Influenza Surveillance in

Thailand 2012

Thitipong Yingyong

Bureau of

Epidemiology,

Thai-DDC

6th NIC&Flu

Surveillance Meeting,

Vietnam

May 29th,2012

Influenza surveillance system

2

R506 > Influenza, Pneumonia

Influenza Like Illness

Outbreak notification

Severe Pneumonia

project

Influenza and AI

case report

Virologic surveillance•Virologic

•ILI and Pneumonia

update on 24/05/55

Adverse Event Following Immunization

NATIONAL PASSIVE SURVEILLANCE:

R506

- R506 software

- Case report

- Geographical, clinical and laboratory

data

- Public hospital and some private

Priority disease surveillance

Influenza reported rate by province, 2006-2010

update on Apr 20, 2011 5

20102009200820072006

Reported rate of Influenza by age group,

THAILAND 2010

update on Apr 20, 2011 6

Ra

te/1

00

,00

0P

OP

Year

Reported case of Influenza by week, R506

since 2005-2008N

um

be

r o

f ca

se

7

Time (week)

Reported case of Influenza by month, 2009-2010

compare with median 5 year, Thailand

8

Nu

mb

er

of

case

Time (month)Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2009 2010 Median 5 year

Geographical distribution

Trend

ILI SYSTEM

OUTBREAK NOTIFICATION SYSTEM

3 parts;

-Routine on outbreak list

-One Tambon One Outbreak (OTOO)

-Sub-district SRRT network

Number of outbreak notification by month,

2007-2011, Thailand

update on 16/01/55 11

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2009 2010 20112007 2008

• email

• Telephone

• FAX

Sub-district SRRT networkevent and outbreak notification system

Number of ILI and Influenza are notified

PANDEMIC INFLUENZA AND AVIAN

INFLUENZA NOTIFICATION

- Case report and investigation

- Suspected AI and PI

- Web based application

- Since late of 2003

- Country wide

SEVERE PNEUMONIA

SURVEILLANCE SYSTEM

- Case report and investigation

- CAP in healthy

- Acute severe or death of unknown etiology

- Both virus and bacteria are tested

Adult age 15+ year old

Children 2 moth - 15 year old

ADVERSE EVENT FOLLOWING

IMMUNIZATION

- AEFI monitoring system

- Pandemic flu vaccine in 2010

- Routine surveillance follow national

campaign

Pandemic vaccine surveillance

System HCWs Pregnant

Obesity

Handicap

Chronic Dz

Timeframe

Call center

� � � �Jan –May 2010

Follow up

� � �

Jan –May 2010

Self-reported

�

Jan –May 2010

17

INFLUENZA SENTINEL

SURVEILLANCE SYSTEM

- Virologic surveillance

- ILI surveillance

- Harmonized data for preparedness

and warning

= NIH

= BOE

NIH BOE

1. Chiang Rai (2 site) 1.Lop Buri

2. Tak 2.Ubon

Ratchathani

3. Nong Khai 3.Pijitt

4. Bangkok 4.Sukhothai

5. Nonthaburi 5.Maha Sarakham

6. Chantaburi

7.Prachuap Khiri

Khan

8. Songkhla

9. Surat Thani

10. Phuket

Phase II : sentinel sites (Sep.2009-Sep.2012)

Predominant subtypes of Influenza

in Thailand, 2005-2011

2005: A / (H3)

2006: A / (H1)

2007: A / (H3)

2008: B

2009: A / (pandemic H1)

2010: A / (pandemic H1)

2011: A / (H3)

Thai National Influenza Center

Results of influenza circulating strain by

antigenic characterization from

8 sentinel hospitals, Jan.-Dec.2011

Percentage of Thai influenza local strains during Jan.-Dec.2011

pdmA(H1N1) % A (H3N2) % B %

A/California/07/2009

(H1N1)

100.00 A/Perth/16/2009

(H3N2)

100.00 B/Brisbane/60/2008

(Victoria lineage)

92.40

B/Florida/60/2008

(Yamagata lineage)

6.33

B/Wisconsin/01/2010

(Yamagata lineage)

1.27

Distribution of type and subtype of

influenza virus resistance to Oseltamivir,

January 2009 – December 2011

Influenza virusResult of Oseltamivir resistance (NAI assay)

Jan.2009 – Dec.2011No. test No. resistance % Resistant

isolatesA(H1N1) 45 43 95.55

A(H3N2) 232 0 0

B 177 0 0

pdm A(H1N1) 687 10 1.46

Weekly Epidemiological Surveillance Report

and pdm H1N1 weekly report

Strengthen rapid reporting system to monitor

the trend of influenza activity and novel influenza strains

� Weekly report ,monitoring trend of the outbreak

by calculation of baseline and epidemic threshold

Influenza Vaccine and

Vaccine Program in Thailand

Vaccine Introduction in the EPI/

national program, Thailand

1977 1984 1986 1988 1990 1997 2005

BCGDTPw OPV

TyphoidM

RHB

JE MMR

DTPw-HB

Source: modified from DDC, MOPH 2009

Flu in HCWs

2004 2008

Should we introduce seasonal influenza vaccine into other target groups???

