Influenza A (H1N1) Pandemic in Thailand Sopon Iamsirithaworn, MD, MPH, PhD Pasakorn Akarasewi, MD, MPH
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1 Influenza A (H1N1) Pandemic in Thailand Sopon Iamsirithaworn, MD, MPH, PhD Pasakorn Akarasewi, MD, MPH Kumnuan Ungchusak, MD, MPH Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 27 October 2010 Acknowledgement SRRTs of MOPH involved in influenza pandemic responses Ms.Malinee Chittaganpitch, National Influenza Center, National Institution of Health, MOPH, Thailand and staff Prof. Pilaipan Puthavathana and staff Dr.Warin Pongkankham Dr.Kanlaya Jongcherdchootrakul Dr.Adisorn Wattanasak DrThitipong Dr.Thitipong Yingyong Ms.Suthanan Suthchana Ms.Ubolrat Naruponjirakul Mr.Thanawan Gapppbirom Dr.Wanna Hanshaoworakul 1
2 Outline of Presentation Early pandemic: imported cases and school outbreaks in Bangkok k Epidemiological characteristics of the 2009 pandemic 1 st, 2 nd and 3 rd pandemic wave Estimation of influenza H1N1 pandemic burden Number of probable influenza, H1N1 (2009) confirmed and death cases, 2009 Oct 16 th 2010 Cases Deaths death H1N influenza (รง. 506) H1N Imported cases Resource : surveillance database of BOE 2
3 Epidemic curve of the first 12 Cases of Laboratory confirmed Influenza A (H1N1) 2009 in Thailand, May June 2009 No. of case H1N1 imported case H1N1indigenous case Many imported cases and local transmission st pandemic wave May October
4 Spatial temporal Distribution of Influenza A (H1N1) 2009, Thailand 2009 Spatial temporal Distribution of Influenza A (H1N1) 2009, Thailand
5 Spatial temporal Distribution of Influenza A (H1N1) 2009, Thailand 2009 Spatial temporal Distribution of Influenza A (H1N1) 2009, Thailand
6 Spatial temporal Distribution of Influenza A (H1N1) 2009, Thailand 2009 Spatial temporal Distribution of Influenza A (H1N1) 2009, Thailand
7 Spatial temporal Distribution of Influenza A (H1N1) 2009, Thailand 2009 Spatial temporal Distribution of Influenza A (H1N1) 2009, Thailand
8 Spatial temporal Distribution of Influenza A (H1N1) 2009, Thailand 2009 Spatial temporal Distribution of Influenza A (H1N1) 2009, Thailand
9 Spatial temporal Distribution of Influenza A (H1N1) 2009, Thailand 2009 Spatial temporal Distribution of Influenza A (H1N1) 2009, Thailand
10 Number of Laboratory confirmed Influenza A (H1N1) 2009 in Thailand, May July 2009 Local transmission Imported cases School outbreaks Number of laboratory confirmed cases of Influenza A (H1N1) 2009 by Age group, Thailand, May Oct 2009 School-age children 10
