WHO Eastern Mediterranean Region (EMR) 2011-2012

U.S. Centers for Disease Control and Prevention (CDC) direct country support through cooperative agreements is established in the following countries:

• Afghanistan [593 KB, 2 pages]
• Arab Republic of Egypt [654 KB, 3 pages]
• Morocco [562 KB, 2 pages]
• Pakistan [1 MB, 3 pages]

In addition, CDC supports the WHO Eastern Mediterranean Regional Office (EMRO) via a cooperative agreement to provide coordination and technical support to WHO EMR Member States.

The core activities of these bilateral agreements are:

• To build sustainable national capacity for the detection, identification of, and response to, seasonal influenza, pandemic influenza, and other emerging diseases in accordance with International Health Regulations 2005 (IHR).
• To build capacity for integrated laboratory and epidemiologic surveillance for influenza-like illness (ILI) and severe acute respiratory infections (SARI). This includes making routine contributions to WHO’s Global Influenza Surveillance and Response System (GISRS) and implementing IHR (2005).
• To develop sustainable epidemiologic and virologic surveillance systems for severe influenza in order to gain an understanding of this disease and its economic burden and that of other respiratory viruses.
• To develop and sustain interagency, national preparedness plans.
• To develop and train local rapid response and containment teams.

Charlene Sanders, MPH, RD (until April 2012)
Project Officer
Extramural Program
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Email: csanders2@cdc.gov

Meg McCarron, MPH (from June 2012)
Health Scientist
Extramural Program
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Email: mmccarron@cdc.gov

Fatimah Dawood, MD
Medical Officer/Epidemiologist
International Epidemiology and Research Team
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Email: fdawood@cdc.gov

A map of the WHO Eastern Mediterranean Region (EMR) shows all 21 EMR member states/countries. The member countries, outlined with gray borders, include Afghanistan, Bahrain, Djibouti, Egypt, Iraq, Iran, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates and Yemen.

Countries with shading indicate that the Influenza Division provides project funding and technical assistance through cooperative agreements. Afghanistan, Egypt and Morocco are shaded yellow to indicate they have Capacity Building Cooperative Agreements. Pakistan is shaded green to indicate they have a Sustainability Cooperative Agreement.

CDC Field Staff, indicated by a yellow dot outlined in red, are located in Cairo.

The Global Disease Detection [GDD] Site, indicated by the red “X”, is located in Cairo. The Naval Medical Research Unit No. 3 (NAMRU-3), indicated by a pink diamond, is also located in Cairo.

WHO National Influenza Centers (NICs), indicated by a purple dot, are located in the following cities: Baghdad, Beirut, Cairo [2], Damascus, Islamabad, Kabul, Khartoum, Kuwait, Muscat, Rabat, Tehran and Tunis.

The WHO Eastern Mediterranean Regional Office (EMRO), indicated by a blue star, is located in Cairo, Egypt.

A five-year project titled Strengthening Surveillance and Response to Avian and Pandemic Influenza in the Eastern Mediterranean Region was launched in October 2006, under a cooperative agreement between the WHO Eastern Mediterranean Regional Office (EMRO) and the U.S. Centers for Disease Control and Prevention (CDC). The current reporting period is the fifth year of the cooperative agreement.

The goal of this project is to strengthen the capacity of all 23 countries in the WHO Eastern Mediterranean Region (EMR) to rapidly detect, assess, respond to and contain public health threats emanating from highly pathogenic avian influenza (HPAI) and human pandemic influenza.

• WHO EMRO organized a sub-regional training workshop on strengthening preparedness for, and mitigation of, pandemic influenza in refugee and displaced population settings.
• WHO EMRO collaborated with CDC and U.S. Naval Medical Research Unit No. 3 (NAMRU-3) to organize a regional influenza surveillance network meeting in October 2011. WHO EMRO supported the participation of 27 representatives from nine countries. The meeting explored ways to expand sentinel surveillance in the region, and a formal regional network was established, the Eastern Mediterranean Acute Respiratory Infection Surveillance (EMARIS) Network. This network was formed to foster greater collaboration and coordination across the region.
• Technical missions to Afghanistan, Jordan, Sudan, and South Sudan were conducted to assess surveillance capacities for integrating influenza-like illness (ILI) and severe acute respiratory infections (SARI) in their routine reporting systems. As a result, Afghanistan and South Sudan have now added ILI to their routine surveillance systems.
• WHO EMRO developed a draft regional guideline for influenza surveillance delineating the objectives, strategy, methods of data collection, analysis and reporting as well as methods for periodic monitoring and evaluation of the surveillance system for ILI and SARI.
• Representatives from WHO EMRO participated in a WHO Headquarters (HQ) meeting to develop global influenza surveillance guidelines. These representatives gave a voice to experiences gained in WHO EMR to help shape those guidelines.

