Current Situation Influenza A (H1N1) 17 May 09

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Current Situation Influenza A (H1N1)

17 May 09

Current Situation Influenza A (H1N1)

17 May 09

Threat of Pandemic InfluenzaThreat of Pandemic Influenza

• Circulating in wild birds, poultry and pigs

Animal Influenza

• Infects humans in rare instances - resulting from close exposure to pigs

• If virus evolves into a human virus it could cause a human influenza pandemic

Pandemic requirements Pandemic requirements

Global outbreak of disease

Appearance of flu virus A with pandemic potential

It causes sustained human-to-human transmission

Population has no or limited immunity

Broad Risks of a PandemicBroad Risks of a Pandemic

• Food and income loss from poultry deaths/ culling & decreased economic activity

• High illness & potentially higher death rates• Overstretched health facilities• Disproportionate impact on vulnerable

• Increased demand for governance & security• Higher public anxiety• Reduced capacity due to illness & death

• Deterioration of coping & support mechanisms• Interruption in public services• Quarantine policies• Trade & commerce disruptions• Degraded labour force• Interruption of regular supply systems

Livelihoods

Social & Humanitarian Needs

Governance & Security

Human Health

Economic Systems

Pandemic PhasesPandemic Phases

Phase 5Phase 5

Phase 5 is characterized by the same identified virus causing sustained community level outbreaks in at least 2 countries in 1 WHO region.

Most countries won't be affected at this stage

Declaration of Phase 5 signals a pandemic could be imminent

Time to finalize organization, communication, implementation of planned mitigation measures is short.

Phase 6Phase 6

Phase 6 is characterized by community level outbreaks of the same virus in at least 1 other country in a different WHO region.

Designation of this phase would indicate that a global pandemic is under way.

Time line current situation (1)Time line current situation (1)

Friday 24 April– Reports of previously undetected Influenza A (H1N1) virus in

USA and Mexico– HQ SHOC activated

Sunday 26 April – IHR Emergency Committee convened– WHO Director-General declares a Public Health Emergency of

International Concern

Time line current situation (2)Time line current situation (2)

Monday 27 April

- WHO increases pandemic alert phase from 3 to 4

- Geographic Containment not feasible

Wednesday 29 April

- WHO raises pandemic alert phase from 4 to 5

Tuesday 5 May

- WHO starts sending antiviral stocks to 72 countries and Regional Offices

Current Epidemiology as of 08:00 GMT 17/05/09

Laboratory confirmed cases Total global cases 8480 cases/72 deaths

Mexico: 2895 cases 66 deathsUS: 4714 cases, 4 deathsArgentina: 1 caseAustralia: 1 caseAustria: 1 caseBrazil: 8 casesCanada: 496 cases, I deathChina: 5 casesColombia:11 casesCosta Rica: 9 cases, 1 deathCuba: 3 case

Denmark: 1 caseEl Salvador: 4 casesFinland: 2 casesFrance: 14 casesGermany: 14 casesGuatemala: 3 casesIreland: 1 caseIsrael: 7 casesItaly: 9 casesJapan: 7 casesNetherlands: 3 cases

NZ: 9 casesNorway: 2 casesPanama: 54 casesPoland: 1 casePortugal: 1 caseRepublic of Korea: 3 casesSpain: 103 casesSweden: 3 casesSwitzerland: 1 caseThailand: 2 casesUK: 82 cases

New human lab confirmed influenza A (H1N1) cases as of 0800 GMT 17/05/09New human lab confirmed influenza A (H1N1) cases as of 0800 GMT 17/05/09

WHO Response (1)WHO Response (1)

Emergency response rooms – mobilised – 24/7

Operations– Field team of 31 experts to Mexico (from WHO and CDC/GOARN)– GOARN network activated– Initiated distribution of oseltamivir stockpile

Global monitoring and assessment– Triage of information and follow up of alerts– Coordination with Regions and National Focal Points (NFP)– Case report form– EIS web updates

