Title: The InterCountry Meeting on Avian Influenza and Preparedness for Human Pandemic Influenza
1Regional Plan for Strengthening Surveillance and
Response for Human Pandemic Influenza in the
Eastern Mediterranean Region (EMR)
- Hassan El Bushra
- Regional Adviser, Emerging Diseases,
- Communicable Diseases Surveillance, Forecasting
and Response, WHO/EMRO
2Pandemic Influenza Burden in Health Care
Services
- The Global influenza Program (GIP) aims at
strengthening global epidemic and pandemic
preparedness through
- Quality global influenza surveillance
- Improved understanding of health and economic
burden of - influenza
- Accelerated influenza vaccine development and use
- More rapid communication and information exchange
(WHO, - influenza Network Members and key partners
and stakeholders)
3Importance of Influenza Surveillance in the EMR
- EMR is nearer the current focus of avian
influenza than any other region outside Asia - Migratory birds flyways pass through the EMR on
their way between Asia, Europe and Africa - Nothing or very little is known about influenza
circulation among populations of almost all EMR
countries
4Importance of Influenza Surveillance in the EMR
- Numerous large cities in the EMR
- Extremely heavy human traffic all over the EMR
- Expatriate workers
- Tourism
- Religious visitors, especially Hajj and Umra
- Is not regarded as a reportable disease
5The Importance of the Regional Influenza
Surveillance Program
6Memorandum of UnderstandingA Tri-lateral
Agreement
7Trilateral MOU Participating Countries
- Morocco, Syria, Pakistan (Geographical
distribution, large population) - Egypt (Vast metropolis of Cairo, massive human
traffic between all continents, concentrating
point of a major migratory bird flyway
- Oman (Significant human movement between the
Sultanate and Asia) - Saudi Arabia (Pilgrimage to Makkah (Hajj))
8Objective 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
9EMR 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)
10Pilgrimage to Makkah (Hajj)
- Sentinel surveillance
- 2 million pilgrims from all around the world
converge on Jeddah (Mecca, Medina, Mina and
Arafat)
- One month buildup
- Close contact for five days
- Departure over 2 wks
- The Hajj shifts back on the calendar 10 days per
year
112004 Hajj Results
H3N2
H1N1
no isolate
12Assessment of capacities and Training Activities
- Visit to all of 6 countries for assess capacities
and needs - Saudi Arabia
- Technical assistance of Hajj of 2004, 2006
- Training two Saudis for weeks at NAMRU-3, Cairo
- Investigated an outbreak of AI in Iraq
- Supporting activities at (Lebanon and Sudan)
- Trained 13 virologists at the UK (one week)
13Expected 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
14EMR Regional Task Force for Avian Influenza and
the Preparedness for Human Pandemic Influenza
- To finalize the Regional Preparedness Plan
(ensure this plan deals with all aspects of the
health system response) - To develop plans and proposals for resource
mobilization to support the implementation of
Plans (the Regional Strategic plan as well as
the country plans) - To work as a forum to develop and disseminate
information on Avian Influenza ( professionals
and the public) - To support the work of CSR Unit in the area of
Avian Influenza
15Regional Alert, Surveillance and Detection of
Outbreak Network (RASDON)
- A web-based system (accessibility to updated
information) - Data entry at source (multi-level, multi-sector,
and multi-role) - Flexibility (Data bases, output, etc.)
- Validation (different levels)
- Security and back up (understanding trends over
years) - Dynamic data entry forms (design, storage, and
retrieval) - Indicators, dynamic mapping (population subgroup)
- Alerts, communication modules (e-mail messages,
SMS)
16Regional Surveillance Advisory Group (SRAG)
- Providing guidance on the scope, function, and
primary responsibilities of the CSR/EMRO - Developing strategies for combating spread of
outbreaks of epidemic-prone diseases with
available resources in the EMR - Mobilizing resources for effective implementation
of IHR - Setting guidelines for long-term epidemic
preparedness - Advising to improve transparency in reporting of
epidemics - Providing recommendations as requested by EMRO
17Strategic Health Operation Centre (SHOC)
- Uses a state-of-the art communication technology
- Well-tested intelligence system (gathering
information from Member States, the Web and from
formal and informal networks) - Verification (Regional network for rapid
verification with countries) - Access to the best scientific expertise, and
timely response (meetings via telephone or
video-conferencing) - Strategic vaccine stockpiles (meningitis, yellow
fever, smallpox and the same for polio in
post-eradication) - Working closely with countries (to revise the
International Health Regulations should a global
public health emergency arise
18 Keeping all informed by
- Forwarding information received from HQ
- Information bulletins
- Intercountry meetings
- Participation in scientific meetings
- Talking to the media when appropriate
- Answering specific queries
- Coordinating efforts
19Challenges
- Only one Regional Reference laboratory for
influenza (Capacity building) - Timely translation of documents into Arabic
- Resource mobilization, including funding
- Stockpiling of antiviral drugs (production at
Regional level) - Access to new influenza vaccines
- Developing adequate capacities takes many years
(retain the trained)
20THANK YOU !