11 Case Fatality of Laboratory confirmed Influenza A (H1N1) 2009 by Age group, Thailand, May Oct 2009 Percent 5% 4% 3.82% 3% 2.38% 2% 1% 0% 0.30% 0.08% 0.19% 1.19% 0.64% > 60 Total Age (Years) 1 st School Outbreak in Bangkok On 9 June 2009, Bureau of Epidemiology received a notification from Thai NIH of a confirmed H1N1 case 11 year boy, with illness onset on June 6, 2009 He had no history of travelling abroad A private school with 5,300 students, grade 1 12 School semester began 18 May 2009 Manyforeigner teachers andstudents returned from abroad Investigation was started on 10 June /253 (77.1%) were positive for influenza A (H1N1)
12 A first School Outbreak of 2009 Pandemic Influenza H1N1 in Thailand 23 Number of confirmed influenza A (H1N1) 2009 by onset date in a School Outbreak, May June 2009 (N=186) Number of cases May June 2009 Source: Kanlaya Jongcherdchootrakul, Bureau of Epidemiology, MOPH, Thailand 12
13 Influenza Transmission in the First School Outbreak, Bangkok, Thailand, May June 2009 No. of case Overall attack rate 50-60% 3 rd wave Student absent School 1 st wave closure (confirmed H1N1) 1 week 2 nd wave Source: Kanlaya Jongcherdchootrakul, Bureau of Epidemiology, MOPH, Thailand Percent of schools with reported influenza outbreaks by school size, Bangkok, June August 2009 School size Source: Chaninan Sonthichai, et al. 13
14 Number of Influenza like illness by onset date Frequency จ านวน Number of cases จ านวนผ ป วยอาการคล ายไข หว ดใหญ ตามว นเร มป วย ในศ นย ฝ กทหารใหม in a military camp, ต งแต 1 ม.ย. June ถ ง ม.ย.52 Distribution of onset AR = 38.18% CFR = 0.09% Investigation รพ.อาภากรฯ และ แผนกแพทย ศ นย ฝ ก ด าเน นการควบคมโรค & control June ว นท เร มป วย 2009 เด อนม ถ นายน Source: Warin Pongkankham, et al. Onset Symptomatic and asymptomatic infection rate of influenza A (H1N1) 2009 in an outbreak (N=90) Source: Adisorn Wattanasak, Bureau of Epidemiology, MOPH, Thailand 14
15 Symptomatic and asymptomatic infection rate of influenza A (H1N1) 2009 in an outbreak (N=90) Source: Adisorn Wattanasak, Bureau of Epidemiology, MOPH, Thailand 2 nd pandemic wave November 2009 May
16 Characteristics of 2nd wave More outbreaks were reported in rural area Lower level of transmission compared to 1 st wave Related to travel to areas with ongoing transmission More school outbreaks reported from remote provinces Increase in age of reported cases Changes in Age Distribution of Laboratoryconfirmed Influenza A (H1N1) 2009 in Thailand 16
17 Cumulative Incidence of 2009 H1N1 pandemic Influenza in Thailand, 1 May May rd pandemic wave May 2010 now 17
18 Characteristics of 3rd wave Outbreaks were reported in institutional setting, e.g., factory, prison, temple, office Increase in age of reported cases Moderate attack rate Some schools reported limited outbreaks Mixed H1N1 (2009) and H3N2 or Flu B infections detected in the same outbreak การระบาดของไข หว ดใหญ ในเร อนจ า 18
