Annual Report: 2010/2011

National Inﬂ uenza Center, National Center of Communicable Diseases, Ministry of Health, Mongolia

ANNUAL REPORT: 2010/2011

covering the period from September 16, 2010 to September 15, 2011 of the Project “Developing Sustainable Inﬂ uenza Surveillance Network” approved by the Cooperative Agreement between DHHS/CDC, USA and MoH/NCCD/NIC, Mongolia

Cooperative Agreement No: IU51IP000331 PAN: B5265G1 B5265G1 Annual Report - 2010/2011

Content

List of abbreviations used ...... 6 Foreword ...... 8

One. Background ...... 9 1.1. Geography and Climate of Mongolia ...... 9 1.2. Political System and Administrative Structure of Mongolia ...... 12 1.3. Demography and Main Health Indicators of Mongolia ...... 12 1.4. Health Service Delivery in Mongolia ...... 15 1.5. USA/Mongolia Collaboration in Health Fields ...... 16 1.6. History of the US/Mongolia Collaboration on Inﬂ uenza Surveillance ...... 17

Two. Inﬂ uenza surveillance in Mongolia ...... 25 2.1. History ...... 25 2.2. Current Surveillance System ...... 29 2.3. Epidemiology of ILI in Mongolia ...... 30 2.3.1. Outpatient-based ILI surveillance ...... 30 2.3.2. Hospital-based pneumonia surveillance ...... 33

Three. Cooperative Agreement Implementation ...... 36 3.1. Project Goal ...... 36 3.2. Project Objectives ...... 36 3.3. Project Implementation in 2009-2010 ...... 36 3.3.1. Strengthening infl uenza epidemiological surveillance ...... 38 3.3.1.1. Outpatient-based ILI surveillance ...... 38 3.3.1.2. Hospital-based infl uenza surveillance ...... 40 3.3.1.3. Pandemics control activities ...... 42 3.3.2. Strengthening infl uenza virological surveillance ...... 45 3.3.3. Ensuring sustainable development of infl uenza surveillance network by good and transparent management ...... 58 3.3.4. International Collaboration ...... 67 Conclusion ...... 69

2 Content

Four. Annexes ...... 71 Annex 1. Recommendation from the Fifth National Infl uenza Workshop ...... 71 Annex 2. Programme of the Mongolia-IPPP re-assessment workshop, June 23-24, 2010 ...... 72 Annex 3. Participants list of the workshop on IPPP re-assessment, June 23-24, 2010 ...... 74 Annex 4. Results of IPPP re-assessment in comparison to the previous assessments ...... 76 Annex 5. Programme of the workshop for moderators on table top exercises of “Emergency Measures Implemented during infl uenza pandemics” NIW 6, October 5, 2010 ...... 78 Annex 6. Participants’ list of the workshop for TTX moderators on NIW-6, October 5, 2010 ...... 78 Annex 7. Program of the Sixth National Infl uenza Workshop (NIW6), October 07-08, 2010, Ulaanbaatar, Mongolia ...... 79 Annex 8. Participants` list of the NIW5 October 7-8, 2010, Ulaanbaatar ...... 85 Annex 9. National Infl uenza Workshop 6 (NIW 6) recommendations .... 93 Annex 10. Laboratory reagents and other consumables received in Infl uenza Laboratory in the fi scal year of 2009/2010 ...... 94 Annex 11. Laboratory and offi ce equipment received in VL/NCCD in the fi scal year of 2009/2010 ...... 96 Annex 12. Laboratory and offi ce equipment received in VL/NCCD in the fi scal year of 20101/2011 ...... 97 Annex 13. Laboratory reagents and other consumables received in Infl uenza Laboratory in the fi scal years of 2010/2011 ...... 98 Annex 14. Programme of training of trainers for “Flu Information System” software, April 14, 2010...... 100 Annex 15. Participants list of the training of trainers on the “Flu Information System” software April 14, 2010 ...... 101 Annex 16. Infl uenza Reporting Assessment tools ...... 102 Annex 17. Programme of Training Seminar for the Team Members of Infl uenza Reporting Assessment, April 23, 2010 ...... 104 Annex 18. Participants list of Training Seminar for Infl uenza Reporting Assessment, April 23, 2010 ...... 104 Annex 19. The list of Assessment Team Members groups ...... 105 Annex 20. Detailed Infl uenza Reporting Capacity Assessment results nationwide, 2010 ...... 106

3 B5265G1 Annual Report - 2010/2011

Annex 21. Programme of the FIS Software training, September 22-23, 2010 ...... 112 Annex 22. Participants list of the FIS Software training, September 22-23, 2010 ...... 113 Annex 23. Assessment results of the FGP-based ISSSs in the capital city and provinces, in 2009 ...... 115 Annex 24. Assessment results of the ISSSs of the province and district hospitals in 2009 ...... 117 Annex 25. Assessment results of the I category FGP-based ISSSs in the capital city and provinces in the fi rst quarter, 2010 ...... 118 Annex 26. Assessment results of the II category FGP-based ISSSs in the capital city and provinces in the fi rst quarter, 2010 ...... 120 Annex 27. Assessment results of the III category FGP-based ISSSs in the capital city and provinces in the fi rst quarter, 2010 ...... 122 Annex 28. Assessment results of the I category ISSSs of the province and district hospitals in the fi rst quarter, 2010 ...... 123 Annex 29. Assessment results of the II category ISSSs of the province and district hospitals in the fi rst quarter, 2010 ...... 124 Annex 30. Assessment results of the III category ISSSs of the province and district hospitals in the fi rst quarter, 2010 ...... 124 Annex 31. Assessment results of the Reference Centers, in 2009 ...... 125 Annex 32. Assessment results of the Reference Centers, in the fi rst quarter of 2010 ...... 125 Annex 33. Assessment results of the I category FGP-based ISSSs in the capital city and provinces in 2010/2011) ...... 126 Annex 34. Assessment results of the II category FGP-based ISSSs in the province in 2010/2011 ...... 128 Annex 35. Assessment results of the III category FGP-based ISSSs in the provinces in 2010/2011 ...... 129 Annex 36. Assessment results of the I category ISSSs of the province and district hospital in 2010/2011 ...... 130 Annex 37. Assessment results of the II category ISSSs of the province and district hospital in 2010/2011 ...... 130 Annex 38. Assessment results of the III category ISSSs of the province and district hospital in 2010/2011 ...... 131 Annex 39. Assessment results of the I category Reference Centers in 2010/2011 ...... 131 Annex 40. Assessment results of the II category Reference Centers in 2010/2011 ...... 131 Annex 41. Participants list of the workshop on 2009 year and fi rst quarter, Content

2010 activities ISSSs in the capital city, April 16, 2010 ...... 132 Annex 42. Programm of the ISSSs training workshop 1, September 8-9,2011 ...... 135 Annex 43. ParticipantsŴ list of the ISSSs training workshop 1, September 8-9, 2011 ...... 137 Annex 44. Programme of training for FIS software, Sep 9, 2011 ...... 143 Annex 45. Participants’ list of the training for FIS software, Sep 9, 2011 ...... 144 Annex 46. Program of the training for laboratory activities, Sep 8, 2011 ...... 147 Annex 47. Participants’ list of the training for laboratory activities, Sep 8, 2011 ...... 147 Annex 48. Program of the training for hospital-based pneumonia surveillance in cooperation with Merieux foundation, France, September 8, 2011 ...... 148 Annex 49. Participants’ list of the for hospital-based pneumonia surveillance workshop in cooperation with Merieux foundation, France, September 8, 2011 ...... 148 Annex 50. Program of the training for inﬂ uenza transmission surveillance in cooperation with Tohoku university, Sendai Japan, September 8, 2011 ...... 149 Annex 51. Participants’ list of the training workshop for inﬂ uenza transmission surveillance in cooperation with Tohoku university, Sendai Japan, September 8, 2011 ...... 149 Annex 52. List of equipment transferred from the project to the ISSSs in 2011 ...... 150 B5265G1 Annual Report - 2010/2011

List of abbreviations used

ARI - Acute Respiratory Infections; ADB - Asian Development Bank; AGH - Aimak General Hospital; BG - Bayangol district, Ulaanbaatar (UB) city, Mongolia; BSL - Biosafety level; BZ - Bayanzurkh district, UB city, Mongolia; CC - Collaborating Center; CDC - Center for Disease Control and Prevention, USA; CIDNF - Center for Infectious Diseases with Natural Foci, MoH; CVR - Central Veterinary Laboratory, MoFALI; ChD - Chingeltei District, UB city, Mongolia; DA - Darkhan-Uul province, Mongolia; DG - Dornogobi province, Mongolia; DO - Dornod province, Mongolia; DGH - District General Hospital; DHHS - Department of Health and Human Services, USA; DPM - Division of Payment Management, DHHS; EQAP - External quality assurance program, WHO; FGP - Family Group Practices; FIS - Flu Information System; GDP - Gross Domestic Products; GGM - CDC - Global Grantee Meeting; GISN - Global Infl uenza Surveillance Network; GMT - Geometric mean titer; HA - hemagglutinin; HI - Hemagglutination inhibiting (titer etc); HIT - Hemagglutination inhibition test; HD - Health Department; HQ - Head Quarter; HSUM - Health Science University of Mongolia; ICD10 - International Statistical Classifi cation of Diseases and related Health Problems, 10th Revision; ICRT - Immunochromatographic rapid test; IEC - Information, Education and Communication; IFM - Immunofl uorescent microscopy; ILI - Infl uenza and Infl uenza-like Illnesses; IPPP - Infl uenza Pandemic Preparedness Plan; ISAC - Infl uenza Surveillance Advisory Committee; ISSS - Infl uenza Sentinel Surveillance Site; IST - Infl uenza Surveillance Team; IV - Infl uenza Virus; KhO - Khovd province, Mongolia; KhU - Khuvsgul province, Mongolia; KhUD - Khan Uul District, UB city, Mongolia; MAS - Mongolian Academy of Sciences; MCHRC - Maternal and Child Health Research Center, MoH;

6 Cooperative AgreementList of abbreviations Implementation used

MDCK - Madin Darby Canine Kidney (cell culture); MN - Micro-neutralization (test) MNT - Mongolian National Tugrug (currency); MoFALI - Ministry of Food, Agriculture and Light Industry; MoH - Ministry of Health; NCC - National Cancer Center; NCCD - National Center of Communicable Diseases; NCHD - National Center of Health Development; NEMA - National Emergency Management Agency, Mongolia; NIC - National Infl uenza Center; NIHEM - National Institute of Hygiene, Epidemiology and Micobiology; MoH (1964-1966); NIID - National Institute of Infectious Diseases, Tokyo, Japan; NIW - National Infl uenza Workshop; ODA - Offi cial Development Assistance; OR - Orkhon province, Mongolia; PAHO - Pan American Health Organization; PAN - Project Access Number, DPM; PCR - Polymerase Chain Reaction; PHC - Primary health care; PHI - Public Health Institue, MoH (since 1996); PPE - Personal Protector Equipment; RCDT - Regional Center for Diagnosis and Treatment, MoH; RT-PCR - Reverse Transcriptase Polymerase Chain Reaction; rt-RT-PCR - real-time RT-PCR RSV - Respiratory sincytial virus; SAR - special administrative region, China; sARI - Severe acute respiratory infection; SBD - Sukhbaatar District, UB city, Mongolia; SE - Selenghe province, Mongolia; SKhD - Songinokhairkhan District, UB city, Mongolia; SPIA - State Professional Inspection Agency; SU - Soviet Union; TB - Tuberculosis; TTX - Table top exercise; UB - Ulaanbaatar (Capital City of Mongolia); UN - United Nations; UNFPA - United Nations Fund for Population Activities; UNICEF - United Nations Children`s Fund; USA - United States of America; UV - Uvurkhangai province, Mongolia; VL - Virology laboratory, NCCD; VRI - Veterinary Research Institute, University of Agriculture, Mongolia; WB - World Bank; WCS - Wildlife Conservation Society, USA WHO - World Health Organization; WPRO - Western Pacifi c Regional Offi ce, WHO; WR - WHO Country Representative, Ulaanbaatar, Mongolia;

7 B5265G1 Annual Report - 2010/2011 Foreword

FOREWORD

I am pleased to introduce again the 2nd Annual Report of the new cycle of the inﬂ uenza surveillance project under the Cooperative Agreement between Ministry of Health, Mongolia and Department of Health and Human Services, USA.

The last infl uenza season being the post-pandemic one was a transition from the pandemics for the structures of infl uenza surveillance built up as a result of the previous Project implemented successfully in 2004-2009. The pandemic was a big challenge of course. However, I can say the Government of Mongolia has effectively controlled the pandemics based on the capacities developed through this Project and with friendly supports rendered by donor organizations and Governments. The pandemics has been documented fi rst time in the history of public health of Mongolia due to capacities and capabilities developed by the DHHS/CDC supported Project for the NIC, Mongolia at NCCD.

