WHO South-East Asia Region (SEAR) 2011-2012

The U.S. Centers for Disease Control and Prevention (CDC) funds eight non-research bilateral influenza cooperative agreements in the South-East Asia Region (SEAR). Cooperative agreements with Ministries of Health (MOH) or institutions designated by the MOH build capacity to routinely identify, diagnose and respond to seasonal, avian and pandemic influenza.

CDC direct country support via cooperative agreements is established in the following countries:

Four of the countries (Bangladesh, India, Indonesia and Thailand) were awarded sustainability grants and are in varying stages of completion. The new grants support the countries for a second five years. Countries are expected to do the following: create and implement a sustainability plan that phases out U.S. government funding, develop and maintain a surveillance system that allows countries to rapidly detect, identify and respond to seasonal, novel and pandemic influenza, and participate in the World Health Organization’s (WHO) Global Influenza Surveillance and Response System (GISRS).

Core activities include improving laboratory and epidemiologic capacity and infrastructure for influenza virologic and disease surveillance; developing sentinel hospital-based surveillance for influenza-like illness and severe acute respiratory infections; integrating laboratory and epidemiologic influenza surveillance; developing and maintaining surveillance for cases and clusters of respiratory illnesses; and training local rapid response and containment teams. Nepal and Sri Lanka are still in the first five-year capacity building phase.

As of FY 2010, all WHO SEAR countries with CDC influenza cooperative agreements had active National Influenza Centers (NIC).

Karen Siener, MPH
Public Health Advisor
Extramural Program
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Email: ksiener@cdc.gov

Fatimah Dawood, MD
Medical Officer/Epidemiologist
International Epidemiology and Response Team
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Email: hgj0@cdc.gov

Danielle Iuliano, MPH, PhD
Research Scientist
International Epidemiology and Response Team
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Email: aoi0@cdc.gov

Katie Lafond, MPH
Epidemiologist
International Epidemiology and Response Team
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Email: gmj3@cdc.gov

SEAR South-East Asia Region map

A map of the WHO South-East Asia Region (SEAR) shows all 11 SEAR member states/countries. The member countries, outlined with gray borders, include Bangladesh, India, Indonesia, Nepal, Sri Lanka, Thailand, Bhutan, DPR Korea, Myanmar, Maldives and Timor-Leste.

Countries with shading indicate that the Influenza Division provides project funding and technical assistance through cooperative agreements. Nepal and Sri Lanka are shaded yellow to indicate they have Capacity Building Cooperative Agreements. Bangladesh, India, Indonesia and Thailand are shaded green to indicate they have Sustainability Cooperative Agreements. These countries also have purple diagonal stripes across them to indicate that Research Platforms exist in these countries.

CDC Field Staff, indicated by a yellow dot outlined in red, are located in the following cities: Bangkok, Dhaka, Jakarta and New Delhi.

The Global Disease Detection [GDD] Sites, indicated by red X’s, are located in Bangkok, Thailand and New Delhi, India.

WHO National Influenza Centers (NICs), indicated by a purple dot, are located in the following cities: Bangkok, Colombo, Dhaka, Jakarta, Kathmandu, Chandigarh, Mumbai, Pune and Rangoon.

The WHO South-East Asia Regional Office (SEARO), indicated by a blue star, is located in New Delhi, India.

The five-year cooperative agreement Surveillance and Response to Pandemic and Avian Influenza by Regional Offices of the World Health Organization (WHO) began in September 2006 and is in its fifth year.

WHO’s South-East Asia Regional Office (SEARO) is located in New Delhi, India. The office serves 11 countries; together their population exceeds 1.7 billion people. Member countries include Bangladesh, Bhutan, Democratic People’s Republic of Korea (DPR Korea), India, Indonesia, Maldives, Myanmar, Nepal, Sir Lanka, Thailand and Timor-Leste. Six of the 11 countries received U.S. Centers for Disease Control and Prevention (CDC) cooperative agreement funds: Bangladesh, India, Indonesia, Nepal, Sri Lanka and Thailand. In 2011, WHO SEARO staff provided support and technical assistance to member countries to strengthen preparedness, surveillance, outbreak response, and laboratory capacity.

WHO SEARO is committed to assisting countries with reviewing policies and regulations, supporting regional production of influenza vaccine, enhancing capacity for disease surveillance activities and harmonizing regional reporting. WHO SEARO is working to sustain the diagnostic capacity of the regional influenza laboratory network and support the information sharing of the National Influenza Centers (NIC). There was a joint meeting of the NICs from the South-East Asia Region and the Western Pacific Region in June 2011.

