UNITED NATIONS
BANGLADESH
CONTINGENCY PLAN
FOR A HUMAN INFLUENZA PANDEMIC
Update: March 2007
coordinated/prepared by:
Name
Designation (UNCT Avian and Human Influenza Focal Point etc.)
Email:
CONFIFIDENTIAL
PREFACE
This is an update of the Contingency Plan that was endorsed by Heads of Agencies in December
2005. New recommendations and advices of the UN Medical Services Staff Contingency Plan
(dated 01 March 2006), Pandemic Planning and Preparedness Guidelines for the United Nations
System (dated 15 March 2006) and United Nations Administrative Guidelines for an Influenza
Pandemic Situation, Framework for United common system Headquarters and Field duty
stations (dated 23 May 2006) have been incorporated in this edition.
This update is warranted as there was a policy change from departure or early departure of UN
Staff to recommending confinement to the duty station residence in the event of a pandemic as
an alternative. This is due to the fact that increasing the movement of people may contribute to
spreading influenza which would not be wise from a public health perspective. Also, leaving the
duty station may not be logistically feasible since airlines may shut down and countries may close
their borders even to their own nationals returning from a pandemic-affected area and
therefore, departure from the duty station may not be in the interest of staff safety. Departure
from the duty station may also not be desirable from a programmatic perspective, in light of the
impact this would have on UN operations.
Furthermore, there was also a change in how the UN security phases are determined. The UN
security phases no longer had direct linkage with WHO pandemic alert phases. While the threat
to the safety of UN staff and operations may be affected by influenza outbreaks, the effects of a
pandemic on the UN security would be assessed on a case-by-case basis through the Security
Management Team and other existing security mechanisms. A change in WHO influenza
pandemic phase is declared by the WHO Director General.
Moreover, additional information on broad frameworks on how the pandemic might emerge,
risk analysis of threats to achieving the UN Country Team objectives, and a comprehensive UN
System Administrative Procedure were provided.
As the avian and human pandemic influenza epidemiological situation evolves, this contingency
plan will be periodically reviewed and updated whenever deemed necessary.
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United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
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LIST OF ACRONYMS
ADB
Asian Development Bank
AI
Avian Influenza
AHI
Avian and Human Influenza
AIFP
Avian Influenza Focal Point
CDC
Centers for Disease Control and Prevention
CISMU
Critical Incident Stress Management Unit
CMT
Crisis Management Team
COG
Crisis Operation Group
CP
Contingency Plan
DANIDA
Danish International Development Agency
DMT
Disaster Management Team
DO
UN Designated Officials for Security
DRR
Disaster Risk Reduction
DSA
Daily Subsistence Allowance
DSS
Department of Safety and Security
FAO
Food and Agriculture Organization
HEWS
Humanitarian Early Warning Service
HNPSP
Health Nutrition Population Sector Programme
HPAI
Highly Pathogenic Avian Influenza
HR
Human Resource
ICDDRB
International Centre for Diarrhoeal diseases Research, Bangladesh
ICMT
In-house Crisis Management Team
ICSC
International Civil Service Commission
ICT
Information, Communication and Technology
IEDCR
Institute for Epidemiology, Disease Control and Research
IFC
International Finance Cooperation
ILO
International Labor Organization
IMF
International Monetary Fund
IOM
International Organization for Migration
JICA
Japan International Co-operation Agency
LCG
Local Consultative Group
MOSS
Minimum Operational Security Standards
NGO
Non-government organization
OiE
Organization for Animal Health
ORS
Oral Rehydration Solution
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PPE
Personal Protective Equipment
RC
Resident Coordinator
RRT
Rapid Response Team
SARS
Severe Acute Respiratory Syndrome
SEARO
South East Asia Regional Office of WHO
SEPT
Senior Emergency Policy Team
SFP
Security Focal Point
SLWFP
Special Leave with Full Pay
SMT
Security Management Team
TOR
Terms of Reference
TWG
Technical Working Group
UN
United Nations
UNAIDS
Joint United Nations Programme on HIV/AIDS
UNCDF
United Nations Capital Development Fund
UNCHS
United Nations Centre for Human Settlements
UNCT
United Nations Country Team
UNDMT
United Nations Disaster Management Team
UNDP
United Nations Development Program
UNDSS
United Nations Department of Safety and Security
UNESCO
United Nations Educational, Scientific and Cultural Organization
UNFPA
United Nations Population Fund for Activities
UNHCR
United Nations High Commissioner for Refugees
UNIC
United Nations Information Center
UNICEF
United Nations Children’s Fund
UNIDO
United Nations Industrial Development Organization
UNOPS
United Nations Office for Project Services
UNRCO
United Nations Resident Coordinator Office
UNSD
United Nations Staff Dispensary
UNSIC
United Nations System Influenza Coordination
UNV
United Nations Volunteers
WB
The World Bank
WFP
World Food Program
WHO
World Health Organization
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
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Table of Contents
PREFACE ....................................................................................................................................................... I
LIST OF ACRONYMS ..................................................................................................................................... III
A. INTRODUCTION ........................................................................................................................................ 1
B. BACKGROUND INFORMATION ............................................................................................................... 1
C. THE PANDEMIC THREAT......................................................................................................................... 3
D. EVOLUTION OF THE THREAT ................................................................................................................. 3
E. INTERVENTIONS FOR AVIAN INFLUENZA PANDEMIC PREPAREDNESS ......................................... 4
I. MEDICAL INTERVENTIONS ........................................................................................................................ 4
1. Vaccines ...........................................................................................................................................................4
2. Antiviral .............................................................................................................................................................5
3. Stockpiling Oseltamivir (Tamiflu) ..................................................................................................................5
4. Antipyretics.......................................................................................................................................................6
5. Medical Supplies .............................................................................................................................................6
6. Antibiotics .........................................................................................................................................................6
7. Personal Protective Equipment.....................................................................................................................7
8. Medical Care and Medical Evacuation ........................................................................................................7
II. NON-MEDICAL INTERVENTIONS.............................................................................................................. 8
1. Psychosocial Support ....................................................................................................................................8
2. Workplace .......................................................................................................................................................8
3. Meetings ...........................................................................................................................................................9
4. International Travel .........................................................................................................................................9
5. Confinement to Duty Station Residence in the Event of a Pandemic .....................................................9
6. Relocation of Staff within Country .............................................................................................................. 10
7. Repatriation of Remains .............................................................................................................................. 10
F. COMMUNICATION ................................................................................................................................... 10
1. GENERAL COMMUNICATION.................................................................................................................. 10
II. EMERGENCY COMMUNICATION ............................................................................................................. 11
G. PANDEMIC INFLUENZA HAZARD ........................................................................................................ 11
H. RISK ANALYSIS - THREATS TO ACHIEVING UNCT OBJECTIVES ................................................... 13
I. UN ADMINISTRATIVE PROCEDURES ................................................................................................... 14
J. CONTINGENCY PLAN ............................................................................................................................. 18
K. SAFETY AND SECURITY CONSIDERATIONS: .................................................................................... 21
L. UN SUPPORT TO NATIONAL PREPAREDNESS AND RESPONSE .................................................... 23
M. RESOURCES’ MOBILIZATION FOR AHI PREPAREDNESS AND RESPONSE IN
BANGLADESH ........................................................................................................................... 25
N. COORDINATION, ROLES AND RESPONSIBILITIES ........................................................................... 28
O. RESPONSIBILITIES OF VARIOUS UN TEAMS..................................................................................... 29
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ANNEXES ............................................................................................................................................ 31
Annex 1: Number of staff and their dependents in each UN agency ................................................................. 33
Annex 2: What might happen? ............................................................................................................................ 34
Annex 3: Detailed Information on Antiviral and Its Use for Prophylaxis, Treatment and Stockpiling of
Oseltamivir .......................................................................................................................................... 37
Annex 4: Proposed Priority Groups for Pandemic Vaccine ................................................................................ 40
Annex 5: Requirements for vaccines, Drugs and Medical Supplies to be Procured ........................................... 41
Annex 6: Personal Protective Equipment Kit ...................................................................................................... 43
Annex 7: Use of Personal Protective Equipment Kit .......................................................................................... 44
Annex 8: Selected Health Care Facilities in Dhaka to be used in the Event of Pandemic .................................. 46
Annex 9: Protecting Yourself and Others against Respiratory Illness ................................................................ 50
Annex 10: Psychosocial Aspects of the Predicted Influenza Pandemic ............................................................... 51
Annex 11: Health Advisory on Self Protection for Travel to/ Through or Living in Outbreak Regions ............ 53
Annex 12: Suggested Terms of Reference of In-House Crisis Management Team for an Influenza Pandemic .. 54
Annex 13: Plans for Home Confinement/Voluntary Quarantine and Home Care for Pandemic Influenza
Patients and Household Members ...................................................................................................... 55
Annex 14: List of 6 Weeks Supplies to be Stocked ............................................................................................ 57
Annex 15: References and Additional Resources ............................................................................................... 59
Annex 16: Frequently asked Questions on Avian influenza ................................................................................ 60
Annex 17: UN Emergency Contact List .............................................................................................................. 62
Annex 18: Agency Security Focal Point ............................................................................................................... 63
Annex 19: International Security Wardens ......................................................................................................... 64
Annex 20: Focal Points for Avian and Human Influenza Pandemic ..................................................................... 65
Annex 21: Check list for AHI preparedness and response for WHO phase 3: ................................................. 66
Annex 22: National Avian Influenza and Pandemic Influenza Preparedness and Response Plan Bangladesh ...... 68
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United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
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A. Introduction
This contingency plan has been developed by adapting recommendations included in various
UN contingency plans and guidelines for Avian Influenza pandemic1 to meet the country
context and specific needs of the UN Country Team in Bangladesh.
The Country Team in Bangladesh consists of UNDP (including UNOPS, UNV, UNAIDS, UN
RCO and UNIC) FAO, UNHCR, UNFPA, UNICEF, UNESCO, WFP, WHO, ILO, IOM, and
ADB, World Bank, IFC and IMF. Number of national and international staff and their
dependents of each UN agency are provided in Annex 1.
The purpose of this contingency plan is to ensure advanced preparation for a timely, consistent
and coordinated response across the UN Country Team (UNCT) in the event of an Avian
Influenza pandemic which could affect Bangladesh. The overall objective is to minimize the
impact of any pandemic on the health and safety of staff in order to maintain and sustain operational
capacity, so that the UNCT can best support national preparedness and response.
This document provides general information on the Avian Influenza, UN administrative
procedures as well as a contingency plan. The plan sets out specific measures and actions
required of the UN Designated Official, Avian and Human Influenza Technical Working Group
(AHI TWG), UN Security Management Team (SMT), and individual agency within the UN
Country Team and staff members to support an effective response.
B. Background Information
Influenza is a viral respiratory disease affecting humans and certain animals. Normally, people
are infected only by human influenza viruses and not animal influenza viruses. Clinical disease
ranges from infection with no symptoms to mild nonspecific illness to many different life
threatening complications, including pneumonia.
On occasion, animal influenza viruses, or influenza viruses containing genes from animal
influenza viruses can begin infecting people. When a completely new strain of influenza virus
emerges among human populations, and has the ability to spread easily from person to person,
the virus can spread world wide within months (and perhaps weeks) leading to higher levels
than usual of mortality and severe illness. In this situation, all age groups are vulnerable to
infection, and there can be disruption of all sectors of the society. Such a situation is called
influenza “pandemic." Pandemics are different from usual influenza seasons and happen relatively
infrequently.
There is currently rising concern that an avian or bird influenza virus, known as influenza A
(H5N1) or simply as "H5N1" or Highly Pathogenic Avian Influenza (HPAI) which is circulating
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United Nations Medical Services Staff Contingency Plan for an Influenza Pandemic (dated 01 March 2006),
Regional Medical services Staff Contingency Plan for an Influenza Pandemic, WHO/SEARO (dated 07 June 2006),
United Nations Contingency Plan for the Avian Influenza Pandemic, Loa PDR (dated 05 July 2005), United Nations
Contingency Plan for the Avian Influenza Pandemic, Myanmar (dated 09 September 2005), Pandemic Planning and
Preparedness Guidelines for the United Nations System (dated 15 March 2006) and United Nations Administrative
Guidelines for an Influenza Pandemic Situation, Framework for United common system Headquarters and Field
duty stations, CEB Human resources network (dated 23 May 2006).
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
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widely among birds primarily in Asia but now parts of Europe and Africa, may gain the ability to
spread easily from person to person and lead to the first influenza pandemic of the 21 st
Century. Many of the prerequisites for the start of an influenza pandemic appear to be in place
but the virus still has not gained the ability to conduct efficient and sustained human-to-human
transmission. The possibility that the H5N1 virus will gain this ability must be considered quite
"real" but also is not certain.
The situation of AI is rapidly evolving in Asia as well as globally. It is geographical wide spreading and
hosts of H5N1 virus are also expanding. Several countries are now infected (e.g. Cambodia, China,
Croatia, Indonesia, Kazakhstan, Laos, Mongolia, Russia, Thailand, Vietnam, Rumania, Iraq and
Turkey). The list of infected countries is growing day by day, partly due to arrival of migratory
birds or wild birds from infected country. Indonesia reported the largest number of cases in
2006 with 56 cases of which 46 were fatal and 6 cases with 5 deaths up to 12 March 2007 and
cases are still continued to occur and Thailand has again confirmed human cases and deaths due
to H5N1 in August 2006. In 2007 up to 12 March Egypt reported 3 deaths, Nigeria reported 1
and another in Laos.
Even though till date there is no reported case of AI in the country, Bangladesh is considered as
at risk as neighboring countries as well as several countries in Asia are endemic having avian
influenza continuously detected. In addition, Bangladesh lies on a major route of migratory birds
that are considered to be one of the major biological vectors by which the disease travels
across and between continents. About 244 species of migratory birds visit Bangladesh during
the winter season (October to March), of which approximately 21 species may carry the
HPAI/H5N1 virus2. Illegal trade of poultry and poultry feeding through international borders,
poor bio-security in the dominant small scale and backyard poultry farms, and dense population
and close living quarters are also vulnerable to this disease. Lack of capacity to detect H5N1
virus and weak surveillance system are other most important issues regarding the matter. It is
therefore imperative to be prepared to tackle the disease effectively in the event of its
occurrence.
If an influenza pandemic would occur, we could anticipate the following:
 Given the high level of global travel, the pandemic virus may spread much of the world
within weeks to months, leaving little or no time to prepare.
 In all three 20th Century pandemic, substantially more young people died from pandemic
influenza than normal when compared with regular influenza seasons. In the 1918 pandemic,
the highest death rates and the largest total numbers of deaths occurred in previously
healthy young adults. These patterns suggest that the next pandemic could have a
substantial impact on the workforce. And such for weeks at a time, significant shortages of
personnel may arise disrupting essential community services.
 Vaccines and antiviral agents for pandemic influenza and personal protective equipment
(PPE) will be in short supply initially, while distribution of available supplies is likely to be
unequal. It will take several months or longer before any effective pandemic vaccine
becomes widely available.
 Many if not most medical facilities in Bangladesh will be overwhelmed by surge of patients.
Moreover, the health care workforce is likely to be reduced because health care workers
also will become ill and will also stay home to care for ill family members.
 For weeks at a time, significant shortages of personnel may occur, disrupting essential
community services.
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National Avian Influenza and Pandemic Influenza Preparedness and Response Plan Bangladesh 2006-2008.
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
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 UN staff, depending on the mandate of their organization may be required to continue their
critical functions.
 Once the virus has gained the ability to spread easily among people, then no country or
region can be considered a low risk area for infection. In essence, there will be no "safe
havens" from potential exposure to the virus.
C. The Pandemic Threat
Concern that an influenza pandemic might be imminent began in January 2004, when Thailand
and Viet Nam reported their first human cases of avian influenza, caused by the H5N1 strain of
Influenza virus A.
Two waves of avian influenza have struck. The initial spread of H5N1 in poultry, which saw the
death or destruction of more than 120 million birds, was accompanied by 35 human cases, of
which 24 were fatal. The human cases occurred in Thailand and Viet Nam, from January 2004
H5N1 detected in Cambodia, China, Indonesia, Japan, Laos People’s Democratic Republic,
Republic of Korea and Indonesia.
These cases include the first instance of probable human-to-human transmission, reported in a
family cluster in Thailand in September 2004. Intensive door-to-door surveillance failed to
detect further instances of such transmission, and the event appears to have been isolated and
limited.
As of 12 march 2007, the H5N1 virus has caused 278 laboratory confirmed human cases, of
which 168 were fatal, were reported from Vietnam, Thailand, Cambodia, Indonesia, China,
Azerbaijan, Egypt, Nigeria, Iraq, Turkey, Djibouti and Laos. No explanation for this unusual
disease pattern is presently available. Nor is it possible to calculate a reliable case-fatality rate,
as mildly symptomatic disease may be occurring in the community yet escape detection.
D. Evolution of the Threat
 H5N1 virus is now endemic in parts of Asia, having established a permanent ecological niche
in poultry. The risk of further human cases will continue, as will opportunities for a
pandemic virus to emerge.
 H5N1 strain has become progressively more pathogenic for poultry, surviving several days
longer in the environment and is expanding its mammalian host range.
 H5N1 virus causes severe disease and deaths in species, including captive tigers (Pantera
tigris) and experimentally infected domestic cats and the highly pathogenic H5N1 virus is
detected in dead migratory birds.
 Wild waterfowl are the natural reservoir of all influenza A viruses and have historically
carried these viruses, in evolutionary equilibrium, without showing symptoms or
succumbing to disease.
 Most recently, asymptomatic domestic ducks have been shown to excrete highly pathogenic
H5N1 virus, suggesting an important silent role in maintaining transmission.
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 Avian influenza outbreaks in poultry, in rural areas are of particular concern, as these may
escape detection and increase the likelihood of human exposures, which may occur when
children play in areas shared by poultry or when families slaughter or prepare birds for
consumption.
It is impossible to predict where and when, or if at all, an outbreak of the Avian Influenza may
occur. There are many uncertainties about the next influenza pandemic. The rate and nature of
a pandemic will be affected by the source and nature of the emergence of a virus capable of
being transmitted between humans, and the impact of prevention and containment efforts. The
three broad frameworks describing possible scenarios that the pandemic might emerge are
provided in Annex 2.
E. Interventions for Avian Influenza Pandemic Preparedness
Following are brief information of medical and non-medical interventions for Avian Influenza
pandemic preparedness. Detailed information on antiviral and its use for prophylaxis and
treatment and stockpiling Oseltamivir is provided in Annex 3.
I. Medical Interventions
1. Vaccines
1.1 Vaccine against seasonal influenza
There is a vaccine available each year to protect against seasonal human influenza. It is
recommended to all UN personnel and their dependants, and particularly those at high risk for
developing serious medical complications from influenza, i.e. all individuals >6 months of age
with chronic heart or lung diseases, metabolic or renal disease, or immunodeficiency disorders;
elderly individuals above nationally defined age group (suggest 60-65 years); contacts of other
high risk individuals; pregnant women; health-care workers; others performing essential
