Meeting of the Global Outbreak Alert and

Response Network (GOARN) Partners from the Western Pacific Region

19 - 20 October, 2009

Beijing, China

($'World Health ~ Organization -'-~ ---

Western Pacific Region

WPR/2009/DCC/08/CSR English only

Report Series Number: RS/2009/GE/26 (CHN)

REPORT

EETING OF THE GLOBAL OUTBREAK ALERT AND RESPONSE NETWORK (GOARN) PARTNERS FROM THE WESTERN PACIFIC REGION

Convened by

THE WORLD HEALTH ORGANIZATION

AND THE CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION

Not for sale

Printed and distributed by:

World Health Organization Western Pacific Regional Office

Manila, Philippines

December 2009

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NOTE

The views expressed in this report are those of the participants and temporary advisers at the Meeting of the Global Outbreak Alert nnd Response Network (GOARN) Partners from the Western Pacific Region and do not necessarily reflect the policies of WHO.

This report was published by the Western Pacific Regional Office for the participants at the Meeting of the Global Outbreak Alert and Response Network (GOARN) Partners from the Western Pacific Region held in Beijing, China, from 19 to 20 October 2009.

TABLE OF CONTENTS

1. BACKGROUND

2. INTRODUCTION

3. THE GLOBAL AND REGIONAL PERSPECTIVE

4. GOARN MISSIONS AND FIELD EXPERIENCE

5. EXPERIENCES FROM THE FIELD: CHINA'S NATIONAL AND INTERNATIONAL RESPONSES

ANNEXES

ANNEX 1 PROGRAMME OF ACTIVITIES

ANNEX 2 LIST OF PARTICIPANTS

ANNEX 3 LIST OF CURRENT GOARN PARTNERS IN THE WESTERN PACIFIC REGION

ANNEX 4 WPRO OFFICES IN THE WESTERN PACIFIC REGION

ANNEX 5 LIST OF RECOMMENDED PRINT AND ONLINE RESOURCES

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Keywords: Disease outbreaks - prevention and control I Communicable diseases, Emerging -prevention and control I Technical cooperation I Natural disasters I Disaster preparedness

1. Background

The Global Outbreak Alert and Response Network (GOARN) is an international grouping of technical institutions that collaborates on the common goal of international outbreak response. The network provides teclmical advice and operational support for the control of cliseilsr: o11thrr:ilk"s worldwide. It has a large and active membership in the Western Pacific Region with over 40 partner institutions. In the last two years, there has been a concerted effort, as part of the Asia Pacific Strategy for Emerging Diseases (APSED), to strengthen the network and encourage greater participation from a wide range of technical institutions in the Region.

A meeting of the GOARN partners in the Western Pacific Region originally was scheduled for 14 to 15 May 2009 in Beijing, China. But the outbreak of the pandemic influenza A (H1N1) 2009 forced the meeting to be rescheduled to 19 to 20 October 2009. The Beijing meeting was hosted by the Western Pacific Region in partnership with the Chinese Center for Disease Control and Prevention (Chinese CDC).

The 2009 GOARN meeting was the third organized by the Western Pacific Region and brought together more than 100 participants from existing and potential GOARN partner institutions from 12 countries. Also in attendance were the GOARN Secretariat, WHO regional staff and observers from various academic institutions and regional bodies with an interest in GOARN activities.

The meeting opened with an introductory and background address by incoming China WHO CountiJ Representative Dr Michael O'Leary. Dr Liang Wannian, Deputy Director General of the Health Response Office of the Chinese Ministry of Health, and Dr Yang Weizhong, Deputy Director General of the Chinese CDC, followed with welcoming remarks. Amy Cawthorne of the Western Pacific Regional Office then briefly reviewed the objectives and outcomes expected for the conference, which included:

• to enroll partner institutions in the Region with a particular focus on technical institutions in China; and

• to draw on the experiences and lessons learnt from recent international responses to disease outbreaks through the GOARN mechanism, including the outbreak of severe acute respiratory syndrome (SARS) in 2002 and 2003, the 2004 Indonesian tsunami, the 2008 Wenchuan earthquake in China and the H1N1 outbreak of2009.

Dato Dr Tee Ah Sian began the morning session with an overview of the APSED and the establishment of GOARN in the Region. Her points set the tone for a lively series of technical presentations and plenary discussions during the two-day event. The complete agenda is available in Annex 1. This report summarizes the main themes, action points and recommendations that emerged from the meeting. It should be used as a reference for current and prospective GOARN partners to better understand GOARN's mission and procedures in response to new, emerging and recognized epidemiological outbreaks, natural disasters and other regional and global occurrences.

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2. Introduction

The Western Pacific Region has witnessed the detection of more than 30 new infectious agents in the past three decades, including SARS, avian influenza A (H5Nl), Nipah virus and drug-resistant malaria. With a population approaching 3.5 billion people, the presence of emerging diseases and their impact on health and economic growth has been underscored by a rash of high-profile epidemiological outbreaks, including the 2009 HlNl pandemic that threatens millions worldwide. The importance of formulating a well-prepared and strong public health system to combat these diseases is a clear priority for the Region.

GOARN was formed in April 2000 at a meeting in Geneva, Switzerland, and brought together 64 technical institutions with expertise in epidemic surveillance and response. Participants identified the need for a global network, building on new and existing partnerships, to deal with the global threats of epidemic-prone and emerging diseases. The network provides an operational framework to link this expertise and skills to keep the international community constantly alert to the threat of outbreaks and ready to respond. A steering committee of network partners also was established to guide its evolution.

GOARN is central to global health security because it:

• combats the international spread of disease outbreaks; • ensures that the right technical assistance reaches affected states rapidly; and • contributes to long-term epidemic preparedness and capacity-building.

Since April 2000, GOARN has been bringing agreed standards to international epidemic response through the formulation of Guiding Principles for International Outbreak Alert and Response and operational protocols to standardize epidemiological, laboratory, clinical management, research, communications, logistics support, security, evacuation and communications systems.

The current roster of participating partners is 150. GOARN has been active in many global crises in the past nine years, both in Asia and worldwide. They include Ebola and other viral haemorrhagic fever outbreaks in parts of Africa, SARS, avian influenza A (H5Nl) and A (HlNl) outbreaks that involved many of the 150 partners. A priority has been to establish consensus and assign protocols for key administrative, managerial and implementing strategies.

WHO and the Chinese CDC hosted the 2009 GOARN meeting for the Western Pacific Region from 19 to 20 October 2009 in Beijing, China. The meeting of current and potential GOARN partners included more than 100 participants from 10 countries, including programme planning, staffmg and logistical support from the Western Pacific Regional Office in Manila, the WHO Office in Beijing and WHO Headquarters.

China has five GOARN partners, and its experiences in recent global events (the Indonesian tsunami and international health crises) have enhanced its preparedness level both at home and abroad. One of the focuses of the meeting was to document China's recent field activities and to report on further efforts to strengthen its protocols and programmes and integrate them with GOARN's.

The meeting opened with an introductory and background address by incoming WHO China Country Representative Dr Michael O'Leary, who spoke about the importance of GOARN in stemming epidemiological outbreaks worldwide, especially in the Asian theatre. He addressed the need to expand GOARN's partners and welcomed his copanelists from China and thanked the China CDC, the Western Pacific Regional Office, WHO staff from Geneva and the local WHO staff for their support and assistance in the planning and logistics for the meeting.

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Dr Liang W annian, Deputy Director General of the Health Response Office of the Chinese Ministry of Health, and Dr Yang Weizhong, Deputy Director General of the China CDC, welcomed the participants to China and offered their support for a successful event.

Amy Cawthorne of the Western Pacific Regional Office briefly reviewed the objectives and expected outcomes of the conference, which included:

• to enroll partner institutions in the Region with a particular focus on technical institutions in China; and

• to draw on the experiences and lessons learned from recent international responses to disease outbreaks through the GOARN mechanism, including the SARS outbreak in 2002 and 2003, the 2004 Indonesian tsunami, the 2008 Wenchuan earthquake in China and the HlNl outbreak of2009.

The APSED was a steering document established in 2005 that mandated that GOARN work with partner institutions to:

• reduce the risk of emerging diseases; • strengthen the early detection of outbreaks of emerging diseases; • enhance the early response to emerging diseases; • build preparedness for emerging diseases; and • establish sustainable technical collaboration with current and prospective new partners within

the Western Pacific Region.

