On Action in Case of Influenza Pandemic

On action in case of influenza pandemic

I. Influenza and its prevalence in the world

Influenza is a communicable virus disease, with high contagion and infection prevalence in a form of epidemic. Epidemic is a widespread outbreak of influenza sickness rate in particular geographical areas. It has tendency towards prevalence mostly in frigid seasons of the year. Influenza pandemic of diverse stages develop in Europe, Japan and the United States of America every year. As a result, more than 100 million people are taken ill.

Certain conclusion can be made about situation in Latvia when influenza epidemiological monitoring data is referred to population: there have been 50 000 influenza sickness cases in the country in the last two epidemic seasons.

Influenza pandemic is significant influenza sickness rate increase and rapid infection communication with many very serious influenza cases and untypical high mortality rate. Pandemic affects wide geographical areas and can be long lasting – from a few weeks to several months. Influenza pandemic has baleful influence on public health and economy. Body count can reach up to millions of people in the world during pandemic period. In the 20th century serious influenza pandemics broke out with a period of 25 years. However, more than thirty years have passed since the last influenza pandemic. Economical losses in the world, according to provisional data, during the next pandemic period are calculated from 71 and reaching up to 166 milliard USD depending on the scale of the disease prevalence.

Influenza pandemic development phases see in appendix no.1.

II. Influenza pandemic threats to public health and forecasts of its influence on inhabitants’ health in Latvia

The potted version for humans of avian influenza virus A/H5N1 is considered to be one of the possible causative agents of the next influenza pandemic. It can cause global epidemic with high morbidity and mortality rate, due to the fact that humans do not have immunity against the new virus version, as it has not been in circulation yet. Fast and widespread prevalence of influenza in society causes sudden contemporaneous shortage of employees in such sectors that supplies society with essential service, e.g., police, fire- fighters, public transport employees, border guards, military personnel etc.

Influenza pandemic threats are not to be compared to any other eventual imminent emergency situations or catastrophes in the society, because influenza

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 1 pandemic is considered to be inescapable. However, it cannot be practically forecasted when and where it will appear and spread. Expectations that scientists will be able to make precise forecasts of virus modifications involved in the next pandemic are also rather tiny.

On the base of US Centres for Disease Control and Prevention Advisory Committee on Immunization Practices method for prognosis of pandemic influence on public health, one can approximately forecast, that in Latvia:  The first waft of next eventual pandemic will last for at least 8 weeks with maximum morbidity rate during the 4th to 5th week.  Outpatient treatment will be prerequisite to 345 000 to 800 000 persons (15% – 35% of total inhabitants)  In the case of the worst epidemiological forecast (35% population affected by influenza): - 5000 to 16 000 will be hospitalized; - 110 to 520 people each week will require medical aid, including 55 to 260 persons to be applied artificial breathing; - 2000 to 4000 inhabitants could die due to influenza sequel.

III. Word Health organization’s and European Commission’s recommendations for preparedness for the influenza pandemic.

World Health Organization (hereinafter – WHO) and European Commission has allocated high priority to preparedness arrangement planning for influenza pandemic. International experience proves that ability to react effectively towards international public health threats, to a great extent depends on two main factors: how thoroughly the problem has been inspected and forecasted previously, and how successful the proper actions have been worked out.

Chances to timely prevent, or at least undermine inimical consequence of influenza pandemic, grow, if influenza pandemic preparedness arrangements are well planned beforehand. Moreover, other important benefits can be reached, e.g., efficient institutional cooperation in emergency situation planning alongside with the developed arrangements would be useful in situations of other biological threats – other contagion epidemic (SARS, pox) and in case of biological terrorism.

In correspondence with the attested document on 26th March 2004 by European Commission “COMMISSION WORKING PAPER on Community Influenza Preparedness and Response Planning”, it has been stated that European Union (hereinafter – EU) member states have to work out or revise

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 2 national influenza pandemic preparedness planning documents. Each member country has to set up national influenza pandemic committees, including the following specialists: epidemiologist, virologist, infectologist/ communicable disease specialist, manufacturers and distributors of vaccine and other remedy against influenza, as well as veterinary science experts or representatives of correspondent institutions, or representatives that are involved in emergency situation solution from other countries.

IV. Present executive update in preparedness for influenza pandemic

1. Management and coordination.

Epidemiology security/ safety law states rights and obligations for public authorities, municipalities, physical and legal entities in epidemiological security/ safety.

