VERSÃO FINAL
Draft of the English
Version 2/16/2016
REPUBLIC OF MOZAMBIQUE
-------------------MINISTRY OF HEALTH
&
MINISTRY OF AGRICULTURE
CONTIGENCY PLAN FOR INFLUENZA PANDEMIC PREPAREDNESS AND
RESPONSE: MOZAMBIQUE
Mozambique, February 2006
APROVADO PELO CONSELHO DE MINISTROS A 2 DE MAIO DE 2006 [11 SESSÃO]
FINAL VERSION
FOREWORD
The Avian Influenza is being spread throughout the world and the Health and Agriculture
Organisations world-wide have already recognised the influenza pandemic as a serious world threat
particularly to human health. As such, several countries are making tremendous efforts to prepare
national contingency plans for combating the Avian Influenza as a way to minimise the negative
impact of this pandemic (outbreak) which has reached our continent.
Although Mozambique does not yet have focus of Avian Influenza but similarly to other countries, it
intends to be prepared to mitigate all the evils and negative effects in social and economic sectors
resulting from an outbreak of this type of disease. With this objective, the Ministries of Health and
Agriculture of Mozambique developed the “National Contingency Plan for Combating Avian
Influenza” which is being presented.
The plan which is being presented includes a number of activities to be developed by different
institutions and departments which by their nature play a key role in the prevention of infection or
dissemination of virus, virus evolution follow-up activities and treatment (epidemiological
surveillance; education and communication for health; research, clinics, laboratories, etc), before
and after the pandemics. Therefore, the plan foresees among other objectives, the strengthening of
epidemiological surveillance with laboratory determination of virus nature, as well as, daily follow-up
of the situation.
The prepared plan constitutes the first step for the integration and harmonisation of the country’ s
response to the Avian Influenza, but at the same time, is a basis for dialogue and a strong tool for
negotiation between the Government of Mozambique and the major co-operating partners which
provide direct support to the State Budget or through SWAP.
Through this current plan which is intended to be dynamic and should be updated whenever appear
new data and elements appear and which could have implications in the scheduled activities, types
of medicines/drugs and equipment to be used, vaccines, number of affected people or information
which could enable to make an estimate of financial and human resources closer to the reality.
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LIST OF ACRONMYS
WB – World Bank
CGA – Avian Influenza Commission
CMAM - Central de Medicamentos e Artigos Médicos
DAM – Medical Assistance Department
DAG – Department for Administration and Management
DDS – District Directorate for Health
DEE – Department for Epidemics and Pandemics
DNP – National Directorate of Livestock
DPS – Provincial Directorate of Health
DRH –Directorate of Human Resources
DSA – Directorate of Animal Health
DNP- National Directorate of Livestock
EPI – Equipment for Individual Protection
FAO – United Nations Organisation for Agriculture and Food
GACOPI – Office for Co-ordinating Projects and Investments
GT – Technical Task Force or Technical Working Group
HCM – Maputo Central Hospital
IEC – Information, Education and Communication
INS – National Health Institute
LCV – Central Veterinary Laboratory
MoH – Ministry of Health
MINAG – Ministry of Agriculture
Mt - Metical
NGO – Non-Government Organisation
GSB – General State Budget
WHO - World Health Organisation
PROSAUDE – General Common Fund
RESP – Office for Education in Public Health
SIS – System of Health Information
USD – American Dollars
US – Health Facility
ES – Epidemiological Surveillance
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FINAL VERSION
TECHNICAL WORKING GROUP – PREPARATION OF NATIONAL
CONTIGENCY PLAN FOR PREPAREDENESS
Ministry of Health
Ana Charles (DSA)
Eduardo Samo Gudo (INS)
Moisés Wamba (DPC)
Félix Malate (DAG)
Diogo Paulo (RESP)
Carla Silva, MD (DEE)
Sandra Mavale (HCM)
Aurora Siba-Siba (HCM)
Ivo Fuigueredo (HCM)
Brana Branquinho (CMAM)
Ministry of Agriculture
Ventura Macamo (DNP)
Fernando Rodrigues (DSA*)
Carlos Lopes Pereira (DAS*)
Manuel Reis (IIAM)
Inocêncio Sigaúque (DSA*)
Adolfo Mavale (DSA*)
Carlos Lopes Pereira (DAS*)
AVIAN INFLUENZA COMMISSION
Mouzinho Saíde (DNS)
Avertino Barreto (DNS)
Florencia Cipriano (DNAV)
Ventura Macamo (DNP)
Ana Charles (DSA)
Ilesh Jani (INS)
Rosa Costa (IIAM)
Fernando Rodrigues (DSA*)
Carlos Lopes Pereira (DAS*)
Manuel Reis (IIAM)
COLLABORATORS
WHO
USAID
World Bank
CDC
Tecno Serve
UNICEF
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FINAL VERSION
STRUCTURE FOR CONTIGENCY PLAN
The current plan outlines the activities which should be implemented by several sectors previously
defined fulfilling integrally the described chronological sequence.
Only with an integral operationalization of all involved sectors and in due time, the defined objectives
can be reached. Within this framework, the current plan was structured in order to facilitate and
guarantee this integrated approach of the activities.
This plan is comprised by 9 sections, namely:
Section 1: Introduction - it contains a brief introduction of the problems with description of some
important landmarks.
Section 2: Objectives of the contingency plan
contingency plan for Mozambique
- are outlined on the major objectives of the
Section 3: Background – there is a description of the phases preceding this plan.
Section 4: Risks of Avian Influenza pandemic in Mozambique - Presentation of the real dangers for
Mozambique by being affected by H5N1 virus taking into account that the country is located at the
migration route of the migratory birds from the affected countries.
Section 5: Impact Analysis on avian influenza in the fields of health and agriculture in Mozambique
- are reported in-depth the burden of the disease in these two sectors.
Section 6: Strategic objectives on the preparedness and response plan – are enlisted and described
the major strategic objectives for prevention and response to avian influenza pandemic.
Section 7: Annexes - are presented the calculation matrices where are described chronologically all
the identified activities by the working group so that the defined objectives are reached.
Matrix 1: it contains all identified activities by the sector of agriculture for prevention and erradication
of bird diseases.
Matrix 2: it contains communication, awareness-building and education activities.
Matrix 3: it contains activities of health sector particularly on issues related to co-ordination, logistic
and clinical management of the patients suffering from avian influenza.
Matrix 4: it contains activities of health sector particularly on issues related to epidemiological
surveillance, laboratory, data management and operational research.
Each matrix has a header with the following items:

Objectives

Expected results

Main activities – it contains the main activities to be implemented in order to reach the
expected result.

Sub-activities

Pandemic phase - WHO has developed a system of terminology for several phases of a
certain pandemic. Based on this, each activity should begin its specific pandemic stage. The
passage from one phase to another is announced by the Director of WHO, and following all
other corresponding activities related to the concerned phase are put in action. The evolution
from one phase to another is guided by biological changes of the virus and through
epidemiological characteristics of the disease at the international level.

Responsibility – it is assigned to one or more people who should co-ordinate or implement the
activity.

Date of commencement and termination of the activities – it is necessary to indicate the month
of commencement and end of the activity.

