Global capacity and responses to - PowerPoint Presentation

Slide1

Global capacity and responses to

pandemics

WHO's

g

lobal strategy –

N. Shindo MD, PhD.

Coordinator

Pandemic and Epidemic Diseases Department

Epidemic Clinical Management

ERS International

Congress 2015, Amsterdam

H

is daughters are

Hygieia ("Hygiene"), Iaso ("Medicine"), Aceso ("Healing"), Aglea ("Healthy Glow"), and Panacea ("Universal Remedy").

Asclepius – Greek god of medicine

HSE cluster and PED Department

Pandemic

and

Epidemic Diseases

Global Capacity and Respnse

Food safety and zoonosis

How many pathogens able to infect humans?

1400

pathogens1 are known to infect human, other are discovered /identified every yearSome of them are responsible of global public health problems e.g. SARS, in 2003, pandemic influenza in 200970% from animal origin

Chikungunya

virus (1956)

Ebola virus (1976-7)

Monkeypox virus (1972)

Hendra virus (1994)

HIV (1983)

1

Jones, K, Nature (2008)

2

Woolhouse, ME,

Proc

. R. Soc. B (2008)

Discovery

curve

for

human

virus species

2

Pandemic and Epidemic diseases department

Perform timely risk assessment and monitoring of infectious epidemic diseases of international concern to define emergency intervention strategies.

Improve shared knowledge and evidence-base for epidemic diseases to inform policies at international and national levels

Support countries throughout the epidemic cycle: Preparedness, Response and Resilience to epidemics 

Optimize treatments and diagnostics to reduce infectious diseases mortality 

Implement global mechanisms and processes to deal with the international dimension of epidemic diseases  

PED activities

DiseasesCholeraEmerging diseasesHendra virus infection Influenza (avian, seasonal, pandemic)Leptospirosis Meningitis Nipah virus infectionPlagueRift Valley fever SARS and coronavirus infectionsSmallpox and human monkeypox TularemiaViral Haemorrhagic fevers (Ebola, Marburg, Lassa, CCHF)Yellow fever

Cross-

cutting

initiatives and network

Antimicrobial

resistance

(AMR)

Battle

against

Respiratory

Viruses

(

BRaVe

) initiative

Communicable

Disease

Control in

Humanitarian

Emergencies (DCE)

Emerging

and

Dangerous

Pathogens

Laboratory

Network (EDPLN)

International Coordinating Group (ICG) for

yellow

fever

,

meningitis

and cholera

Global Infection

Prevention

and Control Network (GIPCN)

Global influenza Surveillance and

Response

System (GISRS)

Global

Leptospirosis

Environmental

Action Network (GLEAN) and

Meningitis

Environmental

Risk

Information Technologies (MERIT)

project

Pandemic

Influenza

Preparedness

framework

(PIP)

Weekly

Epidemiological

Record (WER)

Evidence to reduce disease transmission

e.g. Role of pigs in the transmission/ amplification of some deadly viruses (viral haemorrhagic fever, Influenza)Impact on preventive measures and cross sectorial work(OIE/FAO)e.g. Bats in haemorrhagic fever transmission

Develop public health research agenda

WHO is streamline research efforts done by academia or industry to answer public health questions

How useful it is to stockpile mask for pandemic preparedness? What is the actual risk to face an avian influenza pandemic?How can we foster research on new treatments for viral respiratory diseases to save 700 million children under 5 each year ? (BRAVE initiative)

What do we do ?

Perform timely risk assessment and monitoring of infectious epidemic diseases of international concern to define emergency intervention strategies.

Source: WHO/PED, March 2013

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

 WHO 2013. All rights reserved

Outbreaks on the African continent (2007-2013)A total of 174 epidemics

Avian InfluenzaChikungunyaCholeraEbola Hepatitis E Lassa FeverMarburgMeningitisMonkeypoxNodding diseasePlagueRift Valley Fever TyphoideWest Nile FeverYellow Fever

Number of epidemics

(2007-2013)

Number of epidemic by year in Africa

Analysis excluded Poliomyelitis, HIV, TB and malaria

A total of 15 diseases cause(d) outbreaks include:

Preventive interventions, 2012

Prepositioning of reagents and treatments: meningitisPreventive vaccination campaigns (GAVI support)meningitisyellow fever

Epidemic responses, 2014

Epidemic responses for MERS CoV (Middle East)Avian influenza H7N9 (China) Ebola (West Africa)Global stockpile of vaccine and antivirals

New approaches for old disease: cholera

Close partnership with water sector to reduce cholera transmissionRational use of oral cholera vaccine during emergencies (e.g. global oral cholera vaccine stockpile)

What do we do ?

