CDC Cooperative Agreement Influenza Surveillance Review Project Period(Sep 2004-Sep 2011)
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1 CDC Cooperative Agreement Influenza Surveillance Review Project Period(Sep 2004-Sep 2011) National Institute of Health Department of Medical Sciences, Bureau of Epidemiology Department of Disease Control, Ministry of Public Health, Thailand
2 Outline Project Overview Virological Surveillance Harmonization of Virological and epidemiological Surveillance Systems Lesson learned
3 Thailand Demographics (2011) Population ~65 million M:F 0.98:1 Birth rate 12.95/1000 Death rate 7.29/1000 Population Growth rate 0.8% Life expectancy: M yr, F Yr area of 513,120square kilometers Borders 8,031 kms 5,326 kms inland 2,705 kms coastlines 77 provinces Democracy (Constitutional Monarchy) Agriculture GDP (official exchange rate) $318.9 billion source: 3
4 : Avian influenza S. Pattamadilok, ThaiNIH, DMSc 4
5 Distribution of AI in poultry and human cases, Jan-May 04 Confirmed case Suspect case Poultry outbreak Source from BOE
6 National Strategic Plan on Avian Influenza and Influenza Pandemic Preparedness Plan The Government National Committee on AI Response & Pandemic Influenza Preparedness 1 st Strategic plan on Avian Influenza and Influenza Pandemic Preparedness ( )
7 SRRT Hospital Network Veterinarians Laboratory Pathologist
8 Distribution of AI in poultry and human cases, Jan-May 04 Jun-Oct 04 Jul-Nov 05 Jun-Aug 06 Jan-Nov 07 Confirmed case (25 cases and 17 dead) Suspect case Poultry outbreak Source from BOE
9 National Strategic Plan on Avian Influenza and Influenza Pandemic Preparedness Plan The Government National Committee on AI Response & Pandemic Influenza Preparedness
10 Influenza pandemics in the 20th century 1918: Spanish Flu 1957: Asian Flu 1968: Hong Kong Flu million deaths 1-4 million deaths 1-4 million deaths A(H1N1) A(H2N2) A(H3N2) S. Pattamadilok, ThaiNIH, DMSc 10
11 Genomic of Influenza Virus Orthomyxoviridae Consists of single strand negative sense RNA in 8 segments. The 5' and 3' terminal sequences of all the genome segments are highly conserved. Thai NIC : 22/05/09 11
12 Have questions? : But no answers When What How
13 WHOGlobal Influenza surveillance network WHO National Influenza Center, Thai NIC has been established since 1972 at NIH, DMSc, Thailand Regional Influenza Reference Laboratory (RIRL) for SEA Region has been designated by WHO since 22 July 2010 Thai, RIRL for SEA Region 13
14 WHO Influenza vaccine recommendation Northern hemisphere ( ) A/California/07/2009 (H1N1)-like virus A/Victoria/361/2011(H3N2)-like virus B/Wisconsin/1/2010-like virus Feb 2012 :Composition vaccine recommendation Sep 2012:Vaccine available (Nov 12-Feb 13) influenza season Southern hemisphere (2012) -A/California/07/2009 (H1N1)-like virus -A/Perth/16/2009 (H3N2)-like virus --B/Brisbane/60/2008-like virus Circulating in Thailand ( ) -A/California/07/2009 (H1N1)-like virus -A/Perth/16/2009 (H3N2)-like virus --B/Brisbane/60/2008-like virus - B/Florida/4/2006-like virus - B/Wisconsin/01/2010-like virus Sep 11 :Composition vaccine recommendation March 12 :Vaccine available (May Oct 12) influenza season S. Pattamadilok, ThaiNIH, DMSc 14
15 Collaboration with US CDC Phase I project : Development of Influenza Surveillance Networks period ranged from 09/15/04 09/14/09 Phase II Project : Strengthening Thailand s Influenza Surveillance Network to Support Influenza Control Policy and Improve Pandemic Preparedness period ranged from 09/15/09 up to present
16 U$ Funding Budget ( U$ ) 1,000, , , , , , , , , ,000 0 Year1 Year2 Year3 Year4 Year5 Year6 Year7 Year8 Year
17 Participating organizations 1. CHIANGSAEN HOSPITAL 2. MAECHAN HOSPITAL 3. MAESOT HOSPITAL 4. NONGKHAI HOSPITAL 5. PRAPOKKLAO HOSPITAL 6. HATYAI HOSPITAL 7. PUBLIC HEALTH CENTER 17 PRACHANIWATE 8. Koh Chang Hospital 9. Koh Samui Hospital 10. Bangkok Hospital, Samui, Surat Thani 11. BAMRASNARADURA INFECTIOUS DISEASES INSTITUTE 12. VACHIRA PHUKET HOSPITAL 13. PRACHUAP KHIRIKHAN HOSPITAL
