1. Global surveillance during pandemic Tim Nguyen Global Influenza Programme, WHO WHO updated interim recommendations

2. 2 |2 | Outline 1.Importance and benefits of surveillance and information sharing at global level 2.WHO updated interim guidance on global surveillance 3.Demo FluID

3. 3 |3 | Importance of surveillance at global level Globalisation of risk: international mass gatherings, increased air traffic The global monitoring provides information on the geographical spread of the disease and its characteristics in different settings Globalisation of needs: antiviral, vaccines Communication with the public and media Update of technical guidelines

4. 4 |4 | Sources of information Reporting form Member states and Regional Offices Virtual teleconferences of 4 networks: Virological, epidemiological and clinical networks + network of modellers GISN / FluNet Screening of web sites and Media Review of literature The Friend and Acquaintance network –Sometimes the most valuable and reliable!

5. 5 |5 | Monitoring of the global situation as of 06 Aug 09 Confirmed cases 177457 Confirmed deaths 1462

6. 6 |6 | Monitoring of the global situation Benefit from Information Sharing Web updates, WER,

7. Updated Interim WHO Guidance on Global Surveillance

8. 8 |8 | Goals from Surveillance Tracking appearance, rise and fall, and movement of virus Changes in rates of morbidity or mortality Changes in age distribution of morbidity or mortality Changes in transmissibility Changes in clinical pattern of disease –New or unusual presentations –Clinical course – e.g. bacterial coinfections, viral pneumonias, pulmonary emboli –Risk groups: e.g. obesity, pregnant, age, others? Virologic changes: –Antigenicity and antiviral sensitivity Strain dominance

9. 9 |9 | Phases of the process International Consultation Working group meeting (s) Fieldtesting Dec 2007 2008 Mar Definition framework global surveillance Detailed description of processes Reality check Draft guidelines 2009 Oct Dec April Interim guidelines July Updated Interim guidelines Field test guidelines

10. 10 | Shifting Information Needs b) Description and Assessment a) Early Detection c) Monitoring

11. 11 | Surveillance Guidance – (a) Early Detection For countries not yet affected: –The first confirmed pandemic (H1N1) 2009 virus infection detected in a country should be immediately reported by the IHR National Focal Point And afterwards: –Any changes in the epidemiological, virological or clinical presentation –Any unusual or unexpected public health events, e.g. clusters of severe unexplained acute respiratory illness or unexplained deaths Case detection Outbreak investigation Notification to WHO – IHR

12. 12 | Surveillance Guidance – (b) Description and Assessment Describe the epidemiological and virological features of cases to guide control and prevention activities Assess disease severity Laboratory testing priorities –confirming infection in new areas –Testing severe cases –Monitoring the co-circulation of pandemic (H1N1) 2009 virus and seasonal viruses Characterization of the virus and the disease Initial copmprehensive assessment (FF100) Contact tracing Case-based sentinel surveillance Lab confirmation

13. 13 | Surveillance Guidance (c) Continuous Monitoring Report data to allow tracking of: Lab surveillance of severe cases / deaths and monitoring of co- circulation Assess qualitative indicators –global geographical spread –disease trend and intensity –impact of the pandemic on health-care services In addition if available, quantitative figures –prevalence –changes in viral antigenicity and antiviral sensitivity –deaths from acute respiratory disease.

14. 14 | Outputs Expected - Use of data and information shared A composite picture of severity and transmission characteristics primarily based on local interpretation of data and investigations. A description of clinical presentation, course, complications, and risk factors Virologic data for strain selection and antiviral sensitivity assessment Numbers of cases, hospitalizations, and deaths

15. 15 | Key Related Decisions - Use of data and information shared Target groups for intervention with vaccine or antivirals –Risk groups in need protection. –Target groups that might have greatest impact on transmission. Strain to use for vaccine. Which antivirals to use. Role of nonpharmaceutical interventions. Appropriate management practices

16. 16 | Consent - Use of data and information shared Data collected via WHO’s global influenza A (H1N1) surveillance systems will analysed and summary data will be published in graphs, maps and tables on WHO’s web site and published in the Weekly Epidemiological Record. Scientists from countries providing data will be invited to participate in the development of, and be co ‐ authors on, publications that draw on their country ‐ specific data. Countries will always be consulted in the development of any articles in which their data has been used.

17. 17 | Tools for data collection and dissemination IHR Notification Weekly Summary Reporting Form Case summary Form FluNet FluID

18. 18 | Demo FluID

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22. 22 | Propose Timeline of FluID roll out Data Form Data excel export Automated maps, graphs, Tables Joint viro/epi weekly country reports (pdf) Upload from existing databases / systems Modification from best practices / lessons learned Mid August September October Mid/end Phase 1 Phase 2 Beginning Start Global roll out

23. 23 | Summary First affected countries were extremely open to share information and reports to provide knowledge for the global response Updated interim surveillance guidelines take into account the current knowledge of Pandemic (H1N1) 2009 FluID and FluNet available to support platform for global information sharing mechanism

24. 24 | Acknowledgements Tony Mounts Julia Fitzner Kaat Vandemaele Vivek Shinde Philippe Veltsos Liliana Pievaroli Sylvie Briand Maja Lievre Weigong Zhou Amy Cawthorne Pandemic Surveillance Working Group

25. 25 | THANK YOU