The successful implementation of our Project aims was possible only with extensive support of the responsible offi cers at CDC and DPM/DHHS, especially Dr Nancy Cox, Director, Infl uenza Division, CDC, Mrs. Ann Moen, Deputy Chief, Infl uenza Division, CDC, Dr. Alexander Klimov, Chief, Strain Surveillance Section, Infl uenza Division, CDC, Mrs. Theresa Turski, Health Scientist, Infl uenza Division, CDC, Mr. Steward Nichols, Grant Management Specialist, International and Territories Acquisition and Assistance Branch, CDC and Ms. Janet Fowler, DPM/ DHHS. The Mongolian counterpart team headed by Prof. P.Nymadawa was instrumental during the pandemics with wide-range technical supports to us - decision makers.

On behalf of the Ministry of Health, Government of Mongolia and myself personally I would like to express our deepest thanks to CDC/DHHS, USA for their great assistance for the sustainable development of inﬂ uenza surveillance in my country though this Project.

Mr. S. Lambaa, PhD (Econ.) Minister of Health, Government of Mongolia, Member, Parliament of Mongolia December 1, 2011, Ulaanbaatar, Mongolia

8 Bacêground:Cooperative Geography Agreement and Climate Implementation of Mongolia

ONE. BACKGROUND

1.1. Geography and Climate of Mongolia

Mongolia is a landlocked country in Northeast Asia located between the latitudes of 41°35"N and 52°09"E and the longitudes of 87°44"E and 119°56"E bordering in the North with the Siberian part of the Russian Federation and in the East, West and South with the People’s Republic of China (Figure 1). Mongolia`s total area is 1,566,600 km2. The distance between the most western and the most eastern points is 2,392 km, and between the most northern to the most southern points is 1,259 km. Mongolia is the seventh largest country in Asia and the 18th largest in the world. Also, Mongolia is one of the largest landlocked countries in the world. Mongolia`s territory reaches relatively high altitudes: while the average altitude is 1,580 meters above sea level, 81.2% of the territory is higher than 1,000 meters above sea level, and half of the territory is higher than 1,500 meters above sea level. In Mongolia, all natural zones such as high mountains, valleys between the mountain ranges, wide steppe, desert and semi-desert zones are combined. Ecologically, Mongolia occupies a critical transition zone in Central Asia: here the great Siberian taiga forest, the Central Asian steppe, the high Altai mountains and the Gobi desert converge. Altitude (m, above sea level)

Figure 1. Geographical map of Mongolia

9 B5265G1 Annual Report - 2010/2011

The northwest and central parts of Mongolia are high mountainous regions, while the eastern part is a vast steppe region. The southern part of the country represents the semi-desert and desert area that is known as the Mongolian Gobi. Forests cover 8.1% of the country`s territory, consisting mainly of larch and pine. Saxaul forests occupy certain areas in the Gobi. The climate of Mongolia is a harsh continental with four distinctive seasons, high annual and diurnal temperature ﬂ uctuations, and a low rainfall. Because of the country`s high altitude, it is generally colder than that of other countries in the same latitude. Average annual temperatures range between 8.5°C in the Gobi and -7.8°C in the high mountainous areas. The extreme minimum temperature is usually between -31°C and -52.9°C in January and the extreme maximum temperature ranges from +28.5°C to +42.2°C in July (Figure 2 and 3).

Figure 2. Mean summer temperature, Mongolia

The average annual precipitation is low (200-220 mm) and represents a range between 38.4 mm per year in the extreme South (Gobi desert region) and 389 mm per year in limited areas in the North (Figure 4). Most precipitation occurs in the months of June, July and August; the driest months occur between November and March. Droughts in the spring and summer periods occur about once every ﬁ ve years in the Gobi region, and once every ten years over the most other parts of the country. Mongolia receives an average of 3,000 hours of sunshine annually, which is well above the amount received by other countries of the same latitude.

10 Bacêground:Cooperative Geography Agreement and Climate Implementation of Mongolia

Figure 3. Mean winter temperature, Mongolia

Figure 4. Mean annual precipitation, Mongolia

11 B5265G1 Annual Report - 2010/2011

1.2. Political System and Administrative Structure of Mongolia

Mongolia has drastically changed in 1990 the political system followed for the last 70 years: from the one-party dictatorship to a multi-party parliamentarian democracy and the same time trying to shift from a centrally planned economy to a market-oriented one. According to the Constitution adopted in 1992 the Head of the State is the President who is elected for 4 years by a secret ballot of all citizens of electoral age (above age of 18). The Government has 3 branches: • Legislative-Ikh Khural (Parliament) with 76 seats elected for 4 years, • Executive-Cabinet: Prime Minister (approved by the Parliament on the nomination of the President) and Ministers (approved by the Parliament on the proposal of the Prime Minister), Provincial Governors (approved by the Prime Minister on the proposal of local Khurals: Province Parliaments), • Judical-Constitutional Court (approved by the Parliament on the equal nominations by the President, Parliament and the Cabinet), Supreme Court and Provincial and District Judges (approved by the Parliament on the proposal of the President). Administratively, Mongolia is divided into 21 Provinces (Aimags) and the Capital City-Ulaanbaatar. Provinces are divided into districts (soums) and districts are further fragmented into sub-districts (bags). The capital city has also 9 city districts (duuregs) and city districts are subdivided into city sub-districts (khoroos). Currently Mongolia has 340 districts and 1,671 sub-districts including city districts and city sub-districts.

1.3. Demography and Main Health Indicators of Mongolia1

At the end of 2010, the resident population of Mongolia stood at 2,780.8 thousand. Currently, 48.6% of the population are male and 51.4% are female. In 2010, the percentage of population aged under 15 years was 27.3, aged 15- 64 years was 68.8% and aged 65 years and older was 3.9.

1 Most of the statistical data have been taken from “Mongolian Statistical Yearbook-2010” prepared by the National Statistical Office of Mongolia, Ulaanbaatar, 2011, 463 pp.;

12 Background: DemographyCooperative and Main Health Agreement Indicators Implementation of Mongolia Female Male 200 150 100 50 0 50 100 150 200 Female Male 200 150 100 50 0 50 100 150 200 Figure 5. Population Pyramid of Mongolia in 1992, 2002 and 2010 Figure Female Male 200 100 0 100 200 39 - 5-9 0-4 70+ 30-34 25-29 20-24 15-19 10-14 65-69 60-64 55-59 50-54 45-49 40-44 35 1992 2002 2010 2002 1992

13 B5265G1 Annual Report - 2010/2011

Although the population has doubled since 1960, the average population density 1.75 persons per square kilometer - remains one of the lowest in the world. Still, the density is highly variable, ranging from a high of 247 persons per square kilometer in Ulaanbaatar to a low of 0.3 people in the Umnugobi (South-Gobi) province. Some 56.6% of the population lives in urban area. The capital city, Ulaanbaatar, alone is home to 32% of the population. Population growth rate was relatively high in 1960-1970 reaching 3-4% per year. From the 1980s population growth rate has shown rapid decline till the late 1990s, however again starts increasing due to the new pro-natalist policy (Figure 5). Mongolian population has gone into epidemiological transition also in 1990s (Figure 6). So, Mongolia experiencing double health burden like many of middle-income countries of the world.

Figure 6. Mortality pattern has undergone an epidemiologic transition since 1990s. Currently cardiovascular diseases, cancer, injury and poisoning are the three leading causes of death, and have a tendency for further increase.

In Mongolia by the statistics of 2009, the life expectancy at birth is 68.0, infant mortality rate is 20.2/1,000 live births, under 5 mortality rate is 23.60/1,000 live births, and maternal mortality rate is 81.4/100,000 live births. Diseases of the respiratory system are leading in general population and in the childhood in the registered morbidity structure (Table 1).

14 Background:Cooperative Health ServiceAgreement Delivery Implementation in Mongolia

Table 1. Leading causes of morbidity per 10,000 population in Mongolia (2003-2009)

In general population

Diseases of the respiratory system (ICD-10, Chapter X) 1,027.73

Diseases of the digestive system (ICD-10, Chapter XI) 900.51

Diseases of the uro-genital system (ICD-10, Chapter XIV) 756.4

Diseases of the circulatory system (ICD-10, Chapter IX) 679.44

Injury, poisoning and certain other consequences of external causes 416.91 (ICD-10, Chapter XIX)

1.4. Health Service Delivery in Mongolia

Mongolia has a mixed health care system with dominating Government health institutions of three levels (Table 2). Mongolian health care system offers with total 38,704 employees including 7,140 medical doctors (26/10,000 population), and 15,789 middle level health personnel: nurses, doctor’s assistants, laboratory technicians etc (58/10,000 population) has relatively good health manpower supply among developing countries. As of 2007, health ﬁ nancing compromises: 71.9% from the Government budget, 23.5% from the Health Insurance Fund and 4.6% out of pocket expenses. Total Government health spending is 4.5% of GDP and 12% of total Government Expenditure (2007). 10% of total health expenditure is ODA. The main ODA resource ﬂ ows in the health sector are provided by bilateral resources from Governments of Japan, Germany, Korea and USA, and multilateral institutions: WHO, UNFPA, UNICEF, UN Global Fund and ADB, WB.

15 B5265G1 Annual Report - 2010/2011

Table 2. Health Service Delivery in Mongolia (2006)

Outpatient Health Institutions Hospital Number Beds visits admissions

Total 1,256 18,371 558,221 13,874,487

1. Primary level: 571 4,579 152,022 7,712,980 • District Hospital (Government) 296 3,866 129,126 2,227,062 • Inter-District hospital (Govern ment) 31 713 22,896 355,071 • Family Group Practice (Pri- 230 0 0 5,130,847 vate)

2. Second level: 34 4,644 136,652 3,388,714 • Inter-district General Hospital (Government) 4 282 8,588 123,563 • General Hospitals of Provinces (Government) 18 3,089 82,202 1,614,236 • General Hospital of City Dis- tricts (Government) 12 1,273 45,862 1,650,915

3. Tertiary level: 20 5,815 166,044 1,395,239 • Regional Center for Diagnosis and Treatment 3 1,635 55,650 333,372 • General and Specialized Hos- pitals 17 4,180 110,394 1,061,867 and Centers in Ulaanbaatar

4. Others: 622 3,333 103,503 1,377,564 • Private Hospitals 143 1,839 58,013 0 • Private Clinics 434 0 0 841,856 • Others 45 1,494 45,490 535,708

1.5. USA/Mongolia Collaboration in Health Fields Health sector was not a priority area of US ODA in Mongolia. Therefore, the US/Mongolia health sector collaboration was based mostly on occasional connections of health institutions, philanthropic societies, professionals and NGOs till mid 2000s. An attempt for the national level collaboration in the health ﬁ eld was made in 1995, when CDC and MoH has signed an agreement for a year’s duration on collaboration of epidemiological surveillance and control of infectious diseases, especially regarding meningococcal epidemics which was

16 Background: History of the US/MongoliaCooperative Collaboration Agreement on Inﬂ uenza Implementation Surveillance serious concern of the Government of Mongolia that time. The collaboration has resulted in very successful control of meningococcal epidemics2. Unfortunately, the Agreement has not been extended after a subsequent change of Governments on both sides. US Government has opened on October 22, 2007 a Millennium Challenge Account for Mongolia including a Health Project of US$ 17.03 million covering 5 years given emphasis on non-communicable discases and injuries prevention and clinical management (see details on Millennium Challenge Account-Mongolia webpage: http://www.mca.mn).

