1. Current AH1N1status and MoH Response Measure Sovann Ly, MD, DTMH, MCTM Deputy Director of CDC Department

2. 2 Current AH1N1 status

3. 3 Number of Cases by Week of Detection* June to 6 October 2009 (N =134) JuneJuly Number AugSept/Oct Date of detection = date confirmed by IPC = deaths

4. 4 Number of Cases by Age Group June to 6 October 2009 (N = 134) Age (Years)MaleFemaleTotal 0 – 4 8816 5 – 14 282149 15 – 49 303363 50+ 336 Total 6965 134

5. 5 Nationalities of Pandemic H1N1 Cases in Cambodia, June to 6 October 2009 (N = 134) * 2 foreigners based in Phnom Penh, no travel history

6. 6 Nationalities of Pandemic H1N1 Cases in Cambodia, June to 6 October 2009 (N = 134) NationalityNumber Cambodian107 Australian3 French4 Japanese6 Philippines1 UK2 USA9

7. 7 Pandemic H1N1 Death cases in Cambodia June to 6 October 2009 3 deaths 41 yr old F, no risk factors : died on 27 September 47 yr old male, alcoholism: died on 5 October 25 Yr old F, Pregnant women : died on 6 October, Baby survived and A H1N1 negative

8. 8 Communities transmission, up to 6 October 2009 Evidence of community transmission: cases with no history of foreign travel or contact with foreign case Phnom Penh Kandal Takeo Siem Reap Kampong Speu Kampong Chhnang Battambang Svay Rieng

9. 9 Geographic Spread across time As of 30 June 6 cases, no local transmission As of 31 July 19 cases, local transmission in Phnom Penh As of 31 August, local transmission in Phnom Penh and Kandal = Areas in Cambodia with locally acquired lab confirmed cases

10. 10 Areas with Community Transmission of New Influenza A H1N1 virus (as of 6 October) As of 6 October 2009 134 cases, community transmission in Phnom Penh, Kandal, Siem Reap, Takeo, Kampong Speu, Battambang, Svay Rieng and Kampong Chhnang

11. 11 How were cases detected? PercentNumberDetection Method 4053 Event based Surveillance Calls to MoH Hotline and Contact Tracing 3648Fever surveillance 1824ILI surveillance 34Entry screening 35Others* 100 %134TOTAL * NAMRU lab worker detected during internal training session on specimen collection and PIC lab workers

12. 12 H1N1v Detection at Sentinel Surveillance Sites = H1N1v cases detected = sentinel surveillance not yet detecting H1N1v case = no sentinel site CommentNAMRUSISEASARIILIProvince On going community transmission Battambang Kampong Cham On-going community transmission Kampong Speu On-going community transmission Kandal On-going community transmission Phnom Penh On-going community transmission Siem Reap Svay Rieng 1 st case of community transmission detected on 25 Sept Kampong Chhnang On-going community transmission Takeo = Provinces with no Sentinel site but where cases have been identified by the surveillance programmes

13. 13 MoH Response Measure

14. 14 Communication to public TV broadcasting educate to public since May 2009 Disseminate the Posters and leaflets to communities Dissemination to local authorities and sectors

15. 15 Communication to public Cont’ Regular joint press release (MoH/WHO) on situation update Spokesman update to media Regular update to website (www.cdcmoh.gov.kh)www.cdcmoh.gov.kh Monthly Bulletin Hotlines on duty 24 hours 115 012 488981 089 669567

16. 16 Surveillance Early warning system ARI (countrywide) ILI (6 sites) Fever study (2 provinces) SISEA ( 2 provinces) Detect the single case and clusters Monitor the AH1N1 situation (Increase, stable, decrease)

17. 17 Surveillance (Cont’) At the border International airports and ports International land border Installed 3 Thermoscaners to monitor the passengers cross border

18. 18 Investigation and Response Rapid Response Teams 1200 staffs Trained Kits (PPE, Medicine, Lab collection, Forms, guidelines) 1200 Telephones line communication from national to Health Center level

19. 19 Hospital response 5 Isolate wards All hospitals have separate rooms for ARI Trained infection control Case management Refer system Supplies PPE and medicines Private sector participation to the surveillance system and case management

20. 20 Laboratory 3 National labs Pasteur Institute Cambodia (NIC) National Institute of Public Health Namru 2 All province has lab kits to collect the sample, packaging and sending

21. 21 Challenges Delay incentive to Rapid Response Teams Vaccine to vulnerable group Pregnant women : 140.000 doses/year Health workers : 280.000 doses Underline condition : 980.000 doses

22. 22 Challenges Cont’ Tamiflu doses limited Workload of hospital health workers Other sectors do not have the operational to support MoH and also do not have their operational plan for their sectors business continuity

23. 23 Som Or Kun Thanks for you attention