The 2009 meeting of GOARN from the Western Pacific Region was launched with these directives in mind. The two~day programme included presentations from local and international groups and extensive cultural programmes and off-site events.

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3. The Global and Regional Perspective

This session was moderated by Data' Dr Tee Ah Sian, Director of the Combating Communicable Disease Unit at the Western Pacific. Re:eional Office , and Dr Feng Zijian, Director of the Chinese CDC Office for Disease Control and Emergency Response. The session was organized as an introduction to GOARN and its accomplishments and activities since 2000. It also emphasized communicable disease surveillance response (CSR) activities and promotion in the Western Pacific Region and China's experiences with CSR activities in this area.

Dr Tee opened the session with a brief historical review of GOARN growth in the Western Pacific Region, introducing the International Health Regulations (2005), also lmown as the IHR (2005), as the legally binding document for WHO's efforts to combat the spread of infectious disease at the local, regional and global levels. Created in 2005, the IHR called for all countries to establish the core capacities for surveillance and response no later than June 2012 while stressing the following objectives

• strengthened national capacity for surveillance and response; • strengthened international systems for prevention, alerts and response to international public

health emergencies; and • global partnerships, international collaboration and collective actions.

Also in 2005, the APSED mandated a biregional strategy (with the WHO South-East Asia Regional Office) for strengthening capacity for communicable disease surveillance and response in the Region. The goal of the APSED was "to improve health detection in the Asia Pacific Region through productive partnerships for preparedness planning, prevention, prompt detection, characterization, and the containment and control of emerging infectious diseases" by directing countries to create a five­year, five-step programme to achieve minimum capacity requirements by 2010. The five capacity areas are surveillance and response, laboratory, zoonosis, infection control and risk communication.

Adhering to IHR (2005) and the APSED protocols, GOARN is committed to:

• enhancing technical capacities; • establishing disease surveillance and response; • strengthening laboratory networks; • building collaboration for systems development, and; • expanding collaboration on research among countries, intergovernmental organizations,

nongovernmental organizations (NGOs), public-private enterprises and academic and research institutions.

Recent GOARN deployments in the Region were noted, as were their missions and procedures. The major conclusions drawn about missions were that the emphasis should be on strengthening regional response capacity and the need to maintain a high level of regional and international deployment capabilities. In addition, with regard to regional, scenario-driven training, it was concluded that the involvement of country participants had improved training experiences and outcomes the sustained participation of partners needed to continue training and that the importance of investing in a pool of facilitators was a necessity.

Dr Tee closed her presentation by suggesting key steps to enhance GOARN activities in the Region: (a) regional meetings for continuing discussions and implementing activities; (b) fmalizing GOARN training strategy and training materials; (c) building on international involvement of GOARN partners in the Region; (d) sustained engagement of field epidemiology training programmes (FETPs);

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and (e) continued contingency planning and preparedness to deploy and engage GOARN partners for Pandemic HlNl 2009.

Mr Patrick Drury, Project Manager for Alert and Response Operations for WHO's Pandemic Alert and Response Unit, gave an overview of WHO's establishment of a global strategic partnership. He reviewed WHO's global regional organizations and its involvement in combating infectious diseases from polio to measles to AIDS to, more recently, H5Nl, SARS and HlNl. Mr Drury highlighted event management systems, disease surveillance, analysis and response as key components to WHO/GOARN response planning.

He described GOARN's primary aims of assisting countries with disease control efforts, ensuring rapid appropriate technical support to affected populations, investigating and characterizing events, assessing risks of rapidly emerging epidemic threats and supporting national outbreak preparedness by ensuring that responses contribute to sustained containment of epidemic threats. He then proposed "a radical new approach to all public health threats", involving:

• identifying outbreaks of potential international public health concern; verifying rumours with the affected country; coordinating international risk assessment; communicating public health information; and providing direct technical and operational assistance to the affected country.

In terms of building GOARN, several factors were cited. The mechanisms for outbreak response training, outbreak field logistics, field operations and operations were listed. The overall outcome of building the network would be:

access to resources, information exchange and sharing of best practices and technology transfer;

reducing vulnerability, strengthening resilience and providing redundancy;

alleviating costs by improving the use and mobilization of resources and providing surge capacity; and

strengthening transparency and credibility, enhancing dialogue and building trust.

It was made clear that no single institution has all of the capacity to address the complex and diverse array of epidemiological events affecting many of the world's regions. Different situations required different response methods- bilateral, multilateral, United Nations-coordinated. A brief review of emerging infectious diseases operations was listed. WHO mechanisms that led to declaring the HlNl outbreak a global pandemic also were recounted. The need to assist countries with HlNl prevention and control efforts, including direct technical assistance and field support, also were reviewed.

Currently, GOARN has nearly 200 technical institutions, partners and networks. Internally, it has an operational support team (OST), a steering committee (SCOM) for guidance overseeing planning and technical working groups and subcommittees established to focus on specific projects and issues.

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Mr Drury described GOARN's partners' priorities as:

• equitable and appropriate participation in field missions; • early alerts and requests for assistance; • estahlishing clear terms of referenr.e: for inte:rnfltion<1l missions; • composing clear terms of reference for experts; • rapid, transparent, consistent decision-making; • professional administration and contracting; and • dependable field logistics and consistent operational support.

In closing, Mr Drury stressed three focal points for the organization: (1) devising field information management systems for assessing and directing operations; (2) using the GOARN Steering Committee to evaluate and define guiding principles and standard operating procedures (SOPs) and operational communications protocols; and (3) coordination of training.

Dr Chin-Kei Lee, a medical epidemiologist and the CSR Team Leader with WHO China, spoke about GOARN's growth in China, including its early stages of cooperation with the Ministry of Health and the China CDC. The CDC has more than 3500 field offices in China's 23 provinces, five autonomous regions, four municipalities and two special administrative regions (Hong Kong and Macao).

With an abundance of staffmg, funding and improved management and growing interactions with overseas agencies, China appears ready to assist other nations with their own epidemiological incidents. There is evidence for this because of China's support and participation in the aftermath of relief efforts following the 2004 Indonesian tsunami and its internal experiences with disease surveillance, prevention and control after the 2008 Wenchuan earthquake.

Dr Lee said GOARN's early and continuous growth in China has been mutually beneficial to China and other countries. Both GOARN and China are discussing ways to advance their relationship. Communication and exchange was demonstrated by the creation of a joint China CDC/WHO video link and other collaboration. Expanding the relationship beyond infectious disease seems a certainty for the future.

Dr Yang Wiezhong, Deputy Director General of the China CDC, provided an overview of the Chinese health care network, an organizational review of the Chinese CDC and described Chinese infectious disease surveillance, alerts and the response mechanism for such events. The emergence of the SARS epidemic in 2002 and 2003 alerted the Chinese government to overhaul and expand its CSR activities, which had several recognizable deficiencies when the first of several epidemiological events began to surface early in the last decade. The strategic framework is as follows:

• establishing clear targets for the prevention and control of top priority infectious diseases (AIDS, tuberculosis, schistosomiasis and hepatitis B virus (HBV));

• improving early warning capacity, case management, investigation and intervention for intensified monitoring of infectious diseases (plague, cholera, SARS, H5Nl, A (HlNl);

• expanded vaccination programmes for diseases such as measles, polio, diphtheria, tetanus, mumps, rubella, and other important infectious diseases such as hepatitis Band A, Japanese encephalitis (JE), haemorrhagic fever with renal syndrome, leptospirosis and anthrax; and

• improving the capacity for detecting, identifying, investigating, control and preparedness of emerging infectious diseases such as SARS, H5Nl and HlNl.

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Dr Yang reported that China has introduced multisource information collecting or surveillance systems for disease monitoring and decision-making, including the notifiable infectious disease reporting system, the event-based surveillance system, the enhanced infectious disease surveillance system, the infectious disease-related vector surveillance system and the sentinel surveillance system. For example, the country has expanded its influenza surveillance network to 556 sentinel hospitals 1 411 laboratories covering all 31 provinces, autonomous regions and municipalities since June 2009 for monitoring the disease trends including influenza strains.

The current notifiable infectious disease reporting system is Internet-based and covers all 39 notifiable infectious diseases monitored by hospitals and clinics. With more than 68 000 users, the system covers 100% of CDC satellite units, 97% of county and higher level hospitals and more than 80% of township hospitals. Compared with the old system, the new system has the following advantages:

• improved the timeliness of reports; • improved the completeness and accuracy of surveillance data; • improved the ability of early outbreak detection; and • improved the ability of emerging diseases detection according to the indicator cases, such as

pneumonia, with unknown pathogens.

