI stay at home and minimize their contact
with household members and other persons
MH/NIPH, rPHO,
GP, GP (AC)
• Recommending that household members
minimize their level of interaction outside the
home and isolate themselves once influenza
symptoms appear
MH/NIPH, rPHO,
GP, GP (AC)
• Recommending the restriction of mass
gatherings and reduction of travel, including
public transportation
MH, regions,
rPHO
• Modifying strategies for the use of antivirotics
on the basis of new information, if necessary
MH
From phase 6 • Vaccination with the pandemic vaccine in
accordance with the vaccination strategy, if a
vaccine is available
HF, GP, GP (AC)
• Participation in the monitoring of pandemic
vaccine safety and efficacy
SIDC, HF, GP, GP
(AC)
ENSURING CONTINUED
FUNCTIONING OF THE
HEALTHCARE SYSTEM
• Readiness of the healthcare system at nationwide
and regional level to face the increased
demands on medical services and laboratory
examinations
MH/NIPH, regions,
HF
(preparedness of the
healthcare system for the
increased demand for
• Promoting common principles for diagnosis
and treatment; measures restricting infection
spread and relating to the safe handling of
MH, HF, rPHO
41
medical care) biological material samples and hazardous
waste
• Applying protocols and algorithms for infection
localization, clinical care and treatment of
cases
rPHO, NIPH, HF
• Using the Pandemie IS and data evaluation MH/NIPH, rPHO
• Applying the principles of laboratory safety
and safe sample storage and transport to
laboratories as well as safe waste disposal
HF, rPHO
• Ensuring the rapid reporting and treatment of
suspected human cases of infection with
pandemic potential
MH/NIPH, rPHO,
HF
• Ensuring sufficient capacities for rapid
disease diagnostics as soon as relevant tests
are available
MH/NIPH
• Readiness of the healthcare system with
regard to the detection and management of
influenza incidence in inpatient healthcare
facilities
MH, regions, HF
• Recommendation for healthcare personnel to
consider the diagnosis of influenza in cases of
ARI, especially if the patient has returned
from affected regions or has been in contact
with persons from affected regions
MH/NIPH, HF
• Implementing infection control measures
(barrier measures) at healthcare facilities
HF, rPHO
• Monitoring WHO, EC/ECDC
recommendations
MH/NIPH
• Monitoring updated WHO, EC/ECDC
recommendations regarding the clinical
course, diagnosis and reporting of cases
MH
• Implementing pandemic plans for the full
mobilization of the healthcare system,
institutions and workers at national and
regional level
Crisis
management
bodies, affected
subjects
• Activating alternative plans for ensuring
isolation and provision of medical care, if the
situation so demands
HF
• Ensuring a sufficient amount of personal
protective equipment in accordance with
recommendations issued by the PHPB
Affected subjects
• Providing medical and non-medical help to
patients and their contacts at home and
alternative institutions, if necessary
HF, regions, NNO
• Providing social and psychological support to
healthcare employees, patients and
communities, if necessary
regions, HF, NNO
• Applying wider measures for the disposal of
the dead as necessary
MRD, regions
COMMUNICATION • Active communication with the media,
professional and lay public regarding the
potential and real risks of pandemic influenza
MH, affected
departments,
regions, rPHO
• Monitoring WHO and EC/ECDC
recommendations
MH/NIPH
• Applying the communication strategy MH
• Regular meetings of the working party for MH
42
communication
• Evaluating the global and national pandemic
risk
MH, selected
experts
• Building long-term cooperation with the media
at national and regional level with the aim of
ensuring they are sufficiently informed on the
issue of the pandemic
MH, regions,
rPHO
• Developing an effective dialogue with the
public with the aim of ensuring it is sufficiently
informed on the issue of the pandemic
MH, regions,
rPHO
• Increasing public awareness regarding the
measures that may be available in order to
reduce the risk of pandemic influenza spread;
promoting personal hygiene as a means of
protection against infection
MH/NIPH, regions,
rPHO
• Applying special channels of information for
hard to reach groups of the population
MH, regions
• Updating communication strategies in
accordance with feedback from the public and
partner organizations - collecting and
analyzing information
MH, regions
• Using disease case definitions agreed on by
the WHO / EU for reporting purposes
MH, MA
• Exchanging information relating to the efficacy
of recommended measures at international
level (WHO, EC/ECDC, MS)
MH, MA
• Exchanging information relating to the efficacy
of recommended measures at national level
MH, MA
• Ensuring rapid transmission of information
regarding human infection with a new strain of
