Current AH1N1status and MoH Response Measure

Sovann Ly, MD, DTMH, MCTM

Deputy Director of CDC Department

2

Current AH1N1 status

3

Number of Cases by Week of Detection* June to 6 October 2009 (N =134)

0

5

10

15

20

25

24 to 30 1 to 7 8 10 14 15 to 21 22 to 28 29 to 4 5 to 11 12 to 18 19 to 25 26 to 1 2 to 8 9 to 15 16 to 22 23 to 29 30 to 6

June July

Number

Aug Sept/Oct

Date of detection = date confirmed by IPC

=deaths

4

Number of Cases by Age Group June to 6 October 2009 (N = 134)

Age(Years) Male Female Total

0 – 4 8 8 16

5 – 14 28 21 49

15 – 49 30 33 63

50+ 3 3 6

Total 69 65 134

5

Cambodian80%

Foreigner20%

Nationalities of Pandemic H1N1 Cases in Cambodia, June to 6 October 2009 (N = 134)

* 2 foreigners based in Phnom Penh, no travel history

6

Nationalities of Pandemic H1N1 Cases in Cambodia, June to 6 October 2009 (N = 134)

Nationality Number

Cambodian 107

Australian 3

French 4

Japanese 6

Philippines 1

UK 2

USA 9

7

Pandemic H1N1 Death cases in CambodiaJune to 6 October 2009

• 3 deaths • 41 yr old F, no risk factors : died on

27 September • 47 yr old male, alcoholism: died on 5

October• 25 Yr old F, Pregnant women : died on

6 October, Baby survived and A H1N1 negative

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Communities transmission, up to 6 October 2009 • Evidence of community transmission: cases

with no history of foreign travel or contact with foreign case• Phnom Penh• Kandal• Takeo• Siem Reap• Kampong Speu • Kampong Chhnang• Battambang• Svay Rieng

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Geographic Spread across time

As of 30 June

6 cases, no local transmission

As of 31 July

19 cases, local transmission in Phnom Penh

As of 31 August, local transmission in

Phnom Penh and Kandal

=Areas in Cambodia with locally acquired lab confirmed cases

10

Areas with Community Transmission of New Influenza A H1N1 virus (as of 6 October)

As of 6 October 2009

134 cases, community transmission in

Phnom Penh, Kandal, Siem Reap, Takeo, Kampong Speu, Battambang , Svay Rieng and Kampong Chhnang

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How were cases detected?Detection Method Number Percent

Event based Surveillance

Calls to MoH Hotline and Contact Tracing

53

40

Fever surveillance 48 36

ILI surveillance 24 18

Entry screening 4 3

Others* 5 3TOTAL 134 100 %

*NAMRU lab worker detected during internal training session on specimen collection and PIC lab workers

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H1N1v Detection atSentinel Surveillance Sites

=H1N1v cases detected =sentinel surveillance not yet detecting H1N1v case

=no sentinel site

Province ILI SARI SISEA NAMRU Comment

Battambang         On going community transmission

Kampong Cham          

Kampong Speu         On-going community transmission

Kandal         On-going community transmission

Phnom Penh         On-going community transmission

Siem Reap         On-going community transmission

Svay Rieng          

 Kampong Chhnang         1st case of community transmission detected on 25 Sept 

Takeo         On-going community transmission

=Provinces with no Sentinel site but where cases have been identified by the surveillance programmes

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MoH Response Measure

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Communication to public

• TV broadcasting educate to public since May 2009

• Disseminate the Posters and leaflets to communities

• Dissemination to local authorities and sectors

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Communication to public Cont’• Regular joint press release (MoH/WHO)

on situation update• Spokesman update to media• Regular update to website (

www.cdcmoh.gov.kh)• Monthly Bulletin• Hotlines on duty 24 hours

• 115• 012 488981• 089 669567

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Surveillance

• Early warning system ARI (countrywide)

• ILI (6 sites)• Fever study (2 provinces)• SISEA ( 2 provinces)

• Detect the single case and clusters

• Monitor the AH1N1 situation (Increase, stable, decrease)

Consolidated ILI Data From 6 Sentinel Sites (2009)

0%

1%

2%

3%

4%

5%

6%

7%

8%

Jan Feb Mar Apr May Jun Jul

Month

ILI

Co

nsu

ltati

on

Rate

(%

)

0%

5%

10%

15%

20%

25%

30%

Po

sit

ivit

y R

ate

(%

)

ILI Consultation Rate Positivity Rate

Acute Lower Respiratory Tract Infections in All Provinces (CAM EWARN - 2009)

0

10000

20000

30000

40000

50000

60000

70000

80000

Jan Feb Mar Apr May Jun Jul

Month

Nu

mb

er

of

Cases

Lab-Confirmed Influenza Cases in Febrile Patients of Kandal and Kampong Speu Provinces

(NAMRU-2 - 2009)

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Jan Feb Mar Apr May Jun Jul

Month

Infl

uen

za P

osit

ive/

Sp

ecim

en

s T

este

d (

%)

2009 Influenza Activity 2008 Influenza Activity

New SARI Cases in Takeo and Kampong Cham Provinces (SISEA - 2009)

0

20

40

60

80

100

120

140

160

Jan

Feb

Mar

Apr

May

Jun

Jul

Month

Nu

mb

er

of

Cases

Children (0-16) Adults (>16)

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Surveillance (Cont’)

• At the border• International airports and ports• International land border

• Installed 3 Thermoscaners to monitor the passengers cross border

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Investigation and Response• Rapid Response Teams

• 1200 staffs• Trained

• Kits (PPE, Medicine, Lab collection, Forms, guidelines)

• 1200 Telephones line communication from national to Health Center level

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Hospital response

• 5 Isolate wards• All hospitals have separate rooms for

ARI• Trained infection control • Case management• Refer system• Supplies PPE and medicines

• Private sector participation to the surveillance system and case management

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Laboratory

• 3 National labs• Pasteur Institute Cambodia (NIC)• National Institute of Public Health• Namru 2

• All province has lab kits to collect the sample, packaging and sending

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Challenges

• Delay incentive to Rapid Response Teams

• Vaccine to vulnerable group• Pregnant women : 140.000

doses/year• Health workers : 280.000 doses• Underline condition : 980.000 doses

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Challenges Cont’

• Tamiflu doses limited• Workload of hospital health

workers• Other sectors do not have the

operational to support MoH and also do not have their operational plan for their sectors business continuity

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Som Or KunThanks for you

attention