1.6. History of the US/Mongolia Collaboration on Inﬂ uenza Surveillance

NIC, Mongolia has submitted an application to CDC, USA in May 2004 for a project in response to the call of CDC/DHHS, USA for an institutional development project on “Development of Inﬂ uenza Surveillance Network” under Program Announcement Number 04016 and has awarded a Cooperative Agreement Project for 5 years (U50/CCU024411; B5265G1). The Project has been implemented successfully and a reliable inﬂ uenza surveillance system has been developed in the country. The Cooperative Agreement Project goal was:

• to strengthen infl uenza surveillance network in Mongolia, and the objectives were: 1. to strengthen coordination and collaboration activities in infl uenza surveillance, 2. to strengthen infl uenza reporting system, 3. to strengthen infl uenza clinical surveillance activities, 4. to strengthen infl uenza laboratory surveillance network and activities, 5. to strengthen sentinel surveillance of infl uenza, 6. to strengthen infl uenza outbreak response system, 7. to strengthen infl uenza surveillance activities in animals, 8. to monitor and evaluate activities on infl uenza surveillance, 9. to promote international collaboration on infl uenza surveillance. The results achieved through the Cooperative Agreement Project were:

2 WHO (1995): Meningococcal Disease, Mongolia, Weekly Epidemiological Record,. 70: 281-282;

17 B5265G1 Annual Report - 2010/2011

1. to strengthen coordination and collaboration activities of infl uenza surveillance, Thanks to the Project the coordination and collaboration activities of infl uenza surveillance have been improved dramatically: - By two orders (the order No 241/04 by the Minister of Health, Mongolia issued on November 17, 2004 “Development of laboratory-based sentinel surveillance network of infl uenza”; and the order No 253/06 by the Minister of Health, Mongolia issued on July 10, 2006 “Strengthening of infl uenza surveillance activities”) infl uenza surveillance sites (ISSSs) have been designated and the terms of reference of them have been approved; - Since 2005 the National Infl uenza Workshop (NIW)s have been organized yearly before the start of each infl uenza season including representatives (200-250 offi cials each year) of all stakeholders of the control activities: offi cials from the provinces and the Capital City District Government, Departments of Health Service, Emergency Management, and Veterinary Service, family group practices (FGP) and hospitals;

2. to strengthen infl uenza reporting system, Information fl ow on infl uenza has been improved noticeably: - Infl uenza surveillance became whole year activity since 2006/2007 season; - Daily information from the ISSSs and weekly information from province Government Health Departments became a routine activity; - Rapid analysis and feedback information to the MoH and Health Departments and ISSSs became regular activity and starting April 2009 real-time weekly posting of the surveillance results on the NIC, Mongolia website (http://www.fl u.mn) became routine activity; - Weekly information to WHO fl u.net became also regular activity from 2005/2006 season;

3. to strengthen infl uenza clinical surveillance activities, Clinical surveillance of infl uenza has been substantially improved: - WHO defi nitions for infl uenza, ILI and sARI were adopted for utilization for whole country by orders of Minister of Health, Mongolia (orders No 241/04, No 253/06 and No 323/09); - in total 5,343 medical professionals were trained and re-trained for the clinical diagnosis and management with 121 workshops throughout 5 years period;

18 Background: History of the US/MongoliaCooperative Collaboration Agreement on Inﬂ uenza Implementation Surveillance

4. to strengthen infl uenza laboratory surveillance network and activities, Infl uenza laboratory surveillance has been improved profoundly and now meeting the WHO requirements fully: - The quantity and quality of infl uenza virus detection has been promoted signifi cantly and the number of collected samples has been increased 6.3 times (1,112 in 2004/2005 season and 6,996 in 2008/2009 season) and the detection rate of infl uenza viruses were improved by 1.8% (13/144 (9.0%) on MDCK cell culture in 2004/2005 season and 149/1379 (10.8%) with rt-RT-PCR in 2008/2009 season); - Isolation of infl uenza viruses on MDCK cell culture become the routine investigation (yearly more than 4,000 samples with 200 isolations approximately); - Sharing of the infl uenza virus isolates with WHO CCs become permanent (yearly it has been sent 20-25 virus isolates to NIID, Tokyo, Japan and CDC, Atlanta, USA); - Typing of the isolates in HIT and regular RT-PCR become routine since 2005/2006 season (yearly around 200 experiments); - rt-RT-PCR diagnosis of infl uenza viruses in randomly selected clinical samples started in 2008/2009 season and become routine method for all samples received in NIC, NCCD staring August 2009; - diagnosis of non-infl uenza ILI become possible for adenoviruses, parainfl uenza viruses and RSV in randomly selected clinical samples starting 2007/2008 season and now performed yearly for 1,500 samples approximately; - NIC, NCCD is participating in WHO EQAP (external quality assurance program) since 2007 and has obtained 100% concordant results in all panels except the fi rst one. Based on performance in the EQAP, WHO has listed Virology Laboratory, NIC, Mongolia in the world list of laboratories with capabilities to diagnose A(H1N1)v infl uenza infection by rt_RT-PCR in May 2009 (http://www.who.int/ csr/resources /publications/swinefl u/country_pcr_capacity/en/); - sequencing of some genes of the selected local infl uenza virus isolates has been started in 2007 and the sequences of 20 HA genes performed in collaboration with the scientists from CDC, USA and NIID, Japan, and starting 2009 sequencing of genome segment of infl uenza viruses became routine activity in NIC, Mongolia;

19 B5265G1 Annual Report - 2010/2011

5. to strengthen sentinel surveillance of inﬂ uenza, ISSSs have been established and strengthened covering approximately 64% of the whole population and 56% of the total territory of the country: - 45 out-patient surveillance ISSSs have been established in 2005- 2006 involving 140 medical doctors and 160 nurses based on family group practice (FGP)s in Ulaanbaatar City and Selenghe, Dornogobi, Khovd, Uvurkhangai and Dornod provinces and total 2,165 medical professionals were trained and re-trained; - The out-patient ISSS network was extended in 2006-2007 by 20 FGPs involving 96 medical doctors and 103 nurses in Darkhan-uul and Orkhon provinces and total more than 200 medical professionals were trained and re-trained; - A hospital-based pneumonia surveillance network covering 17 hospitals in Ulaanbaatar City, and Darkhan-Uul, Dornod, Dornogobi, Khovd, Orkhon, Selenghe and Uvurkhangai provinces with participation of 160 medical staff were established in 2006-2007 and now it becomes a routine activity; - A sARI surveillance has been initiated in 2008/2009 season in Baganuur District, Ulaanbaatar City and Selenghe province involving 8 FGPs and 2 hospitals with 147 medical doctors and 253 nurses and all staff has been trained;

6. to strengthen infl uenza outbreak response system, The infl uenza outbreak response capacity of the country has been improved considerably: - IPPP (infl uenza pandemic preparedness plan) in the form of “Main Directives for Prevention of Avian Flu and Infl uenza Pandemics” has been issued by the Government of Mongolia Resolution 110/2006 establishing the Government Emergency Committee chaired by the Vice Prime Minister and adopting the responsibilities of the Government Ministries and Agencies; - IPPP at the country level and sub-national level (provinces and Capital City Districts) have been assessed using tools developed in CDC, USA in 2008-2009 and several table-top exercises have been conducted, and on the basis of these activities it have been proposed updates for IPPP; - Some infl uenza seasonal vaccines produced in Russia and China have been evaluated serologically and clinically in 2006/2007 and 2007/2008 seasons and it has been proposed to include infl uenza seasonal vaccines for health service personnel into routine vaccination

20 Background: History of the US/MongoliaCooperative Collaboration Agreement on Inﬂ uenza Implementation Surveillance

schedule; - On the pledge of the Government of Mongolia, the Government of Japan has funded (a million US$) in 2006-2007 a project on “Activities of behavioral change of population to prevent spread of avian infl uenza and infl uenza pandemics” supported by UNICEF (development and productions of health educational materials, training of medical and veterinary professionals and journalists) and World Bank is funding (4.7 million US$ for 2008-2010) with the lead organization of the National Emergency Management Agency, Government of Mongolia (NEMA) a Project “Avian infl uenza control and human infl uenza pandemic response” for further strengthening of coordination of IPPP and improvement of medical and veterinary services;

7. to strengthen inﬂ uenza surveillance activities in animals, The surveillance of animal inﬂ uenza has been improved considerably: - A WCS (Wildlife Conservation Society, USA) team working together with scientists of the Mongolian Academy of Sciences has collected July-August 2005 samples for a virus isolation from dead wild migratory birds at the Erkhel Lake in Khubsugul Province and at the Khunt Lake in Bulgan Province in the North-Western Mongolia. In the Poultry Research Laboratory in Athens, Georgia, USA H5N1 virus RNAs were detected by RT-PCR (http://www. medicalnewstoday.com/printerfriendlynews.php? newsid=29387). From the PCR positive samples collected in Mongolia in 2005 has been isolated a HPAI virus strain designated A/whooper swan/ Mongolia/244/2005(H1N1) and the genes of which have been sequenced in the Southeast Poultry Research Lab, USDA-ARS, Athens, Georgia, USA and in the Department of Infectious Diseases, St.Jude Children’s Research Hospital, Memphis, Texas, USA and deposited in GenBank (DQ659326; and EU723707;). This HPAI strain A/whooper swan/Mongolia/244/2005 has been selected by the world leading experts of the problem as one of the prototype strains of the clade 2.2. H5N13; - A BSL3 laboratory with the aim of studies on HPAI viruses has been erected in 2007-2008 for the Veterinary Research Laboratory,

3 WHO/OIE/FAO (2008):Toward a unified nomenclature system for highly pathogenic avian influenza virus (H5N1), Emerg. Infect. Dis., 14(7): e1; http:/www./who.int/csr/ disease/avian_influenza/guidelines/nomenclature/en/print.html

21 B5265G1 Annual Report - 2010/2011

Ministry of Food and Agriculture, Mongolia (VRL), and a BSL2+ laboratory in the Center of Infectious Diseases with Natural Foci, MoH, Mongolia (CIDNF) for studies on infl uenza human-animal interfaces has been built in 2007-2008 with support of WHO; - VRL and CIDNF are continuing the surveillance on avian and animal infl uenza viruses on the territory of Mongolia with support of Japanese and USA scientists and have isolated some more HPAI H5N1 and LPAI H12N3, H13N6 and H16N3 viruses in 2006-20094; - NCCD, Mongolia has started in 2008 a collaborative study with the Center for Emerging Infectious Diseases, University of Iowa, USA on “Identifying Risk Factors for Zoonotic Infl uenza Transmission” in Khovd, Dornogovi and Tuv provinces of Mongolia (http://www. public-health.uiowa.edu/CEID/);

8. to monitor and evaluate activities on inﬂ uenza surveillance, A system for monitoring inﬂ uenza surveillance activities in ISSSs has been developed and strengthened: - an assessment system for ISSSs with 10 indicators including records for ILI registration and temperature control of refrigerator for specimen storage, virus isolation rate, activities for health education for population etc in 2006 and improved gradually based on experiences of previous assessments; - a fulltime outreach supervisor for Project has been recruited in 2005 and the outreach supervisor has visited weekly the ISSSs in the Capital City and quarterly the ISSSs in the Provinces. Usually members of NCCD and chief specialists of the MoH on epidemiology and infectious diseases were accompanied the outreach supervisor to give professional advises to the ISSSs; - since 2006 it has been organizing half-yearly assessment workshops in the Capital City involving around 150 representatives in average from all ISSSs with assessment presentations by the outreach supervisor, lectures by leading specialists and some table-top exercises; - The outreach supervisor has made over 120 visits to the Provinces

4 Newman, S.H. et al. (2009): Migration of whooper swans and outbreaks of highly pathogenic avian influenza H5N1 virus in Eastern Asia, PLoS One, 4(5): e5729; Sparkman, E. et al.(2009): Characterization of low pathogenicity avian influenza viruses isolated from wild birds in Mongolia 2005 through 2007, Virol.J, 6(1): 190; Batchuluun, D. et al. (2009): Diag- nosis and surveillance of avian influenza in migrating birds (http://www.flu.mn/mgl/images/ stories/NIW/NIW5/04_Presentation%20_D.Batchuluun_ENG.pdf

22 Background: History of the US/MongoliaCooperative Collaboration Agreement on Inﬂ uenza Implementation Surveillance

with over 15,000 person-day work-load; 9. to promote international collaboration on infl uenza surveillance. The international collaboration has been promoted substantially: - the participation in WHO GISN activities has been improved substantially by weekly regular reporting of ILI situation and infl uenza isolates in Mongolia to WHO fl u.net, regular sending of the representative infl uenza virus strains isolated in Mongolia to the WHO Collaborating Centers in NIID, Tokyo, Japan and CDC, Atlanta, USA and participating in the meetings of WHO GISN (Malta, 2005; Toronto, Canada, 2007; and Barcelona, 2008;), NIC meetings of WHO WPRO and SEARO (Melbourne, Australia, 2007; Tokyo, Japan, 2008 and Beijing, China 2009); sending researchers with presentations to WHO workshops (WHO Workshop: Human Infl uenza Surveillance and Control, Kuala Lumpur, Malaysia, 2005; WHO Training Workshop: Laboratory Diagnosis and Strain Surveillance of H5N1 Infl uenza, Tokyo, Japan, 2006; WHO Workshop: Avian Infl uenza and Pandemic Infl uenza Rapid Containment, Phnom Penh, Cambodia, 2007; WHO/CDC Workshop: Pandemic Infl uenza Rapid Containment, Alma-Ata, Kazakhstan, 2007; WHO/CDC Training Workshop: Laboratory Bio- safety and Bio-security Alma-Ata, Kazakhstan, 2007; WHO Training Workshop: Avian Infl uenza Virus Bioinformatics and Genomics, Hanoi, Vietnam, 2007; WHO WPRO Informal Consultation Meeting on Laboratory Database Development of NICs, Manila, Philippines, 2007; WHO WPRO Consultation on Infl uenza Surveillance Guidelines, Manila, Philippines, 2008; WHO Follow-up EQCP Training for Detection of Infl uenza Virus by PCR, Hong Kong, 2008;); - the collaboration with CDC, USA by regular participation of CDC specialists in National Infl uenza Workshop(NIW)s, and active participation of Mongolian specialists in trainings and workshops organized by CDC (One Month Laboratory Training for Infl uenza Virus Identifi cation using rt-RT-PCR and Sequencing, CDC, Atlanta, USA, 2007; Two Weeks Infl uenza Virus Micro-neutralization Assay Training, CDC, Atlanta, USA, 2007; Options for Infl uenza Control VI, Toronto, Canada, 2007; Project Implementation Meeting and Training-2008, Atlanta, USA; International Conference on Emerging Infectious Diseases, Atlanta, USA, 2008; CDC Global Grantee Meeting, Cairo, Egypt, 2008; CDC/PAHO M&E meeting, Washington, DC, USA, 2009);

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- active participation of Mongolian scientists in international infl uenza meetings (Special Training on Viral Phylo-genetics and Bioinformatics, Hong Kong, 2008; ISIRV[International Society of Infl uenza and other Respiratory Viruses] International Symposium on Viral Respiratory Disease Surveillance, Seville, Spain, 2009; Infl uenza Pandemic Civil-Military Planning, Rome, Italy, 2009; Prof.P.Nymadawa became a member of ISIRV since 2007 and has been elected to the Board Member in 2009); - scientists from the neighboring countries (China, Russia and Japan) are regularly invited to NIWs and the National Virology Conference (NVC)s;

Financially, from the total funds allocated (2,263,033.00 US$) it has been used for the following categories of expenses: - activities (supports for trainings, workshops, monitoring and the vehicle fuel and maintenance): 807,453.3 US$ (35.7%); - purchase of reagents and devices: 835,484.7 US$ (36.9%); - purchase of equipment: 430,571.0 US$ (19%); - a vehicle for the specimen transportation: 30,600.00 US$ (1.4%); - salary for project team members: 158,924 US$ (7%).

