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Avian Influenza/Human Influenza Pandemic Preparedness Plans World Vision Asia-Pacific Region Sri Chander, Regional Healt

Avian Influenza/Human Influenza Pandemic Preparedness Plans World Vision Asia-Pacific Region Sri Chander, Regional Health Advisor May 27, 2006 CCIH Conference. On-the-ground, Field-level realities of life. Can't see beyond today…let alone seeing into the future…

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Avian Influenza/Human Influenza Pandemic Preparedness Plans World Vision Asia-Pacific Region Sri Chander, Regional Healt

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  1. Avian Influenza/Human Influenza Pandemic Preparedness Plans World Vision Asia-Pacific Region Sri Chander, Regional Health Advisor May 27, 2006 CCIH Conference

  2. On-the-ground, Field-level realities of life • Can't see beyond today…let alone seeing into the future… • Can't feed their children… • Don't have access to basic housing… • Don't have access to clean water…soap hard to find • Don't have access to basic sanitation... • Land tenure is insecure… • Can barely pay for school... • Poultry is their savings account…it's their future livelihood…backlash to investigations: Sumatra • Need realistic, practical solutions… • The challenge is to raise awareness when it is difficult to see beyond today…

  3. BACKGROUND AVIAN INFLUENZA (AI) & HUMAN INFLUENZA (HI) Unknowns: • Nature of AI/HI threat (severity/extent) • When and where escalation will be seen • Duration of AI/HI pandemic (most probably last 1-2 years and will come in series of 2 to 4 month waves as the virus further mutates)

  4. BACKGROUNDAVIAN INFLUENZA & HUMAN INFLUENZA KNOWNS: • Local threat with global implications (US$268 billion loss & drop of 6.5% in GDP in Asia alone: ADB) • 2-3 Weeks’ Window (on reaching Level 4) to prevent global pandemic • AI must be fought at source (small-scale/backyard poultry farms & wild birds (30 million HH out of 80 M HH in Indonesia, 8 M HH out of 11 M HH in Vietnam) with Asia as the ground zero • Migratory flyways: Eurasia, North and East Africa • Children are vulnerable • High expectations of NGOs like WV to deliver • Tamiflu/anti-virals: not silver bullets--worldwide shortage • No safe, effective vaccine available to prevent a global HI pandemic

  5. BACKGROUNDAVIAN INFLUENZA & HUMAN INFLUENZA CONCERNS • HI Virus adheres to URT mucosa —more efficient human transmission • H5NI virus: --less replication capacity in URT --adheres to LRT (bronchioles/alveoli) severe hemorrahigic pneumonia —>less efficient human transmission --multiple organ involvement—GIT/CNS • Illegal bird trade>migratory birds?

  6. LATEST AI/HI SITUATION IN ASIA “Avian Flu Wanes in Asian Nations It First Hit Hard” –NYT/FT • Vietnam vaccinated 220M chickens and culled 50 m chickens in last 1 year; CFR dropped: 60% (2004)13% (2005) No AI/HI case in 2006 • Thailand culled and compensated well & trained 100,000 VHVs to report cases • Tamiflu issued small Thai/VN hospitals to treat all flu cases even before confirmation • China: 10 cases in 06: caution/encouraging

  7. Other countries—not good news • Indonesia: “Bird Flu future lies here” --30 M HHs with 200 M backyard chickens --H5NI found in 2/3 of 33 provinces --Can’t compensate—little culling --2nd highest # (33) of bird flu deaths --2006: largest # (22) bird flu deaths --Largest cluster (7 deaths) in N Sumatra with no poultry contact— Ist time passed from 1 person another person 3rd person --Ist time---increasingly contagious? --WHO--raise to Level 4 Pandemic Alert?

  8. Others: Not good news (2) • Myanmnar: > 100 outbreaks in different parts of the country --”Epidemiological black hole” • Cambodia and Laos—vague, few reported cases; silence not neccesarily good news • Risk of virus returning to Vietnam and Thailand ever present • “Tomorrow, the whole thing could change again”---David Nabarro

  9. Global Pandemic Priorities • Contain avian flu epidemic • Culling (50M birds in Vietnam: Dec 03-Dec 05) • Upgraded veterinary infrastructure/vaccination • Improved bio-security • Compensation (ADB offer of USD 500M for Asia) • Prepare for pandemic • Improved surveillance • Stockpiled antivirals and other medications • Personal Protective Equipment (PPE) • Containment plans (quarantine, zoning, etc) • Prepare for pandemic response --Business Continuity Plans (BCPs) to keep vital services and societies going, minimize suffering