Optimize treatments and diagnostics to reduce infectious diseases mortality

Differential mortality and access to care

Hospitalized patient during SARS outbreak (2003)

Cholera Treatment Unit (2003)

Improvement of clinical management and infection control

Guidance for treatment and infection control Access to medicine (prequalification, essential list of medicine)Partnership with experts networks: ISARIC, INFACT

Global Health Security IHR(2005), a paradigm shift

International legal instrument, 194 countriesAim: help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwideIncreased emphasis on early source control rather than bordersApplicability to all hazardsFrom preset measures to adapted response based upon risk assessment, facilitated by communicationIncludes an obligation to build national capacities to detect and respond to potential public health events

Implementation of the PIP framework

Sharing of influenza VirusesGISRS

Sharing of benefitsVaccinesAntiviralsDiagnosticsPublications

Equal footing

Pandemics of the 21rst century

Some recent emerging and re-emerging diseases

Viral haemorrhagic fever : Marburg (1967), Ebola (1976)HIV –AIDS (1980s- now pandemic disease)Yellow fever (re-emergence in west Africa 2000)SARS (2003)H5N1 (2003), H1N1 pdm (2009), H7N9 (2013)MERS-Cov (2012)

Zones infected with

Aedes aegypti

New York city

16 h

Miami

20 h

N

elle

- Orléans

22 h

Sao Paulo

20 h

26 h

26 h

Brisbane

Sydney

Bangkok

16 h

Delhi

14 h

Les durées moyennes de voyage, incluant le temps de transit, ont été fournies par Carlson Wagons-lits ®.

Abidjan

Lagos, Nigeria

YELLOW FEVER INITIATIVE

(Source : Carlson Wagons-lits

)

Rapid spread of infectious diseases

Modeling EID events: Relative risk of an EID

Hot Spots: global distribution of relative risk of an EID event caused by zoonotic pathogens from wildlife, (Jones Nature, 2008).

Recent influenza pandemics

A(H2N2)

1957:

« Grippe asiatique»

1-4 millions de décès

A(H3N2)

1968:

«

Grippe de Hong Kong

»

1 million de décès

A(H1N1)

1918:

«

Grippe

espagnole»

50-100 millions de décès

Credit: US National Museum of Health and Medicine

2009: « Grippe A (H1N1) »

≈ 200 000 décès

A (H1N1)

Laboratory-confirmed human avian influenza infections since 1999

Avian Influenza A(H7N9) Novel Coronavirus (MERS-CoV)

World experiencing emergence of 2 exceptional new virus infectionsAvian influenza A(H7N9)Novel coronavirus MERS-CoVUnusual global situationUnrelated, highly pathogenicPotential to evolve & spreadNo comparable situation since 2003 when SARS & H5N1 (re)emerged

nCoV

EM courtesy of U.S. CDC,

H7N9

EM courtesy of China CDC

4 April: outbreak of ILI in Veracruz

15-17 April: clusters of severe pneumonia in Mexico

27 April: WHO phase 4

May

June

July

August

October

September

March

25 April: PHEIC announcement

23 April: H1N1 confirmed in several patients in MX

27 April: Canada and Spain report H1N1 cases

April

Sustainable Person-to-Person Transmission Crossing of a Threshold

Pandemic Response Tools

1918

1957

1968

1997

2003

2009

Spanish flu

pandemic

Asian flu

pandemic

Hong Kong flu

pandemic

A (H1N1) 2009

pandemic

H5N1

Asia

H5N1

Hong Kong

18 Cases (C)

6 Deaths (D)

Sulfonamides

(1939)

Penicillin

(1945)

Cephalosporins

(1964)

