Current Situation Influenza A (H1N1) 17 May 09

1. Current Situation Influenza A (H1N1)17 May 09

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

3. Pandemic requirements Global outbreak of disease • Appearance of flu virus A with pandemic potential • It causes sustained human-to-human transmission • Population has no or limited immunity

4. Broad Risks of a Pandemic Livelihoods • Food and income loss from poultry deaths/ culling & decreased economic activity • High illness & potentially higher death rates • Overstretched health facilities • Disproportionate impact on vulnerable Human Health • Increased demand for governance & security • Higher public anxiety • Reduced capacity due to illness & death Governance & Security • Deterioration of coping & support mechanisms • Interruption in public services • Quarantine policies Social & Humanitarian Needs • Trade & commerce disruptions • Degraded labour force • Interruption of regular supply systems Economic Systems

5. Pandemic Phases

6. Phase 5 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.

7. Phase 6 Phase 6 is characterized by 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.

8. Time line current situation (1) • Friday 24 April • Reports of previously undetected Influenza A (H1N1) virus in USA and Mexico • HQ SHOC activated • Sunday 26 April • IHR Emergency Committee convened • WHO Director-General declares a Public Health Emergency of International Concern

9. Time line current situation (2) • Monday 27 April - WHO increases pandemic alert phase from 3 to 4 - Geographic Containment not feasible • Wednesday 29 April - WHO raises pandemic alert phase from 4 to 5 • Tuesday 5 May - WHO starts sending antiviral stocks to 72 countries and Regional Offices

10. Current Epidemiology as of 08:00 GMT 17/05/09 • Laboratory confirmed cases • Total global cases 8480 cases/72 deaths NZ: 9 cases Norway: 2 cases Panama: 54 cases Poland: 1 case Portugal: 1 case Republic of Korea: 3 cases Spain: 103 cases Sweden: 3 cases Switzerland: 1 case Thailand: 2 cases UK: 82 cases Denmark: 1 case El Salvador: 4 cases Finland: 2 cases France: 14 cases Germany: 14 cases Guatemala: 3 cases Ireland: 1 case Israel: 7 cases Italy: 9 cases Japan: 7 cases Netherlands: 3 cases Mexico: 2895 cases 66 deaths US: 4714 cases, 4 deaths Argentina: 1 case Australia: 1 case Austria: 1 case Brazil: 8 cases Canada: 496 cases, I death China: 5 cases Colombia:11 cases Costa Rica: 9 cases, 1 death Cuba: 3 case

11. New human lab confirmed influenza A (H1N1) cases as of 0800 GMT 17/05/09

12. WHO Response (1) • Emergency response rooms – mobilised – 24/7 • Operations • Field team of 31 experts to Mexico (from WHO and CDC/GOARN) • GOARN network activated • Initiated distribution of oseltamivir stockpile • Global monitoring and assessment • Triage of information and follow up of alerts • Coordination with Regions and National Focal Points (NFP) • Case report form • EIS web updates • Antivirals Taskforce • Oseltamivir stockpile distribution to regions and 72 priority countries (including Mexico) • Quantities proportional to population • Consultation with manufacturer

13. WHO Response (2) • Trigger International Health Regulations on notification, risk assessment and response • Article 48: emergency committee: - DG establishes EC to provide views on PHEIC, temporary recommendations, phases • Article 42,43 Travel and trade • Monitoring travel and trade measures • Maintaining a dialogue with member states to make sure objective of IHR are mett (least interference with travel and trade) • Ports of Entry and conveyance: • Providing guidance PoE authority • Guidelines for cases on board of planes, ships, trains etc.

14. WHO Response (3) • Technical guidance • Analysis of available data (modelling) • Guidelines on surveillance, lab and diagnostic, infection control, health care management, pandemic response plan, vaccines made available to the public • Vaccine Taskforce • Consultation with manufacturers • Consultation with scientific experts • Communication • daily press conference • interviews will hundreds of media • Disease Outbreak News web updates • media monitoring

15. Diagnostic Kits at country level

16. WHO Response (4)Technical guidance • Tools and standards adapted for country and community use - Checklist on planning and coordination • Rapid detection, alert and investigation mechanisms • Access to diagnostics • Infection control, case management, organization of health care system • Community interventions • Logistics, procurement and supply chain • Risk communication

17. WHO Response (5)Training • Coordinated and targeted training and workshops at regional and sub-regional level • Specific regional, subregional and national context • Web based training and training of trainers • Back up hot line for WR/CO, Qs & As • For COs, MOH, other UN, NGOs

18. WHO Response (6)Deployment of expert teams • Specific developing countries; sequenced • Experts in epidemiology/PH, IC/case management, risk communication, PH Emergency Management, logistics, lab, etc. • Teams tailored to needs • Materiel to enhance surveillance, facilitate diagnosis, protect personnel, treat and prevent cases • Sample shipment for rapid and reliable diagnostics

19. WHO Response (7)Mechanisms • Coordinated with the RO & CO, in liaison with other UN agencies and NGOs • GOARN • Integrated operational platform in HQ and in the regions • System for prioritization demands • Feedback and adaptation of response

20. IHR in WHA 62 • WHA decision on annual reporting on implementation IHR • Yearly questionnaire, Feb 2009. 82 States parties reported • Evidence of more cross sectoral coordination • On line training, surveillance capacity building Lyon Office • Strengthening laboratory quality and bio-safety • Strengthening of National Influenza Centres (NIC) • Relations with other UN agencies, ports and airports authorities • 684 events reviewed (June 2007-dec 2008). 19% reported through National Focal Points. 7% Risk assessment tool was used. Further research needed

21. IHR in WHA A62/6Public Events • Lead intoxication • Resistance to oseltamivir seasonal influenza • Networks on chemical and radio-nuclear thretas up-dated on IHR • Nuclear emergency exercise with IAEA in 2008 • Work on Yellow fever transmitted by conveyances • Legal issues and monitoring of access of NFP to IHR Event Site (IES) • Increased awareness of IHR at regional offices and country level

22. Pandemic Influenza PreparednessWHA A62/5 • Report by the DG " PIP, Sharing of Influenza Viruses and access to vaccines and other benefits" • Intergovernmental Meeting (IGM) with report from 15-16 May 2009 meeting • Advisory board to DG-WHO • Development for the Terms of reference for current and potential future (WHO Network) laboratories for H5N1 and other human pandemic influenza viruses • Fro use in vaccines, diagnostic test materials and pharmaceuticals • Good progress but still some points to solve on International Property Rights, transfer of materials

23. Current WHO Pandemic Alert phase Phase 5 Phase 5 INFLUENZA A(H1N1): SPECIAL HIGHLIGHTS available at http://www.who.int/en/

24. IHR in WHA 62

25. IHR in WHA 62

26. IHR in WHA 62