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Sisea Bernatas Soc Path Exo Jan10


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SISEA project implemented by the International Pasteur Institutes Network

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Sisea Bernatas Soc Path Exo Jan10

  1. 1. 11/02/10 International Pasteur Institutes Network "Surveillance and capacity Plan building in South-East Asia: 1.  What is SISEA? 2.  Main SISEA’s outcomes SISEA project" a.  b.  Improving surveillance through a better knowledge of some EIDs: ARI&AES Capacity strenghtening   Equipment, consumables   HR   Public Health capacities: detection&response of potentially at risk outbreaks 3.  Conclusions & perspectives International Pasteur Institutes Network Surveillance et Investigation des Situations Epidemiques en Asie du Sud-Est 1.  What is SISEA? Context: 2.  Main SISEA’s outcomes "   Outbreak as global social crisis in South-East Asia: SARS a.  Improving surveillance through a better knowledge of some EIDs: ARI&AES b.  Capacity strenghtening (2003-2004, 8096 cases/774 fatalities); avian influenza (2005   Equipment, consumables and sqq.; 467 cases/282 fatalities on Dec. 31st 2009)   HR   Public Health capacities: detection&response of potentially at risk outbreaks 3.  Conclusions & perspectives " International concern and mobilization as soon as northern   countries felt themselves in danger (what will be called by WHO from 2005: “PHEIC” included in the IHR-2005) " And the beginning of an international involvement and   commitments from multilateral and bilateral institutions 4 Budget breakdown – in line with the objectives " A convention was signed in June 2006 for 5 years, between   AFD and Pasteur Institute of Paris (DG) Type of disbursement Amount (€) % " Following, conventions were signed between DAI/IPP and   each partner implementing a piece of the project set up Equipment 720,936 12 through a participative approach Personnel & Training 2,215,543 38 " 5.6 M€ over 4 effective years with 6 partners (5 IPIN’s   Goods and services 2,028,234 34 members) in SEA: Monitoring and evaluation 181,787 3 "   Chine: IP Shanghai "   Vietnam: NIHE, IP Nha Trang, IP HCM Other 369,500 6 "   Cambodge: IP Phnom Penh "   Lao PDR: NCLE (not IPIN) Management fees 384,000 7 5 6 1
  2. 2. 11/02/10 Objectives and content of the SISEA project: Network .... and sub-network The aim of SISEA project is to contribute to improving the detection and the treatment of epidemic episodes in South-East Asia The specific objectives of the SISEA project aim to: " Establish a program for epidemiological surveillance and   investigation of epidemics caused by emerging viruses " Establish a network of laboratories and develop   regional coordination in these fields in association of WHO International Pasteur Institutes Network – 32 members on 5 continents 7 8 3 COMPONENTS Network of laboratories & hospital-based sentinel sites C1: Strenghtening the reference laboratories and establishing a network among them. Increasing the capacities of the lab. to identify pathogens, particularly viral pathogens, and qualify them IPS - pediatric hospital of Nanxiang NIHE - Guangxi CDC C2: Improving the epidemic alert on emerging viruses in each country - Provincial Hospital of Hai Duong - District hospital of Cam Giang -  Strenghtening national epidemiological surveillance system - 19 communes IPNT -  Increasing the involvement of sentinel centers in the network - Provincial Hospital of Binh Dinh NCLE - District Hospital of Phu Cat -  Investigating epidemic episodes -Setthathirath Hospital, Vientiane C3: Strenghtening the epidemic response network at national and regional levels: - In each country, strengthening the connections and coordination between various sector involved IP HCMC in surveillance (IO / WHO, OIE; NGOs) - Ben