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Avian Influenza Situation in Pakistan and Preparedness Efforts for its

Prevention and Control

Dr. Jaleel KamranNational Institute of Health

Ministry of Health, Islamabad, Pakistan

Regional Experts Meeting on Using Space Technology for Avian Influenza monitoring and Early Warning in Asia in the Framework of UN COPUOS, Bangkok, Thailand

1st – 3rd August

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Layout of Presentation

1. Current threat

2. Steps taken for current threat

3. Future threat

4. Preparedness for current & future threats

5. An overview of Disease Early Warning System (DEWS)

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PAKISTAN• 68 outbreaks (48 in Commercial & Backyard poultry,

20 in Wild birds – 3rd February – 25th July 2007) • 21 outbreaks reported in Poultry Farms 27 Feb to

3rd July 2006• No Human Cases detected

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Steps taken by the MoHfor Avian Influenza (H5N1)

outbreaks and pandemic influenza preparedness

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Preparedness & Response• Establishment of Joint National Steering Committee on

Avian and Pandemic Influenza• Establishment of Federal Monitoring Cell at NIH• Designation of Provincial/Regional Focal Persons• Formulation of Rapid Response Teams (RRT)• Collaborative linkages between the Ministry of Health

and the stakeholders like WHO, CDC etc.• Approval of National Preparedness Plan (PC-1) for

Prevention and Control of Avian and Pandemic Influenza, costing Rs.330.680 million (US$ 5.511 million)

• Active Surveillance, 03 kms around affected farm(s)• Establishment of District Monitoring and Response

Committees• Hospital-based surveillance of severe pneumonia at 20

tertiary hospitals

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Laboratory Strengthening

• Approval of PC-1 to establish the Biosafety Level-3 laboratory at NIH

• Enhancement of Lab capacity at NIH for advanced molecular (real-time PCR) studies

• Supply of special sample transport medium to hospitals • Agreement with CDC for 05 years Lab based Influenza

Surveillance Programme• Pilot Project for Surveillance of Influenza-like-illness (ILI)

since November 200. No variants observed in 434 samples

• Exchange of technical information on avian influenza with the National Reference Virology Lab of animal Sciences Institute

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Communications • Communication strategy finalized and launching of

media campaign

Drugs • Registration of national Oseltamivir manufacturing Firms

Personnel Protective Equipments • Pre-positioned to the Provincial Health Departments

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Capacity Buildings

• Training of master trainers form all the provinces, AJK and Northern Areas for surveillance of human influenza

• Toolkit/Guidelines and SoPs for Surveillance, sample collection, clinical management developed and distributed to the Provincial Health Department, AJK and NAs

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Plan for current & future threats

1. Preparedness measures:– Approved Plan (PC-1) having 14 components worth Rs.

330.683 million– National Tool Kit for Out Reach and Lab – Antiviral medicine:

• Thirteen national Firms registered for generic Oseltamivir; orders placed

• Locally manufactured Oseltamivir stockpiled

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PREPAREDNESS MEASURES

Component-6: COMMUNICATION (Rs. 5.000)

Component-7: Establishment (Rs. 34.989)

Component-8: Transport (Rs. 2.700)

Component-9: Lab supplies (Rs. 5.000)Component-10: Civil works (Rs. 37.000)Component-11: Office equipments (Rs. 2.902)

Component-12: Personnel Protective Equipments (Rs. 50.000)

Component-13: CDC Atlanta as technical assistance under lab –based

Influenza like illness (ILI) Surveillance Project (Rs. 5.000)

Component-14: Contingencies (Rs. 9.632)

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An Overview ofDisease Early Warning System (DEWS)

A Joint National Programme of Ministry of Health –World Health Organization & National Institute of Health

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Disease Early Warning System (DEWS)

PURPOSEPredicts and detects in time, the outbreaks of public health importance for effective response

GOALTo minimize morbidity & mortality due to epidemic diseases

OBJECTIVETo detect the occurrence of an epidemic in its earliest possible stage

OUTBREAK/ EPIDEMIC ?Occurrence of more cases of disease than expected in

a given population over a particular period of time

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National Institute of Health (NIH) Pubic Health Laboratories Division (PHLD)