functions; and children of 6-23 months of age.
While seasonal Influenza Vaccine will not protect against a pandemic strain, widespread use of
Seasonal Influenza Vaccine will be very helpful in reducing the possibility that a case of seasonal
influenza might be mistaken for a case of Pandemic Influenza, thereby reducing unnecessary
worry and actions.
The most commonly available vaccine is the ‘Trivalent’, inactivated flu vaccine and for general flu
protection, a single one dose is recommended for adults. If a pre-school child with pre-existing
conditions requires the vaccine, a two-dose schedule is recommended, given one month apart.
Starting in early 2006, each UN Agency has provided seasonal influenza vaccine to all staff and
their dependents annually.
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1.2 Pneumococcal vaccine
Pneumococcal vaccine is considered for staff and their dependents at particular risk for the
bacterial pneumonia complication of influenza, including those 65 years of age or older, those
with heart failure, emphysema, diabetes mellitus, alcoholism, or chronic liver disease, and those
who are otherwise immune compromised.
Each UN Agency will provide Pneumococcal vaccine to staff and their dependents who are at
high risk for the bacterial pneumonia complication mentioned above.
1.3 Vaccine against pandemic influenza
If a new pandemic virus strain emerges, there will be a focused effort by public health
authorities and manufacturers worldwide to develop, distribute and administer an effective and
specific pandemic vaccine. However, the process is complicated and will take a number of
months before a vaccine would be available. Currently, vaccine against the influenza virus
A/H5N1 is being developed and tested but the vaccine is not yet available for general or
widespread use. Moreover, the current vaccine containing a recent H5N1 virus may or may not
be effective against a future H5N1 strain, if such a strain emerges with the ability to spread
easily among people.
Under the best of circumstances, given the global population size and limited production
capacity for influenza vaccine, any pandemic vaccine will initially be in short supply. Demand will
far outstrip availability. Thus initially this vaccine would be given to priority groups.
Priority recipients will include those involved with direct clinical contact with patients, those
staff required to maintain essential functions, and those at particularly high risk of serious
complications, such as the elderly and those with chronic diseases. Such priority lists, as
developed, will have to be compatible with recommendations made for the international
community at the time the vaccine becomes available.
Each UN Agency prepared a list of priority groups for pandemic vaccine for its staff and their
dependents. Suggested priority groups are given in Annex 4.
2. Antiviral
In recent years, new anti-viral agents to prevent or treat influenza infections have been
developed. Two classes of drugs are available; these drugs have been licensed for the
prevention and treatment of human seasonal influenza in some countries. Among the
neuraminidase inhibitors, the only drug easily deliverable (orally in capsules and suspensions) is
Oseltamivir, known in its only commercial form as Tamiflu®.
3. Stockpiling Oseltamivir (Tamiflu)
If a pandemic is declared it is very likely that all stocks of medicine useful against influenza,
particularly Oseltamivir, will be in very high demand and rapidly exhausted. Antiviral will
become a very valued commodity during a pandemic and therefore plans were developed by
each agency for their secure storage locally.
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UN offices each stockpiled enough Oseltamivir to provide for a 5-day course of treatment for
approximately 30% or more of all their staff and their dependants.
In addition, each agency stockpiled enough Oseltamivir to provide prophylaxis (75 mg per day)
for 6 weeks to selected staff who are needed by an organization to maintain its “essential”
functions.
The stockpiled amounts can be increased as resources allow and based upon specific
Organizational considerations. Each agency stockpiled calculated amounts of Oseltamivir and
mentioned in their Contingency Plan.
4. Antipyretics
Antipyretic such as Paracetamol will be indicated as in most febrile diseases to relieve pain and
control fever. Aspirin is contraindicated in those suspected of having influenza.
Antipyretics are widely available in Bangladesh at any drug store and no particular stockpile is
recommended for the UN Agency. Individual staff member, however, is requested to stock
own antipyretic (e.g. Paracetamol).
5. Medical Supplies
Medical supplies like syringes, needles and others will be needed during a pandemic.
These medical supplies are widely available in the drug store of Bangladesh, therefore no
stockpiling is recommended.
However, staff member had been requested to have available at home own thermometer for
body temperature checking.
6. Antibiotics
As influenza can be complicated by secondary bacterial infection of the lungs, antibiotics could
be life saving if a secondary infection develops. Providing rapid outpatient antibiotic treatment is
recommended in order to reduce the number of cases of severe secondary bacterial infection
requiring treatment in a hospital facility.
Antibiotic suitable for outpatient use and targeted to pulmonary bacterial infection (with antistaphylococcal activity, such as a fluroquinolone, co-trimoxazole, amoxicillin+clavulanic acid,
Azithromycin and cephalosporin etc) to treat pneumonia cases are easily available in Bangladesh
at any drug store.
No particular stockpile is recommended but staff member may stockpile some doses according
to their need.
Requirements for vaccines, Antivirals, Antibiotics and Medical supplies to be procured for the
contingency plan for pandemic are provided in Annex 5.
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7. Personal Protective Equipment
Personal protective equipment (PPE) provides a high degree of protection against infection and
is appropriate for persons at unusually high risk of infection. In the absence of an effective
vaccine and limited supplies of antiviral drugs, PPE will be used by all UN Staff at risk of
exposure to possible cases. PPE for pandemic influenza includes masks, goggles or face shield,
gown, gloves, cap, and boots or overshoes. Recommended supply for selected category of staff
with high risk of exposure to H5N1 virus is provided in Annex 6.
During phase 3 of the current H5N1 situation when an influenza virus has the potential to
become a pandemic virus but has not yet evolved and gained the ability to transmit easily
among people, UN staff at high risk will include field investigators who are investigating
outbreaks as well as health care workers who may care for someone infected by the virus.
Once a pandemic has started, however, and the virus has become highly contagious for people,
the medical and paramedical staff providing direct patient care will be the group at highest risk
of frequent contact with the virus. Therefore, those providing medical services during the
pandemic, and those staff and consultants conducting field investigations before the pandemic,
should be equipped with PPE. Guidelines for proper use of personal protective equipments are
available in Annex 7.
PPE provided to UN Dispensaries, and designated UN examining physicians who will deal with
UN pandemic influenza case management.
Influenza viruses are thought to be transmitted primarily through large droplets and to lesser
extent through aerosol and by direct touching. Suspected cases should wear a mask (simple
surgical mask) in order to limit the spread of the virus through cough, speech, and fomites.
Medical staff who will see patients on a frequent basis should be provided with masks of greater
protection, such as "N-95" or higher level masks, as a part of PPE. Such staff may be exposed to
both large droplets as well as aerosolized virus much more often than others.
In the event of a pandemic it is anticipated that many staff will request masks as they may
provide some sense of security although are no guarantee for protection. As a result masks
may be in short supply and it is recommended that UN offices consider stockpiling N 95 masks
(with surgical masks as second alternative) to be able to respond to the initial demand. Such use
should not be encouraged but probably also cannot be prohibited.
Each agency stockpiled N 95 masks and/or simple surgical masks for all staff and their
dependents (for an average of 2 masks per person per day for 6 weeks) and other necessary
PPE as per their need and its functions during the pandemic and mentioned in their own CP,
which is calculated according to the suggestion made in the UNCT CP.
8. Medical Care and Medical Evacuation
UN dispensary at the IDB Bhavan will continue providing basic health care to UN staff and their
dependents. Appropriate plan is developed by the UN Dispensary for surge capacity to deal
with high volume of case loads. However, seriously ill persons will be referred to pre-arranged
medical facilities.
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UN dispensary, in close collaboration with WHO, has identified the major medical facilities with
their road map in Dhaka city for health care3 among them a number of specialized hospitals
were selected by using some indicators in case of an influenza pandemic with their road map is
provided in Annex 8. A pre-arrangement for transportation and admission of ill UN staff and
their dependents will be made with those selected well-established health facilities in Dhaka
that are capable of managing severe respiratory distress.
Requests for medical evacuation of severe cases that cannot be dealt with locally will be dealt
with according to the established rules and regulation on the subject (there will be similarities
to the SARS outbreak and the SARS evacuation plans). Medical evacuation will be considered to
meet the health care needs of the individual in the context of potential risk of international
spread of the disease. However, medical evacuation may not be possible during the pandemic
influenza, as most countries will strengthen their surveillance and screening passengers at the
port of entry and possibly at departure as well.
Each agency will prepare a plan for possible medical evacuation of their staff and dependents so
such evacuation can be suitably facilitated if needed and circumstances permit.
II. Non-Medical Interventions
All UN staff and their dependants will have to follow the public health measures taken by the
national authorities, particularly those relevant to social gatherings (e.g. schools, cinemas, public
transportation etc.). General recommendation regarding "respiratory etiquette" (put your hand
before your mouth when you cough) and hand washing should be emphasized a guideline
regarding the subject is provided in Annex 9.
Each Agency will provide educational and information materials both in English and Bengali to all
staff members.
1. Psychosocial Support
Psychological reactions may occur during all phases of WHO Pandemic. Direct psychological
reactions of distress (e.g. anxiety, panic, denial) related to the release of the contingency plan
and later to the declaration of phase four, may occur.
Each Agency will need to provide psychosocial support to its staff at all stages of the pandemic.
Detailed information and actions of the psychosocial aspects of the predicted influenza
pandemic is provided in Annex 10.
2. Workplace
Each Agency has prepared their own agency contingency plan and defined possible essential
functions for its Organization and the staffing needed to maintain such functions in case of a
pandemic.
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Medical Emergency Handbook for Dhaka, Bangladesh, October 2005 published by the Office of the UN Resident
Coordinator in Bangladesh.
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
CONFIFIDENTIAL
Any staff member who becomes ill should be asked to practice isolation and to stay home for
10 days for cases of uncomplicated pandemic influenza (or longer if the case is complicated). In
addition he/she should as soon as possible start a course of Oseltamivir and wear surgical
masks when meeting other people.
In the early phases of a pandemic (phase 4 and early phase 5), persons who have been exposed
to a known case of pandemic influenza should be asked to practice quarantine and to stay home
to contain the possible spread of infection. Later, as pandemic infections become more
common, the request for voluntary quarantine may be dropped since it would no longer be
effective and practical.
If a staff member has a relative or someone else at home suspected to be affected by pandemic
influenza, he/she should be allowed to abstain from going to work to provide care for that
person.
3. Meetings
If a pandemic is declared all international meetings will be postponed if possible and special
consideration will be given to postponing all other large meetings.
4. International Travel
Influenza is readily transmissible by droplets and air and virus excretion may already occur
during the incubation period. It has a relatively short incubation period (1-3 days). Therefore it
is unlikely that restrictions of travel, and other social distancing efforts can stop spread of
influenza, however, these steps may help slow down the spread of influenza pandemic. Early in
the pandemic, slowing down the spread of influenza pandemic could buy precious time for
vaccine development and access to other essential supplies.
UN Agencies are required to strictly follow WHO recommendations for international travel at
the time of the outbreak. A health advisory on self protection for travel to and through or
living in outbreak regions is provided in Annex 11.
5. Confinement to Duty Station Residence in the Event of a Pandemic
As soon as WHO Pandemic Phase 4 is declared, In-House Crisis Management Team (CMT) of
each UN Agency at the country level will be re-activated. Suggested terms of reference (TOR)
of the Team are provided in Annex 12.
Staff will be instructed to stay in their duty station residence. Plans for home confinement,
voluntary quarantine and home care for pandemic influenza patients and household members
are stated in Annex 13. Staff members should also ensure that they have sufficient emergency
food supplies, water, prescribed medication, medical kits and other essentials at least for 6
weeks (such supplies are listed in Annex 14), until a pandemic wave has passed.
Essential staff may be required to work from home to help facilitate operational continuity
when a pandemic strikes. Additional support and services that will be required by the
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
9
concerned staff would need to be identified by each Agency and require to be mentioned in
their own Contingency plan with essential staff list with an alternative arrangement.
From WHO Pandemic Phase 5 and until the pandemic alert has been officially declared over, all
UN staff remaining in the country will have to check their body temperature at least once daily
and notify the UN physician on duty and the head of the respective agency of any respiratory
symptoms such as cough or any fever (temperature above or equal to 38°C) by phone. A
person with fever will be requested to stay home and be seen by either UN Dispensary
physician or any other health care provider.
6. Relocation of Staff within Country
Relocation of dependants of international staff and/or non-essential international staff from duty
station outside Dhaka may be considered in following circumstances: where staffs are working
in settings with very weak medical infrastructure and there is a potential severe shortage of
essential services or when responses to the pandemic might lead to a marked reduction in
security and safety cover for UN staff. In the event of disruption of essential community
services especially security and medical care, relocation of staff from their duty station outside
Dhaka to Dhaka City become necessary during pandemic phase 5 and above.
7. Repatriation of Remains
Repatriation of deceased staff due to pandemic influenza could be delayed and will necessarily
follow guidelines developed by the UN during the pandemic.
Mortuary bags should be stockpiled where not locally available for 3% of international staff and
their dependents.
F. Communication
1. General Communication
The threat of a pandemic of influenza will create a high demand for information both within the
UN and from external partners. It will be vital to coordinate the information that is circulated
by headquarters, regional and country offices, and different websites (list provided in Annex
15). UNICEF in collaboration with FAO and WHO are supporting to develop national risk
communication strategy, several posters, leaflets, brochures, TV and Radio spots which are
ongoing to implement the component of the national plan in collaboration with the Risk
Communication Wing of the National Multi-sectoral Task Force4. It is aimed to provide proper
information to general public and UN community.
WHO AHI Focal point is responsible for coordinating UN information regarding the disease to
AHI Focal point for each agency. UN security focal point is responsible for coordinating
information and communications regarding security matter to security focal point for each
agency.
4
Currently running under the leadership of Ministry of Fisheries and Livestock as per National AHI plan.
10
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
CONFIFIDENTIAL
WHO Bangladesh prepared English and Bengali leaflets and Frequently Asked Question (FAQ)
on AI and distributed it to all UN agencies and partners (Annex 16) and collecting important
news items on AI and circulating it to all UN agencies and partners on a regular basis by e-mail,
the Local Consultative Group (LCG) Bangladesh Website (http://www.lcgbangladesh.org) is
regularly updating their website with those news items for wide dissemination.
Clear internal and external communication will be essential to rapidly deal with rumors and
anxieties. When there is AI outbreak in animal, FAO will be responsible to provide correct
information through situation report. When there is a human case, WHO will play the lead role
in collaboration with FAO and UNICEF on external communication and advocacy to ensure
dissemination of correct information and appropriate supplies reach the stakeholders and right
people in a timely manner. This includes preparation of situation report and transmission of
daily information and messages to staff and partners on the impact of the virus on the
population. UNICEF is supporting to implement the risk communication component of national
AHI plan. UNRC will be responsible for coordination and media relations with the government
and donors partners.
Lists of UN Emergency Contact, security focal points, international security wardens and focal
points for avian influenza pandemic for each agency are provided in Annexes 17, 18, 19 and
20 respectively.
Each UN agency has adequately briefed their staff on the contingency plan for influenza
pandemic and their responsibility in implementing the plan.
II. Emergency Communication
In the likely event of staff home isolation, it is important to have tested communication systems
in place, as Bangladesh currently is in security phase I, emergency communication system is well
established, operational and tested by UNDSS.
Each agency Focal point is responsible to ensure they have the phone numbers and coordinates
for their staff.
UN emergency contacts play an important role and the existing security warden system for
international and national staff will be used for communicating with staff within their area. The
Security Wardens both in Dhaka and in the field will be well briefed during all pandemic phases.
G. Pandemic Influenza Hazard
The Avian Influenza epizootic has already caused enormous damage to livelihoods and poses a
continuing threat to bird and human health. FAO and OiE and Governments are monitorin g
the hazard. The WHO is coordinating global human influenza threat monitoring.
WHO has defined a series of phases in the progression of influenza pandemic, which facilitates
preparedness planning. These phases cover the progression of influenza pandemic from the first
emergence of a novel virus to its worldwide spread. Although activity levels are expected to
vary from region to region at any point in time, a pandemic phase will be designated for the
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
11
world. A change in WHO influenza pandemic phase is declared by the WHO Director
General.
WHO Pandemic Phases are provided below:
Influenza Pandemic phases
Overarching Public Health goals
Inter-pandemic period
Phase 1
No new influenza virus subtypes have been
detected in humans. An influenza virus subtype
that has caused human infection may be
present in animals. If present in animals, the
risk of human infection or disease is
considered to be low. 5
Phase 2
No new influenza virus subtypes have been
detected in humans. However, a circulating
animal influenza virus subtype poses a
substantial risk of human disease.
Pandemic alert period
Strengthen influenza pandemic
preparedness at the global, regional,
national and sub-national levels.
Phase 3
Ensure rapid characterization of the new
virus subtype and early detection,
notification and response to additional
cases.
Human infection(s) with a new subtype, but no
human-to-human spread, or at most rare
instances of spread to a close contact. 6
Currently WHO declares Pandemic Alert
Phase 3
Phase 4
Small cluster(s) with limited human-to-human
transmission but spread is highly localized,
suggesting that the virus is not well adapted to
humans.
Phase 5
Larger cluster(s) but human-to-human spread
still localized, suggesting that the virus is
becoming increasingly better adapted to
humans, but may not yet be fully
transmissible (substantial pandemic risk).
Pandemic period
Phase 6
Pandemic: increased and sustained
transmission in general population.
Minimize the risk of transmission to
humans; detect and report such
transmission rapidly if it occurs.
Contain the new virus within limited
foci or delay spread to gain time to
implement preparedness measures,
including vaccine development.
Maximize efforts to contain or delay
spread, to possibly avert a pandemic, and
to gain time to implement pandemic
response measures.
Minimize the impact of the
pandemic.
Post-pandemic period
Return to Inter-pandemic period (phase 1
or 2)
5
The distinction between phase 1 and phase 2 is based on the risk of human infection or disease resulting from
circulating strains in animals. The distinction is based on various factors and their relative importance according to
current scientific knowledge. Factors may include pathogenicity in animals and humans, occurrence in
domesticated animals and livestock or only in wildlife, whether the virus is enzootic or epizootic, geographically
localized or widespread, and/or other scientific parameters.
6
The distinction between phase 3, phase 4 and phase 5 is based on an assessment of the risk of a pandemic. Various
factors and their relative importance according to current scientific knowledge may be considered. Factors may
include rate of transmission, geographical location and spread, severity of illness, presence of genes from human
strains (if derived from an animal strain), and/or other scientific parameters.
12
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
CONFIFIDENTIAL
The threat to the safety of UN staff and operations may be affected by influenza outbreaks, the
effects of a pandemic should be assessed on a case-by-case basis through the SMT and other
existing security mechanisms.
H. Risk Analysis - Threats to Achieving UNCT Objectives
The overarching objective is to provide for staff health and safety so as to maintain critical
operations in order to support national response. Potential threats that can have an impact on
the achieving of these objectives along with strategies for mitigating these risks and
vulnerabilities are provided below.
UNCT Objectives
Critical Threats/ Risks
Risk Mitigation Strategy
Minimize impact on the
health and safety of staff.
1. Unpredictable nature of
pandemic and virus.
Flexibility & robustness of contingency
plans.
2. Contingency plans not adequate
or not fully in place when
pandemic occurs.
Formulate plans in stages in line with available
resources and capacities.
3. Lack of capacity for national
response including maintenance
of security and delivery of
essential services.
Identify critical gaps in national health
preparedness; facilitate or augment national
efforts.
1. Significant loss of human
resources through disease
and/or absenteeism.
 Reassure staff through education; effective
communication, and adequate provisions for
their welfare.
 Assign and train alternates for critical posts
 Provide for health protection and treatment.
 Empowering staff to protect themselves and
their families.
2. Inadequate resources (medical,
logistics, communications,
infrastructure, financial) to
sustain operational capacity.
 Prioritize allocation of resources to maintain
essential programmes and critical functions.
 Build-up strategic reserves at agency or country
level.
 Prepare local communication and decision
making systems
 Assess and improve access to medical facilities
available to UN staff and dependents where
required
3. Increase demand for Tamiflu
(Oseltamivir), PPEs and
pandemic Vaccines by the UN
staff and Government.
 Sufficient stocks of the drugs and medical
supplies to be maintained
 Developed a system for supporting
underprivileged group like women children and
elderly poor people
4. Deterioration of governance and
security.
Review existing security measures and fill the
gaps in light of the identified constraints relating
to pandemic
Maintain and sustain
