3.1 Pandemic Planning

The World Health Organization (WHO) defines surveillance as "the systematic ongoing collection, collation and analysis of data for public health purposes and the timely dissemination of public health information for assessment and public health response as necessary".⁷ Surveillance has a fundamental role during public health emergencies to provide accurate and relevant information to guide decision making. The AHMPPI recognises the need for international and domestic surveillance.

A draft surveillance annex to the AHMPPI was being considered by the Scientific Influenza Advisory Group (SIAG) and the AHPC Inter-jurisdictional Pandemic Planners Working Group (IPPWG) when the pandemic emerged. It drew from improvements in routine surveillance for influenza that were being developed by the Seasonal Influenza Surveillance Strategy Working Group (SISSWG) and the standing National Surveillance Committee,⁸ both under the governance of the Communicable Diseases Network Australia (CDNA). The document included different surveillance objectives for each phase, outlining what information would be required, what data would be collected to provide that information, how the data would be collected and by whom. Early in a pandemic it is important to accurately enumerate the number of cases and confirm the virus by laboratory testing of cases; later in a pandemic less detail is required about each case. The document also outlined the proposed reporting of surveillance data to inform policy and interventions during a pandemic.

The AHMPPI acknowledges that there may be a need to reassess the planning assumptions when a pandemic emerges. This would require more information than routine surveillance systems could provide and would need to be informed by field, scientific and epidemiological studies at the time of a pandemic. Studies could include serosurveillance studies as well as household studies such as modelling of virus transmission. How these studies would be undertaken and by whom was still under discussion when the pandemic emerged.
An internet-based national reporting system for disease outbreaks, NetEpi, had been developed and used during multi-jurisdictional outbreaks prior to the pandemic in 2009. NetEpi was developed to provide more detail during an outbreak, including a pandemic, than is usually provided nationally for other notifiable diseases under the National Notifiable Diseases Surveillance System (NNDSS). The recording of standardised information through NetEpi for each case would be facilitated by means of a data collection form (electronic and printable). An interface between NetEpi and each jurisdictional system had commenced development but was not completed before the 2009 pandemic.

3.1.1 Routine influenza surveillance

Influenza surveillance is complex. A full summary of Australia’s routine surveillance systems for influenza is provided elsewhere.⁹ It is impossible to identify and count every case of influenza. Few of the routine surveillance systems include any indication of disease severity. In seasonal influenza outbreaks, it is not critical to identify every case but only to identify enough to be aware of the burden on the community and the impact on health resources. Indicators of the number of cases in the community are usually used. For example, these data may be collected through sentinel surveillance systems for influenza-like illness (ILI) that use a sample of doctors in an area, as is done through the Australian Sentinel Practices Research Network (ASPREN) system. This can give an indication of the number of people with influenza in a wider area who consult a doctor within a given time period, such as one week. However, many factors may affect the representativeness of these data. Both laboratory staff and doctors notify cases of influenza to public health authorities. It had been planned, but not implemented prior to the pandemic, that sentinel laboratories would report the number of tests requested (indicating community ILI) in addition to the number of tests that are positive for influenza.

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⁷ World Health Organization (2005), International Health Regulations (2nd ed.), Geneva, Switzerland.
⁸ This group has now been renamed the National Surveillance Working Group.
⁹Kaczmarek, M, Owen, R & Barr, IG (2010), ‘Annual report of the National Influenza Surveillance Scheme, 2008’, CDI, 34(1), available from www.health.gov.au/internet/main/publishing.nsf/content/cda-cdi3401-pdf-cnt.htm/$FILE/cdi3401b.pdf.