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Avian Influenza Prevention, Preparedness Detection and Response to a human pandemic

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Title: Avian Influenza Prevention, Preparedness Detection and Response to a human pandemic


1
Avian Influenza Prevention, Preparedness
Detection and Response to a human pandemic
  • Dr Henk Bekedam
  • WHO Representative, China
  • 21 November 2005

1
2
Presentation Summary
  • Learning lessons from SARS and avian influenza
  • An update on avian influenza
  • What is an influenza pandemic?
  • How best to prepare?
  • Preventing a pandemic
  • Strengthen early warning system
  • Contain or delay spread at source
  • Reducing the impact of a pandemic
  • UN WHOs role in this respect

2
3
Learning Lessons
  • An infectious disease in one country is a threat
    to others
  • Global threat needs global response
  • The best chance to eradicate or contain a new or
    a re-emerging disease is when it surfaces
  • Early reporting, sharing of information and virus
    samples within countries and with the
    international community is key to timely response
  • Containing emerging diseases requires government
    commitment and international collaboration

3
4
… Learning Lessons
  • 75 of emerging diseases are zoonotic.
    Cooperation between Health, Agriculture Forest
    administrations responsible for domestic and wild
    animals is crucial
  • Market failures in public health. Governments
    need to take greater responsibility in Public
    Health market fails in these areas
  • Awareness
  • Surveillance
  • Hospital infection control
  • Treatment of infectious diseases

4
5
Global animal outbreaks (as of early November
2005)
  • Avian influenza in poultry geographical spreading
    north and westwards to Mongolia, Kazakhstan,
    Russia, and now Europe (Turkey, Croatia, Romania)
    and Kuwait
  • H5N1 more diverse in affecting animals
    migratory birds (2005) which were previously
    resilient to H5N1 tigers and cats can also be
    affected
  • Duck as asymptomatic carriers
  • Spreading of H5N1 outbreak through
  • (1) likely migratory birds (asymptomatic???)
  • (2) trade (England, Kuwait)
  • (3) environmental factors???

5
6
(No Transcript)
7
Source OIE Accessed 11 Nov
8
Global human avian influenza (as of 16 November
2005)
  • Hong Kong 1997 (18 cases / 6 deaths) and 2003 (2
    - 1)
  • Since December 2003 128 cases 65 deaths
  • Human cases in Thailand, Vietnam, Cambodia,
    Indonesia, and now also in China
  • Epidemiological changes North Vietnam
  • Current virus NOT transmittable between humans!!!

8
9
Confirmed human cases H5N1 Dec 2003 to 17 Nov 2005
Over-all CFR 52
10
From WHO Western Pacific Regional Office
(Accessed on 16 November 2005)
11
China avian influenza
  • China has approximately 14 billion domestic
    birds, of which 70 being raised in backyard
    farming
  • H5N1 virus circulating since 1996 with poultry
    vaccination for 20-25 of poultry now want to
    vaccinate 100
  • 2004 50 poultry outbreaks in 16 provinces
  • 2005 21 outbreaks, incl. migratory birds in
    Qinghai others Xinjiang (2x 4x), Tibet,
    Inner Mongolia (2x), Anhui (2x), Hunan, Liaoning
    (4x), Hubei (3x), Shanxi
  • Two confirmed cases and one likely case (Hunan
    Anhui)
  • Three out of 8 major migratory bird routes
    through China

12
From FAO (Accessed on 31 October 2005)
13
CONCLUSION … avian influenza
  • H5N1 well entrenched in big parts of South East
    Asia
  • H5N1 continues to spread more widely role
    migratory birds?
  • H5N1 is a formidable threat
  • H5N1 precursor for pandemic?
  • Mutation of virus
  • Re-assortment

13
14
3. What is an influenza pandemic?
  • Emergence of new strain of influenza that
  • To which humans have no or little immunity
  • Can infect humans and cause severe disease
  • Can spread easily between people

14
15
A human pandemic will spread fast ? need to
plan NOW …
15
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Across the nation in three weeks
19
20
A pandemic is overdue … Influenza pandemics
20th century
Credit US National Museum of Health Medicine
1918 Spanish Flu 20-40 million deaths A(H1N1)
1957 Asian Flu 1-4 million deaths A(H2N2)
1968 Hong Kong Flu 1-4 million deaths A(H3N2)
20
21
Planning Scenario
  • Non-Health
  • Absenteeism in essential services like transport,
    food and security will disrupt our daily lives
  • Slowdown in economic and commercial activity
  • Cancelled air, land and sea transport
  • Fear and public safety concerns and high demand
    for information and advice on services available
  • Health
  • Increased morbidity and mortality
  • Increased demand for health services with severe
    shortage of staff, medical supplies and equipment
  • Disruption of routine health programmes

21
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4. How best can we prepare?
  • What is needed is an increased global capacity.
    The system is as strong as the weakest link.
    There is a clear need for countries to
    effectively help each other.
  • Reduce opportunities for human infection
  • Strengthen early warning system
  • Contain early human clusters and delay spread at
    source
  • Reducing morbidity, mortality and maintain
    essential services

22
23
WHO Pandemic phases
  • Phase 3 Now
  • Phase 4 Small cluster human cases
  • Affected country or close travel/trade (4A)
  • Unaffected country (4U)
  • Phase 5 Large cluster of human cases
  • Phase 6 Pandemic begun

