Thailand’s Experience in Avian Influenza Response and Pandemic Influenza Preparedness

1. Thailand’s Experience in Avian Influenza Response and Pandemic Influenza Preparedness Bureau of Emerging Infectious Diseases http://beid.ddc.moph.go.th Department of Disease Control Ministry of Public Health, Thailand 5 February 2009

2. Jan-Nov 07 Jun-Aug 06 Jun-Oct 04 Jul-Nov 05 Jan-May 04 Confirmed case Suspect case Poultry outbreak Distribution of AI in poultry and human cases, 2004-2007 Fujian-like virus (clade 2) in Nakornpanom Province, while all the rest is Vietnam-like virus (clade 1) Total 25 cases/ 17 deaths during 2004-2007, 22 May08

3. Native Chickens Phichit (Jan. 08) Native Chickens Sukhothai (Nov.08) Native ChickensUthaithani (Nov.08) Broiler Chickens Nakhonsawan (Jan. 08) Yr 2008 Since July 06 to 4 Feb. 09 No human cases

4. Multi-sectoral Coordination for Avian and Pandemic Influenza Control CABINET Other Agencies Private Sectors National AI and PI Committee FAO OIE UNICEF…….. Dept. of Livestock Development WHO US CDC JICA ….… MOPH National Operation Center MOPH Operation Center DLD Operation Center 27 Jan 05

5. 2nd Strategic plan on Avian Influenza and Influenza Pandemic Preparedness (2008-2010) 1st Strategic plan on Avian Influenza and Influenza Pandemic Preparedness (2005-2007) The Government National Committee on AI Response & Pandemic Influenza Preparedness Anim. 27 Mar 08

6. What’s new on the Second Strategic planon AI & PIP Human-centered comprehensive development Safety & knowledge base for targets Dynamic & flexible Systematic integrated operations Management corresponding to the situation

7. Avian influenza 2nd Strategic plan on Avian Influenza and Influenza Pandemic Preparedness (2008-2010) Pandemic influenza Safe animal husbandry Surveillance in animals and man Multi-sector & international cooperation Pandemic influenza preparedness

8. Immediate response to AI outbreak: Stamping out infected poultry DLD

9. Poultry surveillance and control • Routine surveillance • Passive report by owners and volunteers • Periodic active search in the community • Stamping out • Culling of infected flocks, followed by active surveillance, plus 30 days of movement control in 10 km radius • X-ray” campaign • Countrywide door-to-door search & culling diseased flocks 2 round/year • Poultry vaccination is not allowed. 30 Nov 07

10. Stamping out& Carcass disposal Source :Thai DLD. 10

11. Cleansing & disinfection Targeting previously affected areas Source : Thai DLD

12. Control of poultry movement • Zoning & compartmentali-sation of poultry farms • Movement of birds among zones and compartments is not allowed without certification of negative testing. Source : DLD

13. AI survey in migratory birds Source : National Park, Wildlife and Plant Conservation Department

14. Enhanced farm biosecurity -1 Industry farms • Promote EVAP – system, improve slaughter-houses to standard Small farms • Improvement of poultry housing, integrate poultry raising Backyard chicken • Promote building pens, use of nets, segregation from living quarters Free ranging duck • Promote farming system with support loan a and allocate land for duck housing • Establish cooperatives of duck raising farmers 30 Nov 07

15. Enhanced farm biosecurity - 2 Fighting cocks • Registration of fighting cocks, ID (passport) issued. • Monitoring fighting cock every 2 months • Improvement of biosecurity in fighting arenas and gathering places 30 Nov 07

16. Laboratory capacities for animals • Based on virus isolation from cloacal swabs of infected/suspected animals • Tested at National Animal Institute of Health / DLD and at 8 Regional Animal Health Centers • Genome sequencing of all positives isolates at NAIH, university lab, and OIE collaborative lab.

17. Surveillance & control Case management Laboratory investigation Risk communication Public health responses to avian flu

18. Report Report Prov. Livestock Officer Provincial committee Livestock volunteers & community leaders Local health Infra structure District Livestock Officers & staff Exchange & Cooperation Exchange & Cooperation Public health and animal health collaboration at provincial level Mr Bird Flu Health volunteers & community leaders SRRTs 27 Mar 08

19. Public health - animal healthcooperation for AI control • Information exchanges at central and provincial levels: websites, weekly reports, regular meetings • Joint outbreak investigations – both on human illnesses and animal outbreaks • Joint campaigns / press releases eg. Chinese New Year food safety campaign, National “X-ray” campaign for AI infection • Joint research &development • Expert groups and technical meetings • Sharing at national and provincial AI-PI committees • Veterinarians training in FETP

20. Surveillance of avian influenza in humans • Established since Dec. 2003, country-wide coverage. • Detection and report of all pneumonia & • flu-like illnesses with history of exposure to sick/dead poultry or of contact with pneumonia cases • Nasopharyngeal swab of all cases sent for conventional test for H5N1. • Investigations of all reported cases by trained epidemiology teams (SRRTs) • Daily situation monitoring, daily update on website

21. Provincial SRRTs District SRRTs Sub-district Health Centers Village Health Volunteers & Community Leaders Surveillance and Rapid Response Team (SRRTs) • Roles: • Surveillance • Outbreak investigation • Initial disease control • Risk communication Central & Regional SRRTs Over 1000 SRRTs established 3 Mar 06

22. In viral transport media, immediate transport, under 2-8 C temperature Conventional tests at lab. centers in network Laboratory investigation of avian influenza • Specimen collection • Throat swab • NP swab/aspiration • Tracheal suction • Broncho-alv. larvage Indications: Influenza (clinical) Influenza-like illness Pneumonia (suspected of flu) Suspected avian flu • Quick tests at the hospitals • Supplied in early avian flu outbreaks • Later discontinued for poor validity and improved availability of conventional test.