  10. WV Pre-Pandemic Preparations • Well-defined structure with global leadership for global/ regional CAT 3 response • WV Global/Regional AI/HI working group and AI/HI Rapid Response Team established • WV Global Guidelines for Pandemic Preparedness issued • AI/HI point person/working group for each NO—in process to develop Business Continuity Plans • Pre-positioning of 1,500 Tx courses of Tamiflu—plan to double that to cover 35% of 9,000+ staff in 17 countries • Develop risk communication guidelines to quickly disseminate timely, clear, consistent messages • Develop a 2-yr comprehensive operational plan • Develop quick/flexible mechanisms to draw down $

  11. TAMIFLU • Resistance: Vietnam & Japan • Study: gave Tamiflu to 90% of ill & PEP to HH contacts within 24 hrs— attack rate reduced 1/3: 27%->17% • New WHO Anti-V recommendations • Stockpile for >50% of population --Treat ill cases & PEP for >90% of HH contacts within 24-48 hrs --Prepare for 30-35% attack rate in popn • Roche/licensees:400m Rx courses by ’07 • Pediatric concerns: Cx (<1yr); SE (2-12 yr)

  12. Protect WV Staff & Prepare for Business Continuity • Issue risk communications guidelines to all WV staff • Seasonal (twice yearly) HI vaccine for staff in avian flu-affected areas • Stockpile/preposition Personal Protective Equipment (PPE) (gloves, masks, soap, alcohol hand swabs, etc.) at country level • Stockpile/preposition medical supplies at country level (i) Tamiflu to cover at least 30% of WV staff (ii) Other supplies, such as intravenous (i.v.) antibiotics, i.v. fluids and i.v. drip sets, disposable syringes & needles, disinfectants, etc • Develop clear triggers for decision making, clear decision making, and clear authority for decision making • Now in WHO’s Phase 3 of global pandemic warning. Issue WV advisory if/when Phase 4 occurs--borders will be closed in Phases 5 and 6 • Develop business continuity plans at APRO/NO and project levels • Explore pre-positioning > 90-day supply of food at NO/local level

  13. Build AI/HI-Resilient Communities • Participate in AI/HI risk assessments with partners • Jointly conduct a Knowledge-Attitudes-Practices (KAP) survey of communities, especially families with small-scale/backyard poultry farms • Develop behavior change messages & materials for communities: --change harmful farm/market place practices of mixing chickens with ducks and mixing chickens with pigs --promote personal hygiene practices • Facilitate community assets-building exercises to plan for community-based AI/HI Response • Promote vaccination of birds in small-scale/backyard poultry farms • Jointly draw up contingency plans for mitigation of economic impact (especially alternative livelihoods and compensatory mechanisms for culling of birds)

  14. Promote Animal Health as Primary Prevention of AI • Jointly conduct assessment of veterinary services • Increase number of veterinary vaccination centers • Promote expansion of coverage of poultry vaccination in line with national policies • Consider providing transport, vaccination equipment, cold chain equipment for poultry vaccination • Provide bio-safety and clinical equipment, PPE biohazard equipment • Build capacity of public sector veterinary staff in vaccine transport, cold chain maintenance, vaccination & humane culling in line with World Organization for Animal Health (OIE) standards

  15. Jointly Develop Early Warning/Rapid Response Networks at Local Level: • Develop active, community-based surveillance networks for AI/HI in partnership with local and national health authorities: -Provide TA in setting up community-based surveillance of AI/HI -Train WV staff/partners as first-line surveillance agents & mobilize them for same-day, transparent notification of AI/HI cases • Strengthen Rapid Response Capacity of national, local & village-level health and veterinary staff in: -pandemic preparations and planning -surveillance and real-time management information systems -early detection and rapid diagnostic confirmation of suspects -stamp out outbreaks: humane culling & quarantine/zoning of infected areas -treatment and post-exposure prophylaxis with antivirals -clinical management of AI/HI -communications lines

  16. Engage in Risk Communications, Advocacy, Partnerships & Resource Acquisition • Insist on World Vision being at the table for planning with the UN, FAO, WHO, OIE; USG response: USAID, Inter-agency group • Form partnerships with governmental/NGO community AI/HI efforts • Develop a risk communications plan for WV Partnership, communities, sponsors, public sector, private sector, local NGOs and donors • Engage with local media in aggressive evidence-based advocacy • Work with Inter-agency Working Group to secure govt funding • Alert WV SOs of immense needs/quick resource commitments • Document and share lessons learned with strategic networks

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