But the system still faced formidable challenges, including: (a) strengthening the evaluation of the surveillance system; (b) improving the analysis and interpretation of surveillance data; (c) using new methodology and techniques to facilitate information use and decision-making; (d) improving the capability of detecting and identifying other emerging infections; and (e) strengthening laboratory surveillance.

For the enhanced infectious disease surveillance system, encompassing more than 800 sentinel sites, covering 25 diseases such as cholera, plague, JE, shistosomiasis, leptospirosis, malaria, rabies, brucellosis, anthrax and Yersinia enterocolitica, has given the Chinese CDC the ability to get in-depth data about disease epidemiology, the immunity level in the population, pathogen variance and drug resistance.

These experiences allowed China to expand scientific and research development (such as rapid test kits for influenza), strengthening international collaboration (timely information exchanges with WHO and the Centers for Disease Control in the United States of America) and expanding its stockpiles of diagnostic reagents, antivirals and medical equipment.

The last segment of the presentation focused on H 1 N 1 's emergence in China and the country's efforts to control the epidemic, which has affected more than 46 000 Chinese to date. Also noted were efforts to mitigate the pandemic, which included expanding scientific and research development such as creating and distributing rapid test kits for influenza network labs, enhanced international collaboration and improving preparedness.

With the flu season fast approaching, he announced a number of measures aimed at reducing the spread and prevalence of H1N1, which were to include enhancing capacity in surveillance and investigation, launching vaccine distribution and immunization counseling, guiding efforts to control outbreaks in clinical settings, directing medical facilities in preparing infection prevention and control tasks, providing technical guidelines about consulting services for home care patients and establishing public prevention guidelines, information dissemination and communication.

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4. GOARN Missions and Field Experience

Dr Poh-lian Lim, a senior consulting physician with the Communicable Diseases Division of the Singapore Ministry of Health, and Dr Kan Biao, Deputy Director of the Chinese CDC's National Tnstitute for \.ommunicahle Disease Control anci Prf.vf.ntion, ('.haired this session, focusing on recent GOARN missions. The session reflected a range of international responses and the mechanisms in place regionally and globally to address current and emerging outbreaks such as H1N1, hanta and viral haemorrhagic fevers such as Ebola and recent missions primarily in Asia and Africa.

Miss Cawthorne of the Western Pacific Regional Office gave an overview of GOARN field missions during the past decade to show the different variations, large and small, in GOARN mobilizations in response to epidemiological outbreaks. Her report indicated that during the period 2000-2007, GOARN participated in more than 100 mobilizations in more than 60 countries, including:

• avian influenza (31 mobilizations); • viral haemorrhagic fevers (22 mobilizations); • meningococcal disease (13 mobilizations); • SARS (10 mobilizations); • yellow fever (eight mobilizations); and • natural disasters (six mobilizations).

Each mission required expertise in social mobilization and health education, case management and funerals, media communications and press briefmgs, coordination, logistics and security, surveillance, epidemiology and laboratory research. Eight case studies were used to show the varying degrees of responses. These included an Ebola outbreak in Uganda (2000), which involved 500 local and national personnel, 120 international staff, 22 institutions and four isolation facilities over the three affected zones; an Ebola outbreak in Congo (2002); and the post-tsunami CSR activities in Aceh, Indonesia (2005).

Other major events noted were dengue fever and myocarditis outbreaks in Sri Lanka (2005); disease surveillance following the 2008 Wenchuan earthquake in China (2008); the H1N1 virus in Malaysia (2009); a cholera and shigelloses outbreak in Papua New Guinea (2009); and an outbreak of Vibrio vulnificus cases in New Caledonia (2009).

Each of these events required a different level of response, of specialization and mobilization of staff, equipment and other resources. To further illustrate this, in 2006, GOARN's avian influenza response involved 30 missions that required 120 experts. Though each had similar terms of references, the field experiences were different in many cases. But overall, each event faced the same challenges of preparedness, infection control, surveillance system, diagnostic capacities, animal-human interface and social mobilization/risk communication.

In her review, Miss Cawthorne stressed that for most GOARN responses:

• the role of team members was impossible to standardize; • responsibilities sometimes were defmed poorly; • the need for flexibility and adaptability were a necessity; • a high level of technical skills and excellent communication (language) skills were essential in

many instances; and

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• a clear understanding of the playing field, including personnel and staffing requirements, national and local in-country partners, including NGOs and even local political and social leaders, is crucial to success.

Mr Drury of WHO Headquarters narrated a session on the role of craft networks in addressing the challenieS of viral haemorrhagic fevers (VHFs) and other emerging diseases worldwicie. He spoke on behalf of Dr Pierre Formenty of the CDS/CSR Department at WHO HQ who created the presentation but was unable to attend the meeting. The session focused primarily on GOARN's success and efforts in creating effective mechanisms for epidemic response to VHFs, including a Marburg outbreak in Rwanda (2005) and Ebola outbreaks in Uganda (2001) and Congo (2003), Rift Valley Fever in Sudan (2007) as well as pandemic A (HlNl) 2009, SARS, avian influenza and other agents.

As part of WHO's Global Alert and Response Programme, Dr Formenty's presentation focused on the need for:

• technical partnerships and networks to support international health security; • real-time information management and communications: field data and situational reports and

other data for decision-making; • joint risk analysis and decision support; • operational and technical planning; and • coordination of response activities.

An Emerging Diseases and Dangerous Pathogens Laboratory Network (EDPLN) comprised of laboratory outbreak response, assay and reagent development, technology transfer and training, international communication and applied research was recommended as a means of providing:

• A forum for real-time communication immediately following an outbreak alert and the sharing of technical advice on effective diagnostics and applied research platforms requirements.

• Scientific and technical decisions for deployment of effective scalable and deployable laboratory capabilities and coordination with clinical response teams and other stakeholders to improve patient management and outbreak control.

• Research and development on diagnostics, applications for field use and the appropriate transfer of technology to regional networks and countries in threatened regions.

• A safe collaborative environment and framework for sharing of knowledge and scientific expertise on laboratory science and tools for EDPs and disease ecology.

• Opportunities for participation in GOARN field responses.

The need for clinical networking and supporting technical networking also was emphasized to identify new and emerging diseases, clinical management, infection prevention and· control, communications, humanitarian considerations and aetiological/laboratory network.

Dr Formenty also called for the creation of a Global Infection Prevention and Control Network that would provide infection, prevention and control (IPC) recommendations on the prevention and/or containment of virus transmission. Its essential components would be data collection and management, including detailed records of the clinical course, clinical observation and differential diagnosis, clinical pathways, appropriate infection control practices, team management and training and quality assurance and improvement. J

The stated objectives of the presentation were:

• Establishing a global IPC network that would provide IPC recommendations on prevention and/or containment of transmission.

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• Assisting GOARN field responses through training and identifying experts for field deployment. • Supporting sustainable IPC preparedness in health care through advice on basic IPC

infrastructure and other technical advice. • Helping to disseminate WHO IPC policies and materials and lessons learned from crisis

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The presentation concluded with measures for improving GOARN's role in identifying, preventing and controlling epidemics such as creating a mechanism for rapid communications, efficient identification and evaluation of data and enhanced training of laboratory workers for disease diagnosis. Also emphasized was the need for ensuring global strategic protocols for emerging infectious diseases, on allowing countries more rapid access to the GOARN services and resources and turning knowledge into action with regard to communicable disease surveillance, prevention and control.

Professor Janusz T. Paweska, of the South African National Institute for Communicable Diseases, spoke about recent arenavirus outbreaks in Africa - Guinea, Liberia, Sierre Leone and Nigeria, among others. He cited "old world" viruses (Lassa, Mobala, Mopeia, Ippy) and "new world" viruses and the need for balancing public health intervention in the field and scientific research developments to identify, prevent and contain such diseases.

Dr Paweska cited a recent event of arenavirus and other zoonotic agents in Johannesburg, South Africa (2008), a Marburg outbreak in Rwanda (2005) and in Uganda (2001) and Congo (2003). The South Africa case proved particularly noteworthy. A new species of arena virus named the Lujo virus was identified - the first in more than 40 years, with patients showing viral haemorrhagic fever symptoms. The first case had originated near Lusaka, Zambia, and spread to Johannesburg, South Africa, after the original patient was transported to a hospital there.

