Current Situation Influenza A (H1N1) 19 May 09

1. Current Situation Influenza A (H1N1)19 May 09

2. Introduction – Influenza A (H1N1) • Types of influenza • A,B,C • Influenza A and B cause diseases in humans, • Influenza A virus subtypes • There are 16 different HA (H1 to H16) • Nine different NA (N1-N9_ • Influenza A virus causes seasonal influenza in many countries in the world: • Estimated to affect 5-15% of the global population, • results in severe illness in 3-5 million people and causing 250, 000 – 500,000 deaths worldwide.

4. HISTORY • Past experiences indicate that • No regularity to pandemics • No reliable basis for predicting when/where it might arise. • 3 pandemics occurred in the 20th century : interval of 10-39 years

5. The 1918- Pandemic Influenza in USA The flu caused more deaths than suffered World Wars I and II combined

6. HISTORY -2 • In Ethiopia – Influenza named as “The Hedar Beshita” (An Introduction to the medical history of Ethiopia Richard Pankhrust, 1990) • Alaqa Kinfe: “ Many people were dying in AA . Just as a brother would walk over the corpse of his brother on a battlefield so no body troubled to bury the dead by the road side. They simply walked by…….” • Ras Tafari Makonnen ( later Emperor Haile Sellasei) in his autobiography stated that he had been “ seriously ill” but by “God’s goodness he survived.”

7. Current Status

8. Threat of Pandemic Influenza • Criteria for A Pandemic: • A new subtype of the influenza A virus must emerge • Most people in the world would then have little or no immunity causing more morbidity and mortality. • The virus must be sufficiently transmissible from one human to another to cause sustained chains of transmission.

9. Threat of Pandemic Influenza - Animal Influenza • Infects humans in rare instances - resulting from close exposure to pigs/Birds • Circulating in wild birds, poultry and pigs • If virus evolves into a human virus it could cause a human influenza pandemic

10. 2009 Influenza A (H1N1) epidemic • The 2009 outbreak of influenza A (H1N1) virus is an epidemic due to a new strain of influenza A virus • The current outbreak was first detected in Mexico City, where surveillance began picking up a surge in cases of influenza like illness (ILI) starting March 18. • The surge was assumed by Mexican authorities to be "late-season flu" • April 21, CDC sent alert concerning two isolated cases (one from a patient admitted on March 29 and a second from a patient admitted on March 30, 2009 for ILI) of a novel flu virus • Some samples were sent to CDC on April 18 from Mexico and cases were confirmed to be a new strain of H1N1.

11. 2009 Influenza A (H1N1) epidemic- Chronology 1: April 15, 2009 = CDC identified the Virus from a specimen taken from a patient admitted on March 30 for ILI 2: April 17, 2009 = CDC identified the Virus from the 2nd pt admitted on March 29 for ILI and notified WHO/IHR 3: April 23, 2009 = Press Briefing 4: April 25, 2009= WHO declared Public Health Emergency of International Concern 5: April 26, 2009 = WHO reactivated Pandemic Phase 3 6: April 27, 2009 = WHO raised Pandemic alert Phase to 4 7: April 29, 2009 = WHO raised Pandemic alert phase to 5

12. Pandemic Phases

13. Phase 5 • is characterized by the same identified virus causing sustained community level outbreaks in at least 2 countries in 1 WHO region. • Most countries won't be affected at this stage • Declaration of Phase 5 signals a pandemic could be imminent • Time to finalize organization, communication, implementation of planned mitigation measures is short.

14. Phase 6 • is characterized by widespread community level outbreaks of the same virus in at least 1 other country in a different WHO region. • Designation of this phase would indicate that a global pandemic is under way. • PHASE 6 IS NOT YET DECLEARED!!

15. Current situation- Global Status as of May 18, 2009 Total : Cases=8829 Deaths: 74

16. Influenza A (H1N1) Epidemic -Trend

17. Current situation- Africa /National • No confirmed case to date in Africa • Six countries reported suspected cases – most ruled out after lab investigation • Ethiopia – No report of suspected cases • The FMoH – reactivated the national taskforce and established various sub groups • Disseminated SCD and alert to all HFs • Daily monitoring of surveillance reports • Press briefing provided – 3 occasions • Trained health personnel from all regions

18. Current situation- National • Strengthened surveillance and screening activities at Ports of entry (esp Bole International Airport) • isolation and quarantine in place at Bole Int. Airport • Air lines staff provided orientation and PPE • All incoming travelers fill in forms and message being relayed at the Airport • National reference lab at EHNRI- capacity strengthened. Capacity to do PCR in place • More than 100,800 treatment courses of tamiflu –WHO • 32 Hospitals identified nationwide • Identified national requirements and presented to partners

19. WHO - Guidance • The Epidemic is due to a new strain of the influenza A (H1N1) that has not been isolated in pigs • It is a recombinant of the endemic strain of influenza A that is present in Pigs, Birds and humans • Thus - New influenza A (H1N1 – not Swine flu (April 30, 2009) • No risk of infection from this virus from consumption of well-cooked pork and pork products. • No travel restrictions related to the outbreak of the influenza A(H1N1) virus. • Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care

20. WHO - Guidance • Prevention: • Cover your mouth while sneezing or coughing • Wash hands regularly • Avoid shaking hands; touching eyes, nose or mouth • Avoid contact with individuals with ILI symptoms • Stay at home when you develop ILI • Seek medical advise immediately

21. More Information Phase 5 available at http://www.who.int/en/

22. Thank You !!!