the influenza virus at national and
international level using the IHR, EWRS
MH/NIPH, rPHO
• Monitoring the worldwide epidemiological
situation and disease characteristics
according to WHO, EC/ECDC reports
MH/NIPH
• Cooperation with the WHO, EC/ECDC and
the MS on the enforcement of unified and
precise reporting on the disease and
epidemiological situation
MH
• Promoting and providing information
regarding recommended measures for the
prevention and reduction of risks to the
population and individuals
MH
• Holding frequent and previously announced
briefings via the popular media - web, TV,
radio as well as press conferences, with the
aim of containing panic and dispelling rumors
MH
• Exchanging reports intended for the public
and educational materials with other MS, the
EC and ECDC
MH
• Ensuring rapid transmission of information
regarding laboratory-confirmed human
infection via the network of reference
laboratories
MH, NIPH, HF
• Ensuring rapid transmission of information
regarding infection of persons with a new
strain of the influenza virus at national and
international level using the IHR, EWRS
MH
43
• Activation of communication mechanisms to
ensure the widest possible dissemination of
information
MH, CAA, regions,
rPHO, HF
• Setting up procedures to be followed by all
spokespersons to provide consistent
information
MH, CAA, regions
• Regular communication using set
mechanisms
What we know or do not know about the virus,
epidemiological situation, application and
efficacy of measures and the probable
subsequent steps
The importance of restricting the nonessential
movement of persons to and from a
designated region where containment
measures are in force and of the relevant
screening procedures at transit sites
The importance of compliance with
recommended measures in order to limit
further spread of the disease
How to access drugs, basic services and
supplies in the containment region
MH/NIPH, regions,
HF, rPHO
• Regularly updating and informing the public
about what is known and not known about the
pandemic disease, including routes of
transmission, clinical severity, treatment and
possibilities of prophylaxis
MH
• Providing regular information targeting social
issues such as travel alerts, closure of
borders, of schools etc.
MH, MFA, MT,
MEYS, CAA,
regions
• Regular updating of information for the public
regarding healthcare facilities providing
emergency medical services and regarding
the possibilities of self-treatment
MH, regions, HF,
GP, GP (AC)
INTER-SECTORAL
COOPERATION
• Implementing the duties of individual CAA,
other affected subjects and regions within the
scope of their authority, reflecting
developments in the epidemiological situation
as per the pandemic plans
Crisis
management
bodies, affected
subjects
• Implementing planned measures to ensure
the continuity of essential public services
Essential public
services
• Implementing planned measures to ensure
the continuity of activities of inpatient
healthcare facilities
HF
• Implementing planned measures to ensure
the continuity of social and social-medical
services
Regions, affected
subjects
44
POST – PEAK PERIOD MEASURES JURISDICTION
PLANNING AND
COORDINATION
• Identifying lessons to be learnt from
the pandemic
MH, CAA, regions,
rPHO, HF, essential
public services
• Determining the need for potential
resources and capacities for
possible future pandemics
Crisis management
bodies, essential
public services
• Revising nationwide and regional
stocks and service provision
Crisis management
bodies, affected
subjects
• Restoring the functioning of
essential public services
Essential public
services
• Revising the national plan, if
necessary
MH in cooperation
with the affected
departments and
regions
• Evaluating the necessity of
government financial support;
defining the criteria of financial
support and proposing the means of
securing financial resources
MF, government,
crisis management
bodies
MONITORING AND
ASSESSMENT OF THE
SITUATION
• Continuing in the activities of
surveillance in order to detect the
onset of the next wave of the virus
MH/NIPH, rPHO
• Evaluating resources for monitoring
further waves
MH
REDUCING THE SPREAD
OF DISEASE
• Evaluating the efficacy of the
measures used and updating
recommendations, protocols and
algorithms according to needs
MH, crisis
management bodies,
essential public
services
• Continuing with the vaccination
programs in accordance with the PP
CR priorities and vaccine availability
MH, HF, regions,
SIDC, GP, GP (AC)
ENSURING CONTINUED
FUNCTIONING OF THE
HEALTHCARE SYSTEM
• Providing healthcare workers with
opportunities to rest and recover
MH, MLSA, regions,
HF, rPHO
(preparedness of the
healthcare system for the
increased demand for
medical care)
• Replenishing stocks of medicinal
products; resuming supply and
services and renewing basic
healthcare equipment
