Influenza Surveillance—PAHO Region, 2005–2013

Otavio Oliva, MD, MPH

Rakhee Palekar, MD, MPH

January 29, 2013

Achievements and Future Challenges in the Surveillance of Respiratory Viruses

San Jose, Costa Rica

2005–2008

• Threat of a pandemic

• PAHO-CDC Generic Protocol for Influenza Surveillance – Respiratory syndrome surveillance:

influenza-like illness (ILI) and severe acute respiratory infection (SARI)

– Unusual event surveillance (e.g. pneumonia in health care worker)

– Influenza and other respiratory virus laboratory diagnosis

• Laboratory strengthening

– PAHO-CDC task force

• Standardize PCR equipment

• Standardize PCR methodology

– Increase number of National Influenza Centers (NICs) in the Region

2005–2008

2005–2008

• National influenza preparedness plans (NIPPS)

– Multi-disciplinary teams

– Tabletop exercises

http://new.paho.org/hq/index.php?option=com_content&view=article&id=3394&Itemid=2495&to=2290

2009

• Influenza (H1N1)pdm 09 virus emerged

• Challenges

– Limited laboratory capacity in some countries

– Limited data from severe cases

• Lessons learned

– Focus efforts on SARI surveillance

– Link laboratory and epidemiologic data

– Decentralize rRT-PCR capability

– Train laboratorians in data analysis

2010–2012 SARI surveillance network

• 62 hospitals and laboratories

• Locations of hospitals: Barbados (1), Bolivia (8), Chile (6), Colombia (7), Costa Rica (7), Dominica (1), Ecuador (16), Honduras (3), Jamaica (6), Paraguay (5), St Vincents and the Grenadines (1), Suriname (1), and Trinidad and Tobago (1)

Own surveillance system

• Data received and analyzed at Regional level

– Weekly reports summarizing epidemiology of influenza and other respiratory viruses

– Virologic database

2010–2012

http://ais.paho.org/phip/viz/ed_flu.asp

http://ais.paho.org/phip/viz/ed_flu.asp

2010–2012

• Information system linking laboratory and epidemiologic data

2010–2012

• Decentralization rRT-PCR

– Example Chile: all six sentinel sites with rRT-PCR capacity

2010–2012

• Training materials

– Courses (available in English and Spanish)

• SARI training course http://cphp.sph.unc.edu/sari/precurso.html

• Laboratory data analysis course http://cphp.sph.unc.edu/paho/precurso.html

– Videos (available in Dutch, English, French, Portuguese, and Spanish)

• Nasopharyngeal and oropharyngeal sample collection http://new.paho.org/hq/index.php?option=com_content&view=article&id=7920&Itemid=39735&lang=en

• Using PPE http://new.paho.org/hq/index.php?option=com_content&view=article&id=7920&Itemid=39735&lang=en

Unanswered Questions

Unanswered Questions-Other Respiratory Viruses

• What explains the “other 40%”?

– Poor sensitivity of current methodologies for RSV, adenovirus, parainfluenza viruses?

– Viruses missing from current panel (e.g. bocavirus, human metapneumovirus, etc)

• Importance of RSV

– Burden high, not many resources being devoted to surveillance and vaccine efforts

Unanswered Questions

Unanswered Questions

Note: In United States, since 2001, in only half of the seasons did the B strain in the vaccine predominate in circulation

Unanswered Questions-Influenza

• What surveillance strategy to use in Central America where no pattern exists

• Influenza B virus co-circulation

– Trivalent versus quadrivalent vaccines

• Burden of disease

• Novel influenza vaccines

Moving Forward

• Use systems established for influenza surveillance

– Generate influenza and RSV disease burden data

– Support influenza vaccine effectiveness studies

– Expand diagnostics for other respiratory viruses

• Strengthen influenza surveillance systems

– Develop plans for sustainability

– Maintain gains and consider limited expansion of surveillance