Aminoglycosides

(1943)

Erythromycin

(1952)

Introduction of other classes of antibiotics

Antibiotics

Amatadane

for influenza (1966)

Rimatadane

(1993)

Neuraminidase inhibitor

Oseltamivir and Zanamivir (1999)

Antivirals

PH measures (i.e. school closures, mask, mass gathering)

Non-pharmaceutical

Interventions

Inactivated Influenza Vaccine (IIV)

(1944)

Improved IIV

(1960 purified)

IIV

(1968 fragmented)

IIV

(1980 sub-unit)

GISN (1952)

Cell-based IIV(2007)

LAIV (live-attenuated, 1960, Russia)

Adjuvanted IIV(1997)

Vaccines

LAIV

(2003, USA)

Epidemic Disease Patterns Varied by Location

May

June

Source: Japanese Ministry of Health, Labour and Welfare

Japan - Kinki area

390 confirmed cases No hospitalisation(As of 4 June 2009)

USA - Utah

489 confirmed cases 35 hospitalisations 2 deaths (As of 4 June 2009)

Source: Utah department of Health.

May

June

April

3. Communication

Technical scientific communication/ risk communication

Naming of the pandemic

Communication on

global

risks

Gap between "technical" and "public" communication

It is just a technical definition!

Global availability of vaccines

World economies

1

1

World Bank classification 2009

Only high income countries had access to the vaccine in fall 2009

Vaccine deployment to low income countries

WHO has received pledges of approximately 200 million doses of vaccine, 70 million syringes and US$ 48 million for operations.

99 countries requested vaccines

As off May 2010, deployment of vaccine in 39 countries (

approx

20M doses)

Extremely complex project: donation agreements, regulatory, supply and timing issues.

What mechanism should be put in place for future pandemics to ensure more equitable access to vaccine and medicines?

EDCARN:

Emerging Disease Clinical

Assessment and Response Network

Clinical & Infection Control

Pandemic & Epidemic Diseases

WHO-HQ, Geneva

Genesis: Virtual network of SARS clinicians

Clinical information for case definition, public health purposesVirtual network of SARS clinicianNew diseaseInternational spreadNo vaccine, no medicine, IPC?50+ clinicians in 14 countries, telephone conference twice a weekface-to-face meeting, 14 June 2003

Evolution: IHR(2005), biological threat, pandemic fear, global health security

Avian influenza H5N1

2009 H1N1pdm

MERS

CoV

Avian influenza H7N9

SARS CoV

vH3N2, vH1N1

PED's work on clinical management of EID

Provide a

platform for information exchange and mutual support

throughout outbreak/pandemic of infectious diseases of international concern.

Promote clinical data collection

and the standardization of clinical research protocols

;

facilitate greater understanding of the natural history and manifestations.

Monitor possible changes in illness manifestations and disease patterns

that would have implications for initial case recognition/detection and for public health responses.

Provide advice to MoH as well as on-site technical support to frontline clinicians

to promote best evidence-based practices.

Prepare

rapid advice guidelines

by quick literature reviews and expert consultations

Enhance education and readiness of healthcare worker

s by clinical workshops and trainings.

EDCARN: Emerging Disease Clinical Assessment and Response Network

Vision

The mortality due to emerging pathogens is reduced through improved clinical management, even in absence of vaccine or specific treatment. Enhance/empower the role of clinical care / clinicians

Mission

In the Global Health Security context,

To strengthen global collaboration between clinicians, researchers, WHO, medical NGO's, national health authorities and other stakeholders in order to improve clinical management of patients during outbreaks of emerging diseases.

Catalyst of new dynamics of PED control – bench to bed and beyond

Basic science>animal models>regulatory mechanism>clinical trials>improved patient care>public health>policy

Supply of Neuraminidase Inhibitors Related to Reduced Influenza A (H1N1) Mortality during the 2009–2010 H1N1 Pandemic: An Ecological

Study

Paula Miller, Aksharananda Rambachan, Roderick Hubbard, Jiabai Li, Alison Meyer, Peter Stephens, Anthony W. Mounts, Melissa Rolfes, Charles Penn

Policy case

study: Argentina 2009