TECHNICAL REPORT Guide to public health measures to reduce the impact of influenza pandemics in Europe: ‘The ECDC Menu’ www.ecdc.europa.eu ECDC TECHNICAL REPORT Guide to public health measures to reduce the impact of influenza pandemics in Europe: ‘The ECDC Menu’ Stockholm, September 2009 © European Centre for Disease Prevention and Control, 2009 Reproduction is authorised, provided the source is acknowledged. TECHNICAL REPORT Guide to public health measures to reduce the impact of influenza pandemics in Europe Table of contents Glossary...............................................................................................................................................................................iv Executive summary .............................................................................................................................................................. 1 Introduction ......................................................................................................................................................................... 6 General considerations.......................................................................................................................................................... 9 A. What will happen naturally................................................................................................................................................ 9 B. Scientific evidence and experience..................................................................................................................................... 9 C. Diversity in the characteristics and severity between pandemics.........................................................................................10 D. Diversity within the pandemic ..........................................................................................................................................10 E. The diversity of Europe ....................................................................................................................................................10 F. Isolated communities.......................................................................................................................................................11 G. Secondary, social and perverse effects .............................................................................................................................11 H. Timing of use, triggering and sustainability.......................................................................................................................11 I. Dealing with the first outbreaks in a European country .......................................................................................................11 J. Complete or partial protection? .........................................................................................................................................12 K. Multiple layered measures — ‘defence in depth’ ................................................................................................................12 L. The necessity of intersectoral planning and preparation .....................................................................................................12 M. Legal issues, liability and ethics .......................................................................................................................................12 N. General versus selective measures ...................................................................................................................................12 O. Early recognition and diagnosis........................................................................................................................................13 P. Planning, preparation and practice....................................................................................................................................13 Q. Communications .............................................................................................................................................................13 R. Special groups — special considerations ...........................................................................................................................13 S. Protective sequestration — children and adolescents .........................................................................................................13 T. European interoperability .................................................................................................................................................13 U. Research implications ......................................................................................................................................................14 The menu of measures ........................................................................................................................................................15 Travel measures: Restrictions on international travel .............................................................................................................16 1. Travel advice ....................................................................................................................................................16 2. Entry screening .................................................................................................................................................16 3. Border closures .................................................................................................................................................17 Personal protective measures...............................................................................................................................................17 4. Regular hand-washing .......................................................................................................................................17 5. Respiratory hygiene (proper use and disposal of tissues) .....................................................................................18 6. General mask-wearing outside the home ............................................................................................................18 7. Mask-wearing in healthcare settings ...................................................................................................................19 8. Mask-wearing in other high-risk situations ..........................................................................................................20 9. Mask-wearing by people with respiratory symptoms ............................................................................................20 10. Voluntary isolation of cases not requiring hospitalisation ....................................................................................21 11. Voluntary quarantine of household contacts (including protective sequestration) .................................................21 Social distancing measures ..................................................................................................................................................22 12. Internal travel restrictions ................................................................................................................................22 Educational setting and day care-based interventions ............................................................................................................23 13. Reactive school and day care closures ..............................................................................................................23 14. Proactive school and day care closures .............................................................................................................23 Measures in the workplace and public places.........................................................................................................................24 15. Reactive workplace closures.............................................................................................................................24 16. Home working, reducing meetings, safety in the workplace................................................................................24 17. Cancelling public gathering, international events, etc. ........................................................................................25 Early treatment with antivirals..............................................................................................................................................27 18. Early treatment of all those with symptoms.......................................................................................................27 19. Healthcare or other exposed key workers..........................................................................................................27 Antiviral prophylaxis following a single case ..........................................................................................................................27 20. Given to family (household) members of influenza cases....................................................................................27 21. Family and social contacts................................................................................................................................28 22. Family and geographical contacts .....................................................................................................................28