23
24
How best can we prepare?
  • 1. Prevention remains the best reduce
    opportunities for human infection
  • (1) Controlling outbreaks in birds
  • (2) Animal and Human Interaction
  • Animal husbandry living safe with animals
  • Separate animals to avoid cross-infection
  • Challenge of regulating or abolishing wet markets
    and improve slaughter practice
  • (3) Bio-safety bio-security crucial to
    contain emerging diseases

24
25
How best can we prepare?
  • 2. Pre-pandemic planning
  • Assumptions
  • First wave will last for 6 months
  • 30 population ill during first wave
  • Borders may close for first few weeks and may be
    difficult to travel even after that
  • Absenteeism will be very high and country may
    struggle to maintain essential services
    (transport, food, and security)
  • Define roles responsibilities
  • County, prefecture, provincial level authorities
  • National authorities State council, MoH, MoA,
    AQSIQ
  • International authorities WHO, FAO, OIE, other
    UN agencies, and others

25
26
How best can we prepare?
  • 3. Early warning system - detection
  • Human and animal surveillance
  • Strengthen community surveillance for poultry
  • Cluster detection crucial in human surveillance
  • Laboratory diagnostics networks within countries
    and with the international community
  • Sharing of information and virus remain key in
    timely response
  • Disease outbreaks have negative economic impact
    on tourism, travel and trade - disincentive for
    reporting need for a global fund???

26
27
How best can we prepare?
  • 4. Contain or delay spread at source
  • (1) Anti-viral stocks
  • Prophylactic use for those on the front line
    treatment
  • WHO global stocks in case of clusters (H2H)
    during early outbreak
  • Availability of anti-virals for developing
    countries is unrealistic as supplies are limited
    and costs are high
  • (2) Setting up antiviral resistance surveillance
  • (3) Non-pharmaceutical interventions aim to
    reduce number of cases and delay spread of
    pandemic
  • Case isolation, border screening, travel
    restrictions, closing of schools, a ban on mass
    gatherings, travel restrictions, etc.

27
28
How best can we prepare?
  • 5. Reduce morbidity, mortality and social
    disruption
  • (1) Vaccines are the key to containment!!!
  • Augment vaccine supplies 6 months until vaccine
    can be produced, little surge capacity globally,
    stockpiling not possible
  • Need to increase global and local capacity to
    develop vaccine
  • Ensure equitable access to vaccines
  • (2) Monitor evolving pandemic in real time and
    conduct research to guide response measures
  • (3) Introduce non-pharmaceutical interventions
  • (4) Use of anti-virals to protect priority group
    frontline workers

29
How best can we prepare?
  • 6. Communication
  • Must be part of any outbreak response at early
    stage
  • Make people aware of what to do and what not to
    do
  • Important to guide the population Dont create
    panic and unnecessarily fear
  • BUT Communicating what constitutes a public
    health threat is difficult and journalists are
    generally much better in spreading the scary news
    than the re-assuring messages

29
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5. UN WHO role
  • UN role
  • Avian Influenza is more than a Human Animal
    Health issue. It requires a multi-sectoral and
    multi-agency involvement (FAO, WHO, UNDP, WB,
    ADB, UNIDO, UNICEF)
  • UN coordinated approach by Resident Coordinator
    office in supporting a multi-sectoral Govt plan
    to prevent, prepare, and respond to AI

30
31
World Health Organizations Role
  • International Health Regulation (IHR)
  • ensure maximum protection of people against
    international spread of diseases, while
    minimizing interference with world travel and
    trade
  • World Health Assembly May 2005 the new IHR has
    been adopted by 190 member states will enter into
    force by June 2007
  • Capacity building technical assistance to
    member state
  • Global Outbreak Alert and Response Network (GOARN)

31
32
Influenza Pandemic Not a matter of if, but when
…
  • No need to panic no time for complacency either
  • TIME TO PREPARE

33
6. Staff safety and contingency planning
  • Guidance only in response to request for
    information from international community

31
34
Staff safety now
  • Avoid unnecessary contact with live poultry
  • Care when visiting rural households
  • Check no recent deaths poultry, respiratory
    illness in household
  • Avoid close contact with poultry
  • Hand washing (carry alcohol rub)
  • Clean shoes after visit
  • Access to Tamiflu for frontline workers

33
35
Staff safety now
  • Food safety
  • Cook poultry and eggs well (5 minutes, 70
    degrees, no pink meat, no runny eggs)
  • Clean eggs if obviously dirty
  • Hand washing and overall hygiene,
  • Cough etiquette (no spitting please
  • Avoid work if ill
  • Seasonal influenza vaccine
  • High risk complications gt65, chronic illness
  • High risk workers (lab, hospital, poultry)
  • Essential workers
  • Pneumococcal vaccine for gt65 or chronic illness

36
Preparedness
  • Business continuity plans
  • Social distancing/travel
  • Relocation of staff
  • Stockpiling
  • Medical care contingency plans
  • Education and child care contingency plans
  • Communications

36
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Preparedness
  • Business continuity
  • What are the essential functions?
  • Who can and could do these?
  • How can they be done in safest way
  • Distancing of staff
  • Home working, phone etc
  • Screening for fever in office etc
  • Social distancing/travel
  • Trigger point
  • Plans for alternative ways of doing business

37
38
Preparedness
  • 3. Stock piling
  • Antivirals policy for use, child doses
  • Masks
  • Antibiotics and sterile medical equipment
  • Water purification tablets
  • Hand wash/alcohol rub
  • 4. Medical care
  • Medivac
  • Health care Home care
  • 5. Education/child care
  • 7. Communications
  • Start now more is better than less

38
39
Influenza Pandemic Not a matter of if, but when
…
  • No need to panic no time for complacency either
  • TIME TO PREPARE
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