Global Agenda against Influenza

Network focuses on surveillance

A longtime player in the battle against influenza, the World Health Organization recently developed a Global Agenda on Influenza Surveillance and Control. This program was crafted and agreed on by the participants in the WHO Consultation on Global Priorities in Influenza May 6 to 7 at the WHO headquarters in Geneva, Switzerland.

    Although the agenda was initiated by the WHO Global Influenza Programme, it is rightfully the result of the work of many colleagues outside and within the UN body who contributed advice on the development process and participated in the electronic discussion conducted during the preparation of the document.

Capacity Enhancement

    WHO has operated its Influenza Surveillance Network for over half a century, greatly contributing to the understanding of influenza epidemiology and providing an effective basis for regular updating of influenza vaccine formulations. WHO recognized, however, the importance of further developing the capacity for influenza surveillance and control and for encouraging wider input and participation of member states. To this end, the WHO Global Influenza Programme called for contributions to develop a Global Agenda. It was put together, in fact, in a spirit of collaboration, aimed at developing a sense of ownership and support of priority activities among participating countries.

    The Global Agenda comprises prioritized activities critical to reducing morbidity and mortality from the annual influenza epidemics and to prepare for subsequent influenza pandemics. Its major themes are:

• Improvement in the quality and coverage of virological and epidemiological influenza surveillance,

• Improvement in the understanding of health and economic burden of influenza, including benefits from epidemic control and pandemic preparedness,

• Expansion in the use of existing vaccines, particularly in developing countries and in high-risk groups and acceleration in the introduction of new vaccines, and

• Increase in national and global epidemic and pandemic preparedness, including vaccine and pharmaceutical supplies.

Focusing Efforts

    The Global Agenda seeks mainly to provide impartial and prioritized guidance to all parties on research and development for influenza control on both national and global levels, and to support coordination of action for influenza control and surveillance in participating countries. It also aims to extend support to the implementation of identified priorities, as well in advocacy and fund raising for this initiative.

    The international network for influenza surveillance is in some way even older than the WHO itself. It was first envisioned in 1947, a year before WHO was founded and made responsible for the network's administration. The Network now consists of 110 National Influenza Centers in 83 countries and the four WHO Collaborating Centers for Virus Reference and Research in Melbourne, Tokyo, London, and Atlanta.

    This vast network helps WHO monitor influenza activity in all regions of the world and ensures that virus isolates and information are sent rapidly to the WHO Collaborating Centres for Virus Reference and Research for immediate strain identification. Data generated from these efforts are used by WHO in its ongoing consultations to review the currently circulating influenza virus strains worldwide and to recommend the appropriate vaccine composition to be used for the next season.

    While vaccination is usually associated with infants and toddlers, influenza vaccines are specially recommended to the elderly and people with underlying chronic diseases like cardiopulmonary ailments and diabetes. Adults are given this vaccine in a single shot, while young children receive two doses across a month interval.

Game Plan

    Apart from the Global Agenda, WHO has developed a plan for the Global Management and Control of an Influenza Pandemic. The plan's elements include augmented surveillance for and identification of potential pandemic viruses; dissemination of information, logistics, and other support to national health authorities; and promotion of high growth seed virus for vaccine and facilitation of vaccine production and international distribution. The interplay of surveillance information with infuenza vaccine formulation falls within the scope of this plan.

    The plan also calls for each national health authority to develop its own national pandemic emergency response plan. In the Philippines, this is being developed by the National Center for Disease Prevention and Control.

In Cyberspace

    WHO links national influenza centers and collaborating centers for global influenza surveillance through FluNet, an interactive geographical information system that facilitates monitoring of the pandemic via the Internet. Outbreak reports from all of the 110 sites on the network are reflected on FluNet's reporting page. The system was developed in collaboration with the Institute for Medical Research and Health in Paris with financial support provided by the government of Japan and the Department of International Development of the United Kingdom.

Fatter Than They Look

    SINGAPORE

    Asians may look thinner than Westerners but they have proportionally more fat in their bodies, health experts said recently.

    Obesity is less of a problem in Asia compared than in the West, but Asians experience higher cases of obesity-related diseases, they said. For example, Singaporeans have 5.0 percent more body fat than Caucasians, said Mabel Yap, director for research and information management at Singapore's Health Promotion Board. "What this means is we are fatter though we look thinner," she said.

    The latest National Health Survey found that only 6.0 percent of Singaporeans were obese in 1998 compared with 5.0 percent in 1992. But the number of Singaporeans with obesity-related diseases was comparable to levels in the West.

    While those with diabetes remained at 8.0 percent, 27 percent suffered from high blood pressure while 23.5 percent had high cholestrol levels, according to the 1998 survey. Yap said the rates "are comparable" to sufferers in developed countries.

    The WHO officials met in Singapore to discuss whether Body Mass Index (BMI) is an appropriate indicator of health risks and the possible cutoff points for different regions in the world.

    The experts agreed that BMI, which is obtained by dividing weight in kilograms by the square of height in meters, is not an appropriate gauge of a person's health risk because it only measures weight in relation to height. The standard cutoff for obesity is also too generic for nations across the world with people of different ages, genders and races, they said, citing data from 10 Asian countries.

    "BMI is only a screening tool. It alerts you that you might be at risk and you should consult a doctor," Yap said.

    Professor Shiriki Kumanyika, of the University of Pennsylvania School of Medicine who chaired the meeting, said "body fat distribution is not covered in the BMI." Potbellies are a concern as "abdominal fat is a worldwide problem" and people with wider waist circumferences are found to be more prone to obesity-related diseases, the experts said.

    So far, only fat in abdomens is found to be a health risk, said Paul Durenberg, WHO's nutrition consultant. "Fats stored in thighs are not known to cause health problems," he added. Durenberg attributed the obesity problem to "urbanization, lack of physical activity and greater opportunities for fast foods and fatty foods." AFP