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CDC Cooperative Agreement
Influenza Surveillance Review
Project Period(Sep 2004-Sep 2011)
National Institute of Health
Department of Medical Sciences,
Bureau of Epidemiology
Department of Disease Control,
Ministry of Public Health,
Thailand
Outline
• Project Overview
• Virological Surveillance
• Harmonization of Virological and epidemiological Surveillance Systems
• Lesson learned
Population ~65 millionM:F 0.98:1
Birth rate 12.95/1000 Death rate 7.29/1000 Population Growth rate 0.8% Life expectancy: M 71.24 yr, F 76.08 Yr area of 513,120square kilometersBorders 8,031 kms
5,326 kms inland
2,705 kms coastlines77 provinces Democracy (Constitutional Monarchy)
Agriculture GDP (official exchange rate) $318.9 billion
Thailand Demographics (2011)
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source: http://www.indexmundi.com/thailand/
2003-04 : Avian influenza
4S. Pattamadilok, ThaiNIH, DMSc
Distribution of AI in poultry and human cases, 2004-2007
Jan-May 04
Confirmed case
Suspect case
Poultry outbreak
Source from BOE
National Committee on AI Response & Pandemic
Influenza Preparedness
1st Strategic plan on Avian Influenza and Influenza Pandemic Preparedness
(2005-2007)
The Government
National Strategic Plan on Avian Influenza and Influenza Pandemic Preparedness Plan
Network
Hospital
SRRT
Laboratory
Veterinarians
Pathologist
Laboratory
Distribution of AI in poultry and human cases, 2004-2007
Jan-May 04 Jun-Oct 04 Jul-Nov 05 Jan-Nov 07Jun-Aug 06
Confirmed case
Suspect case
Poultry outbreak
Source from BOE
(25 cases and 17 dead)
National Committee on AI Response & Pandemic
Influenza Preparedness
The Government
National Strategic Plan on Avian Influenza and Influenza Pandemic Preparedness Plan
Influenza pandemics in the 20th century
A(H1N1) A(H2N2) A(H3N2)
1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”
20-40 million deaths 1-4 million deaths 1-4 million deaths
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S. Pattamadilok, ThaiNIH, DMSc
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Genomic of Influenza Virus
• Orthomyxoviridae
• Consists of single strand negative sense RNA in 8 segments.
• The 5' and 3' terminal sequences of all the genome segments are highly conserved.
http://www.cdc.gov/eid/content/14/7/e1.htm Thai NIC : 22/05/09
Have questions? : But no answers
• When• What• How
WHOGlobal Influenza surveillance network
Thai, RIRL for SEA Region
WHO National Influenza Center, Thai NIChas been established since 1972 at NIH, DMSc, Thailand
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Regional Influenza Reference Laboratory (RIRL) for SEA Regionhas been designated by WHO since 22 July 2010
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Northern hemisphere (2012-2013)A/California/07/2009 (H1N1)-like virusA/Victoria/361/2011(H3N2)-like virusB/Wisconsin/1/2010-like virus
Southern hemisphere (2012)
WHO Influenza vaccine recommendation
Feb 2012 :Composition vaccine recommendation
Sep 2012:Vaccine available
(Nov 12-Feb 13) influenza season
Circulating in Thailand (2011-2012)
-A/California/07/2009 (H1N1)-like virus
-A/Perth/16/2009 (H3N2)-like virus
--B/Brisbane/60/2008-like virus
- B/Florida/4/2006-like virus
- B/Wisconsin/01/2010-like virus
Sep 11 :Composition vaccine recommendation
March 12 :Vaccine available
(May – Oct 12) influenza season
S. Pattamadilok, ThaiNIH, DMSc 14
-A/California/07/2009 (H1N1)-like virus
-A/Perth/16/2009 (H3N2)-like virus
--B/Brisbane/60/2008-like virus
Collaboration with US CDC
• Phase I project : “Development of Influenza Surveillance Networks” period ranged from 09/15/04 – 09/14/09
• Phase II Project : “Strengthening Thailand’s Influenza Surveillance Network to Support Influenza Control Policy and Improve Pandemic Preparedness” period ranged from 09/15/09 up to present
Funding
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
Year1 Year2 Year3 Year4 Year5 Year6 Year7 Year8
U$
Year
Budget ( U$ )
Participating organizations
1. CHIANGSAEN HOSPITAL
2. MAECHAN HOSPITAL
3. MAESOT HOSPITAL
4. NONGKHAI HOSPITAL
5. PRAPOKKLAO HOSPITAL
6. HATYAI HOSPITAL
7. PUBLIC HEALTH CENTER 17 PRACHANIWATE
8. Koh Chang Hospital
9. Koh Samui Hospital
10. Bangkok Hospital, Samui, Surat Thani
11. BAMRASNARADURA INFECTIOUS DISEASES INSTITUTE
12. VACHIRA PHUKET HOSPITAL
