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

2. 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

3. 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.

4. 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

5. 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Using networks to find unpublished data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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

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

15. 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

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