Giuseppe
Emeritus
Second meeting of National Influenza Centres ? Western Pacific and South-East Asia regions
The second meeting of the National Influenza Centres (NICs) of WHO?s Western Pacific and South-East Asia regions was held in Tokyo, Japan 21?24 April 2008.
Representatives from 21 countries or areas in the regions reviewed accomplishments achieved since the first meeting held in May 2007 in Melbourne, Australia.
Additional topics covered included conducting surveillance for seasonal and avian influenza, developing vaccines and monitoring antiviral resistance.
Draft guidelines for influenza surveillance and studies on the burden of influenza were presented and discussed.
Database software for use in influenza laboratories was introduced.
Background
Influenza surveillance has been established in many countries in WHO?s Western Pacific and South-East Asia regions.
There are 19 NICs(1) in 14 countries in the Western Pacific Region and 9 NICs in 7 countries in the South-East Asia Region.
There is 1 WHO collaborating centre in Australia and 1 in Japan.
WHO recommends virus strains to be included in influenza vaccines twice a year for both the northern and southern hemispheres.
Many of the recommended strains were originally isolated from countries in these regions.
Since 2003, these regions have faced a continual threat from influenza A(H5N1), which has pandemic potential.
Although actions have been taken by WHO and countries in the regions to strengthen the capacity for influenza surveillance, the level of activities and quality of work vary among NICs.
A regular opportunity for the NICs, officials from ministries of health and WHO to meet to share the experiences, successes and challenges is needed.
The first meeting of the NICs in these 2 regions was held in Melbourne, Australia on 1?4 May 2007.(2)
A biregional 4-year workplan for strengthening national capacity for influenza surveillance was developed and endorsed during the meeting.
The workplan was subsequently endorsed by the biregional Asia Pacific Technical Advisory Group for Infectious Diseases as a part of the workplan of the Asia Pacific strategy for emerging diseases.(3)
The workplan requires WHO to take action to strengthen the capacity of NICs.
One of the requirements is that WHO continue to organize annual meetings for NICs to provide opportunities for them to share their experiences, address common concerns and improve communication with WHO and WHO?s collaborating centres.
Objectives
The objectives of the meeting were
-- to review accomplishments since the first meeting using the proposed actions described in the regional plan for strengthening national influenza surveillance capacity;
-- to review and update information on the surveillance of seasonal and avian influenza as well as on the progress of vaccine development;
-- to review, discuss and finalize generic protocols for studies of influenza disease burden and surveillance guidelines;
-- to introduce a laboratory database for NICs;
-- and to provide training on monitoring antiviral drug resistance.
Participants
A total of 59 participants from 21 countries or areas attended the meeting. (Participants came from Australia, Bangladesh, Cambodia, China, Fiji, India, Indonesia, Japan, the Republic of Korea, the Lao People?s Democratic Republic, Malaysia, Mongolia, Myanmar, New Caledonia, New Zealand, Papua New Guinea, the Philippines, Singapore, Sri Lanka, Thailand and Viet Nam).
Participants included directors of NICs, epidemiologists and public health officials.
Temporary advisers to WHO included 9 experts from 3 collaborating centres (the United States Centers for Disease Control and Prevention; the WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia; and the National Institute of Infectious Diseases, Tokyo, Japan); 1 from WHO?s influenza A(H5) reference laboratory in the National Influenza Centre, Centre for Health Protection, Hong Kong Special
Administrative Region of China (Hong Kong SAR); and 1 expert from New Zealand.
The WHO Secretariat consisted of 10 representatives from headquarters, the regional offices for the Western Pacific and South-East Asia, and country offices (Mongolia and Viet Nam).
Additionally, there were 15 observers from international public health agencies and laboratories (the United States Centers for Disease Control
and Prevention, the National Institute of Infectious Diseases in Japan, the Japanese government, the Japan International Cooperation Agency, the Pasteur Institute and the University of Melbourne).
Summary of activities
The first 3 days of the meeting consisted of 7 plenary sessions.
Topics covered included
-- regional reports on progress made since the 2007 meeting;
-- regional and global updates on findings from seasonal influenza surveillance for 2007?2008;
-- updates on influenza A(H5N1) epidemiology, virology and vaccine development;
-- updates on global and regional pandemic preparedness;
-- and updates on WHO?s external quality assurance programme.
A total of 7 countries with confirmed human cases of A(H5N1) influenza shared their experiences in surveillance, prevention and control of avian influenza infection.
