USG Influenza Surveillance, Preparedness, and Response in

UNCLAS SECTION 01 OF 02 NAIROBI 000985

DEPT FOR AF/E Driano, Please pass to CDC Atlanta

SIPDIS

E.O. 12958:N/A
TAGS: PGOV PREL KE
SUBJECT: USG Influenza Surveillance, Preparedness, and Response in
Kenya and East Africa

UNCLASSIFIED - ENTIRE TEXT.



1. SUMMARY: Most Sub-Saharan African countries including Kenya have
lacked proper laboratories and public health infrastructure to
conduct influenza surveillance in support of outbreak response. In
2006, CDC - Kenya, and the US Army Medical Research Unit - Kenya
(USAMRU-K) initiated a collaborative project with the Kenya Ministry
of Public Health and Sanitation (MoPHS) and the Kenya Medical
Research Institute (KEMRI) to conduct influenza surveillance in
Kenya. As a result of these new surveillance systems, Kenya leads
the continent in the ability to detect and respond to the current
outbreak of H1N1 Flu. Although to date the virus has not been
identified in Kenya, this cable outlines our interagency programs at
post relevant to the detection and treatment of pandemic influenza
should it spread to the region. END SUMMARY.

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Influenza Surveillance and Response Activities
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2. CDC-Kenya supports in three surveillance systems for influenza in
Kenya. In addition, USAMRU-K supports an expansive human sentinel
influenza surveillance system and gives significant technical and
financial support to the Kenya National Influenza Centre -- the
national influenza reference laboratory. All USG-funded
surveillance work has built capacity and the knowledge base within
the Kenya public health community, which is essential for them to
respond successfully to the threat of 2009 influenza A (H1N1) virus.
These surveillance systems have been and will continue to be a
critical way to monitor the potential introduction of influenza A
(H1N1) virus into Kenya and the region, especially now at the
beginning of the annual influenza season in Kenya and the southern
hemisphere.

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National Sentinel Surveillance for Influenza
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3. CDC-K, together with the Kenyan Ministry of Public Health and
Sanitation (MoPHS),operates a sentinel surveillance system for
influenza at 10 sites in Kenya - seven provincial hospitals, two
refugee camp hospitals and the national referral hospital in
Nairobi. Surveillance officers are stationed at all 10 sites, and
take samples from patients who present to the hospitals with acute
respiratory illness. Samples are tested at two laboratories: the
National Influenza Center, a KEMRI laboratory jointly equipped and
staffed by CDC, USAMRU-Kenya, and KEMRI; and the CDC-Kenya
International Emerging Infections Program laboratory at CDC-Kenya.
Since national sentinel surveillance was initiated in October 2006,
over 13,000 samples have been tested.

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DoD sponsored Human Influenza Sentinel Surveillance System
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4. USAMRU-K has developed a complementary sentinel surveillance
system for ILI. Cases are identified through their geographically
diverse surveillance site network of eight District Hospitals within
Kenya. Specimen collection has been ongoing since July 2006.
Nasopharyngeal samples are taken from Kenyan volunteers who present
to the participating health facilities with acute upper respiratory
symptoms. Samples are tested at the National Influenza Center in
Nairobi. To date, nearly 8,000 specimens have been tested.

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Population-Based Surveillance for Influenza
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5. The CDC operates population-based surveillance for a number of
diseases at two sites in Kenya --- Kibera, a dense informal urban
settlement in Nairobi, and Lwak, a rural area in Western Kenya. In
Kibera and Lwak, households are visited every two weeks by community
interviewers who ask about illnesses in the home, and collect data
on illnesses and health care seeking practices. The surveillance
population in Kibera is 28,000, and there are 25,000 people in Lwak.
In both sites, field workers go to each household every two weeks
recording illnesses and deaths. Participants within the surveillance
system are allowed free access to the field clinic for any acute
medical condition Samples from patients with acute respiratory
illnesses are collected daily. To date, no patients with influenza A
(H1N1) have been identified in either of the tw population-based
sites.

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Laboratory Support at the Kenya National Influenza Center (NIC) by
USAMRU-K
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NAIROBI 00000985 002 OF 002



6. Though in existence prior to DoD involvement, USAMRU-K has
greatly enhanced the capacity of the Kenya NIC to serve Kenya in the
diagnosis of influenza infections. All activities are conducted in
close consultation and with KEMRI leadership and results are jointly
reported. All influenza diagnostic work is done by a joint team of
KEMRI, USAMRU-K, and CDC staff with USAMRU-K providing quality
assurance and safety guidance to ensure that the Kenya NIC meets
international standards. Since 2006, USAMRU-K has invested over $2
million in laboratory equipment purchases and two major
refurbishments which have doubled the size of the NIC. CDC-Kenya
also supports the NIC with laboratory equipment purchases in
conjunction with USAMRU-K. The NIC now has the capacity to reliably
diagnose influenza within hours with a number of modern laboratory
techniques.

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CDC Laboratory Diagnostics in Nairobi
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7. The Biosafety Level 3 CDC-IEIP Laboratory located on the KEMRI
main campus, Nairobi, Kenya provides invaluable surge capacity in
the event of a larger outbreak. Also, the CDC laboratory
cross-pollinates with the NIC staff by lending manpower, supplies,
and expertise.

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Regional Sentinel Surveillance
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8. CDC-Kenya has provided technical epidemiologic and laboratory
support to help establish influenza sentinel surveillance in at
least 10 countries in Africa. CDC-Kenya has sent epidemiologists and
laboratorians to Ethiopia, Rwanda, Tanzania, Uganda, Democratic
Republic of Congo, and Nigeria, and has trained epidemiologists,
clinicians, and laboratorians in a number of other countries on
issues related to influenza surveillance.


9. USAMRU-K through its Global Emerging Infections System (GEIS)
Program is developing and supporting surveillance programs in
Uganda, Cameroon, Tanzania, and the Seychelles. Great effort is
made to coordinate these regional activities with the CDC presence
there to the benefit of the host nations.

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Outbreak Response
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10. CDC-Kenya and USAMRU-K have been closely involved in the
national and regional response to the 2009 influenza A (H1N1)
worldwide outbreak. CDC-Kenya and USAMRU-K epidemiologists have
helped the GoK to develop case definitions for possible cases in
Kenya and reporting cases forms for Kenyan clinicians, and
communications messages for the public. The CDC-Kenya IEIP
laboratory tested all specimens from persons under investigation for
the first week of the activity. CDC-Kenya expects to get the
specific H1N1 diagnostic assays from CDC-Atlanta this week, at which
point Kenya will have full H1N1 testing in country.


11. CDC-Kenya has also helped coordinate the African regional
response, working with partners at the African Regional Office of
WHO, WHO-Geneva, and CDC-Atlanta, and working with countries
throughout the continent. Likewise the USAMRU-K is coordinating
preparedness and response initiatives with public health colleagues
in Uganda, Cameroon, Tanzania, and the Seychelles.

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USG Interagency Cooperation and Response
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12. The CDC-Kenya Influenza Program Director has lead the US Embassy
Pandemic Task Force in Kenya, which met on April 28 to discuss the
US Embassy response to the H1N1 outbreak and the implications for US
mission employees and their families, Foreign Service Nationals, and
US citizens living in Kenya. The meeting led to a meeting of the
EAC, where pandemic tripwires were further discussed, and a town
hall meeting at the US embassy earlier this week.


RANNEBERGER