Using Geographical Information System tool in containing influenza pandemic threats

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Using Geographical Information System tool in
containing influenza pandemic threats

• Republic of Lebanon
• Ministry of Public Health
• Epidemiological Surveillance Program
• Nada Ghosn, MD

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Influenza seasonal, pandemic, avian
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Human influenza

• Seasonal influenza
• Annual outbreaks due to minor changes in the
  surface of the influenza viruses
• Human have partial immunity due to previous
  infections.
• Pandemic influenza (???????)
• Global and worldwide severe epidemic
• Due to major change
• No human have partial of fully immunity against
  infection because it is a completely new virus.

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Latest Influenza pandemics
Credit US National Museum of Health and 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)
Next? XX Flu millions deaths A(H5N1)?
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Animal influenza

• Avian influenza
• Highly Pathogenic Avian Influenza (HPAI)
• Low Pathogenic Avian Influenza
• Outbreaks of new avian influenza
• Increase the risk of a human pandemic
• Through the merging of animal and human influenza
  viruses.

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Influenza virus H5N1

• The new H5N1 avian influenza is a potential
  candidate for pandemic influenza
• Can affect animals and birds on a large scale
• Can affect humans and cause severe disease
• But still can not be transmitted from
  human-to-human

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How to control/prevent pandemic influenza?

1. Containment of potential human pandemics at the
   source
2. Containment of HPAI in animals at the source

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Pandemic Influenza modelingTime factor

• Any delay will reduce the probability of
  eliminating large epidemics in humans

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Probability of eliminating a large epidemic using
social and geographical targeting prophylaxis,
varying with the delay (0-4 days) from case
detection to prophylaxis for the 5-km radius
policy

• Delay of 4 days reduce the probability of
  eliminating a large epidemic of a new pandemic
  virus to
• lt50 for a virus with R0gt1.5
• R0 quantifies the transmissibility of pathogen

Source Ferguson, Derek, Cummings, Cauchemaz,
Fraser, Riley, Meeyai, Lamsiiriithaworn, Burke.
Strategies for containing an emerging influenza
pandemic in Southeast Asia. Nature. Vol. 437. 8
September 2005
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Containment pandemic influenza WHO plantime
factor

• The success of any strategy for containing an
  emerging pandemic virus is strictly TIME DEPENDENT

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WHO pandemic influenza plan

• The success of any strategy for containing an
  emerging pandemic virus is strictly TIME
  DEPENDENT.
• Objectives of containment strategy
• To stop, or at least to slow, the spread of
  pandemic influenza at the source of its emergence
  in order to reduce global morbidity and mortality
  

Source WHO pandemic influenza draft protocol for
rapid response and containment. 30 May 2006
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WHO pandemic influenza plan

• Recognition of the event
• Epidemiological and virological signals
• Steps of initial investigation
• Verifying the event
• Risk assessment
• Immediate control measures
• Containing the event
• Decision to launch a containment operation
• Phase 1 - standard measures to reduce
  transmission case management, infection control,
  antiviral treatment, intensified surveillance,
  contact tracing, monitoring contacts for signs of
  illness
• Phase 2 - exceptional measures voluntary
  quarantine, social distancing, mass antiviral
  prophylaxis

Source WHO pandemic influenza draft protocol for
rapid response and containment. 30 May 2006
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Containment avian influenza FAO planTime factor

• Timely reporting and timely response

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FAO Recommendations

• Early detection, and rapid response
• The main measures to prevent, control and
  eradicate HPAI are
• Effective disease surveillance for early
  detection and reporting
• Enhanced biosecurity of poultry farms
• Control of movement of birds and products
• Changes to industry practices to reduce risk
• Rapid, humane destruction of infected poultry and
  poultry at high risk of infection (stamping out)
• Disposal of carcasses and potentially infective
  material in a biosecure and environmentally
  manner
• Proper use of vaccine

Source FAO - 2005
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Containment factors available information

• Available information can reduce delay in
  conducting response measures

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Lebanon, March-April 2006 Influenza H7N7 risk
Tyr caza
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Lebanon Influenza H7N7 risk Tyr caza,
March-April 2006

• MOA
• What is the area size?
• What are the target farms?
• What are the target birds size?
• Collecting data was time consuming (gt2 days) and
  has delayed the stamping out measures

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Lebanon Influenza H7N7 risk Tyr caza,
March-April 2006

• MOI
• What is the target area?
• What is the area targeted for quarantine?
• What is the perimeter?
• How many human resources are needed?

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Lebanon Influenza H7N7 risk Tyr caza,
March-April 2006

• Municipality
• How many human resources are needed?
• Short cut of human resources was observed and
  prolonged field activities

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Lebanon Influenza H7N7 risk Tyr caza,
March-April 2006

• MOPH
• What are the exposed persons targeted for health
  monitoring ad active surveillance? Professionals,
  farms, households
• What are the health structures in place for case
  referral and case management?
• What are the needed resources?

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How to avoid containment delay?