operational capacity.
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
13
UNCT Objectives
Prepare new
programme
requirements and
services to support
national responses
Critical Threats/ Risks
Risk Mitigation Strategy
5. Compromised access to
beneficiaries and target
populations.
o travel limitations
o national restrictions
 Pre-position assets.
 Coordinate efforts with national authorities.
 Develop community based approach
1. Lack of clear mandate
 Engage governing bodies and key stakeholders
during planning stage.
2. Resources overwhelmed or
spread too thin
 Undertake new commitments only if essential
to maintain operational capacity or staff safety.
3. Gaps in critical services provided
to particular sectors
 Build national and community capacity to plan,
prepare and respond to pandemic Work with
national authorities and other partners to
identify gaps and coordinate strategies to
provide services and minimize impact
Each UN Agency needs to consider which programmes continue and what resources are
needed to maintain existing operations in the event of a pandemic and plan and included in their
own agency contingency plan. There will also be a need for new programmes for most
vulnerable group e.g. pregnant mothers, neonates, children and elderly people and special
services like Emergency Humanitarian Action and Health Action in Crisis, which are not
previously envisaged. The UN Country Team and concerned agencies will work in close
collaboration with the national authorities to plan for this and create flexible approaches. As
Bangladesh is a disaster prone country, UN Disaster Management Team (UNDMT) has been
working with the Government, NGOs, Donors and other partners very closely to provide
support for emergency and humanitarian actions services.
I. UN Administrative Procedures
Effective operations during a pandemic will be required rapid and effective decision making and
extraordinary dedication from staff. This requires that staff and managers are able to make
informed decisions about administrative matters including travel, leave, pay, insurance,
recruitment, and counseling and death of staff.
In addition, staff will be asking for information regarding personal protective measures in order
to make informed decisions pertaining to their personal life.
Pandemic Influenza specific HR guidelines come into effect when WHO pandemic alert phase 4
is declared by the WHO Director General.
Many of the administrative considerations apply when UN offices are declared closed due to
pandemic. It is assumed that this will occur when only critical staff and functions are to be
performed and the responsible Designated Official shall make this decision.
During WHO Pandemic Alert Phase 3, Heads of Agency are required to identify to the Disaster
Management Team those staff members who are needed to perform "critical" functions in the
event of an influenza pandemic and the closure of offices. Local circumstances will determine
14
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
CONFIFIDENTIAL
which functions are critical and the level of staff required and capable of performing such
functions. Many offices will have no pandemic critical functions.
Criteria for selecting critical functions: Heads of the agency has already determined the
critical staff necessary within respective agency to ensure
•
•
•
•
•
•
Physical security of staff;
Medical care of staff;
Maintenance of telecommunications and information technology services;
Ability to communicate with other Organizations and Governments;
Maintenance of utilities (electricity, water and sanitation); and
Ability to make important operational and policy decisions related to critical aspects of
operations and programme continuity and new programme for humanitarian purpose, if
any as well as staff welfare.
These staff will not necessarily be the heads of section/unit, or even those who "normally" fulfill
these roles. The critical staff will be able to perform multiple functions; and that alternates
should be identified. Systems, training and processes will have to be prepared to allow critical
operational and administrative functions to continue with these identified staff or alternates.
Depending on location critical staff may be required to stay within premises or in alternative
locations during the entire period of office closure (possibly up to 6 weeks) in quarantine.
A list is prepared by each agency for all staff with their dependents, consultants, contractors,
and other non-staff members with their addresses and contact numbers and developed a HR
Network. In order to achieve adequate level of staff awareness on pandemic threat as well as
main recommendations to reduce its impact, updated AHI related information will be shared
with staff on a regular basis. In addition, activities to increase awareness of staff such as forums
and discussions will be held on a regular basis, and periodic updates on the Avian Influenza
situation will be provided to allay fear and panic. Staff will be reminded on the importance of
personal hygiene. The communication toolkit developed by UNICEF will be useful in this
context.
When WHO Pandemic Alert Phase 4 (confirmed human-to-human transmission of the virus)
has been declared by the WHO Director General, most administrative rules will continue to
apply, updated list will be prepared for all staff with their dependents, consultants, contractors,
and other non-staff members and will be communicated for further detailed guidance through
the HR Network. All staff will be aware of any preparedness actions that each organization is
applying in case of a pandemic.
WHO
Pandemic Alert
HR
management
Phase 3
Phase 4 and above
Offices closed
Agencies and offices will
1. Review policies and contact person(s) 1. Contact staff and alert them
to changed situation
1. provided a contact person
2. Work with DSS to ensure there is a
with email, phone and fax; and
method for contacting staff when
2. Work with DSS to ensure
offices are closed to keep them
there is a method for
2. Established channels to
informed of key events, basic
contacting staff when offices
provide regular information
pandemic
information,
and
for
when
closed to keep them
and updates to staff on
pandemic threat has receded and
informed of key events,
administrative arrangements
offices reopened. Also ensure that
basic pandemic information,
and benefits (the UN web site
there
is
a
method
for
staff
to
contact
and for when pandemic
is a part of this system).
the Organization.
threat has receded and
3. Work with administration to
offices reopened.
3.
Contact
staff
(or
HR
Department
staff
ensure that critical staff can
only,
as
appropriate)
and
alert
them
to
perform essential functions.
changed situation.
4. Ensure staff lists with contact details
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
15
WHO
Pandemic Alert
Phase 3
Phase 4 and above
Offices closed
are up-to-date.
Critical staff
1. Each Agency created a list of
"critical" staff (principals and
alternates) and listed in their
own contingency plan
2. Ensure critical staff and
alternates notified, aware of
rights and responsibilities, and
receive appropriate training
3. Staff association of actions
taken regarding critical staff
informed
1. "Critical" staff will be preparing for the 1. Critical staff at duty post.
possibility that Phase 5 and 6 may
occur through team building, briefings
and also through taking care of
personal protection measures.
Attendance
1. No change to established
procedures
1. No change to established procedures
1. Only critical staff to report
to duty.
2. Critical staff will be given
compensatory paid time off
if they are required to
perform functions during the
closure of offices.
3. Implement "Internal
Administrative Guidelines
for an Influenza Pandemic".
Sickness
Staff and managers are
required to keep UN
Dispensary informed of
influenza cases (staff or
spouses / dependents and
members of household).
Staff training
and
sensitization
Each Agency and DSS provided
information and training to staff
on the influenza threat, personal
protective measures and office
health and safety measures
Information sharing on an ongoing basis
to brief staff and keep them calm and
abreast of developments is key.
N/A
Workplace
safety
1. Work with Security and
1. Implement protocols for safety
Medical Services to produce a
related workplace actions in the
list of Fever Clinics, together
event of staff members and/or
with address, name of focal
members of their households
point, and contact information
becoming sick.
including e-mail, and telephone
numbers.
2. In consultation with Security,
UN Dispensary and each
Agency developed protocols
for safety related work place
actions in the event of staff
members becoming sick
Staff pay and
benefits
1. No change to established
procedures.
1. HR and finance sections will plan and
1. Maintain minimum financial
prepare for the payment of a number
and HR services to staff to
of months (to be determined) of salary
implement the "Internal
advance with corresponding benefits
Administrative Guidelines
to international and local staff.
for an Influenza Pandemic"
2. Normally in WHO pandemic phase 5,
effect payment of salary advances and
corresponding benefits to international
and local staff
Duty Travel
1. No change to established
procedures.
1. Non-critical travel may be deferred
with Heads of Departments to
authorize essential travel.
2. If travel is already underway when
16
1. Implement protocols for
safety related workplace
actions in the event of
"critical" staff members
and/or members of their
households becoming sick.
1. Implement "Internal
Administrative Guidelines
for an Influenza Pandemic".
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
CONFIFIDENTIAL
WHO
Pandemic Alert
Phase 3
Phase 4 and above
Offices closed
pandemic phase 4 declared, there are
a range of alternative arrangements. If
staff cannot return to their duty
station they will attempt to work
remotely, or travel to a location
where they can. They will receive DSA
(per diem).
Annual Leave
1. No change to established
procedures
1. Flexibility will be exercised to
authorize leave.
2. Implement "Internal Administrative
Guidelines for an Influenza Pandemic"
when staff member unable to return
to work due to travel restrictions.
1. If offices are closed at the
time when staff is expected
to return to work, the staff
will be placed on Special
Leave with Full Pay (SLWFP)
until the office re-opens.
Home Leave
Travel
1. No change to established
procedures
1. Flexibility will be exercised to
authorize travel advance or deferral.
2. Implement "Internal Administrative
Guidelines for an Influenza Pandemic"
when staff member unable to return
to work due to travel restrictions.
1. If offices are closed at the
time when staff are
expected to return to work,
the staff will be placed on
SLWFP until the office reopens.
Education
grant
1. No change to established
procedures
1. Flexibility will be exercised to
authorize travel advance or deferral.
2. If staff dies, payment of education
grant will continue to the end of
school year.
1. Implement "Internal
Administrative Guidelines
for an Influenza Pandemic".
Recruitment /
Reassignment
No change to established
procedures
Priority will be given when critical
functions are in connection with avian
and human influenza preparedness and
response.
N/A
Contracts and
extensions
1. No change to established
procedures.
1. Renewal and non-renewal actions to
be taken at least one month in
advance.
2. The heightened alert phase shall not
be a factor in deciding on renewal and
non-extension of contracts.
N/A
Insurance
Some health insurances are
covering medical expenses
related to human cases of
avian influenza. HR officers
established which companies
in their duty station provide
coverage and communicate
this to staff.
List kept up to date and available
for staff.
Implement "Internal
Administrative Guidelines for
an Influenza Pandemic".
Death
HR to coordinate actions with
utmost discretion. Consult
National pandemic response
plans as they may affect existing
arrangements in the case of a
pandemic.
Make arrangements in case UN offices
are closed and only "critical" staff is on
duty.
Implement "Internal
Administrative Guidelines for
an Influenza Pandemic".
Visas
1. HR and visa unit to contact
relevant ministry about
planning for visa extensions
should departure become
impossible for those with
expiring visas.
1. HR and visa unit to liaise with the
relevant Office of host country should
travel become impossible for those
with expiring visas.
2. Provide assistance to staff as needed.
1. Provide assistance to staff as
needed.
Hazard Pay
International Civil Service
Commission (ICSC) to approve
special allowance for staff who
are specifically requested by the
Approved hazard pay is
granted to eligible "critical"
staff.
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
17
WHO
Pandemic Alert
Phase 3
Phase 4 and above
Offices closed
organization to be directly
exposed to life threatening
diseases in the performance of
their functions.
J. Contingency Plan
Outcomes of risk analysis and UN administrative procedures in sections H & I above were
taken into account in updating the December 2005 contingency plan.
Security drills have already been conducted by UNDSS. Each agency will need to conduct tabletop exercise within 2007. In addition simulation exercise may be considered if warranted.
The following table shows specific measures that UN agency and staff need to take for each
avian influenza and human pandemic phase, as declared by WHO, and safety and security
consideration pertinent to each WHO pandemic phase. In order to enable the UNCT to asses
the state of AHI preparedness and response for each agency, a check list for WHO phase 3 was
prepared (Annex 21). Each agency has been requested to complete the list as per their
actions already been taken for AHI preparedness and response. Those UN agency actions that
have already been completed are marked with *.
Level
WHO
phase-1
Trigger
Animal virus
known and
bird flu
reported in
the region
UN Agency Action
Responsibility
Staff Action
All required actions are incorporated in WHO Phase 3 below as we are already in that phase
WHO
phase-2
Trigger
No human
cases, animals
have a risky
virus
WHO
phase-3
Trigger
Disease: Bird
Flu
Virus: Avian
Influenza
Human cases
but no human
to human
spread
18
Planning & coordination:
o Create awareness and eradicate panic on
Avian Influenza among UN staff
 Prepare information materials
 Designate focal point(s) for
information dissemination*
WHO
Each Agency
 Wide disseminate information
Each Agency
materials through various means (e.g.
regular briefing, meeting, discussion
group/ seminar, e-mail communication,
etc.)
 Educate staff on Avian Influenza
Each Agency
o Prepared personal effects
inventory and submit to the
agency
o Follow media reports and any
official advice
o Ensure family members with
children and maids/ cooks are
aware of the need to prepare
poultry products properly
o Avoid close contact with
livestock, particularly poultry,
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
CONFIFIDENTIAL
Level
UN Agency Action
Responsibility
individual preventive measures (an
information note, information meeting
etc,)
o Strengthen pandemic preparedness at all
UN Agencies
Staff Action
consider getting rid of any
poultry kept at home
o Stock own thermometers and
antipyretics (e.g. paracetamol).
 Designate Focal Point for each
Agency*
Each Agency
 Establish In-house Crisis Management
Team (ICMT) of 5-6 Members*
Each Agency
 Develop contingency plan for AI for
each agency*
Each Agency
 Plan for operational continuity
mentioned in the CP for each agency*
Each agency
 Plan for program continuity mentioned Each Agency
in the CP for each agency*
o Build-up coordination among all UN
Agencies
 Establish ICT Network with AHI FP of
all agencies*
 Involve actively Security Focal Point in
AHI preparedness*
o Close monitor global situation of Avian
Influenza.
o Update lists of staff and dependents
o Identify essential and non-essential staff
to ensure*
WHO
Each Agency
WHO
Each Agency
Each Agency
 Physical security of staff;
 Medical care of staff;
 Maintenance of telecommunications
and information technology services;
 Ability to communicate with other
Organizations and Governments;
 Maintenance of utilities (electricity,
water and sanitation); and
 Ability to make important operational
and policy decisions related to critical
aspects of operations and programme
continuity (and new programme for
humanitarian purpose, if required) as
well as staff welfare.
Medical Interventions:
o Requirements of seasonal influenza
vaccine (to all staff and their dependents)
and pnuemococcal vaccines (for high-risk
groups), Oseltamivir, masks and other
PPE and medical supplies*
o Procure seasonal vaccines and
Oseltamivir as per requirements of each
agency* (requirements for medicines and
medical supplies and PPE kit are
provided in Annexes 5 & 6
respectively)
Each Agency
WHO
(on reimbursable
basis)
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
19
Level
WHO
phase-4
Trigger
Confirmed
cases of
human-tohuman spread
in the region
UN Agency Action
Responsibility
o Provide Seasonal influenza vaccine
annually* (to all staff and their
dependents) and pnuemococcal vaccine
(to staff and dependents who are highrisk groups)
o Prepare a priority list of recipients of
antiviral drug (i.e. Oseltamivir) and Avian
Influenza pandemic influenza vaccine
Non-Medical Intervention:
o Assess existing in-country health-care
facilities* (Annex 8)
o Provide list of major health care facilities
with road map to staff* (Annex 8)
o Pre-arrange for transportation and
admission of ill staff and dependents with
selected Hospitals
o Strengthen UN dispensary for surge
capacity
Communication:
o Establish effective commutation
strategies*
UN Dispensary
WHO
phase-5
Trigger
Localized
cases of
human-tohuman
transmission.
UN Dispensary &
WHO
UN Dispensary
Each Agency
UN Dispensary
Each Agency
Each Agency
Each Agency
Medical intervention:
o Maintained stocks of Oseltamivir (both
capsule & syrup) and PPE and review
distribution guidelines
Each Agency
Planning & coordination:
o Consider requesting staff to stay at
home until the situation has been
clarified
o Update staff lists
o Review list of essential staff
o Maintain essential functions of the agency
Medical Interventions:
o Monitor staff health and arrange for
appropriate medical care for staff who
are sick
20
Each agency
Planning and Coordination:
o ICMT reinforce
o Advise staff to prepare to stay home for
up t o 6 weeks by stocking supplies
(Annex 14)
Communication:
o Activate emergency communications for
SMT and Wardens
o Provide relevant information on latest
developments to staff at all stages
through designated focal point(s)
Staff Action
UNDP
o Update personal effects inventory
and submit the updated list to the
agency
o No unnecessary movement
o Check validity of self documents
(such as passport, visas)
o Inform the Head of Agency of any
special medical requirements
o Ensure vehicles are refueled and
in good working order
o Stockpile food, water and
essential supplies to last up 6
weeks (Annex 14)
Each Agency
Each Agency
Each Agency
Each Agency
Each Agency
Each Agency &
UN Dispensary
o Be prepared for possible rapid
movement to a higher phase
o Have sufficient funds in cash at
least US $ 750 per person for
international staff and at least Tk.
50,000 per person for national
staff
o Check fever on daily basis and
report fever to Head of Agency
and UN Dispensary
o Advise any visitors on the
situation and request them to
return home
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
CONFIFIDENTIAL
Level
UN Agency Action
Responsibility
o Provide Oseltamivir within 48 hours to
meet clinical case definition and
prophylaxis to essential staff
o Provide masks, PPE and medicines
Each Agency
Non-medical intervention:
o Home isolation of symptomatic person
o Defer all non-essential travel; all travel
for individuals with symptoms
o Defer all meetings
Communication:
o Provide staff update information on
latest developments through designated
focal points
o Inform staff of travel restrictions
o Reinforce health messages
Staff Action
Each agency
Each agency
Each Agency
Each Agency
Each Agency
Each Agency
WHO
Pandemic Period
WHO
phase-6
o Procuring Pandemic vaccine when it
becomes available
o Vaccinate to priority group
WHO
UN dispensary
o Check fever on daily basis and
report fever to Head of Agency
and UN Dispensary
Post-Pandemic Period
Trigger
Control
outbreak &
consider as
disease free
state
o Estimate future impact of Avian Influenza
from lesson learned
o Combat future pandemic occurrence
o Disseminate pandemic information in
world wide to take necessary action
o Evaluate over all contingency plans
Each Agency
Each Agency
Each Agency
Each Agency
K. Safety and Security Considerations:
WHO pandemic alert levels have no direct link with the UNDSS security phases. The threat to
safety of UN staff and operations may be affected by influenza outbreaks, the security
implications of a pandemic will be assessed on a case-by-case basis through the SMT.
Accordingly, adjustments/ modifications will be made to the security plan, security phases and
travel restrictions. In case of increase of WHO pandemic alert level, the SMT will meet to
analyze security and safety implications. Restrictions on movement will be envisaged as a
precautionary measure to prevent spread of infection through travel, and measures will be
taken to mitigate the impact upon staff and their dependents.
Following security management plan will be followed in line with security considerations against
pandemic phases.
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
21
WHO Pandemic Alert
Security Phase and
Security Plan
Phase 3
Phase 4
UNDSS:
UNDSS:
o To review security plan
o To review security plan
o Perform threat analysis
o Revise threat
of security implications
assessment
of pandemic influenza
Ensure safety and security
aspects are considered in
designation of "critical" staff
and alternates
Premises
Phase 5
UNDSS:
o To review security plan
o Revise threat assessment
Each agency:
o Make arrangements to
secure UN premises for
short and long term
periods of vacancy
o Maintain liaison with
guard companies/police
in the event guards do
not report for work
Staff & Dependents
Location and
contacts
Each agency:
o Preparation of a list by
agency including the
following:
 Staff member’s name
 Staff member's
dependants
 Address and
telephone number,
mobile number, and
e-mail address
List of Security Wardens:
include relevant details as
per DSS advisory, including
call/sign, warden +
alternate warden
(recommend 2), and zone
supported by UNDSS.
Each agency:
o Review staff and
dependents list and
personal preparedness
status
o Review warden system
and re-train wardens
supported by UNDSS
Movement
restrictions
Each agency:
o In consultation with the
UNDSS and WHO and
Medical Services advise
on restrictions to travel
and in-country
movement
Each agency:
o Notify staff of
restrictions imposed on
movement (which may
include the event that
staff are required to
remain at their
residences) with the
support from UNDSS
Each agency:
o Notify staff of restrictions
imposed on movement
with the support from
UNDSS
Workplace safety
Each agency:
o Produce a list of fever
clinic and address, name
of focal point, and
contact information
including e-mail, and
telephone numbers
Each agency:
o Review Fever clinic list
and access rights with
the support from UN
Dispensary
Each agency:
o Review Fever clinic list
and access rights with the
support from UN
Dispensary
Security
Telecommunication
Each agency:
o Strengthen Security
Telecommunications
plan.
Each agency:
o Test and review alert
system.
Each agency:
o Test and review alert
system.
[With the support from
UNDSS]
22
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
CONFIFIDENTIAL
L. UN Support to National Preparedness and Response
The National Avian Influenza and Pandemic Influenza Preparedness and Response Plan 2006-2008
has been prepared by a National Multi-sectoral Planning Team from the Ministry of
Environment and Forest, Ministry of Fisheries and Livestock and Ministry of Health and Family
Welfare with joint technical support from the Food and Agriculture Organization (FAO) and
the World Health Organization (WHO) and formally approved by the Honorable Prime
Minister on 17 April 2006. The summary of the plan is provided in the Annex 22.
Following support will be provided to the Government of Bangladesh by the UN Agencies in
addressing key critical issues for National AHI preparedness and response plan.
Key Critical
Issues
Disease
Surveillance
and Early
warning and
outbreak
investigation
(Animal &
Human)
Key Response / Prevention
Activities
 Training in of health and
veterinary workers in disease
surveillance
Responsible
Agency
Supply
Requirements
FAO
WHO
 PPEs
 Antivirals
 Specimen
transportation
equipment
 Training manuals
 Satellite phones
Financial
resources to
cover fuel,
accommodation,
phone, internet
connection,
seminar,
facilitation and
stationery
expenses
WHO
 PPEs
 Specimen
 Provision of surveillance
guidelines
 Strengthen the existing
surveillance system including
Avian flu cases
 Provide technical support for
outbreak investigation teams
 Investigate monitor and
sample migratory bird
movement patterns
 Establish, train and support
Rapid Response Teams (RRT)
 Train laboratory personnel on
Deadline
Continuous
sero-diagnosis
 Facilitate specimen
transportation to reference
laboratories and collaborating
centre
Human Health
Sector
response
 Training of health workers
human case management
 Provide technical support for
transportation
equipment
outbreak investigation teams
 Training in laboratory
 Training
 Infection prevention guidelines
 Respiratory
diagnosis
manuals
and protection from
occupational risks
Ventilators
 Other
 Advice on chemoprophylaxis
equipments
and Post-exposure treatment
 Ensure availability of essential
drugs for regular programs as
well as the pandemic
In Phase 4,5
&6
WHO
UNCT