Tre provincial hospital - Cu Lao Minh district hospital IP Cambodia -  Developing relationships between the various countries (joint training, …) - Provincial hospital of Takkeo - Provincial hospital of Kampong Cham -  Strengthening regional coordination Here are the nodes, and finally, the project -  Including RIIP’Institutes in a vast network coordinated by WHO aims at building the edges, so as it 9 10 -  Technical and scientific oversight of the SISEA project activities and dissemination of the results becomes a real network International International Pasteur Institutes Pasteur Institutes Network Network Improving surveillance in China: 1.  What is SISEA? 1.  IPS: implementation of a respiratory virus diagnosis platform based on multiplex and real-time RT-PCR, and serology (1,2,3,4) working with regional (Hong Kong, Cambodia) 2.  Main SISEA’s outcomes and international (Paris) Pasteur Institutes. 1.  ARI: cohort of 817 children / testing NP samples with mPCR compared with Luminex (Wang et al.) a. Improving surveillance through a better 2.  human rhinoviruses (HRV) identification performed on the same cohort of 817 samples: recombination events involving HRV-A sequences in the newly identified knowledge of some EIDs: ARI&AES species of HRV-C (3). Further studies with IPC; warning on emergence of epidemics of HRV recombinants. b.  Capacity strenghtening 3.  HBoV: persistance of viruses 31 days after onset; frequent viral coinfection   Equipment, consumables 4.  Technology transfer of multiplex RT-PCR to the laboratory of Shanghai Public Health Center to reinforce the preparedness of the alert system during the Shanghai   HR 2010 World Expo   Network integration and partnerships 2.  SARI surveillance in Shanghai Nanxiang Hospital (started in march 2009) 3.  Conclusions& perspectives 3.  Isolation and characterization of JEV and development of new diagnostic tool (NS1 protein, Deubel et Al.) with a collaboration with Guotong China CDC and NIHE in Vietnam) 4.  Study of encephalitis of unknown origin in 2009 in Guangxi province is ongoing. 131 patients included and sampled from January to June 2009 by Guangxi CDC. 2
  3. 3. 11/02/10 International International Pasteur Institutes Pasteur Institutes Network Network Improving surveillance in Cambodia – 1 (Vong S and al.): Improving surveillance in Cambodia - 2 (Vong and al.): 2.  Knowledge of inflenza viruses strains circulating during 2009. From Jan to Nov 2009: 108 cases 1.  Implementation of the ALRI surveillance activities in April,2007: on Nov 2009, among ALRI cases in sentinel sites: 53% A(H3N2), 27% B, 10% A(H1N1)soiv, 6% A(H1N1), 4% other 3177 patients enrolled. In depth clinical classification and data validation (Pr. 3.  SISEA results included in the National Bulletin of respiratory infections since 2008 Mayaud and al.). 4.  Numerous requests from NGOs and other public hospitals for bacterial etiologies of ARI and their susceptibility to ATB 5.  Publication of first data on melioidosis in a National Medical Journal (Health Messenger) 6.  Use of SISEA results by national experts to advocate for changing MoH recommendations on first Percentage % line treatment for ARI (high resistance of S. pneumoniae to ampicillin and cotrimoxazole) Viro and bacterio : # positive results / # samples tested (%) 7.  Presentation of SISEA data by some site clinicians in national and international conferences 8.  Expertise sharing on pathologies between clinicians in Laos and Cambodia BK : # positive / # cases (%) And also, as a main outcome: improving patient care management •  Follow-up of clinical process indicators: –  Monitoring of the number of discrepancies and incoherence in SISEA CRF •  Thru ascertainment of diagnosis Extra-respiratory Other Pneumonia Pleural pathologies respiratory infections •  Thru monitoring of a sample of patients after discharge infections International International Pasteur Institutes Pasteur Institutes Network Network Improving surveillance in Vietnam (SARI and AES)- NIHE: Improving surveillance in Vietnam (SARI and AES) IP-Nha Trang: 1.  