AHI FACILITY Avian & Human Influenza BHUTAN 58047 Improved Preparedness Passes the First Test B hutan has only recently been infected with H5N1, The Health care system was also unprepared to deal with despite being located between two countries a potential pandemic. The surveillance system required where it has become entrenched. Three outbreaks, strengthening and the public health laboratory lacked starting in February 2010, have been rapidly contained, equipment and training to investigate and manage reflecting the country's increased level of preparedness cases. Added to this were the common constraints and effective collaboration among the authorities. associated with insufficient human resources and the difficulties imposed in surveillance and response by the rugged terrain and distribution of the rural population. The Challenge Bhutan is a landlocked Himalayan country of under Responding to the Recent Crisis 700,000 people, many of who live in remote mountain villages. It is highly vulnerable to avian In January 2004, the Ministry of Health (MoH) and influenza, whether through the cross- Ministry of Agriculture (MoA) initiated steps to prevent The owners are paid border importation or smuggling of the introduction of H5N1 virus into the country and to 75 percent of the affected poultry or, to a lesser extent, strengthen the surveillance system to facilitate detection market rate. The through transmission via migratory birds. and response to any outbreak. At this time, the Ministries Bhutan and India share a porous border came together to draft the National Influenza Pandemic compensation is with heavy traffic of people and goods Preparedness Plan (NIPPP). being paid from the and the majority of poultry imports come AHIF grant initiated from India. in 2007. Bhutan's poultry population of 230,000 is - Dr Basant Sharma. found in two semi-commercial farms, several government farms and in typical Regional Veterinary Officer backyard settings. At the outset of the of the Department of project, in October 2007, the general level Livestock of biosecurity in the country was reported as low to moderate and the Regional Veterinary Labs and National Center for Animal Health lacked the required equipment, reagents and expertise to detect influenza viruses and effectively manage them. Agency focal points were identified at this time and coordination and day-to-day collaboration has remained strong, with representatives of each agency being routinely invited to attend meetings organized by the other. The AHI Grants were signed in July 2007 and December 2008. As elsewhere, while the objectives of the project were specific to Highly Pathogenic Avian Influenza (HPAI), the interventions are expected to contribute to the control of other zoonotic and infectious diseases. Developing Preparedness As in other countries, the Animal Health component is supporting national prevention and control strategies. Good progress has been made with regard to disease surveillance and diagnosis, with the Department of Livestock now carrying out clinical surveillance in 203 Geogs (second level administrative units) and mounting The Ministry of Agriculture has developed a legal framework for awareness campaigns through Veterinary Village Teams whenever the containment of AI, including policy, regulations and operating outbreaks occur in the adjacent Indian states of Assam and West procedures. These outputs were reviewed by the World Bengal. Ministry of Agriculture staff have also been equipped and Organization for Animal Health (OIE) and used to update the trained in FAO's TADInfo (Transboundary Animal Disease National Plan. These efforts were tested in a desktop simulation in Information System), designed to provide data management and January 2009, carried out without outside technical assistance, and decision support to national veterinary epidemiology units. in a subsequent field based simulation exercise. The MoH participated in these exercises which were used The health component has also made to establish roles and working relationships, Key Data considerable progress, not least in finalize standard operating procedures, and establishing systematic surveillance. develop a workable mechanism for outbreak Grant Amount: $2.5 million Influenza Like Illness (ILI) surveillance has containment. been established at 11 sites across the Disbursement (to end March 2010): country. Results of the testing are As in other countries, a highly effective $1.3 million summarized each month in the widely communications and awareness raising circulated bulletin, "Fluview". campaign was developed by UNICEF. A Closing Date: November 2010 Knowledge, Attitudes and Practices (KAP) Lab equipment, necessary to diagnose HPAI baseline survey was completed in September has been procured and technicians trained. 2009. This reported that while awareness of AI Consultants are also developing the quarantine system and was high overall, it was lowest (83%) among poultry farmers. This upgrading the isolation rooms. In addition, the much-needed group is most at risk and most likely to engage in risky behaviors. establishment of polymerase chain reaction (PCR) and There was however some evidence of positive behavior change immunofluorescence assay( IFA) capacity in the newly completed among poultry handlers, meat vendors and commercial farmers. hospital at Serbithang is moving forward. In terms of media, the KAP found that the approach needs to be highly differentiated and that the impact of TV spots was generally Capacity building has been extensive, low. with Department of Livestock and Bhutan Agriculture and Food Regulatory Authority staff at central, regional and Going Forward district offices being trained in procedures relating to outbreak The recent arrival of H1N1 provided a test of Bhutan's readiness containment and field staff being and the response was effective, most notably in terms of the close trained in AI preparedness and response. collaboration between the animal and human health personnel. As in the case of agriculture, a Training The AHI Grant has helped Bhutan to significantly improve its of Trainers approach has been used in capacity to respond to HPAI and other infectious diseases. Looking health to develop competency in avian forward, it will be important for the authorities to maintain focus influenza recognition and case and ensure the completion of adequate local diagnostic capacity management, AI surveillance, clinical and the communication of messages about the diseases to those management and infection control. most at risk AHI The AHI Facility is a Multi-donor Trust Fund administered by the World Bank and supported by Australia, FACILITY China, the European Commission, Estonia, Iceland, India, Korea, Slovenia, the Russian Federation and the Avian & Human Influenza United Kingdom