1	Using Geographical Information System tool in containing influenza pandemic threats Republic of Lebanon Ministry of Public Health Epidemiological Surveillance Program Nada Ghosn, MD
2	Influenza: seasonal, pandemic, avian
3	Human influenza Seasonal influenza: Annual outbreaks due to minor changes in the surface of the influenza viruses Human have partial immunity due to previous infections. Pandemic influenza: (الجائحة) Global and worldwide severe epidemic Due to major change No human have partial of fully immunity against infection because it is a completely new virus.
4	Latest Influenza pandemics
5	Animal influenza Avian influenza Highly Pathogenic Avian Influenza (HPAI) Low Pathogenic Avian Influenza Outbreaks of new avian influenza Increase the risk of a human pandemic Through the merging of animal and human influenza viruses.
6	Influenza virus H5N1 The new H5N1 avian influenza is a potential candidate for pandemic influenza: Can affect animals and birds on a large scale Can affect humans and cause severe disease But still can not be transmitted from human-to-human
7	How to control/prevent pandemic influenza? Containment of potential human pandemics at the source Containment of HPAI in animals at the source
8	Pandemic Influenza modeling: Time factor Any delay will reduce the probability of eliminating large epidemics in humans
9	"Delay of 4 days reduce..." Delay of 4 days reduce the probability of eliminating a large epidemic of a new pandemic virus to: <50% for a virus with R₀=>1.5 R₀ quantifies the transmissibility of pathogen
10	Containment pandemic influenza WHO plan: time factor The success of any strategy for containing an emerging pandemic virus is strictly TIME DEPENDENT
11	WHO pandemic influenza plan The success of any strategy for containing an emerging pandemic virus is strictly TIME DEPENDENT. Objectives of containment strategy To stop, or at least to slow, the spread of pandemic influenza at the source of its emergence in order to reduce global morbidity and mortality
12	WHO pandemic influenza plan Recognition of the event: Epidemiological and virological signals Steps of initial investigation Verifying the event: Risk assessment Immediate control measures Containing the event: Decision to launch a containment operation Phase 1 - standard measures to reduce transmission: case management, infection control, antiviral treatment, intensified surveillance, contact tracing, monitoring contacts for signs of illness Phase 2 - exceptional measures: voluntary quarantine, social distancing, mass antiviral prophylaxis
13	Containment avian influenza FAO plan: Time factor Timely reporting and timely response
14	FAO Recommendations Early detection, and rapid response The main measures to prevent, control and eradicate HPAI are: Effective disease surveillance for early detection and reporting Enhanced biosecurity of poultry farms Control of movement of birds and products Changes to industry practices to reduce risk Rapid, humane destruction of infected poultry and poultry at high risk of infection (stamping out) Disposal of carcasses and potentially infective material in a biosecure and environmentally manner Proper use of vaccine
15	Containment factors: available information Available information can reduce delay in conducting response measures
16	Lebanon, March-April 2006 Influenza H7N7 risk Tyr caza
17	Lebanon: Influenza H7N7 risk Tyr caza, March-April 2006 MOA: What is the area size? What are the target farms? What are the target birds size? … Collecting data was time consuming (>2 days) and has delayed the stamping out measures
18	Lebanon: Influenza H7N7 risk Tyr caza, March-April 2006 MOI What is the target area? What is the area targeted for quarantine? What is the perimeter? How many human resources are needed? …
19	Lebanon: Influenza H7N7 risk Tyr caza, March-April 2006 Municipality: How many human resources are needed? … Short cut of human resources was observed and prolonged field activities
20	Lebanon: Influenza H7N7 risk Tyr caza, March-April 2006 MOPH: What are the exposed persons targeted for health monitoring ad active surveillance? Professionals, farms, households… What are the health structures in place for case referral and case management? What are the needed resources? …
21	How to avoid containment delay? Be prepared Visualize risky areas Have centrally available information and maps to decide on strategy and needed resources Save time and act rapidly
22	Avian Influenza Preparedness using GIS tool Preparedness tool Visualization of risky areas Decision tool Save time
23	If Influenza A/H5N1 virus appears in Lebanon All response measures aim to: Prevent the spread of the virus Contain the virus at the source (focus)
24	If Influenza A/H5N1 virus appears in Lebanon Response measures include: Specify a 3km radius zone from the index case and control its movements at entry and exit Control (destroy) all poultry in the security zone (3km radius) Detect poultry cases in a 7km radius zone with enhanced veterinarian surveillance Detect human cases in affected areas Prepare health structures to manage human cases Close community gathering places Rise public and professional awareness
25	Quarantine - Security and Surveillance zones:
26	Quarantine - Security and Surveillance zones: algorithm
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28	2. Destroy poultry in 3km radius zone: algorithm
29	3. Detect poultry cases in a 7km radius zone: questions
30	3. Detect poultry cases in a 7km radius zone: algorithm
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32	4. Detect human cases in affected area: algorithm
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34	5. Prepare health structures to manage human cases: algorithm
35	6. Close community gathering places:
36	6. Close community gathering places: algorithm