Investigation of an outbreak of coronavirus NL-63 detected at the communal 1.  Influenza: 86% flu A/H3, 9% A/H1, 5% A unsubtyped level thanks to the multiplex protocols implemented at NIHE through SISEA. 2.  SARI: 01/10/2008 to 30/09/09: 731 cases/48%+ve mPCR (41% 1-virus; 6% 2- 2.  NIHE: SARI Jan to Nov 2009 viruses; 1% 3-viruses) Eligible  cases  297 Number  cases  enrolled  290  (97.6%) Nega;ve  :  33.4  %  (n=97) Posi;ve  :  66.6  %  (n=193) Agent 1st 2nd 3rd n % 1 H1N1/09* 71 9 80 41.5 2 RHINO 31 7 38 19.7 3 FluB 19 6 1 26 13.5 4 hMPV 12 6 4 22 11.4 5 PARA 1 10 3 1 14 7.3 6 Flu A 10 2 2 14 7.3 7 Others 40 9 1 49 25.4 Total 193 42 9 100 International International Pasteur Institutes Pasteur Institutes Network Network Improving surveillance in Vietnam (SARI and AES) IP-Ho Chi Minh- Improving surveillance in Vietnam: case definition of SARI City: adopted: 1.  Activities implemented in 2009 (cumulative number of SARI cases>2000): Objectives Activities ≤ 05 y.o. > 05 y.o. Viral pathogens of Strengthening the lab. capacity -  Install office and scientific equipments (data management and diagnostic) Cough or breathing difficulty Fever ≥ 38o C (or history of fever) - Training and Technique transfer: Bacterial diagnosis (Sentinel hosp.), JEV/DENV-MAC AND AES ELISA (PMC) AND Cough OR sore throat OR breathing from Jan 2009 to One of the following: difficulty Surveillance - Training: SARI/AES surveillance procedures • Tachypnea AND Nov4.92 4.92 2009 Viral pathogens of SARI cases and 122 AES cases (Jan-Oct 2009) - Enroll 1,271 • Chest indrawing One of the following: % - 50% confirmed SARI by 15 viruses (RhinoV, RSV, Flu V, BocaV); 43% confirmed AES by • General signs of danger • ≥ 30 respirations/min % SARI JEV, DENV & EVs (with 7% arbo-enterovirus co-infection). • New infiltrate on chest X-ray 32.79 • Inability to speak full sentences 57.38 from1.97% 2009 to Jan -  9% confirmed SARI by bacterial (Aug-Nov.2009) with 64% viral co-infection. Onset of symptoms up to and % 12.67 including 7 days • Use of accessory respiratory muscles % Nov 2009 Investigation - Training: AES case management, Entomological survey of JEV case • Arterial O2 saturation ≤ 92% on air 17.31 intervention and % 0.16% 0.55% 3.46% - Field investigation of Flu A/JEV confirmed cases (16 A/H1, 7A/H3, 6 JEV) 2.12% (no oxygen therapy) % 2.2% 3.54% 0.16% 0.31% 1.26% 2.12, - 0.16% JEV vaccination in districts having confirmed cases JE Dengue EV Negetive % 1.42% Adenovirus- Weekly checking the CRFs Onset of symptoms ≤ 7 days Quality control 50.59 % Bocavirus - Weekly supervise the case detection and enrollment Enterovirus-  Specimen quality and timely testing -  Set up the SOPs of sample management and testing for SARI and AES 3
  4. 4. 11/02/10 International International Pasteur Institutes Pasteur Institutes Network Network Improving surveillance in Lao PDR: 1.  Technical assistance in microbiology and epidemiology 2.  ALRI surveillance, complementary approach to the other surveillance system implemented (EWORS, EWARN, ILI): 1.  ILI: 2007 to 2008 : 507 ILI specimens collected → 142 (28 %) +ve for IAV and IBV, 2009 : 533 specimens collected → 139 (26 %) +ve for Influenza IAV and IVB. 2.  ALRI: Jul 08 to Oct 09: 222 specimens collected → 26(11.7%) +ve for IAV and IVB; 24 sputum specimens collected for bacteriology testing: 11(45.8%) +ve: S. pneumonia, H. influenza, S. aureus, P. aeruginosa, K. pneumonia (+ C. albicans) 3.  Contribution to ILI surveillance 4.  Strenghtening virology, bacteriology, epi 5.  Implementing a new sentinel site in Luanprabang International Short Course in Biostatistics - REDI Reaching common administrative standards. June 10, centre - Singapore, November 9-13, 2009. 