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Avian Influenza A(H7N9):

An Ongoing Emerging Disease Threat

Division of Health Security and Emergencies

WHO/WPRO, 19 Feb 2014

Disclaimer: The views expressed in this paper/presentation are the views of the

author and do not necessarily reflect the views or policies of the Asian

Development Bank (ADB), or its Board of Governors, or the governments they

represent. ADB does not guarantee the accuracy of the data included in this

paper and accepts no responsibility for any consequence of their use.

Terminology used may not necessarily be consistent with ADB official terms.

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Outline

About influenza virusSeasonal influenza

Avian influenza

Pandemic influenza

Avian influenza A(H7N9)

Situation update

Risk assessment

WHO response

Why concern? And what to do?

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Human cases of H5N1 reported to WHO(As of 10 Feb 2014)

Human H5N1 Cases by Onset Date and Country

Cambodia

2013: a big A/H5N1 year for Cambodia

2014: human cases reported in Cambodia, China and Viet Nam

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Pandemic Influenza Prerequisites

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Pandemic (H1N1) 2009: Global SpreadApril 2009 - February 2010

April 2009 May 2009 (1 month) July 2009 (3 months)

September 2009 (5 months) December 2009 (8 months) February 2010 (10 months)

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Big questions for all of us

Is the world still facing the pandemic risk? Whythe Asia Pacific Region is seen as a veryvulnerable region?

What are we currently managing - Recent avianinfluenza events affecting humans in the Region

H5N1

H10N8

H9N2

...? Should we worry more about H7N9? Will theH7N9 become the next pandemic flu virus?

Are we well prepared for the next shock?

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Avian Influenza A(H7N9) virus

Avian influenza virusesnormally circulate amongbirds

Avian H7 viruses (H7N2, H7N3and H7N7) occasionally foundto infect humans

No human infections withA(H7N9) viruses reporteduntil March 2013

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Situation Update: H7N9

On 31 Mar 2013, China notified WHO of 3 human cases ofavian influenza A (H7N9) virus as an event that mayconstitute a public health emergency of internationalconcernunder IHR (2005)

As of 18 February 2014, there have been 355 cases and 67deaths

Since 2013, human cases have occurred in mainland China,Hong Kong SAR and Taiwan, China. 1 case with travelhistory detected in Malaysia

Majority of cases continue to have exposure to poultry

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Human infection with Avian Influenza A(H7N9) Virus,

by day of onset ( n= 330, as of 11 Feb 2014)

1st

waveFeb- Sep 2013

2nd waveOct 2013 -

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Provinces reported H7N9: 1stwave

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Provinces reported H7N9: 2ndwave

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Age distribution of human cases in 1stand 2ndwave

(as of 17 Feb 2014)

Age-groups of cases

Numberof

cases

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Sex distribution of human cases in 1stand 2ndwave

(as of 17 Feb 2014)

Numberof

cases

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Most cases continue to haveexposure to poultry (e.g. livebirds markets)

History of known exposure to

poultry at notification

1stwave: 77%*1

2nd wave:~80%*2

17

1. Li et al (2013) NEJM2. Based on current cases information reported

Transmission

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Surveillance of H7N9 in China- animals

Virus does not cause disease in poultry so it is difficult todetect and eradicate

In 2013, >150 million samples from poultry and the environment

88 positive samples were found

In 2014, >33,000 samples were collected from >2,400 locations

6 positive samples found

To date, H7N9 virus has not been identified in poultry farms

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WHOs Response to H7N9

Globally, guided by theInternational HealthRegulations or IHR (2005)

Regionally, implementation

of theAsia Pacific Strategyfor Emerging Diseases orAPSED (2010)

Operationally, managedaccording to the new WHO

Emergency ResponseFramework(ERF)

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Asia Pacific Strategy for Emerging Diseases (APSED)

Provides a common frameworkfor countries to strengthennational and local capacitiesrequired for managing all public

health emergencies, includinginfluenza pandemic

A road map for Member States inthe Asia Pacific Region to build upthe IHR core capacityrequirements

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Essential IHR Reporting

Trigger WHOs system for rapidsharing of information

Event management system(EMS),Event Information Site (EIS),Disease Outbreak News (DON),

talking points, Q&A

Contribute to joint riskassessment and decision-making

Advisepublic health actions

Public health intervention (e.g.travel measures)

Informing pandemic preparednessactions

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WHO Activated EOCs

Within 24 hoursafter the first IHR

notification, One WHO

Event Management

System activated

WPRO activated its newly

upgraded Emergency

Operations Center (EOC)served as a common

operational platform

22

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WHOs new way of working: ERF

The new WHO Emergency ResponseFramework (ERF) provides a usefulguide to facilitate WHO response

WHO 3 policies ( e.g. no regret) and4 core functions

Leadership

Information

Technical expertise

Core services

H7N9 as the first Grade 2 emergency,announced by WPRO Regional Directoron 18 April 2013

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WHO System:Situation Monitoring & Sharing of Information

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- 6 (3 in WPR)

WHO Global Influenza Surveillance and

Response System (GISRS)

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H7N9: why are we still concerned?

High number of human infections with severe illness andfurther human cases are expected

Difficulty to detect in animal population (low pathogenic

in animals)

Critical information gaps (unknowns)e.g. scope of

spread in animal population

Potential for Pandemic?no evidence of human to

human transmission so far, but need for vigilance due to

the unpredictable behaviour

Regional capacities improved but not well-prepared for

rapid response

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IHR core capacities in WPR

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IHR Extension to June 2012 deadline

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H7N9: WHO Framework for action

In line with IHR and APSED, WPROs preparedness andresponse focusing on the following core areas:

Surveillance, risk assessment and response

Event-based surveillance

Indicator-based surveillance Risk assessment and decision for response (LBM closure?)

Laboratories

Collaboration between human & animal health sector

Clinical management, infection prevention and control

Risk communication

An effective regional alert and response system

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Possible Rapid Containment

Shift the peak

Gain the time for

preparing to sustain

the essential social

function

Implementing

Rapid

Containment

measures