|  COUNTRY
PREPAREDNESS
To ensure preparedness, the
country is advised to set up a response structure at the national level and
set up a contingency plan including the designation of a health care facility
trained and equipped to deal with avian influenza. It is urgent that this is
done as soon as possible. In summary the following actions are needed:
 Establish National Task Force with senior
officials of animal husbandry departments
Designate Focal Point
Establish Expert Committee
Establish Surveillance Unit and forge linkages with animal husbandry
departments
Put into place a national surveillance
Designate at least one hospital and one
laboratory
Develop an inventory of supplies and equipment
Provide accurate and timely information to
public by efficient utilization of mass media
Establish a mechanism of monitoring and
supervision
Surveillance and reporting to WHO
For close global monitoring of
the situation and coordination of the global response, the World Health
Organization (WHO) is recommending enhanced surveillance for influenza A/H5
with following objectives:
1. To monitor the global occurrence of influenza
A/H5 viral infection in humans.
2. To identify and characterize any emergent
influenza strain so as to inform control strategies.
3. To monitor changes in transmission patterns of
influenza A/H5 viruses and to detect potential humanto-human transmission of
influenza A/H5 viruses;
4. To monitor unusual morbidity and mortality due
to acute respiratory illness.
5. To contribute to the monitoring of outbreaks
of HPAI in animal populations.
For the purposes of global
surveillance, Member States are requested to report to WHO all laboratory
confirmed cases of influenza A/H5 fulfilling the case definition. WHO
requests that Member States immediately report the first identified
individual fulfilling the confirmed case definition to the relevant WHO
country office, WHO regional office, and WHO headquarters by e-mail or fax
(see Annex 4: Contact details for reporting to WHO).
Once the first case has been
identified, WHO requests that an aggregate report of confirmed cases is sent
daily to the relevant WHO country office, WHO regional office, and WHO
headquarters (see Annex 5: Template for daily country summary). Members
States are requested to report summary case data daily by e-mail or fax or
through the secure password-protected WHO Global Atlas web site. Any Member
State wishing to report daily summary data via the WHO Global Atlas web site should contact outbreak@who.int to obtain the url address and their own
specific password.
WHO requests that case-based
information is sent weekly in a line-listing format (see Annex 6: Template
for line-listing and Annex 7: Data dictionary for line-listing). The
line-listing should include confirmed cases, all persons for whom the
diagnosis of influenza A/H5 is being considered, and any discarded cases. A
form to assist in data collection is also provided (see Annex 8: Template for
case report form) and includes all variables requested in the line-listing.
WHO additionally requests
Member States to send documentation of their case definitions, and any
subsequent revisions of these definitions, to the relevant WHO country
office, WHO regional office, and WHO headquarters, by e-mail or fax.
Only information regarding confirmed cases will be made available in
the public domain.
Following the confirmation of a
case of influenza A/H5 infection, genetic and antigenic characterization of
virus strains should be performed. WHO requests that Member States forward
aliquots of original specimens and the viral isolates to one of the WHO
reference laboratories for diagnosis of influenza A/H5 infection (see Annex
1) to complete these genetic and antigenic analyses.
A case report form should be
completed for every individual for whom a diagnosis of influenza A/H5 viral
infection is being considered (see Annex 8: Template for case report form).
This will provide preliminary information about exposure history to help
target further in-depth investigations. All individuals should be assigned a
case classification according to the locally implemented case definitions.
WHO recommends a thorough field
investigation of the first confirmed case of influenza A/H5 viral infection
occurring in a public health district in any country or territory, to assess
the exposures and the likelihood of human-to-human transmission. Subsequent
confirmed cases should also be similarly investigated.
WHO recommends that Member
States continue with their existing surveillance for influenza like illness
and acute respiratory illness. WHO recommends that Member States with an
existing early warning system for communicable disease or a surveillance
system for severe or emerging acute respiratory illnesses, such as severe
acute respiratory syndrome (SARS), actively investigate any unusual event and
ensure that laboratory investigations for influenza are undertaken as
appropriate.
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