SITREP - WHO | 2002 - Influenza in Madagascar - Update 6

2002 - Influenza in Madagascar - Update 6

30 August 2002

Disease Outbreak Reported

The international team from the Global Outbreak Alert and Response Network assisting the Ministry of Health provided a preliminary report of their findings and recommendations to the Ministry of Health on 29 August.

Summary: An epidemic of influenza was attributed to influenza A/Panama/2007/99?like (H3N2) viruses that impacted the populations of the highlands region of Fianarantsoa Province. This is the same strain that was associated with influenza epidemics worldwide during 2001-02. The most affected area of the province was Ikongo district. The observed increase in excess mortality compared to previous years appeared to be due to widespread transmission and not an especially virulent influenza strain. Most deaths occurred outside of health facilities and disproportionately affected young children. Seasonal epidemics of influenza that have been documented in Antananarivo most likely also affect the highlands region of Fianarantsoa Province each winter, resulting in morbidity and mortality.

Among the recommendations are: expanding the influenza sentinel surveillance system and implementing a standard case definition for influenza-like illness; improving case management and training for health care providers; and providing health education activities to inform the public about influenza and the need for those at high risk (young children,the elderly and those with chronic illness) to seek medical care if experiencing acute respiratory illness.

WHO 2002 - Influenza in Madagascar - Update 6

SITREP - WHO | 2002 - Influenza in Madagascar - Update 5

2002 - Influenza in Madagascar - Update 5

28 August 2002

Disease Outbreak Reported

The outbreak has extended to 5 out of 6 provinces in Madagascar, the exception being Antsiranana province in the north-east of the country (see previous report).

The international team from the Global Outbreak Alert and Response Network continues to work with mobile teams from the Ministry of Health investigating these cases and collecting samples. Since the beginning of August 2002, additional influenza A(H3N2) viruses have been isolated from cases in different provinces. Analysis by the WHO Collaborating Centre for Reference and Research on Influenza in London, United Kingdom and the Institut Pasteur, Madagascar (National Influenza Centre) have shown that the circulating influenza virus is similar to A(H3N2) viruses (A/Panama/2007/99/(H3N2) ) which have been circulating in the northern and southern hemispheres for several years. The virus circulating in Madagascar is similar to those included in the current influenza vaccine and also in the vaccine for the coming influenza season in the northern hemisphere; these vaccines, therefore, protect against infection with this virus.

WHO 2002 - Influenza in Madagascar - Update 5

WHO | 2002 - Influenza in Madagascar - Update 4

2002 - Influenza in Madagascar - Update 4

23 August 2002

Disease Outbreak Reported

As of 22 August, the outbreak has extended to 5 out of 6 provinces in Madagascar, the exception being Antsiranana province in the north-east of the country. The total number of reported cases is 22 646 with 671 deaths. The most affected province is Fianarantsoa with 18 808 cases and 556 deaths. The increase in numbers may be due, in part to a standard case definition established by the Ministry of Health now being applied to all districts.

The international team from the Global Outbreak Alert and Response Network is working with mobile teams from the Ministry of Health investigating these cases and collecting samples. To date, influenza A(H3N2) viruses have been isolated.

Preliminary findings indicate that the high mortality rates may be attributable in part to the lack of access to health care and to very poor nutrition in the affected districts. Along with the Ministry of Health, the WHO country office has been working with UNICEF and the World Food Programme to provide protein-enriched foods as soon as possible and to establish nutritional education centres.

WHO 2002 - Influenza in Madagascar - Update 4

WHO | 2002 - Influenza in Madagascar - Update 3

2002 - Influenza in Madagascar - Update 3

16 August 2002

Disease Outbreak Reported

As of the 13 August 2002, the Ministry of Health has reported 13 300 cases including 444 deaths (CFR 3.3%) of influenza-like illness affecting 6 of 111 districts (see previous report).

The international Global Outbreak Alert and Response Network team arrived in Antananarivo, Madagascar on 14 August and has had productive meetings with Ministry of Health and other officials. The team will work with the Ministry of Health to put a surveillance system in place that will allow health officials to assess disease trends in specific districts. During the coming week, the team also plans to design and implement studies to determine the risk factors for severe disease and death. The Institut Pasteur - Madagascar is testing samples to better characterize the virus(es) in this outbreak.

The government is organizing mobile teams to provide medical support to new foci of disease activity. Health resources are presently focused on providing medical, e.g., antibiotic treatment, to those in need.

WHO 2002 - Influenza in Madagascar - Update 3

SITREP - WHO | 2002 - Influenza in Madagascar - Update 2

2002 - Influenza in Madagascar - Update 2

13 August 2002

Disease Outbreak Reported

The Ministry of Health has reported a total of 5 117 cases including 374 deaths (case-fatality rate of 7.3%) in 5 out of 13 districts in the country (see previous report).

An international team from theGlobal Outbreak Alert and Response Network will be assisting the Ministry of Health in investigating and containing the outbreak. The six-member team includes 2 epidemiologists/clinicians from the Institut Veille Sanitaire, Paris, a laboratorian from Institut Pasteur, Paris, an epidemiologist/clinician from the Centers for Disease Control and Prevention, Atlanta, United States, a microbiologist from the WHO sub-Regional Response Team, WHO Regional Office for Africa and a logistician from WHO headquarters.

Working with the Ministry of Health, Institut Pasteur, Madagascar and the WHO country office, the team will carry out an epidemiological assessment of the outbreak; support the Institut Pasteur, Madagascar in laboratory services during the epidemic; assess the clinical management of cases; and provide logistic support to the outbreak response. WHO is also assisting the Ministry of Health by providing medical supplies.

WHO 2002 - Influenza in Madagascar - Update 2

SITREP - WHO | 2002 - Influenza in Madagascar - Update

2002 - Influenza in Madagascar - Update

07 August 2002

Disease Outbreak Reported

The Ministry of Health has announced that the Institut Pasteur, Madagascar has isolated influenza A (H3N2) viruses from 2 out of 39 samples taken from cases in Fianarantsoa province, an area where outbreaks of an influenza-like illness have been reported (see previous report).

The Ministry of Health has updated the epidemiological data: Since 4 July 2002, a total of 1 291 cases and 156 deaths have been reported.

WHO 2002 - Influenza in Madagascar - Update

SITREP - WHO | 2002 - Influenza in Madagascar - Update 1

2002 - Influenza in Madagascar - Update 1

07 August 2002

Disease Outbreak Reported

The Ministry of Health has announced that the Institut Pasteur, Madagascar has isolated influenza A (H3N2) viruses from 2 out of 39 samples taken from cases in Fianarantsoa province, an area where outbreaks of an influenza-like illness have been reported (see previous report).

The Ministry of Health has updated the epidemiological data: Since 4 July 2002, a total of 1 291 cases and 156 deaths have been reported.

WHO 2002 - Influenza in Madagascar - Update