Lessons learned by mikeholy

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									Avian Influenza in Viet Nam:
      Lessons Learnt



       FAO Technical Meeting on HPAI
                 27-29th June 2007,
                       Rome


               Dr. Hoang Van Nam
           Department of Animal Health
   Ministry of Agriculture and Rural Development
                    VIETNAM
Outlines
•   Situation Analysis;
•   Summary of Lessons Learned:
    –   Strong Commitment and Leadership from the
        Government
    –   Early Detection and Response
    –   Vaccination
    –   Information, Education and Communications
    –   Pandemic Preparedness
    –   Donor support
•   Recommendations
                        Situation Analysis: The Course of the Epidemic
                                  Temporal Pattern of 2003/4 (1st), 2004/5 (2nd), late 2005 (3rd) and 2006/7 (4th) AI
                                                                      Epidemics



                              - 45 mil. poultry culled;
                300           - 27 human cases (16                                                                                               - 4 mil. poultry culled;
                              fatal)
                                                                                                                                                 - 2 human cases                                                                                                              - 99,040 poultry
                250
                                                                                                                                                                                                                                                                              culled;
                                                                                  - 2 mil. poultry culled;                                                                                                                                                                    - No human cases
                200
                                                                                  - 64 human cases (21
No. outbreaks




                                                                                                                                                           Tet holiday                                                                                                                                             Tet holiday
                                                                                  fatal)
                                                                                                                                                           Jan 29-31,                                                                                                                                              Feb 16-22,
                150
                                     Tet holiday                                          Tet holiday                                                         2006                                                                                                                                                 2007
                                   Feb 9-11, 2004                                       Feb 11-13, 2005
                100
                                                                                                                                               Vaccination
                                                                                                                                               Campaign
                50
                                                                                                                                                                       14
                                                                                                                                                                       12
                                                                                                                                                                       10
                                                                                                                                                                       8
                                                                                                                                                                       6
                                                                                                                                                                       4
                                                                                                                                                                       2


                 0                                                                                                                                                     0




                                                                                                                                                                                                                                                                                                      Nov Nov-06
                                                                                                                                                                            Jan-06




                                                                                                                                                                                                                                         Jun-06

                                                                                                                                                                                                                                                        Jul-06




                                                                                                                                                                                                                                                                                                                                  Jan-07
                                                                                                                                                                                     Feb Feb-06
                                                                                                                                                                                                  Mar Mar-06

                                                                                                                                                                                                               Feb Apr-06

                                                                                                                                                                                                                              May-06




                                                                                                                                                                                                                                                                   Aug-06

                                                                                                                                                                                                                                                                            Sep Sep-06
                                                                                                                                                                                                                                                                                         Oct Oct-06


                                                                                                                                                                                                                                                                                                                   Dec Dec-06



                                                                                                                                                                                                                                                                                                                                             Feb-07

                                                                                                                                                                                                                                                                                                                                                            Mar-07
                                              May




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                                                                Aug




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                      Jan




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                                                                                                                                                                                                                                                             Jul
                       2004                                                                      2005                                                                       2006                                                                                                                                                   2007
                                                            Numbers of outbreaks
                              26
                                   -D




                                                    0
                                                        5
                                                              10
                                                                           15
                                                                                     20
                                                                                                        25
                                                                                                                          30
                                     ec
                                           -0
                              02                6
                                   -J
                                      a   n-
                              09               07
                                   -J
                                      a   n-
                              16               07
                                   -J
                                      a   n-
                              23               07
                                   -J
                                      a   n-
                              30               07
                                   -J
                                      a   n-
                              06               07
                                                                                                         n=80 in 8 Prov

                                   -F
                                      e   b-
                              13            07
                                   -F
                                      e   b-
                              20            07
                                   -F
                                      e   b-
                              27            07
                                   -F
                                      e   b-
                              06            07
                                   -M
                                        ar
                                             -0
                              13                7
                                   -M
                                        ar
                                             -0
                              20                7
                                   -M
                                        ar
                                             -0
                              27                7
                                   -M
                                        ar
                                             -0
                              03                7
                                   -A
                                        pr
                              10           -   07
                                   -A
                                        pr
                              17           -   07
                                   -A
                                        pr
Epi Week (week beginning..)



                                           -   07
                              24
                                   -A
                                        pr
                              01           -   07
                                   -M
                                        ay
                                           -0
                              08
                                   -M        7
                                        ay
                                           -0
                              15
                                   -M        7
                                        ay
                                           -0
                                                                                                                               Epi Curve: Viet Nam, A/H5N1, 26-Dec-06 to 25-Jun-07




                              22             7
                                   -M
                                        ay
                                           -0
                              29
                                   -M        7
                                        ay
                                           -0
                              05             7
                                   -J
                                      u   n-
                              12               07
                                   -J
                                      u   n-
                              19               07
                                   -J
                                                                                      n=70 in 18 Prov




                                      u   n-
                                               07
                                                                           north

                                                                   south
                                                                           central
   Situation Analysis: Affected
Communes - 1st wave (2003-2004)
                  Situation Analysis: Affected
 Communes - 2nd wave (2004-2005)




