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Global Influenza Surveillance and Response Update By WHO, Myanmar

Global Influenza Surveillance and Response Update By WHO, Myanmar. ILI/SARI Surveillance Coordination Meeting, Naypyidaw 29 August 2019. Global Influenza Surveillance & Response System. 1918 Spanish flu affecting 1/3 of world population including 50 M deaths. established in 1952.

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Global Influenza Surveillance and Response Update By WHO, Myanmar

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  1. Global Influenza Surveillance and Response Update By WHO, Myanmar ILI/SARI Surveillance Coordination Meeting, Naypyidaw 29 August 2019

  2. Global Influenza Surveillance & Response System

  3. 1918 Spanish flu affecting 1/3 of world population including 50 M deaths • established in 1952 • ..from global problem • to global approach…. to predict unpredictability for timely detection and response to pandemic/epidemic flu Timeline of WHO work on influenza available at https://www.who.int/influenza/gip-anniversary/en/

  4. Global Influenza Surveillance & Response System • effective collaboration and sharing of viruses, data and benefits based on Member States’ commitment to a global public health model • mission : to protect people from the threat of influenza by continuously functioning as • a global mechanism of surveillance, preparedness and response for seasonal, pandemic and zoonotic influenza; • a global platform for monitoring influenza epidemiology and disease; and • a global alert for novel influenza viruses and other respiratory pathogens.

  5. ILI/SARI surveillance

  6. Why ILI/SARI surveillance needs to be strengthened? Health threats have no border

  7. Can predict the unpredictability of flu outbreak timely detection and response Can save lives

  8. IHR (2005) : Rights and obligations of Member States relevant to pandemic influenza _ notification, reporting and verification of public health events to WHO, implementation of measures at international borders, ports and airports,protections for international travellers, required capacities for domestic surveillance and response and coordinated response to public health emergencies of international concern (PHEIC).

  9. Overarching goal of influenza surveillance • To minimize the impact of the disease by providing useful information to public health authorities so they may better plan appropriate control and intervention measures, allocate health resources, and make case management recommendations. Specific goal of influenza surveillance • Describe the seasonality of influenza where feasible. • Provide candidate viruses for vaccine production. • Describe the antigenic character and genetic makeup of circulating viruses. • Identify and monitor groups at high risk of severe disease and mortality. • Establish baseline levels of activity for influenza and severe influenza-related disease • Generate influenza data to estimate influenza burden and help decision-makers prioritize resources and plan public health interventions. • Identify locally circulating virus types and subtypes and their relationship to global and regional patterns. • Monitor antiviral sensitivity. • Detect unusual and unexpected events such as outbreaks of influenza outside the typical season, severe influenza among healthcare workers, or clusters of vaccine failure that may herald novel influenza virus.

  10. Objectives of influenza surveillance and its use in decision-making

  11. Rationale for sentinel surveillance • Most efficient way to collect high-quality data in a timely way. • Reduce resources required as efforts can be focused on a limited number of carefully selected surveillance sites. • Excessively large systems or those that attempt to collect data from all healthcare facilities are resource-intensive and generally do not provide more information than a well-designed and representative sentinel system • Difficult to maintain the quality and timeliness of data generated by large systems which can make their findings difficult to interpret. • Sentinel ILI surveillance - persons seeking care in ambulatory facilities • Sentinel SARI surveillance - persons with more severe illness who have been admitted to hospital for their respiratory illness.

  12. Selection and location of sentinel sites

  13. cont… • There is no ideal number of sentinel sites in a country. Start small with one or a few sentinel sites and only expand if these function well. • In general, small amounts of good quality data are more usefulthan large amounts of poor quality data. • Testing all patients for influenza at a site is ideal, if feasible, but otherwise a sampling strategy should be implemented for selection of patients for testing and data collection.