Test results conducted by epidemiologists at Columbia University in New York and the Centers for Disease Control in Atlanta identified the virus. Ultimately, four of the five patients died, including two of three infected health workers who most likely were infected through contaminated materials and a South African businessman who traveled from Johannesburg to Rio de Janeiro, Brazil, and subsequently succumbed to the disease.

The outbreak of the first new case of an "old world" arenavirus was limited to these five individuals. The source of the Lujo virus, as it is now called, has yet to be determined. GOARN partners continue to support the involved countries in various facets of the outbreak investigation, including laboratory diagnosis, investigations, active cases and follow-up with contacts.

Dr Amadou Alpha Sail, a noted epidemiologist with the Institute Pasteur Dakar, spoke about yellow fever risk assessment, citing 200 000 infections and 30 000 deaths annually in unvaccinated populations. While 90% of cases occur in Africa, some questioned the inevitability of diseases such as yellow fever reaching countries such as China and other largely, unaffected regions of the world and measures - vaccination and vector controls -- in place to reduce this possibility.

The 17D vaccine, developed in the 1930s, has provided protection for more than 10 years, and more than 500 million doses are administered annually. However, in most instances, countries with a prevalence of endemic yellow fever lieport a vaccination rate of merely 50% of the population. But a 2006 programme by WHO and the Global Alliance for Vaccines and Immunization (GAVI) has targeted 12 West African nations for enhanced yellow fever vaccination programmes. Because the disease is widespread in several monkey populations endemic to the region, vaccination is regarded as the best means of controlling yellow fever.

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Dr Sall cited no increased risk of yellow fever in recent studies conducted in Africa, stressing the importance of standardization of protocols and guidelines for controlling the disease. He reported about countries combating yellow fever, including the Central African Republic, which has a relatively low rate of infection because of a high vaccination rate of more than 90% of its population.

An evaluation of efforts by the Central African Republic at assessing the prevalence of the disease in the mosquito populations (32 species of mosquitoes were tested) and among several monkey species (66 animals were tested) also was provided. In addition, a survey was conducted with more than 1800 people to determine their knowledge and infection rate of the disease.

From this research data, Dr Sail reported the following preliminary conclusions and recommendations:

no increased risk of yellow fever activity was found and improvements in yellow fever surveillance were evident; a continued risk for yellow fever emergence as well as spread to other regions remained a possibility;

• detailed analysis by region and zones on progress was necessary; the study might be transferable to travelers from nonendemic regions;

• samples can be used for evaluation of other vector-borne diseases; protocols are being written and being made generic for other regions of the world and Africa; and · technical guidelines are being written from lessons learned.

Dr Li Qun, Deputy Director of the Office for Disease Control and Emergency Response for the China CDC, reported on the Chinese response to the May 2008 Wenchuan earthquake that killed more than 85 000 people and displaced another 15 million. Dr Li gave a comprehensive, statistical review of China's response, which included direct medical services and disease surveillance and prevention and control mechanisms used by the CDC and other Chinese health agencies. The CDC examined its activities in the emergency phase (the first 72 hours after the earthquake) and the reconstruction phase, which is continuing.

In the immediate aftermath (the first 72 hours) of the earthquake, more than 35 000 medical workers were sent to treat nearly 70 000 wounded and 15 000 seriously injured people, the Ministry of Health deployed an additional 3900 antiepidemic staff and 644 epidemic-prevention vehicles to combat potential communicable diseases from water- and food-borne contaminants. Among the activities undertaken was the surveillance for diseases such as cholera, typhoid, hepatitis A, tuberculosis, vector­borne agents, zoonotic viruses and vaccine-preventable infectious diseases.

About 9200 medical staff were mobilized and 2500 immunization sites were established to combat vaccine-preventable diseases (VCDs). Children with no precise immunization histories were a high priority. The rapid restoration of the disease surveillance and reporting system was made possible through a mobile phone system, which employed 560 devices from 368 communicable disease­reporting stations in the affected areas.

The cumulative actions of medical, public health and disease prevention and control efforts included the deployment of more than 6600 medical teams which resulted in a 43% decrease in the number of focal infectious disease and a 38% decrease in mortality rates for those diseases in the comparable period between 2005 and 2007. Consequently, in the earthquake-affected areas:

• no large-scale communicable disease outbreaks occurred;

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• a significant reduction in epidemic risk factors was achieved; • the removal of environmental hazards in the 21 earthquake-affected counties was near 100%;

and • a near 100% restoration of the reporting system for infectious diseases in the affected areas

had been achieved.

The overwhelming message was that the Chinese government learned much from this disaster and preparations and systems are in place for future events of this kind. In addition, there is an increasing willingness of China to lend its support to international responses to natural and epidemiological events.

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5. Experiences from the Field: China's National and International Responses

The session was moderated by Mr Drury and Dr Li Dexin, Director of the National Institute for Viral Disease Control and Prevention at the Chinese CDC. This session focused on China's recent epidemiological response efforts at home and ahroad.

'

Dr Liu Qiyong, Director of the Department of Vector Biology and Control at the Chinese CDC's National Institute for Communicable Disease Control and Prevention, gave a brief review of China's recent experiences with vector-borne disease (VBD) control and response and Chinese government efforts at sustainable management of disease vectors. In China, emphasis is on local mechanisms for dealing with emerging diseases in everyday and disaster scenarios. Dr Liu's presentation shows· China's recent international response mobilizations to contain vector-borne diseases such as dengue fever, JE and malaria in tsunami-affected areas of Sri Lanka (2004-2005), with Chikungunya Fever in Mauritius (2006) and multiple VBD-disease control and management efforts following the Wenchuan earthquake.

Among the items stressed was the need to apply appropriate vector control strategies at different periods, to perfect the vector control system according to the disease growth situation in consideration of factors such as resources and staffing, materials and fmance and risk assessment of VBDs as the key basis for wise and effective vector control, especially in emergency response. Among the major topics of concern were:

emerging vectors and VBDs under climate change; risk assessment and alert on vector and VBDs; rapid and accurate identification of disease vectors; sustainable development and application of pesticides; vector surveillance and control in emergencies; vector surveillance and management in big events; and strategic framework for sustainable management of disease vectors.

Dr Liu cited the establishment of the National Vector Surveillance Network in 2007 as a major achievement in Chinese efforts to establish an effective mechanism for controlling and responding to vector-borne agents. The current network is comprised of 43 cities in 19 provinces of China. In closing, Dr Liu said that through global communications networks and cooperation, the China CDC would promote the development of vector control, the sharing of technical information and the communication of new achievements and new products and thereby contribute significantly to the realization of sustainable vector control.

As part of its effort to show China's expanded participation in international relief efforts, Dr Ji Rang, director of the Biological Contamination and the Monitoring Laboratory at the National Institute of Nutrition and Food Safety at the Chinese CDC, spoke about China's participation in the international response to the 2004 Indonesian tsunami which killed more than 160 000 people and displaced more than 500 000. China dispatched four medical teams and more than 160 personnel to Aceh, Indonesia.

In addition to the medical and pharmaceutical services these teams provided, they also conducted health assessments of drinking water, nutrition, waste disposal and the distribution of supplies in refugee camps, which contributed to the prevention of potential communicable diseases. In its largest international aid operation, the Chinese teams provided significant clinical services while collaborating with relevant local and international organizations and navigated various logistical concerns such as staff management and health, safety and security concerns.

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Dr Tony Stewart of the Burnet Institute of Melbourne, Australia, discussed the institute's activities and participation in GOARN. Located in eight countries in Asia, the Pacific and Africa and with an international medical staff of 160 people, the institute links laboratory research and public health to the aim of reducing the impact of serious infectious diseases such as HIV, hepatitis, malaria, tuberculosis, avian influenza, cancers such as breast, ovarian and prostate, and inflammatory diseases such as rheumatoid arthritis and lupus. Its range of expertise includes virology, immunology, diagnostics development, epidemiology, mother and child health/community paediatrics, communications/information, educational and communication materials development, education and training and health systems strengthening.

As a GOARN member since 2005, the institute is partnered with several United Nations agencies, regional bodies and NGOs at the regional, country and local levels. It also promotes education and training via public and international health doctoral programs with Monash University and the University of Melbourne in Australia and in public health short courses available to the staff of private and nonprofit organizations. Its participation in GOARN has included staff training at WHO HQ, presentations and assistance at previous GOARN meetings, training simulations (Geneva, the Philippines, Australia) and deployment to GOARN activities following the Indonesian tsunami and a cholera outbreak in Zimbabwe in December 2008.

