OFFLU swine influenza virus meeting March 2017 FAO Headquarters, Rome, Italy. Tung Nguyen Department of Animal Health, Vietnam
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1 OFFLU swine influenza virus meeting March 2017 FAO Headquarters, Rome, Italy Tung Nguyen Department of Animal Health, Vietnam
2 Influenza Surveillance in Viet Nam 2017 Hospital SARI/ILI Human Poultry Pig Wildlife Hospital EBS PREDICT Human Illness Monitoring DAH/FAO Influenza Surveillance DAH/FAO Influenza Surveillance PREDICT Wildlife Surveillance Coordinated Surveillance LISN will add More capacity, more sharing, more knowlege, more analysis - More influenza virus characterization - Test existing specimens for other viruses - Strengthen capacity for surveillance and laboratory diagnostics - Share outputs across sectors for situation analysis and risk assessment 2
3 Coordinated Surveillance for Influenza and Potential Pandemic Pathogens (LISN = Longitudinal influenza surveillance network) Objectives: 1. Alignment of the surveillance localities, sampling time and laboratory testing algorithm. 2. Monitor and characterize influenza viruses and other potential pandemic pathogens. 3. Regular information sharing and risk assessment using the aligned surveillance results.
4 Central Regional Provincial GDPM Stakeholders NIHE (NIC, Epi) Pasteur I (NIC, Epi) PDH PPPMC Hospital DAH NCVD RAHO2 (Epi, Lab) RAHO6 (Epi, Lab) RAHO7 (Epi, Lab) DARD Sub-DAH NIHE (Predict) Pasteur I (Predict) RAHO2 (Predict) RAHO6 (Predict)
5 Influenza Surveillance in Humans Objectives Identify unusual events Monitor national influenza activity/trends & inform national influenza control policy Contribute to global influenza control (pandemic monitoring & vaccine determination) Surveillance Strategy in Viet Nam - Event-based surveillance - Reporting from healthcare facilities, labs, communities - Media monitoring - Indicator-based surveillance - Nationally notifiable diseases - Sentinel surveillance (ILI and SARI*) - Characterization of viruses *ILI= influenza-like illness; SARI = Severe acute respiratory infections 5
6 Sentinel Surveillance Lao Cai General Provincial Hospital Ha Giang General Provincial Hospital ILI Surveillance From , US-CDC supported establishment of the system Since 2016, sentinel surveillance is maintained by government funds SARI surveillance Began in 2011 January 2016: new harmonized protocol At least 10 sites Coordinated by MOH, Supported by CDC and WHO Test for Influenza A (subtypes of H1pdm09, H3, H5 and H7) and influenza B Respiratory syncytial virus (RSV); Human metapneumovirus (HMPV); Parainfluenza virus (PIV) 1, 2, 3; Adenovirus (AdV); Supported sites Rhinovirus (RV) WHO/USAID Hà Nội Dak Lak General Provincial Hospital Tay Ninh General Provincial Hospital Dong Thap General Provincial Hospital US-CDC Lang Son Provincial Hospitals National Pediatrics Hospital Quang Ninh Provincial Hospitals Khanh Hoa General Provincial Hospital Children Hospital I, HCMC Hospital of Tropical Diseases, HCMC 6
7 Avian Influenza Surveillance 2017 Objectives 1. Early detection of H7N9 viruses in poultry and LBMs in high-risk areas for rapid response; 2. To understand the epidemiology and the evolution of HPAI H5 viruses in poultry to inform prevention and control strategies, including vaccine selection; and to evaluate the performance of H5Nx control programme 3. To understand the gene pool and the evolution of influenza A viruses in poultry and pigs for early warning of emergence of pandemic influenza A Baseline All the year round Enhanced High season Detection (H7N9) Monitoring (H5)
8 Swine influenza surveillance Surveillance of influenza A virus was initiated in 2013 in order to understand better on; gene pool of influenza A virus in pig population risk factors for virus transmission, circulation, and evolution across sectors based on production systems and value chains Risk-based surveillance targeted at high risk population i.e. large commercial breeding/fattening farms with low farm biosecurity
9 Sampling Design Province: High density of pig population ; 12 provinces ; 19 provinces Farm: Large scale and low biosecurity Breeding: sows Fattening: >1000 pigs Animals and samples: 5-8 & 9-12 weeks old: 30 nasal swabs/farm from each age group Swabs from 60 animals/farm Sera from 10 piglets/farm (+5 sows in breeding farms) Regional Animal Health Office No.7 (RAHO7) Regional Animal Health Office No.3 (RAHO3) National Center for Veterinary Diagnosis (NCVD) Regional Animal Health Office No.4 (RAHO4) Regional Animal Health Office No.6 (RAHO6)
10 Flu A Viruses in Human, Pig, and Poultry in Viet Nam (Publicly available sequences in July 2016) H1 H3 H5 No of HA gene sequence available In public database (Genebank+GISAID) Subtype Poultry Pig Human H H H H H Human Pig Poultry 10
11 Wildlife Surveillance in Viet Nam Surveillance targeting highrisk interfaces for disease transmission between wildlife and humans Screening for viral pathogens of pandemic potential Building local capacity for surveillance & laboratory diagnostics
12 Specimens and Viral Testing PREDICT2 - Focus Viral Families (n=12; 4 in all countries) Corona, Hanta, Arena, Alpha, Paramyxo, Flavi, Rhabdo, Influenza, Seadorna, Picorna, Filo, Reo (Retro) viruses Specimen type Oropharyngeal swab/saliva Rectal swab/feces Urine, blood All taxa: Same sample type Same suit of viral families
13 Wildlife Trade in Viet Nam Source Country Consumer Country Transit Country
14 Coordinated Surveillance for Influenza and Potential Pandemic Pathogens Hospital SARI Surveillance Influenza B PCR Influenza A PCR: H1, H3, H5, H7 Hospital EBS (SARI) CDC Multiplex PCR PREDICT Human Illness Monitoring in Other HCFs DAH/FAO Avian and Swine Influenza Surveillance PREDICT Wildlife Surveillance +ve -ve Seven Respiratory pathogens: Adeno, RSV, Rhino, Para 1, Para 2, Para 3, HMPV Flu + Other Viral + -ve Influenza A PCR: H1, H3, H5, H7, H9 -ve +ve +ve -ve On-going Proposed Influenza sequence PREDICT viral discovery viral family-level consensus PCR: Filo, Corona, Paramyxo, Flavi, Rhabdo, Influenza -ve +ve Provincial Level (PPMC, Sub-DAH) Quarterly coordination meeting between PPMC and S-DAH to review progress and trouble shoot Regional Level (NIHE, PI-HCM, RAHO2,6,7) Six monthly meeting to review virological and epidemiological data Select for cloning and Sqn National Level (GDPM, DAH, CITES) Annual meeting to review risk assessment results and identify potential intervention
15 I don t know where to go, can t do it alone Pandemic detection and prevention Longitudinal influenza evolution Pathogen discovery Strengthened capacity Laboratories e.g. sequencing Risk assessment Routine information sharing (4-way linking, circular 16) Data / Information Epidemiological linked samples / data Viruses characteristics Situational analysis and joint risk assessment
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