Monitoring indicators – they are indicated the monitoring tools of the process.

Budget for activity sustainability.
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FINAL VERSION


Funding Source
Comments
Section 8: Acknowledgements
Section 9: Bibliographical references
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FINAL VERSION
TABLE OF CONTENTS
1. INTRODUCTION
2. OBJECTIVES OF THE CONTINGENCY PLAN
3. BACKGROUND INFORMATION
4. RISKS OF AVIAN INFLUENZA PANDEMIC IN MOZAMBIQUE
5. IMPACT ANALYSIS ON AVIAN INFLUENZA IN HEALTH SECTOR IN
MOZAMBIQUE
6. STRATEGIC OBJECTIVES OF THE PREPAREDNESS AND
RESPONSE PLAN
6.1. To reduce opportunities or risks of human infection by H5N1
6.2. To strengthen the Early Warning Systems
6.3. To create response capacity to the risk of the pandemic
6.4. To keep back or to delay the spreading of the pandemic in the source.
6.5. To reduce the morbi-mortality and social disturbance
6.6. To undertake operational researches on the pandemic
7. CONCLUSION
8. ANNEXES
9. ACKNOWLEDGEMENTS
10. BIBLIOGRAPHIC REFERENCES
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FINAL VERSION
1. INTRODUCTION
The highly pathogenic avian influenza was first identified in Italy in 1879, as an infectious disease of
birds by Perroncito. Only in 1955, it was an agent characterised by Schafer as type A strains of the
influenza virus. The influenza virus is a RNA segmented virus which does not have qualitative
mechanisms of control during the replication and they are susceptible to changes.
In the past, 3 avian influenza pandemics occurred, in 1918 (Spanish Influenza caused by subtype
H1N1), IN 1957 (Asian Influenza caused by subtype H2N2) and in 1968 (Hong Kong influenza,
caused by subtype H3N2). Conservative estimates indicate that mortality resulting from the
pandemic in 1918 was of 20 to 40 millions, however more recent studies held in Africa and Asia
indicate that the number of victims all over the world was of approximately between 50 and 100
millions people.
During the last two years, in Southern Africa has been identified certain activity of avian influenza
virus of H5N2 subtype which has been affecting only ostriches in South Africa and Zimbabwe.
The type A avian influenza are perpetuated in nature in wild birds, predominantly in aquatic birds, on
which there are 16 subtypes (which differs in approximately 30% in their structure which co-exist in
harmony with its focus). In these natural focuses, the virus remains in evolutionary ecstasies,
showing a minimum evolution in amino acids during long periods. After the transfer to new focuses,
either birds or mammals, the avian influenza viruses develop rapidly.
Although there are strains of the virus of low pathogenity in domestic birds and the disease does
manifest in wild birds, the possibility of mutation can turn this virus to be highly pathogenic of H5N1
subtype, which occurred probably before 1997 in the South of China, reaching its enzootic state in
domestic birds in South-east Asia and unexpectedly crossed the barrier of the species infecting
mammals (cats, pigs and humans). Although, this event had its precedents, the substantial number
of cases in humans, associated to a severe disease and various casualties arise serious problems
on the pandemic potentialities of H5N1 strains. More evidences indicate that the virus H5N1
acquired major pathogenicity of H5N1 strain for various mammal species.
To date (February 2006) 29 countries most of them from Asian continent, but also Europe and 2
from Africa (Nigeria and Egypt) reported sources of highly pathogenic avian influenza (H5N1). The
sources in Japan, Malaysia and Republic of Korea were controlled successfully but the virus seems
to be endemic in several countries affected. The outbreaks of Avian Influenza in Asian Southeast
resulted in destruction of more than 150 millions of birds and had severe consequences for
agriculture of the countries, particularly for rural families which depend on poultry of birds for their
living and feeding. Recently (February 2006) in Nigeria more than 140000 birds were killed in a
outbreak which the death rate reached more than 91% and 95% of the birds in risk respectively.
The most recent sources of the same virus in birds in Russia, Kazakhstan, Turkey, Rumania,
Croatia, Italy, France, Italy, Germany, Nigeria and Egypt show clearly that the virus spread besides
the original source.
THE THREAT OF AVIAN INFLUENZA PANDEMIC VIRUS H5N1
The estimates from experts indicate that the next avian influenza pandemic will cause probably more
than 130 millions of patients, 2 millions of hospitalised people and 650,000 deaths in a period of 2
years. The impact will probably be more in developing countries. The avian influenza pandemic in
1918, in case being foreseen for nowadays it would have caused between 180 and 360 million
deaths all over the world.
The confirmed number of cases in humans till today 13 February of current year reached 169 with
91 deaths corresponding a death rate of 53,85% (table 1).
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Table 1. Avian Influenza in Human between 2003 and February 2006
The number of cases in humans confirmed to February 13 of the average year
reached the 169 with 91 deaths that translates the rate of fatality of 53.85%
Accumulated number of cases in human of Avian Influenza
13 February 2006
Coun
try
Cambodja
China
Indonesia
Irak
Thailand
Turkey
Vietnam
Total
2003
2004
2005
cases deaths cases deaths cases deaths
0
0
0
0
0
0
3
3
0
0
0
0
0
0
3
3
0
0
0
0
17
0
29
46
0
0
0
0
12
0
20
32
4
8
17
0
5
0
61
95
4
5
11
0
2
0
19
41
2006
Total
cases deaths cases deaths
0
4
8
1
0
12
0
25
0
3
7
1
0
4
0
15
4
12
25
1
22
12
93
169
4
8
18
1
14
4
42
91
2. BACKGROUND INFORMATION
This plan is a culmination of all activities that are being carried out by the members of the
Preparatory Commission on Avian Influenza, established in 2004. This commission has been
holding meetings once per week and defining strategies for combating this epidemics with
assistance of foreign consultants (Strategic Plan for Veterinary) and with co-operation from WHO,
USAID and World Bank.
In January 2006, as it was deemed necessary, the commission started to work with assistance of the
technical and operational group. The commission approved this decision, starting to work based on
exchange of information, preparation of information of technical scientific nature and material for
dissemination of messages as well as preparation of training kits to support the provinces.
The participation of one member of the commission and two work group members at the preparatory
meeting on avian influenza pandemic organised by WHO-Brazzaville constitutes a great opportunity
to increase the level of knowledge and of understanding in regard to the threat that this disease
represents. It also contributed for the exchange of information and experiences with experts of other
countries which have already their approved plans.
3. OBJECTIVES
This documents result from an intensive and joint work carried out by experts from Ministries of
Health and Agriculture representing a final phase of consultation and discussion process in
preparation for addressing the problem of avian influenza pandemics.
It contains the main guidelines and intentions of the Government of Mozambique in regard to
prevention and response to this pandemic which is eminent.
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FINAL VERSION
WHO has been insisting tirelessly that all countries should prepare a contingency plan for prevention
and response to this eminent pandemic, warning that a careful preliminary work and the application
of plans for a co-ordinated action are determinant factors for the response capacity to national or
international health threat.
Within this framework, WHO-AFRO organised from 12 to 13 February of this year, the First Regional
Meeting in preparation for addressing avian influenza pandemics. In this meeting, there were defined
the main objectives of African Region in relation to the prevention and response.
Based on the defined objectives for African region and with some adjustments in accordance with
Mozambican panorama, the objectives the current plan were as follow:
Overall Objective:

