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Current Situation Influenza A (H1N1)
17 May 09
Current Situation Influenza A (H1N1)
17 May 09
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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
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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
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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
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Pandemic PhasesPandemic Phases
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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.
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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.
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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
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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
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Current Epidemiology as of 08:00 GMT 17/05/09
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
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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
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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
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WHO Response (2)WHO Response (2)
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.
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WHO Response (3)WHO Response (3)
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
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Diagnostic Kits at country levelDiagnostic Kits at country level
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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
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WHO Response (5)Training
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
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WHO Response (6)Deployment of expert teams
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
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WHO Response (7)Mechanisms
WHO Response (7)Mechanisms
Coordinated with the RO & CO, in liaison with other UN agencies and NGOs
GOARN
Integrated operational platform in HQ and in the regions
System for prioritization demands
Feedback and adaptation of response
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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
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IHR in WHA A62/6Public Events
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
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Pandemic Influenza PreparednessWHA A62/5
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
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Current WHO Pandemic Alert phase Current WHO Pandemic Alert phase
Phase 5
Phase 5
INFLUENZA A(H1N1): SPECIAL HIGHLIGHTS
available at
http://www.who.int/en/
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IHR in WHA 62IHR in WHA 62
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IHR in WHA 62IHR in WHA 62
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IHR in WHA 62IHR in WHA 62