Global Influenza Surveillance Network (GISN) Activities in the Eastern Mediterranean Region

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1 Global Influenza Surveillance Network (GISN) Activities in the Eastern Mediterranean Region Dr Hassan El Bushra Regional Adviser, Emerging Diseases, Communicable Diseases Surveillance, Forecasting and Response/EMRO Page 1 of 13

2 WHO Vision: Every country should be able to quickly detect, rapidly verify and appropriately respond to epidemic-prone and emerging disease threats as and when they arise, be they natural, accidental or intentional in origin, thereby containing them locally and minimising their impact on the health and economy of the world's populations Different Types of Influenza: Different Goals, and Different Strategies Seasonal Avian Pandemic Different phases of pandemic influenza Different strategies Page 2 of 13

3 Importance of Influenza Surveillance in the Eastern Mediterranean Region (EMR) Numerous large cities in the EMR with extremely heavy human traffic all over the EMR (Expatriate workers, tourism and religious visitors) 11 out of 22 EMR countries witnessed outbreaks of avian influenza Migratory birds flyways traverse the EMR Nothing or very little is known about influenza circulation among populations of almost all EMR countries Dates of onset of outbreaks of avian influenza in the EMR Palestine 17 March 2006 Jordan 24 March 2006 Iraq 2 February 2006 Egypt 17 February February March 2006 Saudi Arabia 16 November 2007 Sudan 2 May 2006 H5N1 not reported (N=11) H5N1 reported in poultry (N=5) H5N1 reported in wild/migratory birds (N=2) H5N1 reported in poultry and humans (N=4) Kuwait 11 November 2005 Djibouti 9 April 2006 Pakistan 21 March 2006 Page 3 of 13

4 Pilgrimage to Makkah (Hajj) Sentinel surveillance 2-3 million pilgrims from all around the world converge on Jeddah (Mecca, Medina, Mina and Arafat) One month buildup Close contact for three days Departure over 2 wks The Hajj shifts back on the calendar 10 days per year 2004 Hajj Results H1N1 H3N2 B Unkown virus no isolate Page 4 of 13

5 Lessons Learnt Outbreaks are entry points for strengthening capacity for surveillance and response Partnership has improved alerting, reporting and response in the event of suspected outbreaks and saved time, money and lives Expanding partnership beyond health agencies improved reporting and geographical coverage Success in using scarce resources to build capacity: for an integrated disease surveillance and response framework The Importance of the Regional Influenza Surveillance Program Page 5 of 13

6 Memorandum of Understanding A Tri-lateral Agreement Justification for the Trilateral Agreement Surveillance for influenza is a high priority for DCD- EMRO and member countries in the EMR NAMRU-3 is a regional reference laboratory and a WHO collaborating centre. It has technical expertise in influenza surveillance, virus isolation, basic serotyping and molecular characterization Many countries within the region have their own Influenza surveillance but no sharing of data or experience (Morocco, Iran, Pakistan, Egypt, Syria and Oman) Page 6 of 13

7 Objectives of Sentinel Influenza Surveillance To characterize influenza viruses circulating in the EMR: When? Where? Which? Intensity? Dynamics? Impact? To detect unusual events (including the emergence of new strains) To upgrade laboratory and epidemiology capacity for influenza surveillance through: Assessment and training activities Fostering collaboration and data sharing among member countries To assist in disease control by making recommendations based on surveillance data Monitoring and evaluation of prevention activities Why Influenza Surveillance? A well-organized network of diagnostic laboratories forms the basis for the successful surveillance of respiratory viruses and other infectious diseases allows: accurate identification of viruses and exclusion of other infections successful isolation of the virus is crucial for determining its type and subtype and for further characterization. detection and identification of newly emerging epidemic variants in a timely manner Contribution to the selection of appropriate vaccine strains Page 7 of 13

8 Objective for MOU with NAMRU-3 To ensure that NICs has all supplies, training and infrastructure to accomplish virus isolation and subtyping To provide training, supplies and other laboratory services as a reference laboratory To send a random sample of virus isolates and all untypeable isolates are immediately forwarded to a global reference laboratory Expected Outcomes of the MOU Activities Ensuring: vaccine recommended by WHO for the northern hemisphere is also appropriate for people in the EMR Developing possible models of the inter-country transmission of influenza viruses within the region to predict how a pandemic virus spreads Detecting onset of next pandemic in the EMR Page 8 of 13

9 EMR Regional Influenza Network Program Activities Syndromic surveillance for incidence of influenza-like illness (ILI) Tabulation and mapping of data (ILI and virus isolation/subtyping) and publication on an EMRO maintained secure website Ideally: A NIC in every country (Lack of resources and capacities) Steps for Establishing an NIC in the EMR Approvals Country, NAMRU-3 and EMRO Signing the agreement Initial visit to explain work, meet all the partners, meet points of contact (POC), choose & visit the collecting sites, assessment of the lab capacity & agree on plan of work Initial report/ plan Training visit Field and Lab Collecting specimens, testing, reporting and sharing Isolates & data Follow up visits when needed Page 9 of 13

10 Who is the next to join? How can we help? In the EMR we have: Countries with Influenza surveillance and NIC Countries with Influenza surveillance and a working Influenza laboratory Countries with Influenza surveillance but no Influenza laboratory Countries with no Influenza surveillance National Influenza Centers (NICs) in the EMR NIC TA Country TA NIC None Afghanistan Bahrain Djibouti Egypt Iran (Islamic Republic of) Iraq Jordan Kuwait Lebanon Libyan Arab Jamahiriya Morocco Oman Pakistan Palestine Qatar Saudi Arabia Somalia Sudan Syrian Arab Republic Tunisia United Arab Emirates Yemen Page 10 of 13

11 Checklists for NIC Challenges Lack of transparency Inadequate epidemiological and laboratory surveillance capacities in most EMR countries High turnover of staff (train and retain) Inadequate inter- and intrasectoral communication Poor or non-existent infection control programs Missed opportunities: Major outbreaks have not triggered national long-term plans for prevention and control of diseases have not been used to establish prompt and coordinated response and interventions Page 11 of 13

12 Challenges Larger cluster of human cases in Egypt in 2007 Training activities on IATA shipment : Need funding Upgraded laboratories: BL3 / Regional: Only one Regional Reference laboratory for influenza (Capacity building) Stronger CSR Unit: Need a laboratory person Need more NICs Transparency: Who should be reporting? Documentation: Timely translation of documents into Arabic Other supporting/ demanding/ competing/ parallel programs Pandemic H1N1 Avian Influenza Influenza atti-yoor influenza assi roor Implementation of pandemic preparedness plans EMRO: SHOC, press conferences, updates Countries: Weaknesses revealed Management of CPHL/NICs Flow of epidemiologic information Strengthening diagnostic capacities (support from NAMRU-3): Series of training activities, Reagents Regional, sub-regional and country meetings Consultations: Clinical management Sentinel surveillance Closure of schools JAZEERA satellite TV: Painful experience Page 12 of 13

13 Thank you!! Page 13 of 13