In conclusion, Dr Stewart offered benefits that GOARN membership gave to partner institutions (staff training, preparedness for international and transborder events), stressed the importance of establishing agreements on participation, such as staffmg, fmancing and time commitments and showed how the institute's experiences with GOARN serves as a model for other current and participating members in areas such as:

• assisting with the implementation of country and regional training; • participation in regional exercises; • active involvement in the steering committee; and • identifying other institutions that may join GOARN.

Miss Cawthorne of the Western Pacific Regional Office and Dr Feng Zijian, Director of the Office of Disease Control and Emergence Response at the Chinese CDC, gave the closing remarks, thanking the participants and encouraging their continued support and participation in GOARN activities worldwide. Participants also were invited to attend the next GOARN conference, scheduled for March 2010 in Siem Reap, Cambodia.

PROGRAMME OF ACTMTIES

Day 1 -Monday, 19 October 2()(}9 Opening session

Opening Remarks - Dr Michael 0 'Leary, WR/China

Welcome Remarks

ANNEX 1

- Dr Liang Wannian, DDG, Health Response Office, China MoH -Dr Yang Weizhong, DDG, Chinese CDC

Introduction: Meeting Objectives and Outcomes -Amy Cawthorne

Section 1 - GOARN Overview: The Global and Regional Perspective Chair: Dato' Dr Tee Ah Sian and Dr Feng Zijian

APSED and the Development of GOARN in the Region - Dato' Dr Tee Ah Sian, DCC, WHO/WPRO

Global Alert and Response - Dr Mike Ryan, Director, EPRICDS, WHO/HQ

GOARN: Development of a Global Strategic Partnership - Mr Pat Drury

Question and Discussion Period

GOARN: Development in China - Dr Chin-Kei Lee

Overview of the Infectious Disease Surveillance, Alert And Response System in China - Dr Yang Weizhong

Question and Discussion Period

Section 2 - GOARN Missions and Experiences from the Field Chair: Dr Poh-lian Lim and Dr Klm Biao

GOARN Field Missions: An Overview - Amy Cawthorne

Within GOARN, The Role of Craft Networks in Addressing The Challenge of VHFs and Other Emerging Diseases - Mr Pat Drury on Behalf of Dr Pierre Formenty

Arena Virus Outbreaks: GOARN Partners Involvement in the Identification of a New Virus

Professor Janusz T. Paweska

•

Annex 1

Question and Discussion Period

Yellow Fever Risk Assessment Mission - Dr Amadou Alpha Sall

Response to the May 2008 Wenchuan Earthquake (China) DrLiQun

Question and Discussion Period

Day 2 - Tuesday, 20 October 2009

Section 3 - Experiences from the field: China Is national and international responses Chair: Dr Mike Ryan and Dr Li Dexin

Experiences of Participating in an International Response to Vector-Borne Disease Occurences - Dr Liu Qiyong

Experiences of Chinese CDC Is Participation in the Tsunami Response in Indonesia, 2006 - DrliRong

Question and Discussion Period

institutional Motivations, Benefits and Costs for Involvement in WHO Field Missions - Dr Tony Stewart

Question and Discussion Period

Conclusions and Recommendations

Closing Remarks Amy Cawthorne, WPRO Dr Feng Zijian, Director, DCERO/Chinese CDC

Field Trips:

Great Wall Tour

Tour and Dinner at the New Campus of the Chinese Center for Disease Control and Prevention hosted by Dr Wang Yu, Director General of the Chinese CDC

CAMBODIA

CHINA

PROVISIONAL LIST OF PARTICIPANTS, TEMPORARY ADVISERS, OBSERVERS AND SECRETARIAT

1. PARTICIPANTS

Dr Sirenda:VONG, Institut Pasteur du Cambodge 5, Monivong Blvd., P.O. Box 983, Phnom Penh

ANNEX2

Tel. no. : (855) 1280 2982; Fax no. : (855) 2372 5606 Mobile : (855) 12 333 650 E-mail : svong@pasteur-kh.org

Dr MAO Suling, Vice Director Sichuan Provincial CDC, No. 6 Zhongxue Road, Chengdu Tel. no. : 028-85582913; Mobile : 028-85582320 E-mai~ sulingmao@vip.163.com

Dr MAERDANG Abudureheman, Deputy Director CDC of Xinjiang Uyghur Autonomous Region 380 Jianguan Yijie Street, Urumqi, Xinjiang 830002 Tel. no. : 0991-2615505; Fax no. : 0991-2625962 E-mail: xjcdcmed@163.com

Dr LAN Hong, Head, Office dealing with emergency cases Gangsu Provincial CDC, 230 Donggangxi Avenue Room 703, Lanzhou, Gansu 730000 Tel. no. : 0931-8265913; Fax no. : 0931-8272156 E-mail : Gscdcyjb@163.com

Dr LI Zhaoyi, Section Chief Guizhou Provincial CDC, Bageyan Street

- Guizhou Province, Guiyang City Tel. no. : 0851-6822632; Fax no. : 0851-6816162 Mobile : 135-95107118 E-mail : Lizy@gzcdc.gov .en

Dr YUE Jianning, QingHai Provincial CDC 66 Ba Yi Road, Xi Ning, QingHai 81007 Tel. no. : 0971-8801358; Fax no. : 0971-8801318 E-mail: yuejianning@126.com

Dr LI Li, Endemic Diseases Control and Prevention CDC of Ningxia Hui Autonomous Region 470, Shengli Street, Xingging District, Yinchuan, Ningxia Tel. no. : 0951-4087302; Fax no. : 0951-4077307 E-mail: nxcdc_lili@126.com

Annex 2

CHINA (cont'd.) Dr BAI Xuetao, Institute for Environment Hygiene and Health Related Product Safety, Chinese CDC, Beijing Tel. no. : 010-67754147; Fax no. : 010-67719392 E-mail: baixt@.yahoo.com

Dr CAO Bin, Chaoyang Hospital, Chaoyang, Beijing Tel. no. : 13911318339

Dr CAO Minghua, Anhui Provincial CDC, Anhui Tel. no. : 0551-2863087; Fax no. : 0551-2860524 E-mail : comhjackson@sina.com

Dr CAO Wuchun, Military CDC, Beijing Tel. no. : 010-66948501; Fax no. : 010-63815259

Dr CHEN Biyun, Hunan Provincial CDC, Hunan Tel. no. : 0731-4305970; Fax no. : 0731-4305853 E-mail: chenbiyun666@sina.com

Dr CHEN Fengxin, Ditan Hospital, Beijing Tel. no. : 010-84322172; Fax no. : 010-84397205

Dr CHEN Haomin, Henan Provincial CDC, Henan Tel. no. : 0371-68089089; Fax no. : 0371-68089008 E-mail : chenhm@hncdc.com.cn

Dr CHEN Weishi, Guangdong Provincial CDC, Guangdong Tel. no. : 020-89101322; Fax no. : 020-89101322 E-mail chenws3076@163.com

Dr CHEN Zhiping, Zhejiang Provincial CDC, Zhejiang Tel. no. : 0571-87115006; Fax no. : 0571-87115000 E-mail: zpchen@cdc.zj.cn

Dr DENGYing, Beijing CDC, Beijing Tel. no. : 010~64407019; Fax no. : 010-64407019

Dr DING Fan, Office for Disease Control and Emergency Response, Chinese CDC, Beijing Tel. no. : 010-83167453 E-mail: dingfan168@163.com

Dr FENG Lin, Office for International Cooperation Chinese CDC, Beijing Tel. no. : 010-83159113; Fax no. : 010-83159113 E-mail: FENGLINK@126.com

CHINA (cont'd.)

