Preparedness and Response Plan for Avian Influenza

Objectives

The National Influenza Pandemic Preparedness Plan provides a phased national framework to enable Timor-Leste to recognise, prepare for and manage an unpredictable influenza pandemic, reducing its impact on public health and societal structures.[1]It is intended as a living blueprint for government and other stakeholders, to be reviewed and updated in light of the avian influenza situation, scientific evidence and response experience.[1]

• Prepare all levels of the country for interpandemic, pandemic-alert and pandemic phases adopted by the Ministry of Health from the World Health Organization framework.[1][2]
• Prevent human infection with avian influenza, detect infections early, strengthen animal and human surveillance and response, and contain or delay spread at its source.[1][2]
• Minimise morbidity, mortality and social disruption through case management, hospital infection control, protection of health workers and maintenance of essential services.[1][3][4]
• Monitor virus transmission and response effectiveness, identify high-risk populations and geographical areas, and target interventions accordingly.[2][5][6]
• Strengthen public awareness, community participation and factual risk communication through media, churches, non-governmental organisations, community-based organisations and other channels.[5][6]

The plan’s principal areas of action are integrated pandemic preparedness and response management; surveillance and response in animal and human populations; outbreak prevention and containment; health-system response; and public communication.[7][2][4]These priorities extend from preparedness assessment and gap closure through isolation, treatment, contact monitoring, quarantine readiness and continuity planning during escalating transmission.[8][9][10]

Implementation

Implementation relies on a multi-stakeholder National Task Force, supported by a Technical Working Group, to coordinate preparedness and response, assess developments, review implementation, mobilise resources and facilitate information-sharing and technical assistance.[2][11][4]The Ministry of Health and the Ministry of Agriculture and Livestock are lead ministries for human and animal health respectively, while national, district, hospital, laboratory, border-control, private-sector, civil-society and international partners contribute to delivery.[11]

• Coordinate animal and human health action through joint information-sharing, notification of suspected animal outbreaks, joint field investigations and reporting of findings to the Technical Working Group and National Task Force.[12]
• Maintain human surveillance through the Integrated Disease Surveillance system, covering primary health services, hospitals and laboratories, with weekly facility reporting and notification of suspected outbreaks within 24 hours.[12]
• Introduce enhanced surveillance according to risk assessment, including monitoring unusual respiratory illness, poultry-associated mortality, influenza-like illness among poultry workers, and illness among exposed health-care and laboratory workers.[12]
• Conduct animal surveillance through community reporting, routine poultry surveys, serological testing, virus isolation, rapid testing of high-risk poultry and referral of specimens to specialist laboratories.[13]
• Require communities to report five to ten or more poultry deaths within one week to village livestock workers or local authorities.[13]
• Investigate possible human cases within 24 hours, trace and monitor contacts, collect epidemiological information and specimens, and adapt case-based reporting as disease activity intensifies.[9][10][4]

Laboratory and clinical arrangements centre on specimen collection, handling, storage and referral guidance; training of laboratory staff; and referral of samples to international reference laboratories with support from the World Health Organization.[13]The Central Laboratory manages human clinical samples and samples from dead birds and chickens, and maintains rapid antigen detection kits for case and outbreak investigation.[11][13]National Hospital Guido Valadares in Dili is the designated referral hospital for suspected and confirmed patients, supported by triage, isolation or cohorting, clinical management and infection-control procedures.[3][5]

• Prepare hospitals with isolation rooms, treatment protocols, trained staff, personal protective equipment, antivirals, rapid diagnostic kits and other medical supplies.[14][15]
• Provide oseltamivir as the preferred antiviral for eligible suspected and confirmed patients and intended close contacts, with treatment started as early as possible.[4]
• Implement animal outbreak control through field investigation, movement restrictions, destruction of infected poultry and products, biosecure carcass disposal, farm disinfection and possible community compensation.[3]
• Prevent illegal poultry imports, particularly from West Timor, and coordinate cross-border information-sharing with Indonesia, Australia and Papua New Guinea.[13][3]
• Maintain public communication for immediate reporting, feedback, misinformation management, traveller advice and guidance on symptoms, risks and access to care.[4][8][10]

Phase-specific escalation assigns the National Task Force responsibility for declaring relevant alert phases, conducting preparedness assessments, addressing gaps and convening regular review meetings.[8][9][10]During localised and sustained transmission, the approach includes more intensive contact surveillance, contingency activation, mobilisation of additional national and international personnel and resources, expanded isolation capacity, and assessment of effects on health and other essential services.[16][17][18]