24 CooperativeInﬂ uenza Agreement Surveillance Implementation in Mongolia

TWO. INFLUENZA SURVEILLANCE IN MONGOLIA

2.1. History

Starting 1970s infl uenza and infl uenza-like illness (ILI) became serious concern of Health Service of Mongolia due to rapidly increasing population and urbanization in the country. In connection with this it has been initiated in the National Institute of Hygiene, Epidemiology and Microbiology, MoH (NIHEM - since 1996 Public Health Institute, MoH - PHI) laboratory investigations to clarify etiology of ILI outbreaks5. In 1974 on the basis of Virology Laboratory in NIHEM the National Infl uenza Center (NIC) was set up and it has began epidemiological and virological surveillance of ILI on the seasonal basis (from October to June). NIC in collaboration with experienced researchers from Moscow (D.I.Ivanovsky Institute of Virology) and Sofi a (Institute of Epidemiology, Microbiology and Infectious Diseases) has described yearly outbreaks and 4 bigger epidemics of infl uenza in Mongolia in 1970s and identifi ed the causative organisms6.

5 Krylov, V.F., Obrosova-Serova, N.P., Zilina, N.N., Evstigneeva, N.A., Molibog, E.V., Zakstelskaya, L.Ya., Kupul, A., Cerenčimed, O., Hišigdor, A. (1973): Clinical and epidemiological features of an outbreak of influenza in Ulan-Bator in 1971, Bull.Wld.Hlth.Org., 49:567-570; - Äîðæ, Ñ., Õèøãýý, Ø. (1974): Òîìóó ºâ÷íèé òóõàé, Ìîíãîëûí Àíàãààõ Óõààí, 3-4(19-20):21-24 [Dorsh, S., Khishgee, Sh. (1974): About a outbreak of influenza, Mongolian Medical Sciences, 3-4 (19-20): 21-24]; 6 Äîðæ, Ñ. (1976): Èçîëèðàíå íà ãðèïåí âèðóñ À â Ìîíãîëèÿ, Åïèäåìèîëîã., ìèêðîáèîëîã. è èíôåêö.áîë., 13(3): 195-199 [Dor, S. (1976): Isolation of Influenza A virus in Mongolia, Epidemiol.microbiol.infect.bol. (Sofia); 13(3):195-199]; - Îáðîñîâà-Ñåðîâà, Í.Ï., Èñà÷åíêî, Â.È., ×åøèê, Ñ.Ã., Àðñëàí, Ð., Äîðæ, Ñ., Àëòàíõóÿã, Ñ., Õèøèãäîðæ, À. (1977): Íåêîòîðûå îñîáåííîñòè âñïûøêè ãðèïïà â Óëàí-Áàòîðå â 1974 ã, Âîïð.âèðóñîë., 22(3):291-294 [Obrosova-Serova, N.P., Isachenko, V.I., Cheshik, S.G., Arslan, R., Dordzh, S., Altanguyag, A., Khishigdorzh, A,. Kupul, Zh. (1977): Some features of influenza outbreak in Ulan-Bator, 1974, Vopr.virusol., 3:291-294]; - Ïîä÷åðíÿåâà, Ð.ß., Ñ÷àñòíûé, Ý.È., Ìàëüåùåâ, Í.À., Æàìáà. Ã., Î÷èðâààíü. Ã., Àðñëàí, Ð., Òèìîôååâ, Ý.Â., Àëòàíõóÿã. Ñ., Øîìáîí, Í., Ãàëáàäðàõ, Ä., Ëüâîâ, Ä.Ê., (1977): Ê ýòèîëîãèè ÎÐÇ ñðåäè íàñåëåíèÿ ÌÍÐ â 1976 ã. Â êí.: Îáçîð Ðåãèîíàëüíîãî Öåíòðà ïî ãðèïïó çà IV êâàðòàë 1976 ã., ñ.8-11; [Podchernyaeva, R.Ya., Schastnyi, E.I., Malyshev, N.A., Jamba, G., Ochirvaani, G., Arslan, R., Timofeev, E.V., Altankhuyag, S., Shombon, N., Galbadrakh, D., Lvov, D.K. (1977): To the etiology of ILI among population of MPR in 1976, In: Proceedings of the Regional Center for Influenza in SU for IV quarter 1976, pp.8-11]; - Ãàëáàäðàõ, Ä., Àðñëàí, Ð., Òèìîôååâ, Ý.Â., Àëòàíõóÿã, Ñ., Øîìáîí, Í. (1979): Òîìóó, òîìóó òºñò ºâ÷íèéã äàðõàí-òóÿàðàëò áè÷èëõàðóóðûí àðãààð îíîøëîñîí ä¿í, Ìîíãîëûí Àíàãààõ Óõààí, 2 (32): 56-59 [Galbadrakh, D., Arslan, R., Timofeev, E.V., Altankhuyag, S., Shombom, N. (1979): Results of fluorescent microscopy study of patients with influenza and influenza-like illnesses, Mongoliam Medical Sciences, 2 (32): 56-59];

25 B5265G1 Annual Report - 2010/2011

In 1980s NIC activity was strengthened and expanded with supporting groups in 18 province (aimag) centres and 6 sentinel sites based on Pediatric Hospitals in Ulaanbaatar city. Weekly tolerant limits of ILI morbidity for Ulaanbaatar and whole country have been calculated the fi rst time and used for evaluation of the ILI events. Yearly outbreak of ILI and 6 major infl uenza epidemics in 1980-1990s were described and causative agents were isolated and identifi ed: IV A(H1N1) and A(H3N1)-variants7. ILI morbidity for whole country in 1990s and beginning of 2000 was about 3 times lower than the registered ILI morbidity in 1980s (Figure 7). The reasons for this phenomenon may be explained by the following: • ILI registration in provinces and districts are weakly than in Ulaanbaatar city, • Due to demographic transition (see, Part 1.3., Figure 5) the share of child age population groups has declined where ILI events are usually prevailing. Some limited epidemiological trials of inactivated and live (intranasal and oral) infl uenza vaccines produced in the former SU have been undertaken in early 1980s in Mongolia. Despite good seroconversion results of these vaccines, the epidemiological outcome was quite low.

7 Íÿìäàâàà, Ï., Àëòàíõóÿã, Ñ., Òóíãàëàãòóÿà, Ï., Áàòáîëä, ¨. (1988): Óëààíáààòàð õîòîä 1980-1986 îíä á¿ðòãýãäñýí àìüñãàëûí çàìûí öî÷ìîã õàëäâàðò ºâ÷íèé õàëäâàð ñóäëàëûí òºðõ, ¿¿ñãýã÷èéí á¿ðýëäýõ¿¿í, Ìîíãîëûí Àíàãààõ Óõààí, 3 (67): 19-34 [Nymadawa, P., Altankhuyag, S., Tungalagtuya, P., Batbold, Yo. (1988): Etiological features and etiological structure of acute respiratory infections registered in Ulaanbaatar city in 1980-1986, Mongolian Medical Sciences, 3 (67): 19-34]; - Íÿìäàâàà, Ï. (1989): Çàáîëåâàåìîñòü âèðóñíûìè èíôåêöèÿìè è ïîïóëÿöèîííûé èììóíèòåò ê âèðóñàì (íà ïðèìåðå Ìîíãîëüñêîé Íàðîäíîé Ðåñïóáëèêè), Äîêëàä îáîáùàþùèé îïóáëèêîâàííûe ðàáîòû íà ñîèñêàíèå ó÷åíîé ñòåïåíè äîêòîðà ìåäèöèíñêèõ íàóê, Ìîñêâà, ñ.40-52 [Nymadawa, P. (1989): Viral infections and population immunity to viruses (on example of the Mongolian People’s Republic), Thesis for DSc(Med) Degree, Moscow, pp.40-52]; - Ìýíäñàéõàí, Æ., Òóíãàëàãòóÿà, Ï., Ãàíòºìºð, ×., Óóãàíæàðãàë, ×. (1994): Àìüñãàëûí çàìûí öî÷ìîã õàëäâàðûí ¿¿ñãýã÷èéí á¿ðýëäýõ¿¿í, “Âèðóñ ñóäëàëûí òóëãàìäñàí àñóóäëóóä” îíîë-ïðàêòèêèéí åñä¿ãýýð áàãà õóðàë, (èëòãýëèéí òîâ÷ëîë) íîìîíä, õ.5 [Mendsaikhan, J., Tungalagtuya, P., Gantumur, Ch., Uuganjargal, Ch. (1994): Etiological structure of acute viral respiratory infections, In: The Ninth Conference “Current topics of Virology” (Abstracts), pp.5; 49-50]; - Íÿìäàâàà, Ï., Ìýíäñàéõàí, Æ., Ãàíöýöýã, Ò. (1999): Ìîíãîë óëñàä òîìóóãèéí ýïèäåì ¿¿ñãýã÷ âèðóñèéí áèîëîãèéí òºðõ áà õóâüñàìæ, “Àíàãààõ óõààíû ýðäìèéí á¿òýýëèéí òîâ÷îîí-1998 îí” íîìîíä, õ.51-58 [Nymadawa, P., Mendsaikhan, J., Gantsetseg, T. (1999): Influenza activity in Mongolia in 1996-1998, In: Proceedings of Medical Research, pp. 51-58];

26 CooperativeInﬂ uenza Agreement Surveillance Implementation in Mongolia

Figure 7. Median ILI morbidity in Ulaanbaatar, Capital City of Mongolia in 1993-2005 Also, isolation of some atypical IV strains containing genes of PR8/34- strains from patients, domestic and wild birds, horses and camels has jeopardized further extension of IV vaccination trials, while PR8/34-strain was utilized in the SU for designing of fast growing industrial vaccine strains8. Due to lack of funds and also change of profi le in PHI (former NIHEM) in the last part of 1990s the infl uenza virological surveillance has been gradually died. Therefore in 2001 NIC activities were transferred to the newly established NCCD and the re-establishment of infl uenza laboratory studies has been started.

8 Ëüâîâ, Ä.Ê., ßìíèêîâà, Ñ.Ñ., Øåìÿêèí, È.Ã., Àãàôîíîâà, Ë.Â., Ìÿñíèêîâà, È.À., Âëàäèìèðöåâà, Å.À., Íèìàäàâà, Ï., Äàøöåðåí, Ö., Áýõ-Î÷èð, Æ., Æäàíîâ, Â.Ì. (1982): Ïåðñèñòåíöèÿ ãåíîâ ýïèäåìè÷åñêèõ âèðóñîâ ãðèïïà (H1N1) â ïðèðîäíûõ ïîïóëÿöèÿõ, Âîïð.âèðóñîë. 27(4):17-21 [Lvov, D.K., Yamnikova, S.S., Shemyakin, I.G., Agafonova, L.V., Myasnikova, I.A., Vladimirtseva, E.A., Nymadawa, P., Dashtseren, Ts., Bekh-Ochir, Zh., Zhdanov, V.M., (1982): Persistence of genes of epidemic influenza viruses (H1N1) in natural population, Vopr. Virusol, 27(4):17-21]; - ßìíèêîâà, Ñ.Ñ., Íèìàäàâà, Ï., Ïåòðîâ Í.À., Âàñèëåíêî, Ñ.Ê., ßõíî, Ì.À., Ñåìåíîâà, Í.Ï., Ëüâîâ, Ä.Ê. (1991): Õàðàòåðèñòåêà âèðóñà ãðèïïà À (H1N1) ðîäñòâåííûõ À/PR/8/34, èçîëèðîâàííûõ â ÌÍÐ, Âîïð. âèðóñîë., 36 (3): 188-191[Yamnikova, S.S., Nymadawa, P., Petrov, N.A., Vasilenko, S.K., Yakhno, M.A., Semionova, N.P., Lvov, D.K. (1991): Characterization of influenza viruses (H1N1) derived from A/PR/8/34 isolated in MPR, Vopr. Virusol., 36(3):188-191] - Yamnikova, S.S., Mandler, J., Bekh-Ochir, Z., Dashtseren, Ts., Ludwig, S., Lvov, D.K., Scholtossek, C. (1993): A reassortant H1N1 influenza A virus caused fatal epizootics among camels in Mongolia, Virology, 1975 58-563; - Anchlan, D. (1995): Molecularepidemiologische Untersuchurgen an menschichen Influenza- A-Viren des Subtyps H1N1 aus der Mongolei, PhD Dissertation, Giessen, 1995. [Anchlan, D. (1995): Molecular-epidemiological studies on human influenza A(H1N1) strains from Mongolia, PhD Dissertation, Giessen, 119 pp.];

