WHO Western Pacific Region (WPR) 2011-2012

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

• Cambodia [788 KB, 6 pages]
• China [1.1 MB, 4 pages]
• Mongolia [594 KB, 4 pages]
• Secretariat of the Pacific Community [603 KB, 3 pages]
• The Philippines [1.1 MB, 4 pages]
• Vietnam [1.8 MB, 5 pages]

In addition, CDC supports the WHO Western Pacific Regional Office (WPRO) via a cooperative agreement and therefore indirectly provides assistance to the following countries:

• Fiji
• Lao People's Democratic Republic (Lao PDR) [851 KB, 4 pages]
• Papua New Guinea

The core activities of our bilateral agreements and technical assistance are:

• To build sustainable, national capacity for seasonal influenza, pandemic influenza and other emerging infectious diseases and to prepare for implementation of International Health Regulations 2005 (IHR).
• To make routine submissions of surveillance data to WHO’s Global Influenza Surveillance and Response System (GISRS).
• To increase the geographic reach of WHO GISRS.
• To provide early access to critical virus isolates from humans and birds for WHO GISRS.
• To increase the number of influenza isolates for analysis shipped from WHO WPR influenza laboratories to WHO Collaborating Centers (CC) for analysis.
• To develop sustainable epidemiologic and virologic surveillance systems for severe influenza, in order to gain an understanding of the burden of disease from influenza in the WHO WPR.

Vashonia Smith, MPA
Public Health Advisor
Extramural Program
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Email: vdw8@cdc.gov

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

Tomas Rodriguez, MA (from May 2012)
Public Health Advisor
Extramural Program
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Email: trr0@cdc.gov

A map of the WHO Western Pacific Region (WPR) shows all 12 WPR member states/countries. The member countries, outlined with gray borders, include Australia, Cambodia, China, Japan, Lao PDR, Malaysia, Mongolia, Papua New Guinea, Philippines, Singapore, South Korea, and Vietnam.

Countries with green shading indicate that the Influenza Division provides project funding and technical assistance through Sustainability Cooperative Agreements. Cambodia, China, Mongolia, Philippines, Secretariat of the Pacific Community (SPC), and Vietnam are shaded green on the map. Fiji, Lao PDR and Papua New Guinea are shaded dark green to indicate that they receive indirect funding from the Influenza Division. Vietnam has purple diagonal stripes to indicate that they have a Research Cooperative Agreement.

CDC Influenza Division Field Staff, indicated by a yellow dot outlined in red, are located in the following cities: Beijing, Hanoi, Phnom Penh, Manila and Vientiane.

The Global Disease Detection [GDD] Site, indicated by a red “X”, is located in Beijing.

WHO National Influenza Centers (NICs), indicated by purple dots, are located in the following cities: Beijing, Goroka, Hanoi, Ho Chi Minh City, Hong Kong, Kuala Lumpur, Manila, Phnom Penh, Singapore, Taipei, Tokyo, Ulaanbaatar and Vientiane.

The WHO Western Pacific Regional Office (WPRO), indicated by a blue star, is located in Manila, Philippines.

• China’s National Influenza Center (NIC) at the National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, was officially designated a World Health Organization (WHO) Collaborating Center for Reference and Research on Influenza (CC).
• A five-year influenza work plan was developed by the Global Influenza Surveillance and Response System (GISRS) Member States of the WHO Western Pacific and South-East Asia regions, titled “Bi-Regional Plan for Further Strengthening National Influenza Surveillance: Guiding the way towards Influenza Control Policy and Regional Surveillance.”

U.S. CDC Direct WHO Regional Office Support

WHO’s Western Pacific Regional Office (WPRO) is located in Manila, The Philippines. The office serves 37 countries and an area that spans from the Northern Hemisphere, through the tropics and into the Southern Hemisphere. This region covers nearly one-quarter of the world’s population with approximately 1.6 billion inhabitants. Influenza surveillance has been established in many countries in the region. GISRS in the Western Pacific Region (WPR) consists of 21 National Influenza Centers in 15 countries, three WHO CCs, one each in Australia, China, and Japan, and two Essential Regulatory Laboratories, one in Australia and one in Japan.

