1. Northwest Center for Public Health Practice Before we get started with Influenza, let’s take a poll… In my opinion, the amount of media/policy attention being given to preparing for pandemic influenza is: A. Excessive B. Exactly enough C. About right D. Too little Don’t forget to indicate your choice in the feedback section of the toolbar on the left.

2. Northwest Center for Public Health Practice Planning for Pandemic Influenza John Kobayashi Faculty, Northwest Center for Public Health Practice; Foreign Advisor with the Field Epidemiology Training Program in Japan

3. Northwest Center for Public Health Practice What is Pandemic Influenza? Pandemic Influenza: circulation of strains for which most or all of the world’s population lacks immunity Antigenic Drift: small changes in influenza viruses with partial immunity in the population – occurs routinely Antigenic Shift: large changes with little immunity in the population – necessary for pandemic influenza

4. Northwest Center for Public Health Practice Poll Question In my opinion, the strain of influenza that is most likely to cause the next pandemic is the strain currently causing the outbreaks of “bird flu.” A. True B. False

5. Northwest Center for Public Health Practice Influenza as a Zoonosis: A Potential Source of “Antigenic Shift” Human virus virus Reassortantvirus Non-humanvirus 15 HAs 9 NAs DIRECT Diagram source: Ben Schwartz; National Vaccine Program HA = Hemagglutinin NA = Neuraminidase

6. Northwest Center for Public Health Practice WHO Influenza Pandemic Phases Interpandemic Phase 0 (Emergence) Level 0: Usual influenza viruses circulate, causing yearly outbreaks Level 1: Novel Virus Alert: Identification of a novel influenza virus in a person Level 2: Confirmation that the novel influenza virus has infected two or more people, but rapid person-to-person spread and multiple outbreaks have not occurred Level 3: Pandemic Alert: Confirmation of person-to- person spread in the general population with at least one outbreak lasting more than 2 weeks in one country

7. Northwest Center for Public Health Practice H5N1 Outbreaks and Flyways of Birds Sources: AI outbreaks: OIE, FAO, and Government sources. Flyways: Wetlands International Districts with H5N1 outbreaks since January 2005

8. Northwest Center for Public Health Practice Countries Affected by H5N1 Countries affected by H5N1 in birds in the WHO European Region since 7/05 WHO EURO countries with confirmed outbreaks reported Areas with confirmed outbreaks reported Other WHO EURO countries

9. Northwest Center for Public Health Practice A Few Problems with Influenza Surveillance Reports for both animals and people are the tip of the iceberg. Multiple problems exist in many countries affected by avian influenza (e.g., other diseases, natural disasters, political unrest, economic pressures). During early stages, person-to-person spread is difficult to document.

10. Northwest Center for Public Health Practice A Few Pandemic Influenza Strategies Mobilize through national pandemic plans. Use interpandemic influenza as a drill for pandemic influenza. Networking: Public health decisions are frequently made with incomplete information. Incomplete information is generally better from someone you know and trust.

11. Northwest Center for Public Health Practice Training Programs in Epidemiology and Public Health Interventions Network http://www.tephinet.org AETP established AETP under development

12. Northwest Center for Public Health Practice Networking at FETP-Japan Field Epidemiology Training Program (FETP) 2002 Syndromic surveillance: FIFA World Cup. 10 Japanese prefectures and coordination with South Korea 2003 SARS: sent 2 former trainees to Hong Kong 2003 - Ongoing: current trainees sent for 1-2 months to CSR, WHO, Manila

13. Northwest Center for Public Health Practice Networking at FETP-Japan (cont.) 2002 – 2004 International outbreak investigations:  E. coli O157 in Japanese students traveling to Australia  Norovirus in Australians from Japanese oysters  Shigellosis in Japanese and American travelers from Hawaii  E. coli O157 in Okinawans from American hamburger

14. Northwest Center for Public Health Practice 2004 – 2005 Current and former FETP supervisors from Thailand, Malaysia and the US help teach the introductory epidemiology class for FETP Japan 2005 FETP trainee and lab staff assist in national surveillance assessment in Mongolia 2005 Staff sent to India and Indonesia for tsunami relief and avian influenza Networking at FETP-Japan (cont.)

15. Northwest Center for Public Health Practice Questions?