To reduce the morbi-mortality in case of emergence of bird flu and avian influenza pandemics
and to minimise the social-economic rupture in Mozambique.
Specific objectives:
 At national level, to provide a strategic platform as guide for any activities on prevention and
preparation in Mozambican territory.
 To provide an instrument for discussion and rationale in the fund-raising activities at the local or
international levels.
 To identify national priorities and define immediate activities.
 To secure that the activities are implemented in due time.
 To guarantee and facilitate a co-ordinated, integrated and multisectoral implementation in order
to maximise the shortage of material and financial resources.
 To create capacity for prevention or eradication of diseases in birds.
 To create capacity for prevention or eradication of disease in humans.
 To create capacity for timely identification of cases in birds and in humans.
 To help to reduce the fear among the population, including the health care professionals,
avoiding this way possible situation of total pandemonium.
 To guarantee a equality of allocation and distribution of available goods and funds.
NB: Additional objectives are presented in the section on the strategic objectives of this plan.
4. RISKS OF AVIAN INFLUENZA IN MOZAMBIQUE
There are 22 millions of domestic birds in Mozambique. Most of these birds are raised in small
backyard flocks scattered throughout rural or periurban areas. Annually, approximately 7,8 millions
birds are sold by commercial sector. Most than 50% of the birds in rural areas are raised in Manica,
Zambezia and Gaza provinces, while great part live poultry whose activity is aimed to get profits is
located in Maputo. (Picture 1). There is considerable growth of poultry industry (Avian industry) in
Manica and Nampula provinces.
Figure 1. Distribution of birds (birds and ducks) per province in general and of birds in the
commercial sector in Mozambique.
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Distribuicao de Galinhas e patos (% ) por provincia em Mocambique
Producao de Galinhas no sector comercial (milhoes)
20.9
66.7
18.8
13.6
10.5
7.3
4.2
8.9
7.9
25.6
5.2
2.6
7.7
G
az
a
a
bé
zia
Za
m
an
ic
M
Na
m
pu
la
Te
te
ba
ne
In
ha
m
So
fa
la
ss
a
C.
De
lg
ad
o
Ni
a
ap
ut
o
M
5.2
2
0.6
Nampula
Manica
Nº galinhas
Maputo
%
*
dumb duck or moscow duck
One of the risk factors to be taken into account is the fact that Mozambique is part the major
migratory routes of birds from Europe and Asia. Seventy and five (77) species of migratory birds visit
regularly the country and some of them appear in large numbers leaving great quantities of
excrements (picture 2).
Relatively to other risk factors such as (I) human density (ii) bird density (iii) proportion of
birds/humans (iv) presence of humid lands (v) pig density and besides the migratory routes which
are into account, it is possible identify 4 regions of major risk (Picture 3) for the occurrence of the
first cases of disease in birds and possibly in humans. In relation to domestic bird per inhabitant is
variable in Mozambique being the same great, but provinces of Gaza (3,6:1), Manica (3:1) and
Inhambane (1,5:1) and small in provinces of Nampula (0,7:1), Cabo Delgado (0,7:1) and Niassa
(0.9:1). The areas of great risk identified based on the present factors are as follow: South of Cabo
Delgado province and North of Nampula in coastal zone (ii). All Delta of Zambezi river (iii) the region
of Urema Lago in Sofala province (iv). The intermediary coastal zones of Inhambane province and
(v) Gaza and Maputo.
Figure 2. Migratory routes, nº os species and Resting locations of migratory birds.
1
Quirimbas
Lago Niassa
2
26
51
Pebane/Angoche
3
Gorongosa
Delta do Zambeze
Bazaruto
4
Inhambane
Maputo/Inhaca/R.Elefantes
5
These areas require permanent visual and serological surveillance to detect the disease as soon as
it appears and to undertake a rapid response in order to refrain the potential outbreak and to avoid
its spreading. The visual surveillance should concentrate in identification and research of certain
suspicion of avian influenza in live and dead domestic birds and in wild birds found dead. The
serological surveillance should be concentrated in domestic birds near to the areas near to the areas
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where there is probability of contact with wild birds (specially in aquatic and migratory birds) is more
probable, i.e. near to humid lands, lakes and lagoons where migratory birds.
Figure 3. Area with great potentialities for occurrence of first cases of avian influenza in
Mozambique taking into account the most important risk factors.
South of C.
Delgado and
North of
Nampula
Gorongosa,
Urema
Provinces of
Maputo and
Gaza
Zambezi
delta
Bazaruto archipelago
and coastal zones of
Inhambane
Table 2.Breakdown of domestic birds (chickens and ducks) and inhabitants per province in Mozambique
Aves
Habitantes
4.003.915 1.110.845
MANICA
3.164.998 1.046.448
INHAMBANE
1.730.276 1.159.142
MAPUTO
2.386.379 1.819.210
TETE
1.487.913 1.223.539
ZAMBÉZIA
3.598.650 3.107.146
SOFALA
1.444.698 1.368.432
NIASSA
762.345
804.960
C. DELGADO
1.028.476 1.384.531
NAMPULA
2.241.251 3.074.947
Total
21.848.901 16.099.200
PROVÍNCIA
GAZA
A/H
3.6
3.0
1.5
1.3
1.2
1.2
1.1
0.9
0.7
0.7
1.5
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RISK OF PANDEMICS IN MOZAMBIQUE
It is well known in Mozambique that raising of petty animals particularly hens and birds, is a source
for household consumption and income, mainly in rural areas where approximately 80% of the
population live. On the other hand, being it an income-generating activity, entails the movement of
the owners and their goods (chickens, ducks and birds) travelling from one place to another for
selling/or exchanging with other items. Although to import birds being prohibited and therefore,
hypothetically scarce the risk, Mozambique is one of important routes of migratory birds and,
therefore, a risky zone.
In Africa, the unique countries which avian influenza have been reported are Nigeria and Egypt,
without identifying any cases of illness in human beings. Meanwhile, the epidemiological features of
the virus show that the transmission is very rapid and efficient.
The risk of pandemics affecting Mozambique is serious particularly if the occurrence of human cases
persists, since the virus H5N1 can improve its capacity of transmission using man as its host. The
fact that the respiratory failure on man being a predilect case of virus H5N1, of the rate of attack in
other pandemics already described have been higher (25%-35%), of the main symptoms being
common to resfriado, the severity of the cases being variable, the possibility of existence of
asymptotic bearers and the migratory movement of the populations, are the factors which favour the
spreading of the sickness.
5. IMPACT ANALYSIS ON AVIAN INFLUENZA IN THE HEALTH AND
AGRICULTURE SECTORS IN MOZAMBIQUE
The avian influenza has socio-economic effects highly negative and affects the results of the
struggle against poverty. The negative impact of Avian Influenza can take a form of human deaths,
bird deaths with a representative rate of casualties for the cases of commercial poultry superior to
90% which results in great economic consequences for the country.
At social level, the existence of avian influenza reduces considerably the consumption of birds
affecting this way the national economy due to mainly to the absenteeism in large scale and the
domestic economy in particular since it is known that is household sector which has major
concentration of birds for domestic consumption as well as trade as income-generating activity.
The Avian Influenza can have socio-economic negative effects of the phase of evolution of the virus,
therefore, all the contributing activities for the limitation of contamination to the humans will
contribute for minimising the negative impact on the national economy. It is necessary therefore to
concentrate all human, financial and material resources which could contain the spreading of the
virus either among the birds or birds to humans and person to person.
In case in which the virus become pandemics, the negative effects will be devastating implying
losses of productivity, costs related to the acquisition of vaccines, anti-viral, equipment for individual
protection in large quantities besides considerable human losses and consequently, a major
allocation of resources will be demanded.