Monitoring combines routine, sentinel, hospital-based, laboratory and animal surveillance; regular epidemiological analysis; global and regional intelligence from the World Health Organization; and review by the Technical Working Group and National Task Force.[19][11][12]Formal quantitative performance indicators, reporting templates, independent accountability mechanisms and detailed evaluation methodologies are not specified in the supplied text.[12][4]

Resource mobilisation is assigned to the National Task Force and may draw on government and other national and international sources.[11][17]The plan identifies stockpiles and distribution arrangements for antivirals, antibiotics, antipyretics, personal protective equipment, diagnostic kits, laboratory supplies, logistics and health-promotion materials, but does not specify budget amounts, allocations, financing sources, funding gaps or economic assumptions.[5][6][20]

Monitoring & Evaluation

Monitoring and evaluation combine phased surveillance, rapid investigation, laboratory confirmation, routine review and information-sharing to detect avian influenza early, assess transmission and guide response in Timor-Leste. The plan requires monitoring and evaluation of response effectiveness, but does not establish a comprehensive quantitative indicator framework or independent accountability mechanism.[1][2][11][12]

• Maintain integrated surveillance for epidemic-prone diseases and acute respiratory illness through primary health services, hospitals and laboratories, with weekly facility reporting and notification of suspected outbreaks within 24 hours.[12]
• Conduct routine, sentinel and enhanced surveillance according to risk assessment, including influenza-like illness among high-risk groups, poultry workers, exposed health-care workers and laboratory staff.[7][21][12][15]
• Investigate every reported possible human case epidemiologically within 24 hours during pandemic-alert and later phases, trace and monitor contacts, and identify geographical spread and priority populations for intervention.[9][10][22][16][18]
• Monitor animal health through community reporting, routine poultry surveys, rapid diagnostic testing, virus isolation and periodic virological surveys; communities should report five to ten or more poultry deaths within one week.[19][13]
• Maintain specimen collection, handling, referral and transport arrangements for virological characterisation, including referral to international reference laboratories when required.[12][13][6]
• Analyse surveillance data routinely, share data with stakeholders monthly, and provide prompt information on unusual events.[12]
• Use the Technical Working Group to review epidemiological information and recommend action, with investigation findings reported to the Technical Working Group and National Task Force.[11][12]
• Review implementation, preparedness gaps, intervention effectiveness, disease burden and continuity of essential services through regular National Task Force or expert-group meetings, including monthly meetings in phase 3B and weekly meetings in phase 6B.[5][4][10][18]
• Monitor medicine, personal protective equipment and medical-supply availability and expiry dates using a standard stock checklist, with designated focal persons responsible for supply management and delivery.[5]
• Monitor adverse reactions to antiviral treatment during a pandemic.[4][18]

Accountability rests principally on assigned institutional and information-management responsibilities. The National Task Force coordinates and reviews preparedness and response, while the Ministry of Health and agriculture authorities lead human and animal surveillance respectively.[11][5]The Head of the Communicable Disease Department serves as the central repository for human-case information, and the Head of the Department of Livestock serves as the repository for poultry information.[20]Formal performance indicators, reporting templates, detailed evaluation methodologies and evaluation schedules beyond specified review meetings are not specified.[8][10][23][17][20]

Costing & Financing

Financing information is limited. A summary workplan and budget spans the interpandemic, pandemic-alert and pandemic phases and is denominated in United States dollars, but the available material provides no budget total or line-item allocation.[21]Resource mobilisation is assigned to the National Task Force and is envisaged from government, national and international sources, particularly through contingency planning in later pandemic phases.[11][17][18]

• Mobilise resources from government and other sources through the National Task Force to support preparedness and response.[11]
• Prepare contingency arrangements to mobilise national and international resources when sustained transmission requires an expanded response.[17][18]
• Maintain and distribute operational supplies, including antivirals, antibiotics, antipyretics, rapid diagnostic kits, laboratory supplies, personal protective equipment, medical supplies, logistics and additional workforce or volunteer support.[5][6][4][15]
• Maintain stock inventories for medicines, medical supplies, personal protective equipment and health-promotion materials, while reviewing antiviral and protective-equipment stocks across pandemic phases.[8][9][18][20]
• Consider government compensation for communities affected by destruction of infected poultry and poultry products, without a stated amount, funding source or payment mechanism.[3]

Budget amounts, activity costs, unit prices, financing shares, funding allocations, funding gaps, resource-mobilisation targets and economic assumptions are not specified in the supplied sections.[21][13][14][8][22][16]