The InterCountry Meeting on Avian Influenza and Preparedness for Human Pandemic Influenza

1
Regional 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

2
Pandemic 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)

3
Importance 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

4
Importance 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

5
The Importance of the Regional Influenza
Surveillance Program
6
Memorandum of UnderstandingA Tri-lateral
Agreement
7
Trilateral 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))

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

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)

10
Pilgrimage 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

11
2004 Hajj Results
H3N2
H1N1
no isolate
12
Assessment 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)

13
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

14
EMR 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

15
Regional 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)

16
Regional 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

17
Strategic 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

19
Challenges

• 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)

20
THANK YOU !