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an International conference on Avian and Pandemic Influenza Virus
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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)