Annex 2

Dr GUO Weidong, Inner Mongolia CDC, Inner Mongolia Tel. no. c: 0471-6984920; Fax no. : 0471-6984920 E-mail: gwd.com@126.com

Dr HAN Hongwei, Institute for Nutrition and Food Safety Chinese CDC, Beijing Tel. no. : 010-67791292; Fax no. : 010-67711813

Dr HAN JiXiu, Division of International Organization Department of International Cooperation Ministry of Health, Beijing

Dr HE Yi, Shanghai CDC, Shanghai Tel. no. : 021-62758710; Fax no. : 021-62192593 E-mail: yhe@scdc.sh.cn

Dr HONG Rongtao, Fujian Provincial CDC, Fujian Tel. no. : 0591-~7528254; Fax no. : 0571-87607324 E-mail : hrt@fjcdc.com.cn

Dr HUANG Liuyu, Military CDC, Beijing Tel. no. :c 010-66948~07; Fax no. : 010-66948307 E-mail: pengpla@126.com

Dr JIN Huarui, Inner Mongolia CDC, Inner Mongolia Tel. no. : 0471-5984920; Fax no. : 0471-5984902

Dr JIN Ronghua, You' an Hospital, Beijing Tel. no. : 139-0137-4552

Dr KAN Biao, Institute for Communicable Disease Control and Prev~ntion, Chinese CDC, Beijing Tel. no. : 010-61739458; Fax no. : 010-61739458 E-mail: kanbiao@icdc.cn

Dr LI Dexin, Institute for Viral Disease Control and Prevention, Chinese CDC, Beijing Tel. no. : 010-63572877; Fax no. : 010-63572877

Dr LI Qi, Hebei Provincial CDC, Hebei Tel. no~ : 0311-86573358; Fax no. : 0311-86573358

Dr LI Shizhu~ National Institute of Parasitic Disease Chines~ CDC, Shanghai Tel. no. : 021-6474-6458; Fax no. : 021-6474-6458 E-mail : stonelicdc@sh163.net

Dr LI Xinwu, Institute for Environment Hygiene and Health Related Product Safety, Chinese CDC, Beijing Tel. no. : 010-8777-9905; Fax no. : 010-6771-9392 E-mail : lxwcdd@sina.com

Annex 2

CHINA (cont'd.) Dr LIANG Wannian, Deputy Director-General Office of Health Emergency Response Ministry of Health, Beijing Tel. no. : 010-6879-2576 E-mail : Liangwn@moh.gov .en

Dr LIANG Xiaofeng, Director National Immunization Programme Chinese CDC, Beijing Tel. no. : 010-63176737; Fax no. : 010-63171724 E-mail: langxf@hotmail.com

Dr LIU Bo, Office for Disease Control and Emergency Response, Chinese CDC, Beijing Tel. no. : 010-8316-7453 E-mail: paratus@tom.com

Dr LIU Xiaoqing, Jiangxi Provincial CDC, Jiangxi Tel. no. : 0791-8183872; Fax no. : 0791-8319800 E-mail liuxql3@163.com

Dr LU Guiyang, Hubei Provincial CDC, Hubei Tel. no. : 027-87652061;-Fax no. : 027-87652076 E-mail: lgycdc@163.com

Dr LU Shan, Institute for Communicable Disease Control and Prevention, Chinese CDC, Beijing Tel. no. : 010-61739466; Fax no. : 010-61739466 E-mail: wangkanglin@icdc.cn

Dr MA Huilai, CFETP Office, Chinese CDC, Beijing Tel. no. : 010-83133202; Fax no. : 010-83133202 E-mail : huilaima@cfetp.org.cn

Dr MENG Hong, Heilongjiang Provincial CDC, Heilongjiang Tel. no. : 0451-55153609; Fax no. : 0451-55153609 E-mail: menghong66@163.com

Dr NI Daxin, Office for Disease Control and Emergency Response, Chinese CDC, Beijing_ Tel. no. : 010-63177356; Fax no. : 010-63177356 £:.mail: jsndx@vip.sina.com

Dr QIANG Zhengfu, Director Office for International Cooperation, Chinese CDC, Beijing Tel. no. : 010-83160720; Fax no. : 010-83160720 E-mail: qiangzf@chinacdc.cn

ClllNA (cont'd.) Dr QIN Mingfang, Yunnan Provincial CDC, Yunnan Tel. no. : 0811-3610500; Fax no. : 0871-3611102 E-mail: qmfjf@126.com

Dr SHEN Zhuang, Beijing CDC, Beijing Mobile : 13901185153; Fax no. : 010-644U'/U1Y

Annex 2

Dr SID Guoqing, CFETP Office, Chinese CDC, Beijing Tel. no. : 010-83171510; Fax no. : 010-83171510 E-mail: shiguoqing66@sina.com

Dr SID Ping, Jiangsu Provincial CDC, Nanjing Tel. no. : 025-8375-9408 E-mail : shiping@jscdc.cn

Dr SU Qiru, Office for Disease Control and Emergency Response, Chinese CDC, Beijing Tel. no. : 010-83153724; Fax no. : 010-83153724 E-mail : shinefirefly@126.com

Dr SUN Hui, Office for Disease Control and Emergency Response, Cpinese CDC, Beijing Tel. no. : 010-83163341; Fax no. : 010-63047378 E-mail: sunhui124@163.com

Dr SUN Jun, Chongqing CDC, Chongqing Tel. no. : 023-68805196; Fax no. : 023-68805196 E-mail: chongqing@126.com

Dr SUN Junling, Office for Disease Control and Emergency Response, Chinese CDC, Beijing Tel. no. : 010'-6302-5413

Dr TU Wenxiao, Office for Disease Control and Emergency Response, Chinese CDC, Beijing Fax no. : 010-83153724

I

E-mail: tuwenxiao@gmail.com

Dr WANG Jian, General Office, Chinese CDC, Beijing Tel. no. : 010~83164617; Fax no. : 010-63170894 E-mail: wangjian@chinacdc.cn

Dr WANG Rui, Office of Disease Control and Emergency Response, Chinese CDC, Beijing Tel. no. : 010-6317-7356 E-mail: Wangri7224@163.com

Dr WANG Shiwen, Institute for Viral Disease Control and Prevention, Chinese CDC, Beijing Tel. no. : 010-8354-6229

Annex 2

CHINA (cont'd.) Dr WANG Yu, Director-General Chinese CDC, Beijing Tel. no. : 010-63033502 E-mail: wangyu@chinacdc.cn

Dr WANG Zijun, Office for Disease Control and Emergency Response, Chinese CDC, Beijing Tel. no. : 010-63045571; Fax no. : 010-63047378 E-mail: zijunwang@sohu.com

Dr XIONG Weiyi, Office for Disease Control and Emergency Response, Chinese CDC, Beijing Tel. no. : 010-63177356; Fax no. : 010-63177356 E-mail: x_weiyi@vip.163.com

Dr XU Bianli, Henan Provincial CDC, Henan Tel. no. : 0371-68089291; Fax no. : 0371-68089008 E-mail : xubl@hncdc.com.cn

Dr XU Xuqin, Zhejiang Provincial CDC, Zhejiang Tel. no. : 0571-87115140; Fax no. : 0571-87115147 E-mail: xqxu@cdc.zj.cn

Dr XU Zb.en, Office for Disease Control and Emergency Response, Chinese CDC, Beijing Tel. no. : 010-83167453; Fax ·no. : 010-63152572 E-mail : xuzhen@chinacdc.cn

Dr YANG Jinye, CDC of Guangxi Zhuang Autonomous Region, Guangxi . Tel. no. : 0771-2518833; Fax no. : 0771-2518768

Dr YAO Wenqing, Liaoning Provincial CDC, Liaoning Tel. no. : 024-23388236; Fax no. : 024-23373123

Dr YI Jianrong, Guangdong Provincial CDC, Guangdong Tel. no. : 020-84466336; Fax no. : 020-84466336 E-mail : gdyq@cdcp.org.cn

Dr YIN Zundong, Center of Nationallmm.unization Program Chinese CDC, Beijing Tel. no. : 010-8315~9521 E-mail: yinzd@chinacdc.cn

Dr ZENG Zhaochang, Hainan Provincial CDC, Hainan Tel. no. : 0898-6533 3245; Fax no. : 0898:..6533 3245 E-mail: hicdc@163.com

ClllNA (cont'd.)