Transport facilities
Essential drugs
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
23
Key Critical
Issues
Key Response / Prevention
Activities
Responsible
Agency
Supply
Requirements
Deadline

Drugs and supplies
for the pandemic
preparedness
In Phase 4,5
&6


Transport facilities
 Provision and pre-positioning
of health kits and PPE kits for
health workers and other
relevant items
Humanitarian
Action and
essential
Health services
Media Training
Reinforce primary health care
delivery system at both facility
and community levels
o Improving the competency of
health workers to manage the
pandemic
o Enhancing capacity of the
health service delivery system
to respond to the needs of
Pregnant mother, neonates,
women, children, elderly
people and other vulnerable
groups
o Building community support
systems/groups that connects
the community efforts to that
of the facility
WHO
UNICEF
UNFPA
 Orientation of media
UNICEF
WHO
FAO

personnel
 Support Media in information
Transport facilities,
Training/ orientation
materials,
Continuous
None
dissemination to avoid panic
and/or misinformation
Impact of
Culling Process
 Develop a compensation
FAO
WB
ADB
IFC
IMF
 Monitor the impact of culling
UNICEF
UNDP
WFP
 Promotion of personal
UNICEF
FAO
WHO
protocol and implementation
methodology
on the livelihoods and
nutritional status of children
Hygiene
Promotion
hygiene, including handling of
disposal (rubbish) and hand
washing.
June 2007
 Printing of IEC
Continuous
Materials
 Provision of safe water
Coordination
 Distribute early warning and
UNCT
None
Continuous
relevant AI information
received from UN to
Government, donors and
NGOs
 Support Government
coordination efforts, if and
when required
 Facilitate joint UN agency
resource mobilization if
needed
 Ensure UN AHI Contingency
Plan is updated as required
24
AHI TWG
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
CONFIFIDENTIAL
Key Critical
Issues
Food Security
Key Response / Prevention
Activities
Responsible
Agency
WFP
 Carry out needs assessment
UNDP
FAO
WB
ADB
IMF
IFC
Continuous
UNICEF
Continuous
to determine need for longer
term support to re-establish
livelihoods
 Develop livelihood component
accordingly
Nutrition
Water and
Environmental
Sanitation
Deadline
 Vulnerability assessment &
food distribution
Livelihoods
Supply
Requirements

Strengthen the nutritional
monitoring to anticipate a
worsening of the nutritional
status,

In response to culling, arrange
with WFP on provision of
supplementary feeding,

Promote use of high protein
vegetables, i.e. Soya,

Provide therapeutic feeding to
severely malnourished and
separate them from those with
influenza symptoms to avoid
cross infections.

Train statisticians on data
analysis and rapid assessments,
 Strengthen provision of simple
messages on hygiene to diminish
water-borne diseases and
reduce the spread of influenza;
Food supplies
Transport Staff
Continuous
WFP
WHO
UNFPA
UNICEF
WHO
Continuous
 Ensure access to safe drinking
water, especially for pandemic
affected groups;
 Distribution of soap, water
containers, chlorine liquid and
tablets for people with limited
water supply;
 Asses and mitigate impact of
Avian Flu on water supply and
conservation;
 Ensure proper sanitation in case
of large-scale home funerals;
M. Resources’ mobilization for AHI preparedness and response in
Bangladesh
Agency/Organization
UNICEF
Immediate Contribution (USD)
available
Long-Term Contribution
(USD)
UNICEF received US $ 1.8 million from the
Govt. of Japan and supporting the
Government of Bangladesh in implementing
risk communication components of the
National plan in collaboration with FAO,
WHO and NGOs.
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
25
Agency/Organization
Immediate Contribution (USD)
available
Long-Term Contribution
(USD)
FAO
 2,000 PPE kits received from USAID and
supplied to DLS
 2 lab test kits received from USAID
 50 decontamination kit received from
USAID
 500 PPE from OSRO/GLO/
504/MUL/SWI supplied to DLS
 Supplied 600 kg disinfectants (Virkon)
 Supplied motorized sprayers
 Supplied necropsy kits to DLS
 Supplied IATA approved shipping
containers for transportation of sample to
international reference lab from national
reference at BLRI
 Supplied 100 Flu detect kits for rapid
detection of Influenza A in animal
population
 Training of a core trainer group on
proper use of PPE
 Training of core trainer group of DLS on
outbreak management in animals
 Coordination and support trainers
training on commodities (PPE. Test kit
and Decontamination kit ) arranged by
USAID for animal health, human health
and NGO trainers
 Support DLS in the development of
compensation strategy and operational
plan.
 Contracted NGOs for conductive active
surveillance in a duck raising area and two
bordering area
 Contracted NGOs for market system
analysis and development of proposals for
better market chain
 Study tour for DLS, NGO and Private
sector on surveillance arranged.
Received US $ 550,000 from
USAID to implement the animal
health component of National
plan
WHO
WHO supported the Government for
implementing the human health component
of the AI plan (WHO regular budget and
funding from donor sources, estimated over
US $ 2.5 million).
WHO will support with the
Regular Budget for strengthening
of surveillance system, training,
laboratory improvement, case
management and capacity building
of the Government and mobilize
resources from Donors and
Partners.
 Supported Training for all 64 Civil
Surgeons on AHI, rumor verification,
outbreak investigation and infection
control by IEDCR.
 Support provided to National and
District Rapid Response Team (RRT) for
investigation and intervention of outbreak
if any
 Supported to provide training to health
personnel at 464 Upazila Health
Complexes, 64 District’s hospitals, 13
Medical College Hospitals and Central
levels by IEDCR
26
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
CONFIFIDENTIAL
Agency/Organization





Immediate Contribution (USD)
available
Procured rapid kits and reagents for
IEDCR Lab for rapid detection of
suspected H5 avian influenza in human
Provided 448 Computers to the GOB
health facilities to develop a disease
surveillance network in the country
Distributed 16 Respiratory Ventilators to
the Govt. designated AI Management
Hospitals
Distributed Antibiotics, antipyretics,
medical supplies and other essential drugs
to District and sub-district hospitals for
stockpiling to meet up any emergency
including Avian Influenza
Stockpiled Antiviral “Tamiflu”, 110,000
capsules and 5,000 suspensions for Staff
and their dependants and for Govt. Rapid
Response Team (RRT)
Long-Term Contribution
(USD)
The World Bank
 An emergency fund allocated of US$ 2
million in HNPSP for emerging and
reemerging diseases has been allocated to
national preparedness for H5N1 outbreak
in the country for use until the end of the
financial year, June’07

Asia Development
Bank (ADB)
 Provided US $ 400,000 to FAO for
upgrading veterinary GoB lab facilities for
diagnosis of HPAI
DANIDA
 DANIDA is supporting US $ 300,000 for
strengthening of Lab capacity of
Livestock through Ministry of Fisheries
and livestock
JICA
Strengthening of Laboratory Capacity for
Bangladesh Livestock Research Institute
(BLRI) to support AI diagnosis
ICDDR,B: Centre for
Health and
Population Research
Conducting influenza surveillance at
Kamlapur in Dhaka City, they have BSL-2 Lab
to support diagnosis H5
CDC and US Govt.
Supported with US $ 375,000 to improve of
Laboratory capacity of IEDCR, DGHS,
Ministry of Health and Family Welfare
Committed to support with US $
395,000 to improve of
Laboratory capacity of IEDCR for
another two years
Supporting ICDDR,B to upgrade the BSL -2
Lab to BSL-3 with US $ 1.5 million
Supports encephalitis and
expansion of Influenza Like Illness
(ILI) surveillance with US $ 1.5
million for next two years
Appraisal Mission for World
Bank estimated US $ 16.1
million for Human Health
sector and will support
through HPNSP and 22
million for Animal Health and
wild animal sector from
other sources
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
27
N. Coordination, Roles and Responsibilities
The WHO Representative was designated as the Avian and Human Influenza (AHI) Focal point for the UN
Country Team (UNCT) and responsible for coordinating the UN emergency response to AHI and for
facilitating relationship with Government. The AHI Focal point recommends to the UNCT on key policy
issues, plans and programs, and ensures preparedness and response activities are linked with government
priorities and plans.
The ad-hoc AHI Technical Working Group (TWG) for UNCT, which is consisting of all UN agencies AHI
Focal Points and is responsible for the development and updating of the UN Contingency Plan. The AHI
TWG, which is chaired by WHO Representative, will meet to discuss and exchange information on
progress of implementation of preparedness activities on a regular basis.
The below mentioned UN agencies take the lead in the following sectors relevant to the Contingency Plan:

FAO:
Coordination in animal Health

WHO:
Coordinate the human health and response planning and emergency humanitarian
actions and health action in crises services

UNICEF:
Risk Communication Support, Nutrition, Education,
Procurement, Water and Environmental Sanitation, and Child protection.

WFP:
Food Security

UNDP:
Emergency, disaster management & staff security

UNRCO:
Coordination, Communication (media relations)

UNHCR/IOM: Refugees & other displaced communities

WB/ADB/IMF: Resource mobilisation

UNFPA:
Gender, women & vulnerable groups

ILO:
Labour related issues
The UN strategy is to work closely with the Bangladesh Government to support for implementing
National AHI Preparedness and Response activities in collaboration with the National Multi-sectoral
Task Force which is functional as per National AHI Plan consists of 17 relevant line Ministries and
partners. In a parallel process, the UN System established mechanisms to ensure the pandemic’s impact
on staff health and safety is minimized.
The UNCT has a close collaboration with the HNPSP Donors consortium and the Local Consultative
Group (LCG) Bangladesh which is comprised of 32 Bangladesh-based representatives of bilateral and
multilateral donors. The UNCT updated on AHI situation in the country to the LCG group on a regular
basis for mobilizing resources to support Government.
28
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
CONFIFIDENTIAL
O. Responsibilities of Various UN Teams
The UN Resident Coordinator will work to bring together all members of UNCT and
development partners to support the efforts of the government.
Responsibilities of different teams within the UNCT in Bangladesh to support an effective
response are provided below.
•
RC
•
•
•
•
•
•
UNCT
Chaired by RC
WHO Rep: AHI Focal Point
• Principles
• Broad Policy
• Coordinating between
agencies
SMT
Representative
Designated Official
Coordination
Facilitating relationship
with Government
Reporting
Influenza roles:
• Signoff on plans and
progress
• Linking with Govt.
priorities and plans
• Key policy issues
• Oversight of DMT
• Public & media relations
AHI TWG
Chaired by WHO Representative
 Technical advise to UNCT
 Preparation of UNCT CP
 Update of UNCT CP
 Monitor implementation status
 Coordinate with national
Multi-sectoral Task Force
ICMT
DMT
Chaired by DO.
• Advises DO on security
related policies
• Medical evacuation
• Travel arrangements
Chaired by Head of WFP
• Coordinates response to
natural disasters
• Support to Govt.
• Plans
• Operational strategy
Established by each Agency
• Run/manage particular
operational response to a crisis
• Medical, logistics etc.
Influenza roles:

Review security risk
assessment

Review security plans and
phases when situation
changes

No automatic link of WHO
pandemic alert level to
security phase

Localization of travel and
departure policy

Monitoring and review of
security threats resulting
from pandemic.

