Influenza Surveillance in Thailand 2012

Influenza Surveillance in Thailand 2012 Thitipong Yingyong Bureau of Epidemiology, Thai-DDC 6 th NIC&Flu Surveillance Meeting, Vietnam May 29 th,2012

Influenza surveillance system R506 > Influenza, Pneumonia Influenza and AI case report Influenza Like Illness Severe Pneumonia project Outbreak notification Virologic surveillance Virologic ILI and Pneumonia Adverse Event Following Immunization 2 update on 24/05/55

- R506 software - Case report - Geographical, clinical and laboratory data - Public hospital and some private NATIONAL PASSIVE SURVEILLANCE: R506

Priority disease surveillance

Influenza reported rate by province, 2006-2010 2006 2007 2008 2009 2010 update on Apr 20, 2011 5

Reported rate of Influenza by age group, THAILAND 2010 Rate/100,000POP Year update on Apr 20, 2011 6

Reported case of Influenza by week, R506 since 2005-2008 Number of case Time (week) 7

Reported case of Influenza by month, 2009-2010 compare with median 5 year, Thailand Number of case Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Time (month) 2009 2010 Median 5 year 8

Geographical distribution ILI SYSTEM Trend

3 parts; -Routine on outbreak list -One Tambon One Outbreak (OTOO) -Sub-district SRRT network OUTBREAK NOTIFICATION SYSTEM

Number of outbreak notification by month, 2007-2011, Thailand email Telephone FAX Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2007 2008 2009 2010 2011 update on 16/01/55 11

Sub-district SRRT network event and outbreak notification system

Number of ILI and Influenza are notified

- Case report and investigation - Suspected AI and PI - Web based application - Since late of 2003 - Country wide PANDEMIC INFLUENZA AND AVIAN INFLUENZA NOTIFICATION

- Case report and investigation - CAP in healthy - Acute severe or death of unknown etiology - Both virus and bacteria are tested SEVERE PNEUMONIA SURVEILLANCE SYSTEM Adult age 15+ year old Children 2 moth -15 year old

- AEFI monitoring system - Pandemic flu vaccine in 2010 - Routine surveillance follow national campaign ADVERSE EVENT FOLLOWING IMMUNIZATION

Pandemic vaccine surveillance System HCWs Pregnan t Obesit y Handica p Chronic Dz Time frame Call center Jan May 2010 Follow up Jan May 2010 Self-reported Jan May 2010 17

- Virologic surveillance - ILI surveillance - Harmonized data for preparedness and warning INFLUENZA SENTINEL SURVEILLANCE SYSTEM

Phase II : sentinel sites (Sep.2009-Sep.2012) NIH 1. Chiang Rai (2 site) 1.Lop Buri BOE 2. Tak 2.Ubon Ratchathani 3. Nong Khai 3.Pijitt 4. Bangkok 4.Sukhothai 5. Nonthaburi 5.Maha Sarakham = NIH = BOE 6. Chantaburi 7.Prachuap Khiri Khan 8. Songkhla 9. Surat Thani 10. Phuket

Predominant subtypes of Influenza in Thailand, 2005-2011 2005: A /(H3) 2006: A /(H1) 2007: A /(H3) 2008: B 2009: A /(pandemic H1) 2010: A /(pandemic H1) 2011: A /(H3) Thai National Influenza Center

Results of influenza circulating strain by antigenic characterization from 8 sentinel hospitals, Jan.-Dec.2011 Percentage of Thai influenza local strains during Jan.-Dec.2011 pdma(h1n1) % A (H3N2) % B % A/California/07/2009 100.00 A/Perth/16/2009 100.00 B/Brisbane/60/2008 92.40 (H1N1) (H3N2) (Victoria lineage) B/Florida/60/2008 6.33 (Yamagata lineage) B/Wisconsin/01/2010 (Yamagata lineage) 1.27

Distribution of type and subtype of influenza virus resistance to Oseltamivir, January 2009 December 2011 Result of Oseltamivir resistance (NAI assay) Jan.2009 Dec.2011 No. test No. resistance % Resistant isolates A(H1N1) 45 43 95.55 Influenza virus A(H3N2) 232 0 0 B 177 0 0 pdm A(H1N1) 687 10 1.46

Strengthen rapid reporting system to monitor the trend of influenza activity and novel influenza strains Weekly report,monitoring trend of the outbreak by calculation of baseline and epidemic threshold Weekly Epidemiological Surveillance Report and pdm H1N1 weekly report

Influenza Vaccine and Vaccine Program in Thailand

Vaccine Introduction in the EPI/ national program, Thailand 1977 1984 1986 1988 1990 1997 2004 2005 2008 BCG DTPw OPV Typhoid M R HB JE MMR Flu in HCWs DTPw-HB Source: modified from DDC, MOPH 2009

