1. Conclusions 3 rd Meeting of National Influenza Centres in the Western Pacific and South East Asia Regions 18 – 20 August 2009 Beijing, China

2. | 2 General Comments Countries are following a similar path –Sporadic imported cases → local transmission → widespread community transmission –Appearance of severe cases/deaths Different responses are required for different stages –Shifting from Containment to Mitigation –But decision to shift is difficult; should base this on a local risk assessment

3. | 3 General Comments (continued) Epidemiological patterns remain unpredictable –Outbreaks in non-influenza season –Sudden increases and decreases (triggers?) –Majority of cases are self-limiting, but some severe cases (high risk groups) Occurring at the same time as seasonal flu and other viral disease outbreaks in some countries – can confuse the clinical picture Coordinated and strengthened regional information sharing is needed Need expressed to develop contingency/surge plans for NICs

4. | 4 Surveillance and Laboratory Improved surveillance capacity in past years (laboratory capacity, sentinel surveillance systems) –Fully utilized for H1N1 pandemic response Surveillance important to monitor changes in antigenicity, transmission, disease severity, antiviral resistance –Novel H1N1 may evolve further –H5N1 viruses continue to evolve rapidly and remain an important risk to global public health

5. | 5 Surveillance and Laboratory (continued) Changing surveillance strategies at each stage –Doing sampling, testing, case-counting –For early detection, description and assessment, monitoring But this has not always been done in a timely manner –NIC laboratories overwhelmed with samples (insufficient surge capacity) –In later stages, case-counting unsustainable and uninformative Many countries isolating own viruses due to necessity –Impact of BSL guidance?

6. | 6 Public Health Interventions Different responses are required for different stages of the pandemic –Need to shift from “containment” to “mitigation”, but decision to shift appeared to be difficult in some countries (political, technical issues) –Should base response on a local risk assessment Different policies for public health interventions, especially school closures and border measures –Lack of concrete evidence is a challenge –Well-managed school closure measures may have some effect in delaying spread

7. | 7 Public Health Interventions (continued) Potential benefits should be carefully balanced against potentially significant social and economic costs –Decision based on assessed situation and local context – “one size does not fit all” –No standard combination of measures will fit all countries – “one size does not fit all” –Must be communicated to public and other stakeholders Need for continuous planning, monitoring & evidence

8. | 8 Communication Governments have been active in disseminating public health information –Importance of communication well appreciated –Have implemented media briefings, hotlines, IEC etc. Rapidly changing situation difficult to communicate –Continually updating and changing guidelines, strategies, policies –Unknown virus characteristics Issues and challenges –Communications depend on established trust with target groups –Confusing messages to public and confusing media reports –Updated information not reaching target groups (e.g. health care professionals, vulnerable populations) –Communication with other government departments, sub-national levels, private sector

9. | 9 Health Sector Response Many countries addressing hospital preparedness as a priority –Isolation facilities identified/available (but little surge capacity) –Management of severe cases (ICU beds, respirators) Infection control not fully addressed in all areas –Training, availability of PPE resources Case management –Shortage of antiviral stockpiles, late treatment with antivirals –Older people staying in hospital longer

10. | 10 Command High level command system in-place in most countries –Inter-ministerial coordination –Multi-sectoral coordination Responses based on existing national plans (H5N1) –Plans should be adaptable and flexible –Need to review and adapt existing national plans for H1N1 pandemic, re-examine planning assumptions Some issues for coordination –e.g. private sector, communications

11. | 11 Pandemic Preparedness Pandemic Response Pandemic Preparedness Fatigue Pandemic Response Fatigue 2 years H5N1? H9N2? Novel H3N2? Next Steps?

12. Recommendations 3 rd Meeting of National Influenza Centres in the Western Pacific and South East Asia Regions 18 – 20 August 2009 Beijing, China

13. | 13 General Recommendations Pandemic preparedness should continue, even when in pandemic response. Framework of Action can be used to guide country preparedness for community transmission

14. | 14 Surveillance Countries should continue to strengthen comprehensive national influenza surveillance systems*, including surveillance of influenza diseases, viruses, SARI and outbreak events –Particular attention on SARI surveillance and event-based surveillance –Countries should adjust surveillance strategies based on the different stages of the pandemic –Existing systems (such as sentinel surveillance) should be maintained and fully utilized for pandemic surveillance –All surveillance information (including historical data) should be utilised to make a risk assessment –Serological survey should be encouraged –Integration with animal surveillance

15. | 15 Laboratory All National Influenza Centres (NICs) should have a contingency plan to manage possible surge of pandemic activities (e.g. next pandemic wave) –WHO pandemic contingency planning checklists for NICs can be used to guide this process –acceptability Based on technical review and consultation, WHO should consider modification of its guidance on biosafety requirements –e.g. BSL-3 or BSL-2 to handle Pandemic H1N1 2009 virus?

16. | 16 Public Health Interventions Countries with community transmission should plan for and shift from "containment" to "mitigation" strategies in a timely manner based on risk assessment

17. | 17 Regional Information Sharing Mechanisms Regional influenza information sharing mechanism is needed and should be established and strengthened (e.g. regional influenza bulletin). The technical details of such mechanism should be explored through a consultation with the experts in the region –Countries are encouraged to contribute to such collaborative regional mechanism for the benefit of all countries –A review article summarizing national influenza surveillance systems and outcomes in the Asia Pacific could benefit regional and global public health communities and should be considered