1. Be prepared
2. Visualize risky areas
3. Have centrally available information and maps to
   decide on strategy and needed resources
4. Save time and act rapidly

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Avian Influenza Preparednessusing GIS tool

1. Preparedness tool
2. Visualization of risky areas
3. Decision tool
4. Save time

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If Influenza A/H5N1 virus appears in Lebanon

• All response measures aim to
• Prevent the spread of the virus
• Contain the virus at the source (focus)

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If Influenza A/H5N1 virus appears in Lebanon

• Response measures include
• Specify a 3km radius zone from the index case and
  control its movements at entry and exit
• Control (destroy) all poultry in the security
  zone (3km radius)
• Detect poultry cases in a 7km radius zone with
  enhanced veterinarian surveillance
• Detect human cases in affected areas
• Prepare health structures to manage human cases
• Close community gathering places
• Rise public and professional awareness

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Quarantine - Security and Surveillance zones
Actor Questions Parameters
Q1 MI/FSI What are the limits of the security and surveillance zones?
Q2 MI/FSI What are the needed resources to quarantine the security zone? Needed quarantine resources / km (Human, equipment, financial, information)
Q3 MI/FSI What are the suitable places for the entry/exit check points? Criteria for suitable places for check points
Q4 All What are the needed resources at the entry/exit check points? Needed resources / check point (Human, equipment/material, financial, information)
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Quarantine - Security and Surveillance
zonesalgorithm
Roads
Spatial map
Q1
Security zone
Suitable check points
Buffered Zone 3km
Select Road-based Security Zone
Suitable places For checkpoints
Buffer 3km
IndexCase
Q1
Surveillance zone
Buffered Zone 7km
Select Roads-based Surveillance Zone
Buffer 7km
Q2
Q3
Q4
FSI Report Needed Quarantine resources
FSI Report Suitable Entry/exit check points
All Report Needed Resources at check points
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2. Destroy poultry in 3km radius zone
Actor Questions Parameters
Q1 MOA What are target farms and backyards for poultry stamping out? What are the target poultry population for stamping out?
Q2 MOA What are the needed resources for rapid and adequate stamping out? Needed resources for adequate stamping out ( backyard, traditional modern farm)
Q3 MOA What are the needed resources for farms disinfections? Needed farms disinfections resources
Q4 MOA What are the suitable places for disposal carcasses and infective material without water contamination? Criteria for suitable places for carcasses burial without water contamination
Q5 MOA/ MF What are the needed resources for farms compensation? Compensation / poultry species, type and age
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2. Destroy poultry in 3km radius zone algorithm
Q1
Q3
Q2
MOA Report Needed stamping resources
MOA Report Needed Disinfections resources
MOA Report Target Farms in Security Zone
Security zone
Q5
MOA Report Compensation estimations
Q1
Target Farms in security zone
Select within Security Zone
FarmsDataBase
Water resources
Q4
Suitable Places for carcasses burial
Land Use
Suitability place for burial
Spatial map
Farms including slaughterhouses and poultry live
markets
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3. Detect poultry cases in a 7km radius zone
questions
Actor Questions Parameters
Q1 MOA What are the targeted farms and backyards for active surveillance?
Q2 MOA What are the targeted wild birds itinerary for active surveillance?
Q3 MOA What the needed resources for active surveillance, specimens collection and transportation? Needed resources for active surveillance, specimens collection and transportation / surveillance point
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3. Detect poultry cases in a 7km radius zone
algorithm
Q1
MOA Report Target Farms in Surveillance zone
FarmsDataBase
Q1
Target Farms in surveillance zone
Q2
Select within Surveillance Zone
MOA Report Target wild birds surveillance
Surveillance zone
Q2
Target migratory Birds itinerary
Proximity
Migratory birds itinerary
Q3
MOA Report Needed surveillance resources
Index Case
Farms including slaughterhouses and poultry live
markets
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4. Detect human cases in affected area
Actor Questions Parameters
Q1 MOH What are targeted HEALTH STRUCTURES for enhanced and active surveillance?
Q3 MOH What are targeted FARMS for active human surveillance?
Q4 MOH What are targeted HOUSEHOLDS for active human surveillance?
Q5 MOH What the needed resources for active surveillance, specimens collection and transportation? -Needed resources for active surveillance, health monitoring, specimens collection and transportation -Needed resources for antiviral prophylaxis
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4. Detect human cases in affected area algorithm
Q1
Q1
MOH Report Target Health Stru. for active
surveillance
Target Health structures for surveillance
Security zone
Surveillance zone
Target poultry workers
MOH Report Target Poultry workers for active
surveillance
Health Structures
Q3
Q3
MOH Report Target Households for active
surveillance
Target households
Target Farms in security zone
Proximity
Q4
Q4
Spatial Map (building blocks)
Q5
MOH Report Needed Surveillance resources
Population
Q5
MOH Report Needed Anti-viral prophylaxis resource
s
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5. Prepare health structures to manage human
cases
Actor Questions Parameters
Q1 MOH What are targeted health structures for case referral? Criteria for reference health structures
Q2 MOH What are targeted health structures for training on case management and infection control? Criteria for training health structures
Q3 MOH What are needed resources for training on cases management and infection control? Needed resources for training on cases management and infection control / site
Q4 MOH What are needed resources for protecting, monitoring and ensure prophylaxis for care providers? Needed resources for protecting, monitoring and ensure prophylaxis / person
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5. Prepare health structures to manage human
casesalgorithm
Q1
Health Structures
Q1
MOH Report Reference Health structures
Reference Health structures
Patient transport services
Q1
Q1
MOH Report Reference patient transport service
Reference Transport services
Security zone
Surveillance zone
Suitability Proximity
Q3
Q2
MOH Report Needed resources for training on
case management and infection control
Target health structures for training
Spatial Map (building blocks)
Population
Q4
MOH Report Needed resources for protecting care
providers and antiviral prophylaxis
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6. Close community gathering places
Actor Questions
Q1 All What are targeted community gathering places for closure?
Q2 All What are needed resources to ensure closure of targeted community gathering places?
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6. Close community gathering places algorithm
Target Schools for closure
Report Target schools
Security zone
Surveillance zone
Target Common places for closure
Report Target Common places
Proximity
Spatial Map (building blocks)
Schools
Report Needed resources to ensure
Closure implementation
Community gathering places