Recent Updates: December 17, 2006

SMRU to boost influenza and respiratory infections control in the Thai-Burmese border

by François Nosten
SMRU - Director

There are hundreds of thousands of refugees and other displaced people living on the Thai side of the border between Thailand and Burma. The first cause of morbidity and mortality in these communities is respiratory infections. In the coming years many refugees will likely be resettled to the United States.

The Wellcome Trust units in SE Asia are part of an influenza network focussing on optimising management. It is generally agreed that community-based surveillance in this region to identify and contain influenza spread is an urgent priority. The Shoklo Malaria Research Unit (Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand and part of the Wellcome-Trust Mahidol University Oxford Tropical Medicine Research Programme) proposes to set up a system to detect, prevent and control influenza, highly pathogenic avian influenza and other infectious respiratory diseases in this vulnerable population, which lives outside the system developed by the Thai MOPH for the Thai population. The SMRU is in a unique position to carry out this work: it has 20 years of experience of working with the population living on the Thai Burma border and initiated the Malaria Task Force. This network aimed at preventing the risk of malaria epidemics in the refugee camps has been successful. For details on the MTF access: www.shoklo-unit.com

The project described in this proposal will be coordinated with a USAID-funded project administered by the International Rescue Committee (IRC) in Thailand, and both groups will coordinated their activities with the Thai Ministry of Public Health (MOPH).  As currently envisioned, IRC will have the lead in most of the influenza preparedness activities, SMRU will have the lead in developing laboratory capacity, and both groups will lead various surveillance activities. 

Objective

• Establishing a surveillance system for influenza-like illness in the displaced population in Thailand.
• Establishing the laboratory diagnostic facilities to test for influenza and other respiratory pathogens.
• Implementing preparedness, prevention and control measures.

Timeline

July-August, 2006:  Meet with IRC, USAID, and the Thai Ministry of Public Health to develop proposed work plans for influenza preparedness. [This task has been completed]
Late October, 2006:  Annual Malaria Task Force meeting.  The meeting is attended by all NGOs working in health along the Thai-Burmese border.  An additional day will be added to this meeting to discuss influenza. Protocols and SOPs for preparedness, prevention and control measures will be developed in consultation with government agencies, NGOs and other partners, in the first 3 months of the project.
November, 2006:  Order laboratory equipment and supplies, prepare to implement influenza surveillance
December, 2006, to January, 2007: implement surveillance, begin laboratory testing.
February, 2007, on:  Conduct surveillance, implement preparedness plans.

Staff and Responsibilities

• François Nosten will be overall responsible for the SMRU activities within the project. Dr Nosten will be the prime contact person for government agencies (MOPH, US-NHH-CDC).
• Paul Turner will be responsible for the laboratory work.
• Verena Carrara will supervise the data collection and analysis on respiratory infections in the displaced population. Dr Carrara will be the contact person for NGOs and other partners.
• Jerry Ramos will be responsible for the field work. Mr. Ramos will be the focal person for the NGO’s team in the camps.
• Julien Zwang will be responsible for setting up a web-based system for exchange of data and information with the partners.

Operational Plan

A. Surveillance system for influenza-like illness in the settlements for displaced population in Thailand.

In all refugee camps in major migrant workers settlements, an active surveillance of respiratory infections in humans and suspect mortality in poultry will be established.

• Animal disease surveillance:  Locally hired personnel will signal any unusual mortality in poultry and a team of trained workers equipped with protective gears will obtain samples to be analyzed in SMRU lab for evidence of H5N1 virus.
• Human disease surveillance: In medical facilities, cases of respiratory infections will be recorded, using a common case definition. Cases of influenza-like illness requiring hospitalization will be investigated and nasopharyngeal swabs obtained. These specimens will be analyzed to identify the causative pathogens.
• Cross-sectional surveys:  Cross sectional surveys of respiratory infections cases presenting in the camp OPD will be conducted to determine the most common pathogens and the antibiotic sensitivity profiles of the bacterial isolates.
• Data analysis, dissemination of results:  Data collected from the various sites will be compiled, analyzed and uploaded on the web-page accessible to all partners. This will also include the results of the drug sensitivity testing, in order to guide the use of antibiotics for respiratory infections.  Communications with the Thai Ministry of Public Health will be coordinated through the MOPH-CDC collaboration in Bangkok.

B. Implementing preparedness, prevention and control measures.

• Preparedness for a possible AI pandemic in the population will be conducted within the IRC-USAID AI program. SMRU will assist and advise IRC and other NGOs for the information campaigns and the training of health personnel.
• Prevention of the spread of infections suspected to be caused by H5N1 will include isolation of cases and utilization of protective equipment for contact personnel. The immunization of risk groups (young children, elderly people and patients with immuno-suppression will be discussed with the NGOs and other health partners. The strategy of prevention by antiviral chemo-prophylaxis in the contact people will be explored.
• Control measures will include the management of suspected AI infections in poultry and of human respiratory infections.

Measure of Effectiveness

After implementation, the project will be able to:
 - collect accurate data on respiratory infections among the population under surveillance and generate monthly reports
 - identify a variety of respiratory pathogens in specimens submitted from surveillance activities
 - culture S pneumoniae from specimens and test isolates for antibiotic susceptibility
 - generate practical recommendations for treatment of acute respiratory infections along the Thai-Burmese border.

Coordination
This project will be conducted in coordination with the IRC-USAID Avian Influenza project. Meetings will be organized twice a year with IRC and other partners (iNGOs, MOPH) to share information and results of the AI campaign. These general meetings based on the model of the MTF meetings, will also allow exchanges of data and information on other important diseases such as malaria, tuberculosis and HIV/AIDS. SMRU will also coordinate this AI project with the CCSDPT and attend meetings of the medical sub-committee when appropriate. A close cooperation will be kept with the MOPH-USCDC and USAID offices in Bangkok.