DoD Global Emerging Infections DoD Global Emerging Infections Surveillance & Response System Surveillance & Response System (DoD (DoD - - GEIS) GEIS) Global Influenza Surveillance Efforts Global Influenza Surveillance Efforts 8 January 2007 8 January 2007 COL (Ret.) Jose L. Sanchez, MD MPH COL (Ret.) Jose L. Sanchez, MD MPH For presentation to: DoD/CDC Working Group Meeting
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DoD Global Emerging Infections Surveillance & Response ...DoD Global Emerging Infections Surveillance & Response System (DoD-GEIS) Global Influenza Surveillance Efforts 5a. CONTRACT
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DoD Global Emerging InfectionsDoD Global Emerging InfectionsSurveillance & Response SystemSurveillance & Response System
(DoD(DoD--GEIS)GEIS)
Global Influenza Surveillance EffortsGlobal Influenza Surveillance Efforts8 January 20078 January 2007
COL (Ret.) Jose L. Sanchez, MD MPHCOL (Ret.) Jose L. Sanchez, MD MPH
For presentation to:DoD/CDC Working Group Meeting
Report Documentation Page Form ApprovedOMB No. 0704-0188
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1. REPORT DATE 08 JAN 2007 2. REPORT TYPE
3. DATES COVERED 00-00-2007 to 00-00-2007
4. TITLE AND SUBTITLE DoD Global Emerging Infections Surveillance & Response System(DoD-GEIS) Global Influenza Surveillance Efforts
5a. CONTRACT NUMBER
5b. GRANT NUMBER
5c. PROGRAM ELEMENT NUMBER
6. AUTHOR(S) 5d. PROJECT NUMBER
5e. TASK NUMBER
5f. WORK UNIT NUMBER
7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Armed Forces Health Surveillance Center,Silver Spring,MD
8. PERFORMING ORGANIZATIONREPORT NUMBER
9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S)
11. SPONSOR/MONITOR’S REPORT NUMBER(S)
12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution unlimited
13. SUPPLEMENTARY NOTES
14. ABSTRACT
15. SUBJECT TERMS
16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT Same as
Report (SAR)
18. NUMBEROF PAGES
42
19a. NAME OFRESPONSIBLE PERSON
a. REPORT unclassified
b. ABSTRACT unclassified
c. THIS PAGE unclassified
Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18
Lab-BasedInfluenza Surveillance
• Sentinel Surveillance• Air Force Institute for Operational Health (San
Antonio, Texas)
• Population-based Surveillance• Navy Health Research Center (San Diego, California)
• Migratory and domestic bird surveillance• Pediatric and Influenza-like illness study
NAMRUNAMRU--22Highlights of AI/PI Work in FY06/07Highlights of AI/PI Work in FY06/07
NAMRUNAMRU--2 Diagnostic Capability2 Diagnostic CapabilityILI Outbreak & Case Investigation SupportILI Outbreak & Case Investigation Support
• Molecular biology laboratory with sequencing capability• H5N1 real-time RT-PCR screening before culturing• Supports Indonesian MoH and WHO: Identify human and animal H5N1
cases• Only in-country reference lab for work-up of avian and human influenza
samples (referral to CDC influenza lab)• Source of three H5N1 strains (A/Indo/5/05) - Clade 2 vaccine development
by the CDC/NIH• New BSL-3 Lab Suite being built at NIHRD (mid-FY07)
NAMRUNAMRU--22Jakarta, IndonesiaJakarta, Indonesia
• NIHRD, WHO and CDC collaboration during Medan H5N1 cluster investigation in northern Sumatra (May 06)
• NIHRD and CDC investigative support for all H5N1 suspected cases• Total of 74 confirmed cases (Jun 05-Nov 06), young age• Cases sampled within 24 to 48 hrs (37 H5N1 virus isolates)• High-level mortality (57 deaths, 77%)• Eleven familial clusters identified (Jun 05-Nov 06)
NAMRU-2 Team supporting poultry investigation around human H5N1 case investigation
NAMRU-2 Team collecting samples from a suspected human H5N1 case in an ICU
• Training of Indonesian Ecology Health Status Research & Dev Center and NIHRD scientists at UnivIowa’s CEID
US Army Medical Research US Army Medical Research UnitUnit--KenyaKenya
(USAMRU(USAMRU--K)K)Nairobi, KenyaNairobi, Kenya
Inset: LRMC Region
13 Countries Presently 20061201
LRMC
Reference Lab/Hub
Civilian
Future
Present
Military
Future
Present
EUCOM
2006120116 Countries Presently
NAMRU-3
USAMRU-K
Reference Lab/Hub
Civilian
Future
Present
Military
Future
Present
U.S. Embassy
Present
CENTCOM
• Previously no consistent surveillance in sub-Saharan Africa
• High regional threat of avian and pandemic influenza • Goals:
• Isolate and characterize influenza virus strains and other ILI viral causes
• Part of global influenza surveillance network• Protocol
• Max of five (5) ILI samples per day per site• Transport at -80 degrees to Kenyatta Hospital, NIC, Nairobi• Flu A isolates sent to CDC-KEMRI Virus Research Lab