Welcome you all in the sixth International Ministerial Conference on Avian and

Pandemic Influenza in Egypt October 2008

Egypt Experience In Combating Avian Egypt Experience In Combating Avian

Influenza Influenza

Current situation of Current situation of AI in EgyptAI in Egypt

2006 2007

621

212193

26 101 4 8 21028

61 6060

201013 9 5 1 2 1

406819145 6 2 14 2

0

100

200

300

400

500

600

700

800

900

1000

february

march

april

may

june july

augst

septem

ber

octobe

r

novembe

r

decembe

r

january

february

march

april

may

june july

augst

septem

ber

octobe

r

novembe

r

decembe

r

january

february

march

april

may

june july

augst

Septem

ber

Month

no. o

f pos

itive

cas

es

2006 2007 2008

1st Wave

2nd Wave 3rd Wave

Epidemic curve (passive and active surveillance)

Feb. 2006 till September 2008

845

226

35

247

2794

0

200

400

600

800

1000

200620072008

backyard farm

AI situation in farms (sectors 2&3) and backyard (sector 4): 2006 to 2008 .

80%

20%

Human cases of Avian InfluenzaHuman cases of Avian Influenza

• Total Positive Cases 5022 Deaths28 Recovered

• Distribution by Gender : 16 Males34 Females

• Breading Type: 2 Cases Farm workers 48Cases Backyard Owners

Confirmed H5N1Confirmed H5N1 Human Cases Human Cases 20062006--20082008

0

1

2

3

4

5

6

7

8

9

10

Feb. 0

6Mar

chApril

MayJu

ne

July

Aug.Sep

.Oct

.Nov.Dec.

Jan . 0

7Feb

.Mar

chApril

MayJu

ne

July

Aug.Sep

.Oct

.Nov.Dec.

Jan . 0

8Feb

.Mar

chApril

(28 ) Recovered

(22) Dea ths

F

F

F

F

F F

F

F

F

F

F

F

F

F

F

F

FF

F

F

FF

F

F

F

F

FF

F

F

F FF

F

F

M

M

M

M

M

M

M

M

M

MM

M

M

M

Total Admitted, Suspected Human cases Total Admitted, Suspected Human cases for H5N1, Egypt, till October 2008for H5N1, Egypt, till October 2008

Confirmed cases

Suspected casesYear

1819912006

2518292007

716802008

505500Total

National Strategies for control National Strategies for control of HPAIof HPAI

• Egypt has been recognized globally for its transparency policy.

• All information regarding the outbreak in birds and infection in

humans were openly communicated to the public.

• Immediate notification to WHO, OIE, FAO and other

international organizations.

1. Complete Transparency1. Complete Transparency

2. Political Commitment2. Political Commitment

Avian Influenza Steering CommitteeAvian Influenza Steering Committee(AISC)(AISC)

Avian Influenza National CommitteeAvian Influenza National Committee(AINC)(AINC)

Avian Avian Influenza Influenza Technical Technical CommitteeCommittee

(AINC)(AINC)Avian Influenza Local CommitteeAvian Influenza Local Committee

(AINC)(AINC)

• Joint action by different central government ministries.

• Full engagement of the concerned Governors.

• Participation of private producers in control measures.

• Consistent efforts to change consumer’s behavior to consume

frozen poultry meat rather than to purchase and slaughtering live

birds.

3. Inter3. Inter--sectoralsectoral collaborationcollaboration

• The government began HPAI control strategy and implemented stamping out policy (over 30 million 30 million were culled).

• Mass vaccination of commercials & backyard flocks (more than 196 million 196 million household birds free of charge and more than 750 million 750 million farm birds have been vaccinated).

• International regulations regarding avian influenza epidemic were applied and followed through a joint partnership with WHO, FAO, OIE, and other international agencies.

4. Following international 4. Following international recommendationsrecommendations

• Ensure safe poultry production.

• Poultry farms census

• Strengthen active surveillance in poultry farms and backyards.

• Raise Public Awareness, control movement of birds, and strengthen quarantine measures.

• Apply strict Biosecurity regulations.

• Strengthen veterinary services & national lab infra structure.

• Increase capacity of poultry slaughter houses and cold chain.

• Establishment of AI free compartment.

5. Restructuring the poultry 5. Restructuring the poultry industryindustry

Risk factors associated with AI in Egypt

• Migratory birds flyways.

• Some random & condensed poultry farms, Lack of biosecurity.

• Extensive backyard & rooftops rearing of birds

• Live bird Markets & shops

• No geographical borders between the Egyptian governorates that affect movement control .

• Capacity of slaughter houses cover about 50% of our production.

• Egypt developed its own case definition for early detection; an algorithm for dealing with suspected cases, and it established good medical case management that led to decrease in the case fatality rate.

• Dissemination of the case definition, algorithm, and case management protocols.

• Identification of referral hospitals fully prepared and equipped to handle suspected human cases.

• Stockpiling of the antiviral therapy (2.4 Million doses2.4 Million doses) and necessary medical and PPE.

6. Dealing with Human Cases6. Dealing with Human Cases

• Suspected cases are referred to the nearest chest or fever hospital, and the antiviral therapy begins upon admission, with testing for AI.

• The suspected cases are transferred to a previously identified referral hospital upon confirmation of the infection (either through a positive test or severe signs).

• Patients are discharged after tests are negative.