19 จ านวน และส ดส วน (%) ท ตรวจพบเช อไข หว ดใหญ จ าแนกตามสายพ นธ กล มผ ป วย ILI ท ร บบร การในแผนกผ ป วยนอก ของโรงพยาบาลท เป นจ ดเฝ าระว ง ส ปดาห ท 1 42 พ.ศ.2553 (ว นท 3 ม.ค ต.ค. 2553) จ านวน (ราย) % Jan Jan Jan Jan Jan Feb Feb Feb Feb Mar Mar Mar Mar Apr Apr Apr Apr May May May May May Jun Jun Jun Jun July July July July Aug Aug Aug Aug Aug Sep Sep Sep Sep Oct Oct Oct Oct Oct Nov Neg Flu A,B Flu B Flu A Flu A:H H1N1 PDM % H1N1 in ILI Reported Influenza A H1N1 (2009) Cases, Thailand, Cumulative Cases (up to 22 nd Oct 10): 15,149 cases Cumulative Deaths: 129 cases 2009 Cumulative Cases: Cumulative Deaths: 30, cases 197 cases 19
20 Proportion of ILI cases per total OPD cases, week 1 st 41 st of 2010 จ านวน และส ดส วน (%) ท ตรวจพบเช อไข หว ดใหญ จ าแนกตามสายพ นธ กล มผ ป วย ILI ท ร บบร การในแผนกผ ป วยนอก ของโรงพยาบาลท เป นจ ดเฝ าระว ง ต งแต ส ปดาห ท 29/ / (ว นท 19 ก.ค ต.ค. 2553) จ านวน (ราย) 140 % Flu A,B H1N1 PDM % H1N1 in ILI ก.ค ก.ค. 2 ส.ค. 9 ส.ค. 16 ส.ค. 23 ส.ค. 30 ส.ค. 6 ก.ย. 13 ก.ย. 20 ก.ย. 27 ก.ย. 4 ต.ค. 11 ต.ค. 18 ต.ค. 25 ต.ค. 1 พ.ย. 8 พ.ย. 15 พ.ย. 22 พ.ย. 29 พ.ย. 6 ธ.ค. 13 ธ.ค. 20 ธ.ค. 27 ธ.ค. 3 ม.ค ม.ค. 17 ม.ค. 24 ม.ค. 31 ม.ค. 7 ก.พ. 14 ก.พ. 21 ก.พ. 28 ก.พ. 7 ม.ค. 14 ม.ค. 21 ม.ค. 28 ม.ค. 4 เม.ย. 11 เม.ย. 18 เม.ย. 25 เม.ย. 2 พ.ค. 9 พ.ค. 16 พ.ค. 23 พ.ค. 30 พ.ค. 6 ม.ย. 13 ม.ย. 20 ม.ย. 27 ม.ย. 4 ก.ค. 11 ก.ค. 18 ก.ค. 25 ก.ค. 1 ส.ค. 8 ส.ค. 15 ส.ค. 22 ส.ค. 29 ส.ค. 5 ก.ย. 12 ก.ย. 19 ก.ย. 26 ก.ย. 3 ต.ค. 10 ต.ค. 17 ต.ค. 24 ต.ค. 31 ต.ค. 7 พ.ย
21 Source of Information for Projection Analysis of reported H1N1 cases to BoE Estimation of infection rates by age group Simulation by Influ Sim 2.1 Basic Reproductive Number and Herd Immunity = Basic reproductive number (R 0 ) ค าเฉล ยจ านวนผ ต ดเช อรายใหม ได ร บเช อจากผ ป วยรายแรกๆ Herd immunity = 1 (1 / R 0 ) เช น R 0 =1.5 Herd immunity = 1- (1/1.5) = 33% R 0 =2.0 Herd immunity = 1- (1/2) = 50% 21
22 Number of probable influenza, H1N1 (2009) confirmed and death cases, 2009 Oct 16 th 2010 Cases Deaths death H1N influenza (รง. 506) H1N Resource : surveillance ส ปดาห เร มป วย database of BOE Estimation of H1N1 Infections 22
23 Influ Sim 2.1 Number of Confirmed Pandemic Influenza A (H1N1) 2009 by Onset Date, Thailand, 1 May April % infection 1 st wave Approximately 25% have been infected 8-10% infection 2 nd wave
24 Simulation of influenza pandemic wave in Thailand % infection 8% infection??10-12% infection Comparing 3 pandemic waves 1 st Wave 2 nd Wave 3 rd Wave Attack rate High Low Moderate Age group School age older Older Place Urban Rural Urban/Rural Duration May Oct 10 Nov 09 Apr 10 May Oct 10 Intensive Moderate Less Control measures Vaccine No Monovalent H1N1 vaccine Trivalent vaccine 24
25 สร ป การระบาดในป แรก ม อ ตราป วยส งในโรงเร ยนและสถาบ น การระบาดไปท วทกพ นท ในประเทศไทย การระบาดไปทวท กพนทในประเทศไทย อ ตราป วยแตกต างก นในแต ละว ย และแต ละพ นท อ ตราการต ดเช อ H1N ในประชากรไทยอย าง น อย หน งในสาม H1N จะม ส วนในแบ งใน Seasonal influenza transmission น อยลงในระยะต อไป Thank you 25
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