1. UNCLASSIFIED Pandemic Influenza and Regional Emerging Diseases Strengthening the National Bio-Surveillance System Douglas Searles LT, MSC, USN Chief, Technical Services and Quality Assurance, Certifying Scientist Forensic Toxicology Division, Armed Forces Institute of Pathology

2. Flow of Information  Current National Situation  National Plan ◦ Working with neighbors  Strengthening the National plan

3.  Multiple Surveillance Systems ◦ Centers for Disease Control and Prevention (CDC  National Electronic Disease Surveillance System (NEDSS)  Nation Wide Health Information Network (NHIN) ◦ United States Army Center for Health Promotion and Preventive Medicine (USACHPPM) ◦ Navy and Marine Corps Public Health Center (NMCPC)  Medical Events Reporting Systems (NDRSi) ◦ Department of Defense - Global Emerging Infections Surveillance and Response System (DOD- GEIS)  Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE)

8. United States Army Center for Health Promotion and Preventive Medicine (USACHPPM)

9. Department of Defense - Global Emerging Infections Surveillance and Response System (DOD-GEIS) Armed Forces Health Surveillance Center (AFHSC)

11.  United States of America  Canada  Mexico  A Pandemic Threatens All Without Regard to Borders

12.  Controlling the spread with minimal economic disruption  Detect, contain and control an AI outbreak and prevent transmission to humans  Prevent or slow the entry of a novel strain of human influenza to North America  Minimize illness and deaths  Sustain infrastructure and mitigate the impact to the economy and the functioning of society ◦ Influenza will not physically damage critical infrastructure, systems may be weakened by the absence of essential personnel in the workplace or the diversion of resources.

13.  Plan should extend beyond the health and medical sectors to include provisions in relation to critical infrastructure and the movement of goods and services across borders.

14.  International Partnership on Avian and Pandemic Influenza  Standards and guidelines of the World Organization for Animal Health (OIE)  World Health Organization (WHO)  International Health Regulations (IHRs)  Rules and provisions of the World Trade Organization (WTO)  North American Free Trade Agreement (NAFTA)  United Nations Food and Agriculture Organization (FAO)United Nations (UN) System Influenza Coordinator

15.  Novel A/H1N1 Experience ◦ Lessons learned  Detection ◦ Complicated by incorrect models, noisy baselines, and misdiagnosis  Identification ◦ Rapid dissemination of screening/laboratory methods  Communication ◦ “Critical” data changes as epidemics progress  Surveillance ◦ Vital that there are in place good surveillance systems able to return data promptly

16.  Why are reemerging infections becoming a serious public health concern?  Growing human population increases the demand for nutritional support, resulting in intensive agricultural practices.  This involves enormous numbers of animals, or multiple species farmed within the same region.  Update warning processes

17.  Procedural pathways for risk communication ◦ Use of current technologies ◦ Practice, practice, practice  Establish public health liaisons (local, national, international)  Boarder monitoring and control measures ◦ Land crossings - aviation - marine ◦ Determine best practices for in-flight management of ill travelers (likely to develop on longer flights) ◦ Border control with minimal commerce disruption and maximal protection

18.  Vigilance  Practice  Reassessment  COMMUNICATION

20.  CDC http://www.cdc.govhttp://www.cdc.gov  USACHPPM http://chppm-www.apgea.army.milhttp://chppm-www.apgea.army.mil  DoD-GEIS http://afhsc.milhttp://afhsc.mil  NMCPHC http://www-nehc.med.navy.milhttp://www-nehc.med.navy.mil  WHO http://www.who.inthttp://www.who.int  CDHAM http://www.cdham.orghttp://www.cdham.org  US Dept of Health and Human Services http://www.hhs.gov  LT Douglas Searles ◦ Email: douglas.searles@afip.osd.mil