WHO WPR, together with WHO South-East Asia Region (SEAR), uses a common framework to strengthen national and regional capacities to manage emerging infectious diseases, improve pandemic influenza preparedness and comply with the requirements of the International Health Regulations 2005 (IHR). This framework is a product of the Asia Pacific Strategy for Emerging Diseases (APSED) which was expanded in 2010 and subsequently endorsed by the regional committee in July 2011. The strategy includes components such as surveillance and laboratory strengthening, necessary to support GISRS.

The five-year cooperative agreement between the U.S. Centers for Disease Control and Prevention (CDC) and WHO WPRO, which began September 30, 2006 (FY 2011 was the fifth year of the agreement), has supported the implementation of APSED, and therefore influenza surveillance and response capacity, through three pillars of work: 1) preparedness and communications; 2) surveillance and detection; and 3) response and containment. The agreement also included funds directed to countries through WHO offices in Cambodia, China, the Federated States of Micronesia, Fiji, Lao People’s Democratic Republic (Lao PDR), Papua New Guinea and Vietnam.

The availability of data from WHO WPR during the 2009 H1N1 pandemic was a testament to the great strides countries and territories from this region have made in strengthening surveillance systems, including the establishment of syndromic surveillance (e.g. for influenza-like illness (ILI), severe acute respiratory infections (SARI), acute respiratory infections (ARI)) and laboratory capacity for influenza case confirmation. While the response to the recent pandemic indicated that efforts towards preparedness had been beneficial, it also revealed some gaps in influenza surveillance and laboratory-based diagnoses, and varying capacity among countries in the region. Consequently, since the 2009 H1N1 pandemic, surveillance activities, supported by WPRO, have focused on defining the epidemiology and burden of influenza by linking the epidemiological and virological aspects of influenza surveillance and strengthening national and regional networks. This has been achieved through support for:

• Annual bi-regional meeting of NICs;
• Strengthening of national and regional influenza laboratory and epidemiological surveillance and control capacities;
• Disease burden studies in the region;
• Human resources for strengthening national and regional management and coordination of influenza surveillance and control;
• ILI surveillance in Cambodia, China, Lao PDR, Mongolia, the Pacific Island Countries and Vietnam.

Surveillance Activities

• A scientific writing workshop for influenza researchers in the region was conducted in April 2011 in Seoul, Korea. Four manuscripts have been published in peer-reviewed journals, two manuscripts are under review and work continues on the remaining manuscripts.
• The bi-regional (WHO WPR and WHO SEAR) NIC meeting was conducted in June 2011 in Vientiane, Lao PDR. The outcomes from this meeting are published in the WHO Weekly Epidemiological Record: Fifth Meeting of National Influenza Centers–WHO Western Pacific and South-East Asia Regions. WER. 2012; 87(7):61-64.
• A five-year work plan titled “Bi-Regional Plan for Further Strengthening National Influenza Surveillance: Guiding the way towards Influenza Control Policy and Regional Surveillance” has been developed.
• A regional influenza research agenda meeting was held in June 2011 in Vientiane, Lao PDR, from which manuscripts are being developed.
• A surveillance data analysis and writing workshop was held in Ulaanbaatar, Mongolia, from June 20–23, 2011. Manuscript development is in progress.
• Mongolia’s web-based surveillance reporting platform has been translated into English.

Influenza laboratory activities in the region focused on strengthening GISRS and improving virological testing capacity in an environment where safe laboratory practices and quality assurance are ensured through:

• Implementing quality systems that incorporate elements such as biosafety plans, standard operating procedures (SOP), adequate infrastructure, equipment and supplies, streamlined procurement, and administrative assistance;
• Implementing quality standards through the establishment of SOPs for quality assurance and quality control (QA/QC), laboratory algorithms, and participation in the WHO External Quality Assessment Project (EQAP);
• Conducting virus isolation using cell culture or embryonated hen’s eggs;
• Enhancing molecular diagnostic capacity, such as real-time PCR for seasonal influenza, H5N1 and novel influenza viruses;
• Typing and subtyping influenza viruses using standard serologic WHO reagents;
• Enhancing systems and protocols to rapidly detect and respond to unsubtypable viruses;
• Regularly shipping representative influenza strains to a WHO CC and shipping any novel and unsubtypable strains as urgent;
• Developing additional testing as appropriate and feasible, such as gene sequencing, hemagglutination inhibition, micro-neutralization, and antiviral drug sensitivity testing;
• Where appropriate, developing in-country networks, such as networks of subnational laboratories that are mentored by NICs (e.g. in QA/QC, proficiency testing) and can respond rapidly in outbreak/pandemic situations.