Draft guidelines were presented by representatives of the expert consultant groups (?a practical guide to harmonizing virological and epidemiological influenza surveillance? and ?a practical guide for designing
and conducting infl uenza disease-burden studies?).
New database software for use by NICs was also introduced and demonstrated.
A poster session was held to allow NICs to present information on their influenza surveillance systems, the development of their systems and the results of surveillance.
A total of 14 NICs participated in the poster session.
On the fourth day of the meeting, a workshop took place on monitoring antiviral resistance.
The principles and practices of monitoring antiviral resistance were introduced by consultants from 3 WHO collaborating centres.
The NICs from Hong Kong SAR, New Zealand and the Republic of Korea also shared their experiences on monitoring antiviral resistance.
Conclusions, recommendations and actions
The meeting concluded by endorsing the following actions to be taken as next steps.
1) The draft influenza surveillance guidelines will be finalized for publication after comments have been received from participants. Countries are encouraged to review their surveillance system according to the proposed guidelines.
2) The draft guidelines on studying the burden of influenza will also be finalized for publication after comments have been received from participants. A workshop will be organized in late 2008 or early 2009 to implement the guidelines.
3) NICs are encouraged to review and test the newly developed data-management software. A training workshop may be organized if the NICs express interest.
4) WHO?s external quality assurance programme provides a means for monitoring and improving laboratory performance. NICs are encouraged to continue to participate in the programme.
5) Countries are encouraged to review and update their national pandemic preparedness plans based on the lessons learnt from their national pandemic preparedness exercises.
6) A review of influenza surveillance in the Asia Pacific area, which includes both the Western Pacific and South-East Asia regions, was proposed. A proposal will be drafted and presented at the next meeting in
2009.
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http://www.who.int/wer/2008/wer8329.pdf
-
(1) Terms of reference for National Influenza Centres. Geneva, WHO, 2007 (http://www.who.int/csr/disease/influenza/TORNICs.pdf, accessed 2 July 2008).
(2) See No. 45, 2007, pp. 389?395.
(3) Asia Pacific strategy for emerging diseases. Manila and New Delhi, WHO, 2005 (http://www.wpro.who.int/NR/rdonlyre...nalendorsedandeditedbyEDTmapremovedFORMAT.pdf ,
accessed 2 July 2008).
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The second meeting of the National Influenza Centres (NICs) of WHO?s Western Pacific and South-East Asia regions was held in Tokyo, Japan 21?24 April 2008.
Representatives from 21 countries or areas in the regions reviewed accomplishments achieved since the first meeting held in May 2007 in Melbourne, Australia.
Additional topics covered included conducting surveillance for seasonal and avian influenza, developing vaccines and monitoring antiviral resistance.
Draft guidelines for influenza surveillance and studies on the burden of influenza were presented and discussed.
Database software for use in influenza laboratories was introduced.
Background
Influenza surveillance has been established in many countries in WHO?s Western Pacific and South-East Asia regions.
There are 19 NICs(1) in 14 countries in the Western Pacific Region and 9 NICs in 7 countries in the South-East Asia Region.
There is 1 WHO collaborating centre in Australia and 1 in Japan.
WHO recommends virus strains to be included in influenza vaccines twice a year for both the northern and southern hemispheres.
Many of the recommended strains were originally isolated from countries in these regions.
Since 2003, these regions have faced a continual threat from influenza A(H5N1), which has pandemic potential.
Although actions have been taken by WHO and countries in the regions to strengthen the capacity for influenza surveillance, the level of activities and quality of work vary among NICs.
A regular opportunity for the NICs, officials from ministries of health and WHO to meet to share the experiences, successes and challenges is needed.
The first meeting of the NICs in these 2 regions was held in Melbourne, Australia on 1?4 May 2007.(2)
A biregional 4-year workplan for strengthening national capacity for influenza surveillance was developed and endorsed during the meeting.
The workplan was subsequently endorsed by the biregional Asia Pacific Technical Advisory Group for Infectious Diseases as a part of the workplan of the Asia Pacific strategy for emerging diseases.(3)
The workplan requires WHO to take action to strengthen the capacity of NICs.
One of the requirements is that WHO continue to organize annual meetings for NICs to provide opportunities for them to share their experiences, address common concerns and improve communication with WHO and WHO?s collaborating centres.
