Regional event-based surveillance in WHO’s Western Pacific Region

Abstract@#In the Western Pacific Region, event-based surveillance has been conducted for over a decade for rapid detection and assessment of acute public health events. This report describes the establishment and evolution of the Western Pacific regional event-based surveillance system and presents an analysis of public health events in the Region. Between July 2008 and June 2017 there was a total of 2396 events reported in the Western Pacific Region (average of 266 events per year). Events related to infectious diseases in humans account for the largest proportion of events recorded (49%). Maintaining this well-established system is critical in supporting rapid detection, assessment and response to acute public health events, to maintain regional health security.

Public health event communication under the International Health Regulations (2005) in the Western Pacific Region, September 2006-January 2017

@#Highlights • The International Health Regulations, or IHR (2005), establishes timely communication between the World Health Organization (WHO) and Member States to manage acute public health events and protect health security. Experiences of the WHO IHR contact point for the Western Pacific Region demonstrated the communication mechanism has achieved its functions in the Region. • Investment in IHR communication as part of the Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies (APSED III) during peaceful times between public health emergencies builds capacity, confidence and trust in information sharing during emergencies. • IHR communication is integral to the national, regional and global epidemic intelligence and risk assessments system. • Regular simulation exercises (for example, IHR Exercise Crystal) play an important role in testing and strengthening IHR communication. • IHR communication continues to be vital for Member States and WHO Country Offices to advise on health security.

Marking the 1918 influenza pandemic centennial: addressing regional influenza threats through the Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies

@#In 1918, near the close of the First World War, pandemic influenza swept across the world. Spread by the movement of troops and fueled by dense military-camp living quarters, the virus caused unusually high mortality rates in people 20–40 years old. An estimated 500 million people were infected, and up to 50 million died. Since then, pandemics caused by newly emerging influenza viruses have occurred every 10–40 years, with each of the pandemics in 1957, 1968 and 1977 taking the lives of roughly one million people.1 More recently, the 2009 H1N1 influenza pandemic resulted in an estimated half a million deaths and raised concerns about how prepared the global community was to cope with future public health events.2 Past pandemics can teach us important lessons about preventing and responding to emerging global health threats. This special issue highlights significant achievements across the Western Pacific Region in global pandemic preparedness and response.

From H5N1 to HxNy: An epidemiologic overview of human infections with avian influenza in the Western Pacific Region, 2003–2017

Abstract@#Since the first confirmed human infection with avian influenza A(H5N1) virus was reported in Hong Kong SAR (China) in 1997, sporadic zoonotic avian influenza viruses causing human illness have been identified globally with the World Health Organization (WHO) Western Pacific Region as a hotspot. A resurgence of A(H5N1) occurred in humans and animals in November 2003. Between November 2003 and September 2017, WHO received reports of 1838 human infections with avian influenza viruses A(H5N1), A(H5N6), A(H6N1), A(H7N9), A(H9N2) and A(H10N8) in the Western Pacific Region. Most of the infections were with A(H7N9) (n = 1562, 85%) and A(H5N1) (n = 238, 13%) viruses, and most (n = 1583, 86%) were reported from December through April. In poultry and wild birds, A(H5N1) and A(H5N6) subtypes were the most widely distributed, with outbreaks reported from 10 and eight countries and areas, respectively. Regional analyses of human infections with avian influenza subtypes revealed distinct epidemiologic patterns that varied across countries, age and time. Such epidemiologic patterns may not be apparent from aggregated global summaries or country reports; regional assessment can offer additional insight that can inform risk assessment and response efforts. As infected animals and contaminated environments are the primary source of human infections, regional analyses that bring together human and animal surveillance data are an important basis for exposure and transmission risk assessment and public health action. Combining sustained event-based surveillance with enhanced collaboration between public health, veterinary (domestic and wildlife) and environmental sectors will provide a basis to inform joint risk assessment and coordinated response activities.

Ebola preparedness in the Western Pacific Region, 2014

West Africa is currently experiencing the largest outbreak of Ebola virus disease (EVD) in history with intense transmission in several affected countries. For non-affected countries, the best protective measures are adequate levels of preparedness including vigilant surveillance to detect cases early and well-prepared health systems to ensure rapid containment of the virus and to avoid further spread. The World Health Organization Regional Office for the Western Pacific recently conducted two activities: a web-based EVD preparedness survey and an EVD simulation exercise to determine the overall level of EVD preparedness in the Region. The survey and exercise together demonstrate there is a good overall level of preparedness for a potential imported case of EVD in the Western Pacific Region. However, a number of areas still require further strengthening before the Region can efficiently and effectively respond to potential EVD events, including laboratory testing arrangements; clinical management and infection prevention and control; and public health intervention measures, particularly at points of entry. Importantly, the survey and exercise also highlight the unique situation in Pacific island countries and emphasize that special considerations are needed to better support these countries in EVD preparedness.

Sex matters – a preliminary analysis of Middle East respiratory syndrome in the Republic of Korea, 2015

Convincing evidence suggests that females and males are different in regard to susceptibility to both infectious and non-infectious diseases. Sex and gender influences the severity and outcome of several infectious diseases, including leptospirosis, tuberculosis, listeriosis, Q fever, avian influenza and SARS.

Avian influenza A(H7N9) and the closure of live bird markets

On 31 March 2013, the National Health and Family Planning Commission, China notified the World Health Organization of three cases of human infection with avian influenza A(H7N9) from Shanghai and Anhui.1 By 8 May, 131 cases, including 26 deaths, had been notified from 11 provinces/municipalities.1,2 The majority (81%) of reported cases were from Shanghai municipality and Zhejiang and Jiangsu provinces. Available data indicate that more than three quarters of cases (59/77, 76%) had recent exposure to animals. Among these, 58% (34/59) had direct contact with chickens and 64% (38/59) visited a live bird market (LBM).3 Provincial and national authorities in China have collected more than 80 000 samples from LBMs, poultry slaughter houses, poultry farms, wild bird habitats, pig slaughter houses and their environments. As of 7 May, 50 samples were positive for avian influenza A(H7N9): 39 samples from poultry from LBMs in Anhui, Jiangsu, Jiangxi, Guangdong, Shanghai and Zhejiang provinces/municipalities (26 chickens, three ducks, four pigeons, six unknown) and 11 environmental samples from LBMs in Shanghai, Henan and Shandong provinces.4 None of the samples from poultry farms or pigs were positive

International Health Regulations (2005): public health event communications in the Western Pacific Region

The revised International Health Regulations, known as IHR (2005), went into effect on 15 June 2007, requiring World Health Organization (WHO) Member States to notify all events that may constitute a public health emergency of international concern (PHEIC).

Outbreak investigations in the Western Pacific Region

In this issue we introduce a new article type – the outbreak investigation report – with our theme Outbreak investigations in the Western Pacific Region. This new article type allows for concise reports on outbreak investigations and expands the role of the Western Pacific Surveillance and Response Journal (WPSAR) as a regional information-sharing platform, as per the Asia Pacific Strategy for Emerging Diseases (APSED 2010) in line with the International Health Regulation (2005). Timely sharing of outbreak investigations may be useful in informing public health action across the Region.