The 2009 H1N1 pandemic provided an opportunity to expand and build influenza surveillance in the region. Prior to the pandemic, only a few WHO SEAR member countries had established routine sentinel surveillance for influenza and other acute respiratory illnesses.

Throughout 2011 support was provided to strengthen disease surveillance and outbreak response for areas on the Thai-Myanmar-Thai border. Activities included strengthening early warning mechanisms and providing risk communication materials for displaced populations.
In July 2011 influenza surveillance was included on the agenda of the annual WHO SEAR epidemiology (EPI) managers meeting for the first time, as a means to engage EPI staff at both the regional and country level.
WHO SEARO has worked closely with member countries to ensure that reporting on influenza was shared transparently. Influenza-like illness (ILI) surveillance was initiated for the first time in two WHO SEAR countries: Bhutan and DPR Korea.
WHO SEARO is encouraging close coordination between animal and human health sectors with regard to surveillance. This is especially relevant for member countries in the South-East Asia Region because of the high population density and frequent interaction between humans and poultry.

WHO SEARO continued to support efforts to strengthen laboratory infrastructure and build laboratory capacities to accurately and promptly diagnose influenza and monitor antiviral resistance.

WHO SEARO helped establish a regional database to track and monitor results of specimens submitted by National Influenza Centers (NIC) in the South-East Asia Region.
WHO’s Global Influenza Surveillance and Response System (GISRS)—FluNet—is a web-based data tool for global influenza surveillance. Thailand provides weekly laboratory results and Bangladesh provides monthly information from their influenza laboratory sentinel sites. Indonesia, Bhutan and Nepal provide periodic laboratory reports.
WHO SEARO has encouraged sharing of influenza laboratory data and will continue to foster information sharing within the Region.
The National Public Health Laboratory in Kathmandu was strengthened and eventually designated as a NIC for Nepal. With this designation, Nepal became the eighth country in the Region to have a NIC and become part of GISRS.
Bhutan, Maldives and Timor-Leste for the first time established polymerase chain reaction (PCR) facilities for influenza diagnosis with support from WHO.
Bhutan successfully diagnosed an outbreak of influenza A(H1N1)pdm09 in April 2011 using their national facilities.

The 2009 H1N1 pandemic demonstrated that there is a significant amount of expertise and capacity within the Region to respond to pandemic influenza. Lessons learned from this experience guided several regional meetings and resulted in identifying opportunities for strengthening regional and national preparedness and response capacity.

Regional tools for assessment of response to the 2009 H1N1 pandemic were prepared and plans are underway to carry out a review of member countries’ implementation.
WHO SEARO will continue to play a vital role in supporting member countries in the following activities: updating, revising and implementing national pandemic preparedness and response plans; sharing country experiences, lessons learned and best practices; and identifying future steps towards pandemic preparedness and response.
Despite being one of the most densely populated areas of the world and having three vaccine-manufacturing countries (India, Indonesia and Thailand), the Region currently has limited capacity for influenza vaccine production. There remain many opportunities for developing partnerships to introduce new technologies for vaccine manufacturing, and to build on existing collaborations for regional vaccine and essential medicine production.
As regional vaccine manufacturing capacity develops, technical assistance to member countries will be essential for developing national plans that reflect rational, sustainable and cost-effective new vaccine introduction. In the last half of 2011, the Region worked with member countries to update their vaccine deployment plans and planned for a regional workshop for the beginning of 2012 to review and share information within the Region.
In early 2011, a tool was finalized by WHO SEARO to support the review of national response to pandemic influenza. In July 2011, the tool was used to support an assessment in DPR Korea and revision of the national pandemic plan.

Richard Brown
Regional Advisor
Disease Surveillance and Epidemiology
South-East Asia Regional Office
World Health Organization
New Delhi, India
Email: brownr@searo.who.int

Patrick O’Connor
Regional Advisor
Disease Surveillance and Epidemiology
South-East Asia Regional Office
World Health Organization
New Delhi, India
Email: oconnorp@searo.who.int

Sangay Thinley
Director, Department of Communicable Diseases
South-East Asia Regional Office
World Health Organization
New Delhi, India
Email: thinleys@searo.who.int

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