Members of the national EpiNet teams, animal health specialists and laboratory experts from all over the Pacific participated in a workshop on the topic of “PPHSN Preparedness for Influenza and other Potential Threats like Dengue and SARS” held in Noumea, New Caledonia, 7–11 June 2004.

The workshop was co-organised by the Secretariat of the Pacific Community (SPC) and the World Health Organization (WHO) in response to the influenza threat and other potential epidemics. Representatives came from all Pacific Island countries and territories (PICTs), except Tokelau, Tuvalu and Wallis and Futuna, who could not make it.

Background
In December 2003, avian influenza caused an outbreak in the poultry population of the Republic of Korea, and spread to seven other Asian countries. In January 2004, the health authorities of Viet Nam and Thailand reported their first cases of human infection caused by avian influenza of strain H5N1, with fatalities. Other avian flu outbreaks with influenza A (H7) strains simultaneously occurred in other parts of the world (USA and Canada), and the WHO confirmed that influenza A strain H7 in Canada had caused conjunctivitis in a human.
If the H5N1, a highly pathogenic avian influenza (HPAI) virus, continues to mutate it could give rise to a novel type of virus with potential for inter-human transmission and possibly start an influenza pandemic.

This situation has caused concern to PPHSN partners like WHO and SPC who take pivotal responsibility in scientifically and technically assisting human populations to attain good health, as well as collaborating with animal health key players in maintaining well-being and safety of both humans and animals.

Influenza is not the only threat that faces the PICTs. Dengue, measles and SARS were also on the agenda. There is a need to continue strengthening infection control so that if SARS or another similar disease (re-)emerges, PICT preparedness level is appropriate, and achievements in this area are not lost.

Agenda
The participants discussed a number of key issues on influenza: epidemiology of influenza; influenza outbreaks in animals and poultry in Asia and other parts of the world; animal influenza control measures; human cases of influenza A/H5N1 in Asia in 2004 and human public health implications; description and country experiences with influenza in the Pacific; human influenza control measures; options for influenza disease burden assessment; laboratory tests for influenza including rapid diagnostic tests; influenza surveillance (guidelines for inter-pandemic influenza surveillance and PPHSN influenza preparedness guidelines); animal influenza surveillance; linking influenza surveillance with pandemic preparedness levels; and pandemic guidance (WHO Pandemic Preparedness Checklist and PPHSN Pandemic Guidance).

They also discussed: other zoonoses; hospital-based active surveillance for acute fever and rash (measles/rubella) and acute flaccid paralysis; dengue serotype 3 threat to the region and successful dengue surveillance and control experiences in the Pacific); infection control in relation to SARS; SARS preparedness in some PICTs; infection control protocol for highly pathogenic avian influenza infection/outbreak; PPHSN Regional Infection control Network; international health regulations and their implications for the PPHSN; HIV/STI surveillance; and leptospirosis survey.

Recommendations
In response to these issues, the participants agreed on the following general recommendations:

1. To establish and maintain strong collaboration between human and animal health services both in country and at regional level.
2. To develop and strengthen capacity on influenza surveillance in PICTs to facilitate swift detection of an outbreak, and to undertake responsibility of preparedness to influenza pandemic threat or occurrence.
3. To explore and develop feasible options for the assessment of the burden of influenza in PICTs.
4. To develop and strengthen laboratory capacities to facilitate efficient surveillance, especially influenza virologic surveillance, in PICTs.
5. To further develop and improve surveillance systems in the PICTs by optimising use of scarce resources for the PPHSN expanded list of priority diseases.
6. To undertake training in epidemiology to facilitate improvement in the surveillance and response to communicable disease threats and events in the Pacific region.
7. To promote a good understanding of the new international health regulations (IHR) and related issues, and integrate IHR into the framework of the PPHSN.
8. To review and improve on the infection control measures in PICTs by establishing and formalising the Pacific regional infection control network under the umbrella of PPHSN.
9. To formalise and operationalise the Regional EpiNet team with clear roles and functions, including funding implications, for endorsement by the Health Ministers meeting in Samoa in 2005.

Plan of action
A plan of action was also developed. It has been sent to all members of the National EpiNet teams for their comments and approval. The final version will be posted on the PPHSN website.

Acknowledgements
We would like to express our gratitude to the Asian Development Bank, the French and New Zealand Governments through PREPARE and the World Health Organization, for their financial support. We would also like to extend our thanks to all the participants for their valuable contributions to this successful workshop