1

Global health security, with special emphasis on MERS-CoV and avian influenza A

(H5N1)Agenda item 3(a)

62nd Session of the WHO Regional Committee for the Eastern Mediterranean

5–9 October 2015, Kuwait

Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 2

Global health security threats• Current global health security threats

– Ebola virus disease in the African Region– Avian influenza A (H7N9) infection in the Western Pacific

Region – MERS-CoV and avian influenza A (H5N1) infection in the

Eastern Mediterranean Region

• Implication of global health security – Can cause social unrest and loss of economic opportunities – Interconnected world provides ground for international spread

Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 3

Objectives• Highlight the current health security threats in the

Eastern Mediterranean Region• Consider accelerated actions for Member States

for prevention, detection and response• Emphasize the shared responsibility of both

Member States and WHO for global health

Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 4

Global health security threats in the Eastern Mediterranean Region

• Middle East respiratory syndrome coronavirus (MERS-CoV)

– Novel respiratory virus and zoonotic in origin– Amplification in health care settings– Important knowledge gaps on exposure and transmission risk

factors

• Avian influenza A (H5N1) in Egypt

– Novel influenza virus and zoonotic in origin– High mortality in patients where treatment is delayed– Important knowledge gaps on transmissibility of the virus

Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 5

MERS: Global situation, April 2012 to 15 September 2015

AustriaAlgeriaEgyptGreeceIslamic Republic of IranLebanonMalaysiaNetherlandsTurkeyUSAYemen

GermanyPhilippinesChinaRepublic of KoreaThailand

TunisiaKuwaitOmanFranceGermanyItalyUnited Arab EmiratesUnited Kingdom

JordanSaudi ArabiaQatar

Cumulative

1570 Cases

555 Deaths

Epidemic curve of MERS cases reported from the Republic of Korea

8-M

ay

10-M

ay

12-M

ay

14-M

ay

16-M

ay

18-M

ay

20-M

ay

22-M

ay

24-M

ay

26-M

ay

28-M

ay

30-M

ay

1-Ju

n

3-Ju

n

5-Ju

n

7-Ju

n

9-Ju

n

11-J

un

13-J

un

15-J

un

17-J

un

19-J

un

21-J

un

23-J

un

0

2

4

6

8

10

12

14

16

18

20

Survived Died

Number of cases

6Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1)

Date of symptom onset

Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 7

Epidemiological characteristics of MERS cases reported from January to September, 2013–2015  

Characteristics JanSep 2013 JanSep 2014 JanSep 2015

Number 129 593 377Median age in years 50 48 56Percentage of males 60 62 69Percentage of primary cases 21 23 12Percentage of secondary cases 64 39 42

Unknown contact history (percentage) 15 35 21

Percentage of cases in health care workers 19 28 12

Percentage of fatal cases 49 40 41

Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 8

MERS: Epidemic curve of cases reported from the Eastern Mediterranean Region, April 2012 to

September 2015

Reported period in moths (June 2012-September 2015)

PrimarySecondary

2014 201520132012

No of reported cases180160140120100806040200

6 8 10 12 2 4 6 8 10 12 2 4 6 8 10 12 2 4 6 8

Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 9

Reported cases of MERS in health care workers

Source: WHO

400350300250200

150100500

No of cases

Infection in health care workers

Infection in others

Health care workers = 21%

2014 201520132012Month of onset

3 4 6 9 10 121 2 3 4 5 6 7 8 9 1011 121 2 3 4 5 6 7 8 9 1011 1 2 3 4 5 6 7 8

Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 10

Current challenges

• Both the MERS-CoV and avian influenza A (H5N1) virus have pandemic risk

• Global knowledge on transmission risk factors of both MERS-CoV and avian influenza A (H5N1) virus remains limited

• Critical gaps for prevention, detection and response to emerging health threats identified for Ebola virus disease

Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 11

Strategic actions for consideration • Monitor and track the pandemic risk in real time

– Establish/strengthen sentinel-based surveillance systems for severe acute respiratory infection in all countries

• Respond rapidly to every case(s) and cluster – Set up trained multidisciplinary rapid response teams in each country

• Prevent amplification of hospital outbreaks – Establish or strengthen infection prevention and control programmes in all

countries

• Address critical knowledge gaps– Prioritize and conduct public health research and disseminate the

research findings rapidly

Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 12

Conclusion: the way forward

• Both the MERS-CoV and H5N1 virus have pandemic risk potential which remains unpredictable

• The Region needs to be better prepared to respond to sustained events resulting from these two major threats

• Member States and WHO need to act now as part of shared responsibilities to protect global health

Cholera outbreak in Iraq• Outbreak

– Total number of laboratory-confirmed cases: 827

– Over 1200 suspected cholera cases – 12 out of 19 governorates have reported

laboratory-confirmed cases • Humanitarian crisis

– Over 153 000 Syrian refugees are in northern Iraq

– Over 1.2 million Iraqi people are displaced in the northern region of Iraq

Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 14

BABYLON

BAGHDAD-KARKH

BAGHDAD-RESAFA

BASRAH

DIWANIY

A

DIYALA

KERBALA

MUTHANNA

MISSAN

NAJAF

THI-QAR

WASSIT

0

100

200

300

400

500

600

700Suspected cases

Lab-confirmed cases

Governorates reporting cholera cases

No

of re

porte

d ca

ses

Geographical distribution of suspected and laboratory-confirmed cases, 930 September 2015

Strategic actions for control in Iraq• Standardizing cholera case management• Enhancing surveillance and conducting active

case-finding• Prioritizing laboratory sample collection and

testing • Treating water at point of use • Conducting social mobilization in high-risk areas • Considering the use of oral cholera vaccines to

limit geographical spread

Strategic actions for neighbouring countries of Iraq

• Enhancing surveillance for early detection of any suspected case

• Improving preparedness measures (stockpiling, health education and awareness measures, etc)

• Complying with the health requirements of IHR (2005)– No trade or travel embargo – No screening or quarantine of travellers coming

from cholera-affected areas– No proof of vaccination for entry – No prophylactic administration of antibiotics