Ministry of Health Order No. 74 “Management of Emergency Situations” from 22nd March 2003 approves the regulation of State operational medical commission, int. al. commission tasks, obligations, structure and management to ensure management and coordinated action of the other subordinated institutions of the Ministry of Health in the management of emergency situations under the competence of the Ministry of Health.

An intersectional group has been established to fulfil the tasks for a national planning committee proposed by European Commission.

2. Epidemiological surveillance

Order No. 260 attested on 6th December 2002 by Ministry of Health “On influenza anti epidemic activities” determines in detail influenza epidemiological and virology surveillance in the country, int. al. influenza monitoring. On the base of this order government agency “Public Health Agency” (hereinafter – PHA) collects/gets operative standardized epidemiological information on influenza morbidity rate in the country. Virology examination laboratory provides information on influenza and other infectious viruses of upper respiratory tract. The PHA cooperates with WHO and EU influenza epidemiology surveillance network on the epidemiology and virology level.

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 3 3. Preventive and response arrangements.

Vaccination against influenza. Influenza can be prevented by vaccination. WHO recommends annual vaccination against influenza to persons over 65 years of age, as well as to those whom vaccination has been indicated due to state of health, int. al. children, in order to scale down the risk of influenza sequel and lethality caused by influenza in all countries. Vaccination is also recommendable to medical personnel. Annual vaccination would give opportunity to get organizationally ready for mass vaccination in situation of influenza pandemic.

The current capacity of manufacturing vaccines against influenza in EU reaches approximately to 160 mil.doses per year, and only 90 mil of them are ought to be spread in EU countries. It has been forecasted that there would be immense deficit in vaccines during influenza pandemic, if the manufacturing capacity stays at its current level. Only those countries that will have made a contract of guaranteed delivery (signing of a contract in chronological order) will be able to buy vaccines. Countries that already have organized annual vaccination will face up with comparatively lower expenses for the above- mentioned contract.

In the current situation Latvia do not finance annual vaccination against influenza from the State budget. Due to this, a temporarily solution could be active promotion of the voluntary health insurance (involving employers), usually covering also a prepaid vaccine against influenza. It is advisable to vaccine children up to 7 years of age and persons over 65 years of age.

Influenza drug-induced therapy possibilities. Anti-virus drugs have decisive meaning in treatment of influenza affected ones during pandemic. There are 4 anti-virus drugs used in the world nowadays: rimantadin, amantadin, Tamiflu/ Oseltamivir and Relenza/ Zanamivir (annex no.1) To ensure treatment effectiveness medicament/ drug treatment needs to be started as soon as possible, but not later than 48 hours after affection.

There has not been currently made any special anti-virus medicine purchase and there are no stocks in Latvia. Anti-virus drugs can be bought in pharmacies.

Antimicrobial agents are used to treat influenza sequel.

The existing stocks of antibiotics in Latvia are not enough to ensure treatment of patients of influenza pandemic. Limited amount of antibiotics is

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 4 available in medical institutions. Antibiotics can also be purchased in pharmacies.

Capacity of medical institutions. The forecasted number of influenza patients per day, who will require in-patient treatment in the maximum week (5th week) is 2500 patients.

In accordance with results of hospital survey, there is a possibility to remake 306 units (hospital structural units) in 84 in-patient treatment units with 2500 bed places for infectious influenza patients. All in all, it meets the forecasted needed hospital capacity during pandemic of influenza, although bed division among administrative territories substantially differs. 14 cities and regions may require additional beds during pandemic of influenza.

In accordance with hospital survey data, approximately 300 artificial lung ventilation (further – ALV) devices are currently available. Artificial lung ventilation has to be done to influenza patients with serious complications after vital indications. Due to this fact, number of lethal cases is strongly related to the availability of ALV devices. The planned necessary amount of ALV devices for treatment of influenza patient during influenza pandemic on week 5th (the maximum week) is 260 apparatus per day. Provision of missing apparatus will be ensured within the framework of Ambulatory/ outpatient and stationary/ in-patient health care service providers development program.

4. Communication planning Public information and linkage with society, as well as mutual concerted action between institutions is very essential.

The general public with help of mass media is regularly (September- April) informed on influenza prophylaxis, its symptoms, treatment possibilities and options and influenza prevalence. Public Health Agency (further – PHA) does it. Information on influenza prophylaxis and its symptoms is available also on PHA web page www.sva.lv. In case of urgent necessity Public relations department of the Ministry of Health also gets involved in the communication with the society on issues of influenza and the carried out influenza prevention activities.