MH, regions, HF
• Revising and if need be updating
pandemic plans for the next
pandemic wave
MH/NIPH, affected
departments,
regions, HF, rPHO
• Revising case definitions, treatment
protocols and other algorithms
MH
COMMUNICATION • Regularly informing the public and
other partners regarding changes in
the status of the pandemic
MH
• Communicating the need for
vigilance and disease prevention to
MH, regions, HF,
SIDC
45
the public in order to prevent a
further rise in morbidity
• Updating information for healthcare
workers regarding potential changes
in signs and symptoms or in case
definitions, protocols and algorithms
MH, regions, HF
INTER-SECTORAL
COOPERATION
• Elaborating plans for the renewal of
essential public services
Crisis management
bodies, essential
public services
46
POST-PANDEMIC PERIOD MEASURES JURISDICTION
PLANNING AND
COORDINATION
• Evaluating the efficacy of measures
used
MH, crisis
management bodies
• Revising the lessons learnt and
incorporating results into pandemic
plans at all levels
Crisis management
bodies
MONITORING AND
ASSESSMENT OF THE
SITUATION
• Collecting and analyzing available
data in order to evaluate the
epidemiological, clinical and
virological characteristics of the
pandemic
MH, rPHO, NIPH/MH,
HF
• Revising monitoring and evaluation
tools for the next pandemic
MH
• Incorporating the pandemic subtype
into routine seasonal surveillance
MH
REDUCING THE SPREAD
OF DISEASE
• Evaluating measures implemented in
order to limit disease spread
MH
• Evaluating pharmaceutical
interventions including:
Efficacy, safety and resistance to
the antivirotics used
Vaccine coverage; vaccine
efficacy and safety
MH/NIPH, SIDC,
rPHO
• Revising and updating corresponding
recommendations, if necessary
MH
• Continuing with the vaccination
program in accordance with the PP
CR priorities and vaccine availability
MH, HF, regions,
SIDC, GP, GP (AC)
ENSURING CONTINUED
FUNCTIONING OF THE
HEALTHCARE SYSTEM
• Collecting and analyzing available
data in order to evaluate the
response of the healthcare system to
the pandemic
MH/NIPH, HF, rPHO
(preparedness of the
healthcare system for the
increased demand for
medical care)
• Revising the lessons learnt from the
pandemic and sharing information
internationally
MH
• Amending plans and procedures in
accordance with the lessons learnt
from the pandemic
MH, regions, HF
• Providing psychological help to
individuals as well as communities as
needed
MH, NGO, affected
subjects
COMMUNICATION • Informing the public and other
partners about the lessons learnt
regarding the efficacy of the response
during the pandemic and about how
the identified shortcomings will be
redressed
MH/NIPH, rPHO
• An appeal to all partners across the
sectors to revise pandemic and crisis
Government, MH,
crisis management
47
plans on the basis of the lessons
learnt
bodies, affected
subjects
• Extending the communication
strategy and activities to cover other
infectious diseases and using the
principles of communication in order
to build a dialogue with the public on
healthcare issues
MH
• Improving communication plans in
preparation for the next major public
health threat
MH, affected
subjects
INTER-SECTORAL
COOPERATION
• Improving cooperation across sectors
at all management levels with the aim
of solving identified shortcomings
Affected subjects
48
Abbreviations used:
ARDS - Acute Respiratory Distress Syndrome
ARI - Acute Respiratory Infection
CNS - Central Nervous System
R - Czech Republic
MS - Member States
DIC - Disseminated Intravascular Coagulation
ECDC - European Centre for Disease Prevention and Control
EC - European Commission
EU - European Union
EWRS - Early Warning and Response System
GDP - Gross domestic product
IHR (2005) - International Health Regulations (2005)
ILI - Influenza Like Illness
Pandemie IS - Pandemie Information System
rPHO - regional Public Health Office
MT - Ministry of Transport
MF - Ministry of Finance
MRD - Ministry of Regional Development
MD - Ministry of Defense
MIT - Ministry of Industry and Trade
MLSA - Ministry of Labor and Social Affairs
MJ - Ministry of Justice
MEYS - Ministry of Education, Youth and Sports
MI - Ministry of the Interior
MH - Ministry of Health
MA - Ministry of Agriculture
MFA - Ministry of Foreign Affairs
NATO - North Atlantic Treaty Organization
NGO - Non-governmental organization(s)
NRL for Influenza - National Reference Laboratory for Influenza
PHPB - Public Health Protection Bodies
GP - General practitioner
PP CR - Pandemic Plan of the Czech Republic
RDS - Respiratory Distress Syndrome
ASMR - Administration of State Material Reserves
SIDC - State Institute for Drug Control
SVA - State Veterinary Administration
NIPH - National Institute of Public Health
CEC - Central Epidemiology Commission
CAA - Central Administrative Authorities
WHO - World Health Organization
HF - healthcare facility