WHO South-East Asia Region (SEAR) 2012-2013

Six of the eight countries (Bangladesh [802 KB, 2 pages] , India [787 KB, 2 pages] , Indonesia [1.2 MB, 2 pages] , Nepal [834 KB, 2 pages] , Sri Lanka [821 KB, 2 pages] and Thailand [848 KB, 2 pages] ) were awarded sustainability grants and are in varying stages of completion. These grants support the countries for additional five years. Bhutan [531 KB, 1 page] and Maldives [531 KB, 1 page] were awarded their first influenza capacity building grants in September 2013. Countries are expected to do the following: develop and maintain a surveillance system that allows countries to rapidly detect, identify and respond to seasonal, novel and pandemic influenza, participate in the World Health Organization’s (WHO) Global Influenza Surveillance and Response System (GISRS), and create and implement a sustainability plan that phases out U.S. government funding.

Core activities include improving laboratory and epidemiologic capacity and infrastructure for influenza virologic and disease surveillance; developing and maintaining 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.

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

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. Bhutan and the Maldives are shaded yellow to indicate Capacity Building Cooperative Agreements. Bangladesh, India, Indonesia, Nepal, Sri Lanka, and Thailand are shaded green to indicate Sustainability Cooperative Agreements. Bangladesh and India also have yellow diagonal stripes across the country to indicate Research Cooperative Agreements.

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: Colombo, Dhaka, Jakarta, Kathmandu, Nonthaburi, Pune, Pyongyang, and Yangon.

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

• Provided leadership and guidance during the recent H7N9 outbreak by updating member states on the status of the outbreak, issuing interim guidelines, and looking into stockpiling antivirals and creating vaccine deployment plans.
• Provided guidance to countries regarding seasonal influenza vaccinations.
• Conducted an Influenza Data Management Training for SEAR member states, in collaboration with CDC, to assist data managers and epidemiologists in improving influenza surveillance systems and analytical skills.

US CDC Direct Support

In September 2006, WHO Regional Office for South-East Asia (SEARO) was awarded their first five-year influenza cooperative agreement, and is currently in their second five year agreement which began in 2012.

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, DPR Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. Eight of the 11 countries are currently receiving CDC Influenza Division cooperative agreement funds: Bangladesh, Bhutan, India, Indonesia, Maldives, Nepal, Sri Lanka, and Thailand.

In 2012 and 2013, WHO SEARO staff provided training, support and technical assistance to member countries to strengthen preparedness, surveillance, response and laboratory capacity. WHO SEARO provides technical expertise, assistance and financial support to member states to strengthen their integrated influenza surveillance, to prepare for and effectively respond to influenza outbreaks and pandemics, to improve infrastructure and capacity of national influenza centres (NICS)/national influenza laboratories and to develop human resources. Responsibilities for these activities lay with SEARO’s Disease Surveillance and Epidemiology (DSE), Blood Safety and Laboratory Technology (BLT) and Immunization and Vaccine Development (IVD) units.

SEARO with Prince Songkla University and U.S. CDC held an Influenza Data Management training for SEAR member states in February 2013 to assist data managers and epidemiologists in establishing, maintaining and improving influenza surveillance systems and analysis. The course better familiarized participants with FluNet and FluID data bases for collecting epidemiological and virological data for the Global Influenza Surveillance and Response System (GISRS).

Surveillance Activities

• Established two positions in the SEARO vaccine preventable disease IVD Unit that support influenza through data management, emerging vaccine preventable disease surveillance and vaccine safety and quality.
• Traveled to Bhutan and Maldives to meet with staff to explain the benefits of working with CDC and to encourage them to apply for CDC influenza grants.

WHO SEARO continued to support efforts to strengthen laboratory infrastructure and build laboratory capacities to accurately and promptly diagnose influenza and monitor antiviral resistance. Eight countries in the region have functional NICs in part due to the technical and financial support provided to the countries through the cooperative agreement. Of these NICs, two have full capacity for influenza viral sequencing, the regional reference lab for influenza in Thailand and the global reference laboratory for H5N1 in Pune, India.