Epidemic Investigation Cell (EIC)

1. Oversight of epidemic incidence

2. Technical support for guidelines, training material and DEWS tools

3. Epidemics response, when called

4. Need assessment for international assistance

5. Operational research and situation analyses

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EDO (Health)

DHQHTHQHRHCBHU

ClinicsNGOs

Provincial EIC

ProvincialTaskForce

NIH-EIC

Information Sharing & Response

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DEWS Case definitionsEpidemic-prone Infectious Diseases

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Disease Early Warning System

( NIH - HMIS )

Code No: _______________________ NATIONAL INSTITUTE OF HEALTH (NIH) - HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS)Distt:___________ Tehsil:___________ MINISTRY OF HEALTH, GOVERNMENT OF PAKISTAN

Week No:_________ Month:________ REPORTER: DR/MRDate, form sent:___________________

Health facility:____________________ HEALTH FACILITY: TEHSIL: DISTT: PROVINCE:

Sentinel site: DATE: From / / / /02 /02 HMIS CODE NO: WEEKLY

Weekly Total MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY TOTAL

GROUP A GROUP A

AFP/POLIO AFP/POLIO

CHOLERA CHOLERA

DENGUE DENGUE

PLAGUE PLAGUE

VHF VHF

GROUP B GROUP B

AIDS AIDS

DIPHTHERIA DIPHTHERIA

HEPATITIS HEPATITIS

INFLUENZA INFLUENZA

MALARIA MALARIA

MEASLES MEASLES

MENINGITIS MENINGITIS

N.N.T. N.N.T.

PERTUSSIS PERTUSSIS

TYPHOID TYPHOID

Name of sender:_______________ Group A: Immediately report & also include in weekly reporting Group B: Report weekly

Signature: * Report any case of Lymphoedema/Elephantiasis/Filariasis

DISEASE EARLY WARNING SYSTEMDAILY RECORDING FORM

WEEK NO:

DEWS Weekly/ Daily Recording Form

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HIMS Weekly Watch Chart

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OPD Register

Information Recording (DEWS HIMS)

Disease Early Warning System

( NIH - HMIS )

Code No: _______________________ NATIONAL INSTITUTE OF HEALTH (NIH) - HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS)Distt:___________ Tehsil:___________ MINISTRY OF HEALTH, GOVERNMENT OF PAKISTAN

Week No:_________ Month:________ REPORTER: DR/MRDate, form sent:___________________

Health facility:____________________ HEALTH FACILITY: TEHSIL: DISTT: PROVINCE:

Sentinel site: DATE: From / / / /02 /02 HMIS CODE NO: WEEKLY

Weekly Total MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY TOTAL

GROUP A GROUP A

AFP/POLIO AFP/POLIO

CHOLERA CHOLERA

DENGUE DENGUE

PLAGUE PLAGUE

VHF VHF

GROUP B GROUP B

AIDS AIDS

DIPHTHERIA DIPHTHERIA

HEPATITIS HEPATITIS

INFLUENZA INFLUENZA

MALARIA MALARIA

MEASLES MEASLES

MENINGITIS MENINGITIS

N.N.T. N.N.T.

PERTUSSIS PERTUSSIS

TYPHOID TYPHOID

Name of sender:_______________ Group A: Immediately report & also include in weekly reporting Group B: Report weekly

Signature: * Report any case of Lymphoedema/Elephantiasis/Filariasis

DISEASE EARLY WARNING SYSTEMDAILY RECORDING FORM

WEEK NO:

DEWS Weekly/ Daily Recording Form HIMS Weekly Watch Chart

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0102030405060708090

1 4 7 10 13 16 19 22 25 28 31 34 37 40

DAY

CASES

Outbreak Detection and ResponseF Case

Detection/Reporting

LabConf

Response

Opportunity for control

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Conclusion

• DEWS is a low cost - highly effective and recognized system for combating epidemics under ordinary circumstances and during disasters.

• The consolidation and application of this system will significantly prevent morbidity and mortality resulting from loss of natural barriers induced by disasters

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Thank you