Review of the DoD-GEIS Influenza Programs Strengthening Global Surveillance and Response (2008) / Chapter Skim
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6 U.S. Army Medical Research Unit Kenya Avian and Pandemic Influenza Activities
6 U.S. Army Medical Research Unit Kenya Avian and Pandemic Influenza Activities
Pages 123-146
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From page 123... ...
Army Medical Research Unit Kenya (USAMRU-K) , a special foreign activity of the Walter Reed Army Institute of Research in Washington, D.C., was activated on a temporary basis at the request of the government of Kenya to study trypanosomiasis (DoD-GEIS, 2007a)
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. Migratory bird surveillance is also being conducted using DoD-GEIS avian influenza (AI)
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USAMRU-K also signed a contract with the Henry M Jackson Foundation, which included approximately $1.7 million of 2006 AI/PI funds, to develop and maintain influenza surveillance in Uganda and Cameroon and, potentially, other countries in the region.
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In addition, the USAMRU-K staff working in the National Influenza Center (NIC) on influenza surveillance receive the same salaries as their counterparts being paid by KEMRI.
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The IOM site visit team considered the investment in a specimen cataloguing and tracking system to be a wise use of DoD-GEIS money as it will benefit all of WRP's activities, improving the handling of specimens generated there as well as those from DoD-GEIS influenza surveillance.
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From page 128... ...
Human Surveillance The DoD-GEIS influenza surveillance in Kenya aims to isolate and characterize influenza viruses circulating among human populations, to estimate the burden of influenza disease among Kenyan children and adults, and to identify other viral and bacterial agents causing acute respiratory illnesses (USAMRU-K, 2007c)
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From page 129... ...
to test stool specimens from patients with gastroenteritis in order to detect H5 influenza virus. Several of the current surveillance sites provide opportunities to test specimens from pediatric and adult patients with acute respiratory illness for other viruses (e.g., RSV A and B, parainfluenza viruses 1, 2, and 3, adenovirus, and human metapneumovirus)
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RECOMMENDATION 6-2. To foster collaboration and illustrate the value of the surveillance activities to stakeholders, USAMRU-K should consider supporting a weekly or biweekly summary of the number of cases of acute respiratory illness and of influenza virus isolations, by age group, to be sent to all the surveillance sites to provide feedback to the clinicians involved in the surveillance system.
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. The epidemiologic concern is that migratory birds carrying highly pathogenic influenza viruses can transmit the avian viruses to domestic waterfowl or domestic chickens.
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The IOM site visit team discussed with WRP Kenya staff the possibility of visiting NAMRU-2 to learn how scientists there perform tracheal cultures. At the present time, there is no systematic surveillance for influenza viruses among either domestic chickens or industrial poultry farm chickens in Kenya.
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Diagnostic capabilities exist for influenza viruses, adenoviruses, enteroviruses, parainfluenza viruses, human metapneumovirus, and RSV. Real-time PCR is expected to be fully operational in the NIC before the end of March.
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This means the national government is expected to promptly report isolation of influenza viruses to WHO and promptly forward representative isolates to WHO-designated reference laboratories. NIC is not directly involved in the NAMRU-3 wild bird surveillance project.
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, which is already a primary DoD-GEIS program laboratory, and the USAMRU-K Kondele research laboratory, which was toured by the IOM site visit team. These two labs could each process an additional 500 samples per week, bringing the total capacity to 2,000 samples per week in a periepidemic situation.
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. Conclusions While there have not been any cases of avian influenza in Kenya, USAMRU-K has a history of participating in infectious disease outbreak investigations alongside the MoH and CDC representatives and has a well developed surge capacity plan in the event that an avian outbreak does occur.
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in influenza virus-infected cells, harvest of influenza viruses from infected cell cultures, cryopreservation of MDCK cells as well as virus isolates, and hemagglutinin/human avian influenza practicum. A field trip to a bird breeding and feeding location at the Ruai sewage plant in Nairobi was organized in conjunction with personnel from the National Museums of Kenya to trap birds and collect cloacal swabs.
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This means the national government is expected to promptly report isolation of influenza viruses to WHO and promptly forward representative isolates to WHO-designated reference laboratories. Conclusions USAMRU-K is working closely with relevant partners in Kenya to implement avian influenza activities.
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entities, which may represent lost opportunities for efficiency. UGANDA The proposed Uganda program would involve surveillance for H5 and other influenza viruses, including obtaining cloacal cultures from captured migrating waterfowl and assaying for influenza viruses; epidemiological and virologic investigation of chicken die-offs; and detection of influenza virus infections among a systematic sample of pediatric and adult ambulatory patients who present with acute respiratory illnesses to the outpatient department of Mulago Hospital in Kampala or to rural Kayunga District Hospital (Wabwire-Mangen, 2007)
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will be collected from each patient. Clinical specimens will be processed in the refurbished microbiology laboratory of the Veterinary School of Makerere University to detect the presence of influenza viruses.
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MAAIF has no avian influenza diagnostic capabilities itself and in the case of avian influenza relies on the UVRI, which is designated the WHO National Influenza Center. The UVRI is responsible for rapid analysis and sharing of specimens or isolates for (influenza)
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Conclusions The existence of a well-documented national plan, the inclusion of the Ugandan Ministry of Health and Environment, the sharing of personnel between the MoH and Makerere University, and the established programs of both MUWRP and CDC provide a unique opportunity for collaborative influenza surveillance activities in Uganda. Details of such collaborative activities remain to be worked out.
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U.S. Army Medical Research Unit-Kenya.
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Doug Walsh, U.S. Army Medical Research Unit Kenya Samuel Sinei, Walter Reed Project, Kericho, Kenya Dr.
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Col. Mark Polhemus 1200-1300 Tour Kondele facilities 1300-1345 Travel to Kombewa 1345-1500 Overview of Flu program and CDC-International Emerging Infections Program (IEIP)
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146 REVIEW OF THE DOD-GEIS INFLUENZA PROGRAMS Wednesday, March 14, 2007 0900-1600 Travel to Kampala, Uganda Thursday, March 15, 2007 0900-1030 Introductions and presentation of Uganda Influenza Work Plan 1030-1200 Courtesy visits Chairman of AI/PI Task Force Makarere University School of Veterinary Medicine Mulago Hospital Outpatient Clinic Makarere University Walter Reed Project (MUWRP) facilities 1630-1630 Field site visit to Kayunga District Hospital 1700-1700 Summary of day's events 1700- Return to hotel Friday, March 16, 2007 0930-1130 Informal discussions and site visit wrap-up 1130-1230 Final out-brief 1230-1700 Lunch and free time 1700- Departure
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