Antivirals Taskforce– Oseltamivir stockpile distribution to regions and 72 priority countries (including Mexico)– Quantities proportional to population– Consultation with manufacturer

Trigger International Health Regulations on notification, risk assessment and response

Article 48: emergency committee:

- DG establishes EC to provide views on PHEIC, temporary recommendations, phases

Article 42,43 Travel and trade – Monitoring travel and trade measures – Maintaining a dialogue with member states to make sure objective of IHR are

mett (least interference with travel and trade)

Ports of Entry and conveyance: – Providing guidance PoE authority– Guidelines for cases on board of planes, ships, trains etc.

Technical guidance – Analysis of available data (modelling)– Guidelines on surveillance, lab and diagnostic, infection control, health care

management, pandemic response plan, vaccines made available to the public

Vaccine Taskforce – Consultation with manufacturers– Consultation with scientific experts

Communication– daily press conference– interviews will hundreds of media– Disease Outbreak News web updates– media monitoring

Diagnostic Kits at country levelDiagnostic Kits at country level

WHO Response (4)Technical guidanceWHO Response (4)Technical guidance

Tools and standards adapted for country and community use

- Checklist on planning and coordination – Rapid detection, alert and investigation mechanisms– Access to diagnostics– Infection control, case management, organization of health care

system– Community interventions– Logistics, procurement and supply chain– Risk communication

WHO Response (5)Training

Coordinated and targeted training and workshops at regional and sub-regional level

Specific regional, subregional and national context

Web based training and training of trainers

Back up hot line for WR/CO, Qs & As

For COs, MOH, other UN, NGOs

WHO Response (6)Deployment of expert teams

Specific developing countries; sequenced

Experts in epidemiology/PH, IC/case management, risk communication, PH Emergency Management, logistics, lab, etc.

– Teams tailored to needs

Materiel to enhance surveillance, facilitate diagnosis, protect personnel, treat and prevent cases

Sample shipment for rapid and reliable diagnostics

WHO Response (7)Mechanisms

Coordinated with the RO & CO, in liaison with other UN agencies and NGOs

Integrated operational platform in HQ and in the regions

System for prioritization demands

Feedback and adaptation of response

IHR in WHA 62IHR in WHA 62

• WHA decision on annual reporting on implementation IHR• Yearly questionnaire, Feb 2009. 82 States parties reported • Evidence of more cross sectoral coordination

• On line training, surveillance capacity building Lyon Office• Strengthening laboratory quality and bio-safety• Strengthening of National Influenza Centres (NIC)• Relations with other UN agencies, ports and airports authorities• 684 events reviewed (June 2007-dec 2008). 19% reported

through National Focal Points. 7% Risk assessment tool was used. Further research needed

IHR in WHA A62/6Public Events

• Lead intoxication• Resistance to oseltamivir seasonal influenza• Networks on chemical and radio-nuclear thretas up-dated on IHR• Nuclear emergency exercise with IAEA in 2008• Work on Yellow fever transmitted by conveyances• Legal issues and monitoring of access of NFP to IHR Event Site

(IES)• Increased awareness of IHR at regional offices and country level

Pandemic Influenza PreparednessWHA A62/5

• Report by the DG " PIP, Sharing of Influenza Viruses and access to vaccines and other benefits"

• Intergovernmental Meeting (IGM) with report from 15-16 May 2009 meeting

• Advisory board to DG-WHO• Development for the Terms of reference for current and potential

future (WHO Network) laboratories for H5N1 and other human pandemic influenza viruses

• Fro use in vaccines, diagnostic test materials and pharmaceuticals

• Good progress but still some points to solve on International Property Rights, transfer of materials

Current WHO Pandemic Alert phase Current WHO Pandemic Alert phase

Phase 5

INFLUENZA A(H1N1): SPECIAL HIGHLIGHTS

available at

http://www.who.int/en/

IHR in WHA 62IHR in WHA 62

Current Situation Influenza A (H1N1) 17 May 09

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