1. National Influenza Centres in SEA Region Dr Rajesh Bhatia / Dr Oommen John WHO Regional Office for South-East Asia New Delhi 5 th Meeting of NIC in Western Pacific and South East Asia Region

2. Timor Leste SEAR

3. Seasonal Influenza True burden in SEA Region still not fully understood Disease burden studies –Thailand Influenza occurs year-round Follows a bimodal seasonal pattern with substantial variability. Young children & elderly most affected In-hospital deaths are more common than previously appreciated –Myanmar Influenza exhibits seasonality, coincides with the rainy season June to Aug –India Seasonality varies geographically

4. Influenza Seasonality Pune (west) Kolkota (east) Chennai (south) Delhi (north)

5. Timor Leste Location of NICs and H5 Reference Lab in SEAR

6. NIC in SEAR Country*BSL3Virus isolationPCREQAS Since 2008 Bangladesh -+++ DPR Korea -+++ India NIV ++++ Nepal -+++ Indonesia -+++ Myanmar -+++ Sri Lanka -+++ Thailand ++++ *Bhutan, Maldives, and Timor Leste do not have a NIC at present but can perform PCR

7. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO from SEA Region as on 01 June 2011 Country20042005200620072008200920102011Total CDCDCDCDCDCDCDCD CD Bangladesh 0000000010000020 30 Indonesia 00201355454237242021199765 177146 Myanmar 0000001000000000 10 Thailand 171252330000000000 2517 Total1712251558484337252021199785206163

11. National networks: Indonesia NIHRD SubNIC Micro UI SubNIC Micro UNISU SubNIC Micro UNHAS SubNIC Micro UNDIP SubNIC Micro UDAYANA SubNIC BLK Palembang SubNIC BLK Bandung SubNIC BLK Sby LOCAL LABORATORY :  BTKL  Hospital Laboratory  District Laboratory NIC

12. National network in India

13. National network in Thailand 13 regional Medical Science Center Location of

14. Regional strategy: 2008 Strategic directionKey elements Establishment of Regional Influenza Laboratory Network Strengthen operational NICs Expand the laboratory network Implement external quality assessment scheme Establish partnerships Capacity buildingTraining staff in all NIC Organize extramural training for specialized tests Conduct training on bio-safety & shipment Introduction of e-based training/orientation Monitor influenza activitiesDevelop Lab data management system Integrate influenza surveillance in NIC database Support multi-site surveillance Conduct risk assessment

15. Activities in 2009-10 Regional workshop on diagnosis of H1N1 Regional workshop on monitoring resistance in influenza viruses Regional Workshop on Biosafety and Biosecurity in labs : Study visits to NIC staff within Region Reagents procurement Funding from various international partners

16. Challenges Capacity to diagnose all H types Limited access to diagnostic services No NIC in three countries Coordination with animal health sector Revision of NIPPP (post pandemic) Data management and information sharing Indigenous reagents production

17. Future plans NIC in all Member countries Hand holding by established NIC for new and upcoming NICs Revision of NIPPP Collaboration with animal health sector Expanding immunization and surveillance Data sharing

18. Experience from H1N1 2009 Pandemic Expertise and Capacity within Region Opportunity for strengthening regional and national preparedness and response capacity Regional tools for assessment of response to pandemic H1N1( 2009) Sharing of country experiences, lessons learned and best practices

19. SEAR VPD Laboratory Network, 2010 (Polio, Measles/Rubella, JE/AES, Rota, IBD) National labs Global specialized lab (Polio) Reference labs

20. Objectives 1.Strengthen the preparedness and capacity of SEAR member countries to respond to influenza with pandemic potential 2.Strengthen and integrate the capacity to carry out surveillance and response to seasonal and pandemic influenza 3.Strengthen laboratory infrastructure and build laboratory and epidemiology capacity to accurately and promptly diagnose seasonal influenza and influenza with pandemic potential.

21. Implementation Provide on going support to member countries in SEAR to review and modify their NIPRP Assist member countries in SEAR to review regulations and policy related to use of Influenza vaccine Build collaborative partnerships for research and production of influenza vaccine

22. Implementation Implementation of the Global Influenza Surveillance guidelines at regional level Define minimum data sets needed for surveillance Monitoring and evaluation support

23. Build laboratory and epidemiology capacity annual regional meeting of NICs to review progress provide updates on new issues related to early detection of influenza and novel influenza strains monitoring of anti-viral resistance support for on-site laboratory trainings

24. Collaborative Venture - National Influenza Centres –The Disease Surveillance and Epidemiology (DSE) unit of the Communicable Disease Surveillance (CDS) Department and –Immunization Vaccine and Development (IVD) unit of Family Health and Research (FHR) Department –Supported by CDC, Atlanta

25. Thank You