Treatment priority list dependent on epidemiological data

Decisions as to who will be treated first in case resources are scarce should an influenza pandemic hit Malta will be made at the time based on epidemiological data.

A spokesman for the Health Ministry said a priority list will be used during a flu pandemic outbreak if the attack rate is much higher than the projected 25 per cent.

The list will be drawn up during the actual pandemic because epidemiological data about the virus would be needed in order to maximise resources so that many can benefit.

Asked who will be given priority if there are not enough hospital beds or ventilators at the Intensive Care Unit, the spokesman said a decision would also be made at the time, depending on the virulence of the virus and the epidemiological data available then.

"The aim, at the end of the day, is to reduce the morbidity and mortality caused by the virus," he said, adding that all resources will be used to their maximum.

It is estimated that the virus causing the pandemic would affect 25 per cent of the population and the government has in fact ordered enough doses of the antiviral Tamiflu for one fourth of the population. The antivirals are expected to arrive in two lots, one by the end of this year and the second in the first months of 2006.

Moreover, the vast majority of the Maltese people - 90 per cent - will be vaccinated against the virus causing the pandemic as soon as this is available. At present there is no vaccine available because the virus, which is believed would cause the next pandemic - the H5N1 virus that has killed thousands of poultry, mainly in South East Asia - has not yet mutated into a form that enables it to transmit easily from person to person.

The assumption is that the vaccine will arrive six months after the manufacturing company gets hold of the virus sample and the plans are already in place to mass vaccinate 90 per cent of the Maltese population over four days.

Questioned about the contingency plan, the spokesman said the plan detailing the response by the Health Division has already been drafted and was being continuously updated.

"This is an ongoing process as new information keeps coming in. Presently we are working with the Gozo General Hospital and St Vincent de Paul Residence to finalise their plans and eventually incorporate them with that of the Health Division," the spokesman added.

He said that, as was the case with all other EU member states, Malta has submitted its plan to the European Commission and the World Health Organisation for their evaluation and the authorities were awaiting feedback. "One has to keep in mind that every ministry is also preparing a contingency plan and eventually all will be put together to have a national influenza pandemic plan for Malta," he explained.

The spokesman said the Health Division's plan includes all the steps that need to be taken at hospital and community level for every phase of the pandemic. Five stages - planning and coordination, situation monitoring and assessment, prevention and containment, health care response and communications - have been identified and a list of actions that will need to be taken is detailed for each stage.

Although the plan is detailed with a number of recommendations and guidelines, the spokesman stressed the fact that a number of issues will have to be decided at the time, depending on the situation.

This year the health authorities have lowered the age at which individuals are entitled to the seasonal influenza vaccine for free from 65 to 55. A number of people have also decided to take it privately.

"We are still administering the vaccines but so far the response has been good both in the private and public sector. We have to wait until December to have a clear picture of who and how may have been vaccinated," the spokesman said.

An information leaflet about the pandemic was sent to all households in Malta last month. The leaflet explains the difference between the seasonal influenza that strikes annually and an influenza pandemic. It also gives information about what an influenza pandemic is and how it starts and answers frequently asked questions. WHO's recommendations and what the local government is doing are also included in the leaflet.

The spokesman said the general response to the leaflet was good and it helped people better understand what a pandemic is. He pointed out that education about the pandemic is an ongoing process and the information leaflet was the first step.

In case of any difficult one can phone the influenza information line - 2132 4086. An average of 10 calls a day are made to the helpline.