WHO Western Pacific Region (WPR) 2012-2013

The core activities of our bi-lateral agreements and technical assistance are:

• To build sustainable national capacity for seasonal influenza, pandemic influenza and other emerging diseases and preparedness for implementation of the International Health Regulations 2005 (IHR).
• To make routine contributions of surveillance data to the WHO Global Influenza Surveillance and Response System (GISRS).
• To increase the geographic reach of WHO’s GISRS.
• To provide earlier access to critical virus isolates from humans and birds for WHO GISRS.
• To increase the numbers of shipments and influenza isolates provided by WHO WPR influenza labs to WHO Collaborating Centers for analysis.
• To develop sustainable epidemiologic and virologic surveillance systems for severe influenza in order to gain understanding of the burden of disease from influenza in the WHO WPR.

In FY13, CDC expanded its cooperative agreement portfolio to include two new cooperative agreements with Vietnam and China to introduce or expand the use of seasonal influenza vaccines by public health programs outside the United States. The core activities include: conducting a needs assessment to identify barriers, developing a three-year action plan to introduce vaccines, implement the plan and introduce or expand vaccine use to the target population through a national policy.

Vashonia Smith, MPA
Public Health Advisor
Extramural Program
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Email: vdw8@cdc.gov

Tomas Rodriguez, MA
Public Health Advisor
Extramural Program
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Email: trr0@cdc.gov

Danielle Iuliano, PhD, MPH
Research Scientist
International Epidemiology and Research Team
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Email: aoi0@cdc.gov

A map of the WHO Western Pacific Region (WPR) shows 12 of the 37 WPR member states/countries. The member countries shown, outlined with gray borders, include Australia, Cambodia, China, Japan, Lao PDR, Malaysia, Mongolia, Papua New Guinea, Philippines, Singapore, South Korea, and Vietnam.

Countries with green shading indicate that the Influenza Division provides project funding and technical assistance through Sustainability Cooperative Agreements. Cambodia, China, Mongolia, Philippines, Secretariat of the Pacific Community (SPC), and Vietnam are shaded green on the map. Fiji, Lao PDR and Papua New Guinea are shaded purple to indicate that they receive indirect funding from the Influenza Division. Vietnam has pink diagonal stripes to indicate that they have a Research Cooperative Agreement. China and Vietnam are also shaded with blue dots to indicate that they have Vaccine Policy Cooperative Agreements.

CDC Influenza Division Field Staff, indicated by a yellow dot outlined in red, are located in the following cities: Beijing, Hanoi, Phnom Penh, Manila and Vientiane.

The Global Disease Detection [GDD] Site, indicated by a red “X”, is located in Beijing.

WHO National Influenza Centers (NICs), indicated by purple dots, are located in the following cities: Beijing, Goroka, Hanoi, Ho Chi Minh City, Hong Kong, Kuala Lumpur, Manila, Phnom Penh, Singapore, Taipei, Tokyo, Ulaanbaatar and Vientiane.

The WHO Regional Office for the Western Pacific (WPRO), indicated by a blue star, is located in Manila, Philippines.

• Ensured timely information collection, risk assessment and information dissemination to enable decision-making for H7N9 response.
• Upgraded EOC inaugurated on March 8, 2013 and activated for first time to serve as the common platform for command, control and coordination of A(H7N9) response.
• Conducted the first meeting on seasonal influenza vaccines in the WPR on Oct. 22–23, 2012 in Manila, Philippines emphasizing the importance of national level surveillance data to guide domestic influenza vaccine policies.

U.S. CDC Direct Support

The Regional Office for the Western Pacific Region (WPRO) is located in Manila, Philippines. The office serves 37 countries and areas that span from the northern hemisphere through the tropics and into the southern hemisphere. This region covers nearly one-quarter of the world's population with approximately 1.8 billion people.

Influenza surveillance has been established in many countries in the region. The Global Influenza Surveillance and Response System (GISRS) in the Western Pacific Region currently consists of 21 National Influenza Centres (NICs) in 15 countries, three WHO Collaborating Centres (CCs) for Reference and Research on Influenza, one each in Australia, China, and Japan, two Essential Regulatory Laboratories, in Australia and Japan as well as an H5 Reference Laboratory in Hong Kong, China.

The Western Pacific Region (along with the South-East Asia Region) developed and uses the Asia Pacific Strategy for Emerging Diseases (APSED 2010) to provide a common framework to strengthen national and regional capacities to manage emerging diseases and public health threats, improve pandemic influenza preparedness and comply with the core capacity requirements of the International Health Regulations (2005). It includes components (such as surveillance and laboratory strengthening) that support the GISRS.

