Country Experience in Health Crisis Management on H5N1/H1N1 Outbreak in Lao PDR Dr Nyphonh Chanthakoummane Chief of Diseases Surveillance and Response.

Dr Nyphonh ChanthakoummaneChief of Diseases Surveillance and Response Division

Department of Disease Control Ministry of Health , Lao PDR

The 1st round:January-March, 2004The 2nd round: July, 2006The 3rd round: February-March, 2007

Health education campaign Poultry killed/eggs destroyed Close surveillance both in human and

animal (RRT) Sample taken ( human and animal ) Training health center staffs

Culling take place in affected villages, Namma Village, Long District Luangnamtha

Compensation paid immediately

National Committee for Communicable Diseases Control

(NCCDC)National Committee

for Communicable Diseases Control Secretariat

National Committee for Communicable Disease Control Office (NCCDCO)or =

(NAHICO)

Organization Organization chartchart

Director / Deputy Director

NAHICO

Coordination/ Collaboration Unit

Planning/ Financing Unit

Monitoring/ Evaluation

Unit

Strategy 1

The Plan is based on 5 strategies

Animal Health. Development of disease free avian influenza management, under leadership of MAF. FAO as lead support agency

Strategy 2

Human Health. Disease surveillance and response in humans during outbreak, under leadership of MoH. WHO as lead support agency

Strategy 3

Strategy 4

Strategy 5

Human Health. Laboratory and Curative Care, under leadership of MoH. WHO as lead support agency

Information, Education and Communication. Health Education and Community Action, under leadership of Ministry of Information and Culture (MIC). UNICEF as lead support agency

Project coordination, project management and regulatory framework, including strengthening of Institutional and Legal Frameworks

Provincial Coordinating Committee on CDC Chaired by

Governor/Vice Governor Members: Health, Agriculture, Information, Trade, Tourism, Transport,

Interior, Mass Organizations Provincial CDC

Secretariat Chaired by Health

Department/AgricultureStrategy

1

Ad Hoc

Committee on AHI during outbreak

Strategy 2Strategy

3Strategy 4Strategy

5

Advocacy, motivate

community participation in reporting dead

bird

Mobilize manpower for mass bird

cullingCompensationControl animal

movement

Assess, report to Provincial CDC,

National CDC Sec

IEC Taskforce: Health, Agriculture, Information, Trade, Tourism, Transport, Interior, Mass Organizations

Members: Health, Agriculture, Information, Trade, Tourism, Transport, Police, Military, Mass Organizations

– WHO Pandemic alert phase 4 to first case detected in Lao PDR = 7 weeks

• Allowed preparation time

– Response in five areas:1. Co-ordination and Decision Making 2. Surveillance and Response3. Clinical Management and Infection Control4. Risk Communication5. Public Health Interventions

Other Ministries

• NEIDCO an effective coordinating body• High level political support• Cooperation between National Health Authorities• International Cooperation

◦ Indicator-based: Used existing surveillance notification mechanism for nationally notifiable diseases Frequency: Weekly Daily Syndromes reported:

Acute Respiratory Illness (ARI) Influenza Like Illness (ILI)

◦ Event Based Surveillance from HCW and community (‘166 hotline’)

Severe illness /death Cluster of ILI cases from same village ( local

investigation)

◦ Sentinel hospital sites for ILI and SARI lab-surveillance

◦ Daily integrated reporting and feedback

P o rts / Im m igra tio n C h e ck P o in ts

D isp e n sa ries /V illa g e H e a lth P o s ts S u p p le m en ta rysu rve illa n ce

(A c tive case se a rch)

D is tric t H e a lth O fficeD is tric t S e c tio n fo r H yg ie ne

a n d E p id e m io lo gy

C a p ita l C ity / p ro v in cia l S e c tionfo r H yg ie n e a n d E p id e m io lo gy

N a tio n a l C e n te r fo r L ab o ra to rya n d E p id e m io lo gy

M O HD H P /C D C T a sk F o rce

NEIDCO

Natl / ProvHospitals

Private Clinics

District Hosp

Active SurvPassive Surv

Active SurvPassive Surv

Weekly report

Weekly reportFax/phone

Weekly/monthly

Feed-back report

Flow chart: National Surveillance of Notifiable Selected Diseases

Training on Pandemic (H1N1) CM and infection control (IC) throughout country

On-call duty system for clinicians from provincial hospitals and for National authorities

- Advice on Pandemic (H1N1) CM and IC - Outbreak support

Development of Lao specific Pandemic (H1N1) CM and IC guidelines

Set-up of screening systems and isolation rooms in hospitals

Limited Tamiflu and PPE stockpile and distribution◦ Tamiflu for severely ill patients and high risk groups

Referral of patients to designated area in OPD if ILI symptoms• Designated Screening Room• Isolation and cohorting of in-patients Availability of PPE and IEC material Regular cleaning and disinfection

– IEC material for public and HCW – Press releases, TV and radio spots – Workshops for journalists and those involved in

media briefing

◦ Isolation of patients home isolation of mild cases hospital isolation of severe cases

◦ Border control & International travel Health information and advice

Screening: thermal scanners and entry form isolation implemented when positive cases identified

◦ School closures Some school closures but recent national decision not

to close schools

◦ Mask Use for sick people, front-line HCWs and care givers

Thank you very much

Limited human and physical resources to develop an effective control program to

eliminate HPAI from the country.

Lack of the veterinarians and the skills on disease control of the available personnel

are still weak and moreover the veterinary institute within the country is also not

available.

The infrastructure and facilities for disease reporting, early warning diagnosis as

well as for the surveillance and concerned plan of the all level are not developed

effectively.

Inadequate operational fund.

The production system and management of the farmer is almost underdeveloped;

the knowledge and the understanding of the farmers about the animal disease is

very low.

Strong political commitment and a forum for open dialogue are crucial

Strong teamwork & partnerships lead to efficiency and progress e.g. Govt, International groups, NGOs

Pandemic Preparedness Plans should not only be developed but actually used

Epidemiology and Laboratory should not be seen as separate entities

Public health risk communication is a cross-cutting strategy that should increase awareness but not fear e.g. H1N1 situation

Ongoing small group activity oriented training is better than large group didactic training