27 B5265G1 Annual Report - 2010/2011

l” FGP, SKh-I-Tolgoit; SKh-I-Tolgoit; l” FGP, . “Enerelt olzii” FGP, Baganuur district; . “Enerelt olzii” FGP, 8. “Tegsholzii” FGP, ChD-XVI-Khailaast; FGP, 8. “Tegsholzii” district; BG-XIX-IV 12. “Shardegd” FGP, “Enkhsunder” FGP, SB; “Enkhsunder” FGP, school; th school; 11. “Itgel-ugtakh” FGP, BG-XII-VI microdistrict; “Itgel-ugtakh” FGP, school; 11. th Figure 9. ILI sentinel surveillance sites in Ulaanbaatar City since 2007 City District General Hospitals (DGH): 1. Bayanzurkh DGH; 2. Sukhbaatar DGH; 3. Chingeltei DGH; 4. Bayangol DGH; Reference Centers: 1. National Center of Communicable Diseases (NCCD); 2. Maternal and Child Health Research Center (MCHRC); Reference Centers: 1. National Center of Communicable Diseases (NCCD); FGPs:  5. “Sankol” FGP, SB-XIII-5 buudal; 5. “Sankol” FGP, SKh- I district; 17. “Ono-achit” FGP, Baganuur district; 21. “Bivaangitd” FGP, ChD-XVIII-37 SB-“Dalai eej” market; 7. “Uilsnegten” FGP, FGP, 6. “Tegshmend” Baganuur district; 22. “Ach-Elberel” FGP, Nalaikh district; SKh-IX-Bayan khoshuu; 19. “Ami-Erdene” FGP, 18. “Enkh-elberel” FGP, Baganuur district; 23. “Enkh-Urkh” FGP, 20    BZ-XII-Amgalan; 1. “Amgalan-itgekhui” FGP, KhU-III-120000; 13. “Enkh-titem” FGP, BZ-XVI-Shar khad; 2. “Nasan-urt” FGP, khemjuur; BZ-IV-Jin 3. “Eruul-orkh” FGP, 4. KhU-V-Yarmag; 14. “Manai-uils” FGP, KhU-X-Nisekh; 15. “Amin tus” FGP, 5. Khan-Uul DGH; 16. “Buyant-mana 6. Songinokhairkhan DGH; 7. Baganuur DGH; 9. “Tumenjargalan” FGP, ChD-XII-Denjiin myanga; FGP, 9. “Tumenjargalan” BG-XI-46 10. “Gurvansanchir” FGP, 28 28 CooperativeInﬂ uenza Agreement Surveillance Implementation in Mongolia

2.2. Current Surveillance System

ILI surveillance is coordinated by NIC in NCCD. The surveillance was seasonal: from October 1 to May 31 next year till 2006/2007 season. By the order of the Minister of the Health, Mongolia starting from 2006/2007 season the ILI surveillance has been extended to cover the whole year events. The surveillance has 2 tiers: epidemiological and virological. Epidemiological surveillance is based on clinical diagnosis of ILI in outpatient and inpatient visits: • Routine weekly information ILI/all outpatient visits from all 21 provinces and 9 City-districts by phone, • Daily active reporting by phone ILI/all outpatient visits from 64 sentinel sites (2 National Centers and 20 FGPs in Ulaanbaatar city and 42 FGPs in 7 provinces: Selenghe, Dornogobi, Uvurkhangai, Khovd, Dornod, Orkhon and Darkhan-Uul, Figures 8 and 9). • Weekly active reporting by phone pneumonia hospitalizations/ all patients from 15 sentinel sites (2 National Centers and 6 district hospitals in Ulaanbaatar city and 7 provincial hospitals in the above mentioned provinces, Figures 8 and 9).

Figure 8. ILI Epidemiological Surveillance Structure in Mongolia in 2004-2009

29 B5265G1 Annual Report - 2010/2011

Virological surveillance is based on daily collection of samples from ILI patients visiting sentinel sites of UB and weekly transportation of samples from ILI patients visiting 78 sentinel sites in 7 provinces. VL in NIC/NCCD has capacity: • IV antigen detection by rapid immuniochromatographic tests and rt- RT-PCR • ILI antigen detection by immunofl uorescent microscopy, • IV isolation in MDCK cell culture and embryonated hen’s eggs, • IV strain identifi cation and detection of signifi cant mutations of IV genes in RT-PCR, • Sequencing of IV genes, and • IV HA identifi cation and antibody titration in HIT.

2.3. Epidemiology of ILI in Mongolia

2.3.1 Outpatient - based ILI surveillance

ILI events were relatively low in the 2004/05, 2005/06, 2006/07, 2007/08 and 2008/09 seasons (Figure 10) in comparison to the reported morbidities in 1980-1990s (see part 2.1). There were no countrywide big epidemics; however, it has been observed localized outbreaks of ILI events in different parts of the country. In 2003/2004, 2004/2005 and 2005/2006 infl uenza seasons ILI morbidity peak has been observed mainly in December and January. In 2003/2004 infl uenza season ILI at the national level and in Ulaanbaatar were above the epidemic threshold from 47th week and reached maximum value during 48th and 49th week. In 2004/2005 ILI parameters were above the epidemic threshold from 44th week and reached maximum value during 51st and 52nd weeks. In 2005/2006 season ILI reached maximum value during 1st and 2nd weeks of 2006 and was above the epidemic threshold from 49th week until 4th week in 2006. But in 2006/07 and 2007/08 seasons the peaks have been shifted to February/March and a mild infl uenza epidemic were registered at the end of March 2007 and in end of February 2008. During these two seasons ILI at the national level and in Ulaanbaatar were reached maximum meaning at 11th, 12th weeks of 2007 and 7th and 8th weeks of 2008 (Figure 10). From 14th week of 2007 ILI morbidity has been decreased slowly and from 22nd week ILI has been decreased by 2 times in comparison with the same periods of previous years. From 9th week of 2008 ILI morbidity has been decreased slowly and from 16th week ILI has been registered under upper tolerant limits.

30 CooperativeInﬂ uenza Agreement Surveillance Implementation in Mongolia

In 2008/2009 ILI event have not exceded the upper tolerant limits (Figure 10).

Figure 10. ILI epidemiological and virological surveillance in 2004-2009 in Mongolia

At the national level there were registered approximately 755.6 ILI per 10,000 population per year with 5.5% of all registered outpatient visits in average in 2004-2009. In 2003/2004 at the national level there were registered approximately 753.8 ILI per 10,000 population, which consists 8.5% of all registered outpatient visits. In 2004/2005 this indicator decreased up to 701.1. In 2005/2006 season the registered ILI morbidity has been decreased by 1.12% in comparison to the previous season. In 2006/2007 inﬂ uenza season there have been registered 753.8 ILI per 10,000 population which consists 5.8% of all 3,309,421 outpatient visits. The registered ILI morbidity per 10,000 population was higher by 18.3 cases and percentage of outpatient visits with ILI was 0.3% lower in comparison with 2005/2006 season. In comparison with the average of the three previous seasons the registered morbidity per 10,000 population among children from 0-11 months old was higher by 265.6 cases, in age group from 1 to 4 years old-by 415.1 cases and in the age group from 5 to 9 years old by 147.3 cases. In 2007/08 inﬂ uenza season there have been registered 745.1 ILI per 10,000 population which consists 4.8% of all 3,947,059 outpatient visits. ILI events have been relatively low in this season (1 October, 2007 to 1 June, 2008) in comparison to reported morbidities in the previons seasons (Table 3).

31 B5265G1 Annual Report - 2010/2011

Table 3. Comparative indicators of ILI events in Mongolia in 2004-20099

2004/05 2005/06 2006/07 2007/08 2008/09 Indicators season season season season season 1. Epidemiology ILI/ total outpatient 7.2% 6.1% 5.8% 4.8% 3.7% visits (%) Total morbidity/10,000 701.1 735.5 753.8 745.1 842.3 Morbidity of 0-11 9,974.5 9,532.2 10,194.4 11,028.5 10,722.7 months olds /10,000 Morbidity of 1-4 years 2,629.7 2,645.4 2,932.0 2,997.8 3,543.8 olds/10,000 Morbidity of 5-9 years 1,339.9 1,341.5 1,475.2 1,342.5 1,451.0 olds/10,000 Morbidity of 10-15 697.5 769.1 827.2 701.5 660.3 years olds/10,000 Morbidity of 16-64 179.6 217.0 315.0 266.8 586.0 years olds/10,000 Morbidity of 65 year 349.8 427.8 323.8 340.9 308.5 and older/10,000 2. Laboratory Number of samples 1.112 2,728 5.0880 5,823 6,996 collected* IV antigen positive 144/1,112 00 00 /tested (%) (12,9%) IV isolation 13/144 161/2,728 513/5,088 198/5,823 114/6,996 /tested (%) (9.0%) (5.9%) (10.08%) (3.4%) (1.6%)

IV A(H1N1) [%] 8(61.5%) 2(1.2%) 144 (28%) 1(0.5%) 112(98.2%) IV A(H3N2) [%] 5(38.5%) 159(98.8%) 12 (2.3%) 72(36.2%) 1(0.8%) IV B [%] 0 0 357 (69.6%) 125(63.1%) 1(0.8%) IFM: positive/tested (%) Not Not Not 117/985 125/2,082 tested tested tested (11,9%) (6%) Amomg them: Infl uenza A 30(25.6%) 53(42.4%) Infl uenza B 14(11.9%) 0 RS Virus 18(15.4%) 2(1.6%) Adenovirus 20(17.1%) 3(2.4%) Parainfl uenza virus 35(30.0%) 67(53.6%) rt-RT-PCR: positive / Not Not tested Not tested Not tested 149/1,379 tested (%) tested (10.8%) Among them: IV A(H1N1) [%] 144 (96.6%) IV A(H3N2) [%] 4 (2.6%) IV B [%] 1 (0.6%)

* This number is the part of samples collected in the influenza seasons of all collected samples.

32 CooperativeInﬂ uenza Agreement Surveillance Implementation in Mongolia

The morbidity per 10,000 population among children from 0 to 11 months old was higher by 2,663.6 cases, in age group from 1 to 4 years old - by 810.9 cases and in the age group from 5 to 9 years old by - 262.0 cases. The registered ILI morbidity per 10,000 population was lower by 8.7 cases and percentage of outpatient visits with ILI was 1.0% lower in comparison with 2006/07 season. The laboratory surveillance during the period under the description has been expanded dramatically thanks to the activities through this USA/ Mongolia Cooperative Agreement: number of samples, collected has increased from 701 (2003/2004 season) up to 6,996 (2008/2009 season). If in 2003/2004 season have been isolated 4 viruses, in 2007/2008 it has been isolated 275 infl uenza viruses, on average of the last 3 seasons resulting by 68.7 times increase of the virus isdation. In 2007/2008 season a testing for antigen of infl uenza A, B and other respiratory viruses (RSV, Parainfl uenza 1,2,3 and adenoviruses 4) by IFM using mixed hybrid cell culture (R-Mix, DHI, USA) was introduced and 117 viruses have been detected by this method. In 2004/2005 season collected samples have been increased by 411, IV antigen detection by 1,112 and IV isolation by 3.2 times in comparison with the previous year. All collected nasal swabs were studied for infl uenza virus (IV) antigen detection by BD Directigen Flu A+B test kits. 144 (12.9%) samples were positive by this method and 141 (97.9%) were infl uenza A and 3 (2.1%) were infl uenza B. All IV positive specimens were inoculated into MDCK cell culture and 13 viruses were isolated. All of them were infl uenza A viruses by RT-PCR. The study of antigenic variants of infl uenza viruses was successfully conducted alongside with surveillance activity in the recent years in Mongolia10.

2.3.2 Hospital-based pneumonia surveillance

Since 2006/07 inﬂ uenza season has been started a hospital based- surveillance on pneumonia in the selected sentinel sites (7 provinces: Darkhan-Uul, Dornogovi, Dornod, Ovorkhangai, Orkhon, Selenghe, Khovd and 6 UB District general hospitals, MCHRC and NCCD in Ulaanbaatar city). During 3 seasons under description we have observed totally 30,601 (6.5% of all hospitalizations) cases of pneumonia with 109(0.4%) mortality

10 Darmaa B., et al. (2009): Influenza virus strains circulating in Mongolia in 2003-2007, Mongolian Journal of Health Sciences, 6(1):8-19.

33 B5265G1 Annual Report - 2010/2011 cases in the selected 16 hospitals. Mainly mortality cases were registered during the inﬂ uenza epidemic period. 82.4% of all mortality cases were registered among children under 4 years olds (Figure 11 and Table 4).

