Question

identify gaps and how you might connect to other resources to meet needs that are not locally available for influenza

Answer 1

Gaps

While data on the burden of influenza disease has increased in the last few years , major gaps remain.

• First, to advise global policymakers and public health advocates as they set their goals, high-quality and up-to - date assessments of the magnitude of severe influenza at global and regional level are required. Although new estimates of global respiratory mortality rates due to influenza are available, additional models benefit from the expansion of influenza surveillance are available Laboratory confirmation, especially in tropical countries and LMICs, can offer more accurate country and region-specific estimates of disease.

· Second, too many LMICs have yet to produce accurate national estimates of the full extent of influenza disease at country level, which would encourage evidence-based investment in local influenza prevention decisions.

• Third, the ability to tailor vaccination programmes for key populations within a country depends on providing accurate data on the disease burden and the potential effects of vaccination within particular focus groups at high risk. During the 2009 pandemic, the importance of risk group-specific assessments was evident when data on the high risk for extreme results among pregnant women, aggressive efforts were made to vaccinate and treat this group appropriately, and persuaded obstetricians to recommend and offer vaccines; this effort provided data for the 2012 recommendations of the WHO Strategic Advisory Group of Experts.

• In comparison, the lack of adequate data on serious disease among pregnant women during seasonal epidemics was one explanation cited by the Global Alliance for Vaccinations and Immunizations for its decision to open an investment window to support low-income countries to vaccinate pregnant women as part of its new investment strategy for vaccinations. Data have long shown that people with particular underlying diseases are at high risk for serious influenza, but without a clear understanding of the disease burden in those populations in countries that adopt vaccine policies, it is unreasonable to expect policymakers to engage in programmes to target them.

· Few data were obtained outside high-income countries on other components of the health burden, in particular the contribution of influenza infections to illness and death from underlying diseases exacerbated by influenza, such as heart disease or chronic pulmonary disease, and the non-health consequences of influenza, such as economic burden and productivity consequences.

Ongoing Work to Address the Gaps and Future Needs

• Substantial work is under way to fill those holes. The WHO has developed a comprehensive programme to gather data on the global and national influenza burden and to help assess the danger group burden.

• Two manuals were developed to direct Member States' efforts to quantify influenza disease and economic burden from data gathered from ongoing surveillance of influenza. Both manuals are used by countries, partly because of the Implementation Plan for Pandemic Influenza Preparedness, which encouraged country-level disease burden estimates in many countries around the world. These activities have led to recent, funded by WHO, publications from LMICs that include valuable data on the burden of influenza disease.

• WHO also funded influenza-associated disease burden assessments between pregnant women and their children.

• New international partnerships will help to build more reliable global estimates of influenza mortality and hospitalisation based on recent work on national estimates and information on influenza burden among key high-risk groups.

• These initiatives take advantage of the recent increase in studies at local or country level that have expanded data beyond temperate, high-income environments.

•         WHO also maps current information from published literature to make it easier to navigate available data and to recognise the remaining primary gaps. Finally, WHO is creating a set of economic resources that promote the use of data on disease burden that measure net costs, the cost of vaccine services and vaccine cost-effectiveness.

•         In addition, there are other multinational partners operating in the region. Collaborations with > 50 countries around the world have been established by the US Centers for Disease Control and Prevention to strengthen surveillance and laboratory testing capabilities, including expanding global genetic sequencing capabilities, which have produced data on influenza epidemiology and disease burden.

• More recently, the Global Health Protection Agenda has increased funding for many developed countries to improve monitoring and response capabilities, which would also contribute to new evidence on the relative burden of influenza compared to other infectious diseases; The European Disease Control Center has developed free tools to help countries in the region measure the risk of influenza and other infectious diseases. These activities have led in the past 5 years to a significant rise in country-specific burden projections and aim to lead to many more in the next 1–2 years.

• Vaccine probe studies have been suggested as a tool for calculating the preventive fraction of the burden of disease, concentrating research on results of greatest public health concern (e.g., pneumonia and death). Whether vaccine probe studies could be properly planned to account for the variable and relatively modest vaccine effectiveness and variability in the characteristic annual disease burden

• Ultimately, year-to-year variability in the burden of disease involves the compilation of data over many years and the creation and evaluation of new statistical methods to assess the burden in settings with year-round influenza circulation.