PHA, in case of need, elaborates recommendations to municipalities on determination of quarantine in educational, medical and social care establishments, as well as on restriction of organization of public events in administrative territories accordingly to influenza epidemiological situation.

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 5 V. Arrangements to ensure readiness for influenza pandemic

The aim of arrangement is to decrease the morbidity and mortality rate among inhabitants during influenza pandemic and to prevent its negative influence on social sphere and national economy as much as possible.

1. Management and coordination

1.1. The coordination of preventive and response measures in the country in the situation of influenza pandemic is implemented by State Operative Commission on Emergency situations in association with State operative medical commission of the Ministry of Health.

1.2. Ministry of Health ensures an effective working process of the work group by involving the most competent specialists from the interested institutions.

1.3. Cabinet of Ministers, after the request form the State Operative Commission on Emergency situations or any other minister, decides on allocating additional resources for influenza prevention and prophylaxis activities during pandemic. 1.4. In the regions the work is coordinated by the Emergency Situation Operative Commission of the particular region..

2. Epidemiological surveillance

2.1. PHA Virology laboratories fulfil the functions of WHO National Influenza Reference Centre in Latvia. Reference laboratories actively cooperate with the State and foreign epidemiological surveillance structural units and virology laboratories in the issue of animal influenza diagnostics.

2.2. Medical personnel actively take part in influenza epidemiological surveillance. At the same time they also fulfil the tasks allocated to them by the State Operative Commission on Emergency situations and in established order report on influenza cases and sends away clinical examples to reference laboratory for the isolation of the virus and testing its reaction to chemical preparations.

2.3. PHA ensures monitoring of influenza affection and performs operative data analysis, informs the relevant institutions, as well as

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 6 ensures an exchange of epidemiological information with international epidemiological surveillance institutions.

2.4. The Food and Veterinary Service ensure the epizootic and virology surveillance of avian influenza morbidity in aviculture and hog- breeding facilities. The Food and Veterinary Service in cooperation with PHA mutually exchange information on the determination of avian influenza virus stem among humans and animals.

3. Preventive and response activities.

3.1. Medical care establishments elaborate or update institution work plans in case of epidemic/pandemic, int. al. training, resource (incl. human resource) planning, preventive measures and restructuring of hospital bed places. Centre of Emergency and Disaster Medicine provides a bed place, incl. intensive therapy bed and facility rational usage coordination during influenza pandemic.

3.2. Municipalities: 3.2.1. Plan and provide preparation of alternative premises for placement and health care of patients, if the particular hospitals do not have enough capacity during influenza pandemic, as well as plans provision of necessary equipment, food and care items; 3.2.2. Plan involvement of voluntary workers from the inhabitants in influenza anti pandemic activities, such as patient health care and surveillance. 3.2.3. Decides on quarantine activities in children educational establishments and public places during influenza pandemic in accordance with the Epidemiological safety law, second part of paragraph no.8 .

3.3. State Compulsory Health Insurance Agency (hereinafter- SCHIA): 3.3.1. Ensures health care service availability for influenza patients without a patient fee. 3.3.2. In case vaccine purchase is sustained: 3.3.2.1. Ensures the purchase of anti influenza vaccines for annual vaccination. 3.3.2.2. ensures negotiations with vaccine manufacturers and signs contracts of guaranteed delivery of anti virus vaccines (with pandemic stem of influenza virus)

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 7 ensuring their sufficient coverage during influenza pandemic. The vaccine distribution chain of State Immunization programme is used for vaccine distribution among medical institutions and follow-up of their usage. 3.3.4. If the purchase is sustained, SCHIA performs the purchase of anti virus aid in case of influenza pandemic to ensure: a) Influenza prophylaxis among contact persons in case of influenza pandemic in the early stage (the first 25 hospitalized influenza patients) b) Treatment of influenza patients during influenza pandemic (in out-patient and in-patient facilities) 3.3.5. Signs contracts of guaranteed antibiotics delivery for optimal distribution to protect influenza patients from serious sequel. 3.4. Ministry of Health works out proposals (variants) for anti influenza vaccination.

Proceeding options for vaccination and treatment

Option A

1. Annual vaccination against influenza (with the available anti influenza vaccine) from the State budget finance during inter pandemic periods is provided to persons over 65 years of age as well as to those persons, to whom vaccination has been indicated on the subject of health status, incl. children health risk groups (indicated by WHO) (hereinafter – health risk group), as well as to medical personnel.

