Global surveillance during pandemic

Global surveillance during pandemic

Tim Nguyen

Global Influenza Programme, WHO

WHO updated interim recommendations

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OutlineOutline

1. Importance and benefits of surveillance and information sharing at global level

2. WHO updated interim guidance on global surveillance

3. Demo FluID

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Importance of surveillance at global level

Importance of surveillance at global level

Globalisation of risk: international mass gatherings, increased air traffic

The global monitoring provides information on the geographical spread of the disease and its characteristics in different settings

Globalisation of needs: antiviral, vaccines

Communication with the public and media

Update of technical guidelines

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Sources of information Sources of information

Reporting form Member states and Regional Offices

Virtual teleconferences of 4 networks: Virological , epidemiological and clinical networks + network of modellers

GISN / FluNet

Screening of web sites and Media

Review of literature

The Friend and Acquaintance network– Sometimes the most valuable and reliable!

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Monitoring of the global situation as of 06 Aug 09

Monitoring of the global situation as of 06 Aug 09

Confirmed cases 177457

Confirmed deaths 1462

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Monitoring of the global situation Benefit from Information SharingMonitoring of the global situation Benefit from Information Sharing

Web updates, WER,

Updated Interim WHO Guidance on Global

Surveillance

Updated Interim WHO Guidance on Global

Surveillance

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Goals from SurveillanceGoals from Surveillance

Tracking appearance, rise and fall, and movement of virus

Changes in rates of morbidity or mortality

Changes in age distribution of morbidity or mortality

Changes in transmissibility

Changes in clinical pattern of disease– New or unusual presentations– Clinical course – e.g. bacterial coinfections, viral pneumonias, pulmonary emboli– Risk groups: e.g. obesity, pregnant, age, others?

Virologic changes: – Antigenicity and antiviral sensitivity

Strain dominance

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Phases of the processPhases of the process

International Consultation

Working group meeting (s)

Fieldtesting

Dec

2007 2008

Mar

Definition frameworkglobal surveillance

Detailed description of processes Reality check

Draft guidelines

2009

Oct Dec April

Interim guidelines

July

UpdatedInterim

guidelinesField test

guidelines

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Shifting Information NeedsShifting Information Needs

b) Description and Assessmenta) Early Detection c) Monitoring

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Surveillance Guidance – (a) Early Detection

Surveillance Guidance – (a) Early Detection

For countries not yet affected:– The first confirmed pandemic (H1N1) 2009 virus

infection detected in a country should be immediately reported by the IHR National Focal Point

And afterwards:– Any changes in the epidemiological, virological or

clinical presentation – Any unusual or unexpected public health events, e.g.

clusters of severe unexplained acute respiratory illness or unexplained deaths

Case detectionOutbreak investigation

Notification to WHO – IHR

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Surveillance Guidance –(b) Description and Assessment

Surveillance Guidance –(b) Description and Assessment

Describe the epidemiological and virological features of cases to guide control and prevention activities

Assess disease severity

Laboratory testing priorities– confirming infection in new areas– Testing severe cases – Monitoring the co-circulation of pandemic (H1N1) 2009

virus and seasonal viruses

Characterization of the virusand the disease

Initial copmprehensive assessment (FF100)Contact tracingCase-based sentinel surveillanceLab confirmation

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Surveillance Guidance (c) Continuous Monitoring

Surveillance Guidance (c) Continuous Monitoring

Report data to allow tracking of:

Lab surveillance of severe cases / deaths and monitoring of co-circulation

Assess qualitative indicators– global geographical spread– disease trend and intensity– impact of the pandemic on health-care services

In addition if available, quantitative figures– prevalence– changes in viral antigenicity and antiviral sensitivity– deaths from acute respiratory disease.

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Outputs Expected - Use of data and information shared

Outputs Expected - Use of data and information shared

A composite picture of severity and transmission characteristics primarily based on local interpretation of data and investigations.

A description of clinical presentation, course, complications, and risk factors

Virologic data for strain selection and antiviral sensitivity assessment

Numbers of cases, hospitalizations, and deaths

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Key Related Decisions - Use of data and information shared

Key Related Decisions - Use of data and information shared

Target groups for intervention with vaccine or antivirals– Risk groups in need protection.– Target groups that might have greatest impact on transmission.

Strain to use for vaccine.

Which antivirals to use.

Role of nonpharmaceutical interventions.

Appropriate management practices

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Consent - Use of data and information shared

Consent - Use of data and information shared

Data collected via WHO’s global influenza A (H1N1) surveillance systems will analysed and summary data will be published in graphs, maps and tables on WHO’s web site and published in the Weekly Epidemiological Record.

Scientists from countries providing data will be invited to participate in the development of, and be co‐authors on, publications that draw on their country‐specific data.

Countries will always be consulted in the development of any articles in which their data has been used.

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Tools for data collection and disseminationTools for data collection and dissemination

b) Description and Assessmenta) Early Detection c) Monitoring

IHR Notification

Weekly Summary Reporting Form

Case summary Form

FluNet

FluNet

FluID

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Demo FluIDDemo FluID

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Propose Timeline of FluID roll outPropose Timeline of FluID roll out

• Data Form• Data excel export

• Automated maps, graphs, Tables• Joint viro/epi weekly country reports (pdf)

• Upload from existing databases / systems• Modification from best practices / lessons learned

Mid

August September OctoberMid/end

Phase 1 Phase 2

Beginning

Start Global roll out

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SummarySummary

First affected countries were extremely open to share information and reports to provide knowledge for the global response

Updated interim surveillance guidelines take into account the current knowledge of Pandemic (H1N1) 2009

FluID and FluNet available to support platform for global information sharing mechanism

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AcknowledgementsAcknowledgements

Tony Mounts

Julia Fitzner

Kaat Vandemaele

Vivek Shinde

Philippe Veltsos

Liliana Pievaroli

Sylvie Briand

Maja Lievre

Weigong Zhou

Amy Cawthorne

Pandemic Surveillance Working Group

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THANK YOU