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


The Inter-Country Meeting on Avian Influenza and ... 2 million pilgrims from all around the world converge on Jeddah (Mecca, Medina, Mina and Arafat) ... – PowerPoint PPT presentation

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

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

Pandemic Influenza Burden in Health Care
  • 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
  • influenza Network Members and key partners
    and stakeholders)

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

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

The Importance of the Regional Influenza
Surveillance Program
Memorandum of UnderstandingA Tri-lateral
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))

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

EMR Regional Influenza Network Program
  • 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)

Pilgrimage to Makkah (Hajj)
  • Sentinel surveillance
  • 2 million pilgrims from all around the world
    converge on Jeddah (Mecca, Medina, Mina and
  • One month buildup
  • Close contact for five days
  • Departure over 2 wks
  • The Hajj shifts back on the calendar 10 days per

2004 Hajj Results
no isolate
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)

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

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

Regional Alert, Surveillance and Detection of
Outbreak Network (RASDON)
  • A web-based system (accessibility to updated
  • 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
  • Dynamic data entry forms (design, storage, and
  • Indicators, dynamic mapping (population subgroup)
  • Alerts, communication modules (e-mail messages,

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
  • Advising to improve transparency in reporting of
  • Providing recommendations as requested by EMRO

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
  • Strategic vaccine stockpiles (meningitis, yellow
    fever, smallpox and the same for polio in
  • Working closely with countries (to revise the
    International Health Regulations should a global
    public health emergency arise

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

  • 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)