MOSS compliance
Influenza roles:

Review of risk analysis and
evaluation of national
capacity and gaps of
National AI Preparedness
and Response Plan.

Preparation of continuity of
operations plans

Coordination of plans and
preparedness

Linking to National plans

Monitoring of preparedness

Sectoral/Cluster planning
and prioritization

WHO to advise on
technical issues and medical
plans
Roles viz. DSS/SMT during crisis
need to be further clarified.
Influenza roles:



Operations management during
pandemic
Coordinating particular issues
during response e.g. logistics,
health support etc.
Liaison to other UN agencies,
UNDMT and National crisis
response team during pandemic
response.
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
29
30
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
CONFIFIDENTIAL
ANNEXES
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
31
32
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
CONFIFIDENTIAL
Annex 1: Number of staff and their dependents in each UN agency
(As of 28 January 2007)
Sl.
No
1
Agencies
ADB
Number of
National
Staff
Member
Dependents
51
123
Number of
International
Staff
Member
5
Dependents
Total
10
189
2
FAO
20
74
6
13
113
3
ILO
32
63
4
5
104
4
IMF
6
9
1
3
19
5
IOM
64
25
4
3
94
6
UNDP + UNV +
UNOPS + UNAIDS+
UNIDO + UNCHS +
UNDSS
270
173
35
22
507
7
UNESCO
15
27
1
3
46
8
UNFPA
69
48
3
7
127
9
UNHCR
25
51
8
7
91
10
UNICEF
170
311
30
55
566
11
World Bank
97
185
15
29
326
12
WFP
143
334
11
22
510
13
WHO
39
78
10
14
141
60
74
13
23
170
1061
1644
146
218
14
IFC
Total
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
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33
Annex 2: What might happen?
There are many uncertainties about the next pandemic. The rate and nature of a pandemic will
be affected by the source and nature of the emergence of a virus capable of being transmitted
between humans, and the impact of prevention and containment efforts. There are three broad
frameworks for how the pandemic might emerge (Box 1).
Box 1. Representation of three model frameworks
Note: This illustration is purely for planning purposes and does not represent any specific predictions or
timeframe/forecasting. In this diagram "Impact" is a qualitative indicator used to represent the impact on
human health.
One scenario is where there is no substantial evolution in the current avian influenza virus
(H5NI) towards increased human transmissibility. In this situation - an extended WHO
pandemic phase 3 - the need for pandemic planning remains, as the risk of a pandemic continues
indefinitely. There is also the risk of the emergence of other infectious diseases. The UN system
needs to mainstream pandemic planning and build national capacity, while continuing to
respond to avian influenza outbreaks and the impact of containment measures.
There is also the possibility "at any time" of the rapid emergence of a pandemic virus.
Depending on the quality of surveillance this might not become evident until weeks or months
after emergence. It is likely that the viruses that caused the 1957 and 1968 influenza pandemics
emerged rapidly after a single genetic event. To prepare for these scenario UN offices, agencies,
funds and programmes need to urgently develop pandemic response plans and prepare
for their implementation, while noting that a pandemic may not emerge for some years.
In between these two extremes is the potential for the slow evolution of the H5NI virus: a
series of genetic changes leading to greater human transmissibility until it is sufficiently infectious
to cause a pandemic. It is likely that this is how the virus that caused the 1918 pandemic
emerged. Unlike 1918, there is now intense monitoring of H5NI. If surveillance and response
systems are good enough there will be opportunities to contain the virus. In this scenario
UN agencies need to support national surveillance and responses to enable containment. The
UN has a role in ensuring that global responses to this situation are appropriate to the threat.
Depending on how it evolves the influenza disease itself may be relatively benign (similar to a
"normal" flu) or it may be relatively deadly.
34
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
CONFIFIDENTIAL
Extended WHO pandemic phase 3 with continuing outbreaks of avian influenza
Model One:
The alert level remains at Phase 3, while outbreaks of avian influenza continue to spread. H5N1
does not acquire efficient human-human transmissibility. During this time, the threat of a
pandemic remains.
The impact of avian influenza on the livelihoods and live are substantial in many regions
Possible Global Scenario:
The threat of a human pandemic in the minds of government and the public peaks over the
next 4-6 months.
The UN System attempts to minimize the adverse impacts of preventing and containing avian
epizootic and its impact on livelihoods within the context of compensation and assistance
programmes.
However, after 12 months of media stimulated cycles of anxiety, but no sustained movement to
WHO Pandemic Alert Level 4, donor interest begins to wane and the cohesiveness of the
international response is challenged.
Slow onset – WHO pandemic phase 4-5 with moderate and localized impact
Model Two:
The virus only progressively acquires human infectiousness. Depending on the evolution of the
virus, it may be possible to contain and prevent a pandemic after the development of human
transmissibility. May also develop into pandemic.
Possible Global Scenario:
Virus spreads slowly but is limited to a small number of specific regions, infection and mortality
rates high within affected regions.
 Initial human-to-human transmission highly localized.
 Travel within affected regions is restricted due to national containment policies.
 Many staff not able to come to work in affected regions. Planning should envisage up to
30% non-attendance for a period of 6 weeks.
 Deterioration in essential services and governance, law and order within specific
affected areas.
 High demand on medical facilities and supplies.
 Supply chain systems in affected regions disrupted for a large proportion of humanitarian
operations.
 Depending on how it evolves the influenza disease itself may be relatively benign (similar
to a “normal” flu) or it may be relatively deadly and result in significant social and
economic impact.
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
35
Rapid onset – escalation to WHO pandemic phase 6 with widespread impact
Model Three:
The pandemic phase (6) is reached when the H5N1 virus develops the ability for efficient and
sustained human to human transmission. While the progress of the pandemic cannot be
predicted the possibility of multiple “waves” of infection and impact should not be discounted.
Direct affect of the pandemic on UN staff at this point must be considered.
Possible Global Scenario:
Rapid global spread with multiple clusters with high infection rate.







Many staff not able to come to work. Planning should envisage up to
30% non-attendance for a period of 6 weeks.
International travel is badly disrupted due to nationally imposed travel restrictions and
high demand.
High demand on medical facilities and supplies.
Deterioration of law and order reported in a number of countries.
Depending on how it evolves the influenza disease itself may be relatively benign (similar
to a “normal” flu) or it may be relatively deadly and result in significant social and
economic impact.
Major disruption to humanitarian operations.
Post Pandemic Issues
Formally the post pandemic phase will occur with a return to pandemic alert at level 1 or 2. It
is important to note that a reduction in the number of influenza cases does not rule out the
possibility of further outbreaks. It might be a “lull” before another pandemic “wave”. As such,
while recovery will be the primary focus during such a period, there must also be efforts to
maintain and sustain readiness and increase preparedness for possible future outbreaks. This
will include the application of core containment measures if and when further localized
outbreaks occur.
Key planning and preparedness actions required whenever possible during or immediately after
a pandemic outbreak are:



36
Revise contingency plans applying lessons learnt.
Replenish resources and provide for staff recovery.
Continue monitoring, and where necessary, containment activities.
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
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Annex 3: Detailed Information on Antiviral and Its Use for Prophylaxis,
Treatment and Stockpiling of Oseltamivir
1. Antiviral
In recent years, new anti-viral agents to prevent or treat influenza infections have been
developed. Two classes of drugs are available (the M2 inhibitors such as amantadine and
rimantadine and the neuraminidase inhibitors such as oseltamivir and zanimivir). These drugs
have been licensed for the prevention and treatment of human seasonal influenza in some
countries.
However, initial analysis of viruses isolated from the recent human cases of A/H5N1 indicates
that many of these viruses currently are resistant to the M2 inhibitors. In addition, only the
neuraminidase inhibitors have been shown, in animal laboratory tests, to be effective against
influenza virus A/H5N1. At this time, there is extremely little real world clinical experience with
use or effectiveness of antiviral drugs against H5N1 viral infections in humans. Among the
neuraminidase inhibitors, the only drug easily deliverable (orally in capsules) is oseltamivir,
known in its only commercial form as Tamiflu®.
Other antivirals, such as amantadine, have not shown effectiveness against A/H5N1 in
laboratory settings, but could potentially have some effectiveness against another new emerging
strain.
The following provides guidance on use of Oseltamivir as prophylaxis or treatment:
1.1 Prophylaxis
Antiviral drugs used for prophylaxis are given to people who are not infected and who are not
ill. The purpose of prophylaxis is to try and prevent the development of severe pandemic
disease in people who are potentially exposed to pandemic influenza.
Oseltamivir can be offered to selected staff who are needed by an organization to maintain its
essential functions. The current prophylactic regimen is one tablet of 75mg per day per person.
The upper limits for safe use of oseltamivir as prophylaxis is unknown. However, it is assumed
that based on past pandemics and epidemics that in local areas, the duration of elevated risk of
exposure to the pandemic virus in an area will be several weeks. In this document, to aid
planning efforts, this period has been defined as 6 weeks. Use of antiviral drugs for prophylaxis
is extremely resource consuming. Therefore, pre-exposure prophylaxis will be limited to
maintenance of essential functions of an Organization. Since pandemic influenza is an infection
transmitted primarily by respiratory droplets, during a pandemic, the risk of infection will be
relatively similar for most people in UN Organizations except persons such as medical workers,
who will be at highest risk because of their frequent contact with many ill persons.
Oseltamivir is licensed for up to six weeks of continuous use for prophylaxis.
As an alternative to daily prophylaxis, antiviral drugs could be reserved for treatment of
persons if fever or other symptoms of infection develop. This approach could stretch the
supply of available antiviral drugs, but also is more complicated logistically to implement and
might be less effective theoretically in preserving maintenance of essential functions.
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
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Nonetheless because supplies of antivirals during a pandemic situation are expected to be very
limited, in many situations this use of oseltamivir for may be the most feasible option.
1.2 Treatment
(a) Of ill persons: In symptomatic patients suspected of having pandemic influenza,
Oseltamivir can be administered as treatment. Current recommendations for treatment,
based on treatment against seasonal influenza, are is two 75 mg. capsules a day (total of 150
mg. per day) for 5 days. There are no data for use for children below the age of 1 year. Oral
suspension for children could be administered up to 40 kg when adult dosage can be used (ref:
product information). For maximum effect, the drug should be started within 48
hours of onset of symptoms. During a pandemic situation, the possibility to test an
individual patient for influenza infection will be extremely limited and therefore decision about
whether
to treat or not will depend upon clinical findings. Moreover, current
recommendations on the amount and duration of treatment may change as more information
becomes available about the effectiveness of dosages of antiviral drugs against pandemic
influenza.
(b) Post-exposure treatment: If the local supply is considered adequate, then oseltamivir could
be provided to a person who does not have symptoms but who has had close and unprotected
contact with another person who is suspected or confirmed to have pandemic influenza7. In this
situation it will not be clear if the exposed person is infected. However, giving that person
antiviral drug theoretically could potentially protect the person from infection or reduce the
severity and duration of the disease if the person has become infected. The drug would be
administered in treatment doses as detailed above. The effectiveness or efficiency of this
approach in preventing illness is theoretical, however, and has not been demonstrated.
Moreover, for most people, it will not be known if they were "exposed" to pandemic influenza
and during a widespread pandemic, it will not be feasible to give post-exposure
treatment to most non-ill contacts. In most situations, it is expected that most
oseltamivir will be used for treatment of persons with febrile or respiratory
illnesses rather than prophylaxis.
2. Stockpiling Oseltamivir
If a pandemic is declared it is very likely that all stocks of medicine useful against influenza,
particularly Oseltamivir, will be in very high demand and rapidly exhausted. Therefore UN
offices must be prepared and stockpile Oseltamivir according to each agency need.
The amount of oseltamivir stockpiled by the UN system at the country level is expected to vary
from location to location reflecting the following considerations:
1. Based on past epidemics, a reasonable overall attack rate (i.e., the number of new
symptomatic illnesses per 100 persons over one year) for pandemic influenza will be
30%. However, attack rates in some areas and in places such as institutions, attack rates
may be much higher (or lower).
7
In this context, a close contact is defined as an intimate contact, providing care, in the same household,
having direct contact with respiratory secretions (saliva droplets of a suspected case, coughing or
sneezing), body fluids and/or excretions (e.g. faeces) of highly suspected or probable cases.
38
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2. In addition, since many people who will develop symptoms will not have pandemic
influenza but may have colds or other respiratory infections, some of the oseltamivir will
be used up by treating non-pandemic illnesses.
3. In addition, organizations at the country level may choose to use oseltamivir for
prophylaxis to maintain essential functions further increasing the optimal supply.
4. Finally, differences in resources may allow some offices to purchase oseltamivir in
relatively larger amounts.
5. Different offices may choose to allocate use of oseltamivir somewhat differently.
On the hand, oseltamivir is an expensive resource, and available supplies are limited globally due
to very limited production capacity.
Based on these all of considerations, UN offices each will stockpile enough oseltamivir to
provide for a 5-day course of treatment for approximately 30 % or more of all their staff and
their dependants. The stockpile amounts can be increased as resources allow and based upon
specific Organizational considerations.
In addition, stockpile enough oseltamivir to provide prophylaxis for 6 weeks for all persons
who are needed to maintain all functions identified as “essential” by the specific UN
Organization.
It must be acknowledged that in a global pandemic, there will not be sufficient Oseltamivir to
meet the full demand. UN Headquarters Medical Services could initially stockpiling a reserve
stock to help cope with additional emergency needs.
Antivirals will become a very valued commodity during a pandemic and therefore plans should
be developed for their secure storage locally. The current shelf life for Tamiflu capsules is 5
years, although this date may be extended.
Some stocks of medications will be under the responsibility of the UN Dispensary physician at
post. The organizations’ representatives or UN Agency heads will hold the Oseltamivir
stockpile. Medical counterparts or contractor physicians will be identified, who will be in charge
of specific decisions about use of antiviral drugs since oseltamivir is a prescription drug. Each
physician or medical team involved in care should receive adequate briefing and personal
protective equipment (PPE). Specific criteria for prescription of Oseltamivir will be provided by
the UN Medical Services.
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Annex 4: Proposed Priority Groups for Pandemic Vaccine
Proposed Priority groups for pandemic vaccine:
Group
1. Health professionals (healthcare providers and relevant public health specialists, e.g.
WHO/FAO)
2. Staff performing critical functions with high risk of exposure
3. Remaining staff performing critical functions
4. Persons at high risk of severe or fatal outcomes following influenza infection
 staff and dependents with high risk medical conditions
 immunocompromised
 >65 years of age
 children between 6 – 23 months of age
 pregnant women
5. Children 24 months to 18 years
6. Healthy adults
Even though the recommended priority groups are determined, they will be continually revised
in light of new information that is learnt about the pandemic virus.
When sufficient pandemic influenza vaccine is available, the entire staff population will be
offered vaccination.
40
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Annex 5: Requirements for vaccines, Drugs and Medical Supplies to be
Procured
All types of antibiotics to treat pneumonia cases, antipyretics and medical supplies like syringes,
needles and others are widely available in the drug store of Bangladesh, therefore no stockpiling
is recommended. Note should be taken of the expiry date and unused vaccines or antiviral
should be donated to local healthcare facilities in good time for use and restocked accordingly.
Action
8
**
Requirements
Availability
in local
market
Unit cost
(in US dollars)
12.5/dose
Notes
Seasonal human flu
vaccines
For all staff and
dependents8
Pandemic strain
vaccines
For selected number of
staff and dependents
(as per identified priority
groups -- Annex 4 is
referred).
Antiviral:
Treatment
Tamiflu
(Oseltamivir)
For 30% of staff and their
dependents with
additional 10% for a
cushion.
(A 5-day treatment
course --10 capsules per
course)
Syringes and
needles**
For all staff and their
dependents
(One set of syringes and
needles per staff member
and dependent)
Widely
available, not
recommended
for stockpiling
12.0/pack of 100
(half 5 ml and half
10ml syringes
with 23G and
21G needles)
Need to order in blocks
of 100 at minimum
Antibiotics
Amoxicillin (500
mg) + Clavulanic
Acid (125 mg)
For 7.5% of all staff and
their dependents
(1 course of 30 tablets)
Widely
available, not
recommended
for stockpiling
4.50/ course of
30 tablets
(Available as
blister 10x5
tablets)
Oral drug to be used for
secondary (bacterial)
pneumonia – good for S.
pneumonia
Antibiotics
(fuoroquinolone)
Ciprofloxacin
For 2.5% of all staff and
their dependents
(1 course of 20 tablets)
Widely
available, not
recommended
for stockpiling
0.56/ course of
20 tablets
(Available as 500
mg x 100
tablets/bottle or
blister 10x10
tablet)
Oral drug to be used for
secondary (bacterial)
pneumonia if not
responding to Augmentin
– good for H. Influenza
but may not be good for
S. pneumonia
N/A
16.4/pack of 10
capsules
Single dose syringe
Not expected to be
available for at least 6
months after the
pandemic virus has been
isolated
Treatment
Each Agency will define who are “staff and their dependants” of its own organization.
To ensure injection safety, if injectbles have to be used at the local facilities, this stockpile is not specific
for pandemic.
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
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Availability
in local
market
Unit cost
(in US dollars)
For 2.5% of all staff and
their dependents
(1 course of 5 tablets:
500 mg tablet once per
day for five days)
Widely
available, not
recommended
for stockpiling
1.08 : Cipla, India
(Available as 6
caps/bottle)
Repatriation of
bodies of deceased
international staff
and family
members
(mortuary bags)
3% of international staff
and their dependents
If unavailable
locally
PPE Kit
For health workers and
those performing critical
functions with high risk of
exposure
N95 masks
(Simple 3-ply
surgical masks as
alternative)
For all staff and their
dependents
(2 per day per person x
42 days)
Action
Antibiotics
Azithromycin
Requirements
23.08: Durbin,
U.K.
(4caps/bottle)
Notes
Taken once per
day for five days –
Staph and S.
pneumonia and
also for those
allergic to or not
responding to
amoxicillin.
18.0
When local
availability is not
sufficient
50.00
The cost of one kit
with supplies to
cover 2 changes
for 42 days is
$650.00 as per
Annex 6.
N 95 = 0.49
Surgical mask =
0.06
Each agency prepared its own procurement plan based on the requirements of the organization
and numbers of staff and dependents mentioned in its own agency CP.
For effective management of the plan WHO is responsible for procurement on reimbursable
basis.
Expenses to be paid will include cost for item to be procured plus shipping, packing, freight,
insurance and programme support cost (at a special rate for emergency and humanitarian
action).
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Annex 6: Personal Protective Equipment Kit
This is an average supply that has been worked out for select category of staff, calculating 2 changes
per day for each person for 6 weeks.
Item
Description
Unit
Quantity
Per day
Quantity
for 6
weeks
Unit
price in
USD
Total cost
for 6 weeks
in USD
Each
3
N/A
$8.00
$24.00
BX/20
2
84
$0.49
$41.16
1
Protective goggles, polycarbonate, reusable
2
Face mask grade P2 (or N95), disposable
3
single use gloves, small, anatomically shaped,
latex, non-sterile
Pair
10
420
$0.06
$25.20
4
Single use gloves, medium, anatomically
shaped, latex, non-sterile
Pair
10
420
$0.06
$25.20
5
Single use gloves, large, anatomically shaped,
latex, non-sterile,
Pair
10
420
$0.06
$25.20
6
Single use plastic apron,
Each
2
84
$0.07
$5.88
7
Rubber Gloves (reusable for environmental
cleaning
Pair
10
N/A
$3.00
N/A
8
Coverall, disposable, non sterile
Each
2
84
$5.38
$451.92
9
Alcohol rub disinfectant** – Dangerous
goods – UN code 1987, Class 3
bottle/
1000ml
1
N/A
$8.25
$8.25
10
Disposable bag for bio-hazardous waste –
Each
42 bags
N/A
$0.35
$14.70
1 bag per day for 6 weeks.
11
Disposal bag for bio hazardous waste, small,
with “Bio-Hazard” print, polypropylene –
42 bags
Each
42 bags
N/A
$0.35
$14.70
42 bags
1 bag per day for 6 weeks
Total US$ 636.21
**
This should be procured locally to avoid problems with shipping of dangerous goods. If it cannot be
supplied locally, order separately. Alternatively, chlorhexidine gluconate 4% solution in bottles of 250 ml
each (that means 4 bottles per kit to equal the liter requirement per kit), could be procured.
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Annex 7: Use of Personal Protective Equipment Kit
If full personal protective equipment needs to be worn, please note the following.
The order for putting on personal protective equipment is not important, however, for
practicality, the following sequence is given as an example:
 When required, wear boots / or shoe covers with trousers tucked inside
 Wear a mask (N95 or equivalent). This should be correctly fitted ensuring a good
face seal
Mould the nose piece to the shape of your nose. Ensure there is a correct seal.