18 Mae Sot Nong Khai Nonthaburi Bangkok Chanthaburi Trad Suratthani Chiang Saen Mae Chan Hat Yai Phase I : sentinel sites (Sep.2004-Sep.2009) First year Mae Sot hospital,tak Nong Khai hospital Phra Pok Klao hospital, Chantaburi Hat Yai hospital, Songkhla Health Center 17, Bangkok Second year Mae Chan hospital, Chiang Rai Chiang Saen hospital, Chiang Rai Third year Koh Chang hospital Trad Koh Samui hospital, Bangkok hospital, Samui, Surat Thani Fifth Year Bamrasnaradura Infectious Diseases Insitute, Bangkok
19 Phase II : sentinel sites (Sep.2009-Sep.2012) NIH 1. Chiang Rai (2 site) 1.Lop Buri BOE 2. Tak 2.Ubon Ratchathani 3. Nong Khai 3.Pijitt 4. Bangkok 4.Sukhothai 5. Nonthaburi 5.Maha Sarakham = NIH = BOE 6. Chantaburi 7.Prachuap Khiri Khan 8. Songkhla 9. Surat Thani 10. Phuket
20 System goals & objectives PhaseI General objective: To strengthen the current laboratory-based surveillance network for influenza Specific objectives: To monitor for new antigenic variants To serve as a national and international resource to guide public health decisions
21 System goals & objectives PhaseII General objective: To assess policy and strategies of influenza surveillance, epidemiological analysis related to seasonal and pandemic influenza in Thailand Specific objectives: To document achievements, strengths and weaknesses in policy, strategy and practice To identify potential applications of surveillance information to guide policies, strategies and response To make recommendations for improving sustainable influenza surveillance in Thailand
22 Case Definition: A suspected case of influenza-like illness(ili) individual presenting with fever (temperature 38 o C) and one or more of the following symptoms: cough; sore throat A confirmed case of influenza any case of influenza-like illness whose throat swab tests positive viral culture for influenza or positive PCR for influenza A S. Pattamadilok, ThaiNIH, DMSc 22
23 Enrollment criteria Phase I: Year Average number of ILI cases seen per week (At least 5 patients/week/site) 20 patients/month/site S. Pattamadilok, ThaiNIH, DMSc 23
24 SPECIMEN COLLECTION S. Pattamadilok, ThaiNIH, DMSc 24
25 Specimens processing for ILI surveillance : Phase I Nasal swab ( NS ) Test with Quick Vue Rapid test specimen collection Throat swab kept in VTM at 4 0 C < 48hrs. and transfer to liquid N2 tank Weekly transport to Thai NIC by N2 tank Viral confirmation At WHO collaborating Center. viral isolation/pcr Thai National Influenza Center S. Pattamadilok, ThaiNIH, DMSc 25
26 Case Definition Pneumonia A suspected case of Pneumonia infection in Community Acquired Pneumonia 5 Sample/week/site S. Pattamadilok, ThaiNIH, DMSc 26
27 Laboratory-based Influenza Surveillance network partly supported by US-CDC & BOE Phase I Development of Influenza Surveillance Networks Five years : 15 Sep Sep ILI : 5 sample/week/site Phase II Strengtening Thailand s Influenza Surveillance Network to Support Influenza Control Policy and Improve Pandemic Preparedness Five years : 15 Sep Sep.2014 ILI : 10 sample/week/site SARI : 5 sample/week/site
28 Outline Project Overview Virological Surveillance Harmonization of Virological and epidemiological Surveillance Systems Lesson learned
29 Outline Project Overview Virological Surveillance Harmonization of Virological and epidemiological Surveillance Systems Lesson learned
30 Lessons learned
31
32
33
34
35 Thailand award for public service quality, 2007 Virological laboratory Testing Process for Suspected Avian influenza cases Thai National Influenza Center
36 Acknowledgement Institutional Counterparts - Thai National Institute of Health - Regional Medical Sciences Centers (RMSC) - Thai Department of Disease Control (DDC) - Thai Bureau of Epidemiology (BOE) - Sentinel Hospitals Collaborating Agencies - WHO Global Influenza Surveillance and Response System Network (WHO GISRS ) - US -CDC Collaboration-International Emerging Infections Program (CDC-IEIP) Thailand 36
37 Thank you
38
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