Review of the DoD-GEIS Influenza Programs Strengthening Global Surveillance and Response (2008) / Chapter Skim
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to increase and improve its worldwide influenza surveillance network through upgrades to its domestic and overseas laboratories' capabilities. Though the twentieth century saw the emergence of three influenza pandemics, the one that remains most widely researched is the 1918-1919 pandemic, commonly referred to as the "Spanish flu." This pandemic killed an estimated 50 million to 100 million people, thereby qualifying as the most deadly disease outbreak in history (Tumpey et al., 2005)
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in 1996, which declared that national and international capabilities for infectious disease surveillance, prevention, and response were inadequate to protect the health of U.S. citizens from emerging infectious diseases and called for a more robust national policy to improve these capabilities (IOM, 2001)
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in Egypt, Indonesia, Iraq, Kazakhstan, and Turkey. Additionally, the laboratories provide laboratory and field support, train host country and U.S.
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the worth of each funded project's contribution to a comprehensive AI/PI surveillance program; b. the adequacy of the program in view of the evolving epidemiologic factors; c.
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These efforts include multimillion-dollar programs at the five DoD overseas labs and at the Naval Health Research Center in San Diego. Some of these new players have built enough independent laboratory capacity that they no longer are dependent on the laboratory services of the Air Force Institute for Operational Health (AFIOH)
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RECOMMENDATION 10-1. The executive agency functions of the DoD influenza and respiratory disease surveillance program should be reexamined in light of the evolution of the program in response to the potential of pandemic influenza.
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. Over the years, the overseas laboratories have expanded their roles in host countries and in the surrounding geographic regions to include training activities and collaborative studies of pathogens of importance to the general public, but taking on a surveillance role, such as the AI/PI surveillance program, has been a significant departure from the historical research orientation.
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Adequacy of the Program in View of Evolving Epidemiologic Factors -- Animal Influenza Surveillance Most of the DoD-GEIS laboratories that received AI/PI supplemental funds are implementing animal surveillance programs, the majority of which are in wild bird populations. Despite the challenges, wild bird surveillance can, if done well, yield useful information on highly pathogenic influenza viruses.
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DoD-GEIS headquarters and laboratories should seek collaborative opportunities to partner with organizations already studying influenza transmission in wild and domestic birds and animals in their areas. Adequacy of the Program in View of Evolving Epidemiologic Factors -- Laboratory The AI/PI supplemental funding has been allocated to expanding or enhancing physical structure and laboratory capacity in all of the DoD-GEISsupported sites.
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RECOMMENDATION 10-10. The DoD-GEIS influenza surveillance programs in the overseas laboratories should be complementary to the host-country laboratory system and help to increase surge capacity at the host country levels.
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Such a document should include a clear statement of the labora tory designated by WHO as the reference laboratory for isolates from the host country. Coordination and Collaboration -- International Partners While significant effort has been put into strengthening the coordination of avian and pandemic influenza activities, the overseas laboratories must continue their efforts to work within each country's national plan, thereby increasing national capacity and avoiding unintentionally working against the national plan.
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RECOMMENDATION 10-13. DoD-GEIS should further strengthen its coordination and collaboration on pandemic influenza and other emerging infectious diseases with all U.S.
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DoD-GEIS headquarters should continue to strengthen its in-house influenza expertise as necessary in order to give DoD laboratories and other relevant in stitutions the assistance needed to implement quality influenza surveillance and response activities. DoD-GEIS headquarters should continue to work with U.S.
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14 REVIEW OF THE DOD-GEIS INFLUENZA PROGRAMS BOX S-3 Chapter 4 Recommendations Armed Forces Research Institute of Medical Sciences Thailand AFRIMS should establish more intensified surveillance for seasonal and novel strains of influenza at sites in temperate and tropical/subtropical parts of Nepal, in locales with commercial poultry production units, and at migratory bird resting sites. AFRIMS should continue to work toward self-sufficiency in its isolation and iden tification systems in order to release PCR results more quickly to its national partners while taking appropriate steps to ensure laboratory containment and quality assurance.
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NAMRU-3 should assist the host country to develop the capacity to find emerging influenza pathogens beyond H5N1 and should integrate seasonal influenza and AI/PI programs as much as possible. NAMRU-3 should explore opportunities to support the Ministry of Agriculture in increasing surveillance of domestic birds kept in homes and backyards.
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To foster collaboration and illustrate the value of the surveillance activities to stake holders, 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. USAMRU-K should draw on the experience of other DoD OCONUS laboratories in animal influenza surveillance.
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BOX S-7 Chapter 8 Recommendations Naval Health Research Center San Diego NHRC should investigate factors contributing to the ability or inability of the eight military training sites to meet maximum FRI surveillance targets as well as continue to explore methods to validate the reliability of virus-effectiveness data, which are available from no other populations on a consistent basis. The services should explore interpretation of the syndromic surveillance mandate to include laboratory diagnostic testing of clinically ill subjects in order to facili tate crucial febrile respiratory illness and other infectious disease surveillance in military populations.
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AFIOH should consider the expansion of its laboratory capacity to include multi tasking diagnostic equipment for respiratory diseases. AFIOH should create a sustainable and useful archive of the original patient sam ple and virus isolate materials in this laboratory to ensure this national resource can be used to fulfill the missions of the DoD-GEIS AI/PI program.
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2006. The Department of Defense Global Laboratory Based Influenza Surveillance Program: FY 2006 annual report.
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