The Ministry of Health has established a multisectoral committee, the Task Force for Pandemic Avian Influenza, consisting of a group of experts (technicians) from different ministerial departments and partners. This committee is responsible for the preparation, coordination, management and control of avian influenza during all phases of the disease. 

The current surveillance system in Djibouti is based only on syndromic surveillance of influenza-like illness and serious acute respiratory infection through the routine surveillance system and notifiable diseases procedures without using specific case definitions. No data analysis has been done to describe the trends of influenza-like illness in Djibouti. 

The response to an epidemic or pandemic event was established in 2006 and applied to deal with the 2009 (H1N1) pandemic in the framework of intersectoral collaboration. This plan has been simplified and was implemented in 2010 by the Ministry of Health to deal with the cholera epidemic, but without the participation of other sectors. In fact, Djibouti has reported only one case of avian influenza (H5N1), in 2006.

The Public Health Laboratory in Djibouti is not recognized as a national influenza centre. Virus isolation, polymerase chain reaction and sequencing are not offered; only serology is available, but with no information about its function. 

Strengths

The health system was really put to the test after the last pandemic influenza A/H1N1 (2009). A response plan based on the guidelines of the World Health Organization Global Plan was developed, tested and implemented in full coordination with all involved sectors. Awareness and initiation of the International Health Regulations (2005) are already going very well in the country.

The Peltier Hospital, selected as the first site for surveillance of influenza-like illness and severe acute respiratory infection in Djibouti, has a medical staff that can evaluate patients for these two conditions. It has the capacity to take samples and to transfer patient samples packaged for transport to the Djibouti National Institute of Public Health laboratory. This laboratory will be responsible for virological diagnosis of influenza by real-time polymerase chain reaction as soon as the full set of virus isolation equipment (present in Djibouti since 2009) is installed.

Gaps and recommendations

The Government of Djibouti is encouraged to establish a permanent mechanism for coordination and response to epidemics, including all relevant sectors such as the mechanism put in place to manage pandemic influenza A(H1N1) 2009. A rapid implementation of sentinel surveillance for influenza-like illness and severe acute respiratory infection is necessary to meet the objectives of the pandemic influenza preparedness framework in Djibouti. 

Until the time when the National Institute of Public Health laboratory is ready, samples from patients with influenza-like illness and severe acute respiratory infection must be frozen at –80 °C prior to their transportation to the National Reference Centre for Influenza in Morocco, where the virological diagnosis will be confirmed. The Dr Chakib Pneumophtisiology Hospital is a tuberculosis centre which has competent human resources to evaluate patients for influenza-like illness and severe acute respiratory infection, but the hospital mainly supports tuberculosis patients and does not undertake the monitoring of cases of influenza-like illness and severe acute respiratory infection in the general population of Djibouti.

There are gaps in Djibouti’s surveillance system, however it is expected that the Partnership Contribution funds will benefit the country by improving its surveillance and laboratory capacities for the detection of any respiratory outbreaks with major epidemic or pandemic potential.