JAPAN

Dr ZHANG Jiemin, Shanxi Provincial CDC, Shanxi Mobile: !3903513179; Fax no. : 0351-7553026

Annex 2

Dr ZHANG Qian, Office for Disease Control and Emergency Response, Chinese CDC, Beijing Tel. no. : 010-83133671; Fax no. : 010-K:lU:;671 E-mail : zhangqian527@126.com

Dr ZHANG Weidong, Office for Disease Control and Emergency Response, Chinese CDC, Beijing Tel. no. : 010-63132075; Fax no. : 010-63132075 E-mail: crunoh07@yahoo.com.cn

Dr ZHANG Weimin, Institute for Nutrition and Food Safety Chinese CDC, Beijing Tel. no. : 010-67791292; Fax no. : 010-67711813

Dr ZHANG Wensheng, Tianjin CDC, Tianjin Tel. no. : 022-24333432; Fax no. : 022-24333433 E-mail : zws.202@163.com

Dr ZHANG Yanping, Institute for Viral Disease Control and Prevention, Chinese CDC, Beijing Tel. no. : 010-83546729; Fax no. : 010-83559952 E-mail : zyp345@Sohu.com

Dr ZHENG Liping, Office for International Cooperation Chinese CDC, Beijing Tel. no. : 010-63022960; Fax no. : 010-63022960 E-mail : zhenglp@chinacdc.cn

Dr XU Min, Office of Health Emergency Response Ministry of Health, Beijing Tel. ·no. : 010-6879-2976 E-mail : xumin@moh.gov .en

Dr ZHOU Hang, Office for Disease Control and Emergency Response, Chinese CDC, Beijing Te~. no. : 010-83163341; Fax no. : 010-63047378 E-mail: zhouhang@chinacdc.cn

Dr Kouichi MORITA, Professor and Head Department of Virology, Institute of Tropical Medicine Nagasaki UniversitY,, 1-12-4 Sakamoto-machi Nagasaki 852,..8523 Tel. no. : (81 95) 819 7827; Fax no. : (81 95) 819 7830 E-mail : moritak@nagasaki-u.ac.jp

Annex 2

JAPAN (cont'd.)

NEW CALEDONIA

PHILIPPINES

Dr Kazuhiro KAKIMOTO, Technical Official and Communicable Disease Control Advisor Bureau of International Cooperation, International Medical Center of Japan, 1-12-1, Toyama, Shinjuku City, Tokyo Tel. no. : (81 3) 3202 7181; Fax no. : (81 3) 3205 7860 E-mail : k-kakimoto@it.imcj.go.jp

Dr Nobuhik:o OKABE, Director Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku Tokyo 162-8640 Tel. no. : (81 3) 5285 1111 Ext. 2501 Fax no. : (81 3) 5285 1129 E-mail : okabenob@nih.go.jp

Dr Toru CHOSA, Senior Consultant of Internal Medicine Kyushu Industry Health Foundation, St. Mary Hospital Nagata Bldg 4F, Chuou-Maehi 32-24 Kurume-Shi, Fukuoka 830-8583 Tel. no. : (81 9) 4235 8195; Fax no. : (81 9) 4238 7063 E-mail : tchosa@tkk.att.ne.jp

Dr Justus BENZLER., Communicable Disease Surveillance Specialist, Secretariat of the Pacific Community BP D5, NC 98848, Noumea Cedex Tel. no. : (687) 26 20 00 Ext. 232; Fax no. : (687) 26 38 18 E-mail : justusb@spc.int

Dr Vito ROQUE Jr., Medical Specialist IV Public Health Surveillance and Informatics Division N ational1 Epidemiology Center, First Floor, Building 9 Department of Health, San Lazaro Compound, Tayuman St. Sta. Cruz, Manila 1003 Tel no. : (632) 251 4203; Fax no. : (632) 743 8301 E-mail: vitogroquejr@yahoo.com

2. TEMPORARY ADVISERS

Professor John S. MACKENZIE, Australian Biosecurity CRC Curtin University of Technology, GPO Box U1987 Perth, W A6845 Tel no. : (613) 9822 6223; Mobile : (614) 3987 5697 Fax no. : (618) 9266 1650 E-mail : J .MacKenzie@curtin.edu.au

Annex 2

TEMPORARY ADVISERS (cont'd.) Dr Anthony PauLSTEWART, Medical Epidemiologist Emerging Infectious Diseases, The Macfarlane Burnet Institute, for Medical Research & Public Health Ltd., Centre for Internati9nal Health, GPO Box 2284, Melbourne, Victoria Tel no. : (614) 1429 8627; Fax no. : (613) 9787 8210 E-mail : tonys(g)bumet.edu.au

Dr Poh Lian LIM, Senior Consultant Physician Department of Infectious Diseases, Tan Tack Seng Hospital Communicable Diseases Division, Ministry of Health 11 Jalan Tan Tack Seng, Singapore 308433 Tel no. : (658) 126 3253; Fax no. : (656) 252 4056 E-mail : poh_lian_lim@ttsh.com.sg; LIM_Poh_Lian@moh.gov.sg

Dr Amadou Alpha SALL, lnstitut Pasteur de Dakar Unite des Arbovirus et Virus de fievres hemorragiques 36, Avenue Pasteur, BP 220, Dakar, Senegal Tel. no. : (221) 338399223 (fixe); (221) 775700303 (portable) Fax no. : (221) 338399210 E-mail : asall@pasteur.sn

Professor Janusz T. PA WESKA, Head Special Pathogens Unit, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4 Sandringham-Johannesburg, 2131 Modderfontein Road 1 Gauteng, South Africa . Tel. no. : (2711) 386 6382 I 6336; Fax no. : (2711) 882 3741 E-mail : januszp@nicd.ac.za

Dr YANG Weizhong, Deputy Director-General China Center for Disease Control and Prevention #27 Nanwei Road, Xuanwu District, Beijing Tel. no. : 010-8315288; Fax no. : 010-8315288 E-mail : yangwz@chinacdc.cn

Dr LI Qun, Deputy Director Office for Disease Control and Emergency Response China Center for Disease Control and Prevention #27 Nanwei Road, Xuanwu District, Beijing Tel. no.·: 010-63045571; Fax no. : 010-63047378 E-mail: fyklq@vip.sina.com

Dr LIU Qiyong, Assistant Director and Research Fellow Institute for Communicable Disease Control and Prevention China C~nter for Disease Control and Prevention #5, Liuzi, Changping District, Beijing Tel. no. : 010-61731296; Fax no.: 010-61731296 E-mail : liuqiyong@icdc.cn

Annex 2

TEMPORARY ADVISERS (cont'd.) Dr ll Rong, Director of Biological Contamination and Monitoring Laboratory, Institute for Nutrition and Food Safety, China Center for Disease Control and Prevention #7 Panjiayuan, Chaoyang District, Beijing

AUSTRALIAN AGENCY FOR INTERNATIONAL DEVELOPMENT (AUSAID)

EMBASSY OF CANADA

WHOIWPRO

Tel. no. : 010-67799342; Fax no. : 010-67799342 E-mail : Jirong36@163.com

Dr FENG Zijian, Director for Office for Disease Control and Emergency Response, China Center for Disease Control and Prevention, 27 Nanwei Road, Xuanwu District, Beijing Tel. no. : 010-63131219; Fax no. : d10-63131219 E-mail: fengzj@chinacdc.cn or; fengzj64@sina.com

3. OBSERVERS/REPRESENTATIVES

Dr Linna CAl, Senior Policy Officer (Health) Development Cooperation, Australian Embassy 21 Dongzhimen , Wai Dajie, Beijing 100600 Tel. no. : (86 10) 5140 4404; Fax no. : (86 10) 5140 4199 E-mail : linna.cai@dfat.gov .au

Dr Felix Ll, Minister Counsellor (Health) 19 Dongzhimenwai Dajie, Chaoyang District, Beijing Tel. no. : (86 10) 5139 4058; Fax no. : (86 10) 5139 4454 E-mail : felix.li@international.gc.ca

4. SECRETARIAT

Dato' Dr TEE Ah Sian, Director Combating Communicable Diseases, World Health Organization,-Regional Office for the Western Pacific P.O. Box 2932, 1000 Manila Tel. no. : (632) 528 9701; Fax no. : (632) 521 1036 E-mail : teeas@wpro. who.int

Ms Amy CAWTHORNE, Epidemiologist Communicable Dis_ease Surveillance and Response World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila -Tel. no. : (632) 528 9917; Fax no. : (632) 528 1036 E-mail : cawthornea@wpro. who.in

WHOIWPRO (cont'd.)

