Avian Influenza Preparedness and Response in Afghanistan 2008

AI/PI Preparedness and Response project : 

AI/PI Preparedness and Response project By: Jawad Mofleh, MD.MBA, EFC, Ultrasonologist AI Coordinator/ DEWS & Surveillance Director MOPH/APHI April 2008

Facts : 

Facts WWI Military dead:Over 9.700,000Civilian dead:Over 10.300,000Total dead:Over 20,000,000

Facts : 

Facts WWII Military dead:Over 14,000,000Civilian dead:Over 36,000,000Total dead:Over 50,000,000

Pandemic Influenza 1918-1919 : 

Pandemic Influenza 1918-1919 The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I (WWI), at somewhere between 40-60 million people. It has been cited as the most devastating epidemic in recorded world history. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351. Known as "Spanish Flu" or "La Grippe" the influenza of 1918-1919 was a global disaster

Estimation : 

Estimation This is more than the all deaths happened in the 2 decades of war with USSR

Estimated Total Deaths : 

Estimated Total Deaths

Current Status of Avian and Human H5N1 Influenza at the global level : 

Current Status of Avian and Human H5N1 Influenza at the global level

Worldwide Status of HPAI H5N1 : 

Worldwide Status of HPAI H5N1 Between Nov 2003 and Feb 18, 2008:  H5N1 detected in birds in 60 countries - 6,117 poultry outbreaks reported - more than 250 million birds have died or been culled to control the disease - affected countries in Asia, Europe, Near East, Africa H5N1 detected in humans in 14 countries - total of 361 cases and 227 deaths reported - average of 5-9 new cases per month - fatality rate = 63% sources: WHO, OIE

Slide 10: 

2006 2007 Bangladesh* Burma* China* Egypt* India Indonesia* Nigeria* Pakistan* Romania Russia S. Korea Thailand Turkey Ukraine Vietnam* Nearly Continuous H5N1 Transmission in 8 Countries (*) from Feb 07 to Feb 08 Only shown are countries with 40 or more poultry outbreaks since Dec 2003 Based on OIE, WHO, and media reports through 2/18/08. 2008

Slide 11: 

About Half of Human Cases and Deaths Occur in People Younger than 20 Years Old Cases (n=316) Deaths (n=214) Age 0-20 Age 21-40 Age 0-20 Age 21-40 Age 40+ Age 40+ Source: WHO reports through 2/15/08.

Pandemic Influenza Caused More Deaths Than Wars in Which the US Was Involved : 

Pandemic Influenza Caused More Deaths Than Wars in Which the US Was Involved

Slide 14: 

Total number of cases includes number of deaths.WHO reports only laboratory-confirmed cases. All dates refer to onset of illness.

What is required for a pandemic of influenza to occur? : 

What is required for a pandemic of influenza to occur? Novel virus to which population has little or no immunity Virus that is pathogenic and virulent in humans Virus must be capable of sustained person-to-person transmission

Can a pandemic be prevented? : 

Can a pandemic be prevented?

Slide 17: 

Days Since First Case Daily Cases Pandemic Outbreak: No Intervention Pandemic Outbreak: With Intervention Delay outbreak peak Decompress peak burden on hospitals/infrastructure Diminish overall cases and health impacts

Back ground -Afghanistan : 

Back ground -Afghanistan Afghanistan had outbreaks of disease in poultry first in March 2006 and than in Feb 2007 in poultry

Background-Afghanistan : 

Background-Afghanistan poor country Animal husbandry is a main source of income Porous borders east-south, Route of migratory birds high IMR, MMR and <5MR Prevalence of ARI 19%(MICS 2003), Indonesia(9%), Vietnam(14%), Turkey(12%),Nigeria(6.7%) Every child has chance to get ARI 5 times a year

Background Cont… : 

Background Cont… Treatment not seek for ARI (15 days period from survey) 72% national (MICS-2003) Low education -71% of people are illiterate South east of Asia is an endemic area for HPAI-which increase chance of human infection

Background Cont… : 

Background Cont… Repeated history of 2006 07/02/07 H5N1 Fancy birds in NWFP Pakistan 20/02-1 case of H5N1 in Jalalabad (JBD)-backyard poultry On 07.03.07 four positive cases of H5N1 in two provinces of country and than disease spread to four provinces

Slide 22: 

1 2 2 3 Highways Highways 1 2 3 AI cases in 2007

AI Organogram : 

AI Organogram Vice President Nation Avian Influenza Commission Ministry of Public Health Ministry of Agriculture, Irrigation and Livestock Avian Influenza Secretariat Human Health Animal Health Communication

Specific Objectives : 

Specific Objectives To prevent the occurrence and spread of avian influenza in Afghanistan and preparing the necessary resources for containing the disease in the event of an outbreak To strengthen capacity and undertake disease surveillance and laboratory diagnosis for HPAI; To safeguard human health by improving public awareness and information; To develop emergency preparedness plans for HPAI.