Fifteen National Influenza Centers (NIC) are now functional in WHO EMR due, in part, to technical and financial support provided to countries through the CDC-WHO EMRO cooperative agreement.

Laboratory Activities

• Assessments of influenza virus isolation units were conducted in collaboration with NAMRU-3 in Bahrain, Jordan, Yemen, and the Kingdom of Saudi Arabia. The missions included on-site training courses on influenza virus isolation. Following the course, these laboratories have begun the formal designation process to be accredited as NIC by WHO.
• WHO EMRO provided support to seven NICs through the provision of reagents, primers, and other laboratory supplies to further improve capacity for isolation and sequencing of influenza viruses.
• WHO EMRO supported two laboratory staff from two countries in the region to attend training on biosecurity and biosafety management for novel influenza viruses at the NAMRU-3 laboratory.

National preparedness plans for human pandemic influenza were reviewed and updated in all 23 countries in WHO EMR drawing on lessons learned during the 2009 H1N1 pandemic. Technical support was provided in the areas of assessment, infection prevention and control, and risk management.

Preparedness Activities

• Regional personnel visited Saudi Arabia to advise national health authorities on public health preparedness measures for prevention and control of respiratory virus infections, including influenza, during the annual Hajj. This mission drew on lessons learned for appropriate public health responses to epidemic-prone disease in mass gathering situations.
• WHO EMRO organized a workshop for the assessment of infection prevention and control of influenza and other respiratory disease programs in health care settings. As a result of this workshop, evidence-based tools were developed to guide effective infection control measures, including the Infection Prevention and Control Assessment Tool (IPCAT). The intended use of this tool is for self-assessment of national infection and control policies and programs, and to guide changes to those programs.
• WHO EMRO participated in the WHO HQ revision of the pandemic influenza preparedness guidelines and the development of the pandemic influenza preparedness (PIP) framework.
• WHO EMRO participated in the Global Infection Prevention and Control Network (GIPCN) meeting organized by WHO HQ in Geneva from June 7–8, 2011, where they contributed to the development of a global work plan for the prevention of infection in health care settings from influenza and other acute respiratory infections (ARI).

• A sub-regional training course for the improvement of epidemiological surveillance capacity for ILI and SARI was held in Beirut, Lebanon. Four additional courses were held on methods for setting up surveillance for ILI and SARI.
• A training package on building ILI and SARI surveillance and response capacities for district level health officials has been developed and standardized.
• Two training courses on infection prevention and control for ARIs in health care facilities were organized in the region.
• All 23 countries in WHO EMR were trained on infection control measures in health care facilities.
• WHO EMRO and the WHO Global Influenza Program (GIP) jointly conducted two training courses on the packaging, transportation and shipment of influenza viral specimens following IATA guidelines in South Sudan and Sudan.
• WHO EMRO held a workshop on the management of public health risk for pandemic influenza. The focus of this course was management in displaced population settings.

Hassan El Bushra, MBBS, MCM, MPH, PhD, MFPHM
Regional Advisor, Emerging Diseases
Communicable Disease Surveillance, Forecasting and Response
WHO Regional Office for the Eastern Mediterranean
Cairo, Egypt
Email: elbushrah@emro.who.int

L. Martin Opoka, MBBS, PG Diploma, MSc
Technical Officer
Communicable Disease Surveillance, Forecasting and Response
WHO Regional Office for the Eastern Mediterranean
Cairo, Egypt
Email: opokal@emro.who.int

Ali R. Mafi, MD, MPH
Medical Officer
Communicable Disease Surveillance, Forecasting and Response
WHO Regional Office for the Eastern Mediterranean
Cairo, Egypt
Email: mafia@emro.who.int