global health security, with special emphasis on mers-cov and h5n1
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Global health security, with special emphasis on MERS-CoV and avian influenza A
(H5N1)Agenda item 3(a)
62nd Session of the WHO Regional Committee for the Eastern Mediterranean
5–9 October 2015, Kuwait
Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 2
Global health security threats• Current global health security threats
– Ebola virus disease in the African Region– Avian influenza A (H7N9) infection in the Western Pacific
Region – MERS-CoV and avian influenza A (H5N1) infection in the
Eastern Mediterranean Region
• Implication of global health security – Can cause social unrest and loss of economic opportunities – Interconnected world provides ground for international spread
Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 3
Objectives• Highlight the current health security threats in the
Eastern Mediterranean Region• Consider accelerated actions for Member States
for prevention, detection and response• Emphasize the shared responsibility of both
Member States and WHO for global health
Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 4
Global health security threats in the Eastern Mediterranean Region
• Middle East respiratory syndrome coronavirus (MERS-CoV)
– Novel respiratory virus and zoonotic in origin– Amplification in health care settings– Important knowledge gaps on exposure and transmission risk
factors
• Avian influenza A (H5N1) in Egypt
– Novel influenza virus and zoonotic in origin– High mortality in patients where treatment is delayed– Important knowledge gaps on transmissibility of the virus
Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 5
MERS: Global situation, April 2012 to 15 September 2015
AustriaAlgeriaEgyptGreeceIslamic Republic of IranLebanonMalaysiaNetherlandsTurkeyUSAYemen
GermanyPhilippinesChinaRepublic of KoreaThailand
TunisiaKuwaitOmanFranceGermanyItalyUnited Arab EmiratesUnited Kingdom
JordanSaudi ArabiaQatar
Cumulative
1570 Cases
555 Deaths
Epidemic curve of MERS cases reported from the Republic of Korea
8-M
ay
10-M
ay
12-M
ay
14-M
ay
16-M
ay
18-M
ay
20-M
ay
22-M
ay
24-M
ay
26-M
ay
28-M
ay
30-M
ay
1-Ju
n
3-Ju
n
5-Ju
n
7-Ju
n
9-Ju
n
11-J
un
13-J
un
15-J
un
17-J
un
19-J
un
21-J
un
23-J
un
0
2
4
6
8
10
12
14
16
18
20
Survived Died
Number of cases
6Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1)
Date of symptom onset
Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 7
Epidemiological characteristics of MERS cases reported from January to September, 2013–2015
Characteristics JanSep 2013 JanSep 2014 JanSep 2015
Number 129 593 377Median age in years 50 48 56Percentage of males 60 62 69Percentage of primary cases 21 23 12Percentage of secondary cases 64 39 42
Unknown contact history (percentage) 15 35 21
Percentage of cases in health care workers 19 28 12
Percentage of fatal cases 49 40 41
Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 8
MERS: Epidemic curve of cases reported from the Eastern Mediterranean Region, April 2012 to
September 2015
Reported period in moths (June 2012-September 2015)
PrimarySecondary
2014 201520132012
No of reported cases180160140120100806040200
6 8 10 12 2 4 6 8 10 12 2 4 6 8 10 12 2 4 6 8
Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 9
Reported cases of MERS in health care workers
Source: WHO
400350300250200
150100500
No of cases
Infection in health care workers
Infection in others
Health care workers = 21%
2014 201520132012Month of onset
3 4 6 9 10 121 2 3 4 5 6 7 8 9 1011 121 2 3 4 5 6 7 8 9 1011 1 2 3 4 5 6 7 8
Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 10
Current challenges
• Both the MERS-CoV and avian influenza A (H5N1) virus have pandemic risk
• Global knowledge on transmission risk factors of both MERS-CoV and avian influenza A (H5N1) virus remains limited
• Critical gaps for prevention, detection and response to emerging health threats identified for Ebola virus disease
Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 11
Strategic actions for consideration • Monitor and track the pandemic risk in real time
– Establish/strengthen sentinel-based surveillance systems for severe acute respiratory infection in all countries
• Respond rapidly to every case(s) and cluster – Set up trained multidisciplinary rapid response teams in each country
• Prevent amplification of hospital outbreaks – Establish or strengthen infection prevention and control programmes in all
countries
• Address critical knowledge gaps– Prioritize and conduct public health research and disseminate the
research findings rapidly
Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 12
Conclusion: the way forward
• Both the MERS-CoV and H5N1 virus have pandemic risk potential which remains unpredictable
• The Region needs to be better prepared to respond to sustained events resulting from these two major threats
• Member States and WHO need to act now as part of shared responsibilities to protect global health
Cholera outbreak in Iraq• Outbreak
– Total number of laboratory-confirmed cases: 827
– Over 1200 suspected cholera cases – 12 out of 19 governorates have reported
laboratory-confirmed cases • Humanitarian crisis
– Over 153 000 Syrian refugees are in northern Iraq
– Over 1.2 million Iraqi people are displaced in the northern region of Iraq
Global health security, with special emphasis on MERS-CoV and avian influenza A (H5N1) 14
BABYLON
BAGHDAD-KARKH
BAGHDAD-RESAFA
BASRAH
DIWANIY
A
DIYALA
KERBALA
MUTHANNA
MISSAN
NAJAF
THI-QAR
WASSIT
0
100
200
300
400
500
600
700Suspected cases
Lab-confirmed cases
Governorates reporting cholera cases
No
of re
porte
d ca
ses
Geographical distribution of suspected and laboratory-confirmed cases, 930 September 2015
Strategic actions for control in Iraq• Standardizing cholera case management• Enhancing surveillance and conducting active
case-finding• Prioritizing laboratory sample collection and
testing • Treating water at point of use • Conducting social mobilization in high-risk areas • Considering the use of oral cholera vaccines to
limit geographical spread
Strategic actions for neighbouring countries of Iraq
• Enhancing surveillance for early detection of any suspected case
• Improving preparedness measures (stockpiling, health education and awareness measures, etc)
• Complying with the health requirements of IHR (2005)– No trade or travel embargo – No screening or quarantine of travellers coming
from cholera-affected areas– No proof of vaccination for entry – No prophylactic administration of antibiotics
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