13. PRACHUAP KHIRIKHAN HOSPITAL
First year
Mae Sot hospital,Tak
Nong Khai hospital
Phra Pok Klao hospital, Chantaburi
Hat Yai hospital, Songkhla
Health Center 17, Bangkok
Second year
Mae Chan hospital, Chiang Rai
Chiang Saen hospital, Chiang RaiThird year
Koh Chang hospital Trad
Koh Samui hospital,
Bangkok hospital, Samui, Surat Thani
Fifth Year
Bamrasnaradura Infectious Diseases Insitute, Bangkok
Nong Khai
Mae Sot
Chanthaburi
Hat Yai
Bangkok
Chiang SaenMae Chan
Trad
Suratthani
Nonthaburi
Phase I : sentinel sites (Sep.2004-Sep.2009)
= NIH
= BOE
NIH BOE
1. Chiang Rai (2 site) 1.Lop Buri
2. Tak 2.Ubon Ratchathani
3. Nong Khai 3.Pijitt
4. Bangkok 4.Sukhothai
5. Nonthaburi 5.Maha Sarakham
6. Chantaburi
7.Prachuap Khiri Khan
8. Songkhla
9. Surat Thani
10. Phuket
Phase II : sentinel sites (Sep.2009-Sep.2012)
System goals & objectives
PhaseI
General objective:
To strengthen the current laboratory-based surveillance network for influenza
Specific objectives:
• To monitor for new antigenic variants
• To serve as a national and international resource
to guide public health decisions
System goals & objectives
PhaseII
General objective: To assess policy and strategies of influenza surveillance, epidemiological analysis related to seasonal and pandemic influenza in Thailand
Specific objectives:
To document achievements, strengths and weaknesses in policy, strategy and practice
To identify potential applications of surveillance information to guide policies, strategies and response
To make recommendations for improving sustainable influenza surveillance in Thailand
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Case Definition: 2004 - 2009
A suspected case of influenza-like illness(ILI)
• individual presenting with fever (temperature ≥38oC) and
–one or more of the following symptoms: cough; sore throat
A confirmed case of influenza
– any case of influenza-like illness whose throat swab tests positive viral culture for influenza or positive PCR for influenza A
S. Pattamadilok, ThaiNIH, DMSc 22
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Phase I: Year 2004-2009
Average number of ILI cases seen per week
(At least 5 patients/week/site)
20 patients/month/site
Enrollment criteria
S. Pattamadilok, ThaiNIH, DMSc 23
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SPECIMEN COLLECTION
S. Pattamadilok, ThaiNIH, DMSc 24
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Specimens processing for ILI surveillance : Phase I
viral isolation/PCR
Viral confirmation
At WHO collaborating
Center.
Nasal swab ( NS )
kept in VTM at 4 0 C< 48hrs. and transfer
to liquid N2 tankTest with Quick Vue
Rapid test
Weekly transport
to Thai NIC by N2 tank
Throat swab
specimen collection
Thai National Influenza Center
S. Pattamadilok, ThaiNIH, DMSc25
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Case Definition Pneumonia
A suspected case of Pneumonia infection in
Community Acquired Pneumonia 5 Sample/week/site
S. Pattamadilok, ThaiNIH, DMSc 26
Phase I “Development of Influenza Surveillance Networks”Five years : 15 Sep.2004 -14 Sep.2009-
ILI : 5 sample/week/site
Phase II “Strengtening Thailand’s Influenza Surveillance Network to Support Influenza Control Policy and Improve Pandemic Preparedness ”
Five years : 15 Sep.2009 -14 Sep.2014ILI : 10 sample/week/siteSARI : 5 sample/week/site
Laboratory-based Influenza Surveillance networkpartly supported by US-CDC & BOE
Outline
• Project Overview
• Virological Surveillance
• Harmonization of Virological and epidemiological Surveillance Systems
• Lesson learned
Outline
• Project Overview
• Virological Surveillance
• Harmonization of Virological and epidemiological Surveillance Systems
• Lesson learned
Lessons learned
Thai National Influenza Center
Thailand award for public service quality, 2007
“Virological laboratory Testing Process for Suspected Avian influenza cases”
Institutional Counterparts - Thai National Institute of Health- Regional Medical Sciences Centers (RMSC)- Thai Department of Disease Control (DDC)- Thai Bureau of Epidemiology (BOE)- Sentinel Hospitals
Collaborating Agencies
- WHO Global Influenza Surveillance and Response System Network
(WHO GISRS )- US -CDC Collaboration-International Emerging Infections Program (CDC-IEIP) Thailand
Acknowledgement
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Thank you