2. Signing of a guaranteed delivery contract on anti influenza vaccine (with influenza virus pandemic stem) during influenza pandemic (for health risk groups, medical personnel, for persons who are responsible for securing public order, as well as for the unplanned group, definition of which depends on the specific epidemiological situation during pandemic. It is essential to ensure possibility to purchase a vaccine to 80% of the country population).

3. Vaccination (with influenza virus pandemic stem) from national budget during influenza pandemic is provided to 80% inhabitants, int. al., persons included in the risk group, medical personnel, as well as persons

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 8 who are responsible for securing public order: State Police, State Fire fighting and Rescue Service, National Armed Forces, border guards, border sanitary control, Imprisonment administration personnel, as well as vaccination to unplanned groups.

4. Provision of medication and treatment of all influenza patients (also including out-patient) with anti virus aid.

5. Provision of medication and treatment with antibiotics for sequel patients.

Option B

1. Annual voluntary vaccination of inhabitants against influenza with instant anti influenza vaccine during inter pandemic period (on their own budget).

2. Signing of a guaranteed delivery contract on anti influenza vaccine (provided to persons included in the risk group, priority group and unplanned group) during influenza pandemic.

3. Vaccination (with influenza virus pandemic stem) during influenza pandemic is provided to persons included in the priority group and unplanned group, as well as to persons who are responsible for securing public order: State Police, State Fire fighting and Rescue Service, National Armed Forces, border guards, border sanitary control, Imprisonment administration personnel.

4. Provision of medication and treatment of all influenza patients (also including out-patient) with anti virus aid.

5. Provision of medication and treatment with antibiotics to patients affected by sequel.

Option C

1. Annual vaccination against influenza from the State budget finance during inter pandemic periods is provided to at least 20% children up to 7 years of age and persons over 65 years of age, taking into account that only 5% of inhabitants are currently vaccinated against influenza.

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 9 2. Annual voluntary vaccination of the rest inhabitants against influenza with instant anti influenza vaccine during inter pandemic period (on their own or employers budget).

3. Provision of medication and treatment of all influenza patients (also including outpatient) with anti virus aid.

Option D

1. Annual voluntary vaccination of inhabitants against influenza with instant anti influenza vaccine during inter pandemic period (on their own budget).

2. Provision of the treatment with anti virus aid to persons included in the health risk group and medical personnel during pandemic period.

Summary of all options

Option A Option B Option C Option D 1. Inter pandemic period: 1 731 578 - 679 777 - Annual vaccination Persons older of persons included than 65 yrs and in the health risk children up to group and medical 7yrs (20% of personnel (from the total state budget) number) 2. Inter pandemic period: - - - - Annual voluntary vaccination of inhabitants (from their own resources) 3. Signing a contract for guaranteed 1 372 799 59 598 - - supply of anti influenza vaccines in case of influenza

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 10 pandemic. 4. In case of influenza 1 930 459 - - - pandemic: Vaccination of risk group persons and medical personnel against influenza (vaccine with influenza virus pandemic stem from state budgetary resources) Incl. Vaccination of persons 310 761 - - responsible for (+ Medical securing public personnel) order: State Police, State Fire fighting and Rescue Service, National Armed Forces, border guards, border sanitary control, Imprisonment administration and unplanned groups (10% of additional vaccine stock) 5. In period of influenza 4 010 294 - - - pandemic: Provision of vaccines to 80% of inhabitants 6. In period of 8 400 000 8 400 000 max 8 400 000 max influenza (max option - pandemic: using Tamiflu/ Provision of anti Oseltamivir) virus treatment to all influenza 1 053 960 (min 1 053 960 min 1 053 960 min patients (from state option using budgetary rimantadin) resources) 7. Provision of anti virus medication - - - 2 421 846 max treatment to 332 139 min influenza patients

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 11 included in the risk group and medical personnel (from state budgetary resources)

8. Treatment with antibiotics of all 384 120 384 120 384 120 384 120 influenza patients with sequel (from state budgetary resources)

Total: 17 829 250 9 154 479 max 9 463 897 max 2 805 966 max max 1 808 439 min 2 117 857 min 716 259 min 10 483 210 min 9. Planning and 154 500 154 500 154 500 154 500 implementation of public relations campaign TOTAL: 17 983 750 9 308 979 9 618 397 max 2 960 466 max max max

