Communicable Disease Surveillance & Response WHO-WPRO Pandemic (H1N1) 2009 situation and response in the Western Pacific Region Takeshi Kasai Communicable

Communicable Disease Surveillance & Response WHO-WPRO

Pandemic (H1N1) 2009 situation Pandemic (H1N1) 2009 situation and response in the Western and response in the Western

Pacific RegionPacific Region

Takeshi KasaiTakeshi KasaiCommunicable Disease Surveillance and Response, Communicable Disease Surveillance and Response,

Western Pacific Regional OfficeWestern Pacific Regional OfficeWorld Health Organization World Health Organization


WPRO Response-Risk AssessmentWPRO Response-Risk Assessment

VirologicalMutation

InterventionContainment to Mitigation

ImpactHealth Care

ImpactSociety

ClinicalDevelop guideline

Epidemiological Prediction & Set up reference

Action Oriented Risk Assessment


Number of Countries/Areas Reporting Confirmed Number of Countries/Areas Reporting Confirmed Pandemic (H1N1) 2009 Cases to WPRO by WeekPandemic (H1N1) 2009 Cases to WPRO by Week

0

5

10

15

20

25

30

17 18 19 20 21 22 23 24 25 26 27 28 29 30

Epidemiological Week

Num

ber

of C

ount

ries/

Are

as

South Hemisphere North Hemisphere Tropical Pacific


Seasonal influenza and Pandemic (H1N1) 2009 Situation in WPRO

North Hemisphere

Not yet in flu season, low ILI activity but higher compared to previous years

Number of cases is gradually increasing Pandemic (H1N1) 2009 is widely distributed geographically

South Hemisphere

In the middle of flu season. Laboratory test results are predominantly Pandemic (H1N1) 2009

rather than seasonal influenza Spread is higher compared to seasonal influenza Shows signs of slowing virus activity

Tropics Seasonal Influenza activity is getting higher compared to previous

years Pandemic (H1N1) 2009 activity is continuing

Pacific 18 out of 21 countries/areas have reported cases of Pandemic

(H1N1) 2009 Fiji and Samoa has reported near 100 cases as of Aug 13 2009.


Pandemic (H1N1) 2009 Fatal CasesPandemic (H1N1) 2009 Fatal CasesWestern Pacific RegionWestern Pacific Region

Total Deaths Total Deaths 136136

Clinical picturesClinical pictures (N=48)(N=48)75% - with underlying medical 75% - with underlying medical condition condition 3 deaths among pregnant, all without 3 deaths among pregnant, all without underlying medical conditionunderlying medical condition

Clinical Course Clinical Course (N=27)(N=27)9 days - median interval from onset of 9 days - median interval from onset of symptoms to death (range: 4-14)symptoms to death (range: 4-14)5 days - median interval from onset of 5 days - median interval from onset of symptoms to hospitalization (range: 2-symptoms to hospitalization (range: 2-8)8)3 days – median interval from 3 days – median interval from hospitalization to death (range: 2-9)hospitalization to death (range: 2-9)

Final diagnosis Final diagnosis (N=42)(N=42)62% - severe pneumonia62% - severe pneumonia14% - congestive heart failure14% - congestive heart failure12% - ARDS12% - ARDS

Confirmed case-deaths associated with pandemic(H1N1) by Age Group WPR, 2009

0.0

4.21.5

12.510.4

6.3

2.1 2.1

6.3

16.7

25.0

12.5

0.0

5.0

10.0

15.0

20.0

25.0

30.0

<4 5-14 15-19 20-39 40-64 65+

Age Group


Influenza Virus TypingInfluenza Virus Typing

# o

f re

po

rte

d c

ase

s

Week

JapanJapanWeek 19-32Week 19-3220092009

New ZealandNew ZealandAugust 2009August 2009


Reported Cases of Oseltamivir Resistance

Country/Country/areasareas

TamifluTamiflu DetailDetail

1 Denmark Prophylaxis Contact with traveller.

Developed symptoms on 5th day of prophylaxis

Index: Sensitive

No further cases were indentified.