Cont.Cont. Case management protocolsCase management protocols

7. Training7. Training

• Rapid Response Team training (1996 trainee1996 trainee).

• Ongoing training courses on safe culling and disposal of infected dead birds (11,00011,000 traineetrainee).

• Training for hospitals and health directorates staff (1000 trainee1000 trainee).

• Infection control training for health care workers.

• Training of lab personnel in the field of avian influenza diagnosis and molecular characterization of AIV.

• Training on proper sampling, identification and transportation of samples for (4200 trainee4200 trainee).

8. Surveillance8. Surveillance

• Regular reporting system established.

• Establishing two reference labs. two reference labs. in Cairo one in MOHP and the other in MOALR.

• Establishing fourfour peripheral peripheral public health labs and 3 satellite Labs of MOALR.

• More than 600,000 samples from chickens were tested for AI.

• Sequence of Egyptian AI H5N1 viruses isolated from birds.

• Capacity building for Labs. staff, field epidemiologists.

• Immediate notification and reporting from peripheral to central level.

• Hospital based influenza surveillance is ongoing.

9. Communication9. Communication

• Over 10 million 10 million home visits conducted by 13,000 trained female health educators.

• Sixteen TV spots were produced and aired.

• More than 67006700 seminars for raising awareness of public were conducted.

• Raising awareness campaigns using mobile vansmobile vans.

• More than 2,000,0002,000,000 posters and leaflets were produced and disseminated.

• Surveillance is difficult due to Extensive rearing of backyard and roof top birds in rural and urban areas.

• No geographical borders between the Egyptian governorates that affect movement control .

• Lack of biosecurity measures in small scale poultry farms. • Egyptian culture regarding the handling of live poultry and the

practice of slaughtering the birds at home.• Avian Flue Fatigue among the public, media, health and

veterinary sectors.

Key Constraints & ChallengesKey Constraints & Challenges

Pandemic Preparedness PlanPandemic Preparedness Plan

Guiding MeasuresGuiding Measures

1. Social distancing

2. Organizing health care services

3. Regulation of socio-economic life

4. Application of infection control measures

5. Use of anti-viral drugs

6. Use of vaccines

Associated PlansAssociated Plans

1. Supplies management plan.2. Infection Control protocols.3. Quarantine measures plan.4. Clinical management protocols.5. Deaths manipulation plan.6. Hospital management plan.7. Primary health care units management plan.8. Communication and education plan.9. Roles of all related ministries and their interventions plan.

A set of protocols and plans are already prepared A set of protocols and plans are already prepared for pandemic preparedness:for pandemic preparedness:

Strategic Level (Political)

Planning & Preparation Level

(Tactic)

Executive Level (Operational)

Higher Ministerial Committee

National Pandemic Inter-ministerial

Committee

Governorates

Command And Control in EgyptCommand And Control in Egypt

National “Pandemic”Inter-Ministerial Committee

National “Pandemic”Inter-Ministerial Committee

Operational Room(IDSC)

Operational Room(IDSC)

(MOH)Local Directorates

Hospitals

Ministry of Health (MOH)

Emergency Police

Other Community Gatherings

Schools / Universities Private Clinics Health care

UnitsCivil

Society

Governorate(local authority)

WHO

The Higher Ministerial Committee(Cabinet secretariat)

The Higher Ministerial Committee(Cabinet secretariat)

Flow of Flow of ““PandemicPandemic”” AlertAlert

Ministry of Interior Directorates

Cities / Centers / Districts

(MOH)Sub-local unit

Emergency Police

Schools / Universities

Hospitals / Private Clinics

Health care Units

Civil Society

Mass Media

The Higher Ministerial Committee(Cabinet secretariat)

The Higher Ministerial Committee(Cabinet secretariat)

National “Pandemic”Inter-Ministerial Committee

National “Pandemic”Inter-Ministerial Committee

Operational Room(IDSC)

Operational Room(IDSC)

Ministry of Health (MOH)WHO Governorate

(local authority)

Other Community Gatherings

(MOH)Local Directorates

Notification FlowNotification Flowduring Pandemic phaseduring Pandemic phase

(MOH)Local Districts

(MOH)Local Directorates

Ministry of Health (MOH)

Hospitals / Health care

Units

Ministry of Communication and Information Technology

Ministry of Water Resources & Irrigation

Ministry of Higher Education and the State for Scientific Research

Ministry of Agriculture and Land Reclamation

Supreme councils of Youth & Sports

Ministry of International Cooperation

Ministry of State for Local Development

Ministry of Education

Ministry of Finance

Ministry of Interior affairs

Foreign Affairs

Ministry of Petroleum

Ministry of Tourism

NGOs

Ministry of Information

Ministry of Awqaf

Ministry of Justice

Ministry of Culture

Suez canal authority

Ministry of Transport

WHO

Ministry of defense

Ministry of Civil Aviation

Ministry of State for Environment Affairs

Ministry of Social Solidarity

Ministry of Electricity and Energy

Ministry of Manpower and Immigration

Ministry of trade and Industry

The Higher Ministerial Committee(Cabinet secretariat)

The Higher Ministerial Committee(Cabinet secretariat)

National “Pandemic”Inter-Ministerial Committee

National “Pandemic”Inter-Ministerial Committee

Operational Room(IDSC)

Operational Room(IDSC)

PandemicPandemic”” Response Chain of CommandResponse Chain of Command(National Level)(National Level)