Avian Influenza in Viet Nam: Lessons Learnt

FAO Technical Meeting on HPAI

27-29th June 2007,

Rome

Dr. Hoang Van Nam

Department of Animal Health

Ministry of Agriculture and Rural Development

VIETNAM

Outlines

• Situation Analysis; • Summary of Lessons Learned:

– Strong Commitment and Leadership from the Government

– Early Detection and Response– Vaccination– Information, Education and Communications – Pandemic Preparedness– Donor support

• Recommendations

Situation Analysis: The Course of the EpidemicTemporal Pattern of 2003/4 (1st), 2004/5 (2nd), late 2005 (3rd) and 2006/7 (4th) AI

Epidemics

Mar

Feb

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

0

50

100

150

200

250

300

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep Oct

Nov

Dec Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep Oct

Nov

Dec Jan

Feb

Mar

No

. o

utb

reak

s

Tet holiday Feb 9-11, 2004

Tet holiday Feb 11-13, 2005

Tet holiday Jan 29-31,

2006

2004 2005 2006

Vaccination Campaign

- 45 mil. poultry culled;

- 27 human cases (16 fatal)

- 2 mil. poultry culled;

- 64 human cases (21 fatal)

- 4 mil. poultry culled;

- 2 human cases

2007

Tet holiday Feb 16-22, 2007

- 99,040 poultry culled;- No human cases

Epi Curve: Viet Nam, A/H5N1, 26-Dec-06 to 25-Jun-07

0

5

10

15

20

25

30

26-D

ec-0

6

02-Ja

n-07

09-Ja

n-07

16-Ja

n-07

23-Ja

n-07

30-Ja

n-07

06-F

eb-0

7

13-F

eb-0

7

20-F

eb-0

7

27-F

eb-0

7

06-M

ar-0

7

13-M

ar-0

7

20-M

ar-0

7

27-M

ar-0

7

03-A

pr-0

7

10-A

pr-0

7

17-A

pr-0

7

24-A

pr-0

7

01-M

ay-0

7

08-M

ay-0

7

15-M

ay-0

7

22-M

ay-0

7

29-M

ay-0

7

05-Ju

n-07

12-Ju

n-07

19-Ju

n-07

Epi Week (week beginning..)

Nu

mb

ers

of

ou

tbre

ak

s

north

central

south

n=70 in 18 Prov

n=80 in 8 Prov

Situation Analysis: Affected Communes - 1st wave (2003-2004)

Situation Analysis: Affected Communes - 2nd wave (2004-2005)

Provinces

Communes

No of outbreaks

1

2 - 3

4 - 7

8 - 14

15 - 21

22 - 37

Provinces

Communes

No of outbreaks

1

2 - 3

4 - 7

8 - 14

15 - 21

22 - 37

Situation Analysis: Affected Communes – 3nd wave (late 2005)

Situation Analysis: Affected Communes – 4th wave (Dec 2006 – Mar 2007)

Situation Analysis: Current situation

• 2 new human cases after over a year and a half.

• A series of outbreaks in late 2006-early 2007 indicated that there is persistent circulation of virus both in the south and the north.

• Since the beginning of May, another wave of epidemic started.

• Outbreaks have been identified always in unvaccinated flocks, particularly in ducks.

Current situation (Cont’d)…since 1st May 2007 to 6 June

Province # of commune infected

Nghe An 18

Quang Ninh 4

Can Tho 3

Son La 3

Nam Dinh 26

Dong Thap 3

Bac Giang 4

Hai Phong 2

Ninh Binh 10

Bac Ninh 1

Ha Nam 1

Vinh Phuc 1

Hung Yen 1

Quang Nam 2

Thai Binh 1

Situation Analysis: Significant trends

• Recent marked increase in duck population (subsequent to cessation of the ban on hatching waterfowl)

• High proportion of these ducks moved from province to province to graze on paddies after rice harvest did not receive H5N1 vaccination remain highly susceptible to the disease.

• Within this wave of outbreak, most of outbreaks have been reported in provinces in the Red River Delta

• Genetic sequencing of recent virus isolates have shown no significant change in the antigenicity Current vaccine is still effective.

Strong Commitment and Leadership from the Government• Establishment of the National Steering Committee

for Avian Influenza Prevention and Control (NSCAIPC);

• Political systems from Central to grassroots levels were called upon, resulted in: Clear chain of command; and Quick response activities, i.e. funds release, human

resources, etc.;

• Several missions led by Cabinet Members dispatched to the field;

• Experiences in responding to (SARS) in 2003.

Summary of Lessons Learned

Early Detection and Response

• Emergency reporting system using telephones and faxes;

• Online reporting system (TADinfo) piloted to assist in HPAI information management;

• AI Reporting Hotline set up;• Compensation policy revised;• Outbreak containment procedures modified

in the light of new knowledge and experiences.

Vaccination: Scope and progress

• Now focused on 33 provinces in high risk areas (Red River and Mekong River deltas) with vaccination of all long-lived poultry and all poultry in villages

• Vaccination of high risk poultry in other provinces • Other minor poultry not vaccinated due to insufficient

information on response to vaccination• In 2005, some 166.3 million doses given to chickens and

78.1 million doses to ducks• 2006: 368 million doses given to chickens and ducks (for

2 rounds)• Vaccination Plan Phase II 2007-2008 approved; 1st

vaccination campaign in 2007 started mid-March, and as of 15 May, 131.7 million birds vaccinated.

Information, Education and

Communications

• Communication plays the critical role in raising public awareness;

• Clear, updated information was disseminated to the public regularly through mass media;

• Daily updates on disease situation and progress of vaccination published on DAH’s website, available both in Vietnamese and English.

• Various IEC materials were produced and distributed using diverse media to reach diverse audiences. A National and several provincial telephone hotlines, for HPAI were established.

Pandemic Preparedness

• One lesson learned was that emergency preparedness plans help coordinate local response.

• In August 2005 MARD released its Avian Influenza Pandemic Preparedness Plan;

• Control measures would have been done better if a preparedness was available prior to the first outbreak;

• Integrated National Operational Program of Avian and Human Influenza (OPI) was produced in May 2006 with the participation of various agencies and donors;

• Practical SOPs for humane culling, biosecurity, etc. are needed.

International support

• FAO was quick to provide limited assistance through regional and national projects;

• A World Bank Project (Phase I) initiated in 2004; • A UN Joint Program Phase I initiated in 2005 with

funds from several donors; Phase II to start.• A Japan Trust Fund project is providing support

through FAO and OIE. • A credit facility through World Bank will fund a four-

year project commencing in mid-2007.• Various bilateral assistances.

KEY TECHNICAL SUPPORT GAPS

• Enhance national DAH epidemiology capacity

• Review legislation and regulations • Upgrade laboratory• Improve procedures for disease reporting• Periodic review of HPAI control strategy• Improve vaccination delivery• Improve field surveillance

Recommendations

Recommendations: (Cont’d)

• Improve response to outbreaks• Strengthen research• Improve biosecurity of poultry production

and marketing• Improve international border inspection

procedures

Issues need further study

• Decision model on controlling of outbreaks• Ecology and epidemiology of avian influenza virus• Molecular epidemiology• Role of migratory birds • Humane methods for culling• Vaccine efficacy trails;• Survey of free-ranging ducks• Develop risk-reduction strategies for free-ranging

ducks• Feasibility of local vaccine production