2 Japan

40s, F

Prophylaxis Developed symptoms on 7th day of prophylaxis

Index: Sensitive


3 HK, 16 F None Travelled from San Francisco

4 Japan Young child


Index: Sensitive


5 Canada

59 M

Prophylaxis Developed symptoms during prophylaxis

Index: Sensitive

6 Japan

30s, M


Index: Sensitive


7 Japan No Young child


Index: Sensitive


8 Singapore 28F

Treatment Travelled to New Caledonia, Hawaii. Isolates showed mutation on 3 rd day of treatment

Data as of 13 Aug


Surveillance & Response StrategiesSurveillance & Response Strategies

Strategy Strategy No No Community TransmissionCommunity Transmission

WithWithCommunity TransmissionCommunity Transmission

ContainmentContainment Example: Example: Mongolia Mongolia Resource intensive andResource intensive and

minimal public health minimal public health benefitbenefit

MitigationMitigation Lost opportunity to delay Lost opportunity to delay the spreadthe spread

Example: Example: Australia, Australia, Japan, New ZealandJapan, New Zealand


Cases with Travel HistoryCases with Travel HistoryPhilippines and AustraliaPhilippines and Australia

AustraliaAustralia

Country and areasCountry and areas # of cases# of cases

FijiFiji 11

Viet NamViet Nam 77

South KoreaSouth Korea 11

SamoaSamoa 11

Hong Kong, ChinaHong Kong, China 2121

New ZealandNew Zealand 22

Taiwan, ChinaTaiwan, China 33

MalaysiaMalaysia 3232

Mainland, ChinaMainland, China 1414

SingaporeSingapore 2222

TOTALTOTAL 9595

PhilippinesPhilippines

Country and areasCountry and areas # of cases# of cases

Macao, ChinaMacao, China 55

PNGPNG 11

Saudi ArabiaSaudi Arabia 22

Taiwan, ChinaTaiwan, China 11

MalaysiaMalaysia 88

South KoreaSouth Korea 22

Mainland, ChinaMainland, China 55

SingaporeSingapore 1010

JapanJapan 1010

Hong Kong, ChinaHong Kong, China 77

TOTALTOTAL 5050


Monitoring of Pandemic ImpactMonitoring of Pandemic Impact

Pandemic impact still remains Pandemic impact still remains uncertain and is currently under uncertain and is currently under monitoring monitoring

Pandemic impact on a Pandemic impact on a population has many population has many dimensions: health, social and dimensions: health, social and economic consequenceseconomic consequences

No severe impact on health-care No severe impact on health-care services as a result of acute services as a result of acute respiratory disease reportedrespiratory disease reported

Pressures on local hospitals and Pressures on local hospitals and potential economic loss reported potential economic loss reported in some countriesin some countries

Pademuc impact indicators reported in the Western Pacific Region

4 4

00

1

2

3

4

5

Low Moderate Severe

Degree of disruption of health-care services as a result of acute

respiratory disease

Nunb

er o

f cou

ntrie

s &

area

s


WPRO ResponseWPRO Response

Risk Management (1)•Communication•Rapid Gap Assessment•Guideline development

Risk Management (2)•Technical Support

Risk Assessment•IHR•MS information•Surveillance

Framework for Action


APSED AND WORKPLAN APSED AND WORKPLAN

IHR (Public Health Emergencies of International Concern)

Asia Pacific Strategy for Emerging Diseases (APSED)

Bi-Regional Workplan

AvianInfluenza

Pandemic preparedness


Framework for ActionFramework for Action

SURVEILLANCE

COMMAND

PUBLIC HEALTH INTERVENTIONS

COMMUNICATIONHEALTH CARE

RESPONSEHEALTH SECTOR

How to slow down transmission

How to improve care and reduce deaths

Laboratory

PA

RT

NE

RS

INDIVIDUAL LEVEL SOCIETAL LEVEL


H5 ResponseH5 Response

H5H5

BIRDS HUMANInterfaceInterface

Information SharingInformation Sharing

SurveillanceSurveillance

RapidRapid ResponseResponse

Monitoring of PigsMonitoring of Pigs

PIGS

H1

New ResponseNew Response

H1

H1 Pandemic ResponseH1 Pandemic Response

H5

Re-assortment

Re-assortment

Monitoring of humanMonitoring of human

Diagram Showing Responses to Reduce Probability of Viral Re-assortment


ConclusionConclusion

Epidemiological Situation differs by countryEpidemiological Situation differs by country Virus has not undergone any significant mutation Virus has not undergone any significant mutation

and majority of cases have been mild. However, and majority of cases have been mild. However, severe and death cases have been reported in severe and death cases have been reported in countries with sustained community countries with sustained community transmission. transmission.

For those who have not yet experienced For those who have not yet experienced extensive community transmission, it is extensive community transmission, it is important to prepare both national and local important to prepare both national and local levels as much as possible. levels as much as possible.

WPRO-SEARO have developed a Framework WPRO-SEARO have developed a Framework for Action to assist preparations with the goal to for Action to assist preparations with the goal to minimize preventable deathsminimize preventable deaths

Documents

Communicable Disease Surveillance & Response WHO-WPRO Pandemic (H1N1) 2009 situation and response in the Western Pacific Region Takeshi Kasai Communicable