1. Communicable Disease Surveillance & Response WHO-WPRO Pandemic (H1N1) 2009 situation and response in the Western Pacific Region Takeshi Kasai Communicable Disease Surveillance and Response, Western Pacific Regional Office World Health Organization

2. Communicable Disease Surveillance & Response WHO-WPRO WPRO Response-Risk Assessment Action Oriented Risk Assessment Epidemiological Prediction & Set up reference Clinical Develop guideline Impact Society Impact Health Care Intervention Containment to Mitigation Virological Mutation

3. Communicable Disease Surveillance & Response WHO-WPRO Number of Countries/Areas Reporting Confirmed Pandemic (H1N1) 2009 Cases to WPRO by Week

4. Communicable Disease Surveillance & Response WHO-WPRO Seasonal influenza and Pandemic (H1N1) 2009 Situation in WPRO North Hemisphere Not yet in flu season, low ILI activity but higher compared to previous years Number of cases is gradually increasing Pandemic (H1N1) 2009 is widely distributed geographically South Hemisphere In the middle of flu season. Laboratory test results are predominantly Pandemic (H1N1) 2009 rather than seasonal influenza Spread is higher compared to seasonal influenza Shows signs of slowing virus activity Tropics Seasonal Influenza activity is getting higher compared to previous years Pandemic (H1N1) 2009 activity is continuing Pacific 18 out of 21 countries/areas have reported cases of Pandemic (H1N1) 2009 Fiji and Samoa has reported near 100 cases as of Aug 13 2009.

5. Communicable Disease Surveillance & Response WHO-WPRO Pandemic (H1N1) 2009 Fatal Cases Western Pacific Region Total Deaths 136 Clinical pictures (N=48) 75% - with underlying medical condition 3 deaths among pregnant, all without underlying medical condition Clinical Course (N=27) 9 days - median interval from onset of symptoms to death (range: 4-14) 5 days - median interval from onset of symptoms to hospitalization (range: 2- 8) 3 days – median interval from hospitalization to death (range: 2-9) Final diagnosis (N=42) 62% - severe pneumonia 14% - congestive heart failure 12% - ARDS

6. Communicable Disease Surveillance & Response WHO-WPRO Influenza Virus Typing # of reported cases Week Japan Week 19-32 2009 New Zealand August 2009

7. Communicable Disease Surveillance & Response WHO-WPRO Reported Cases of Oseltamivir Resistance Country/are as TamifluDetail 1 DenmarkProphylaxisContact with traveller. Developed symptoms on 5th day of prophylaxis Index: Sensitive No further cases were indentified. 2 Japan 40s, F ProphylaxisDeveloped symptoms on 7th day of prophylaxis Index: Sensitive No further cases were indentified. 3 HK, 16 FNoneTravelled from San Francisco 4 Japan Young child ProphylaxisDeveloped symptoms on 4th day of prophylaxis Index: Sensitive No further cases were indentified. 5 Canada 59 M ProphylaxisDeveloped symptoms during prophylaxis Index: Sensitive 6 Japan 30s, M ProphylaxisDeveloped symptoms on 6th day of prophylaxis Index: Sensitive No further cases were indentified. 7 Japan No Young child ProphylaxisDeveloped symptoms on 7th day of prophylaxis Index: Sensitive No further cases were indentified. 8 Singapore 28F TreatmentTravelled to New Caledonia, Hawaii. Isolates showed mutation on 3 rd day of treatment Data as of 13 Aug

8. Communicable Disease Surveillance & Response WHO-WPRO Surveillance & Response Strategies StrategyNo Community Transmission With Containment Example: Mongolia Resource intensive and minimal public health benefit Mitigation Lost opportunity to delay the spread Example: Australia, Japan, New Zealand

9. Communicable Disease Surveillance & Response WHO-WPRO Cases with Travel History Philippines and Australia Australia Country and areas # of cases Fiji1 Viet Nam 7 South Korea 1 Samoa1 Hong Kong, China 21 New Zealand 2 Taiwan, China 3 Malaysia32 Mainland, China 14 Singapore22 TOTAL95Philippines Country and areas # of cases Macao, China 5 PNG1 Saudi Arabia 2 Taiwan, China 1 Malaysia8 South Korea 2 Mainland, China 5 Singapore10 Japan10 Hong Kong, China 7 TOTAL50

10. Communicable Disease Surveillance & Response WHO-WPRO Monitoring of Pandemic Impact Pandemic impact still remains uncertain and is currently under monitoring Pandemic impact still remains uncertain and is currently under monitoring Pandemic impact on a population has many dimensions: health, social and economic consequences Pandemic impact on a population has many dimensions: health, social and economic consequences No severe impact on health- care services as a result of acute respiratory disease reported No severe impact on health- care services as a result of acute respiratory disease reported Pressures on local hospitals and potential economic loss reported in some countries Pressures on local hospitals and potential economic loss reported in some countries

11. Communicable Disease Surveillance & Response WHO-WPRO WPRO Response Framework for Action

12. Communicable Disease Surveillance & Response WHO-WPRO APSED AND WORKPLAN IHR (Public Health Emergencies of International Concern) Asia Pacific Strategy for Emerging Diseases (APSED) Bi-Regional Workplan Avian Influenza Pandemic preparedness

13. Communicable Disease Surveillance & Response WHO-WPRO Framework for Action SURVEILLANCE COMMAND PUBLIC HEALTH INTERVENTIONS COMMUNICATION HEALTH CARE RESPONSE HEALTH SECTOR How to slow down transmission How to improve care and reduce deaths Laboratory PARTNERS INDIVIDUAL LEVELSOCIETAL LEVEL

14. Communicable Disease Surveillance & Response WHO-WPRO H5 Response H5 BIRDS HUMAN Interface Information Sharing Surveillance Rapid Response Monitoring of Pigs PIGS H1 New Response H1 H1 Pandemic Response H5 Re-assortment Monitoring of human Diagram Showing Responses to Reduce Probability of Viral Re-assortment

15. Communicable Disease Surveillance & Response WHO-WPRO Conclusion Epidemiological Situation differs by country Epidemiological Situation differs by country Virus has not undergone any significant mutation and majority of cases have been mild. However, severe and death cases have been reported in countries with sustained community transmission. Virus has not undergone any significant mutation and majority of cases have been mild. However, severe and death cases have been reported in countries with sustained community transmission. For those who have not yet experienced extensive community transmission, it is important to prepare both national and local levels as much as possible. For those who have not yet experienced extensive community transmission, it is important to prepare both national and local levels as much as possible. WPRO-SEARO have developed a Framework for Action to assist preparations with the goal to minimize preventable deaths WPRO-SEARO have developed a Framework for Action to assist preparations with the goal to minimize preventable deaths