National Influenza Centres in SEA Region

Dr Rajesh Bhatia / Dr Oommen JohnWHO Regional Office for South-East Asia

New Delhi

National Influenza Centres in SEA Region

Dr Rajesh Bhatia / Dr Oommen JohnWHO Regional Office for South-East Asia

New Delhi

5th Meeting of NIC in Western Pacific and South East Asia Region

#

Nepal

#

Bhutan

# Myanmar (Burma)

# Thailand

#

Bangladesh

# Sri Lanka

Indonesia

India

Maldives

#

Timor Timur

#DPR Korea

N

Timor Leste

6% of Land Area

25% of Humans

28% of Burden

SEAR

Seasonal Influenza

• True burden in SEA Region still not fully understood

• Disease burden studies– Thailand

• Influenza occurs year-round • Follows a bimodal seasonal pattern with substantial variability. • Young children & elderly most affected • In-hospital deaths are more common than previously appreciated

– Myanmar • Influenza exhibits seasonality, coincides with the rainy season

June to Aug

– India• Seasonality varies geographically

Influenza SeasonalityInfluenza Seasonality

0

4

8

12

16

20

24

28

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

Winter Summer Rainy Season

Pune (west)

0

4

8

12

16

20

24

28

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

Winter Summer Rainy Season

Kolkota (east)

-1

3

7

11

15

19

23

27

31

35

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

Summer Winter Rainy Season

Chennai (south)

0

4

8

12

16

20

24

28

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

Winter Summer Rainy Season

Delhi (north)

#

Nepal

#

Bhutan

# Myanmar (Burma)

# Thailand

#

Bangladesh

# Sri Lanka

Indonesia

India

Maldives

#

Timor Timur

#DPR Korea

N

Timor Leste

Location of NICs and H5 Reference Lab in SEAR

NIC in SEARNIC in SEAR

Country* BSL3 Virus isolation PCR EQAS

Since 2008

Bangladesh - + + +DPR Korea - + + +India NIV + + + +Nepal - + + +Indonesia - + + +Myanmar - + + +Sri Lanka - + + +Thailand + + + +

*Bhutan, Maldives, and Timor Leste do not have a NIC at present but can perform PCR

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO from SEA Region

as on 01 June 2011

Country 2004 2005 2006 2007 2008 2009 2010 2011 Total

C D C D C D C D C D C D C D C D C D

Bangladesh 0 0 0 0 0 0 0 0 1 0 0 0 0 0 2 0 3 0

Indonesia 0 0 20 13 55 45 42 37 24 20 21 19 9 7 6 5 177 146

Myanmar 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0

Thailand 17 12 5 2 3 3 0 0 0 0 0 0 0 0 0 0 25 17

Total 17 12 25 15 58 48 43 37 25 20 21 19 9 7 8 5 206 163

National networks: IndonesiaNational networks: Indonesia

NIHRD

SubNICMicro

UI SubNICMicroUNISU

SubNICMicro

UNHAS SubNICMicroUNDIP

SubNICMicro

UDAYANA

SubNICBLK

Palembang

SubNICBLK

Bandung

SubNICBLKSby

LOCAL LABORATORY : BTKL Hospital Laboratory District Laboratory

NIC

National network in IndiaNational network in India

National network in ThailandNational network in Thailand

13 regional Medical Science Center

Location of

Regional strategy: 2008Regional strategy: 2008

Strategic direction Key elements

Establishment of Regional Influenza Laboratory Network

Strengthen operational NICs

Expand the laboratory network

Implement external quality assessment scheme

Establish partnerships

Capacity building Training staff in all NIC

Organize extramural training for specialized tests

Conduct training on bio-safety & shipment

Introduction of e-based training/orientation

Monitor influenza activities Develop Lab data management system

Integrate influenza surveillance in NIC database

Support multi-site surveillance

Conduct risk assessment

Activities in 2009-10Activities in 2009-10

• Regional workshop on diagnosis of H1N1

• Regional workshop on monitoring resistance in influenza viruses

• Regional Workshop on Biosafety and Biosecurity in labs :

• Study visits to NIC staff within Region

• Reagents procurement

• Funding from various international partners

ChallengesChallenges

• Capacity to diagnose all H types

• Limited access to diagnostic services

• No NIC in three countries

• Coordination with animal health sector

• Revision of NIPPP (post pandemic)

• Data management and information sharing

• Indigenous reagents production

Future plansFuture plans

• NIC in all Member countries

• Hand holding by established NIC for new and upcoming NICs

• Revision of NIPPP

• Collaboration with animal health sector

• Expanding immunization and surveillance

• Data sharing

Experience from H1N1 2009 Pandemic

• Expertise and Capacity within Region

• Opportunity for strengthening regional and national preparedness and response capacity

• Regional tools for assessment of response to pandemic H1N1( 2009)

• Sharing of country experiences, lessons learned and best practices

SEAR VPD Laboratory Network, 2010(Polio, Measles/Rubella, JE/AES, Rota, IBD)

National labs

Global specialized lab (Polio)

Reference labs

Objectives

1. Strengthen the preparedness and capacity of SEAR member countries to respond to influenza with pandemic potential

2. Strengthen and integrate the capacity to carry out surveillance and response to seasonal and pandemic influenza

3. Strengthen laboratory infrastructure and build laboratory and epidemiology capacity to accurately and promptly diagnose seasonal influenza and influenza with pandemic potential.

Implementation

• Provide on going support to member countries in SEAR to review and modify their NIPRP

• Assist member countries in SEAR to review regulations and policy related to use of Influenza vaccine

• Build collaborative partnerships for research and production of influenza vaccine

Implementation

• Implementation of the Global Influenza Surveillance guidelines at regional level

• Define minimum data sets needed for surveillance

• Monitoring and evaluation support

Build laboratory and epidemiology capacity

• annual regional meeting of NICs to review progress

• provide updates on new issues related to early detection of influenza and novel influenza strains

• monitoring of anti-viral resistance

• support for on-site laboratory trainings

• Collaborative Venture

- National Influenza Centres– The Disease Surveillance and Epidemiology (DSE)

unit of the Communicable Disease Surveillance (CDS) Department and

– Immunization Vaccine and Development (IVD) unit of Family Health and Research (FHR) Department

– Supported by CDC, Atlanta

Thank YouThank You