WHO/HQ

WHO/CHN

Ms Janet MINA, Administrative Assistant Communicable Disease Surveillance and Response

Annex 2

World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila Tel. no. : (632) 528 9729; Fax no. : (632) 521 1036 .E-ma11 : mmaJ@wpro. who.int

Mr Patrick DRURY, Project Manager Alert and Response Operations (ARO) Department of Epidemic and Pandemic Alert and Response World Health Organization, Geneva Tel. no. : (41 22) 791 3692; Fax : (41 22) 791 1397 E-mail: druryp@.who.int

Ms Sameera SURI, Communications Officer Global Outbreak Alert and Response Network World Health Organization, Geneva Tel. no. : (41 22) 791 1058; Fax no. : (41 22) 791 1397 E-mail : suris@.who.int

Dr Michael O'Leary, WHO Representative in China World Health Organization, 401, Dongwai Diplomatic Office Building, 23, Dongzhimenwai Dajie Chaoyang District, Beijing 1000600 Tel. no. : (8610) 6532 7189 Ext. 81210 Fax no. : (8610) 6532 2359 E-mail: olearym@wpro.who.int

Dr Chin-Kei LEE, Medical Epidemiologist Communicable Disease Surveillance and Response World Health Organization, 401, Dongwai Diplomatic Office Building, 23, Dongzhimenwai Dajie

. Chaoyang District, Beijing 1000600 Tel. no. : (8610) 6532 7189 Ext. 81249 Fax no. : (8610) 6532 2359 E-mail : LeeC@wpro. who.int

Mr ZHANG Xiaodong, National Programme Officer (NPO) Communicable Disease Surveillance and Response World Bealth Organization, 401, Dongwai Diplomatic Office Building, 23, Dongzhimenwai Dajie Chaoyang District, Beijing 1000600 Tel. no. : (8610) 6532 7189 Ext. 81244 Fax no. : (8610) 6532 2359 E-mail : zhangxia@wpro. who.int

Annex 2

WHO/CHN (cont'd.) Ms WU Sheng, Secretary Communicable Disease Surveillance and Response World Health Organization, 401, Dongwai Diplomatic Office Building, 23, Dongzhimenwai Dajie Chaoyang District, Beijing 1000600 Tel. no. : (8610) 6532 7189 Ext. 81245 Fax no. : (8610) 6532 2359 E-mail : wus@wpro.who.int

Ms SUN Yue, Secretary Communicable Disease Surveillance and _Response World Health Organization, 401, Dongwai Diplomatic Office Building, 23, Dongzhimenwai Dajie Chaoyang District, Beijing 1000600 Tel. no. : (8610) 6532 7189 Ext.-81291 Fax no. : (8610) 6532 2359 E-mail : sunyu@wpro. who.int

5. CONSULTANT

Mr Chris TERRY, President T & T Publishing Associates, Fangcaodi Xijie 6, Di Yang Gong Yu 6071, Chaoyangqu District, Beijing 100020 Mobile : (86) 13 43 951 0432 E-mail : cterrychina@gmail.com; SKYPE: christo1922

ANNEX3

Listing of GOARN Partners in the Western Pacific Region

As of October 2009, forty (40) GOARN Partners are currently active in countries within the Western Pacific Region. The listings of organizations by country is as follows:

Australia

Cambodia

China

Victorian Infectious Diseases Reference Laboratory (VIDRL) http://www. vidrl.org.au/

National Centre for Epidemiology and Population Health (NCEPH), The Australian National University (ANU) http:/ /nceph.anu.edu.au/

Westrnead Hospital http: I /www. cidm. info/

Burnet Institute for Medical Research and Public Health http://www. burnet.edu.au

Australian Biosecurity Cooperative Research Centre (CRC), Curtin University http:/ /wwwl.abcrc.org.au/

Office of Health Protection, Department of Health and Ageing (DOHA) Health.Ops@Health.gov.au ·

Australian Infection Control Association (AICA) http://www .aica.org.au

Path West Laboratory Medicine W A http://www. path west. com. au

Institute Pasteur (IP) http :www. pasteur. fr

Centre for Health Protection (CHP), Department of Health http://www.chp.gov.hk

Chinese Center for Disease Control and Prevention, (Chinese CDC) http://www.chinacdc.cn

Centre for Disease Control and Prevention of Guangdong Province http://www .cdcp.org.cn

The Chinese University of Hong Kong http://www.cuhk.edu.hk/med/mic/index.html

University of Hong Kong http://jmsc.hku.hk/2009/10/the-jmsc-public-health-programrne/

Annex 3

Japan

Korea

Malaysia

New Caledonia

Association of Medical Doctors of Asia (AMDA) narazu@amda. or .jp

Center for Infectious Diseases, Nara Medical University kassan@.naramed-u.ac.jp

Department of Public Health, Osaka City University Faculty of Medicine http://www .med.osaka-cu.ac.jp/kouei

Department of Virology, Tohoku University, School of Medicine oshitanih@mail.tains.tohoku.ac.jp

Hokkaido University http://www .hq~dai.ac.jplbureau/e/index-e.html

Institute of Tropical Medicine, Nagasaki Upiversity http://www .nagasaki-u.ac.jp/index _ en.html

International Medical Center of Japan http://www.imcj.go.jp

Kurume University hwafu@med.kurume-u.ac.jp

.. .

National Institute of Infectious Diseases (NIID) http://www .nih.go.jp/niid/index-e.html

Osaka University http://www .biken.osaka-u.ac.jp/

Our Lady of Snow Medical Juridical Corporation St. Mary's Hospital inter@st-mary-med.or .jp

School of Medicine, Niigata University hsuzuki@med.niigata-u.ac.jp

Korea Centres for Disease Control and Prevention (KCDC) http://www .english.mohw .go.kr

Institute of Health & Community Medicine (IHCM) Universiti Malaysia Sarawak http://www. unimas.my /researchlihcm/index.html

Institute of Public Health, National Institute of Health, Malaysia http://www .iku.gov .my

Secretariat of the Pacific Community (SPC) http: I lwww. spc. int

New Zealand

Papua New Guinea

Philippines

Singapore

Institute of Environmental Science and Research Limited (ESR) http://www .esc.cri.nz

Papua New Guinea Institute of Medical Research (PNG TMR) http://www. pngimr. org. pg/

Annex 3

National Epidemiology Center, Department of Health, Ministry of Healtj nee_ doh@yahoo.com

Ministry of Health, Singapore http://www.moh.gov.sg/

National University of Singapore (NUS) http://www.nus.edu.sg/

Regional Emerging Diseases Intervention (REDI) Center http://www.redi.org.sg

Singapore General Hospital ling.ai.ee@sgh.com.sg

Tan Tack Seng Hospital http://www.ttsh.com.sg

ANNEX4

Listing of WHO Offices in the Western Pacific Region

As of October 2009, WHO has offices in the following countries in the Western Pacific Region:

American Samoa

Australia

Brunei Darussalam

Cambodia

China

Cook Islands

Fiji

French Polynesia

Guam

Hong Kong

Japan

The Republic of Korea

The Lao People ' s Democratic Republic

Macao

Malaysia

The Marshall Islands

The Federated States of Micronesia

Mongolia Nauru

New Caledonia

New Zealand

Niue

The Commonwealth of the North Mariana Islands

Palau

Papua New Guinea

The Philippines

Pitcairn Islands

Samoa

Singapore

Solomon Islands

Tokelau

Tonga

Tuvalu

Vanuatu

VietNam

Wallis and Futuna

To view contact information for any of these offices, visit the WPRO website at: www .wpro. who.int

ANNEX5

KEY PUBLICATIONS AND RESOURCES

Publications

Asia Pacific Strategy for Emerging Diseases. World Health Organization (2005)

Meeting Report: Meeting of t!Je Global Outbreak Alert and Response Network (GOARN) Partners from the Western Pacific Region, Melbourne, Australia. World Health Organization- Western Pacific Region (July 2008)

Meeting Report: Meeting of the Global Outbreak Alert and Response Network (GOARN) Partners from the Western Pacific Region, Melbourne, Sendai, Japan. World Health Organization- Western Pacific Region (July 2007)

Regional Committee Report on the 5f!h World Healtl1 Assembly Regulations WHA58.3. Revisions of the International Health Regulations. May 2005. World Health Organization. (July 2005).

WHO International Standard Terminologies 011 Traditional Medkine in the Western Pacific Region. WHO-Western Pacific Region. (2007)

The Work of WHO in the Western Pacific Region, July 2008- June 2009: Regional Director's Report. WHO Western Pacific Region. (2009).

Websites

www.who.int

www.wpro.who.int

www.paho.org

www .emro. who.int

www.euro.who.int

www.searo.who.int

www. wp ro. who. i nt