wrap-up day 2. plenary four: pandemic and avian influenza updates pandemic h1n1 – origin of...

Wrap-up Day 2

Plenary Four: Pandemic and avian influenza updates

• Pandemic H1N1– Origin of pandemic H1N1 virus– Genetically and antigenically homogenous– A few isolates resistant to oseltamivir– Pathogenesis and transmissibility: ferret model

• Higher virulence?• Lower transmissibility

– Serosurveys• No cross reactivity with seasonal H1N1• 33 % elderly have antibody

• H5N1– 436 human cases– 2009 human cases in Egypt, Vietnam and China– Antigenic differences among different clades– Unique characteristics of H5N1 epizootic (spread / various species /

human cases / mutations)

Virology Update: Pandemic H1N1 and H5N1


• H5N1– More than 20 clinical trials– Different types of vaccines– No standard reagents

• Pandemic H1N1– Quality / efficacy / safety– Clinical trial starting– Immunogenecity: Probably OK– Adjuvant required?– Availability– Access

Vaccine development: Pandemic H1N1 and H5N1


• Cambodia– 8 cases so far, 7 died– Continue vigilance– Rapid response team ready to respond– Hospital preparedness– Laboratories (PI, NIPH, NAMRU2)

• China– Surveillance– 38 cases – Lower mortality in children– Two family clusters: one possible h-to-h

• Viet Nam– 111 cases with 56 deaths– 4 cases in 2009– Human isolates in different clades – Continuous outbreaks in poultry– Different clades in South and North

Updates on AI Situation

Plenary Five: Pandemic preparedness and response

– Prepare for extensive community transmission– APSED approach– Framework for action– Different stages and required intervention– Gaps identified

Framework of action

Fukuoka Meeting Summary

– Progress with Pandemic preparedness– Areas for improvement– Recommendations

Plenary Five: Pandemic preparedness and response

– Goals of PH intervention– Many available PH measures– Key considerations

• Bases on risk assessment, esp severity and potential impact• Should be evidence-based• Balance benefits against costs• Need to be tailored to country and local setting• Planning, coordination and communication are a key

Options for public health measures

Monitoring and Evaluation Joint WPRO/ USCDC

– Assess core capabilities– Determine progress– Compatible with APSED framework– Some key findings

SURVEILLANCE

COMMAND

PUBLIC HEALTH INTERVENTION

COMMUNICATIONHEALTH CARE

RESPONSE

HEALTH SECTOR

SOCIETAL LEVELHow to slow downthe transmission

Individual LEVEL

Laboratory

How to minimize

preventabledeaths

Partnership

Lessons Learnt(Epidemiology)

• Countries have been experiencing different stage– Sporadic imported cases– Local transmission / unlinked cases / school outbreaks– Widespread community transmission– Appearance of severe cases / deaths

• Different responses are required for different stages– Containment to mitigation: difficult to make a decision

(political / technical issues)• Majority cases self-limiting, but some severe cases /

deaths– Occurrence of severe cases / deaths depend on

epidemiological situation

Lessons Learnt(Command)

• Responses are based on existing national plan– National plans developed / revised before H1N1 pandemic

• Needs for adaptations of plan for H1N1 pandemic• High level command system in place in most countries– Inter-ministerial coordination– Multi-sectoral coordination

• Some issues for coordination– e.g. private sectors

Lessons Learnt(Surveillance)

• Improved surveillance capacity in past years – Fully utilized for H1N1 pandemic response– Laboratory capacity– Sentinel surveillance system

• Counting cases– Important and necessary in early stage– Less important and less informative after widespread community transmission– Changing sampling strategies

• Changing objectives for surveillance– Early detection / Description and assessment / Monitoring

• Change in sampling strategy not done in timely manner– Large number of samples sent to NIC– Pressures from hospitals / national authorities / politicians– Testing for PH surveillance vs. Testing for patient management– Labs overwhelmed

• Limited laboratories with diagnostic capability available– No lab at local level

Lessons Learnt(PH Interventions)

• Different policies for public health interventions, esp. school closures and border control measures– Lack of concrete evidence– Some effect in delaying the spread?– Negative impact / consequences depend on local setting– Public acceptance also depends on local setting

Lessons Learnt(Communication)

• Most countries appreciate importance of communication• Governments have been active in disseminating

necessary information– Media briefing– 24/ 7 hotlines etc.

• There are some issues and challenges– Confusing messages from media– Information does not reach to target groups (e.g. physician)

Lessons Learnt(Hospital preparedness)

• Many countries put hospital preparedness as a priority– Isolation facilities identified– Available isolation facilities limited (no surge capacity)

• Infection control: important, but still not fully addressed– Training – Availability of PPE

• Case management– Shortage of antiviral stockpiles– Late treatment with antivirals– Many challenges and issues if many severe cases occur (ICU beds,

respirator)

• Coordination: important but not easy– Hospital authorities– Private hospitals

Epidemiological Curve in JapanNumber of Confirmed Cases

5/5

5/7

5/9

5/11

5/13

5/15

5/17

5/19

5/21

5/23

5/25

5/27

5/29

5/31 6/

26/

46/

66/

86/

106/

126/

146/

166/

186/

206/

226/

246/

266/

286/

30 7/2

7/4

7/6

7/8

7/10

7/12

7/14

7/16

7/18

7/20

7/22

0

50

100

150

200

250

300

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

報告数累積報告数

5/5

5/7

5/9

5/11

5/13

5/15

5/17

5/19

5/21

5/23

5/25

5/27

5/29

5/31 6/

26/

46/

66/

86/

106/

126/

146/

166/

186/

206/

226/

246/

266/

286/

30 7/2

7/4

7/6

7/8

7/10

7/12

7/14

7/16

7/18

7/20

7/22

0

50

100

150

200

250

300

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

報告数累積報告数

Epidemiological Curve in JapanNumber of Confirmed Cases

8 Weeks

Pandemic Preparedness

Pandemic Response

Post-Pandemic Preparedness


Pandemic Response

2 years


2 years

Pandemic Response


2 years

Pandemic Response

Pandemic Preparedness Fatigue


2 years

Pandemic Response

Pandemic Preparedness Fatigue

Pandemic Response Fatigue


2 years



2 years

Pandemic Response

H5N1?

H9N2?

Novel H3N2?


2 years

Pandemic Response

H5N1?

H9N2?

Novel H3N2?

• Influenza viruses are unpredictable

• There have been and will be many unexpected

• There are still many unknowns about H1N1 pandemic

• We have to be prepare for unexpected

• We should not forget about other threats

wrap-up day 2. plenary four: pandemic and avian influenza updates pandemic h1n1 – origin of...

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