current ah1n1status and moh response measure sovann ly, md, dtmh, mctm deputy director of cdc...
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Current AH1N1status and MoH Response Measure
Sovann Ly, MD, DTMH, MCTM
Deputy Director of CDC Department
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Current AH1N1 status
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Number of Cases by Week of Detection* June to 6 October 2009 (N =134)
0
5
10
15
20
25
24 to 30 1 to 7 8 10 14 15 to 21 22 to 28 29 to 4 5 to 11 12 to 18 19 to 25 26 to 1 2 to 8 9 to 15 16 to 22 23 to 29 30 to 6
June July
Number
Aug Sept/Oct
Date of detection = date confirmed by IPC
=deaths
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Number of Cases by Age Group June to 6 October 2009 (N = 134)
Age(Years) Male Female Total
0 – 4 8 8 16
5 – 14 28 21 49
15 – 49 30 33 63
50+ 3 3 6
Total 69 65 134
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Cambodian80%
Foreigner20%
Nationalities of Pandemic H1N1 Cases in Cambodia, June to 6 October 2009 (N = 134)
* 2 foreigners based in Phnom Penh, no travel history
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Nationalities of Pandemic H1N1 Cases in Cambodia, June to 6 October 2009 (N = 134)
Nationality Number
Cambodian 107
Australian 3
French 4
Japanese 6
Philippines 1
UK 2
USA 9
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Pandemic H1N1 Death cases in CambodiaJune to 6 October 2009
• 3 deaths • 41 yr old F, no risk factors : died on
27 September • 47 yr old male, alcoholism: died on 5
October• 25 Yr old F, Pregnant women : died on
6 October, Baby survived and A H1N1 negative
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Communities transmission, up to 6 October 2009 • Evidence of community transmission: cases
with no history of foreign travel or contact with foreign case• Phnom Penh• Kandal• Takeo• Siem Reap• Kampong Speu • Kampong Chhnang• Battambang• Svay Rieng
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Geographic Spread across time
As of 30 June
6 cases, no local transmission
As of 31 July
19 cases, local transmission in Phnom Penh
As of 31 August, local transmission in
Phnom Penh and Kandal
=Areas in Cambodia with locally acquired lab confirmed cases
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Areas with Community Transmission of New Influenza A H1N1 virus (as of 6 October)
As of 6 October 2009
134 cases, community transmission in
Phnom Penh, Kandal, Siem Reap, Takeo, Kampong Speu, Battambang , Svay Rieng and Kampong Chhnang
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How were cases detected?Detection Method Number Percent
Event based Surveillance
Calls to MoH Hotline and Contact Tracing
53
40
Fever surveillance 48 36
ILI surveillance 24 18
Entry screening 4 3
Others* 5 3TOTAL 134 100 %
*NAMRU lab worker detected during internal training session on specimen collection and PIC lab workers
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H1N1v Detection atSentinel Surveillance Sites
=H1N1v cases detected =sentinel surveillance not yet detecting H1N1v case
=no sentinel site
Province ILI SARI SISEA NAMRU Comment
Battambang On going community transmission
Kampong Cham
Kampong Speu On-going community transmission
Kandal On-going community transmission
Phnom Penh On-going community transmission
Siem Reap On-going community transmission
Svay Rieng
Kampong Chhnang 1st case of community transmission detected on 25 Sept
Takeo On-going community transmission
=Provinces with no Sentinel site but where cases have been identified by the surveillance programmes
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MoH Response Measure
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Communication to public
• TV broadcasting educate to public since May 2009
• Disseminate the Posters and leaflets to communities
• Dissemination to local authorities and sectors
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Communication to public Cont’• Regular joint press release (MoH/WHO)
on situation update• Spokesman update to media• Regular update to website (
www.cdcmoh.gov.kh)• Monthly Bulletin• Hotlines on duty 24 hours
• 115• 012 488981• 089 669567
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Surveillance
• Early warning system ARI (countrywide)
• ILI (6 sites)• Fever study (2 provinces)• SISEA ( 2 provinces)
• Detect the single case and clusters
• Monitor the AH1N1 situation (Increase, stable, decrease)
Consolidated ILI Data From 6 Sentinel Sites (2009)
0%
1%
2%
3%
4%
5%
6%
7%
8%
Jan Feb Mar Apr May Jun Jul
Month
ILI
Co
nsu
ltati
on
Rate
(%
)
0%
5%
10%
15%
20%
25%
30%
Po
sit
ivit
y R
ate
(%
)
ILI Consultation Rate Positivity Rate
Acute Lower Respiratory Tract Infections in All Provinces (CAM EWARN - 2009)
0
10000
20000
30000
40000
50000
60000
70000
80000
Jan Feb Mar Apr May Jun Jul
Month
Nu
mb
er
of
Cases
Lab-Confirmed Influenza Cases in Febrile Patients of Kandal and Kampong Speu Provinces
(NAMRU-2 - 2009)
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
Jan Feb Mar Apr May Jun Jul
Month
Infl
uen
za P
osit
ive/
Sp
ecim
en
s T
este
d (
%)
2009 Influenza Activity 2008 Influenza Activity
New SARI Cases in Takeo and Kampong Cham Provinces (SISEA - 2009)
0
20
40
60
80
100
120
140
160
Jan
Feb
Mar
Apr
May
Jun
Jul
Month
Nu
mb
er
of
Cases
Children (0-16) Adults (>16)
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Surveillance (Cont’)
• At the border• International airports and ports• International land border
• Installed 3 Thermoscaners to monitor the passengers cross border
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Investigation and Response• Rapid Response Teams
• 1200 staffs• Trained
• Kits (PPE, Medicine, Lab collection, Forms, guidelines)
• 1200 Telephones line communication from national to Health Center level
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Hospital response
• 5 Isolate wards• All hospitals have separate rooms for
ARI• Trained infection control • Case management• Refer system• Supplies PPE and medicines
• Private sector participation to the surveillance system and case management
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Laboratory
• 3 National labs• Pasteur Institute Cambodia (NIC)• National Institute of Public Health• Namru 2
• All province has lab kits to collect the sample, packaging and sending
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Challenges
• Delay incentive to Rapid Response Teams
• Vaccine to vulnerable group• Pregnant women : 140.000
doses/year• Health workers : 280.000 doses• Underline condition : 980.000 doses
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Challenges Cont’
• Tamiflu doses limited• Workload of hospital health
workers• Other sectors do not have the
operational to support MoH and also do not have their operational plan for their sectors business continuity
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Som Or KunThanks for you
attention