1. 5th SARInet Annual Meeting
Strategies for Influenza Surveillance - Deliberation from Experience of GISRS and OneHealth Wenqing Zhang
28 – 30 May 2018 • Cartagena, Colombia

2. Influenza – a virus problem
Courtesy of Drs. K.Gopal Murti and Robert Webster, St Jude Children’s Research Hospital of Memphis , Tennessee, USA.

3. Influenza – a virus problem
Unique features
Knowledge status
Annual seasonal epidemics
Certain though rare pandemics
Persisting zoonotic threat
No eradication: vast silent reservoir in aquatic birds
Unknown conducive factors to acquisition of human-to- human transmissibility
Adventitious emergence of pandemic strains

4. Surveillance – 65 years efforts

5. The health of people is connected to the health of animals and the environment.
This connection requires a multisectoral, One Health approach to improve health for all.

6. Surveillance capacity – reality check
31 May
WHO recommendation on H7N9 vaccine virus
31 March
- 1st IHR notification
- GSD in GISAID
10 April
1st virus sharing to CCs/ERLs
10 May
1st potential CVVs availability
101 days
80 days
50 days
40 days

7. Influenza surveillance purposes
65 years ago when GISRS was first established
Focus on knowledge development of the viruses
Structure, mechanism of infection, ecology, epidemiology
Research a priority
-> -> -> nowadays
Facilitate and/or develop risk management/impact mitigation
Detect and characterize emerging and circulating viruses
Monitor associated disease and epidemiology
Form evidence base and assess associated risk
Complexities: seasonal, zoonotic and pandemic
Dynamics: all-hazards, whole-of-society, whole-of-government, global health security

8. Influenza surveillance context
International Health Regulation (2005)
Global Health Security
Surveillance at human-animal interface
Epidemiological/disease surveillance
Laboratory/virological surveillance
Clinical alert and surveillance
Integrated disease surveillance
International Treaties/Conventions
$£€¥ Competing priorities

9. Laboratory surveillance
GISRS – Uniting the world in the fight against influenza
Trust-base system for 65 years
Intellectual authority and credibility of confidence
Now: each 1% improvement need exponentially increasing efforts

10. Laboratory - specific surveillance
Strategic planning ahead
Lab service coverage (access) to all countries
IHR core capacity
Virus detection capacity must be sustained
EQAP and continuous update of lab diagnostics
Empower GISRS with newly available technologies
Continuous transformation with NGS, multiplex platforms, high throughput
GSD workshops
Strategy in retaining traditional virology capacity

11. Laboratory - specific surveillance
Strategic planning ahead
Innovation and research e.g.
Assays  change in H3N2 specificity and affinity of receptor binding
Fitness trajectories of genetic variants  predictive modelling
GISRS resilience – other respiratory viruses
Influenza, RSV, MERS … – coordinated approach
GISRS pandemic preparedness planning

12. Epidemiological - specific surveillance
Surveillance standards and norms
WHO standards published in 2014, implementation
Situation assessment – systematic approach
Severity assessment in seasonal epidemics  pandemic PISA
Workshops
Use of data  policy making
Projection of seasonal influenza activity
New tools and methods

13. Clinical - specific alert and surveillance
Thinking from the detection of the 1st case of H7N9
Healthcare system  detect
Alert e.g. unusual cases, in certain context
Protocols

14. Lab, Epi and Clinical integrated surveillance
Surveillance Studies and research
Surveillance – continuous, long-term, public health nature (government)
Studies – focused, research element, time limit, public and private sector
Complement and support each other
Burden of Diseases, vaccine effective studies, various trials  impact on severe diseases
Broaden knowledge and understanding on the virus and disease
Surveillance Response
Situation monitoring, zoonotic outbreaks at Human-Animal Interface
Response-orientated evidence base
Vaccine (seasonal and pandemic) response
Antiviral susceptibility monitoring  antiviral use
Surveillance Preparedness
Surveillance components under PIRM (Pandemic Influenza Risk Management) Framework
Shape/re-shape response measures through seasonal and zoonotic outbreaks

15. Lab, Epi and Clinical integrated surveillance
Sharing, timely
Virus sharing
Surveillance data reporting
Other data e.g. GSD sharing
Quality
“Minimum” and “optimal” – sizes of surveillance  various public health objectives
From US CDC “right-size” endeavour

16. Influenza surveillance in a broad context
Evolving context
Modern world philosophy “give and return”
Open and “free” sharing from 65 years ago … 2003 re-emergence of H5N1
Pandemic Influenza Preparedness (PIP) Framework adopted in 2011
Convention on Biological Diversity (CBD) and Nagoya Protocol
Global health security, Joint-external-evaluation (JEE), Post-JEE NAP, IHR…
Emergency response (seasonal flu?)
New vaccines e.g. “universal”, antiviral drugs and other medicine
Evolving demands to influenza surveillance
Courtesy: Olav Hungnes

17. Influenza surveillance in a broad context
A united global system – GISRS
All GISRS members:
NICs, CCs, ERLs, H5 Ref Labs – equally important, complementary to each other
United - coordinated by WHO – efforts are joined
Connecting epidemiological and clinical surveillance components
Active collaboration
Format to be reviewed
A resilient global system – longevity in public health
Leveraging for other public health needs e.g. RSV and other emerging viruses
Rapid adjustment to evolving public health demand
e.g. emergency response, new vaccines, post-universal vaccines era
Continuous strengthening and development
Open and inclusive – new technologies e.g. using Big Data; new and emerging resources

18. Influenza surveillance in a broad context
Outreach and communication
Member States roles  NICs, Epi institutions, Vet labs
Conventions, treaties, WHAs and other governing body processes
GISRS presentation, formalization
Internet era – scientific information to be understandable  general public  social, political impact
Promote influenza as a disease specific example in “all-hazards” endeavour
Partnership
FAO/OIE/OFFLU, international/national agencies/institutions initiatives e.g. OneHealth
Vaccine and other private entities
Research academia and other initiatives e.g. GISAID

19. Closing slide Racing: Virus evolution -vs- Countermeasure development
Counter- measures
Sharing
Timeliness
Science and innovation
Global coordination

20. Acknowledgement
WHO GISRS (Global Influenza Surveillance and Response System)
WHO GIP (Global Influenza Programme)
Maja Lievre, Aspen Hammond, Thedi Zigler

21. Thank You