Under the International Health Regulations (2005),1 the Chinese Government reported three human cases of avian influenza A(H7N9) virus on 31 March 2013 to the World Health Organization (WHO). Previous public health events have shown that early detection, rapid response and sharing of information can reduce the impact of emerging and re-emerging diseases.2 Risk communication is critical in providing accurate, direct and relevant information as the event unfolds, especially when the disease is of public health importance and/or there is high public anxiety.3,4 Communication between government authorities and the public is especially important during these health events, particularly during outbreaks.5 The Internet is one important tool used to present information to the public; globally, one in three people have access to the Internet6 and Internet search engines, such as Google and Yahoo, have become a frequently used means to obtain information.

Abstract Since the first confirmed human infection with avian influenza A(H5N1) virus was reported in Hong Kong SAR (China) in 1997, sporadic zoonotic avian influenza viruses causing human illness have been identified globally with the World Health Organization (WHO) Western Pacific Region as a hotspot. A resurgence of A(H5N1) occurred in humans and animals in November 2003. Between November 2003 and September 2017, WHO received reports of 1838 human infections with avian influenza viruses A(H5N1), A(H5N6), A(H6N1), A(H7N9), A(H9N2) and A(H10N8) in the Western Pacific Region. Most of the infections were with A(H7N9) (n = 1562, 85%) and A(H5N1) (n = 238, 13%) viruses, and most (n = 1583, 86%) were reported from December through April. In poultry and wild birds, A(H5N1) and A(H5N6) subtypes were the most widely distributed, with outbreaks reported from 10 and eight countries and areas, respectively. Regional analyses of human infections with avian influenza subtypes revealed distinct epidemiologic patterns that varied across countries, age and time. Such epidemiologic patterns may not be apparent from aggregated global summaries or country reports; regional assessment can offer additional insight that can inform risk assessment and response efforts. As infected animals and contaminated environments are the primary source of human infections, regional analyses that bring together human and animal surveillance data are an important basis for exposure and transmission risk assessment and public health action. Combining sustained event-based surveillance with enhanced collaboration between public health, veterinary (domestic and wildlife) and environmental sectors will provide a basis to inform joint risk assessment and coordinated response activities.

Abstract In the Western Pacific Region, event-based surveillance has been conducted for over a decade for rapid detection and assessment of acute public health events. This report describes the establishment and evolution of the Western Pacific regional event-based surveillance system and presents an analysis of public health events in the Region. Between July 2008 and June 2017 there was a total of 2396 events reported in the Western Pacific Region (average of 266 events per year). Events related to infectious diseases in humans account for the largest proportion of events recorded (49%). Maintaining this well-established system is critical in supporting rapid detection, assessment and response to acute public health events, to maintain regional health security.

Problem: Quantifying mortality from coronavirus disease (COVID-19) is difficult, especially in countries with limited resources. Comparing mortality data between countries is also challenging, owing to differences in methods for reporting mortality. Context: Tracking all-cause mortality (ACM) and comparing it with expected ACM from pre-pandemic data can provide an estimate of the overall burden of mortality related to the COVID-19 pandemic and support public health decision-making. This study validated an ACM calculator to estimate excess mortality during the COVID-19 pandemic. Action: The ACM calculator was developed as a tool for computing expected ACM and excess mortality at national and subnational levels. It was developed using R statistical software, was based on a previously described model that used non-parametric negative binomial regression and was piloted in several countries. Goodness-of-fit was validated by forecasting 2019 mortality from 2015–2018 data. Outcome: Three key lessons were identified from piloting the tool: using the calculator to compare reported provisional ACM with expected ACM can avoid potential false conclusions from comparing with historical averages alone; using disaggregated data at the subnational level can detect excess mortality by avoiding dilution of total numbers at the national level; and interpretation of results should consider system-related performance indicators. Discussion Timely tracking of ACM to estimate excess mortality is important for the response to COVID-19. The calculator can provide countries with a way to analyse and visualize ACM and excess mortality at national and subnational levels.

In this editorial, the Editorial Team reviews WPSAR journal's achievements over its 14 volumes so far, including the assignment of its first impact factor, and announces an expanded journal scope.

OBJECTIVE: The World Health Organization’s (WHO’s) Field Epidemiology Fellowship Programme in the Western Pacific Region aims to strengthen countries’ capacities for surveillance and risk assessment and build a workforce to tackle public health emergencies. A survey was conducted to assess the on-the-job training experience of the Regional Fellows, evaluate the strengths of the Programme and gain feedback on areas for improvement. Methods: Between 25 September and 25 October 2018, an online survey was sent to Regional Fellows who had participated in the Programme between July 2006 and September 2018. The survey was shared with WHO country offices in the Western Pacific Region and directly with graduates of the Programme. Responses were recorded electronically and analysed. Results: A total of 53 former Regional Fellows responded (54% response rate; 53/98). At the time of Programme participation, the Fellows’ median age was 35, 62% (33/53) were female and 72% (38/53) were affiliated with a national or subnational health department. Fellows gained experience in event-based surveillance and risk assessment and worked among a diverse group of professionals in various Member States. Altogether, 77% (41/53) of respondents believed that the Programme had helped them move into a better career position with greater responsibility. Ninety-four percent (50/53) would recommend the Programme to their colleagues. Discussion Alumni from the Western Pacific Region’s Field Epidemiology Fellowship Programme perform key health security roles, particularly within governmental systems, and directly contribute to managing health emergencies in their countries, in the Region and globally. The Programme is building a workforce with surge capacity to ensure that public health events in the Region can be addressed. Furthermore, connections developed through the Programme are helping to develop an alumni network, and enhance communications among Member States and between Member States and WHO.
*Epidemiology/education

The establishment of enhanced surveillance systems for mass gatherings to detect infectious diseases that may be imported during an event is recommended. The World Health Organization Regional Office for the Western Pacific contributed to enhanced event-based surveillance for the Tokyo 2020 Olympic and Paralympic Games (the Games) by using Epidemic Intelligence from Open Sources (EIOS) to detect potential imported diseases and report them to the National Institute of Infectious Diseases (NIID), Japan. Daily screening of media articles on global infectious diseases was conducted using EIOS, which were systematically assessed to determine the likelihood of disease importation, spread and significant impact to Japan during the Games. Over 81 days of surveillance, 103 830 articles were screened by EIOS, of which 5441 (5.2%) met the selection criteria for initial assessment, with 587 (0.6%) assessed as signals and reported to NIID. None of the signals were considered to pose a significant risk to the Games based on three risk assessment criteria. While EIOS successfully captured media articles on infectious diseases with a likelihood of importation to and spread in Japan, a significant manual effort was required to assess the articles for duplicates and against the risk assessment criteria. Continued improvement of artificial intelligence is recommended to reduce this effort.