presentation slide by

Dr. Charung Muangchana MD, PhD

Deciding on new vaccine introduction into the

EPI / national program, Thailand

� Public health priority� Disease burden� Economic & financial � Vaccine safety & efficacy � Alternative interventions

� Policy issues

+� Programmatic

issues� Programmatic strength� Supply availability� Sustainability

Parameter or issue

Methodology Key findings investigator / Reference

Influenza & pneumonia burden

Routine surveillance

Reported • Influenza cases: 17,424 / yr• Pneumonia case: 145, 290 / yr• Pneumonia deaths: 874 / yr

Bureau of Epidemiology, 2006

Prospective pop.-based surveillance

• 23% flu positive among ILI at OPD • 10% of hospitalized pneumonia caused by influenza

• OPD visits from flu: 924,478 / yr• Loss of work days: 3.1 mill. / yr • Loss of school days: 1.7 mill. / yr

Simmerman M, et al, 2006

Extrapolation from study of Simmerman, on reported data

Estimated (min)• Flu cases: 749,189 cases / yr • Pneumonia cases: 242,150 / yr • Flu pneumonia cases 26,637 / yr• Flu pneumonia deaths 161/ yr

Charung M, In flu vaccination project proposal to NHSO Board, 2007

Estimation of seasonal influenza impact : Thailand

Parameter or issue

Methodology Key findings investigator / Reference

Risk group Prospective pop.-based surveillance

Groups at risk of serious complications• Elderly and young children• Persons with chronic cardiac and respiratory diseases

• Persons hospitalized in previous year

Simmerman M, et al, 2006

Seasonality Prospective surveillance

Influenza cases peak during June-October

Simmerman M, et al, 2006

Routine surveillance

Influenza cases are reported all year round, more case during May-October, peaks usually in July

Bureau of Epidemiology

Match of circulating & vaccine virus

Laboratory surveillance, over the past

decade

Characters of circulating flu viruses in Thailand each year are close to those of recommended vaccine strains for both northern and southern hemispheres

NIH/ Dep.of Med. Sci./ MOPH

Estimation of seasonal influenza impact : Thailand (2)

Parameter or issue

Methodology Key findings Reference

Medical cost Prospective study

Unit cost of pneumonia treatment: $ 490.8 in community hospital, $ 628.6 in provincial hospital

Olsen J S, et al. In Int J of ID (2006)

Vaccine

effectiveness

Epidemiologic Survey

Flu vaccination to the elderly will reduce pneumonia incidence by one half (AR 4.83% in vaccinated group compared with 10.88 in unvaccinated)

1.Rungnirand P. et al. In J Med Assoc Thai 2005

Epidemiologic Survey

Flu vaccine effectiveness 76% in persons with COPD

Wongsurakiat P, et al. In J Med Assoc Thai, 2003

Benefit of flu vaccination

Simple estimation

Flu cases prevented: 400,000 / yr

Pneumo. deaths prevented: 25,000/ yr

Medical cost saved: 736 M baht

Indirect cost saved: 800 M baht

Charung M, In flu vaccination project proposal to NHSO Board, 2007

Estimation of seasonal influenza impact : Thailand (3)

Deciding on new vaccine introduction into the EPI /

national program, Thailand

� Public health priority� Disease burden� Economic & financial � Vaccine safety & efficacy � Alternative interventions

� Policy issues

+� Programmatic

issues� Programmatic strength� Supply availability� Sustainability

Seasonal influenza vaccine introduction into other target

groups

2004-7

Target groups & no. of doses of influenza vaccination, Thailand

0.40 million doses per yr• HCWs• Poultry cullers

* COPD, asthma, heart disease, cerebro-vascular dis., renal failure, chemotherapy, DM

2004-7

2008-9

Expanding target groups & no. of doses of influenza vaccination, Thailand

0.52 – 2.20 million doses per yr• Elderly > 65 yrs• Pop with chronic conditions*

2010

0.40 million doses per yr• HCWs• Poultry cullers

2.4 – 2.5 million doses per yr• Pregnant• Obesity• Brain handicap• Children 6 – 23 months 2011

+

+

* COPD, asthma, heart disease, cerebro-vascular dis., renal failure, chemotherapy, DM

Seasonal influenza vaccination

services

• Pattern : National campaign

• Place : Hospitals

• Provider : Physicians, nurses

• Target : Voluntary

• Duration : June – September

• Free of charge

�Village Health Volunteers (over 800,000) in all communities actively participate in risk communication, health education including surveillance for flu and ILI.

�Local administrations, health authorities and NGOs jointly run regular villager dialogues on health issues including flu. This forum is instrumental for effective flu prevention in the community.

Community involvement

in risk communication

Lesson learnt from Thai’s influenza

immunization program

• Key success factors

– Strong evidence (information)

– Clear vaccination strategy

– Systematic vaccination managing

– Closed monitoring and evaluating

– Sufficient community and

public informing & communicating

• Sustainability - not only budget,

but also showing the impact

I would like to thank to ….

Dr. Charung Muangchana MD, PhD.

National Vaccine Institute (NVI),

Ministry of Public Heath