Tuesday, December 05, 2017

WHO Guidance For Surveillance During An Influenza Pandemic



While I wouldn't read too much into the timing, since it has been 8 to 10 years since the last round of major pandemic guidance releases, the World Health Organization has joined the ranks of the ECDC and the HHS in updating some of their pandemic guidance documents from the end of the last decade.

Recent updates from Europe and the United States include:
ECDC: Guide To Revising The Influenza Pandemic Preparedness Plan
CDC/HHS Community Pandemic Mitigation Plan - 2017
HHS Pandemic Influenza Plan - 2017 Update

The latest update from the World Health Organization is their WHO Guidance for Surveillance during an Influenza Pandemic -Update 2017. The executive summary follows, but you'll want to download the full 59-page document.

Executive Summary

An influenza pandemic will affect every country; therefore, standardized and coordinated international information sharing is crucial to manage such an event at global and national levels. National authorities will need to know how the pandemic is evolving, not only in their own country but also in neighbouring countries and continents. Surveillance during the pandemic will provide the core information on which pandemic-response decisions are based. Sharing of information and virus isolates at the global level will be of benefit to all.

This guidance is an update to an earlier document – Global surveillance during an influenza pandemic (1), published in April 2009 – and it focuses on the different surveillance components used during the pandemic. In general, the purpose of this guidance is to outline the data requirements and surveillance strategies that Member States can use throughout the course of a pandemic. This will ensure that Member States can make informed risk management decisions and will have the capacity to meet their obligations under the International Health Regulations (2005) (2)
Key new additions include:ƒ
  • roles and responsibilities of WHO and Member States;
  • reference to the new global pandemic phases (interpandemic, alert, pandemic and transition);
  • ƒinformation on risk and severity assessments to be conducted by Member States
  • recommendations to cease case-based reporting once sustained human-to-human transmission is occurring in the community; and
  • an emphasis on the need for Member States to determine pandemic responses based on national risk assessments.
This guidance covers the period from the reporting of sustained human-to-human transmission. It is designed to assist Member States with surveillance immediately before and during an influenza pandemic, from the verification and detection of sustained human-to-human transmission, through risk and severity assessments and monitoring of the pandemic. Some of these surveillance components will happen concurrently.

Early detection of the start of a pandemic is crucial to rapidly implement measures to control the outbreak at its source, and to mitigate the impacts by slowing the spread of the virus. Early surveillance data will inform public health interventions aimed at slowing transmission, including non-pharmaceutical interventions, which may involve movement restrictions, cancelling mass gatherings and social distancing; and pharmaceutical interventions, such as antiviral prophylaxis and vaccination. Surveillance activities are focused on verifying reports of sustained human-to-human transmission and detecting first influenza cases in other Member States.
Once sustained human-to-human transmission has been verified, detailed risk and severity assessments of the earliest cases of pandemic influenza will be needed. The primary objective of the risk and severity assessment surveillance component (together with information from special studies) is to characterize the new pandemic at an early stage, to facilitate more effective responses both nationally and internationally. Information from risk and severity assessments will be critical to policy-makers in the affected country for making informed decisions about pandemic mitigation strategies, to health-care providers for treating ill persons, and to the general public for reducing their risk of infection and minimizing damaging rumours. Understanding the transmissibility, seriousness of disease and impact of the influenza virus will help in ascertaining the likelihood of a severe pandemic.

The primary objective of surveillance monitoring during the pandemic is to track the course of the pandemic. Surveillance will include geographical spread, disease trends, intensity of transmission, impact of the pandemic on health-care services and changes in the epidemiology, as well as antigenicity and antiviral sensitivity. Monitoring the pandemic will help in modifying response strategies; it will also help to indicate whether a second wave is occurring. Risk and severity assessments should continue throughout the pandemic.
Through the implementation of this guidance, WHO aims to standardize the collection of pandemic influenza data by recommending minimum data requirements for surveillance. The reporting of these data to WHO will enable the aggregation of data at a global level, providing better information on the characteristics and progress of a pandemic, and helping to mitigate the impact of the pandemic.
(Continue . . . .)

A deep concern during any emerging infectious disease outbreak - but particularly during a pandemic - is that twelve years after the World Health Organization produced the first major revision to the IHR (International Health Regulations) in 35 years, which was voted upon and approved to go into effect in 2007- only about 1/3rd of the countries of the world currently self-report they have met the core requirements.
The new 2005 IHR required – among other things – that countries develop mandated surveillance and testing systems, and that they report certain disease outbreaks and public health events to WHO in a timely manner.
Two years ago, in Adding Accountability To The IHR, we looked at 6 recommendations to strengthen the IHR in the Report of the Ebola Interim Assessment Panel, but how much progress has been made since then is difficult to gauge. 

All of which means that while the guidance may be there, for many places around the world the infrastructure  - and in some cases the political will - to follow it are still lacking.

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