Laboratory Activities

• Provided support to the national laboratories in Bhutan, Maldives and Timor-Leste which now have polymerase chain reaction (PCR) capability to diagnose influenza and an interest in becoming NICs. The SEARO BLT unit organized appraisals of the three laboratories to identify gaps and recommend measures to build capacity towards designating the laboratories as NICs.
• Encouraged sharing of influenza laboratory data and will continue to foster information sharing within the Region.

The recent avian influenza A/H7N9 outbreak in China provided an impetus for the South-East Asia region to direct the attention of the member states to the need for ensuring preparedness for responding to novel strains of influenza with pandemic potential. Taking a leadership role at the height of the avian influenza A/H7N9 outbreak in China, SEARO updated its member states on the status of the outbreak, convened inter-departmental meetings to discuss plans for shaping the regional response, issued interim guidelines, discussed the possibility of mobilizing financial resources from different sources including CDC and looked into stockpiling antiviral medicines in order to prepare for an effective response to possible imported cases and cases due to local transmission. Attention was focused on revising national influenza pandemic preparedness and response plans including national pandemic vaccine deployment plans.

Preparedness Activities

• Nepal – At the request of the Government of Nepal, in August 2013, a SEARO staff member traveled to Nepal to support their national response to an upsurge in outbreaks of avian influenza A/H5N1 in poultry. SEARO met with the Ministry of Health, Ministry of Agriculture, FAO, CDC influenza grantees and other partners and provided recommendations on surveillance, risk assessment, outbreak response, communications and laboratory diagnosis.
• India – In the third meeting of the SEAR Immunization Technical Advisory Group (ITAG) held in 2012 in New Delhi, technical advisors reviewed the status of implementing the recommendations related to seasonal influenza adopted in the 2nd SEAR ITAG meeting.
• Thailand – Conducted their seasonal influenza vaccination campaign.
• The Maldives – Carried out their immunization campaign for Haj/Umra pilgrims. SEARO was technically consulted for selecting the most appropriate vaccine in terms of its antigenical match to circulating influenza strains in Saudi Arabia taking into account the mass gathering of pilgrims from different parts of the world.

• Conducted an Influenza Data Management and Epidemiological Analysis Training Course, in collaboration with Prince Songkla University and CDC in Bangkok, Thailand (February 2013). Twenty three representatives from eight countries participated.
• Supported country participation in the International Conference on Human Infection with Novel Influenza Viruses in Beijing, China (August 2013).
• Conducted a joint meeting of NICs from the South-East Asia Region and the Western Pacific Region in Beijing, China (November 2013).

Sangay Thinley, MBBS, MPH
Director, Family Health and Research
South-East Asia Regional Office
World Health Organization
New Delhi, India
Email: thinleys@searo.who.int

Arun Thapa, MBBS, MS
Coordinator, Immunization and Vaccine Development
South-East Asia Regional Office
World Health Organization
New Delhi, India
Email: thapaa@who.int

Patrick O’Connor, MD
Regional Advisor
Immunization and Vaccine Development
South-East Asia Regional Office
World Health Organization
New Delhi, India
Email: oconnorp@who.int

Pushpa Ranjan Wijesinghe, MD, MPH, MSc
Medical Officer
Emerging Vaccine Preventable Disease Surveillance
South-East Asia Regional Office
World Health Organization
New Delhi, India
Email: wijesinghep@who.int

Rajesh Bhatia, MBBS, MD, DIM, DIT
Director, Communicable Diseases
South-East Asia Regional Office
World Health Organization
New Delhi, India
Email: bhatiaraj@who.int

Richard Brown, BM, DTM&H, DA, MPH, MRCGP, MFPH
Regional Advisor
Disease Surveillance and Epidemiology
South-East Asia Regional Office
World Health Organization
New Delhi, India
Email: brownr@who.int

Aparna Singh Shah, MBBS, MD, Post-doctoral Fellowship
Regional Advisor, Blood Safety and Laboratory Technology
South-East Asia Regional Office
World Health Organization
New Delhi, India
Email: shahap@who.int