Taking into account the threat that avian influenza represents at the national level, it is indispensable
the involvement of several socio-economic stakeholders but, the Ministries of Health and Agriculture
play a key-role as the lead-institutions in issues related to warning, health education, epidemiological
surveillance, prevention and treatment.
5.1. ANALYSIS OF THE AVIAN INFLUENZA IMPACT IN THE HEALTH SECTOR
In Mozambique, the lack of information on the quantity of drugs, equipment and necessary
specialised technicians to contain the avian influenza moreover in its pandemics phase make it
difficult to determine the financial resources to combating avian flu in case of occurring.
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Being an emergency plan which is being drafted in 2006 to be response to possible situation which
could happen perhaps during this year, there is a need to mobilise a set of resources which are not
foreseen in on-going plans but which are necessary to give response to this situation. Additional
funds will be requested either to the Government of Mozambique or to other co-operating partners
which are working in the health sector in Mozambique. In the worst, in a very unpredictable
hypothesis, the available funds and scheduled in plans of health sector in the implementation in
detriment of several activities of routine but also extremely important and indispensable in the
struggle against the burden of illnesses which affect our economy. That could be a significant
setback in the struggle against extreme poverty defined by the Government of the Republic of
Mozambique.
The table below shows that for the current year, the total of funds foreseen for the health sector is
totalling an amount of 248,056,679 millions American dollars corresponding an increase rate of 15%
compared with previous year. In case there is outbreak of this pandemics during this year and
supplementary financial resources are not allocated, the Ministry of Health will have to allocate the
unique funds on which it has a control which are of approximately 200 millions American dollars
(Common Funds + State Budget) once the Vertical Funds are not controlled by the Ministry.
But, in case the pandemics does not happen during this year, the necessary funds to fund this
contingency plan could be scheduled for the plan of 2007 to be prepared in the planning cycle 200607 starting in May of this year. Thus, if this is like this and assuming that an a growth of funding of
the sector will maintain (from 2005 to 2006 was of 2%), given the trend of the co-operating partners
of the country providing direct support to the State Budget, the Ministry of Health will have to in its
exercise of planning allocate the necessary funds to combating against the flu.
Table 3: Total of Funds for Health Sector in 2005 and 2006
Moeda: US$
Fonte
Orçamento do Estado
Fundos Comuns
Fundos Verticais
Total
2005
104,117,714
112,866,835
122,808,546
339,793,095
2006
108,200,514
98,400,944
141,455,221
348,056,679
Evol.
4%
-13%
15%
2%
5.2 IMPACT ANALYSIS OF AVIAN INFLUENZA IN THE AGRICULTURE SECTOR
More than 2 millions of people are by certain or other ways linked to production of chickens in rural
areas (medium size = 10 birds). There are 1,000 aviaries of medium size=600 birds) and 12 aviaries
of great dimensions (medium size = 200000 birds). The medium value of one chicken is of 67,000
Mt (US$ 2.68). The total amount of the poultry industry is of approximately US$ 75 millions (picture
2).
Figure 4. Number of poultry producers, number of birds and value of poultry industry in Mozambique
Produtores de Galinhas e No. de galinhas por sector
Valor da industria avicola em Mocambique
73.2
Preço médio
68,300=US$2
19.3
Total=0.3
PIB
52.7
Preço médio
65,900=US$2
.6
2
2
0.6
0.1
Familiar
Pequena escala
Produtores
27.1
20.5
19.3
7.8
0.00012
Comercial
Familiar
Pequena Escala
Total
Galinhas
nº galinhas
Valor
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An outbreak of great proportions could cause damages of approximately US$ 50 millions and with
great probability of occurrence of illnesses in humans.
Once there is no other method besides killing of the infected birds and in risk to refrain the
dissemination of the disease, it would be necessary more than 750 people/per month and an
investment of approximately US$ 300,000 to undertake the work. The destruction of more than
8000000 millions of birds would be nightmare from logistical point of view being necessary to
compensate with more than US$ 20 millions to the poultry producers affected.
Figure 5. Economic losses in the worst scenario (3 affected provinces with emerging commercial
aviculture and rural aviculture).
Perdas economicas (no pior cenario) aprox. US$ 50 milhoes
47.3
21.8
17.8
5.7
2
Perdas em animais
Perdas em lucro
(familiar)
Perdas em lucros
Perdas nas
(comercial)
industrias de racao
Total
With the evolution of events with other sectors like Education, Culture, Finance, Industry and
Commerce, Tourism, Women and Social Affairs, Home Affairs, Defence, Labour, Foreign Affairs,
Transports and Communication as well as associations, institutes and NGOs will be called upon to
provide their contributions in relation to the impact of this disease in their sectors in order to enable
us to have the real impact on the country’s economy, which is foreseen to be of catastrophic
proportions.
6. STRATEGIC OBJECTIVES OF THE PREPAREDNESS AND
RESPONSE PLAN
6.1 REDUCE THE OPPORTUNITIES OF HUMAN INFECTION BY H5N1 VIRUS
The probability of avian influenza transmission to human can be reversed in case that the control of
occurrence of the disease in birds is effective. In this way, a National Strategy for Prevention,
Control and Eradication of Avian Influenza (ENPCEIA) which guides the preparation and the
response to (I) avoid the entrance of virus of IA in Mozambique through animals and animal-made
products, (ii) stop, refrain ou limitate the dissemination of the disease from birds to human beings.
The pillars of this strategy are as follow:
1. Prevention
2. Detectation, communication and early reaction.
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3. Vigilance and diagnostic.
4. Containment and eradication.
1. Prevention
– Application of the legal procedures of import and fiscalization in borders. Prohibition, import
of alive birds ou their products of infected regions or countries.
– Improvement of the bio-safety of aviaries through the application of Standardised Operational
Procedures (SOPs) in the industry and the home-made of raising birds.
– Review and if necessary to change the methods of raising which increase the risk of
introduction and/or dissemination of Avian Influenza (AI).
– Prohibition of simultaneous raising of pigs and birds at the same establishment/place.
– Education of population in order to avoid accidental contact with sick or dead birds and to
increase the distance between them and the birds in the home-made systems of raising
animals.
2. Communication Detection and rapid reaction
– Dissemination of information to the public in general in urban and suburban areas in relation to
safe practices to deal with sick or dead birds, communication of suspicious occurrences and on
elimination of the carcasses. This will be carried out through the intense use of media,
extension networks, non-government organisations, leaflets and pamphlets in national
languages.
– Dissemination of information to industry (Aviaries of medium and big size and ration producers)
on bio-safety in the aviaries in form of SOPs for production and safe handling of birds,
communication of the occurrences and safe elimination of the carcasses.
– Creation of Standardised Operational Procedures (SOPs) for reaction in case of suspicion of
disease case/focus.
– Creation of 11 teams (1 national and one per province) to undertake a research of suspicious
cases, situational evaluation and containment of the focus.
– To develop Awareness-Building Programme of the Community with the objective to reach the
capacity of early detection and sustainable state of warning in rural areas.
– To develop a control mechanism of the process through the creation of an Operational Centre.
3. Surveillance and Diagnostic
-
-
Visual and serological surveillance in 4 identified areas as of greater risk (I) active serological
surveillance in relation to domestic birds and improvement of the diagnosis of bird diseases,
through the increase of samples sent to laboratory including wild birds found dead.
Improvement of the laboratory diagnosis, through the refinement of diagnosis methods and
