The new subtype of influenza A H1N1

Ministry of Public Health (MoPH), Afghanistan

July 28, 2009

The new subtype of influenza A H1N1 first detected in the USA in mid April 2009, later on attacked most countries of the world. On 11 June 2009, Director General of WHO announced phase six (pandemic influenza). Director General of WHO announced that pandemic influenza is unstoppable. As per the last update of WHO total number of confirmed cases in the world reached 134503 and total number of deaths hit to 816 in 6 regions of WHO.

So far in Afghanistan 29 confirmed cases of AH1N1 have been detected (28 in Bagram Airfield and one in Kabul city), all are ISAF military and civil workers. Also the Diseases Early Warning System (DEWS) has picked a rumor, telling that 20 suspected H1N1 cases are admitted and quarantined in Heart airport hospital, run by PRT Italy. The issue is communicated with them for clarification and response is awaited.

Attack rate of disease in the closed and crowded areas are very high and can cause high morbidities and mortalities. Due to this reason, scientists from earliest time that this virus was detected were concerned that this virus can cause severe disease while introduced into the large gatherings such as Hajj and Umbra. To find out solution for these problems series of meetings were conducted within Arab and other Islamic countries with the presence of international organizations such as WHO, CDC and others. In all these meetings and gatherings the scientists believed that there are some measures that can decrease the chance of disease during Hajj and Umra. Recently minister of health of EMRO countries met in the Cairo Egypt and they agreed on some points which are suggested for the Muslim countries:

1. Adequate screening for pandemic H1N1 2009 at ports of entry into the country should be continues in order to limits its spread using measures currently in use.
2. All hajj and Umra visitors to receive the seasonal influenza vaccines at least two weeks prior to travel to the holy places.
3. Use of pandemic vaccine if available.
4. Adherence by Hajjis and Umra visitors to good personal hygiene measures, including cough etiquette, use of antiseptic hand gels and frequent had washing with soap and water.
5. In order to better to ensure the health and well being of hajjis and Umra visitors the following risk groups for severe disease postpone their participation in Hajj and Umra this year: the elderly (over 65), pregnant women, people with chronic disease and children (under 12).
6. All member states to adhere to regulations issued by the Ministry of health.
7. Also meeting recommended wide distribution of these recommendations through various media, and underlined how important it is that countries participating in the Hajj and Umra facilitate their implementation.

Activities that MOPH Afghanistan implemented to prevent the spread of the virus and respond to the pandemic influenza are as follows:

1. Strengthening of surveillance system throughout the country, MOPH has 154 sentinel reporting sites all over the country, that collect the reports from provinces and share the compiled report to the stakeholders
2. Media campaigns through 7 TV channels and 6 Radio channels
3. Workshops for religious leaders, media, teachers
4. 800 health care workers trained
5. Refresher training for rapid response teams of 13 provinces.
6. Distribution of 5000 capsules of oseltamivir per region, which is enough for treatment of 500 sever cases
7. Distribution of 500 PPE kit per region which include mask, gown, gloves, boot cover and head cover)
8. Establishment of units for monitoring of passengers coming to the country, preparation/distribution of banners for airports and entry points
9. Establishment of command and control center and opening of three hotlines 0798684404, 0798665085 and 0798660829
10. MOPH has allowed private sector to import antiviral medications for treatment of cases
11. Assessment of all Kabul hospitals, Parwan hospital and health facilities around Bagram airfield for suspected cases, no case has been found so far.

Response to pandemic influenza need all sector cooperation, MOPH is unable to provide a full response without support of other sectoral supports.

In this regard, MoPH has a close communication and coordination with the Ministry of Hajj and Awqaf. Both ministries will act according to the decision of Afghan cabinet meeting on 27 July 2009 and based on the recommendations of health ministry meeting of member countries of Eastern Mediterranean Region of WHO.

MOPH provide impartial health care services to all people throughout Afghanistan, and request from all parties to respect MOPH and support our health care providers to implement their activities at best possible level.