10 637 710 1 962 939 2 272 357 870 759 min min min min

4. Public relations

4.1. Ministry of Health in cooperation with the competent institutions ( PHA, SCHIA, state agency „ State Infectology Centre of Latvia” and Centre of Emergency and Disaster Medicine) provides: 4.1.1.Public information (through mass media) on the readiness of the government and medical institutions to face influenza pandemic threats, on the epidemiological situation in the world and its relations with pandemic threats, on activities carried out in Latvia and in the world to eliminate pandemic of influenza, as well as on prophylaxis of influenza. 4.1.2. Planning and implementation of public information campaign on the issues of prophylaxis of influenza; 4.1.3. Elaboration of standardized recommendations for inhabitants and institutions on high epidemiological risk, as well as elaboration of guidelines for medical personnel on the issues of prophylaxis and treatment of influenza;

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 12 4.1.4. Distribution of the previously mentioned recommendations to medical personnel, establishments of epidemiological risk, as well as to inhabitants, int. al. through all available mass media; 4.1.5. Development of a specially designed web page, where information on influenza pandemic and advice will be regularly provided to inhabitants, medical personnel, establishments of epidemiological risk and relevant institutions; 4.1.6. Establishment of a hot telephone line, where one can receive answers to questions interested in relation with pandemic of influenza.

4.2. PHA, SCHIA, state agency „Infectology Centre of Latvia” and Centre of Emergency and Disaster Medicine provides: 4.2.1. Regular data communication to the Ministry of Health on the actualities in the situation of pandemic of influenza. 4.2.2. Training of medical personnel in the area of treatment of influenza patients. 4.2.3. Training of persons working at the hot telephone line.

Specific activities ought to be done prior and during pandemic of influenza according to the tasks referred to in section V., are elaborated/implemented by intersectoral work group.

VI. Calculation of necessary additional finance to ensure readiness for influenza pandemic

1. Management and coordination – within the framework of the existing budget.

2. Epidemiological surveillance – additional finances are required to pay overtime work, communication and transportation provision, as well as for reagents for laboratory testing. These costs can be defined only after the implementation of activities; during pandemic the existing resource should be disposed.

3. Preventive and response activities

Readiness of medical institutions – additional finances are required to pay staffs’ overtime work and to pay for the work of additional medical personnel, as well as for communication and transportation provision. These costs can be defined only after the implementation of activities; during pandemic the existing resource should be disposed. Procurement of pulmotors

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 13 will be implemented within the framework of the implementation of ambulatory and stationary health care providers development program.

Readiness activities of municipalities – ration, payment for overtime work. These costs can be defined after the implementation of activities; the existing resource should be disposed during pandemic.

Provision of health care service availability to influenza patients in out- patients clinics and in-patients clinics. These costs can only be defined after the implementation of activities. During pandemic the existing resource should be disposed. (In case of pandemic of influenza, shifting the finance from the end of the year to particular month changes the budgetary plan of medical institutions. Afterwards additional finance is requested from the State budget subsidy fund, introducing changes in the law on the state budget for the current budget year).

Possible finance resource 1. Finances for unforeseen circumstances from Ministry of Finance; 2. European Commission Solidarity Fund (operating in correspondence with EU regulation No. 2012/2002 on the foundation of European Union Solidarity Fund accepted on 11th November 2002). The regulation is being converted and improved now. After the new regulation comes into force, its aim will also be to financial support EU member states in the cases of public health threats, incl. cases of pandemic of influenza in order to purchase necessary drugs, medical goods and equipment.

Annual costs Option A

Activity Running Costs in case of Total costs costs influenza (LVL) (LVL) pandemic from budgetary reserve (LVL) First year, incl.: 3 105 877 10 100 000 max 13 205 877max 2 753 960 min 5 859 837 min Annual influenza vaccination 1 731 578 1 731 578 Contract on guaranteed 1 372 799 1 372 799 supply of influenza vaccines Anti virus drugs - purchase 8 400 00 8 400 0 of Oseltamivir 0 max 00 max Anti virus drugs – purchase 1 053 960 1 053 960 of Rimantadin min min

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 14

*Lung artificial ventilation 1 700 000 1 700 000 equipment Public relations: 1 500 1 500 development and maintenance of web page Annual costs, incl.: 3 104 944 3 104 944 Annual influenza vaccination 1 731 578 1 731 578 (with the available vaccine) Contract on guaranteed 1 372 866 1 372 866 supply of influenza vaccines Public relations: 500 500 maintenance of web page Costs in case of influenza 6 478 373 6 478 373 pandemic, incl.: Vaccination in case of 1 930 459 1 930 459 influenza pandemic Provision for vaccine 4 010 294 4 010 294 availability to population (80% of inhabitants) Antibiotic treatment of 384 120 384 120 hospitalized influenza patients with sequal Public relations, incl.. hot 153 500 153 500 telephone line, web page maintenance Total: 6 210 888 16 578 373 max 22 789 261 max 9 232 333 max 15 443 221 min *Provision of necessary apparatus will be ensured within the framework of Ambulatory/ outpatient and stationary/ in-patient health care service providers development program.

