WHO project to generate influenza disease burden estimates Julia Fitzner Global Influenza Programme

Why do we try to measure disease mortality and morbidity? Support development of public health policy for influenza prevention and control Support decisions on influenza vaccine introduction Support decision on vaccine expansion Inform treatment guidelines (e.g. antibiotic use, antiviral use) Evaluate existing influenza prevention and control strategies Inform allocation of resources Communicate disease severity Compare global/regional and national estimates and other disease estimates Compare a pandemic burden to seasonal burden Research / expand knowledge - e.g. strain specific define risk group

Pandemic Influenza Preparedness – Burden of influenza disease WHO through the project of Burden of Influenza Disease, Partnership Contribution (PC) of the PIP Framework, aims to narrow the gap in understanding of the burden of influenza disease.

PIP Partnership Contribution Expected Outputs by 2016 for Burden of influenza disease Output 1: Derive regionally representative influenza disease burden estimates from selected countries Output 2: Develop a global estimate of influenza disease burden derived from national estimates

WHO Main Strategy to come to influenza disease burden estimate Provide guidance on how to measure influenza disease burden and economic burden Use estimates derived from the “WHO”-methods as standard and triangulate with estimates derived from other methods Mapping of existing knowledge Literature reviews Using networks to find unpublished data Hold consultations to find and understand gaps Use international expertize to join results

http://www.who.int/influenza/resources/publications/manual_burden_of_disease/en/

Main points of the WHO BoD manual The WHO disease burden manual is based on sentinel surveillance data with influenza confirmation (focusing on SARI data) Gives methods on how to estimate the denominator Is based on extrapolation Depends on good understanding of the case ascertainment biases and has limitations when case numbers in risk groups or age groups are small Is the basis for the economic burden tool

Production of national estimates for hospital and economic burden, and mortality Establishment of a technical steering group to advise WHO on disease burden activities Pool of experts to provide technical support to countries Training of national health professionals to use the WHO Manual on Burden of Diseases Studies and the economic burden estimate tool

Progress on the national estimate 40 (19 PIP) countries planning or doing the disease burden studies (using the “WHO” method) 13 (2 PIP) are done or about to be done 25 (16 PIP) are likely to be finished by end of 2016

Development of standardized tools for economic burden estimates Define costing inputs and relevant methods for analysis Develop tool to provide national estimates of economic impact due to influenza Tool ready to be used Plans in 6 countries use the tool

Development of a methodology to estimate the global influenza burden Produce credible global burden estimates of influenza mortality, and hospitalization, including information on high risk groups Ongoing work in 5 areas Literature review for mortality and incidence Literature review on risk factors Under 5 years burden estimate with comparison to RSV Global mortality estimate for seasonal influenza Global morbidity estimate for seasonal influenza

Next steps Meeting in July 2016 to gather burden estimates from countries with recent burden estimates (either with WHO method or estimates to triangulate) Summarizing the accumulated knowledge to a best estimate and identify next steps

Call for assistance Publish or share your burden estimates to be used for a global estimate More countries to use the WHO method- including those that have other estimates to triangulate Experts to review and guide extrapolation methods

We hope at the end of the project to update the 250-500 000* death/year estimate and give global morbidity estimates to lay out a strategy to further close the gap in burden estimate *FAQ – WHO influenza 250-500 000* deaths/year is a crude extrapolation from US estimates to global population with minor adjustment for age distribution.

Acknowledments Advisory group WHO regional offices WHO HQ Caroline Brown Diane Gross Sarah Hamid Erika Dueger Philip Gould Supriya Bezbaruah Soatiana Rajatonirina Ali Ahmed Yahaya Rakhee Palekar Amgad Elkholy Mamunur Malik Wasiq Khan Joe Bresee Cheryl Cohen Anand Krishnan Vernon Lee Jorge Jara Harry Campbell Kaat Vandemaele Wenqing Zhang Philipp Lambach Raymond Hutubessy WHO HQ

谢谢  Спасибо! Merci! Thank you !!! شكرا Gracias!! Thank you Danke!!