     Provinces


Communes
No of outbreaks
     1
                                                      Provinces
     2-3
     4-7                                         Communes
     8 - 14                                      No of outbreaks
     15 - 21                                          1
     22 - 37                                          2-3
                                                      4-7
                                                      8 - 14
                                                      15 - 21
                                                      22 - 37
Situation Analysis: Affected
Communes – 3nd wave (late 2005)
Situation Analysis: Affected
Communes – 4   th   wave (Dec 2006 – Mar 2007)
     Situation Analysis: Current situation

• 2 new human cases after over a year and a
  half.
• A series of outbreaks in late 2006-early 2007
  indicated that there is persistent circulation of
  virus both in the south and the north.
• Since the beginning of May, another wave of
  epidemic started.
• Outbreaks have been identified always in
  unvaccinated flocks, particularly in ducks.
 Current situation (Cont’d)
…since 1st May 2007 to 6 June
Province        # of commune infected
Nghe An                  18
Quang Ninh               4
Can Tho                  3
Son La                   3
Nam Dinh                 26
Dong Thap                3
Bac Giang                4
Hai Phong                2
Ninh Binh                10
Bac Ninh                 1
Ha Nam                   1
Vinh Phuc                1
Hung Yen                 1
Quang Nam                2
Thai Binh                1
  Situation Analysis: Significant trends

• Recent marked increase in duck population
  (subsequent to cessation of the ban on hatching
  waterfowl)
• High proportion of these ducks moved from
  province to province to graze on paddies after
  rice harvest did not receive H5N1 vaccination 
  remain highly susceptible to the disease.
• Within this wave of outbreak, most of outbreaks
  have been reported in provinces in the Red
  River Delta
• Genetic sequencing of recent virus isolates
  have shown no significant change in the
  antigenicity  Current vaccine is still effective.
Summary of Lessons Learned
 Strong Commitment and
 Leadership from the Government
 •   Establishment of the National Steering Committee
     for Avian Influenza Prevention and Control
     (NSCAIPC);
 •   Political systems from Central to grassroots levels
     were called upon, resulted in:
        Clear chain of command; and
        Quick response activities, i.e. funds release, human
         resources, etc.;
 •   Several missions led by Cabinet Members
     dispatched to the field;
 •   Experiences in responding to (SARS) in 2003.
Early Detection and Response


  •   Emergency reporting system using
      telephones and faxes;
  •   Online reporting system (TADinfo) piloted to
      assist in HPAI information management;
  •   AI Reporting Hotline set up;
  •   Compensation policy revised;
  •   Outbreak containment procedures modified
      in the light of new knowledge and
      experiences.
Vaccination: Scope and progress

• Now focused on 33 provinces in high risk areas (Red
  River and Mekong River deltas) with vaccination of all
  long-lived poultry and all poultry in villages
• Vaccination of high risk poultry in other provinces
• Other minor poultry not vaccinated due to insufficient
  information on response to vaccination
• In 2005, some 166.3 million doses given to chickens and
  78.1 million doses to ducks
• 2006: 368 million doses given to chickens and ducks (for
  2 rounds)
• Vaccination Plan Phase II 2007-2008 approved; 1st
  vaccination campaign in 2007 started mid-March, and as
  of 15 May, 131.7 million birds vaccinated.
Information, Education and
Communications

•   Communication plays the critical role in raising public
    awareness;
•   Clear, updated information was disseminated to the
    public regularly through mass media;
•   Daily updates on disease situation and progress of
    vaccination published on DAH’s website, available
    both in Vietnamese and English.
•   Various IEC materials were produced and distributed
    using diverse media to reach diverse audiences. A
    National and several provincial telephone hotlines, for
    HPAI were established.
Pandemic Preparedness

 •   One lesson learned was that emergency
     preparedness plans help coordinate local response.
 •   In August 2005 MARD released its Avian Influenza
     Pandemic Preparedness Plan;
 •   Control measures would have been done better if a
     preparedness was available prior to the first
     outbreak;
 •   Integrated National Operational Program of Avian
     and Human Influenza (OPI) was produced in May
     2006 with the participation of various agencies and
     donors;
 •   Practical SOPs for humane culling, biosecurity, etc.
     are needed.
International support

  •   FAO was quick to provide limited assistance
      through regional and national projects;
  •   A World Bank Project (Phase I) initiated in 2004;
  •   A UN Joint Program Phase I initiated in 2005 with
      funds from several donors; Phase II to start.
  •   A Japan Trust Fund project is providing support
      through FAO and OIE.
  •   A credit facility through World Bank will fund a four-
      year project commencing in mid-2007.
  •   Various bilateral assistances.
       Recommendations
KEY TECHNICAL SUPPORT GAPS
•   Enhance national DAH epidemiology
    capacity
•   Review legislation and regulations
•   Upgrade laboratory
•   Improve procedures for disease reporting
•   Periodic review of HPAI control strategy
•   Improve vaccination delivery
•   Improve field surveillance
Recommendations: (Cont’d)

 •   Improve response to outbreaks
 •   Strengthen research
 •   Improve biosecurity of poultry production
     and marketing
 •   Improve international border inspection
     procedures
Issues need further study

 •   Decision model on controlling of outbreaks
 •   Ecology and epidemiology of avian influenza virus
 •   Molecular epidemiology
 •   Role of migratory birds
 •   Humane methods for culling
 •   Vaccine efficacy trails;
 •   Survey of free-ranging ducks
 •   Develop risk-reduction strategies for free-ranging
     ducks
 •   Feasibility of local vaccine production

								
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