IN THIS ISSUE

Interviews were conducted with all 48 health centers involved in the outbreak response using a structured questionnaire to explore reasons for vaccine wastage. This loss was due to a change in the size of the diluent vials, and the healthcare professionals were not aware of this change. Forty percent of the groups reported vaccinators misusing syringes, resulting in frequent syringe jams and vaccine discards.

Poor documentation and communication resulted in indiscriminate distribution of vaccines to health centers and poorly planned clinics. The assumption that only a small number of vaccine doses remained in the health centers after the campaign may have led to an overestimation of the wastage rate. We also described the demographic and epidemiological characteristics of confirmed cases in the fifth epidemic and compared them with the previous epidemics.

In the fifth epidemic, the number of cases was higher and the cases were more widely distributed than in the second, third and fourth epidemics (Table 1). The number of provinces affected by the H7N9 virus during the fifth epidemic increased from four provinces (Jiangsu, Zhejiang, Fujian and Guangdong) in September, October and November 2016 to seven provinces (Jiangsu, Zhejiang, Anhui, Guangdong, Fujian , Hunan, Shanghai) by December 31, 2016. While the genetic markers of mammalian adaptation and antiviral resistance of virus strains isolated during the fifth epidemic remained similar to previous epidemics.

There were several possible reasons for the sudden increase in H7N9 cases in the fifth epidemic.

Table 1. Number of measles vaccine doses issued, wasted, percentage wasted and cost by districts in Madang Province, Papua New Guinea, June 2014 to March 2015

DISCUSSION

Comparison of the first three waves of avian influenza A(H7N9) virus circulation in the mainland of the People's Republic of China. Standard operating procedures for surveillance and response were introduced, along with a sustainability plan, including a monitoring and evaluation framework, to facilitate the transition of mass collection surveillance improvements to routine surveillance. Enhanced Monitoring for the Third United Nations Conference on Small Island Developing States, Apia, Samoa, September 2014.

There were three primary purposes for the enhanced surveillance: (1) to provide a simple surveillance system for the rapid detection and response to disease episodes or outbreaks in a timely and efficient manner; (2) to disseminate strategic epidemiological information throughout the Pacific region; and (3) to sustainably improve disease surveillance in Samoa after the mass gathering. Surveillance operations of the second phase begin up to six months before the event and include pilot testing, training and implementation of the improved surveillance system. The sustainability phase begins one week after the event and involves transition to the regular surveillance system and evaluation of the impact of the improved surveillance.

A sustainability plan was created to transition improvements from mass collection surveillance to the routine surveillance system to leverage the significant effort involved in implementing enhanced surveillance. The sustainability plan was discussed during a joint session of the PSC and MoH at the end of the mass gathering.

Table 2. Comparison of demographic and epidemiological characteristics of H7N9 virus infections reported by time period, 19 February 2013–31 December 2016

RESULTS

The control was tested in the week before the SIDS conference and went live on August 26. Control registers were collected daily at each control point and exchanged for new registers. SAGES OE is a free tool developed by the Johns Hopkins University Applied Physics Laboratory (JHU-APL).12 SAGES OE has been adapted for enhanced control by JHU-APL and SPC, and was previously used successfully by SPC for control mass collection;13 however, technical challenges in hosting the system locally prevented the full use of SAGES OE at the SIDS conference, so a spreadsheet-based alternative was used to store daily data and generate graphical output.

The surveillance team provided early warnings for immediate response follow-up of all priority syndromic cases (such as acute fever and rash or bloody diarrhea) found at the time of daily data collection. SitReps were emailed to MoH and SIDS organizing stakeholders and were disseminated to regional health professionals via the PacNet Pacific regional public health email network. No new outbreaks of infectious diseases were recorded for the SIDS conference and the surveillance system worked well, providing important guarantees for public health.

This is shown with 30% of encounters as syndromic cases, compared to only 7%–10% of encounters recorded as syndromic cases in previous SPC-implemented mass collection surveillance activities in the Pacific. The benefits of improved surveillance can be sustained when the mass collection surveillance experience is integrated with long-term surveillance. Likewise, the extra effort involved in mass collection enhanced surveillance is more likely to be implemented when the work involved is similar to ordinary surveillance.

The SIDS Conference Enhanced Supervision was implemented by building on the existing weekly supervision, facilitating a smooth transition to the conference, as well as allowing lessons learned and benefits gained to be readily applied. This was demonstrated at the SIDS conference, where insufficient time was allocated to test the SAGES OE installation. It is essential to run a pilot to test the surveillance system before it goes live to ensure that the system can work as expected.

Mass collection control is characterized by a short period of intensive activity to collect, compare and analyze data on a daily basis and create meaningful interpretations. SIDS conference surveillance data collection is time-consuming as it relied on daily visits to individual surveillance sites. This was compounded by the number and locations of guards, which more than doubled from four to 10 due to increased surveillance, and included an international airport 33 km from Apia.

Table 2. Reports of syndrome cases by all points of care: 26 August to 6 September 2014

CONCLUSIONS

Enhanced syndromic surveillance for mass gatherings in the Pacific: a case study of the 11th Festival of Pacific Arts in Solomon Islands, 2012. An ILI case was defined as a person with sudden onset of fever (temperature >38 °C) and cough and/or sore throat in the absence of other diagnosis. To our knowledge, this is one of the first documented assessments and applications of the WHO thresholding method in the tropics or subtropics.

We adapted the WHO method described in the WHO Global Standards for Epidemiological Surveillance of Influenza (WHO manual) to determine seasonal and alarm values for the three parameters described above, with some modifications (Figure 1).17. In this study, based on the WHO method for determining seasonal and alarm thresholds for influenza, we investigated a range of thresholds for three easily accessible parameters and determined practical thresholds for influenza High Threshold. These findings have important implications for countries in the tropics, subtropics, and resource-limited environments.

National Institute of Public Health, Cambodia; and the Centers for Disease Control and Prevention, Cambodia Office for their contribution in the ILI and influenza surveillance system. First, ILI syndrome surveillance may not be an appropriate parameter for influenza activity in the tropics and subtropics. Epidemiological and virological characteristics of influenza in the Western Pacific Region of the World Health Organization, 2006-2010.

For most countries and regions in the World Health Organization (WHO) Western Pacific Region, the decline in tuberculosis (TB) epidemics and population aging occurred simultaneously in recent decades. Influenza in the Western Pacific Region Western Pacific Region Global Influenza Surveillance and Response System. Western Pacific Region Global Influenza Surveillance and Response System Influenza in the Western Pacific Region, 2011–2015.

Previous WHO definition: a person with sudden onset of temperature >38 °C and cough or sore throat in the absence of other diagnosis. In 2011, influenza A(H1) virus circulated mainly during the first half of the year, followed by B (origin not determined) later in the year (Table 2 and Fig. 2). Evidence from the WHO external quality assessment program shows an increase in the number of laboratories in the region participating in the program and consistently good results from participating laboratories (personal communication).

Continued efforts on quality laboratory testing will ensure an accurate understanding of influenza in the region. Communication in the region and globally continues to improve with increased reporting from NICs to FluNet. Influenza surveillance in the region continues to evolve, and efforts to determine disease burden are ongoing.

Epidemiological, antigenic and genetic characteristics of seasonal influenza A(H1N1), A(H3N2) and B influenza viruses: basis for the WHO recommendation on the composition of influenza vaccines for use in the 2009–2010 season in the Northern Hemisphere.