Wear a gown
Wear an impermeable apron if splashes of blood or body fluids are expected
Wear a cap
Wear protective eye wear / goggles (reusable, wash with water and detergent after
every use)
 Wear gloves with gown sleeve cuff tucked into glove
Removing personal protective equipment.
The key principle when removing personal protective equipment is that the wearer should
avoid contact with respiratory secretions and other contaminants. Mask should be kept on until
all other PPE is removed. Hands should be washed or decontaminated with 70% alcohol
solution once all PPE has been removed.
The following is an example of how to remove personal protective equipment:
 Remove gloves.
 Remove gown/apron.
 Remove goggles and cap.
 Remove boots (if worn).
 Remove mask. Do not touch face
 Wash hands or decontaminate hands using 70% alcoholic hand-rub.
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Full personal protective equipment using coverall instead of a surgical gown
Hood of coverall
Coverall
(Reference: WHO. Practical Guidelines for Infection Control in Health Care Facilities, Regional Office
for South-East Asia, New Delhi, WHO, 2004.)
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Annex 8: Selected Health Care Facilities in Dhaka to be used in the
Event of Pandemic
Following indicators were used in selecting health care facilities to be used by the UN Agency
for case management in the event of a human pandemic.
INDICATORS
1. Multi-profile hospital with up-to-date equipped Intensive Care Unit
2. Availability of appropriate personnel and equipment for provision of a treatment of the
possible respiratory complications
3. Availability of appropriate personnel and equipment for provision of a treatment of the
possible complications
4. Availability of appropriate personnel and equipment for provision of a treatment and care for
children and adolescents
5. Availability of a hospital ambulance service for prompt transportation and or medical
evacuation in case urgency
Addresses, contact numbers and road maps of those selected health care facilities in Dhaka are
provided below.
Hospital
APPOLLO HOSPITAL
Address
Plot 81, Block E,
Bashundhara R/A,
Dhaka
GULSHAN GROUP
CLINIC
House 6, Road 51,
Gulshan-2 (behind
Saffron Restaurant)
CENTRAL HOSPITAL
House 2, Road 5,
Green Road, Dhaka
IBN SINA HOSPITAL
House 68, Road 15 A,
Dhanmondi, Dhaka
46
Telephone
989 1661-5, 989 1680 - 1
988 7880; 989 6332
966 005 -19; 8624514-18
811 9513-5
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
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Available facilities and contact numbers of the UN clinic:
Physician-in-Charge of UN Staff Dispensary Physician:
Dr Alicia P. Wycoco
Tel: 811-8600 ext. 2621,
Mobile: 01713-032083
The United Nations Staff Dispencery
UN Building, (8th floor), IDB Bhaban
Begum Rokeya Sharani Avenue
Sher-e-Bangla Nagar
Agargaon
Service Available
Sunday through Thursday: 08:00 – 16:30 hours
Friday and Saturday: Closed
Tel: 811-2777, 811-8600
Fax: 811-3586
e-mail: unsd@undp.org
The UN Staff Dispensary started its operations in 1975 and has been serving all UN Staff
members their recognized dependents in Bangladesh, providing primary health care services. An
expatriate physician, assisted by two local nurses, a laboratory technician, and an administrative
assistant, manages this UN Clinic. The UN Ambulance service is available during office hours.
The Ambulance is normally parked at the basement of the UN Building.
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HOSPITALS IN DHAKA
APOLLO HOSPITALS DHAKA
Plot 81, Block E, Bashundhara R/A, Dhaka 1229
Tel: 989-1661-5 (Information), 989-1680-1
(Appointments)
Fax: 989-6139
This is a newly opened hospital with 450-bed
facility. Tertiary hospital which focuses on
Cardiology, Cardiac-surgery, critical care, and
other secondary care specialties. It is very clean
with up-to-date equipment, specialists from India,
and they are targetting international patients.
With short prior warning, an English-speaking
guide will escort the patients to whichever
department the patient may require. This hospital
also plans to start nurses' training education, and
the dental centre is already up and running. Also
has good check-up and diagnostic facilities.
GULSHAN GROUP CLINIC
House 6, Road 51, Gulshan 2, Dhaka
Tel: 988-7880; 989-6332
Founder and ex-Medical Director: Late Dr. A.M.A. Zaman (UN Designated physician)
Chief Nursing Officer: Mrs. Christine L. Zaman
Accident Care.
48
Private hospital handling all
types
of
common
emergencies; well-maintained
and relatively clean; ambulance
service and duty doctors are
available 24 hours; duty-physicians
are reliably prompt in attending to
patients;
ICU-Medical
and
Surgical
care;
Laparoscope
examination and Operation;
ECG, X-ray, Echocardiography,
Ultrasonography and all kinds of
laboratory tests; minor and major
surgical operations; Child delivery,
Caesarian sections, Paediatric
treatment, Blood transfusion
procedures,
intravenous
infusion/'rehydration, Trauma and
United Nations Contingency Plan for the Avian and Human Influenza Pandemic – Bangladesh
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CENTRAL HOSPITAL
House 10, Road 5, Green Road, Dhanmondi R/A, Dhaka Tel:
Ext. 1101
Emergency Medical Officer
Ext. 1109-10Reception
Ext. 1107 Administration
966-0015-19, 861-9324
Tertiary hospital staffed with
medical
specialists
in
all
departments; can handle all types
of emergencies; relatively clean
and well-maintained; equipped
with the necessary equipment for
obstetric operations and general
surgery; 24 -hour duty doctors
and ambulance service; normally
crowded like most tertiary
hospitals in Dhaka.
IBNS1NA HOSPITAL
House 68, Road 15 A, Dhanmondi, Dhaka
Tel: 811 9513-5
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Annex 9: Protecting Yourself and Others against Respiratory Illness
Respiratory illnesses like influenza are spread by coughing, sneezing or contaminated hands. To
help stop the spread of microorganisms,
 Cover the nose and mouth when coughing or sneezing
 Use a tissue and dispose of it after use in the waste.
 Clean your hands after coughing or sneezing
 Wash with soap and water or
 Clean with alcohol-based hand cleaner.
 If using a surgical mask, dispose of it carefully after use and wash hands.
 Be careful with respiratory secretion (e.g. coughing and sneezing) when around other
people.
 It may be best to avoid contact with individuals at risk (small children or those
with underlying or chronic illnesses such as immune- suppression of lung disease)
until respiratory symptoms have resolved.
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Annex 10: Psychosocial Aspects of the Predicted Influenza Pandemic
The psychosocial aspects of the Avian Flu are taken into account and addressed properly since psychological
reactions may occur during all phases. Direct psychological reactions of distress (anxiety, panic, denial) related to
the release of the contingency plan and later to the declaration of phase four, may occur. At phases five to six, the
consequences of the pandemic – psychological and financial burden of the illness, death, drastic changes in the sociobehavioral and cultural patterns stemming from the virus containment measures (movement restrictions, people
wearing masks, decrease of direct inter-personal contacts, changes in the cultural mourning and bereavement
processes) – may add on to the distress of the populations and create major crisis situations if they are not
addressed in a culturally sensitive manner.
Coordination and implementation mechanisms
Overall coordination
The UN Department of Safety and Security Critical Incident Stress Management Unit (UNDSS CISMU), under the
supervision of the Head of the CISMU, coordinates the global UN psychosocial response to UN staff. The agency
Focal point is responsible for planning, implementation and evaluation of the staff related psychosocial activities
within the agency, in coordination with the UNDSS CISMU. The UNDSS/CISMU will ensure that all UN staff
receives psychosocial support services.
The UNDSS/CISMU will ensure that all individuals involved in psychosocial activities receive accurate, timely
information in line with the communication activities of the Contingency Plan.
Local implementation
The Focal point for the ICMT of each agency is responsible for the coordination, planning, and implementation of
psychosocial interventions at the country level reporting to Head of the CISMU through the Crisis Management
Team.
The psychosocial needs of UN staff should be addressed at all stages of the pandemic.
Serial Objectives
Actions.
No.
Before the Crisis:
(From the release of the contingency plan to up to declaration of phase 4)
1
Sensitization and information strategies
 The Country and Organizational Crisis Management
on the Avian Flu, including the potential
Teams briefed on the psychosocial aspects of the
psychological reactions of staff, are
contingency plan, the potential psychological reactions of
carried out as soon as the contingency
staff members in such a crisis, and the recommended
plan is released.
measures that could be taken.
 The stress counseling team collaborates with various
agencies in development, pre-testing, and dissemination
of educational material for staff members and
dependents.
2
Capacities should be built at the country
Stress management training imparted to UN staff, in the
level to address the psychosocial wellfollowing priority:
being of staff in a manner that promotes
 Country and Organizational Crisis Management Team
self-reliance. This would include the
members.
creation at the Crisis Management Team
 Staff members identified as “essential staff” by various
level of Critical incident Stress
agencies.
Intervention Cells composed of peer
 Staff from agencies involved in high exposure work e.g.
helpers (including family focal points) who
WHO, FAO, UNICEF, UNFPA and UNDSS etc.
will need to be trained as soon as
 Other staff members.
possible.
 Dependents of staff members
Training of 30 UN staff members as peer helpers to form the
Critical Incident Stress Intervention Cells to act as a rapid
response force in case of an outbreak.
United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
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During the crisis
(Phases 5 and 6 are declared)
3
Ongoing assessment and monitoring of
staff psychosocial needs will be ensured
throughout the crisis at all levels.
4
Appropriate psychosocial services
(preventative and reactive) should be
provided to all staff in need including, but
not limited to the Crisis Management
Team at country level, security officers ,
human resource officers, counselors,
medical doctors and peer helpers.
After the crisis: the pandemic is under control
5
Follow up mechanisms at the agency and
country levels are recommended in order
to:
 Maintain the flow of accurate, timely
information

Ensure continuing support to
caregivers and managers

Facilitate a smooth transition of staff
back to work;

Continue the provision of counseling
services,

Draw lessons learned from the crisis.
Both formal and informal psychosocial assessments shall be
serially conducted, by the Critical Incident Stress Intervention
Cells.
The following services shall be provided:
 Group and individual stress counseling sessions.
 Implementing self-help strategies, such as buddy systems,
distance coaching, and staff support groups, etc.
 Other services, such as grief counseling, and crisis
intervention counseling etc,
The following services shall be provided:
 Collaboration with other agencies to maintain a smooth
flow of accurate, timely and appropriate information to
all staff members and dependents, through identification
of focal points at all levels and the production of
education and information material (e.g., newsletters,
web page updates);

Support to caregivers and managers through services
such as coaching, buddy system, and staff support groups;

Maintaining longitudinal services, including bereavement
counseling services, through implementation of an
efficient tracking system of staff and dependants;
Guidelines for managers when communicating with staff
The following guidelines for communicating with staff about the UN System Planning and Pandemic Preparedness
Guidelines and responding to their questions and comments, can serve to contain and channel staff reactions, and help
them to prepare and protect themselves and their families in a realistic way.
 Consider including counsellors, peer helpers and medical staff in group meetings on the topic, to respond to
questions about health risks and protection;
 Upon release of the UN System Planning and Pandemic Preparedness Guidelines, managers may consider strategies
for ensuring that staff associations are well-informed to promote partnerships;
 It is important that staff be given facts about the situation and have their immediate concerns addressed so that
they can dispel the rumours. This information will be disseminated to staff at all levels including headquarters,
country offices, and sub-offices. Acknowledging what is not known but assuring staff that additional information
will be provided as it becomes available in the WHO website (http://www.who.int.en) will promote trust and
increase resilience;
 Note that action is an antidote for feelings of helplessness. The Agency will monitor closely with WHO of the
situation the evolution and will regularly keep staff informed;
 A calm and reassuring approach is an antidote for anxiety. Encourage staff to raise questions and concerns and
listen to and acknowledge them. Also pay attention to what is unspoken and to staff who may be
withdrawn;
 Efforts should be made to keep the discussion supportive. Venting of strong negative feelings are a normal
reaction to an upsetting event, but expressions of strong emotions may leave other colleagues feeling
anxious or vulnerable, so responses should be guided and contained. However, do not attempt to deny or
minimize the potential impact on staff;
 Remind staff of the availability of resources for information and support — medical services staff, stress
counsellors, Peer Support Volunteers/ Personnel, HR officers and others, as well as UN stress management
materials (booklets, brochures, etc) and encourage staff to make use of those;
 Regular briefings in all offices are essential to contain staff anxiety as well as rumour circulation. Make sure
that Frequently Asked Questions are continuously updated and available to all staff members and posted on
the intranet; and
 Staff and families will benefit from the initiatives of managers in promoting, both in their respective
offices and homes, the culture of compliance with the UN Medical Services Guidelines for an Influenza Pandemic.
52
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CONFIFIDENTIAL
Annex 11: Health Advisory on Self Protection for Travel to/ Through or
Living in Outbreak Regions
The following recommendations are directed to UN staff and their recognized dependents travelling
to/through or living in areas where avian influenza A (H5N1) outbreaks among poultry or human H5N1
cases have been reported. These recommendations may be revised as more information becomes
available.

To minimize the possibility of infection, observe precautions to safeguard your health. Specifically,
travelers should avoid touching live or dead poultry (e.g., chickens, ducks, geese, pigeons, quail)
or any wild birds or their feces, and avoid settings where H5N1-infected poultry may be present,
such as commercial or backyard poultry farms and live poultry markets.

Do not eat uncooked or undercooked poultry or poultry products, including dishes made with
uncooked poultry blood.

As with other infectious illnesses, one of the most important preventive practices is careful and
frequent hand washing. Cleaning your hands often, using either soap and water (or waterless,
alcohol-based hand rubs when soap is not available and hands are not visibly soiled), removes
potentially infectious materials from your skin and helps prevent disease transmission.
When preparing food:

Separate raw meat from cooked or ready-to-eat foods. Do not use the same chopping board or
the same knife for preparing raw meat and cooked or ready-to-eat foods.

Do not handle either raw or cooked foods without washing your hands in between.

Do not place cooked meat back on the same plate or surface it was on before it was cooked.

All foods from poultry, including eggs and poultry blood, should be cooked thoroughly. Egg yolks
should not be runny or liquid. Because influenza viruses are destroyed by heat, the cooking
temperature for poultry meat should reach 70°C (158° F).

Wash egg shells in soapy water before handling and cooking, and wash your hands afterwards.

Do not use raw or soft-boiled eggs in foods that will not be cooked.

After handling raw poultry or eggs, wash your hands and all surfaces and utensils thoroughly with
soap and water.
If you believe you might have been exposed to avian influenza, take the following precautions:

Monitor your health for 10 days.

If you become ill with fever and develop a cough or difficulty breathing, or if you develop any
illness during this 10-day period, consult a health-care provider. Before you visit a health-care
setting, tell the provider the following: 1) your symptoms 2) if you have had direct poultry
contact, and 3) where you traveled.

