Pandemic Influenza Current situation and Global Preparedness

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Pandemic InfluenzaCurrent situation and Global
Preparedness
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Three Kinds of Influenza
Seasonal Influenza The Flu
Avian Influenza Bird Flu
Pandemic Influenza A Pandemic
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Three Kinds of Influenza
Seasonal Influenza The Flu

• Human viral respiratory infection
• Self-limiting, but can be serious fatal in
  elderly very young 500,000 deaths globally
  each yr.
• Occurs seasonally
• Routine vaccination available

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Three Kinds of Influenza
Avian Influenza Bird Flu

• Bird virus - different from human influenza virus
• Spreads from birds to birds
• Can sometimes infect humans
• Can sometimes mutate into human virus

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Three Kinds of Influenza
Pandemic Influenza A Pandemic

• Global outbreak of new human influenza (different
  from seasonal and avian influenza)
• Rare but recurrent event (every 10-42 years).
  Associated with increased morbidity mortality
• Last 3 pandemics in last 100 yrs 1968 (3m
  deaths), 1957 (2m deaths and 1918 (50m deaths)
• Past 3 pandemics - avian viruses became a human
  virus

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Threat of H5N1 Human Influenza
Inter-pandemic Period
Pandemic Alert Period
Pandemic Period
?
H5N1

• Circulating in wild birds and poultry since 2003
• Highly contagious / deadly among birds
• Spreading from Asia to Europe, Middle East and
  Africa

• Has infected humans in rare instances - resulting
  from close exposure to sick birds and/or their
  droppings

• If H5N1 evolves into a human virus it could cause
  a human influenza pandemic
• Also possibility that H5N1 never evolves into a
  human virus

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Pandemic Influenza Prerequisites
A new influenza virus emerges to which the
general population has little/no immunity
The new virus must be able to replicate in humans
and cause disease
NOT TO DATE
The new virus must be efficiently transmitted
from one human to another
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We are now at WHO Pandemic Phase 3
Inter-pandemic period Phase 1 No new influenza virus detected in humans. If a new influenza virus presents in animals, the risk of human infection is considered to be low
Inter-pandemic period Phase 2 No human infections, but a circulating animal influenza virus poses a risk to humans
Pandemic alert period Phase 3 Human infection(s) with a new virus, but no (or very infrequent) human-to-human spread.
Pandemic alert period Phase 4 Small human-to-human cluster(s) - less than 25 people, lasting less than 2 weeks, highly localized - virus is not well adapted to humans
Pandemic alert period Phase 5 Larger human-to-human cluster(s) - between 25-50 people, lasting from 2-4 weeks, still localized but virus increasingly better adapted to humans
Pandemic period Phase 6 Significantly increased and sustained transmission in general population
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Influenza Pandemics of the 20th Century
Credit US National Museum of Health and Medicine
1918 Spanish Flu
1957 Asian Flu
1968 Hong Kong Flu
A(H1N1)
A(H2N2)
A(H3N2)
40-100 million deaths
1-4 million deaths
1-4 million deaths
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specific impacts of an influenza pandemic
livelihoods

• food and income loss from poultry deaths/ culling
  decreased economic activity

• high illness potentially higher death rates
• overstretched health facilities
• disproportionate impact on vulnerable

human health

• increased demand for governance security
• higher public anxiety
• reduced capacity due to illness death

rule of law and governance

• deterioration of coping support mechanisms
• interruption in public services
• quarantine policies

humanitarian needs

• trade commerce disruptions
• reduced availability of key persons
• interruption of regular supply systems

economic systems
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Cumulative Numbers of Confirmed Human Cases of
Avian Influenza A/H5N1 A (H5N1) Reported to WHO
August 23rd, 2006
Countries Cases Deaths Case Fatality Rate
Azerbaijan 8 5 62
Cambodia 6 6 100
China 21 14 67
Djibouti 1 0 -
Egypt 14 6 43
Indonesia 60 46 77
Iraq 2 2 100
Thailand 24 16 67
Turkey 12 4 33
Vietnam 93 42 45
Total 241 141 59
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Development National Pandemic Influenza
Preparedness Plans
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National Capacity

• The best way to prevent international spread of
  diseases is to detect public health threats early
  and implement effective response actions whenthe
  problem is small
• Early detection of unusual disease events by
  effective national
• surveillance
• Systems to ensure response
• at all levels

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PAHO Technical Cooperation

• Multi-Disciplinary Task Force on Epidemic Alert
  Response
• Trainings in Communication
• Workshop on Health Services Preparedness
• Training and Establishment of Regional National
  Rapid Response Teams
• Development of New Surveillance Standards for
  influenza
• Development of tool to assess core capacities for
  NIPPPs implementation
• NIPPP Self-Assessment workshops

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PAHO Strategy for supporting Member States in the
development of National Influenza Preparedness
Plans
Development of draft Plans (28 Member States)
2. Assessment of draft Plans (7 Member States)
3. Local implementation of Plans (11 Member States)
4. Monitoring and strengthening of NIPPPs
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Challenges

• Validation of National Plans
• Implementation of national plans at the local
  level
• Monitoring and evaluation of local contingency
  plans
• Strengthening and expansion of information
  systems for influenza

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A Call to the Media

• Join us in educating the public
• No impartial observers
• The public is entitled to fair, realistic
  information that affects their lives
• Working together is a challenge and an
  opportunity
• Its also a necessity

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Thank you