Avian InfluenzaHuman Influenza

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• Avian Influenza/Human Influenza
• Pandemic Preparedness Plans
• World Vision Asia-Pacific Region
• Sri Chander, Regional Health Advisor
• May 27, 2006
• CCIH Conference
• 
  

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On-the-ground, Field-level realities of life

• Can't see beyond todaylet alone seeing into the
  future
• Can't feed their children
• Don't have access to basic housing
• Don't have access to clean watersoap hard to
  find
• Don't have access to basic sanitation...
• Land tenure is insecure
• Can barely pay for school...
• Poultry is their savings accountit's their
  future livelihoodbacklash to investigations
  Sumatra
• Need realistic, practical solutions
• The challenge is to raise awareness when it is
  difficult to see beyond today

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BACKGROUND AVIAN INFLUENZA (AI)
HUMAN INFLUENZA (HI)

• Unknowns
• Nature of AI/HI threat (severity/extent)
• When and where escalation will be seen
• Duration of AI/HI pandemic (most probably last
  1-2 years and will come in series of 2 to 4 month
  waves as the virus further mutates)

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BACKGROUND AVIAN INFLUENZA
HUMAN INFLUENZA

• 
  KNOWNS
• Local threat with global implications
• (US268 billion loss drop of 6.5 in GDP
  in Asia alone ADB)
• 2-3 Weeks Window (on reaching Level 4) to
  prevent global pandemic
• AI must be fought at source (small-scale/backyard
  poultry farms wild birds (30 million HH out of
  80 M HH in Indonesia, 8 M HH out of 11 M HH in
  Vietnam) with Asia as the ground zero
• Migratory flyways Eurasia, North and East Africa
• Children are vulnerable
• High expectations of NGOs like WV to deliver
• Tamiflu/anti-virals not silver
  bullets--worldwide shortage
• No safe, effective vaccine available to prevent a
  global HI pandemic

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BACKGROUND AVIAN INFLUENZA
HUMAN INFLUENZA

• CONCERNS
• HI Virus adheres to URT mucosa
• more efficient human transmission
• H5NI virus
• --less replication capacity in URT
• --adheres to LRT (bronchioles/alveoli)
• ?severe hemorrahigic pneumonia
• gtless efficient human transmission
• --multiple organ involvementGIT/CNS
• Illegal bird tradegtmigratory birds?

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LATEST AI/HI SITUATION IN ASIA

• Avian Flu Wanes in Asian Nations It First Hit
  Hard NYT/FT
• Vietnam vaccinated 220M chickens and
• culled 50 m chickens in last 1 year
• CFR dropped 60 (2004)?13 (2005)
• No AI/HI case in 2006
• Thailand culled and compensated well
• trained 100,000 VHVs to report cases
• Tamiflu issued small Thai/VN hospitals to treat
• all flu cases even before confirmation
• China 10 cases in 06 caution/encouraging

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Other countriesnot good news

• Indonesia Bird Flu future lies here
• --30 M HHs with 200 M backyard chickens
• --H5NI found in 2/3 of 33 provinces
• --Cant compensatelittle culling
• --2nd highest (33) of bird flu deaths
• --2006 largest (22) bird flu deaths
• --Largest cluster (7 deaths) in N
• Sumatra with no poultry contact
• Ist time passed from 1 person?
• another person? 3rd person
• --Ist time---increasingly contagious?
• --WHO--raise to Level 4 Pandemic Alert?

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Others Not good news (2)

• Myanmnar gt 100 outbreaks in
• different parts of the country
• --Epidemiological black hole
• Cambodia and Laosvague, few
• reported cases silence not
• neccesarily good news
• Risk of virus returning to Vietnam and Thailand
  ever present
• Tomorrow, the whole thing could change
  again---David Nabarro

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Global Pandemic Priorities

• Contain avian flu epidemic
• Culling (50M birds in Vietnam Dec 03-Dec 05)
• Upgraded veterinary infrastructure/vaccination
• Improved bio-security
• Compensation (ADB offer of USD 500M for Asia)
• Prepare for pandemic
• Improved surveillance
• Stockpiled antivirals and other medications
• Personal Protective Equipment (PPE)
• Containment plans (quarantine, zoning, etc)
• Prepare for pandemic response
• --Business Continuity Plans (BCPs) to keep
  vital
• services and societies going, minimize
  suffering

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WV Pre-Pandemic Preparations