Do not travel while sick, and limit contact with others as much as possible to help prevent the
spread of any infectious illness.
United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
53
Annex 12: Suggested Terms of Reference of In-House Crisis
Management Team for an Influenza Pandemic
Before the Crisis









Establish the Emergency Contingency Plan.
Define an emergency in terms that are relevant to the organization.
Assess the most likely crisis scenario.
Conduct a vulnerability assessment and impact analysis if required.
Identify methods and resources to mitigate the risks.
Identify essential functions (Critical Organization Processes) and staff associated with those
functions.
Identify an alternative worksite.
Test and update the Plan on a regular basis or whenever necessary.
Recommend and arrange appropriate training exercises in preparedness and recovery.
During the Crisis



Declare the crisis
Execute the Emergency Contingency Plan
Assess the damage
After the Crisis



54
Conduct a lessons learned exercise
Review strengths and weaknesses of the Emergency Contingency Plan and modify if necessary.
Anticipate and prepare for the second wave of the pandemic.
United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
CONFIFIDENTIAL
Annex 13: Plans for Home Confinement/Voluntary Quarantine and
Home Care for Pandemic Influenza Patients and Household Members
1) Home confinement of staff members during pandemic phase 5 & 6.
Staff members and their dependants should be instructed to stay in their duty station residence,
having ensured that they have sufficient food, water, prescribed medication & supplies, medical
kits and other essentials to last 6-8 weeks (Annex 14) until a pandemic wave has passed.
Maintenance of health of “home confined” staff
o
If a staff member suspects that he/she has avian/pandemic influenza, he/she should be
encouraged to seek advice/consultation over the telephone (telephone triage) with preidentified health care providers (Fever clinic physician; RMS; UN physician) who will guide as
appropriate. This may include a visit to the “fever clinic” or hospital if the HCW suspects flu
o
If the need arises & anti-virals are not available with the health care facility, Tamiflu will be
made available to the staff member within 48 hours of onset of symptoms, in a suspected
case of pandemic flu.
o
If the condition of the staff member deteriorates in spite of anti-virals and antibiotics after
consultation with fever clinic physician, the staff member will be shifted to a pre-identified
health care facility for further management provided availability of beds.
2) Voluntary Quarantine of staff members in pandemic alert phase 3 & 4 and early phase 5
o
Any staff member who becomes ill should be asked to practice isolation and stay home for 7
to 10 days after resolution of fever for suspected or confirmed cases of uncomplicated
avian/pandemic influenza. In addition, Tamiflu should be started within 48 hours as per case
management protocol. Patient should wear a surgical mask when meeting other people.
o
Any staff member who has been exposed to a known/suspected case of avian/pandemic
influenza should be asked to practice quarantine and stay home for a period of 7 to 10 days
to contain the possible spread of infection.
Later, as pandemic influenza becomes more common, the request for voluntary quarantine
may be dropped since it would no longer be effective nor practical.
o
If a staff member has a relative or someone else at home suspected to be effected by
pandemic influenza, he/she should be allowed to abstain from going to work to provide care
for that person.
Infection Control: Home Care for Pandemic Influenza Patients and Household Members
Most patients with pandemic influenza will remain at home during the course of their illness and can be
cared for by family members or others who live in the household. Anyone who has been in the
household with an influenza patient during the incubation period is at risk for developing influenza. A key
objective in this setting is to limit transmission of pandemic influenza within and outside the home.
United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
55
Management of influenza patients in the home.

Physically separate the patient with influenza from non-ill persons living in the home as much as
possible.

Patients should not leave the home during the period when they are most likely to be infectious to
others (7 days from the resolution of fever for adults and 21 days from the onset of symptoms for
children)

When movement outside the home is necessary (e.g. for medical care), the patient should follow
respiratory hygiene/cough etiquette (i.e. should cover their mouth and nose when coughing and
sneezing) and should wear a simple surgical mask
Management of other persons in the home:

Visitors who have not been exposed to pandemic influenza and who are not essential for patient care
or support should not enter the home while persons are still having fever due to pandemic influenza

If unexposed persons must enter the home, they should avoid close contact with the patient.

Persons living in the home with the patient with pandemic influenza should limit contact with the
patient to the extent possible; consider designating one person as the primary care provider.

House hold members should be vigilant for the development of influenza symptoms
Infection control measures in the home:

All persons in the household should carefully follow recommendations for hand hygiene (i.e. hand
washing with soap and water or use of an alcohol-based hand rub) after contact with an influenza
patient or the environment in which they are receiving care.

Although no studies have assessed the use of masks at home to decrease the spread of infection,
using a surgical (3 ply) masks by the patient or caregiver, during interactions may be beneficial.

Soiled dishes and eating utensils should be washed either in a dishwasher or with warm water and
detergent. If possible keep these items separate.

After washing up these items remember to wash your own hands with warm water and soap or by
using an alcohol based hand rub.

Laundry may be washed in a standard washing machine using warm or cold water with detergent.
Although it is not necessary to separate the laundry from the general household’s, care should be
taken when handling the unwashed items to limit the spread of the virus and self contamination.

Any solid body waste should be carefully removed from the linen prior to laundering with gloves or
tissues and placed in the toilet, the lid should then be closed (when applicable) and the toilet flushed.

After handling contaminated laundry hand wash your hands.

Remove masks only by the straps and place in a plastic bag at the bedside. Soiled tissues should also
be disposed of in the same bag. These bags can then be disposed of with the other household waste
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United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
CONFIFIDENTIAL
Annex 14: List of 6 Weeks Supplies to be Stocked
Water:
Stock bottled water or store water in plastic containers such as soft drink bottles:
A normally active person needs to drink around two litres of water each day. Plan to store 4 litres of water per
person per day (2 litres for drinking and two litres for household use such as food preparation and sanitation).
Water requirements will also depend on other factors such as temperature, in hot climates an individual’s water
requirement may double and children, nursing mothers and those who are ill often require additional supplies.
You should store enough water for at least a six-week period with under ground water tank full. Water purification
kits or filters are readily available and should be purchased as a back up.
Food:
 Store a six-week supply of non-perishable foods, you may wish to consider if you can start a vegetable garden
and what you could grow yourself during the winter season, in order to supplement your provisions.
 Select foods that require no refrigeration as electricity supplies may not be available. Consider how you will
cook the food, if you need to stock up on gas bottles, for example. As clean water may be limited, choose
foods that require little or no water to prepare. Foods that you may consider are:
Ready-to-eat canned meats and soups, fruits and vegetables
Dry goods such as noodles (remember that you will need to allow for enough water to cook
these items). Dry cereal, granola, dried fruits and crackers
 Canned juices
 Peanut butter or nuts
 Staples (salt, sugar, pepper, spices, etc.)
 High energy foods such as protein or fruit bars
 Food for infants – canned or jarred baby food and formula
 Comfort/stress foods
 Pet food
 Other supplies such as soap and water or alcohol based hand wash


Buy extra garbage bags and cleaning supplies; viruses such as Avian Influenza are easily cleaned
away with formalin and iodine-based disinfectants. For bathing soap and water is sufficient
 Spare contact lenses
 Denture and personal hygiene needs (tissues, toilet paper, disposable diapers)
 Other supplies (continued)








Hearing aid batteries
Fire extinguisher (make sure you all know how to use it)
A clock that runs off batteries (include spare batteries)
Flashlight
Extra batteries
Portable radio
Manuel can opener
Food Storage Advice:
 Keep food in the driest and coolest spot in the house – a dark area if possible. Make sure that it is sealed off
from possible vermin
 Keep food covered at all times
 Open food boxes or cans carefully so that you can close them tightly after each use.
 Wrap cookies and crackers in plastic bags, keep them in tight containers, this will stop them from going stale
and prolong shelf life
 Empty opened packages of sugar, dried fruits and nuts into screw-top jars or airtight cans to protect them from
pests
 Inspect all food containers for signs of spoilage before use
 If you lose power, minimize waste by using the food in your fridge first, then the freezer and then finally your
non-perishable items
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United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
Shelf Life of Foods for Storage: Here are some general guidelines for rotating common emergency foods.
Use within six months: Powdered milk (boxed), dried fruit (in metal container), dry, crisp crackers (in metal
container), and potatoes
Use within one year: Canned condensed meat and vegetable soups: canned fruits, fruit juices and vegetables;
ready-to-eat cereals and uncooked instant cereals (in metal containers); peanut butter, jams; hard candy, chocolate
bars and canned nuts
May be stored indefinitely (in proper containers and conditions): Wheat: vegetable oils; corn; backing
powder, soybeans, instant coffee, tea, vitamin C and cocoa, salt, non-carbonated soft drinks, white rice, bouillon
products, dry pasta, powdered milk (in nitrogen-packed cans)
Fuels:
 Purchase an emergency supply of petrol/diesel for your car and Generator
 Buy extra provisions of candles, paraffin lamps, batteries, etc. as electricity supplies may not be available
 Consider how you will prepare foods and consider non-electrical alternatives
Disposal of Wastes: Remember that if there is movement restrictions imposed in an area, the collection of waste
may not be possible. It is important that you consider alternative arrangements such as composting food wastes,
worm farms, etc.
Medical Kits: Emergency services may be limited during a time of crisis, therefore make sure your home
emergency medical kit is not out-of-date, check all supplies for expiry dates and replace any items that are out-ofdate or nearing the expiration date with general medications. Following items may consider important:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.


58
Glucose and blood pressure monitoring kit
Adhesive bandages, various sizes
Sterile dressings, small and large
Roller gauze bandage and Triangular bandages
Packs of sterile gauze pads, large and small
Adhesive tape, 2” width
Pairs of medical grade non-latex gloves, medium and large
Waterless alcohol-based hand sanitizer
Antiseptic wipes and Anti-bacterial ointment
Cold pack
Scissors (small, personal) and Tweezers
Thermometers – remember to have a spare
CPR breathing barrier, such as a face shield
Face masks, 3-ply simple surgical masks
Pain and fever reliever – remember to include both children and adult supplies
Anti-diarrhea medication
Antacid (for stomach upset)
Vitamins
Fluids with electrolytes (an oral rehydration solution, ORS)
Stock up on prescription medications that you might need, for example, if one of your family members is
diabetic, ensure that you have enough supplies for at least 6 weeks, or if someone has a heart condition, ask
your doctor for an extra prescription so that you can have an emergency supply of all the medications your
family members need.
You may need extra bedding if a family member becomes sick, such as sheets, towels, plastic mattress covers,
etc. Consider where you could make up a sick bay which could be isolated from the rest of the house, how
would you ventilate this room? It is important that air from the room is expelled to the outside of the house
and not back into the house.
United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
CONFIFIDENTIAL
Annex 15: References and Additional Resources
Food and Agriculture Organization (FAO) animal health and Avian Influenza website
http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html
Humanitarian Early Warning Service (HEWS) website
http://www.hewsweb.org/avian flu/
Local Consultative Groups (LCG) in Bangladesh
http://www.lcgbangladesh.org/
UN Staff Information web-page on avian and human
influenza http://avianinfluenza.staffinfo.un.int
UN System Influenza Coordination (UNSIC) website
http://influenza.undg.org
Contingency planning page http://www.undg.org/content.cfm?id= 1483
UN System contingency planning toolkit (for password please contact headquarters AHI focal
points http://www.undg.org/content.cfm?id= 1611
UN System Planning and Preparedness toolkit
UN System contingency planning toolkit (for password please contact headquarters
AHI focal points) http://www.undg.org/content.cfm?id= 1611
World Organization for Animal Health (OiE)
http://www.oie.int/eng/en_index.htm
World Health Organization (WHO) pandemic influenza preparedness website
http://www.who.int/csr/disease/influenza/pandemic/en/index.htmltfprepare
WHO pages on response to H5NI in humans:
http://www.who.int/csr/disease/avian_influenza/en/
World Health Organization, Bangladesh
http://www.whoban.org/
United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
59
Annex 16: Frequently asked Questions on Avian influenza
What is avian influenza?

Avian influenza, or “bird flu”, is a contagious disease of animals caused by type A (H5N1) strains of the
influenza virus that normally infects only birds and less commonly, pigs. The disease, first identified in Italy
more than 100 years ago, occurs worldwide.

Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them. However,
bird flu is very contagious among birds and can make some domesticated birds, including chickens, ducks,
and turkeys, very sick and kill them.

It spreads very rapidly through poultry flocks, causes disease affecting multiple internal organs, and has a
mortality that can approach 100%, often within 48 hours.

Migratory wildfowl, notably wild ducks, are natural carriers of the viruses, but are unlikely to actually
develop an infection.

Domestic birds are particularly susceptible in epidemics.
How are avian, pandemic, and seasonal flu different?
 Avian flu is caused by avian influenza viruses, which occur naturally among birds.
 Pandemic flu is flu that causes a global outbreak, or pandemic, of serious illness that spreads easily from
person to person. Currently there is no pandemic flu.
 Seasonal flu is a contagious respiratory illness caused by influenza viruses.
Do bird flu viruses infect humans?
Bird flu viruses do not usually infect humans, but several cases of human infection with bird flu viruses have
occurred since December 2003.
How many people have been affected?
As of 12 March 2007, there had been 278 laboratory confirmed cases of avian flu in humans in Azerbaijan,
Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Laos, Nigeria, Thailand, Turkey and Vietnam to 168 deaths.
How does bird flu spread?
Infected birds shed flu virus in their saliva, nasal secretions, and feces. Susceptible birds become infected when they
have contact with contaminated excretions or surfaces that are contaminated with excretions. It is believed that
most cases of bird flu infection in humans have resulted from contact with infected poultry or contaminated
surfaces. The spread of avian influenza viruses from one ill person to another has been reported very rarely, and
transmission has not been observed to continue beyond one person.
How do humans catch bird flu?
Humans catch the disease through close contact with live infected birds.
Birds excrete the virus in their faeces, which dry and become pulverized, and are then inhaled.
Do migratory birds spread highly pathogenic avian influenza viruses?
Recent events make it likely that some migratory birds are now directly spreading the H5N1 virus in its highly
pathogenic form. Further spread to new areas is expected.
What are the symptoms of bird flu in humans?
Symptoms of bird flu in humans have ranged from typical flu-like symptoms (fever, cough, sore throat and muscle
aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress), and other
severe and life-threatening complications. The symptoms of bird flu may depend on which virus caused the infection.
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CONFIFIDENTIAL
Is there a vaccine to protect humans from H5N1 virus?
There currently is no commercially available vaccine to protect humans against the H5N1 virus that is being seen in
Asia and Europe. However, vaccine development efforts are taking place. Research studies to test a vaccine to
protect humans against H5N1 virus began in April 2005, and a series of clinical trials is underway.
Is it safe to eat poultry and poultry products?
Yes, though certain precautions should be followed in countries currently experiencing outbreaks. In areas free of
the disease, poultry and poultry products can be prepared and consumed as usual, with no fear of acquiring infection
with the H5N1 virus.
In areas experiencing outbreaks, poultry and poultry products can also be safely consumed provided these items are
properly cooked and properly handled during food preparation. The H5N1 virus is sensitive to heat. Normal
temperatures used for cooking (70oC in all parts of the food) will kill the virus. Consumers need to be sure that all
parts of the poultry are fully cooked and that eggs, too, are properly cooked.
How serious is the current pandemic risk?
The risk of pandemic influenza is serious. With the H5N1 virus now firmly entrenched in large parts of Asia, the risk
that more human cases will occur will persist. Each additional human case gives the virus an opportunity to improve
its transmissibility in humans, and thus develop into a pandemic strain. The recent spread of the virus to poultry and
wild birds in new areas further broadens opportunities for human cases to occur. While neither the timing nor the
severity of the next pandemic can be predicted, the probability that a pandemic will occur has increased.
Is there any treatment of Bird Flu?
There currently is no vaccine to protect Avian Influenza, but discover a drug named ‘Tamiflu’ in limited amount,
which is very costly and not easily available. But the drug is highly effective to protect the disease.
Does hand washing kill bird flu virus?





Hand washing done properly destroys bird flu virus.
Hand washing is best performed using soap and warm running water.
Ensure that all areas of the hand have been washed properly.
Wash hands for a minimum of 15 to 20 seconds. It gives adequate time for the soap to kill the virus.
After washing, pat dry the hands.
If a pandemic sets in, what should be done?




Don’t panic.
Follow the instructions of national public health authorities.
Make plan for emergency supplies, contact numbers of important people as well as develop a contingency plans.
A pandemic is likely to cause social disruption and strict measures such as social distancing and travel
restrictions may be imposed by national authorities.
Can a person visit such countries where bird flu is reported from poultry and/ or humans?



No travel restrictions have been suggested so far. It is safe to visit any affected country.
While visiting these countries avoid contact with poultry, do not visit markets where chicken are slaughtered
and sold and adopt good hygiene practices.
Consume thoroughly well-cooked poultry products.
Why is H5N1 of particular concern?






