PROGRESS ACTIVITIES OF MBDS CORE STRATEGY

1. PROGRESS ACTIVITIES OF MBDS CORE STRATEGY Prof,Dr. Soe Lwin Nyein Director (Epidemiology) Department of Health MOH,MYANMAR

2. MBDS Core Strategies Rest of the World 6 countries XB cooperation and information exchange Info sharing Animal-human interface (zoonoses) HR development - epidemiology MBDS Community-based surveillance Laboratory Risk communications Info & Communication Technology Policy research MBDS Partners

3. SURVEILLANCE Compulsory Reporting for: Diseases/events that fall under International Health Regulations (IHR, 2005) … Smallpox …. Poliomyelitis caused by wild-type poliovirus … Avian Influenza &Human influenza caused by a new subtype … Severe acute respiratory syndrome (SARS) … Other Public Health Emergency of International Concern (PHEIC) Any outbreak declared of national concern (compulsory, within 48 hours) Routine Surveillance for the following diseases: … Dengue (monthly basis, cases and deaths only) … Malaria (quarterly basis) … HIV, tuberculosis and rabies (on an annual basis, with analysis, using Country formats) Reporting of: … Information on imported cases (when available) … Cross notification on disease outbreaks (when available)

4. ANIMAL & HUMAN INTERFACE,COMMUNITY SURVEILLANCEStage-wise Intervention Local Gov’t Action pandemic response rapid containment averting avian influenza Central Gov’t Action Inter Pandemic (1 -3) Pandemic Alert (4) Pandemic (5-6)

5. 4 diseases to notify polio ( wild type virus), smallpox, human influenza new subtype), SARS. Diseases to use the algorithm: cholera, pneumonic plague, Yellow Fever, Viral haemorragic fevers (Ebola, Lassa, Marburg), West Nile Fever, méningococcal disease. Any event of potential international public health concern ( unknown or other events/diseases) Decision instrument

6. The Course of the Poultry Outbreak Mar/April 2006 1st Human case outbreaks June 2007 November 2007 July 2007 Feb/March 2007 May 2007 July 2007 September 2007 0 Bago (Lapatan) Mon (Than Phyu Zayat Bago (Thanutpin) Kyaing Tone Sagaing Mandalay Yangon Bago (Bago) Yangon (Insein)

7. Surveillance Networking OUT BREAK SITUATION

9. Laboratory Capacity Strengthening • Establishment and Designation of National Influenza Center at National Health Laboratory • Establishment of in- country laboratory capacity BSL 2+(esp: H5N1 Laboratory investigation) • Training of lab-staff • Laboratory surveillance capacity & networking • CEU, NHL, FDA, MR Networking • Cross border Lab surveillance

10. Isolation and Identification of Influenza virus in Myanmar • National Health Laboratory conducted a surveillance of influenza like illnesses (ILI) in patients attending the OPD at some Township Medical Centers and general practitioners. • The present study reports surveillance done in Yangon during the first influenza season of 2007 from May to September. • Nasal swabs/throat swabs were collected in viral transport media from 36 patients. The patients included 15 males and 21 females with ages ranging from less than a year to over fifty years. Influenza virus antigen was detected in the specimens using Directigen Flu rapid influenza test kit. Only 10 samples showed positive for Influenza A antigen. • Influenza virus isolation was done in Madin Darby Canine Kidney (MDCK) cell lines. Isolates were obtained from 6 samples and influenza types and subtypes were identified by Haemagglutination Inhibition test using human ’O’ cells. Two isolates were identified as Influenza A (H3N2) and four isolates were Influenza Type B, subtype B/Malaysia/2506/2004-like (Victoria Lineage). • Although the number of samples in this surveillance did not reflect the disease burden, this surveillance could report that Influenza A (H3N2) and Influenza B (B/Malaysia/2506/2004-like (Victoria Lineage) co circulated in Yangon in 2007 influenza season, with Influenza B predominance.

