Influenza sentinel surveillance training

I WENT TO NAIROBI with 4 colleagues from the USA and a few others to be trained on sentinel surveillance systems for influenza. Influenza (flu) is a viral disease that typically causes respiratory symptoms as well as other (you guessed it) flu-like symptoms. In kids in particular, flu can also cause gastrointestinal symptoms. Influenza causes significant morbidity and mortality each year in the USA and worldwide, particularly among kids and the elderly.

One big concern is that a new subtype of flu will emerge and spread among humans, causing a pandemic. Flu is subtyped by H's and N's according to which hemagglutinin and neuraminidase proteins, respectively, it expresses. Right now the major subtypes affecting humans are H1N1 and H3N2. Birds are affected with a subtype called H5N1 that's more pathogenic. According to the World Health Organization, as of June 19, 2008, 385 humans are known to have contracted H5N1, and 243 of those have died. But there hasn't yet been sustained human-to-human transmission of H5N1. Yet. That's the concern, though, about avian (or bird) flu. A pandemic could be a major public health problem. To say the least.

Having a surveillance system -- that is, a system that monitors the number and characteristics (including subtype) of flu cases -- will allow us to better understand who gets flu, what subtypes of flu are around (to determine the strains that next year's vaccine should target and to identify whether new subtypes -- like H5N1 -- have emerged in humans), and how much morbidity and mortality flu causes. So flu surveillance is conducted in the USA and in an increasing number of countries abroad, including African countries. My task in the Democratic Republic of Congo is to help get a flu surveillance system off the ground here.

The week-long training in Nairobi aimed to teach us how to get a surveillance system up and running -- a challenge in general, but particularly in countries (including some in Africa) with less developed infrastructures for health care and in general.

In Naioribi and other places in Kenya there are already flu surveillance sites. One of them is at Kenyatta National Hospital (KNH), one of the largest hospitals in the country, located in Nairobi. We toured KNH and the National Influenza Center (NIC) laboratory near KNH to get a better sense of how the system works there.

There's a shot of me in front of the Kenyan Centre for Public Health Research, where the NIC
is located. There's also a photo of me and my brother and me and other trainees and a surveillance staff member, both in front of KNH. A really nice, motivated, and smart group from Kenya, the USA, and other countries...