Figure 11. Hospital-based pneumonia surveillance results in 2006-2009 in Mongolia

VL has collected 1,718 samples from hospitalized patients and isolated 72(4,1%) infl uenza viruses in the 2006/07 infl uenza season. Among them 50(69.4%) were infl uenza B isolates, 19 (26.3%) were A(H1N1) and 3(4.1%) were A(H3N2) viruses (Table 4). During the 2007/2008 season 2,126 samples were collected from hospitalized patients and all samples were inoculated to MDCK cells for infl uenza virus isolation. We have isolated 22(1.03%) infl uenza viruses. Of these 7(31.8%) were infl uenza A(H3N2) and 15(68.2%) infl uenza B viruses by RT-PCR. 545(25.6%) of all samples were inoculated in to Mixed Cell Culture (R-Mix, DHI, USA) for other respiratory virus detection by IFM. There were 60(11%) positive: 12(20%) infl uenza A, 3(5%) infl uenza B, 14(23.3%) RSV, 14(23.3%) adenovirus and 17(28.3%) parainfl uenza viruses respectively (Table 17).

34 CooperativeInﬂ uenza Agreement Surveillance Implementation in Mongolia

Table 4. Results of hospital-based pneumonia surveillance in Mongolia in 2006-2009

Indicators 2006/07 2007/08 2008/09 1. Epidemiology Total registered ILI morbidity (in the 16 159,364 160,434 148,537 selected sites of 7 provinces and UB) Total pneumonia admission (%) 11,026 (6.9%) 10,957 (6.8%) 8.618 (5.8%) 24 (0.3%) Total pneumonia mortality (%) 52 (0.5%) 33 (0.3%) Pneumonia mortality in 0-4 years old (%) 43 (82.7%) 27 (81.8%) 20 (83.3%) Pneumonia mortality in 5-9 years old (%) 0 (0.0%) 2 (6.1%) 2 (8.3%) Pneumonia mortality in10-19 years old (%) 3 (5.8%) 0 (0.0%) 1 (4.2%) Pneumonia mortality in 20-59 years old (%) 6(11.5%) 1(3.0%) 1(4.2%) Pneumonia mortality in 60 and older (%) 0 (0.0%) 3 (9.1%) 0 (0.0%) 2. Laboratory Number of samples collected 1,718 2,126 2,007 IV isolation: positive / tested (%) 72/1,718 22/2,126 41/2,007 (4.1%) (1.03%) (2.0%) Among them: IV A(H1N1) [%] 19 (26.3%) 0 39 (95.1%) IV A(H3N2) [%] 3(4.1%) 7(31.8%) 1 (2.4%) IV B [%] 50(69.4%) 15(68.2%) 1 (2.4%) IV RNA with rt-RT-PCR: positive / tested Not tested Not tested 37/297 (%) (13.2%) Among them: 35 (94.5%) IV A(H1N1) [%] 1 (2.7%) IV A(H3N2) [%] 1 (2.7%) IV B [%] Antigen detection with IFM on R-Mix: Not tested 60/545 47/1,019 positive/tested (%) (11%) (4.6%)\

Among them: Influenza A 12(20%) 14 (31.1%) Influenza B 3(5%) 1 (2.2%) RSV 14(23.3%) 0 Adenovirus 14(23.3%) 2 (4.4%) Parainfluenza viruses 17(28.3%) 30 (66.6%)

35 B5265G1 Annual Report - 2010/2011

THREE. COOPERATIVE AGREEMENT IMPLEMENTATION

3.1. Project goal: To strengthen and extending the existing inﬂ uenza surveillance system and ensure its sustainable function enabling early detection and effective prevention of inﬂ uenza pandemics.

3.2. Project objectivies: - to strengthen infl uenza epidemiological surveillance to cover the whole country, - to strengthen infl uenza virological surveillance ensuring rapid and effi cient detection of seasonal and pandemic infl uenza viruses on territory of Mongolia, - to ensure sustainable development of infl uenza surveillance network by good and transparent management

3.3. Project Implementation in 2009-2011: NIC, NCCD, MoH, Mongolia has submitted in May 2009 to CDC, USA an application intended for 5 years duration for development of sustainable infl uenza surveillance, and has received on September 1, 2009 an offi cial letter from CDC, USA containing a Cooperative Agreement Document informing about an award of 475,000.00 US$ covering the period from September 14, 2009 to September 15, 2010 and it has been extended for the 2nd fi scal year from September 14, 2010 to September 15, 2011. From 15 September 2009 we have successfully started the new project activities. “Annual Report: 2008/2009” and “Final Progress Performance Report: 2004-2009” of the previous project: U50/CCU024411were printed and disrtibuted. The fi fth NIW was organized in collaboration of the NEMA with the fi nancial assistance of the World Bank project “Avian infl uenza control and human infl uenza pandemic preparedness response” on October 7-8, 2009, at the Chingghis Khaan Hotel, Ulaanbaatar, Mongolia. The main goal of this workshop was to improve the participation and close cooperation of all national and international stakeholders in infl uenza pandemic preparedness and response. The workshop was attended by 220 participants including H.E. Mr M. Enkbold, Vice Prime Minister, Government of Mongolia, governors of 21 provinces, representatives of emergency management, health and veterinary service institutions from UB and all provinces of Mongolia, and the relevant

36 Cooperative Agreement Implementation

Government ministries and agencies, and international organizations and partner institutions of neighboring countries such as WHO, World Bank, US Embassy in Mongolia, Center of Epidemiology and Ecology of Inﬂ uenza, D.I.Ivanovski Research Institute of Virology, Russian Academy of Medical Sciences, Moscow, Russia, and NIC, China CDC, Beijing. At the end of NIW5, the participants have developed and approved a recommendation (Annex 1). An IPPP re-assessment was conducted in collaboration with CDC specialists (Mrs.Theresa Turski, Dr. S.Epperson) on June 23-24, 2010 (Annex 2). There were involved totally 31 people from NEMA, MoH, NCCD, CIDNF, NCHD, MoFA, CVL and specialized organizations such as WHO and UNICEF representatives in Mongolia (Annex 3). Participants discussed with relevant stakeholders, agencies and assessed national current capacity on IPPP according to the assessment questionnaire. The brief report on IPPP re-assessment was developed by workshop organizers and submitted to all relevant parties (Annex 4). In the framework of the NIW6 preparation, it has been conducted a workshop for TTX moderators on 6 October 2010 (Annex 5). There were participants from NCCD, NEMA, MoFA, General Hospital No1, MCHRC (Annex 6). The 6th NIW was organized on October 7-8, 2010, at the Sunjin Grand Hotel, Ulaanbaatar, Mongolia. The main goal of this workshop was to summarise the lessons learnt from the pandemics and to improve the participation and close cooperation of all national and international stakeholders in inﬂ uenza pandemic preparedness and response (Annex 7) The workshop was attended by 265 participants including H.E. Mr S.Lambaa, Minister of Health, Government of Mongolia, governors of 21 provinces, representatives of emergency management, health and veterinary service institutions from UB and all provinces of Mongolia, and the relevant Government ministries and agencies, and international organizations (Annex 8 and Figure 12). The participants of the NIW6 have issued a recommendation (Annex 9)

37 B5265G1 Annual Report - 2010/2011

Figure 12. Participants of the Sixth National Inﬂ uenza Workshop (NIW6), Sunjin Grand Hotel, Ulaanbaatar, Mongolia, October 7-8, 2010

3.3.1. Strengthening inﬂ uenza epidemiological surveillance 3.3.1.1. Outpatient - based ILI surveillance

A new order of the Minister of Health, Mongolia for extension of inﬂ uenza surveillance network has been issued (No 323, October 6, 2009). According to the new order ISSSs have to be established in all provinces of Mongolia to perform standardized ILI epidemiological surveillance for: 1) the incidences of ILI, 2) clusters of ILI, sARI and weekly reporting for a whole year to NIC, NCCD. By the component of the laboratory surveillance ISSS were divided into 3 categories: • category I – daily collection of samples from the appropriate ILI cases and regular sending them to IVL, NIC, Mongolia, • category II – collection of samples from the clustered cases of ILI and sending them to IVL, NIC, Mongolia, • category III – collection of samples for virological study when it has been observed ILI outbreaks. On September 23-25, 2009 a workshop has been organized at NCCD for epidemiologists from all 21 provinces and some staff from ISSSs in UB on the introduction of the new inﬂ uenza surveillance system. In November and December 2009 teams of consultants including an epidemiologist, a clinician and a virologist have been sent to all 21 provinces to on-site support to the newly established ISSSs. So, since October 2009, 159 ISSSs (more than 2

38 Cooperative Agreement Implementation times increase in comparison to the existing 69 ISSSs) are fully functional in Mongolia (Figure 13).

Figure 13. Current Inﬂ uenza Surveillance (since October 2009) Network in Mongolia

During this period from 40th week 2009 to 39th week 2010 has been registered 2,170.9 ILI per 10,000 population, which is 7.9% of all registered outpatient visits (7,144.213) nationwide. ILI cases have been increased by 4.2% (2.1 times) in outpatient visits and per 10,000 population were increased by 1,328.6 cases (2.6 times) in comparison to the corresponding period of the previous 2008/09 inﬂ uenza season due to pandemic A(H1N1) spread peaking in the week 44 of 2009 and B viruses epidemics with the peak in the week 8 of 2010. In 2010/11 inﬂ uenza season ILI activity was low in comparison to the corresponding period of 2009/10 and ILI morbidity has been decreased in outpatient visits by 2.8% and per 10,000 population was decreased by 799.2 cases (Figure 14).

39 B5265G1 Annual Report - 2010/2011

180

160

140

120 0000 100

60 ILI morbidity per 1

1 0 0 0 0 1 0 0 0 0 1 0 0 0 10 2 3 4 5 1 20 3 4 5 1 2 30 4 2009 2010 2011

Lower tolerance limit (95%) Upper tolerance limit (95%) registered ILI events

Figure 14. ILI morbidity from 1st week, 2009 to 40th week, 2011 (per 10,000 populations)

Overall ILI morbidity indicators were around 2 times higher in the season of 2009/10 due to the pandemics and it has been returned to the seasonal pattern in the season of 2010/11 (Table 5).

Table 5. Comparative indicators of ILI surveillance in the 2009/2010 seasons

Indicators The previous 5 2009/10 2010/11 seasons average season season ILI/ total outpatient visits 6.2% 7.9% 5.1% Total morbidity/10,000 614.8 2173.1 1371.7 Morbidity of 0-11 months olds /10,000 10,119 19,692.3 17,873.9 Morbidity of 1-4 years olds/10,000 2,705.4 7,920.6 5,570.1 Morbidity of 5-9 years olds/10,000 1,296.5 3,675.8 2,430.0 Morbidity of 10-15 years olds/10,000 732.2 2,750.4 1,184.6 Morbidity of 16-64 years olds/10,000 199.6 701.0 912.5 Morbidity of 65 year and older/10,000 356.1 1,027.6 559.9

3.3.1.2. Hospital-based inﬂ uenza surveillance Currently there are totally 37 hospital-based sentinel surveillance sites functioning within our Inﬂ uenza Surveillance Network from the 2009/2010 season, namely: 8 city-district hospitals, 21 provincial hospitals, MCHRC, NCCD, NCC, General Referral Hospitals No1 and No3 in Ulaanbaatar city.

40 Cooperative Agreement Implementation

In the previous 3 infl uenza seasons (2006/07, 2007/08, 2008/09) in the infl uenza season (from the beginning of October to end of May) in 15 hospital-based surveillance sites yearly have been admitted 8,181 patients with pneumonia and sARI in average, which is 4-5% from all ILI registered cases with 96(0.4%) deaths in the areas of coverage (Table 6 and Figure 15). But during the 2009/2010 infl uenza season there has been admitted 15,449 pneumonia and sARI cases and 51(0.3%) deaths. If we compare that death rate to pneumonia in the 2009/2010 season seemed same with the rate of previous seasons but the absolut numbers of the admitted patients with pneumonia are higher than the previous seasons by 1.9 times and deaths by 1.6 times.

18% 15 Percentage Deaths 16%

14% 12

12% 9 10%

8% 6 6%

4% 3 2%

0% 0 1 45 50 10 20 30 40 50 10 20 30 40 2009 2010 2011 Deaths Percentage of patients w ith pneumonia among all hospitalized patients in average Percentage of patients w ith pneumonia among hospitalized Figure 15. Prevalence of patients with pneumonia among hospitalized patients (based on 37 hospital-based surveillance sites)

The registered pneumonia mortality among children of ages from 0 to 4 years old was higher by 39 cases, in age group 10-19 years old - by 4 cases, in age group 20-59 years old - by 22 cases and in the age group in 60 and older by 2 cases in comparison with the average of the last three previous seasons.