11. Influenza • * A/Lyon/1331/2006 (Brisbane – lineage) • ** A/Fukushima/141/2006 • *** B/Bangladesh/3333/2007

12. Influenza Antibody Status of Myintkyinar AFP cases

13. Myeik Influenza Antibody Status of AFP cases

14. FETP FETP short course curriculum Coordinate with LBVD 2weeks course in September,08 / 12 weeks course in Oct - Dec,08 3 weeks course in March/09 Human Resource Development

15. Scope of work beyond AI/PI to cover other diseases and unusual health events Rapid Response Team(RRT)- State & divisions (17) District level (130) Response more than 30 out break(AI,Polio,Cholera,mening-itis,Chickenpox)& cyclone nargis Joint MOH + LBVD RRT Success in Myanmar

16. Cross Border Collaboration at ground crossing points • IHR Implementation • Myanmar-Thai cross border meetings • Joint action plan developed • Similar meeting to be organized with other Neighbouring countries • Study Tour Singapore & Hong Kong

17. Capacity for designated airports, ports and ground crossings To provide access to an organised medical service located so as to allow the prompt assessment and care of ill travellers, and to adequate staff, equipment and premises. Capacity to transport ill traveller To provide access to equipment and personnel for the transport of ill travellers to an appropriate medical facility. Capacity to maintain safe environment for travellers using points of entry facilities, including potable water supplies, eating establishments, flight catering facilities, public washrooms, appropriate solid and liquid waste disposal services and other potential risk areas. Core capacity for designated airports, ports and ground crossings

18. KAP,Information travel by work of mouth,Traditional media, Point of information channel,Materials developement Risk Communication & Public Awareness

19. Strengthening ICT Capacity Health Facilities Camps/clinic Temporary camps S/C INGO Station Hosp Data collection compilation and analysis Lab confirmation RHC NGO/INGO at Yangon TMOS Divisional Health Department Health Cluster Agencies Response and feedback MOH National Surveillance System

20. Public awareness for behavioural Changes Earlywarning & response Capacity building, (Epidemiology & Lab, ICT) Cross border collaboration Sector wise contingency plan TTX , Simulation Ex Reviewed & Revised of National Strategic Plan Strengthening Networking Resources Mobilization Financial Support OVERALL CHALLENGES

21. Principles for Partnership • Common Purposes/ Objectives/ Targets and Goals • Pooling of resources – Human/ Technical/ Financial • Working together – collaboration • Collective responsibility • Sharing achievements COORDINATION, COLLABORATION,COMMUNICATION, COMMITMENT NO COMPETITION!

22. Thank You

23. Build on Success and move beyond AI/PI to emerging and reemerging diseases toward IHR compliance Drills/simulation- updating pandemic plan Surveillance- EWARS, HR Development: FETP, RRT expansion Moving from quantity into quality: ie NIC/NHL-QA/QC, outbreak investigation and case management from IEC production into behavioural changes Moving from State/Divisions to townships and communities Cross border/regional collaboration and partnership M&E Implementing MBDS core strategy Way Forward 2009-2010

24. Strengthen field epidemiology capacity Strengthen and support epidemiological network Develop capacity and promote collaboration among human and animal health sectors Improve capacity for early detection and response to disease outbreaks (RSO,SDCU TEAM ,RRT,MO,PARAMEDICS) FUTURE PLAN Human resources

25. FUTURE PLAN Strengthen collaboration between animal & health sectors at XB, provincial, national and regional levels • Develop mechanism/advocacy for collaboration between two sectors within each country • Identify priority diseases and relevant partners • Develop regional coordination/collaboration mechanism • Conduct joint activities on risk identification & reduction on transportation of animal, especially across border • Organize regional workshop on animal-human health interface • (FETP 2,3 wks training,RRT, Adhoc & Monthly meeting, Joint Teaching Program)

26. Strengthen Lab capacity Assess lab and biosafety capacity needs at XB sites Support lab capacity development for Priority diseases Promote adoption of Diagnostic technologies,SOP& Guideline (BSL3,LAb capacity at all levels& xB,Net working) FUTURE PLAN Lab capacity

27. Future Plan Communication and Coordination Communication channel among all parties concerns, Email,Telephone,Fax,Web based,Developing newsletters Workshop and meeting Cross border meeting participation Organize technical Workshop TTX with other sectors Coordinate with other network by sharing information

28. FUTURE PLAN Risk communication Improve risk communications planning and coordination in the region for priority diseases including PHEICs Develop a MBDS risk communication framework. Develop curriculum for risk communication Train a critical mass of risk communicators at different levels of the health system. At cross-border sites, provincial level and national level (NFP/ IHR). Develop and test risk communications messages for the public. Follow up on specific priority actions from national and regional pandemic preparedness TTXs.

29. Policy Research • Conduct situation analysis of all border sites (both animal-human health sectors) to assess the current situation, identify priority problems/gaps and recommend solutions. • Conduct policy research (1 emerging zoonosis diseases).

30. THANK YOU