Option B

Activity Running Costs in case Total costs costs of influenza (LVL) (LVL) pandemic from budgetary reserve (LVL) First year, incl.: 61 098 10 100 000 10 161 098 max max

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 15 2 753 960 2 815 058 min min Contract on guaranteed supply 59 598 59 598 of influenza vaccines Anti virus drugs - purchase of 8 400 000 max 8 400 000 Oseltamivir 1 053 960 min max Anti virus drugs – purchase of 1 053 960 Rimantadin min

*Lung artificial ventilation 1 700 000 1 700 000 equipment Public relations: development 1 500 1 500 and maintenance of web page Annual costs, incl: 60 098 60 098 Contract on guaranteed supply 59 598 59 598 of influenza vaccines Public relations: web page 500 500 maintenance Costs in case of influenza 848 381 848 381 pandemic, incl.: Vaccination in case of pandemic 310 761 310 761 Antibiotic treatment of 384 120 384 120 hospitalized influenza patients with sequal Public relations: hot telephone 153 500 153 500 line and web page maintenance Total: 121 196 10 948 381 11 069 577 max max 3 602 341 3 723 537 min min *Provision of necessary apparatus will be ensured within the framework of Ambulatory/ outpatient and stationary/ in-patient health care service providers development program.

Option C

Activity Running Costs in case Total costs costs of influenza (LVL) (LVL) pandemic from budgetary reserve (LVL) First year, incl.: 681 277 10 100 000 10 781 277

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 16 max max 2 753 960 3 435 237 min min Anti virus drugs - purchase of 8 400 000 8 400 000 max Oseltamivir max 1 053 960 min Anti virus drugs – purchase of 1 053 960 min Rimantadin

*Lung artificial ventilation 1 700 000 1 700 000 equipment Public relations: development 1 500 1 500 and maintenance of web page Vaccination of children up to 679 777 679 777 7yrs and people over 65 yrs of age (from the state budgetary resources) Annual costs, incl.: 500 500 Public relations: web page 500 500 maintenance Costs in case of influenza 537 620 537 620 pandemic, incl.: Antibiotic treatment of 384 120 384 120 hospitalized influenza patients with sequal Public relations: hot telephone 153 500 153 500 line and web page maintenance Total: 681 777 10 637 620 11 319 397 max max 3 291 580 min 3 973 357 min

*Provision of necessary apparatus will be ensured within the framework of Ambulatory/ outpatient and stationary/ in-patient health care service providers development program.

Option D

Activity Running Costs in case Total costs costs (LVL) of influenza (LVL) pandemic from budgetary reserve (LVL) First year, incl.: 1 500 4 121 846 4 123 346 max

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 17 max 2 033 639 min 2 032 139 min Anti virus drugs - purchase of 2 421 846 2 421 846 max Oseltamivir max 332 139 min Anti virus drugs – purchase of 332 139 min Rimantadin

*Lung artificial ventilation 1 700 000 1 700 000 equipment Public relations: development 1 500 1 500 and maintenance of web page Annual costs, incl: 500 500 Public relations: web page 500 500 maintenance Costs in case of influenza 537 620 537 620 pandemic, incl.: Antibiotic treatment of 384 120 384 120 hospitalized influenza patients with sequal Public relations: hot telephone 153 500 153 500 line and web page maintenance Total: 2 000 4 659 466 4 661 466 max 2 569 759 2 571 759 min *Provision of necessary apparatus will be ensured within the framework of Ambulatory/ outpatient and stationary/ in-patient health care service providers development program.

Minister of Health G.Bērziņš

Minister of State secretary Responsible Head of the Legal Responsible Health person for the Unit person control

G.Bērziņš U. Līkops M. Briede A. Vembre D.Viļuma

17.10.2005 16:17 3812 D.Viļuma, 7876080 [email protected]

Ministry of Health 171005; Informative report „On action in case of influenza pandemic” 18