2008: = Management and Administrative Routines Workshop held in Nha Trang, Vietnam on 29-30 May. Capacity strengthening and epidemiology On-site training/Transfert of technology: - February 2008, Institut Pasteur Cambodia. PCR multiplex. 2 weeks/2 virologist from IP NT 24 trainees/12 from SISEA Daily and final evaluation; very good input from SISEA - September/October 2009, Institut Pasteur Cambodia: PCR multiplex 2 weeks/2 trainees virologist from NCLE (Vientiane, PDR Lao) Very good perception by the trainees - November 2009: 1 bacteriologist from NCLE for 1 month in IPC New ties with profesionals coming from Indonesia, and Singapore High quality of the collaboration with REDI and NUS, who are demanding for 21 22 other collaboration in training International Pasteur Institutes HKU-Pasteur Virology Course 2009 Network • Focus on neurotropic viruses • Neurobiology, clinical, molecular virology • Practical sessions (molecular, cellular, bioinformatics) • 24 students, 4 from IPS • 4 speakers from IP, 3 Asian experts • SISEA session 23 4
  5. 5. 11/02/10 International Pasteur Institutes First Forum GMS forum on Japanese Encephalitis/viral Network Encephalitis prevention and control: Achievements and orientation, 29-30 October 2009, Hué City, Vietnam: over 40 experts from Cambodia, China, France, Japan, Laos, Malaysia, Singapore, USA and Vietnam. Cosponsored with ADB/ GMS-CDC project CEROPATH Workshop, Siem Reap 17-20 November 2009 Community ecology of rodents and their pathogens in South-East Asia Biodiversity changes and implications in health ecology. ANR; many universities and institutions from France, Thailand, Belgium, Finland and Laos. Partnership with CIRAD 25 Overtoom R, Khieu V, Overtoom R, Khieu V, Hem S, Cavailler P, Te V, Chan S, Lau P, Guillard B, Vong S. A first report of pulmonary melioidosis in Cambodia. Trans R Soc Trop Med Hyg. 2008 Dec;102 Suppl 1:S21-5 Vallée J, Dubot-Pérès A, Ounaphom P, Sayavong C, Bryant JE, Gonzalez JP.Spatial distribution and risk factors of dengue and Japanese encephalitis virus infection in urban settings: the case of Vientiane, Lao PDR.Trop Med Int Health. 2009 Sep;14(9): 1134-42. Epub 2009 Jun 28. Public health and research = mutual feeding Wang W, Ren P, Hou L, Tsai C, Chan KH, Chen P, Shen J, Buchy P, Sun B, Toyoda T, Lim W, Peiris JSM, Zhou P, Deubel V. (2009). Design of multiplexed detection assays for identification of avian influenza a virus subtypes pathogenic to humans by SmartCycler real- time reverse transcription-PCR. J Clin Microbiol. 47:86-92 Research → Public health: cf. Previous slides Wang W, Ren P, Sheng J, Mardy S, Yan H, Zhang J, Hou L, Vabret A, Buchy P, Freymuth F, Deubel V. (2009). Simultaneous detection of respiratory viruses in children with acute respiratory infection using two different multiplex reverse transcription-PCR assays. J Virol Methods 162:40-45. Public health → research : Publications supported by the activities of SISEA. Huang T, Wang W, Bessaud M, Ren P, Sheng J, Yan H, Zhang J, Lin X, Wang Y, Delpeyroux F, Deubel V. Evidence of recombination and genetic diversity in human rhinoviruses in children with acute respiratory infection. PLoS One. Jul 27;4:e6355 Wang K, Wang W, Yan H., Ren PJ, Zhong J, Shen J, Deubel V. Correlation between human bocavirus infection and humoral Limitations: data have been collected according to a surveillance objective, response, and co-infection with other respiratory viruses in children with acute respiratory infection. J. Clin. Virol. (in press) and no research design has been really set up regarding to scientific Tsai C, Caillet C, Hu H, Zhou F, Ding H, Zhang G, Zhou B, Wang S, Lu S, Buchy P, Deubel V, Vogel FR, Zhou P. Measurement of neutralizing antibody responses against H5N1 clades in immunized mice and ferrets using pseudotypes research questions, and financial support is provided for public health expressing influenza hemagglutinin and neuraminidase. Vaccine. 