Global Challenges of Pandemic and Avian Influenza 19 December 2006 Keiji Fukuda Global influenza Programme
Summary of Current H5N1 Situation 1997 First known outbreak infecting humans 18 people hospitalized (6 deaths) Hong Kong Associated local poultry outbreaks / infections 2003 Three documented human infections Family from Hong Kong visiting China Retrospectively reported case 2004 Poultry outbreaks reported by 8 Asian countries In retrospect, activity since 2003
Summary of Current H5N1 Situation 2006 Ongoing infections among poultry, wild birds & people Control in some countries Reappearance of H5N1 in some previously "controlled" areas Lack of adequate control in some countries Diminishing media coverage in late 2006 H5N1 viruses detected every year since 1997 except 1998 1997 goose/guangdong HA gene remains constant
Global AI activity Human cases since 2003
Global AI activity Human cases since January 2006
Summary of Current Human H5N1 Infections As of 17 Dec 2006 258 infections (154 deaths) since 2004 Percentages of total human cases by year 2003: 1.6% 2004: 18.0% 2005: 38% 2006: 43% Human infections continue to parallel poultry infections WHO assessment remains pandemic alert "phase 3" No sustained human-to-human virus transmission Rare examples limited human-to-human transmission
H5N1 Current Concerns Continued genetic & antigenic evolution of H5N1 viruses Increasing numbers of "clades" Need to closely monitor for significant changes & to develop new vaccine candidate strains Potential to acquire greater transmissibility among humans Ongoing poultry activity Especially among sector 3 & 4 poultry farms Will epidemiologic patterns change with poultry vaccination? Risk of human infections while viruses circulate in poultry
H5N1 Current Concerns Need to maintain (long term) effort to strengthen preparedness & response capacities among countries AI & PI acknowledged as threat by most countries Significantly better organization than 1-2 years ago National fatigue noticeable
Role of WHO
Role of WHO Uniquely acceptable institution for all countries Combined technical, practical & political roles Guidance on global preparedness & response Development of critical capacities among Member States Global coordination Preparedness Alert Communications Response Normative function
HO Strategic Action Plan for Pandemic Influenza: Five Core Areas Reduce human exposure to H5N1 virus Strengthen early warning system Intensify rapid containment operations Build capacity to cope with pandemic Coordinate global scientific research & vaccine development
WHO Programmes Implementing Strategic Action Plan Global leadership, technical and scientific guidance and support International Health Regulations Preparing vulnerable populations Zoonoses, animal health Antiviral drug use Policy, business continuity plans, external relations Rapid response and containment, coordinating field missions Ethical issues Social mobilization Communicating with the public Enhancement of the Global Private Network, strengthening of communication links Staff security Vaccine research and development
Direct assistance to countries since January 2006 >200 experts sent to assist countries 9 missions to investigate human cases 30 missions to assist with national preparations Lab testing & specimen collection; Epidemiological investigations, surveillance, risk assessment; Social mobilization & outbreak communications; Clinical care and infection control; Logistics >360 tele- & 55 video-conferences with >30 countries AI investigation kits to >116 countries 14,00 sets of personal protective equipment 30,000 courses of influenza antiviral drugs sent out
Selected Examples of WHO Activities Guidance & guidelines >50 available on WHO web site Anti viral drugs; Infection control and clinical care; Outbreak response Preparedness assistance National pandemic preparedness planning Training Laboratory; Risk communications; Social mobilization. Broad collaboration U.N. Agencies, other technical groups..
Selected Examples of WHO Activities "Animal-human interface" Linkage of animal & human flu surveillance efforts Facilitating data, virus & reagent sharing between animal & human labs New initiatives Pandemic Vaccine Global Action Plan Increase seasonal influenza vaccine use Increase production capacity & promote wider geographic distribution Develop more potent & effective vaccines by promoting research International Health Regulations International legal framework Support greater global health security
Influenza Surveillance Nonspecific GPHIN Global Influenza Surveillance Network (GISN) In place for >50 years Goals Monitor circulating viruses for antigenic & genetic changes Update influenza vaccine strains each year Pandemic risk assessment, antiviral susceptibility testing
Influenza Surveillance Coordinates & links national influenza virus surveillance systems Foundation built upon National Influenza Centres and their contributing laboratories 5 Collaborating Centres 4 for vaccines 1 for "animal / human" interface Other applicants Associated national disease reporting through FLUNET
WHO Global Influenza Surveillance Network 1 laboratory 1 laboratory national network 115 National Influenza Centres 4 WHO Collaborating Centres & Reference Labs for human viruses ~ 175,000-220,000 samples ~ 15,000-40,000 virus isolates ~ 2000-10,000 viruses characterized
Recent & Ongoing Activities Development of H5N1 Reference Network Provide increased regional testing capacity Ongoing development of H5N1 vaccine strain candidates Applications for potential new Collaborating Centres Closer linkage FAO/OIE on animal virus surveillance
Recent & Ongoing Activities Expansion of GISN More Collaborating Centres & National Influenza Centres More Centres in regions, particularly Africa Continued efforts to integrate Animal & human virus surveillance Virus & disease surveillance Internationally accepted framework for rapid sharing of influenza viruses & genetic sequences
Conclusions Future new infectious disease threats are inevitable They are highly complicated threats to global security Cannot be addressed by any single country Long-term strategy Built around framework of global health security Balance between threat specific & generic capacities Acceptance & implementation of key concepts IHR Global Pandemic Vaccine Action Plan Virus and genetic sequence sharing