Advisory Forum, November 2005 ECDC and European Pandemic preparedness and Avian Influenza (H5N1) Angus Nicoll SNE Influenza Activities Coordinator

Advisory Forum, November 2005 What has happened since September’s Advisory Forum? I was wrong

ECDC 2005 What has happened this year – influenza epidemiology - Human A moderate human influenza winter with A/H3N2 and H1N1 plus type B in the East Some change from previous years in A/H3N2 and B but little effect on clinical activity Higher than usual activity in Netherlands and Spain As in previous 3 years Spread from West to East and South to North Peak Incidence in Children Poor use of influenza vaccine in risk groups and the general population Season has started quietly looking similar to Source EISS

ECDC 2005 Timing of peak of influenza peak activity Every 2 weeks in Europe in the season

ECDC 2005 What has happened this year – Influenza Epidemiology - Animal Spring H5N1 outbreaks in poultry in Thailand, Vietnam and Indonesia with sporadic human cases in those living with poultry Late spring – H5N1 in wild birds in Qinhai Lake North West China July – October reported H5N1 outbreaks in Poultry in Central Russia and Kazakstan Early October in turkeys in Turkey – Qinhai virus Mid October Confirmed H5N1 in wild birds and domestic birds in Romania’s Danube Delta Late October in wild birds in Croatia

ECDC 2005 Kazakhstan Golubuvka, 29 Jul 05 Russian Federation Novosibirsk region, 18 Jul 05 Altai Territory, Chelyabinsk, Kurgan, Omsk, Aug 05 Tula, 18 Oct 05 Roumania Cearmulia de Jos, 15 Oct 05 Maliuk, 19 Oct 05 Turkey Kiziksa, 08 Oct 05 Croatia Orahovica 22 Oct 05 H5N1 Avian Influenza in World Health Organization European Region by End October 2005 Visual Presentation Developed by WHO European Region In addition an imported bird was discovered to have H5N1 in a quarantine centre in the UK on October 21st

Advisory Forum, November 2005 Management and Political Events Lots of these

ECDC 2005 Meanwhile in China – Multiple Avian Outbreaks sporadic Human Cases – but with a mix of H5N1 types all of which seem to occasionally transmit to humans

ECDC 2005 Chinese Response Admission that it has H5N1 National Surveillance for Human Cases Massive poultry influenza immunization – H5N1 & H5N2 14 billion per annum Penalities for those not reporting poultry outbreaks

ECDC 2005 Current Risk Assessment Influenza in China and SE Asia Last two pandemics started in China Chinese Surveillance system weak – good anatomy but poor physiology Poultry immunisation massive but unmonitored may make H5N1 endemic in poultry in Vietnam and China Disincentives to report poultry outbreaks There are no health and safety mechanisms But does H5N1 have pandemic potential?

ECDC 2005 Predictions ”It is very hard to make predictions – especially about the future” Yoggi Berra General interest in influenza will diminish in 2006 Some members of the public will be sure that ’we’ (the public health community) predicted a pandemic in 2005 The real need for Preparations for a future pandemic will continue and must be sustained. The next pandemic will come from the East but will not necessarily be due to H5N1

ECDC 2005 ECDC Influenza Activities Risk monitoring and assessing the threats of avian and pandemic influenza Strengthening European, ECDC and country preparedness Further developing surveillance of seasonal and epizootic influenza and devising pandemic surveillance Ensuring effective communication among Member States, European agencies and the European Commission, international partners, and especially to the public Monitoring developments, providing scientific opinion and promoting scientific issues

ECDC 2005 ECDC Influenza Activities Undertaking advocacy Developing tools and guidance Helping develop countermeasures and interventions Supporting MS for investigation and response at early phases Establishing crisis co-ordination internally Developing key partnerships

ECDC 2005 What would we like the Advisory Forum to do Has the recent influenza exercise raised learning points that ECDC should pick up? Are there any key areas of work that ECDC is missing and are not being covered by other European Bodies? ECDC has been producing web guidance on Influenza – could the members comment? Could members comment on the recent Workshop on pandemic planning especially as ECDC will host a 3rd Joint EC – ECDC – Euro Workshop in the Spring. What topics should predominate at this workshop? Initial suggestions are Surveillance, Multi-sectoral Working, Use of Antivirals and Enhancing Efforts against Seasonal Influenza