Should we introduce seasonal influenza vaccine into other target groups??? presentation slide by Dr. Charung Muangchana MD, PhD

Deciding on new vaccine introduction into the EPI / national program, Thailand Policy issues + Programmatic issues Public health priority Disease burden Economic & financial Vaccine safety & efficacy Alternative interventions Programmatic strength Supply availability Sustainability

Estimation of seasonal influenza impact : Thailand Parameter or issue Influenza & pneumonia burden Methodology Key findings investigator / Reference Routine surveillance Prospective pop.-based surveillance Extrapolation from study of Simmerman, on reported data Reported Influenza cases: 17,424 / yr Pneumonia case: 145, 290 / yr Pneumonia deaths: 874 / yr 23% flu positive among ILI at OPD 10% of hospitalized pneumonia caused by influenza OPD visits from flu: 924,478 / yr Loss of work days: 3.1 mill. / yr Loss of school days: 1.7 mill. / yr Estimated (min) Flu cases: 749,189 cases / yr Pneumonia cases: 242,150 / yr Flu pneumonia cases 26,637 / yr Flu pneumonia deaths 161/ yr Bureau of Epidemiology, 2006 Simmerman M, et al, 2006 Charung M, In flu vaccination project proposal to NHSO Board, 2007

Estimation of seasonal influenza impact : Thailand (2) Parameter or issue Risk group Seasonality Match of circulating & vaccine virus Methodology Key findings investigator / Reference Prospective pop.-based surveillance Prospective surveillance Routine surveillance Laboratory surveillance, over the past decade Groups at risk of serious complications Elderly and young children Persons with chronic cardiac and respiratory diseases Persons hospitalized in previous year Influenza cases peak during June-October Influenza cases are reported all year round, more case during May-October, peaks usually in July Characters of circulating flu viruses in Thailand each year are close to those of recommended vaccine strains for both northern and southern hemispheres Simmerman M, et al, 2006 Simmerman M, et al, 2006 Bureau of Epidemiology NIH/ Dep.of Med. Sci./ MOPH

Estimation of seasonal influenza impact : Thailand (3) Parameter or issue Medical cost Vaccine effectiveness Benefit of flu vaccination Methodology Key findings Reference Prospective study Epidemiologic Survey Epidemiologic Survey Simple estimation Unit cost of pneumonia treatment: $ 490.8 in community hospital, $ 628.6 in provincial hospital Flu vaccination to the elderly will reduce pneumonia incidence by one half (AR 4.83% in vaccinated group compared with 10.88 in unvaccinated) Flu vaccine effectiveness 76% in persons with COPD Flu cases prevented: 400,000 / yr Pneumo. deaths prevented: 25,000/ yr Medical cost saved: 736 M baht Indirect cost saved: 800 M baht Olsen J S, et al. In Int J of ID (2006) 1.Rungnirand P. et al. In J Med Assoc Thai 2005 Wongsurakiat P, et al. In J Med Assoc Thai, 2003 Charung M, In flu vaccination project proposal to NHSO Board, 2007

Deciding on new vaccine introduction into the EPI / national program, Thailand Policy issues + Public health priority Disease burden Economic & financial Vaccine safety & efficacy Alternative interventions Programmatic issues Programmatic strength Supply availability Sustainability Seasonal influenza vaccine introduction into other target groups

Target groups & no. of doses of influenza vaccination, Thailand 2004-7 0.40 million doses per yr HCWs Poultry cullers * COPD, asthma, heart disease, cerebro-vascular dis., renal failure, chemotherapy, DM

Expanding target groups & no. of doses of influenza vaccination, Thailand 2004-7 0.40 million doses per yr HCWs Poultry cullers 2008-9 2010 2011 + + 0.52 2.20 million doses per yr Elderly > 65 yrs Pop with chronic conditions* 2.4 2.5 million doses per yr Pregnant Obesity Brain handicap Children 6 23 months * COPD, asthma, heart disease, cerebro-vascular dis., renal failure, chemotherapy, DM

Seasonal influenza vaccination services Pattern: National campaign Place : Hospitals Provider: Physicians, nurses Target : Voluntary Duration: June September Free of charge

Community involvement in risk communication Village Health Volunteers (over 800,000) in all communities actively participate in risk communication, health education including surveillance for flu and ILI. Local administrations, health authorities and NGOs jointly run regular villager dialogues on health issues including flu. This forum is instrumental for effective flu prevention in the community.

Lesson learnt from Thai s influenza immunization program Key success factors Strong evidence (information) Clear vaccination strategy Systematic vaccination managing Closed monitoring and evaluating Sufficient community and public informing & communicating Sustainability - not only budget, but also showing the impact

I would like to thank to. Dr. Charung Muangchana MD, PhD. National Vaccine Institute (NVI), Ministry of Public Heath