41 B5265G1 Annual Report - 2010/2011

Table 6. Comparative indicators of pneumonia/sARI surveillance in the 2009/2010 and 2010/11 seasons

The previous 3 2009/10 2010/11 Indicators seasons average* season** season** Total registered ILI morbidity (in the 141,365 423,214 557,084 selected sites) Total pneumonia admission 9,504 25,234 19,603 Total pneumonia mortality number 34 101 55 Pneumonia mortality in 0-4 years old 28 67 48 Pneumonia mortality in 5-9 years old 111 Pneumonia mortality in10-19 years old 151 Pneumonia mortality in 20-59 years old 3255 Pneumonia mortality in 60 and older 130 * 15 hospital-based ISSSs; ** 37 hospital-based ISSSs;

The pneumonia cases were higher by 22,919.0 that those registered in 2009/10 season due to increased number of ISSSs and in 2010/11 there were hospitalized 19,603 pneumonia and sARI cases which was 4.7% of all-cause hospitalization in the hospital-based surveillance sites. Hospitalization due to pneumonia and sARI cases were decreased by 5,631 and mortality has been decreased 2 times in comparison to the previous pandemic 2009/10 season.

3.3.1.3. Pandemics control activities When the fi rst A(H1N1)v case has been registered in UB on October 12, 2009, NCCD has been shifted to the Emergency Regimen. On the next day (October 13, 2009) the National Emergency Committee has been convened under its chairman Mr M.Enkhbold, Vice Prime Minister of Mongolia and nominated an Operative Group led by Mr S.Lambaa, Minister of Health, Mongolia to put forward the measures in a such case determined by the National IPPP. According to the IPPP MoH and City Government UB have strengthened the containment measures and started retrospective tracing of the fi rst cases. It has been revealed the fi rst A(H1N1)v case was not detected by border screenings, however by the routine ILI surveillance. On 13 October, 2009 the National Emergency Committee has approved an offi cial recommendation No03 on the “Prevention measures of novel A(H1N1)v virus infection”. Government Working Group on Pandemic Infl uenza (GWGPI) led

42 Cooperative Agreement Implementation by Mr. M. Enkhbold, Vice Prime Minister and Head, State Emergency Committee was set up on 2 November, 2009 by the Decree No104 of the Prime Minister of Mongolia. On November 3, the State Emergency Committee issued a resolution to raise the alert level and implemented strict social distancing measures, including the banning of cultural events, extension of school holidays two additional weeks, closure of kindergartens and open markets, restriction of travel within the country and cancellation of domestic ﬂ ights, trains and car mobilization to provinces and from those for two weeks. The government decided to implement extensive school closures from week 43 to 45; all primary schools were closed from 20 October, all high schools from 23 October and all kindergartens from 2 November. Open markets closed and public transports to provinces were stopped in the weeks 45-46. The Government of Mongolia has approved No328 by the Resolution a budget of 6.4 billion Tugriks (approximately USD 4.4 million) for response to the pandemic, including logistical support and additional health personnel, and has also approved a Government Resolution No335 on 4 November, 2009 regarding to the law from October 30, 2009 on tax exemption of pharmaceuticals, medical equipment and supplies (including disinfectant), and H1N1 pandemic vaccine. The Minister of Health, Mongolia has issued several orders: • No345 on the hospital bed mobilizations and allocation of additional funds for the treatment of the hospitalized patients; • No346 on the establishment of expert groups for urgent consultations for medical staff in UB and rural areas: 1) monitoring and evaluation of rapid response activities and improvement of medical emergency care; 2) clinical care; 3) epidemiology; and 4) Logistics, planning and coordination; • No349 on the mobilization of the post-graduate students of the HSUM to support for primary health institutions; • No350 on the additional supply of pharmaceuticals, medical equipment and supplies (including disinfectants); and • No364 on the strengthening of infection control measures in the health facilities and prevention of health care workers etc. The Minister of Health, Mongolia has requested to prepare 255 beds additionally to the existing beds in the 1st Referral General Hospital, MCRHC, Infants Clinical Sanatorium, “Аchtan Elite” private hospital and the Military Hospital; 3 health care units at student dormitories in UB, 1 health care unit at the Nursing school were established for emergency cases

43 B5265G1 Annual Report - 2010/2011 and NCCD opened a special ward with 50 beds for suspected A(H1N1)v severe pneumonia cases. Prof. P.Nymadawa, PI and Project Director has been nominated as a member of GWGPI led by the Vice Prime Minister and has participated in different level meetings and decision-makings throughout the pandemics. The MoH developed and widely distributed IEC materials for the public institutions, workplaces and all levels of health facilities, requested the Clinical Expert Working Group to develop patient care advice for resource- limited settings and revised clinical management guidelines in Mongolia based on WHO guidance for Pandemic (H1N1) 2009. Have been conducted several trainings among health care workers, emergency facilities’ staff and authorities of educational and related sectors (cumulative number of staff – approximately 1.000) on the prevention activities from fl u. The trainings were conducted among epidemiologists of province and city health departments and among more than 200 practitioners and public health staff from UB city kindergarten and schools on “Infl uenza pandemic and prevention”. Also has given lecture to the epidemiologists and clinicians of city and district health departments on “Emerging, re-emerging infectious diseases and response in worldwide and in Mongolia” and introductory lecture to the visited guests from MoH, China, China CDC, Inner Mongolian CDC and Inner Mongolian Hospital on Infl uenza Surveillance Structure and Situation on Pandemic H1N1. In terms of pandemic response Mongolian government purchased 31,486 (75mgx10) tablets of Tamifl u and 50,160 tablets (75mgx10) Tamifl u received from WHO the during infl uenza outbreak period. A total of 500 pulse oximeters donated to Mongolia from WHO (supported by funding by the Government of Japan) at the beginning of December 2009. According to the WHO recommendation MoH, Mongolia and NCCD developed a National Deployment Plan of pandemic vaccines and Mongolia has been one of the fi rst countries receiving pandemic vaccines donated by WHO. Has been developed draft on stockpile of “Tamifl u”, needed in 2010. The Ministry of Health, Mongolia received 270.000 doses of infl uenza vaccine in January and February by the donation of WHO. A total of 164.852 risk group persons were vaccinated with this vaccine (97.7%). Mongolian Government purchased two different infl uenza vaccines in order to prevent from pandemic infl uenza spreadness. The fi rst installment was 60.000 person/ doses of “Panenza” vaccine from the Sanofi Paster, France, which was used among school children of 9 districts of Ulaanbaatar city in December, 2009. A total of 57,203 schoolchildren of more than 40 schools were vaccinated.

44 Cooperative Agreement Implementation

The vaccination coverage rate was 70.8%. The second installment was 540.000 person/doses of “Arepanrix” vaccine from the Glasko Smith Klein, Canada, which was used among children of age groups of 6-15 years who live in centers of Darkhan-Uul, Orkhon, Selenge and Dorno-Gobi aimaks. Moreover, the risk group persons of Ulaanbaatar city were vaccinated. A total of approximately 800,000 people were vaccinated with the pandemic vaccine according to the national plan. “Inﬂ uenza pandemic preparedness and response” modul has been updated in April 2010 by the order No141 of Health Minister.

3.3.2. Strengthening inﬂ uenza virological surveillance

During the 2009/2010 season has been processed 8,321 nasopharyngeal samples from patients with ILI collected from 128 ISSSs: 4,517 samples were collected from hospitals, and 3,804 samples were collected from outpatient health institutions. All samples were tested by rt-RT-PCR and have detected 1,769(24.2%) samples positive for infl uenza virus type A(H1N1) v and 306 (3.7%) for B viruses. 766 (36.4%)rt-RT-PCR positive specimens were inoculated into MDCK cell culture and 387(50.5%) infl uenza viruses have been isolated. There were identifi ed as 279(71.3%) A(H1N1)v and 108(28.7) B viruses (Figures 16-17). 1,547(18.6%) of all samples were inoculated also into R-Mix mixed hybrid cell culture (DHI, Inc., USA) and DFA has been used for a rapid detection of respiratory viruses: infl uenza A and B, RSV, adenovirus, parainfl uenza viruses 1,2, 3 and 4. Of these 125(8.08%) was positive: infl uenza A 44(35.2%), B 31(24.8%), parainfl uenza 1 virus 13(10.4%), parainfl uenza 2 virus 54%), parainfl uenza 3 virus 10(8%), adenovirus 11(8.8%) and RSV 1(0.8%). The number of collected samples was increased by 3,851 and the number of infl uenza virus isolation was increased by 187 isolates. In comparison with the results of 2009/2010 season, IFM testing was increased by 13 tests, and rt-RT-PCR testing was increased by 6,821 analysis (Table 7).

45 B5265G1 Annual Report - 2010/2011

300 Number of NumberNumber of 700 detected viruses specimensof tested specimens 250 600

500 200 400 150 300 100 200

50 100

0 0 1 10 20 30 40 50 1 10 20 30 40

2009 2010

B AH1 AH3 Unsubtyped Parainfluenza- RSV HuMPV Rhino- Enter o- Adeno- Corona- HBoV Mic oplas ma Number of specimens

Figure 16. Number of the screened specimens and detected viruses in the outpatient visits in 2009/2010 season in Mongolia

20 Number of Number of 100 detected viruses specimens

15 75

10 50

5 25

0 0 40 50 1 10 20 30 40

2010 2011

B AH1 AH3 Unsubtyped Parainfluenza- RSV HuMPV Rhino- Enter o- Adeno- Corona- HBoV Micoplasma Number of specimens

Figure 17. Number of screened specimens and detected viruses in the outpatient visits in 2010/2011 season in Mongolia

46 Cooperative Agreement Implementation

Table 7. Results of ILI laboratory surveillance in the previous three seasons, 2009/10 and 2010/11 seasons

The previous 3 Indicators 2009/10 season 2010/11 season seasons average Number of samples collected 4,349 8,200 4,197 IV isolation /tested (%) 200/4,349 (4.60%) 387/2,102 (18.4%) 106/473 (22.4%) IV A(H1N1) [%] 53(26.50%) 279(71.3%) 35 (33.0%) IV A(H3N2) [%] 50(25.00%) 0(0.0%) 71 (67.0%) IV B [%] 97(48.50%) 108(28.7) 0 (0.0%) IV RNA rt-RT-PCR: positive / 149/1,379 10.80%) * 2,102/8,200(25.63%) 473/4,197(6.6%) tested (%) Among them: IV A(H1N1) [%] 144 (96.6%) 1,796 (85.44%) 103 (21.8%) IV A(H3N2) [%] 4 (2.6%) 0(0.0%) 361 (76.3%) IV B [%] 1 (0.6%) 306 (14.55%) 7(1.5%) IFM on R-Mix: positive/ 121/1534(7.89%) ** 115/1547(7.4%) 28/686(4.1%) tested (%) Among them: Infl uenza A 42(34.71%) 44(38.26%) 0 (0.0%) Infl uenza B 7(5.79%) 31(26.95%) 0 (0.0%) RSV 10(8.26%) 1(0.86%) 4 (14.3%) Adenovirus 12(9.92%) 11(9.56%) 9 (32.1%) Parainfl uenza virus 51(42.15%) 28(24.34%) 6 (21.6%) Multiplex rt-PCR positive / Not tested Not tested 342/782(43.7%) tested [%] Among them: Infl uenza A(H1) 30 (8.8%) Infl uenza A(H3) 0 (0.0%) Infl uenza B 0 (0.0%) Coronaviruses 49 (14.3%) Parainfl uenza viruses 54 (15.8%) Human metapneumovirues 32 (9.4%) Rhinoviruses 94 (27.5%) RSV 71 [20.8%] Adenoviruses 33 (9.6%) Enteroviruses 25 (7.3%) Human Bocaviruses 30 (8.8%) Mycoplasma pneumoniae 3 (0.9%) * data for the 2008/09 season; ** average of the 2007/08 and 2008/09 seasons;

The number of samples collected in 2010/11 season was lower by 4,003 and inﬂ uenza virus positive rate by rt RT-PCR test was lower by 19.03 % compared with 2009/10 season (Table 7).

47 B5265G1 Annual Report - 2010/2011

From the 2010/11 season multiplex rt-PCR detection of non-infl uenza respiratory pathogens (Coronavirus NL63, Coronavirus 229E, Coronavirus OC43, Coronavirus HKU1, Parainfl uenza 1, Parainfl uenza 2, Parainfl uenza 3, Parainfl uenza 4, Human metapneumovirus A and B, Rhinovirus, RSV A and B, Adenovirus, Enterovirus, Parechovirus, Bocavirus, Mycoplasma pneumoniae) has became a routine surveillance. It has been tested 782 clinical samples randomly selected from the negative for infl uenza viruses samples in 2010/11 season and the overall detection rate was 342 (43.7%)

In comparison with the average of 3 previous seasons the number of samples collected in 2009/10 season from hospitals was higher by 2,621 cases and inﬂ uenza virus isolation test was higher by 2,621 cases, IFM was lower by 33 cases, and rt-RT-PCR test was higher 4,174 cases in comparison with 2009/2010 season (Table 8 and Figure 18).