Objectives
The objectives of the meeting were
-- to review accomplishments since the first meeting using the proposed actions described in the regional plan for strengthening national influenza surveillance capacity;
-- to review and update information on the surveillance of seasonal and avian influenza as well as on the progress of vaccine development;
-- to review, discuss and finalize generic protocols for studies of influenza disease burden and surveillance guidelines;
-- to introduce a laboratory database for NICs;
-- and to provide training on monitoring antiviral drug resistance.
Participants
A total of 59 participants from 21 countries or areas attended the meeting. (Participants came from Australia, Bangladesh, Cambodia, China, Fiji, India, Indonesia, Japan, the Republic of Korea, the Lao People?s Democratic Republic, Malaysia, Mongolia, Myanmar, New Caledonia, New Zealand, Papua New Guinea, the Philippines, Singapore, Sri Lanka, Thailand and Viet Nam).
Participants included directors of NICs, epidemiologists and public health officials.
Temporary advisers to WHO included 9 experts from 3 collaborating centres (the United States Centers for Disease Control and Prevention; the WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia; and the National Institute of Infectious Diseases, Tokyo, Japan); 1 from WHO?s influenza A(H5) reference laboratory in the National Influenza Centre, Centre for Health Protection, Hong Kong Special
Administrative Region of China (Hong Kong SAR); and 1 expert from New Zealand.
The WHO Secretariat consisted of 10 representatives from headquarters, the regional offices for the Western Pacific and South-East Asia, and country offices (Mongolia and Viet Nam).
Additionally, there were 15 observers from international public health agencies and laboratories (the United States Centers for Disease Control
and Prevention, the National Institute of Infectious Diseases in Japan, the Japanese government, the Japan International Cooperation Agency, the Pasteur Institute and the University of Melbourne).
Summary of activities
The first 3 days of the meeting consisted of 7 plenary sessions.
Topics covered included
-- regional reports on progress made since the 2007 meeting;
-- regional and global updates on findings from seasonal influenza surveillance for 2007?2008;
-- updates on influenza A(H5N1) epidemiology, virology and vaccine development;
-- updates on global and regional pandemic preparedness;
-- and updates on WHO?s external quality assurance programme.
A total of 7 countries with confirmed human cases of A(H5N1) influenza shared their experiences in surveillance, prevention and control of avian influenza infection.
Draft guidelines were presented by representatives of the expert consultant groups (?a practical guide to harmonizing virological and epidemiological influenza surveillance? and ?a practical guide for designing
and conducting infl uenza disease-burden studies?).
New database software for use by NICs was also introduced and demonstrated.
A poster session was held to allow NICs to present information on their influenza surveillance systems, the development of their systems and the results of surveillance.
A total of 14 NICs participated in the poster session.
On the fourth day of the meeting, a workshop took place on monitoring antiviral resistance.
The principles and practices of monitoring antiviral resistance were introduced by consultants from 3 WHO collaborating centres.
The NICs from Hong Kong SAR, New Zealand and the Republic of Korea also shared their experiences on monitoring antiviral resistance.
Conclusions, recommendations and actions
The meeting concluded by endorsing the following actions to be taken as next steps.
1) The draft influenza surveillance guidelines will be finalized for publication after comments have been received from participants. Countries are encouraged to review their surveillance system according to the proposed guidelines.
2) The draft guidelines on studying the burden of influenza will also be finalized for publication after comments have been received from participants. A workshop will be organized in late 2008 or early 2009 to implement the guidelines.
3) NICs are encouraged to review and test the newly developed data-management software. A training workshop may be organized if the NICs express interest.
4) WHO?s external quality assurance programme provides a means for monitoring and improving laboratory performance. NICs are encouraged to continue to participate in the programme.
5) Countries are encouraged to review and update their national pandemic preparedness plans based on the lessons learnt from their national pandemic preparedness exercises.
6) A review of influenza surveillance in the Asia Pacific area, which includes both the Western Pacific and South-East Asia regions, was proposed. A proposal will be drafted and presented at the next meeting in
2009.
-
http://www.who.int/wer/2008/wer8329.pdf
-
(1) Terms of reference for National Influenza Centres. Geneva, WHO, 2007 (http://www.who.int/csr/disease/influenza/TORNICs.pdf, accessed 2 July 2008).
(2) See No. 45, 2007, pp. 389?395.
(3) Asia Pacific strategy for emerging diseases. Manila and New Delhi, WHO, 2005 (http://www.wpro.who.int/NR/rdonlyre...nalendorsedandeditedbyEDTmapremovedFORMAT.pdf ,
accessed 2 July 2008).
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