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Global surveillance during pandemic
Global surveillance during pandemic
Tim Nguyen
Global Influenza Programme, WHO
WHO updated interim recommendations
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OutlineOutline
1. Importance and benefits of surveillance and information sharing at global level
2. WHO updated interim guidance on global surveillance
3. Demo FluID
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Importance of surveillance at global level
Importance of surveillance at global level
Globalisation of risk: international mass gatherings, increased air traffic
The global monitoring provides information on the geographical spread of the disease and its characteristics in different settings
Globalisation of needs: antiviral, vaccines
Communication with the public and media
Update of technical guidelines
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Sources of information Sources of information
Reporting form Member states and Regional Offices
Virtual teleconferences of 4 networks: Virological , epidemiological and clinical networks + network of modellers
GISN / FluNet
Screening of web sites and Media
Review of literature
The Friend and Acquaintance network– Sometimes the most valuable and reliable!
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Monitoring of the global situation as of 06 Aug 09
Monitoring of the global situation as of 06 Aug 09
Confirmed cases 177457
Confirmed deaths 1462
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Monitoring of the global situation Benefit from Information SharingMonitoring of the global situation Benefit from Information Sharing
Web updates, WER,
Updated Interim WHO Guidance on Global
Surveillance
Updated Interim WHO Guidance on Global
Surveillance
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Goals from SurveillanceGoals from Surveillance
Tracking appearance, rise and fall, and movement of virus
Changes in rates of morbidity or mortality
Changes in age distribution of morbidity or mortality
Changes in transmissibility
Changes in clinical pattern of disease– New or unusual presentations– Clinical course – e.g. bacterial coinfections, viral pneumonias, pulmonary emboli– Risk groups: e.g. obesity, pregnant, age, others?
Virologic changes: – Antigenicity and antiviral sensitivity
Strain dominance
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Phases of the processPhases of the process
International Consultation
Working group meeting (s)
Fieldtesting
Dec
2007 2008
Mar
Definition frameworkglobal surveillance
Detailed description of processes Reality check
Draft guidelines
2009
Oct Dec April
Interim guidelines
July
UpdatedInterim
guidelinesField test
guidelines
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Shifting Information NeedsShifting Information Needs
b) Description and Assessmenta) Early Detection c) Monitoring
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Surveillance Guidance – (a) Early Detection
Surveillance Guidance – (a) Early Detection
For countries not yet affected:– The first confirmed pandemic (H1N1) 2009 virus
infection detected in a country should be immediately reported by the IHR National Focal Point
And afterwards:– Any changes in the epidemiological, virological or
clinical presentation – Any unusual or unexpected public health events, e.g.
clusters of severe unexplained acute respiratory illness or unexplained deaths
Case detectionOutbreak investigation
Notification to WHO – IHR
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Surveillance Guidance –(b) Description and Assessment
Surveillance Guidance –(b) Description and Assessment
Describe the epidemiological and virological features of cases to guide control and prevention activities
Assess disease severity
Laboratory testing priorities– confirming infection in new areas– Testing severe cases – Monitoring the co-circulation of pandemic (H1N1) 2009
virus and seasonal viruses
Characterization of the virusand the disease
Initial copmprehensive assessment (FF100)Contact tracingCase-based sentinel surveillanceLab confirmation
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Surveillance Guidance (c) Continuous Monitoring
Surveillance Guidance (c) Continuous Monitoring
Report data to allow tracking of:
Lab surveillance of severe cases / deaths and monitoring of co-circulation
Assess qualitative indicators– global geographical spread– disease trend and intensity– impact of the pandemic on health-care services
In addition if available, quantitative figures– prevalence– changes in viral antigenicity and antiviral sensitivity– deaths from acute respiratory disease.
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Outputs Expected - Use of data and information shared
Outputs Expected - Use of data and information shared
A composite picture of severity and transmission characteristics primarily based on local interpretation of data and investigations.
A description of clinical presentation, course, complications, and risk factors
Virologic data for strain selection and antiviral sensitivity assessment
Numbers of cases, hospitalizations, and deaths
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Key Related Decisions - Use of data and information shared
Key Related Decisions - Use of data and information shared
Target groups for intervention with vaccine or antivirals– Risk groups in need protection.– Target groups that might have greatest impact on transmission.
Strain to use for vaccine.
Which antivirals to use.
Role of nonpharmaceutical interventions.
Appropriate management practices
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Consent - Use of data and information shared
Consent - Use of data and information shared
Data collected via WHO’s global influenza A (H1N1) surveillance systems will analysed and summary data will be published in graphs, maps and tables on WHO’s web site and published in the Weekly Epidemiological Record.
Scientists from countries providing data will be invited to participate in the development of, and be co‐authors on, publications that draw on their country‐specific data.
Countries will always be consulted in the development of any articles in which their data has been used.
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Tools for data collection and disseminationTools for data collection and dissemination
b) Description and Assessmenta) Early Detection c) Monitoring
IHR Notification
Weekly Summary Reporting Form
Case summary Form
FluNet
FluNet
FluID
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Demo FluIDDemo FluID
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Propose Timeline of FluID roll outPropose Timeline of FluID roll out
• Data Form• Data excel export
• Automated maps, graphs, Tables• Joint viro/epi weekly country reports (pdf)
• Upload from existing databases / systems• Modification from best practices / lessons learned
Mid
August September OctoberMid/end
Phase 1 Phase 2
Beginning
Start Global roll out
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SummarySummary
First affected countries were extremely open to share information and reports to provide knowledge for the global response
Updated interim surveillance guidelines take into account the current knowledge of Pandemic (H1N1) 2009
FluID and FluNet available to support platform for global information sharing mechanism
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AcknowledgementsAcknowledgements
Tony Mounts
Julia Fitzner
Kaat Vandemaele
Vivek Shinde
Philippe Veltsos
Liliana Pievaroli
Sylvie Briand
Maja Lievre
Weigong Zhou
Amy Cawthorne
Pandemic Surveillance Working Group
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THANK YOU
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