Achievements : 

Achievements

Three types of Surveillance : 

Three types of Surveillance DEWS and ILI surveillance Health monitoring of persons exposed to H5N1 Poultry workers and cullers on “infected” farm Community members within “infected” radius Health workers, surveillance officers, lab workers Enhanced surveillance in an area of identified H5N1 Active surveillance at health facilities serving community in 10 km radius

2- Case Investigation to detect human cases of Avian Influenza : 

2- Case Investigation to detect human cases of Avian Influenza In 2007 so far 12 outbreaks of Influenza A/H5N1 reported by Ministry of Agriculture in the bird population in the 4 provinces of the country. Families visited 13474( 81000 individuals) Suspected cases found 81 Confirmed H5N1 in human 0(zero) all cases have received antiviral therapy

3- Virology Lab/National Influenza Center : 

3- Virology Lab/National Influenza Center Located in Central Public Health Lab in Kabul Established late 2006. Undergone biosecurity enhancements Staff are trained Supported by NAMRU-3

Human Resources / Organogram : 

Human Resources / Organogram

Capabilities : 

Capabilities The National Influenza Center (NIC) Virology Laboratory has two lab rooms - clean cell culture and virus isolation - and ancillary space. Each lab room has a certified class II biosafety cabinet, a CO2 incubator and an inverted microscope. Centrifuges, vortexers and ancillary equipment are also present in appropriate places. Ancillary space houses a -80C freezer and a refrigerator/-20C freezer as well as liquid nitrogen tanks.

Seasonal Influenza virus isolation lab : 

Seasonal Influenza virus isolation lab

PCR Lab : 

PCR Lab The NIC real time PCR lab is capable of performing real time PCR for influenza A and H5 It has three rooms - Extraction, PCR and Master Mix. It has two class II biosafety cabinets, a PCR work station, an AB 7300 real time PCR machine and ancillary equipment. 4 technicians have been trained in Cairo on real time PCR The same PCR equipment can be used for any real time PCR assay.

Achievements : 

Achievements The NIC virology lab successfully accomplished virus isolation of an influenza B virus in March, enabling Afghanistan to participate in global influenza surveillance for the first time ever The isolate has been characterized at the WHO collaborating center for influenza at the CDC, Atlanta via NAMRU-3, Cairo

4- Rapid Response Teams : 

4- Rapid Response Teams 34 teams trained in 34provinces of country. 08 back up teams also trained at the regional levels Each team consist of 4 people IEC & CDC officers, lab tech and vet Coordinated by DEWS regional coordinator

5-Information Education and Communication : 

5-Information Education and Communication Branding of IEC materials for AI P1 2006, for 21 at high risk provinces P2 2006, for 34 provinces ECC for 10 border provinces ICC in the radius of 3KM from index chicken case in 12 foci- 4 infected provinces KAP survey to develop a National Communication Strategy. National AI communication strategy development workshop ( July 2007) New radio and TV spots Developing prototype materials for the up coming phases of AI in the country. (On going) 273,000 pages of different kinds of IEC material distributed

Intensive communication campaign(ICC) : 

Intensive communication campaign(ICC) Advocacy workshops ( Authorities, village leaders, com. Councils, Teachers, Rep. of women associations) Media campaign Interpersonal communication campaigns ( house to house approach)

Information Education & Communication : 

Information Education & Communication IEC campaign border provinces KAP province

% of people who heard of AI : 

% of people who heard of AI

Perception of AI as a threat for human health : 

Perception of AI as a threat for human health

6-Isolation wards : 

6-Isolation wards Eight Isolation wards in Seven provinces Assessment completed Equipment for two IWs of Kabul ordered and partially arrived in stock Constraints in establishment of IWs proper place (Building) e.g.Herat, Badakhshan, Bamyan, Kandahar Shortage of trained staff Lack of state of art equipment which increase chance of survival of patients

Slide 43: 

Locations of planned Isolation wards in the Country

7-Other achievements : 

7-Other achievements DEWS Manual Developed (Dari, Pashto and English) Avian Influenza Toolkit Developed (Dari, Pashto and English) 400 MOPH and MAIL staff vaccinated against seasonal Influenza

Slide 45: 

AI cases in poultry 2007 The Difference 2006-07 2006 this time of year- 09 infected provinces 2007- 05 infected provinces so far AI cases in poultry 2006 Outcome of interventions

Challenges/Constraints : 

Challenges/Constraints Security DEWS operational cost 500K/annum Fund for establishment of Isolation wards One confirmatory lab in the country Serious Shortage in availability of Seasonal Flu Vaccine Shortage of Antiviral drugs Training for staff No screening equipments in airports and border points

Challenges in creating awareness : 

Challenges in creating awareness

Close or Direct Contact with Chickens Potentially Infected with H5N1 : 

Close or Direct Contact with Chickens Potentially Infected with H5N1

Close contact increase chance of human infection : 

Close contact increase chance of human infection

Our expectations : 

Our expectations Advocacy for support Support of yourselves Personal commitment to response Communication (vertical and longitudinal) Involvement of people/communities in preparedness and response to AI/PI

Slide 51: 

Thanks