techniques and improvement of bio-safety at the Central Veterinary Laboratory.
Establishment of the co-ordination with the reference laboratory and with regional laboratories
(Kenya and South Africa) para virulogical diagnosis of Avian Influenza and appropriate
mechanisms for shipping samples to those laboratories.
To develop a community-based-programme of surveillance based on training extension workers and
community-based workers with the objective to create a proactive attitude in the detection and
communication of suspicious cases of diseases to be Avian Influenza.
To train all veterinary staff in Avian Influenza, detection, collection, handling and shipping of samples
and safe handling of birds and carcasses.
4. Containment and eradication
In case of confirmation of Avian Influenza, the subsequent activities will be under the responsibility
and command of the Head of Department of Animal Health and the Government of Mozambique will
make every effort to carry out the activities for immediate containment and eradication of the focus at
the place of occurrence. This activity will comprise the slaughtering of birds in a radium of 3.5 km
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and the establishment of surveillance zone of 10 km in relation to the focus epicentre, in which
foreseen measures in the law will be applied.
This will be carried out by trained teams and with the appropriate equipment for protection of
personnel.
The elimination of carcasses and decontamination will follow slaughtering of birds by human and it
will be carried out in a safe manner and in environmentally acceptable conditions.
The containment measures will include the temporary suspension activities in markets where the
birds are sold or their products in authorised locations or informal markets after the detection of the
first case of bird flu. This measure will be lifted after 21 days if all bio-safety measures have been
carried out.
The Government of Mozambique will compensate all individuals affected in kind (replacement of
birds) or financially based on the price practised for each bird at the local market. In this moment, a
group is working in a proposal of regulation for compensation mechanisms. Prohibiting measures for
exporting birds and its by-products from affected countries by bird flu are being implemented in our
countries.
Institutional and legal framework for the establishment of a national strategy for prevention
of Avian Influenza, in birds in Mozambique
The State Veterinary Services currently represented by the National Directorate of Livestock
(DINAP) is a Veterinary Authority responsible for epidemiological surveillance and for controlling
diseases affecting animals. The response capacity of this institution and of representatives of
Veterinary Authority in provinces (The Provincial Services of Livestock and District Services for
Agriculture) will play a determinant role in control prevention and eradication of Avian Influenza.
To face a contagious and epidemics disease of economic importance and in public health is
necessary that the Veterinary Authority should have a chain with clear leadership, scientific capacity
and infra-structures (material and human resources) to carry out their diagnostic activities,
epidemiological surveillance, control and eradication in animals. This responsibility was established
by the Council of Ministers´Decree nº8/2004 dated 01 April. The global strategy of prevention of
Avian Influenza established by World Health Organisation (WHO) and by its counterpart World
Organisation of Animal Health (OIE) as well as by the United Nations for Food and Agriculture
Organisation (FAO) is aimed to avoid the occurrence of diseases in animals and this way, preventing
the possibility for transmission to the man.
The Veterinary Authority at the different levels need to work in close co-operation with the Ministry of
Health, partners in Industry, private sector, private veterinarians and other professionals involved in
animal production and with producers in general towards reaching the success in their interventions
and as the control measures will have great impact in poultry industry, in producers and consumers
of poultry products. It is extremely important to recognise that the Veterinary Authority in
Mozambique is presently fragmented and has weak chain of leadership being very far of reaching
the internationally minimum standards established by OIE and FAO. In this context, the on-going
reforms in the country should take into consideration the need to safeguard the non-fragmentation of
the veterinary authority competencies
Scenario for the implementation of the Mozambique Contingency Plan for Influenza
Pandemic Preparedness and Response (ENPCEIA)
To refrain/contain a such harmful disease for the human health and with great economic impact, the
Veterinary Authority at the national and provincial level, has to be organised, well equipped with
human and material means, and under unified and capable leadership to decide, co-ordinate and
implement the measures of control prevention and eradication under ENPCEIA in accordance to the
law.
For such effect, it is necessary and urgent:
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a) To implement the principles and dispositions foreseen in the Regulation of Animal
Health/Sanity (Decree 8/2004, 1 April) which confer power for application of the established
norms in the same diploma.
b) To strengthen the vertical command of the Veterinary Authority making that all Heads of
Provincial Services of Livestock (representatives of Veterinary Authority) so that they can be
responsible for addressing issues related to ENPCEIA and other diseases of compulsory
declaration and of national and regional importance, are directly under the National Director
in accordance with the national interests and international standards.
c) To guarantee that the Provincial and District Governments provide all necessary
collaboration and support for the fulfilment of the Regulation of Animal Sanity and
implementation of the ENPCEIA.
d) To secure that Central Laboratory of Veterinary (IAAM) undertakes the diagnostic work in
birds in accordance to the priorities and locations established by Veterinary Authority.
e) To secure that the National Directorate of Agrarian Services, is reinforced through human an
material means to implement ENPCEIA and the programmes of Prevention and Control of
Diseases of Compulsory Declaration.
f) To guarantee the availability of funds for the implementation of activities related to the
proposed strategy and its desimbursement is made very rapidly.
6.2 TO STRENGTHEN THE EARLY WARNING SYSTEMS AND CREATE THE RESPONSE
CAPACITY TO THE PANDEMICS
In case of outbreak of pandemics, the country should be prepared to:
-
Detection of the case
Surveillance and Notification/Reporting
Epidemiological Research
Operational Research
Strengthen the evaluation of risk
Strengthening of capacity building
Advocacy and international partnership
Creation of a Multisectoral Forum
Establishment of a multisectoral team with the participation of the following Ministries and sectors:
-
Ministry of Health
-
Ministry of Agriculture and Fisheries
-
Health National Institute
-
National Institute for Veterinary Research
-
Ministry of Science and Technology
-
Bio-Technology Centre
-
Faculty of Medicine
-
Faculty of Veterinary
-
Ministry of Finance
-
Ministry of Industry and Trade
-
Ministry of Foreign Affairs and Co-operation
-
Ministry of Tourism
-
National Institute for Disaster Management (INGC)
-
Mozambique Association of Avicultors
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-
Association of the Poultry keepers from Mozambique
-
Association of Consumers
-
Mozambique Red Cross
Relevant activities
To improve the detection of the case in man
-
To activate provincial and district nucleus of response to the epidemics (already
existing)
-
To provide in due time financial resources
-
To create conditions for isolation of patients
-
To create conditions for collection, reception and shipping of samples to the laboratory
of reference
-
To create conditions for registration, reporting, minimum analysis of data and feed
back
-
To implement clinic surveillance of the cases (clinic and laboratory diagnostic)
-
Recruitment of human resources
-
Necessary equipment (cirurgical medical material, laboratory, equipment for bio-safety,
drugs, etc.) including prophylactics for clinical staff.
-