It mutates rapidly and seems to acquire genes from viruses infecting other animal species.
It can cause severe disease in humans.
Birds that survive infection excrete virus for at least 10 days, orally and in feces, helping spread the virus at live
poultry markets and by migratory birds.
The more birds that come down with bird flu, the greater the opportunity for direct infection of humans.
The more humans get infected, the greater the likelihood people can become infected with both human and
bird flu strains.
Humans could then serve as a "mixing vessel" for a new type of virus that could easily be transmitted from
person to person. Such an event would mark the start of an influenza pandemic.
United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
61
Annex 17: UN Emergency Contact List
(As of 28 January 2007)
ID
1
Name
Ms. Renata Lok
Dessallien
Agency Office Phone
UNDP
811-8600/2401
Mr.Manoj Basnyat
Security Title (SMT)
Radio
Designated
Official Delta- 1
(DO) for Security in
Bangladesh/ UN Resident
Coordinator/UNDP
Resident Representative
Country Director
Delta-2
2
UNDP
811-180
3
Mr. Richard Jansen
SA
Sierra-1
UNDSS
8118600/2675
4
Mr. Ad Spijkers
Representative
Alpha- 1 FAO
8113072
5
Mr. Mohamed
Toure
Mr. LouisGeorges
Arsenault
Mr. Hassan
Keynan
Mr. Douglas A
Broderick
Ms. Hua Du
OIC
Bravo-1
81519035
8825673
0171-3010523
Representative
Charlie-1 UNICEF
9335802
8859991
0171-566824
OIC
Echo-1
Representative
Foxtrot 1 WFP
811-3573
Country Director
Golf-1
ADB
815600-8
8821636
0171-3043940
Dr. Duangvadee
Sungkhobol
Mr. Jonathan C.
Dunn
Representative
Hotel- 1
WHO
8614653-55
9884976
0171-1549198
Representative
Juliet-1
IMF
712-0679
712-0680
8824253
017-13035167
Mr. Gopal K.
Bhattacharya
Mr. M. Shahidul
Hague
Representative
Lima-1
ILO
811-6989
8859820
0171-3000456
Regional Representative
Mike-1
IOM
881-4604
881-7699
8819590
0171-1595764
Ms. Carolyn
Ben bowRoss
Ms. Pia Phiri
OIC
Papa-1
UNFPA
8110836
Representative
Romeo- 1 UNHCR 8826802-8
6
7
8
9
10
11
12
13
14
15
16
17
18
WB
Res. Phone Mobile No
8823889
0171-3047171
0171-3142930
9891148
0171-1567251
UNESCO 9872889
Mr. Deepak
Adhikary
Dr. Alicia Pine
Wycoco
Deputy General Manager Tango- 1 IFC
9861711-20
UN Physician
X-Ray-1
8119071
Bijay Shah
DSA
Sierra-1.1 UNDSS
UNSD
0171-3036042
01713-3452941
0171-1593945
0171-1560632
8825887
0171-3001040
8827070
0171-1592178
0171-3 032083
8118600/2683
8834095
0171-3047509
Alternative Members of the SMT
ID
Name
Security Title (SMT)
Radio
Agency
Phone O
Phone R
Mobile
1
2
3
4
5
6
7
8
9
Mr. Larry Maramis
Ms. Margaret Goon
Mr. Subash Dasgupta
Ms. Rosella Morelli
Mr. Edward Kallon
Mr. Putu Kamayana
Mr. Tete Amouh
Mr. Francis Teoh
Mr. Pornchai Suchitta
DCD (P)
DCD (0)
Assistant FAO Rep
Sr/Programe Coord
Deputy Rep
Sr.Country Prog Officer
Migration Health Physician
Sr/Protection Officer
Deputy Rep
Delta-3
Delta-4
Alpha 1.1
Charlie 1.1
Foxtort- 2
Golf-2
Mike-2
Romeo-2
Papa-2
UNDP
8112820
8855872
01713067822
UNDP
8118617
8823452
01713049888
FAO
9152544
8113072
01713011771
62
UNICEF
01711590143
WFP
01713034269
ADB
815600-8
8822950
01713043941
IOM
8814604
01713047312
UNHCR
8826802-8
01713090375
UNFPA
8110836
01713046970
United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
CONFIFIDENTIAL
Annex 18: Agency Security Focal Point
(As of 28 January 2007)
ID
Name
Security Title
(SFP)
1
Mr. M. Haroon
2
Radio
Agency Office Phone
Res.
Phone
Mobile No
UNAIDS, UNOPS, Delta -7
UNV, UNCDF and
UNDP
Funded
Project's SFP
UNDP
8018235
01713 063153
Ms. Susan Alberi
UNICEF
Charlie-2
UNICEF 933-5640
885-0987
01711 566825
3
Mr. AKM Sharfuddin
WFP
Foxtrot-5
WFP
8119064-72
Extn. 2112
8112358
01711 591517
4
Mr. JL Das
UNFPA
Papa-2
UNFPA
811108361/2811 8125971
01713495963
5
Ms. Susan EllisonMcGee
World Bank
Bravo-4
World
Bank
8159001-14
8855542
01713 015125
6
Mr. Abul Kashem
ILO
Lima- 2
FAO
9112876
7114585
01711 607602
7
Mr.Murray Singer
Focal Point
Hotel-2
WHO
9112907
8614653-55
882-8834
01199812244
8
Mr. Bhupesh Roy
FAO
Alpha-2
FAO
8118015-8
0189
202039
01711 408440
9
Ms. Anindita Bashar
IMF
Julllet-2
IMF
7120679,
7120680
7120144
01713044282
10
Ms. Shamima Afroze
IOM
Mike-2
IOM
8814604
8052429,
8053129
01713 010068
11
Mr. Erwin Policar
UNHCR
Romeo-2
UNHCR 8826802-6/106
01713 000443
12
Mr. Mahabubur
Rahman
UNESCO
Echo-5
UNESCO 9862073
8828282
8813844
9118400
13
Mr. M Enamul Aziz
ADB
Golf-2
ADB
8156000,
8156009
8650801/
8650799
01713043945
14
Mr. K A Reza
UNIC
Uniform -1
UNIC
8117898 /2601
8626387
01199869893
15
Mr. Rajeev Gopal
IFC
Tango ....
IFC
8833752-67
9889052
0171 1593568
811-8600/2402
01711592931
Note: SFP= Security Focal Point
United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
63
Annex 19: International Security Wardens
(As of 28 January 2007)
ID Name
Security Title Agency
1
Agola Susan Amimo
Warden
Rakesh Jani
2
3
4
5
6
7
8
Res. Phone # Mobile No
Zone
WHO
01713062515
Zulu –1
Deputy Warden
UNDP
01713015685
Zulu – 1A
Bloukh Mommad Issa
Senior Warden
UNICEF
01711593800
Zulu –2
Johnston Richard
Deputy Warden
UNICEF
01713030536
Zulu - 2A
Ekelund Stefan
Warden
ADB
8822624
0189243642
Zulu –3
Usha Mishra
Deputy Warden
WFP
8860877
01713034270
Zulu –3A
Ayshanie Labe
Warden
UNDP
9893187
01711802323
Zulu –4
Putu Kamayana
Deputy Warden
ADB
8822950
01713043941
Zulu –4A
Mr. Anwar Naeem
Warden
WFP
01713012301
Zulu –5
Diane Prioux
Deputy Warden
WFP
01713013982
Zulu –5A
James Crittle
Warden
IFC
8820203
0171759576
Zulu –6
Rajeev Gopal
Deputy Warden
IFC
9889052
0171459576
Zulu – 6A
NO
STAFF
NO
STAFF
Zulu –7
NO
STAFF
N0
Martina Locher
Warden
UNDP
Judith Alen Graeff
Deputy Warden
UNICEF
Murray Singer
Warden
WHO
ONLY
2
STAFF
John Mc Harris
Warden
Hans G Carlsson
8825652
STAFF
Zulu – 7A
0171959576
Zulu –8
0171502678
Zulu- 8A
011-99812244
Zulu –9
IN THE AREA
Zulu - 9A
WFP
01711596032
Zulu –10
Deputy Warden
ADB
0189243643
Zulu – 10A
Yohannes Hailu
Warden
UNICEF
8829988
01713000989
Zulu –11
Erwin Policar
Deputy Warden
8855564
01713000745
Zulu – 11A
NO STAFF
NO
STAF
NO
STAFF
Zulu –12
NO STAFF
NO STAF
NO STAF
NO
STAFF
Zulu – 12A
Ms. Irmelin Johnson
Warden
WHO
8827266
01199808322
Zulu –13
-do-
Deputy Warden
14
-do-
ONLY 2
15
-do-
16
Tete Amouh
Warden
Vacant
Deputy Warden
9
10
11
12
13
8813703
MEMBERS
Zulu-13A
STAFF
ONLY
2 STAFF
Zulu –14
Zulu –15
IOM
01713047312
Zulu –16
Zulu – 16A
17
-do-
Zulu –17
18
-do-
Zulu - 18
19
-d0-
Zulu-19
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United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
CONFIFIDENTIAL
Annex 20: Focal Points for Avian and Human Influenza Pandemic
WHO Representative
Dr Duangvadee Sungkhobol
AHI Focal Point for UNCT
and Chairman of AHI TWG
Email: sungkhobold@searo.who.int
Mobile: 01711-549198
Agency AHI Focal point and member of AHI TWG from UN agency
Sl. No.
Agency
Name
Contact Details
1
ADB
Mr. Arun Kumar Saha
2
FAO
Mr. Nafis Khan
3
IFC
Mr. Gopal Rajeev
4
ILO
Mr. Abul Kashem
5
IMF
Mr. Jonathan Dunn
6
UNDP
Dr Najmus Sahar Sadiq
7
UNDSS
Mr. Richard Jansen
8
UNFPA
Dr Rebeka Sultana
9
UNHCR
Dr Zahid Jamal
10
UNICEF
Dr Iyrlumun Uhaa
11
UNSD
Dr Alicia Pine Wycoco
12
World Bank
Mr. Qaisar Khan
13
World Bank
Ms. Farzana Ishrat
15
WHO
Mr. Murray Singer
14
WHO
Dr Biswas M. K Zaman
Email: asaha@adb.org
Tel: 9334017 Ext. 201
Email: Nafis.Khan@fao.org
Mob: 017 1306 8419
Email: rgopal@ifc.org
Mob: 017 1159 3568
Email: kashemA@ilodhaka.org
Mob: 017 1160 7602
Email: JDunn@imf.org
Mob: 017 1303 5167
Email: najmus.sadiq@undp.org
Mob: 019 1134 7321
Email: richard.jansen@undp.org
Mob: 017 1303 6042
Email: rebeka@unfpa-bangladesh.org
Mob: 017 2005 4422
Email: JAMALZ@unhcr.ch
Mob: 011 9920 4081
Email: iuhaa@unicef.org
Mob: 017 1300 4617
Email:Alicia.Wycoco@undp.org
Mob: 017 1303 2083
Email: qkhan@worldbank.org
Tel: 8159001-14
Email: fishrat@worldbank.org
Tel: 9669301-08 Ext. 647
Email: singerm@searo.who.int
Mob: 011 9981 2244
Email: zamank@searo.who.int
Mob: 011 9981 6018
15
WFP
Mr SM Murshid
16
IOM
Dr Tete Amouh
Email: Sm.Murshid@wfp.org
Mob:
Email: tamouh@iom.int
Mob: 017 1304 7312
United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
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Annex 21: Check list for AHI preparedness and response for
WHO phase 3:
Name of Organization:
Indicator
Yes
No
Comment
1. Designated focal point(s) for
information dissemination
2. Disseminated information materials
through various means (e.g. leaflet,
regular briefing, meeting, discussion
group/ seminar, e-mail
communication, etc.)
3. Educated staff on AHI individual
preventive measures (e.g.
information note, information
meeting etc,)
4. Established and tested effective
communication strategies
5. Designated Focal Point for AHI
preparedness
6. Actively Involved Security Focal
Point in AI preparedness
7. Established In-house Crisis
Management Team (ICMT)
8. Developed contingency plan for AHI
9. Planned for essential programme (s)
continuity
10. Identified & prioritized
programme(s) and activities
11. Updated lists of staff and dependents
with address and contact numbers
12. Identified essential and non-essential
staff
13. Identified critical staff with an
alternate including those will work
from home
14. Ensured that those working from
home are able to perform critical
functions
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United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
CONFIFIDENTIAL
Indicator
Yes
No
Comment
15. HR and Administration policies and
actions regarding travel, leave,
medical, pay, staff tracing were in
place
16. Simulation exercise completed
17. Stockpiled Oseltamivir (Tamiflu) For
30% of staff and their dependents
with additional 10% for a cushion.
18. Stockpiled Masks (N95 and/or
Surgical masks) as per UNCT CP
19. Stockpiled PPE ( Gown, Gloves,
Goggles, Head and Shoe cover)
20. Seasonal influenza vaccine provided
to all staff and their dependents
21. Prepared a priority list of recipients
of antiviral drug Tamiflu and Avian
Influenza, pandemic influenza vaccine
22. Prepared a priority list of recipients
for pandemic influenza vaccine
23. Ensured pre-arrangement of
transportation and admission facility
for ill staff and dependents with
selected Hospitals
United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
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Annex 22: National Avian Influenza and Pandemic Influenza
Preparedness and Response Plan Bangladesh
National Avian Influenza and Pandemic Influenza Preparedness and Response Plan 2006 – 2008 has been prepared
by a National Multi-sectoral Planning Team from the Ministry of Environment and Forest, Ministry of Fisheries and
Livestock and Ministry of Health and Family Welfare with joint technical support from the Food and Agriculture
Organization and the World Health Organization. This National Plan has been formally approved by the Honorable
Prime Minister of the People’s Republic of Bangladesh on 17 April 2006.
This National Plan provides a strategic framework for coordinating activities within and between the various sectors
and stakeholders for preparedness and response to avian and human pandemic influenza in Bangladesh. Sectoral
operational plans will be developed to translate these strategic directions into action. Moreover, this National Plan
can also serve as a framework for mobilizing support from Development Partners to strengthen national
preparedness and response efforts.
The Plan will adopt a multi-disciplinary approach, based into five strategies, as outlined below, to respond to various
periods of avian and human pandemic influenza.
1.
2.
3.
4.
5.
Planning and coordination;
Surveillance and early warning;
Prevention and control;
Sector response; and
Risk communication.
Specific activities based on each of the five strategies are:
Planning and Coordination: This will define the roles and responsibilities of agencies involved in implementing the
Plan and coordinated decision-making procedures. A multi-sectoral response to prevent the spread and minimize
the impact of outbreaks and a pandemic will be mounted at all levels from national down to community involving
government, private, NGOs, civil society, elective representatives, professional & business bodies and others.
Surveillance and Early Warning: Disease surveillance in animal and human systems will be continually strengthened
with essential laboratory support. The capacity for early warning and epidemiological investigations will be
enhanced, together with improved implementation of influenza-like illness surveillance, with a particular focus on
avian influenza diagnosis in wild-bird, poultry and humans.
Prevention and Control: This includes specific measures for minimizing the spread of influenza in animals and
humans, such as the implementation of public health measures including awareness raising, culling plus disposal of
infected poultry; and the protection of health care workers and other vulnerable groups. The farmers/owners of
culled poultry will be rationally compensated. The availability and distribution of antivirals and vaccine will also be
considered according to the situation.
Sector Response: The field veterinary and diagnostic service must be reinforced to prevent incursion and arrest of
the virus at the outset. The health care system must be reinforced in order to adequately deal with the increased
demand on hospitals and health services required for an emerging pandemic. Referral hospitals must be properly
equipped and their staff appropriately trained. Facility and staff surge-capacity will need to be developed.
Risk Communication: Transparency is a key strategy to gain the public’s trust in the government and other
stakeholders and is critical to disaster management. It will be essential to provide timely, adequate and effective
information to various groups, particularly health care personnel, stakeholders, and the media during each pandemic
stage. A comprehensive, multi-sectoral and proactive communications strategy will be followed. It will include
establishment of a media centre, nomination of a spokesperson, the development of key messages to address public
concerns and stakeholders as guided by established principles of communication guidelines for risk communication.
The communications guidelines will be developed by a communication wing under National Multi-sectoral Task
Force. This communication wing will draw members from MoH&FW, MoEF, MoFL, Ministry of Information, UN
Bodies, BCCP, representatives from NGOs working in the field of poultry, livestock; private electronic and print
media, and the private sector, etc. It will be ensured through the Wing that no communication initiative will be in
place without accreditation from National Multi-sectoral Task Force.
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United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
CONFIFIDENTIAL
BUDGET
Resources for prevention and management of pandemic will be borne jointly by government and development
partners. Furthermore, government will provide support through existing infrastructure, facilities and human
resources. Indicative budget for three years (2006-2008) was estimated a total of US $ 113.834 million.
MULTI-SECTORAL COLLABORATION AND COORDINATION
There is limited collaboration and coordination between human and animal health sectors in surveillance, disease
reporting, risk communication, and other key areas. Moreover, there is minimal communication, involvement and
coordination between relevant ministries necessary for effective prevention and response to avian influenza and
human pandemic influenza in Bangladesh. So multi-sectoral collaboration and coordination are of paramount
importance and must be established urgently for successful implementation of this plan.
The following key Ministries/Divisions have been identified as playing a significant role in prevention and control of
avian influenza and human pandemic influenza in Bangladesh:



















The Prime Minister’s Office
Ministry of Environment and Forest
Ministry of Fisheries and Livestock
Ministry of Health and Family Welfare
Economic Relation Division (ERD)
Ministry of Civil Aviation and Tourism
Ministry of Commerce
Ministry of Communication
Ministry of Education
Ministry of Food and Disaster Management
Ministry of Finance
Ministry of Home Affairs
Ministry of Industries
Ministry of Information
Ministry of Law, Justice and Parliamentary Affairs
Ministry of Local Government, Rural Development and Cooperation
Ministry of Planning
Ministry of Shipping
NGO Affairs Bureau
However, of these Ministries, the Ministries of Environment and Forest, Fisheries and Livestock, and Health and
Family Welfare will play the most prominent roles in the various stages of the pandemic in Bangladesh.
In addition to these, collaboration and partnerships with members of UN bodies, non-governmental organizations
(NGO), civil society organizations, religious bodies, and the private sector will be instrumental in ensuring effective
response to influenza pandemic through development of capacities and utilization of resources.
NATIONAL ADVISORY COMMITTEE
This will be the apex body with ministers of 17 relevant ministries as the members. The ministers of MoFL and
MoH&FW will lead the committee depending upon the pandemic stage. In Phase 1, the Honorable Minister of MoFL
will be the chairperson while in Stage 2, Honorable Minister of MoH&FW will chair the committee. However during
the pandemic period concerted activities will be carried out under the leadership of the Honorable Prime Minister
of Bangladesh.
NATIONAL MULTI-SECTORAL TASK FORCE
This committee comprised of representatives from relevant ministries, directorates, UN bodies, professional
bodies, business bodies, NGO, civil society and nominated members. National Task Force will take measure to
implement decisions taken by the national advisory committee.
United Nations Contingency Plan for the Avian Influenza Pandemic - Bangladesh
69