23. Stockpiling and logistics Seasonal influenza vaccine For health personnel Personal ProtectiveEquipment 3 Mar 06

24. Case management & hospital infection control • Develop standard guidelines, train medical personnel on case management including application of triage, rational use of rapid test & antivirals, and hospital infection control • Improve hospitals infection control • Isolation rooms • Hand hygiene • PPE 3 Mar 06

25. Risk communication & education • Village health volunteers’ door-knocking campaign to provide risk communication • Hand washing and mask wearing campaigns • IEC through mass media eg: • Radio, TV, news papers • Brochures/ posters/ exhibitions • Call center / hotlines • Websites 30 Nov 07

26. (Ex) PM’s move to ease public concern on food safety in 2007

27. Collaboration among the Public, Private Sectors

28. Protection of high-risk groups For cullers and HCWs • Use of personal protection equipment and techniques • Influenza vaccination • Antiviral drug • Close surveillance post-operation

29. H5N1

30. National pandemic preparedness plan Strategies toward pandemic vaccine access Short term • Import • Resort to global stockpile (emerging opportunity) Long term • Establish local capacity for development and manufacture of influenza vaccine, ready for pandemic vaccine production • Stepwise expansion of seasonal flu vaccination • Strengthen national capacity for vaccine regulatory, logistics and delivery, R&D

31. Drive toward pandemic influenza vaccine capacity • 2005-2006, MOPH working group to study and plan pandemic influenza vaccine access • Early 2007, Thailand requested WHO support under GAP for development of pilot production of pandemic influenza vaccine. • Mid 2007, MOPH requested government support for establishing manufacture of influenza vaccine, the project approved May 2007 • June 2008 MOPH has launched national influenza vaccination program, initially targeting the elderly with chronic diseases.

32. Regional / International collaboration • Example of Collaborations • Surveillance and information exchange • Health Personnel training • Laboratory investigations • Logistics support • Joint outbreak investigations • Other Bilateral • With neighbours: Laos, myanmar, Cambodia, Vietnam, Malaysia • With assistance providers: US, Japan, EU, Australia, etc. Regional • Through ASEAN, APEC, ACMECS, etc. International • Through WHO, OIE, FAO, UNICEF, etc.

33. Functional drills Table-top exercise Exercises of pandemic influenza preparedness plans Central level Provincial level Service center level 7 Feb 05

34. Departmental level Provincial level Pending Calendar for TTxon Influenza Pandemic National level 8 Mar 07 Ministerial level Start July 06 Start Mar 06 Now all 76 provinces completed

35. A Package of Guideline on Tabletop Exercise • Guideline for Tabletop Exercise on Influenza Pandemic • Preparedness at the Provincial Level for Exercise Organizers • and Facilitators, 2006 • Master Operation Plan for Influenza Pandemic Preparedness for • Multi- sector Coordination 2006 • - six compact discs containing different contents: CD1- tabletop exercise, CD2, 3, and 4- the video presentation of lectures, CD5- slide presentation, and CD6- document files.

36. TTX in Nakorn-nayok Tabletop exercises at provinces

37. Tabletop exercises at MOPH Departments 27 Mar 08

38. Tabletop exercises at MOPH 27 Mar 08

39. National policy on Public Emergency Preparedness 2005 National Public Emergency Preparedness Committee (chaired by PM) National Committee on Civil Public Emergency Preparedness (chaired by PM/DPM) National plan on Civil Public Emergency Preparedness National Committee on Avian Influenza Control and Pandemic Influenza Preparedness (chaired by Dep. PM) National Strategic plan on Avian Influenza and Pandemic Influenza Preparedness AI control and pandemic influenza preparedness integrated in National Public Emergency Preparedness 27 Mar 08

40. Policy National Strategic Plan From Policy Practice National Operational Plan Operational Plan / Guidelines / Protocols at all levels Exercises at all levels

41. Safety of staff • and owners • Continuation of • business during • pandemic • Cooperation with • public sector in • pandemic response • Rapid recovery • after pandemic Businesses, industries, markets, department stores, hotels, travel & tourism, communications & IT, transportations, power plants, gas stations, water supply, banks, hospitals, etc. Business continuity planning Getting prepared 27 Mar 08

42. Private sector preparedness

43. Private sectorPreparedness

44. Next step for BCP Business Continuity Plan for Influenza Pandemic Preparedness Package • Fact Sheet • BCP for IPP Manual • Poster (Hygiene, mask) • CD (Power Point, Video Presentation)

45. ANTS’ PHILOSOPHY ANTS THINK WINTER ALL SUMMER • So ants are gathering their winter food in the middle of summer. • How much will an ant gather during the summer to prepare for the winter? • All that he possibly can. Do the most we can to maximize our preparedness and response to emerging diseases !

46. Conclusion • Thailand has been struggling to control and prevent H5N1 AI on animal health and public health fronts with continuous improvement. Infections in poultry are under control, no new human cases have been seen since August 2006. • In awareness of the risk of pandemic influenza, the country is joining global efforts in pandemic preparedness. National preparedness plan highlights national capacity for self-reliance and regional / international cooperation. • Effective AI response & pandemic preparedness rely on: • Government’s leadership and support • Strength of existing infrastructure and manpower • Extent and quality of multi-sector cooperation • Knowledge and understanding of partners & the public • Problems and limitations prevail and change with time, need to be continuously managed among partners, with perseverance, reconciliation and transparency. 22 May 08

47. Thank You Khob Khun