Necessary equipment (surgical medical material, laboratory, biossegurança
equipment, medications, etc.), including prophylactics for personal clinical
-
Take into account the Cholera Treatment Centre (CTC), tents, etc.
-
Prepare logistical conditions
-
Create conditions for notification of the cases “rapid cases” (telephone, fax-e.mail,
radio)
-
Training of all staff involved in the activities of prevention and control of the disease.
-
To guarantee water and light
-
Treatment of corpses
-
Garbage Handling
-
Treatment of the garbage
-
Transport
Advocacy and international collaboration
The search for external support is fundamental in this phase. We must promote and take part in
meetings which will enable us to increase our knowledge in this matter and to exchange information
and experiences and to find potential partners.
Clinical Treatment of the patients
The avian flu can be described as an epidemic event characterised by world circulation of a new
influenza virus for which the population has less or none immunity, resulting in higher morbimortality. When the epidemic happens is extremely important to have the capacity to evaluate its
extension and possible progression/evolution to the epidemics.
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The basic cares consist on individual or collective work, located at the primary level in the National
Health System (NHS), with the objective to promote health, intensify the prevention, treatment and
the rehabilitation/recovery.
To face an epidemic, it is necessary to:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Prepare a functional fluxogramme for the patients in health units.
To acquire EPI for the Service Staff Provider of medical cares and medicines;
Training of trainers in issues related to the treatment of patients and bio-safety
Training of clinic staff in the whole country in issues related to the treatment of
patients and bio-safety.
Identification of infra-structures for the isolation of cases.
Provision of EPI, hospital equipment and diagnostic methods for rapid distribution in
Health Centres in case of need.
To prepare attendance norms to the patient suspicious of being affected by H5N1.
Purchase in due time of Tamiflu or Relenza for high risk groups.
Purchase in due time of seasonal vaccine for high risk groups.
To acquire other supportive medications for combating the pandemics.
To prepare a distribution plan of equipment, anti-viral and vaccines.
To acquire vaccines against pandemics virus for high risk groups.
To vaccinate the high risk groups.
Institution of appropriate treatment to all suspicious cases and its contacts.
For the successful control of pandemics, surveillance activities in humans, complemented with
information and education for health (health promotion and disease prevention) should be intensified
targeting to the population in general and to high risk groups.
Early warning System
In case the country is affected, the epidemiological surveillance should be based in rural zone, since
most of the cases occur in this zone. On the other hand, the early detection of cases will be
complicated due to higher prevalence in population (the same which is occurring in other countries)
of other respiratory diseases presenting the same symptoms particularly, where the prevalence of
HIV/AIDS associated with lung tuberculosis or pneumonia is higher.
5 sentry posts should be established, namely: (1) Pemba Provincial Hospital, (2) Provincial Hospital
of Quelimane, (3) District/Rural Hospital of Manica, (4) District/Rural Hospital of Vilanculos, (5)
Maputo Central Hospital (reference). The ideal is to treat the patients on the site.
The reporting system should be set up so that the surveillance is done at the same time in animals
and in humans. The use of “rapid way” is fundamental. All the available means of communication
should be used for the exchange of information. It is important to establish a programme of weekly
report on the evolution of the bird flu with the support of information organs.
Experiences of the affected countries show that many activities defined in the plans of response to
pandemics are activated due to the changes. The detection of these changes and the interpretation
of its meaning depends if the clinical-epidemiological and virulogical data are opportune and safe. To
every human case, it will be necessary to undertake an evaluation of risks.
The public health laboratory has a central role in the early warning system. It is a strong assistance
for active and passive surveillance of the disease in humans whose role é to secure the confirmation
and early identification of the subtype and viral race from clinical samples.
Active search of cases in humans
-
Identification of focal points (They do exist for epidemiological Surveillance)
-
Definition of the CASE
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-
Identification of high risk population groups
-
Preparation of reporting form for research based on the CASE
-
Preparation of registration book
-
Computer processing of all information (collection, analysis, interpretation, report)
-
Mapping
-
Establishment of a system for rapid and safe transport of samples
-
Control of borders, contact with authorities of neighbouring countries
-
Training of joint team (for active and search and research of the case)
-
Recruitment of activists and identification of focal points in the community (active
search in the community)
-
Definition of the periodicity of active search
-
Search and identification of contacts
-
Prophylactics of the contacts
-
House Desinfection
-
Information, education and communication to the populations (IEC)
-
Training
Strenghtening of the national centre for Avian Influenza in prone-risk areas (regions)
A surveillance system for avian influenza virus was set up at the HCM paediatrics services and the
laboratory of microbiology of the Faculty of Medicine.
-
To evaluate the activities, existing material and human resources;
-
To create conditions for the submission of request of support to WHO for what could
be deemed as necessary, especially in equipment, training of personnel and reagents
for diagnosis.
Laboratory
In spite the fact that the country has certain experience in giving prompt response to the emergency
situations, in terms of epidemiological surveillance, treatment of cases, etc., although, with scarce
resources, the difficulties are enormous relatively to the laboratory capacity in replying rapidly in
case of emerging of new diseases. Tests of diagnosis for detection of H5N1 virus are technically
difficult and very costly. They require very sophisticated equipment associated to the needs of
material and special precautions of bio-safety in collection, handling, shipping and laboratories
processing of the samples.
Every laboratory activity for handling and testing of samples will be done exclusively by the Unit of
Virology Laboratory of Immunology of the INS which must have the capacity for such purpose. The
collected samples of suspicious individuals must be sent to the INS Immunology Laboratory fulfilling
the required bio-safety requirements. For such purpose, it is necessary to update the budget to
upgrade the level of bio-safety of veterinary and health laboratories in order to be at the level to
provide response to the complexity required for the detection and handling of the avian influenza.
The other useful measure would be the establishment of co-operation relations with other
laboratories of the world (Vietnam, Cuba, Brazil and France) which have experience in handling
samples of avian influenza virus.
Creation of the capacity for detection of H5N1 Virus
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The capacity of the laboratories to secure the detection and early confirmation of the pandemics
virus constitutes the key-factor for surveillance activity. Now, Mozambique does not possess the
laboratory capacity for the identification of H5N1 virus.
The development of the capacity for laboratorial confirmation of suspicious cases is comprised by 2
phases, namely:
Phase 1 – Upgrading the capacity of the Unit of INS Immunology Laboratory in bio-safety for
the manipulation of clinical samples for the shipping to the CDC Reference Laboratory-in
Atlanta
In the first phase, the identification of H5N1 virus will be made in CDC-Atlanta. The samples
received by the Immunology Laboratory will be later sent to the CDC Reference Laboratory-in
Atlanta.
For such purpose, capacity and conditions should be created, including:

Physical reforms of the Virology unit of the INS Immunology Laboratory

Purchase of equipment

Creation of an effective and safe system for sending the samples to Atlanta through
the circulation with companies carriers.

Training of 2 researchers in Atlanta in bio-safety procedures of level III, including
collection, handling and sending of samples.
Phase 2 – Upgrading the capacity of Virology Unit of the INS Immunology Laboratory for
identification of H5N1 virus through the PCR technology in real time.
At the second phase, capacities for identification of H5N1 in Mozambique should be created at the
Virology Unit of the INS Immunology Laboratory.
With the area of virology previously created at the phase 1 of development of capacity, all the
resources must be mobilised for installing PCR technology in real time. The require prerequisites for
this phase are:

Purchase of equipment which includes PCR machine in real time “open”

Purchase of reagents for the PCR reaction and kits for extraction of genetic viral
material (RNA).

Purchase of material for isolation of sequence specific viral.

Training of 2 researchers of the Virology Unit of the INS Immunology Laboratory in
specific issues of PCR in real time and bio-safety.
In parallel to this activity, the training of laboratory technicians throughout the country in the field of
collection, handling and shipping of samples to the laboratory is fundamental.
Meanwhile, even after installing the capacity for laboratory diagnosis in Mozambique, the periodical
and systematic shipping of samples to the WHO reference laboratory in Atlanta, it is important due to
following reasons:

To undertake more specialised tests for surveillance of recombination ou mutations.

Extraction of antigens which could be included in “pool” for the manufacturing of
vaccines so that the produced vaccines are effective against circulating virus in the
region.
A system of management, analysis and sharing of laboratory data will be set up in order to enable a
rapid exchange of information and laboratory data with WHO and the affected countries.
6.3 TO REFRAIN OR DELAY THE SPREADING OF THE PANDEMICS IN THE SOURCE
While the world still waits for the appearance of effective vaccine against viral gene responsible for
the next pandemics, countries like Mozambique should be more aggressive in preventive measures
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for refraining ou delaying the spreading of the pandemics. The prophylactics with anti-viral drugs
seem till now fundamental measure in the medical field.
However, it is necessary to pay attention to the fact of being necessary to vaccinate 80% of the
population within three weeks from the first clinical case of infection by pandemics virus till reaching
a protective immunity.
To enable that such measure is successful, it should be combined the massive administration of
supportive medications as well as through the implementation of an adequate quarantine service.
Therefore, the great limitation of this strategy is the lack to date of vaccines and anti-viral drugs in
enough stocks.
The pillars of this strategy are as follow:
–
–
Establish a National Stock of Anti-Viral Drugs
To develop a distribution plan for rapid and effective distribution of drugs
Establish a National Stock of Anti-viral Drugs
The Ministry of Health through the CMAM should make a prevision of necessary drugs to challenge
the pandemics and to make the identification of potential suppliers, acquisition and purchase of the
medications in enough quantities.
In addition to this, the logistic capacity should be installed or strengthened to guarantee that the first
group of people affected have access to medication in first hand.
To develop a rapid and effective plan of distribution of drugs
Mozambique is a country with long experience in massive distribution of medications and medicalcirurgical equipment in emergency situation as well as vaccines in vaccination campaigns,
(Smallpox, Measles, Poliomyelitis,). However, in case of pandemics, this experience should be
adapted to meet the needs to address duly with the distribution of anti-viral drugs whose
transportation and administration should comply with more complex criteria and standards.
6.4. TO REDUCE A MORBI-MORTALITY AND SOCIAL DISTURBANCE
The administration of vaccines (first line of defence) and anti-viral drugs constitute the most
important medical interventions to reduce the morbi-mortability during of an eventual outbreak of
pandemics. As the availability of vaccines will be null or limited, the anti-viral drugs have the critical
role in the inception of the pandemics. On the other hand, the role of the government institutions in
the introduction of non-medical interventions to reduce the morbi-mortality and social disturbances is
very important, taking into account the inappropriate destruction of vaccines and lack of equity of its
access.
Notwithstanding the fact that the scientists not being capable to determine with exactness the time
horizon and the gravity of the next pandemics, the history shows that it appears in explosive manner
causing a large number of patients, dead, stoppage of public services and lost of productivity and of
economy.
The health services must be prepared to give response to great demand of intensive care services
and to accommodate great number of deaths resulting from this pandemics. The ever increasing
rate of absenteeism in all sectors of labour force will have disastrous consequences in the provision
of health, security, transport, social and telecommunication services.
For the experience acquired in past pandemics, the demand for installing services of rapid response
to pandemics will not be throughout the whole country at the same time which will enable to the
stakeholders to act in order to refrain the spreading of the disease from one region to another. An
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FINAL VERSION
important measure to minimise the devastating impact of pandemics of the pandemics, it will
necessary to guarantee an adequate nutritional support, measures of hygiene and medications to
treat the opportunistic infections.
This strategy is based in:
 Monitoring
 Introduction of non-pharmaceutical interventions
 Use of anti-viral drugs for high risk population groups
 Supply of vaccines
 Equity in the access of vaccines
 Communication of the risks to the public
Monitoring
With the technical assistance of WHO, the national team of experts will undertake monitoring
activities to detect early the epidemiological and clinical behaviour of the new viral focus in real time.
This activity will enable to obtain the information on the main target population groups, virulence,
severity of the disease, rate of attacks, the risk for the health workers and the mortality rate.
The monitoring allows also to determine if the sintomatology is caused by the primary viral
pneumonia ou secondary bacterial pneumonia which answer to the antibiotics. A monitoring enables
to forecast the trend of disease in a most realistic way.
Introduction of non-pharmaceutical interventions
Some measures such as closing of schools, quarantine, banning concentrations of people or to
impose restrictive measures of travels which could be useful to avoid that the virus is rapidly and
uncontrolled disseminated.
Use of anti-viral drugs for high-risk population groups
WHO recommends that the countries which have financial and logistic means to invest towards
having an enough stock of anti-viral drugs particularly to face the pandemics.
Supply of vaccines
In this moment the vaccine is not available in enough quantities for the whole world. This causes
limitations on the development of activities of the countries in terms of logistical organisation, storage
so that they can be prepared in time to face the eventual pandemics.
Equity in the access of vaccines
As a country, we need to think in a balanced distribution of vaccines to avoid arguments of ethical
and humanitarian nature.
Communication of the risks to the public
As soon as the pandemic is declared, the communication of the real risk should be communicated to
the public. Therefore, it is useful to have a communication strategy which is practical and effective.
All and any type of typical difficulties of this nature of situation should also be communicated to the
public. Therefore, it is important to have a communication strategy which is practical and effective.
6.5 TO CONDUCT OPERATIONAL RESEARCHS ON THE PANDEMICS
With an outbreak of an avian influenza pandemic, new drugs and vaccines whose efficiency and
safety in Mozambican population are not known should be administrated in mass. In addition to this,
it is not possible to determine what will be the virulence potential, the characteristics of transmission
of the virus and much less what are the most affected population groups by the pandemics virus.
In this term, in the eventuality of an avian influenza pandemics become a reality, these important
issues should be addressed in real time to enable that the opportune adjustments of the strategies
and activities are made to redefine the activities and priorities.
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In this base, the main objectives of the operational research in time for pandemics are as follow:

To guarantee that the vaccines and anti-viral administrated are effective and safe.

