1. Country Experience in Health Crisis Management on H5N1/H1N1 Outbreak in Lao PDR Dr Nyphonh Chanthakoummane Chief of Diseases Surveillance and Response Division Department of Disease Control Ministry of Health, Lao PDR

2. Outbreak of H5N1 in Laos  The 1 st round:January-March, 2004  The 2 nd round: July, 2006  The 3 rd round:February-March, 2007

3. Measures undertaken during outbreak  Health education campaign  Poultry killed/eggs destroyed  Close surveillance both in human and animal (RRT)  Sample taken ( human and animal )  Training health center staffs

4. Measurement taken during outbreak Culling take place in affected villages, Namma Village, Long District Luangnamtha Compensation paid immediately

5. Train leaders for reporting and active case search in catchments areas

6. National Committee for Communicable Diseases Control (NCCDC) National Committee for Communicable Diseases Control Secretariat National Committee for Communicable Disease Control Office (NCCDCO)or = (NAHICO) Organization chart Director / Deputy Director NAHICO Coordination/ Collaboration Unit Planning/ Financing Unit Monitoring/ Evaluation Unit

7. Strategy 1 The Plan is based on 5 strategies Animal Health. Development of disease free avian influenza management, under leadership of MAF. FAO as lead support agency Strategy 2 Human Health. Disease surveillance and response in humans during outbreak, under leadership of MoH. WHO as lead support agency Strategy 3 Strategy 4 Strategy 5 Human Health. Laboratory and Curative Care, under leadership of MoH. WHO as lead support agency Information, Education and Communication. Health Education and Community Action, under leadership of Ministry of Information and Culture (MIC). UNICEF as lead support agency Project coordination, project management and regulatory framework, including strengthening of Institutional and Legal Frameworks

8. Provincial Coordinating Committee on CDC Chaired by Governor/Vice Governor Members: Health, Agriculture, Information, Trade, Tourism, Transport, Interior, Mass Organizations Provincial CDC Secretariat Chaired by Health Department/Agriculture Strategy 1 Ad Hoc Committee on AHI during outbreak Strategy 2 Strategy 3 Strategy 4 Strategy 5 Advocacy, motivate community participation in reporting dead bird Mobilize manpower for mass bird culling Compensation Control animal movement Assess, report to Provincial CDC, National CDC Sec IEC Taskforce: Health, Agriculture, Information, Trade, Tourism, Transport, Interior, Mass Organizations Members: Health, Agriculture, Information, Trade, Tourism, Transport, Police, Military, Mass Organizations

9. Pandemic Preparation for response in Laos – WHO Pandemic alert phase 4 to first case detected in Lao PDR = 7 weeks Allowed preparation time – Response in five areas: 1. Co-ordination and Decision Making 2. Surveillance and Response 3. Clinical Management and Infection Control 4. Risk Communication 5. Public Health Interventions

10. Co-ordination and Decision-making Other Ministries NEIDCO an effective coordinating body High level political support Cooperation between National Health Authorities International Cooperation

11. ◦ Indicator-based: Used existing surveillance notification mechanism for nationally notifiable diseases  Frequency: Weekly  Daily  Syndromes reported:  Acute Respiratory Illness (ARI)  Influenza Like Illness (ILI) ◦ Event Based Surveillance  from HCW and community (‘166 hotline’)  Severe illness /death  Cluster of ILI cases from same village ( local investigation) ◦ Sentinel hospital sites for ILI and SARI lab- surveillance ◦ Daily integrated reporting and feedback

12. NEIDCO Natl / Prov Hospitals Private Clinics District Hosp Active Surv Passive Surv Active Surv Passive Surv Weekly report Fax/phone Weekly/ monthly Feed-back report Flow chart: National Surveillance of Notifiable Selected Diseases

13. Clinical Management and Infection Control  Training on Pandemic (H1N1) CM and infection control (IC) throughout country  On-call duty system for clinicians from provincial hospitals and for National authorities - Advice on Pandemic (H1N1) CM and IC - Outbreak support  Development of Lao specific Pandemic (H1N1) CM and IC guidelines  Set-up of screening systems and isolation rooms in hospitals  Limited Tamiflu and PPE stockpile and distribution ◦ Tamiflu for severely ill patients and high risk groups

14. Set-up Screening System  Referral of patients to designated area in OPD if ILI symptoms Designated Screening Room Isolation and cohorting of in-patients  Availability of PPE and IEC material  Regular cleaning and disinfection

15. Risk Communication – IEC material for public and HCW – Press releases, TV and radio spots – Workshops for journalists and those involved in media briefing

17. ◦ Isolation of patients  home isolation of mild cases  hospital isolation of severe cases ◦ Border control & International travel  Health information and advice  Screening: thermal scanners and entry form  isolation implemented when positive cases identified ◦ School closures  Some school closures but recent national decision not to close schools ◦ Mask Use for sick people, front-line HCWs and care givers

18. Thank you very much

19.  Limited human and physical resources to develop an effective control program to eliminate HPAI from the country.  Lack of the veterinarians and the skills on disease control of the available personnel are still weak and moreover the veterinary institute within the country is also not available.  The infrastructure and facilities for disease reporting, early warning diagnosis as well as for the surveillance and concerned plan of the all level are not developed effectively.  Inadequate operational fund.  The production system and management of the farmer is almost underdeveloped; the knowledge and the understanding of the farmers about the animal disease is very low.

20.  Strong political commitment and a forum for open dialogue are crucial  Strong teamwork & partnerships lead to efficiency and progress e.g. Govt, International groups, NGOs  Pandemic Preparedness Plans should not only be developed but actually used  Epidemiology and Laboratory should not be seen as separate entities  Public health risk communication is a cross-cutting strategy that should increase awareness but not fear e.g. H1N1 situation  Ongoing small group activity oriented training is better than large group didactic training Lessons Learnt