• Well-defined structure with global leadership for
  global/ regional CAT 3 response
• WV Global/Regional AI/HI working group and AI/HI
  Rapid Response Team established
• WV Global Guidelines for Pandemic Preparedness
  issued
• AI/HI point person/working group for each NOin
  process to develop Business Continuity Plans
• Pre-positioning of 1,500 Tx courses of
  Tamifluplan to double that to cover 35 of
  9,000 staff in 17 countries
• Develop risk communication guidelines to quickly
  disseminate timely, clear, consistent messages
• Develop a 2-yr comprehensive operational plan
• Develop quick/flexible mechanisms to draw down

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TAMIFLU

• Resistance Vietnam Japan
• Study gave Tamiflu to 90 of ill PEP to HH
  contacts within 24 hrs attack rate reduced 1/3
  27-gt17
• New WHO Anti-V recommendations
• Stockpile for gt50 of population
• --Treat ill cases PEP for gt90 of
• HH contacts within 24-48 hrs
• --Prepare for 30-35 attack rate in popn
• Roche/licensees400m Rx courses by 07
• Pediatric concerns Cx (lt1yr) SE (2-12 yr)

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Protect WV Staff
Prepare for Business Continuity

• Issue risk communications guidelines to all WV
  staff
• Seasonal (twice yearly) HI vaccine for staff in
  avian flu-affected areas
• Stockpile/preposition Personal Protective
  Equipment (PPE) (gloves, masks, soap, alcohol
  hand swabs, etc.) at country level
• Stockpile/preposition medical supplies at country
  level
• (i) Tamiflu to cover at least 30 of WV
  staff
• (ii) Other supplies, such as intravenous
  (i.v.) antibiotics, i.v. fluids and
• i.v. drip sets, disposable syringes
  needles, disinfectants, etc
• Develop clear triggers for decision making, clear
  decision making, and clear authority for decision
  making
• Now in WHOs Phase 3 of global pandemic warning.
  Issue WV advisory if/when Phase 4
  occurs--borders will be closed in Phases 5 and 6
• Develop business continuity plans at APRO/NO and
  project levels
• Explore pre-positioning gt 90-day supply of food
  at NO/local level

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Build AI/HI-Resilient Communities

• Participate in AI/HI risk assessments with
  partners
• Jointly conduct a Knowledge-Attitudes-Practices
  (KAP) survey of communities, especially families
  with small-scale/backyard poultry farms
• Develop behavior change messages materials for
  communities
• --change harmful farm/market place practices
  of mixing chickens
• with ducks and mixing chickens with pigs
• --promote personal hygiene practices
• Facilitate community assets-building exercises to
  plan for community-based AI/HI Response
• Promote vaccination of birds in
  small-scale/backyard poultry farms
• Jointly draw up contingency plans for mitigation
  of economic impact (especially alternative
  livelihoods and compensatory mechanisms for
  culling of birds)

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Promote Animal Health as Primary
Prevention of AI

• Jointly conduct assessment of veterinary services
• Increase number of veterinary vaccination centers
• Promote expansion of coverage of poultry
  vaccination in line with national policies
• Consider providing transport, vaccination
  equipment, cold chain equipment for poultry
  vaccination
• Provide bio-safety and clinical equipment, PPE
  biohazard equipment
• Build capacity of public sector veterinary staff
  in vaccine transport, cold chain maintenance,
  vaccination humane culling in line with World
  Organization for Animal Health (OIE) standards

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Jointly Develop Early Warning/Rapid Response
Networks at Local Level

• Develop active, community-based surveillance
  networks for AI/HI in partnership with local and
  national health authorities
• -Provide TA in setting up community-based
  surveillance of AI/HI
• -Train WV staff/partners as first-line
  surveillance agents mobilize
• them for same-day, transparent notification of
  AI/HI cases
• Strengthen Rapid Response Capacity of national,
  local village-level health and veterinary staff
  in
• -pandemic preparations and planning
• -surveillance and real-time management
  information systems
• -early detection and rapid diagnostic
  confirmation of suspects
• -stamp out outbreaks humane culling
  quarantine/zoning of infected areas
• -treatment and post-exposure prophylaxis with
  antivirals
• -clinical management of AI/HI
• -communications lines

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Engage in Risk Communications, Advocacy,
Partnerships Resource Acquisition

• Insist on World Vision being at the table for
  planning with the UN, FAO, WHO, OIE USG
  response USAID, Inter-agency group
• Form partnerships with governmental/NGO community
  AI/HI efforts
• Develop a risk communications plan for WV
  Partnership, communities, sponsors, public
  sector, private sector, local NGOs and donors
• Engage with local media in aggressive
  evidence-based advocacy
• Work with Inter-agency Working Group to secure
  govt funding
• Alert WV SOs of immense needs/quick resource
  commitments
• Document and share lessons learned with strategic
  networks