  14. Recommended minimum data set • Unique identifier (to link laboratory and epidemiological data, and for tracking patient if necessary). • Sex. • Age. • History of fever and body temperature at presentation • Date of symptom onset. • Date of hospitalization (SARI patients only). • Date of specimen collection. • Antiviral use for present illness at the time of specimen collection. • Pregnancy status. • Presence of chronic pre-existing medical illness(es).* ( Chronic respiratory disease, Asthma, Diabetes, Chronic cardiac disease, Chronic neurological or neuromuscular disease)

  15. Collaboration of WHO for ILI/SARI surveillance implementation

  16. Countries reporting influenza data to WHO https://extranet.who.int/sree/Reports?op=vs&path=/WHO_HQ_Reports/G5/PROD/EXT/Influenza Reporting+Global+Map

  17. WHO’s collaboration in Influenza surveillance • Technical support • Annual bi-regional NICs meeting to share global & regional flu updates • Technical consultations with and recommendations by WHO SEARO, WHO Myanmar and WHO CC • ILL/SARI surveillance guideline printing and dissemination • ILI/SARI surveillance data management software development and data management trainings • Capacity building of health care professionals from laboratory and surveillance system • Logistics and administrative • Essential laboratory reagents and consumables support to NIC • Joint supportive M&E visits of NHL and CEU to sentinel sites • Transport & logistic cost from hospital to NHL • Assist international collaboration for External Quality Assessment Program, virus sharing

  18. Flu surveillance in other countries

  19. Bangladesh • Web Based Integrated Disease Surveillance (using DHIS2) • Event Based Surveillance • Cell Phone Based Disease Surveillance System (CPBDSS) • Hospital based influenza surveillance (HBIS) _ 9 hospitals across Bangladesh (tertiary level), SARI and ICU/CCU • National Influenza Surveillance _ 10 District hospitals (district level), LI and SARI • Timor-Leste • 5 ILI sites in Community Health Centers (CHCs) of Dili Municipality • 3 SARI sites in 3 referral hospitals US Virologic Surveillance _100 public health and over 300 clinical labs through National Respiratory and Enteric Virus Surveillance System Outpatient Illness Surveillance – through U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet). > 3,500 enrolled outpatient healthcare providers in all 50 states Hospitalization Surveillance - Influenza Hospitalization Surveillance Network (FluSurv-NET) . laboratory-confirmed influenza-related hospitalizations in children younger than 18 years of age and adults). • Bhutan • sentinel sites for ILI and SARI are selected based on geographic, climatic and demographic representativeness and also the feasibility such as capacity and accessibility of a hospital. • Previously all the sentinel sites (11 sites) • To improve efficiency of surveillance, existing ILI sites will be down sized to 7. • 11 sites continue conducting SARI surveillance.

  20. Myanmar’s PIP achievement at a glance

  21. Summary • Influenza is unique. • Circulating both in human & animal and another pandemic is inevitable. • ILI/SARI surveillance is a key to timely detect and respond flu outbreak and help effective vaccine production.

  22. ARE WE READY? We can be ready only when we improve our system based on previous lessons learned!!!!

  23. References • https://www.who.int/influenza/en/ • https://www.who.int/influenza/surveillance_monitoring/updates/latest_update_GIP_surveillance/en/ • Global Epidemiological Surveillance Standards for Influenza, WHO, https://www.who.int/influenza/resources/documents/WHO_Epidemiological_Influenza_Surveillance_Standards_2014.pdf?ua=1 • Presentation by Dr Isabel Bergeri , WHO HQ GIP (Global Influenza Programme) on Laboratory and surveillance capacity building: focusing on country impact during Regional Planning Meeting for the Implementation of Pandemic Influenza Preparedness, SEARO Region, New Dehli, 28 and 29 March, 2019 • Presentation by Kanta Subbarao, WHO Collaborating Centre for Reference and Research on Influenza & Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity during Bi-regional NICs Meeting, 21-23 August 2019

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