The five-year cooperative agreement between CDC and WHO WPRO, which began on September 30, 2011, has supported the implementation of APSED 2010, including influenza surveillance and response capacity development. The agreement also included funds directed to countries through WHO country offices in Cambodia, China, Fiji, Lao People's Democratic Republic, and Viet Nam.

As part of response for Avian Influenza A(H7N9), WHO activated an organization-wide mechanism involving the three levels of WHO–China Country Office, WPRO and Headquarters. The Emergency Response Framework provided overall guidance in line with the emergency management system and ensured adequate human resource surge capacity for monitoring and assessment of the event. The WPRO EOC was the common platform to coordinate the response. Timely information collection, risk assessment and information dissemination were vital to enable decision-making during the A(H7N9) response.

The first meeting on influenza vaccines in the WPR was held on October 22–23, 2012 in Manila. The meeting emphasized the importance of national level surveillance data to guide domestic influenza vaccine policies. It recognized that more data are needed to better understand burden of disease and influenza vaccine effectiveness and encouraged countries to undertake vaccine effectiveness studies and use WHO guidelines on developing a national vaccine deployment plan.

Surveillance Activities

WPRO

• Ensured timely information collection, risk assessment and information dissemination through the online Western Pacific Surveillance and Response Journal (WPSAR).
• Hosted the International Conference on Human Infection with Novel Influenza Viruses, in Beijing, China, August 2013.
• Supported two epidemiologists, a programme management officer, and a national professional officer in China and administrative support.

Cambodia

• Strengthened ILI surveillance at seven provincial sites and at the CDC department with weekly reports produced by each sentinel site and monthly respiratory disease bulletin produced and distributed to partners.
• ILI surveillance review, work plan development, an assessment of A(H5N1) situation, and quality assurance site-visits by national and provincial teams.
• Supported event based surveillance including human A(H5N1) cases.
• Conducted outbreak investigations by national and provincial rapid response teams and confirmatory testing for suspected influenza A(H5N1) cases. WHO was notified timely of human A(H5N1) cases through IHR mechanisms.
• Applied Epidemiology Training (AET) including data quality improvements.
• Conducted indicator based surveillance including a CamEWARN review workshop in December 2012.
• Supported a medical officer, national professional officer and administrative support.

Laos

• Fourth cohort of Lao FETP graduated in February 2013. Cohort Five began in February 2013.
• Conducted ILI and SARI sentinel surveillance in five provinces including workshops and site visits. A review meeting of all sites was held on November 22, 2012 and introduced new SARI case definitions and forms.
• Developed SARI case management guidelines including infection control and specimen collection. SARI surveillance and clinical management workshops in March and June 2013.
• Conducted an Annual Surveillance and Response workshop reviewed past activities and outbreaks.
• Supported an epidemiologist, national professional officer (FETP) and administrative support.

Pacific Island Countries

• Heightened influenza surveillance through strengthening of syndromic surveillance.
• Supported NIC in Fiji and surveillance officers to Ministries of Health of Fiji, Solomon Islands and Vanuatu.
• Supported a medical officer, epidemiologist and surveillance coordinators.

Support was provided for expert visits, laboratory equipment and supplies in Cambodia, Lao People’s Democratic Republic, the Pacific Island Countries and Viet Nam. Existing regional laboratory networks provided essential mechanisms for sharing laboratory information and providing diagnostic resources for A(H7N9) cases. The Chinese National Influenza Centre in Beijing shared virus isolates from the initial three cases with other WHO collaborating centres and related laboratories to facilitate development of diagnostic protocols for A(H7N9). As a result, a candidate vaccine virus was identified in a timely manner.

Laboratory Activities

WPR

• Conducted “Regional Training on Sequencing and Phylogenetic Analysis of Influenza Viruses for National Influenza Centres Laboratory Staff” at the WHO Collaborating Centre for Reference and Research on Influenza in Melbourne, Australia, April 29 – May 3, 2013.
• Provided technical guidance and support for development of a national public health diagnostic laboratory network work plan for infectious diseases in Mongolia.
• Supported laboratory officer in Vietnam and provided RT-PCR and supplies.

Cambodia

• Conducted laboratory testing for seasonal influenza, A(H5N1) and other samples at the Institute Pasteur de Cambodge and shipping to WHO CC.
• Procured laboratory supplies for testing for A(H7N9) and translation of materials on laboratory maintenance.