To identify early the lost of anti-viral effectiveness of the drugs ou of anti-virus pandemics
vaccines.

To identify early the adverse effects non-tolerable of drugs or of anti-virus pandemics
vaccines.

To identify in time the relevant virus mutations and recombination.

To identify the most risk population groups and to evaluate the aspects related with viral
biology.

To share with other countries in the region the results and experiences relatively the relevant
research and to secure the rapid information sharing on the transmission characteristics, the
virulence and the most affected groups.
For the materialisation of these objectives, an integrated approach with the intervention of the sector
of public health laboratory and of epidemiological surveillance is required.
The identification of sentry posts of epidemiological surveillance and the systematic collection of
samples and the relevant information constitute very crucial activities. This component will be coordinated by INS, with strong support of the DEE.
Thus, the list of proposed operational researches comprises among the other activities the following:

Virus surveillance to evaluate susceptibility of the virus to the anti-viral.

Clinical Surveillance of the adverse effects related to the administration of the anti-viral in
humans.

Evaluation of the vaccine effectiveness of the anti-virus pandemics vaccine administrated.

Identification of the most affected population groups by the disease caused by the pandemics
virus.

Evaluation of the standard of virulence attributed to the pandemics.

Identifications of virus mutations and recombination of H5N1 virus and evaluation of its
relevance in the therapy, in the anti-viral diagnosis.
As an example, the study on close contacts of patients, closed communities where some cases
occurred, especially in risk population groups, for example, health workers provide us a panorama of
behaviour change of the virus. Information on clinical evolution of the cases provide important
information, level of severity of the disease associated to the diminution of the lethal effects indicate
some or nome improvements of the transmissibility.
For the materialisation of many of these activities, it will be necessary to establish partnerships with
WHO reference laboratories for the execution of more specialised testages which are not possible to
be undertaken in Mozambique. For example, the analysis to the virus collected during surveillance
activities, enable to the WHO laboratory to discover the changes occurred in the virus and to
determine if these indicate improvement in the transmissibility assisted by epidmiologic clinical
observations.
Support to epidemiological research
GOARN is presently developing a specific manual for epidemiological research of H5N1 pandemics
based on the results in different countries. The viable evaluation of risk depend on research of
sporadic human cases which occurred in certain settlements.
-
Translation and adaptation of the manual
-
Reproduction and distribution
-
Training of health personnel
Co-ordination of clinical research with other countries
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FINAL VERSION
Data obtained in the clinic need to be compiled and compared in order to elucidate the transmission
ways of the disease, identification of risk population groups and seek for better ways for treatment.
The country possesses a Telemedicine Centre in Maputo (Radiology service, never used) with
contract with Nampula and Beira (Central Hospitals).
-
To know the operational state of the equipment
-
To know if there is trained staff capable to use
-
To explore the capacity of contact with overseas
-
To seek other ways of contacts (e-mails)
The use of this type of technology enables the rapid exchange of information and experience
incentivating the standardisation of protocols for treatment and of research procedures.
The impact of the measures of prevention and of treatment of patients and in the last stage of the
current plan depends of the effectiveness and speed in the implementation of these researches. In
addition to these, visits for the exchange of experiences with countries already affected by avian
influenza will be of great usefulness to the country as it will enable it to become better prepared to
face the epidemics.
7. CONCLUSION
This plan seeks to provide a more realistically possible picture of the activities that are necessary to
undertake an effective struggle against an eminent catastrophe, in case that it happens in
Mozambique. It is clear that joint efforts should be carried out not only by the Mozambique
Government and group of experts in various social fields, but moreover with direct and active
involvement of civil society and the population in general will be determinant for a successful
struggle against this disease. It is obvious that all efforts should be made in an exercise of full
conscience in all levels meaning that the information should be available to all stakeholders in
particular civil society and population in general.
The information, besides facilitating the decision-taking with the consent of the population, it can, de
per si, be a great gun of struggle against this disease.
In the struggle against this disease, we should place priority to epidemiological surveillance at the
level of birds and in humans, at the same time.
A WHO old slogan says “it is better to prevent than curing” is gaining perfect echo if we look for the
budget of the present budget. From a total amount of 13,289,072,288.33 billions of Meticais
(531,562,891.53 USD) approximately 12,907,775,070.45 billions of Meticais (516,311,002.82
USD, cerca de 97%) will be used in the field of co-ordination, logistics and maintenance and from
this amount, more than 60% (8,061,848,437.50 billions of Meticais) only to guarantee the activities
in the curative field (anti-viral treatment for 25% of the population) in the case the disease being
declared as reality in Mozambique.
And therefore, it is mandatory since all our efforts are being invested to guarantee the
implementation of the activities of prevention, reinforced by a good information, communication and
education of the whole civil society and of the public in general, otherwise all efforts that are being
made towards reducing absolute poverty will be reduced to zero.
APPROVED BY THE COUNCIL OF MINISTERS ON 02 MAY 2006 (11TH SESSION)
26
FINAL VERSION
ACKNOWLEDGEMENTS
WHO, USAID, World Bank, SADC, administrative staff and assistant of the DAS, DNP and DNS.
REFERENCES
1. WHO, Preparing Influenza Pandemic Preparedness Plans: A step-by-step Approach, WHO,
Sep-2005
2. WHO/CDC/CRS/GIP, Checklist for Influenza Pandemic Preparedness Planning, Apr-2005
3. WHO/CDC/CRS/GIP, Responding to the Avian Influenza Pandemic Threat, Recommended
Strategic Actions, Ago-2005
4. WHO, Strategic Action Plan for Pandemic Influenza 2006-2007(Draft)
5. WHO, Pandemic Influenza Draft Protocol for Rapid response and Containment, Jan-2006
6. WHO, Report on a Regional Ad hoc Expert Panel Meeting, Harare, Zimbabwe, 12-13 Oct-2005
7. WHO AFRO, Influenza Pandemic Risk Assessment and Preparedness in Africa, WHO-AFRO,
Brazzaville, 2005,
8. , WHO AFRO, Regional Pandemic Influenza Preparedness and Response Plan, 2006-2007,
WHO AFRO, Dez-2005
9. Tanuri A., Relatório sobre o desenvolvimento da capacidade de diagnóstico laboratorial do
vírus H5N1 em Humanos em Moçambique, CDC/GAP ATLANTA
10.
11.
12.
13.
www.who.int
www.medscape.com
www.destinationrx.com
www.rxalpharmacy.com
APPROVED BY THE COUNCIL OF MINISTERS ON 02 MAY 2006 (11TH SESSION)
27
FINAL VERSION
ANNEXES
1. Orçamento para o combate a Gripe das aves e possível pandemia.
CAREÇE DE TRADUÇÃO
2. Panfleto com informações sobre a gripe aviaria CAREÇE DE
TRADUÇÃO
APPROVED BY THE COUNCIL OF MINISTERS ON 02 MAY 2006 (11TH SESSION)
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