2009 Sep 2. [Epub ahead of print] concerns Buchy P., Fourment M., Mardy S., Sarn S., Davun H., Vong S, Peiris J.S.M., van der Werf S. Molecular Epidemiology of Clade 1 Influenza A Viruses (H5N1), Southern Indochina Peninsula, 2004-2007. Emerg Infect Dis. 2009 Sep available at However, the observation of the data rises fundamental or applied research content/15/10/1641.htm questions: co-infections, diagnosis tools, negative samples (more or less Fourment M, Mardy S, Channa M, Buchy P. Evidence for viral persistence, antiviral resistance and reassortment events in seasonal influenza viruses circulating in Cambodia. J Clin Microbiol. 2009 Nov 4. 50%...) Buecher C. , Mardy S. , Wang W. , Duong V. , Vong S., Vabret A. , Freymuth F., Deubel V., Buchy P. Use of a multiplex PCR/RT-PCR approach to assess the viral causes of influenza-like illnesses in Cambodia during three consecutive dry seasons. J. Med. Virol. (in press) 27 28 Next steps … After 2010 ...? • Epidemiological and clinical description of various bacterial or viral infections " Needs and wishes from the partners   • Bacterial resistance: characterization and determinants "  Funding ? Who ("WHO"?, AFD, ADB, US-CDC, DHHS, ...) • Risk factors for severe infections by pathogen • Phenotypic and genotypic determinants of viral virulence "  Network of laboratories and of hospital-based sentinel sites set up at the end of the project = sustainability of the system • Viral resistance to antivirals " Knowledge, know-how, applicable for many lab techniques   • Diagnosis of SARI by use of scoring system for severity • Bacteria of interest: M. tuberculosis, B. pseudomalleii, K pneumoniae "  Geographical expansion within a country or to other countries? • Viruses of interest: influenzas, HRV, RSV, hMPV, BocaV "  Other pathologies (rabies, …), or other EID concerns as viral/bacterial resistance as an emerging infectious disease event • Clinical outcomes: guidelines/recommendations/GCP for improving patient management, both in ARI and AES " I  mproving connection between human and animal surveillance (in line with “One World One Health" initiative 29 " I  ntegration with environmental issues and climate change under the scope of 30 risk assessment 5
  6. 6. 11/02/10 Better “Knowledge is the understanding heritage of humanity.” ≠ should teach us to avoid such mistakes ! « Science doesn't belongs to one OR country, or rather science encompass the whole humanity" ≠ Louis Pasteur (1822-1895) 31 32 Many  thanks  to:   Ins;tut  Pasteur  du  Cambodge  :    Dr  Sirenda  Vong,  Dr  Sowath,  Dr  Laurence     Borand,  Sophie  Goyet,  Dr  Philippe  Buchy,  Dr  Bertrand  Guillard.  Pr  Jean-­‐Louis  Sarthou,     NIHE  :  Pr  Nguyen  Tran  Hien,  Dr  Nguyen  Thi  Thuong,  Dr.  Nguyen  Van  Duong   Ins;tut  Pasteur  Nha  Trang  :  Pr  Bui  Trong  Chien,  Dr.  Vien  Quang  Mai,     Dr.Trinh  Thi  Xuan  Mai   Ins;tut  Pasteur  Ho  Chi  Minh  Ville  :  Pr  Tran  Ngoc  Huu,  Dr.Kien  Quoc,  Dr.  Huong     Vu  Thi  Hu  Que   Ins;tut  Pasteur  de  Shanghai  :    Dr  Wei  Wang,  Dr  Peijun  Ren,  Dr  Jin  Zhang,     Dr  Changgui  Dong,  Dr  Yize  Li,  Dr  Peng  Lu,  Dr  Vincent  Deubel,  M.  I.  Robin   NCLE  :  Dr  Phengta  Vongprachanh,  Dr  Hansila  Phoupaseuth,  Dr.  Somvay       Ongkhammy,  Dr  MaShida,  Dr  Darouny  Phonekeo,  Dr.  Noikaseumsy  Sithivong,     Dr  Thongchanh  Sissouk,  M.  Phayvan,   Unité  de  Coordina;on  :  Mme  Silvia  Ostberg,  Dr  Roberto  Bruzzone  (HKU-­‐Pasteur  InsVtute  –  scienVfic   advisor)   DAI  :  Dr  Isabelle  Catala,  Dr  Marc  Jouan     And to all the hospital's staff involved in THANK YOU FOR the sentinel surveillance 33 YOUR ATTENTION 6