Lao People’s Democratic Republic

• Laboratory influenza supplies including A(H7N9) were provided to the National Centre for Laboratory and Epidemiology (NCLE) in Lao PDR. NCLE continues to contribute to GISRS through submission of influenza isolates and samples to WHO CC. NCLE virology laboratory tested an average of 38 specimens/week for influenza during this reporting period (outbreak and surveillance specimens) and found the proportion influenza positive to range between 0–18%.
• The sequencing team composed of laboratory technicians from NCLE, the National Animal Health Centre (NAHC) completed their first full genome sequencing for avian influenza specimens from poultry.
• Repaired critical laboratory equipment at NCLE and supported a laboratory specialist.

Pacific Island Countries

• Enhanced laboratory-based influenza surveillance.
• Conducted IATA training in Papua New Guinea in June 2013.
• Supported laboratory specialist for Fiji NIC.

Capacities of IHR National Focal Points (NFPs) were strengthened and tested through IHR communication exercise. Another important exercise, PANSTOP, practiced, validated and strengthened various aspects of and procedures related to communication, coordination and decision-making to help countries determine whether initiation of a rapid containment operation is necessary to stop or slow the spread of an outbreak of influenza with pandemic potential. Other preparedness activities focused on infection prevention and control and support for local rapid response teams in Cambodia and Lao People’s Democratic Republic.

Preparedness Activities

WPRO Regional

• Conducted the fourth annual IHR exercise (named “IHR Exercise Crystal”) in December 2012 to test the functionality of the NFP system, ensure contact information was up-to-date and that protocols were clearly understood.
• Conducted the PANSTOP exercise in Vietnam, January 2013. The exercise involved the outbreak of a fictional respiratory disease in a northern province. As a result of the exercise, the Ministry of Health will revise its risk communications strategy to target multiple audiences with specific information suited to their needs.

Cambodia

• Conducted a training of trainers on infection prevention and control through Department of Hospital Services in December 2012.

Lao People’s Democratic Republic

• Procured supplies (PPE, specimen collection equipment, etc.) for provincial rapid response teams.
• Meeting of the National Infection Control Committee in January 2013 revised and extended the National Infection Prevention and Control strategy to district level.
• Printed and disseminated the national Emerging Infectious Diseases Plan, 2011–2015.
• Supported an epidemiologist.

WPR

• Conducted “Regional Training on Sequencing and Phylogenetic Analysis of Influenza Viruses for National Influenza Centres Laboratory Staff” at the WHO Collaborating Centre for Reference and Research on Influenza in Melbourne, Australia on April 29–May 3, 2013.

Cambodia

• Conducted refresher trainings on strengthening ILI sentinel surveillance in November 2012 and June 2013.
• Conducted a train-the-trainers session on infection prevention and control in December 2012.
• Conducted refresher training for village health volunteers in four affected provinces by H5N1 between March and April 2013.
• Conducted a workshop on H7N9 and MERS with participation from the Provincial Health Department, provincial clinicians, and Provincial Agriculture Department, July 2013.

Lao People's Democratic Republic

• Conducted two trainings using the “Basic Infection Prevention and Control (IPC) Training Package” developed in 2011 (50 participants trained to be IPC key staff).

Pacific Island Countries

• Conducted IATA training in PNG in June 2013.

Members of the Western Pacific Region Global Influenza Surveillance and Response System (in press). Seasonal influenza vaccine policies, recommendations and use in the World Health Organization’s Western Pacific Region. WPSAR.

Partridge J, Kieny, MP. Global production capacity of seasonal influenza vaccine in 2011. Vaccine. 2013 Jan 21;31(5):728–31. doi: 10.1016/j.vaccine.

Samaan G, McPherson M, Partridge J. A Review of the Evidence to Support Influenza Vaccine Introduction in Countries and Areas of WHO’s Western Pacific Region. PLoS One. 2013 Jul 16;8(7):e70003. doi: 10.1371/journal.pone.0070003. Print 2013.

Gabit Ismailov, MD, MPH
Programme Management Officer
Division of Health Security and Emergencies
World Health Organization, Western Pacific Regional Office
Manila, Philippines
Email: ismailovg@wpro.who.int

Chin Kei Lee, MB ChB, MPH, MAE
Team Leader
Emerging Disease Surveillance and Response
World Health Organization, Western Pacific Regional Office
Manila, Philippines
Email: leec@wpro.who.int