Laboratory Activities

• WPRO supported the NIC, National Centre of Laboratory and Epidemiology, Ministry of Health, Lao PDR, with the procurement of a sequencing machine.
• WPRO supported the NIC, Institute of Medical Research, Papua New Guinea, with procurement of equipment to establish virus culture capacity.
• WPRO supported the NIC, Research Institute of Tropical Medicine, the Philippines, with procurement of equipment to strengthen laboratory capacity.
• In collaboration with the WHO CCs in Atlanta and Melbourne, a laboratory capabilities and capacity review was conducted at the NIC, Institute of Medical Research, in Papua New Guinea, June 27–29, 2011. Based on this review, a one-year work plan for improvement of the NIC was drafted and two graduate scientific officers from the NIC were trained in molecular techniques and virus culture at the WHO CC in Melbourne.
• A regional training workshop for laboratory staff in the International Air Transport Association (IATA) guidelines for shipping infectious substances was conducted in Phnom Penh, Cambodia, September 14–16, 2011. Fifteen participants from seven countries in the region (Cambodia, China, Lao PDR, Malaysia, Papua New Guinea, the Philippines and Vietnam) attended the training.
• A second regional training workshop for laboratory staff in the IATA guidelines for shipping infectious substances was conducted three months later in Hanoi, Vietnam, December 6–10, 2011. Thirty participants from nine countries in the region (Cambodia, China, Lao PDR, Malaysia, Mongolia, the Philippines, Singapore, South Korea and Vietnam) attended the training.

Influenza preparedness and response activities in the region focused on support for:

• Member States and/or WHO country offices to exercise pandemic containment plans.
• Member States to develop and exercise risk communication plans.
• Member States to strengthen outbreak response capacity.
• Preparedness and response activities in Cambodia and Lao PDR.

Preparedness Activities

• A pandemic containment exercise was conducted jointly with WPRO, the WHO country office in Mongolia, and the Japan International Cooperation System (antiviral stockpile management) in December 2010. A regional pandemic review was conducted in Beijing, China, March 2011.
• Four countries (Cambodia, China, Mongolia, and the Philippines) were supported to conduct in-depth, retrospective reviews of media messages they produced at the time of the 2009 H1N1 pandemic and how these messages were reported by print, television and radio media. These countries have developed national reports on their pandemic-related, media-based communication experiences and lessons learned and these reports will be consolidated into a regional report.
• The establishment of WPRO’s Emergency Operation Center (EOC) was supported with procurement of equipment.
• WPRO supported the establishment of an EOC in the WHO Lao PDR Office through the procurement of equipment.

• WPRO supported training on molecular techniques and virus culture for a Laboratory Specialist from the NIC in Fiji at the WHO CC in Melbourne.
• Forty-five people from 10 countries participated in the “Regional Training Workshop of Laboratory Staff for IATA Licensing for Transportation of Infectious Substances” either in Hanoi, Vietnam, or Phnom Penh, Cambodia.
• Three government staff from Papua New Guinea participated in the Field Epidemiology Training Program (FETP) short course in Chennai, India.
• ILI surveillance and outbreak response trainings were supported in Cambodia, China, Lao PDR and the Pacific Island Countries.

Publications

• McCallum L, Partridge J. Epidemiological characteristics of the influenza A(H1N1) 2009 pandemic in the Western Pacific Region. Western Pacific Surveillance and Response Journal. 2010;1(1).

Jeffrey Partridge, PhD
Epidemiologist, Influenza Surveillance
Emerging Disease Surveillance and Response
WHO Western Pacific Regional Office
Manila, The Philippines
Email: partridgej@wpro.who.int