100 Number of Number of 300 detected viruses specimens 90 250 80 70 200 60 50 150

40 100 30 20 50 10

0 0 41 45 50 1 10 20 30 40 50 1 10 20 30 40

2009 2010 2011 B AH1 AH3 Unsubtyped Parainfluenza- RSV HuMPV Rhino- Enter o- Adeno- Corona- HBoV Mic oplas ma Number of specimens Figure 18. Number of screened specimens and detected viruses of patients with pneumonia in 2009/2010 and 2010/2011 seasons

48 Cooperative Agreement Implementation

Table 8. Comparative indicators of laboratory results for hospital-based pneumonia surveillance in the previous three seasons, 2009/10 and 2010/11 season

The previous 3 Indicators 2009/2010 season 2010/2011 season seasons average

Number of samples collected 1,950 4,571 1,781 IV isolation: positive / tested 45/1,950(2.31%) 243/1,184 (20.5%) 24/154(15.6%) (%) Among them: IV A(H1N1) [%] 19(42.96%) 151(62.1%) 9 (37.5%) IV A(H3N2) [%] 4(8.15%) 0(0.0%) 15 (62.5%) IV B [%] 22(48.89) 92(37.90%) 0 (0.0%) IV RNA by rt-RT-PCR: 37/297(12.46%) ** 1,184/4,571(26.33%) 154/1,781(8.7%) positive / tested (%) Among them: IV A(H1N1) [%] 35 (94.60%) 30(2.50%) 44 (28.6%) IV A(H3N2) [%] 1 (2.70%) 170(14.35%) 105 (68.2%) IV B [%] 1 (2.70%) 974(82.26%) 5 (3.2%) Antigen detection with IFM 7/222 54/782 (6.84%) * 70/749(9.30%) on R-Mix: positive/tested (%) (3.2%) Among them: Infl uenza A 13(24.07%) 21(30.00%) 0 (0.0%) Infl uenza B 2(3.70%) 17(24.30%) 0 (0.0%) RSV 7(12.96%) 1(1.40%) 2 (28.6%) Adenovirus 8(14.81%) 8(11.40%) 2 (28.6%) Parainfl uenza viruses 24(43.52%) 23(32.85%) 1 (14.3%) Multiplex rt-PCR positive / Not tested Not tested 151/372 tested [%] (40.6%) Among them: A(H1) 6 (4.0%) A(H3) 0 (0.0%) B 0 (0.0%) Coronaviruses 14 (9.3%) Parainfl uenza viruses 29 (19.2%) Human metapneumovirues 13 (8.6%) Rhinoviruses 35 (23.2%) RSV 42 (27.8%) Adenoviruses 12 (7.9%) Enteroviruses 11 (7.3%) Human Bocaviruses 17 (11.3%) Micoplasma pneumoniae 1 (0.7%) * data for 2007/08 and 2008/09 seasons; ** data for 2008/09 season;

49 B5265G1 Annual Report - 2010/2011

In 2009/2010 43 new ISSSs in 7 additional provinces were established and provided with the appropriate equipment supplies and reagents for specimen collection, storage and transportation under funding of this Cooperative Agreement Project. Medical doctors and nurses of the new ISSSs were trained on collection, storage and transport of clinical specimens from patients with ILI by specialists of VL. The establishment of the regional virology laboratories in Erdenet City, Orkhon province and Darkhan City, Darkhan-Uul province has started in 2009 with the procurement of rt-PCR machines, biosafety laminar boxes and some accompanying devices and reagents through the World Bank project. Appropriate rooms for virology laboratories were selected in the General Hospitals of both provinces with support of NIC, Mongolia specialists and began their re-construction under the fi nancing of the relevant local Governments. A new extension for laboratories including virology laboratory (for human-animal interface studies of infl uenza) of the building of NCIDNF has been completed with the Government budget support. A medical doctor and a laboratory assistant were selected from the General Hospitals of the above-named provinces and NCIDNF and have been completed their training for a specialization on medical virology with duration of 6 months in VL, NCCD involving the rt-PCR machines purchased for their respective laboratories. Since 12 March 2010 the new laboratories have started conducting testing for H1N1 in the laboratory of mentioned provinces. On April 8-9, 2010 the offi cial opening ceremonies of the new laboratories took place in Darkhan and Erdenet Cities. During the ceremonies Dr D.Nyamkhuu, MD, PhD, Director-Geberal, NCCD and Director, NIC, Mongolia has handed over the Diplomas of Virologists to Drs (Mrs) B.Byamba-erdene, MD (Darkhan-Uul) and E.Erdenejargal, MD (Orkhon) and laboratory assistants Mr P.Erdene-ochir (Darlhan-Uul) and Ms T.Munkhzul (Orkhon) graduated from the 6-months on-site training course at NCCD. The VL specialists are monitoring and assisting the new regional laboratories on that procedures of handling specimen, biosafety, rt-RT- PCR techniques for infl uenza virus detection and subtyping and usage of laboratory standard protocols. The regional laboratory in Orkhon province has collected 378 samples from 17 ISSS and tested by rt-RT-PCR and 45(11.9%) for infl uenza viruses: 23(51.1%) A (H1N1)v and 22(48.1%) A (H3N2) subtypes in 2010/11 season. The regional laboratory in Darkhan Uul province has collected 190 samples from 6 ISSS and tested by rt-RT-PCR and 5(2.6%) for infl uenza viruses: 1(20%) A (H1N1)v and 4(80%) A (H3N2) subtypes in 2010/11 season.

50 Cooperative Agreement Implementation

Infl uenza virus strains isolated in cell culture at the beginning of pandemics in Mongolia have been sent to WHO Reference laboratory at the National Institute of Infectious Diseases, Tokyo, Japan for the identifi cation of antigenic serotypes. The fi ndings of this analysis were confi rmed that all Mongolian isolates were similar to the original pandemic infl uenza virus strains isolated in USA and Japan (Table 9).

Table 9. Serological identiﬁ cation of some pandemic inﬂ uenza virus strains isolated in Mongolia in 2009/2010 season (tests have been performed in WHOCC in NIID, Tokyo, Japan)

REFERENCE ANTISERA Brisbane California Narita Sampling Narita /1/2009 Strains /59/2007 /07/2009 /1/2009 date (H1N1)pdm C1 (H1N1) (H1N1)pdm (H1N1)pdm No.6 E No.2 E2+1 No.1 E1 No.3 REF.Ag A/Brisbane 2007/07/01 640 <10 <10 <10 /59/2007 A/California 2009/04/09 <10 1280 2560 1280 /07 /2009 A/Narita/1/2009 2009/05/08 <10 2560 5120 2560 A/Narita/1/2009 2009/05/08 <10 2560 5120 2560 TEST.Ag A/Mongolia/ 2009/10/12 <10 2560 10240 5120 JP5558/2009 A/Mongolia/ 2009/10/14 <10 2560 10240 5120 JP5701/2009 A/Mongolia/ 2009/10/12 <10 2560 5120 5120 JP5555/2009 A/Mongolia/ 2009/10/13 <10 2560 5120 2560 JP5621/2009 A/Mongolia/ 2009/10/13 <10 1280 5120 1280 JP5624/2009 A/Mongolia/ 2009/10/14 <10 1280 5120 1280 JP5627/2009 A/Mongolia/ 2009/10/14 <10 1280 5120 1280 JP5699/2009 A/Mongolia/ 2009/10/13 <10 1280 2560 1280 JP5581/2009 A/Mongolia/ 2009/10/15 <10 1280 2560 1280 JP5759/2009 A/Mongolia/ 2009/10/15 <10 640 2560 640 JP5756/2009

51 B5265G1 Annual Report - 2010/2011

NIC, Mongolia has sent in December 2010 further 10 strains of A(H3N2) to WHO CC in Tokyo, Japan and 10 representative strains to WHO CC in Atlanta, USA January, 2011 for the more detailed analyses (Table 10).

Table 10 H3N2 strains isolated in Mongolia in 2010/2011 season( tests have been performed in WHO CC in NIID, Tokyo, Japan)

Strains Sampling date Uruguay/716/07 Egg No.2 Victoria/210/09 Egg No.1 Perth/16/09 Egg No.2 Niigata/403/09 Cell No.1 Brisbane/11/10 Egg No.1 Shizuoka/736/09 Cell No.2 Hunan- beihu/1313/09 Cell No.1 REF.Ag A/Uruguay/716/2007 2007/06/21 1280 80 40 40 160 160 320 A/Victoria/210/2009 2009/06/02 10 640 160 320 160 160 40 A/Perth/16/2009 10 640 320 320 160 160 20 A/NIIGATA/403/2009 2009/03/12 40 1280 320 320 320 320 160 A/Brisbane/11/2010 20 320 160 160 640 320 80 A/SHIZUOKA/736/2009 2009/05/23 80 1280 320 320 320 320 320 A/Hunan-beihu/1313/2009 2009/05/07 160 40 20 40 40 20 640 TEST.Ag A/Dornogobi/3875/2010 2010/12/06 80 2560 640 1280 1280 1280 320 A/Uvurkhagai/3970/2010 2010/12/09 40 1280 640 1280 1280 1280 160 A/Ulaanbaatar/3920/2010 2010/12/10 40 1280 320 1280 1280 1280 160 A/Ulaanbaatar/3887/2010 2010/12/09 80 1280 640 1280 640 1280 160 A/Dornogobi/4064/2010 2010/12/15 40 1280 320 640 640 640 160 A/Dornogobi/4067/2010 2010/12/13 40 1280 320 640 640 640 160 A/Ulaanbaatar/3893/2010 2010/12/08 40 640 160 320 320 320 160 A/Ulaanbaatar/3805/2010 2010/12/02 20 640 160 160 160 160 80

Since 2009 NIC, Mongolia has started using sequencing exercises in the routine analysis of inﬂ uenza surveillance. IVL staff has sequenced in 2009/2010, 9 HA, 7 M, 3 PB1, 2 PB2, 3 PA, 3 NP, 3 NS and 4 NA genes of inﬂ uenza strains isolated in Mongolia and all 31 gene sequences were deposited in GenBank (accession numbers: CY050844, CY053364, CY050846, CY050845, CY065987, CY065989, CY065990, CY065988, CY065991, CY065985, CY065984, CY065986, CY052366, CY053365, CY054546, CY054547, CY055169, CY055170, CY055171, CY056363, CY055308, CY057191, CY057083, CY065995, CY065997, CY065998, CY065996, CY065999, CY065993, CY065992, CY065994, CY054548, CY054549, CY073448) after careful consultations

52 Cooperative Agreement Implementation and correspondences with the specialists from CDC, USA and NIID, Japan. In 2010/2011 season we have sequenced HA, PB2, PB1, NP, NA, MP, NS and PA genes of 3 infl uenza strains isolated in Mongolia and 1 HA, 1 PB2, 2 PB1, 1 NP, 1 NA, 1 MP, 2 NS, and 1 PA gene sequences were deposited in GeneBank ( CY080420, CY080571, CY080572, CY080573, CY080574, CY080592, CY080593, CY081057, CY080271, CY080295). We have also undertaking some exercises of evolutionary analysis of the HA genes of infl uenza strains isolated in Mongolia with audio-visual consultation of Dr Noami Komadina, WHO CC, Melbourne, Australia. The maximum likelihood trees of HA genes released by GenBank of the respresentative infl uenza virus strains isolated in Mongolia has been constucted using PAUP test with MEGA4 and GENEOUS packages. (Figures 19-21). A phylogenetic analysis the obtained results was performed in comparison to the published data on HA A(H1) ( M.I.Nelson, C.Viboud, L.Simonsen et al., 2008), A(H3) (C.A.Russel, T.C.Jones, I.G.Barr et al., 2008) and B (J.Shen et al., 2009).

A/Arvaikheer/8802/2009 A/Unmugobi/9586/2009 A/Sainshand/8886/2009 A/Dundgobi/10320/2009 A/Chiobalsan/8524/2009 A/Ulaanbaatar/190/2011 A/Karaj/5327/2010 A/Ulgii/9911/2009 A/Mongolia/JP5756/2009 A/Ulaanbaatar/5882/2009 A/California/07/2009 A/Ulaanbaatar/2212/2007 A/Ulaanbaatar/1599/2009 A/Ulaanbaatar/1628/2009 A/Orkhon/1779/2009 A/Ulaanbaatar/1341/2009 A/Ulaanbaatar/0607/2008 A/Ulaanbaatar/0957/2007 A/Ulaanbaatar/116/2007 A/Memphis/03/2008_ A/Brisbane/59/2007_ A/Solomom Islands/03/2006 A/New_York/8/2006 A/Ulaanbaatar/1429/2005 A/Mongolia/327/2004 A/Mongolia/754/2004 A/New_Caledonia/20/1999 A/New_South_Wales/24/1999 A/Beijing/262/95 A/New_York/653/1996 A/Memphis/6/1996_ A/Bayern/7/95 A/Mongolia/162/91 A/Memphis/3/1987 A/Taiwan/01/1986 A/Memphis/39/1983 A/Chile/1/1983_ A/Mongolia/231/85 A/USSR/90/1977 A/Albany/4836/1950__ A/Roma/1949 A/Brazil/11/78 A/Malaysia/54__ A/Fort_Monmouth/1/1947 A/AA/Huston/1945_ A/Weiss/43 A/Mongolia/111/91 A/Mongolia/153/88 A/PuertoRico/8/34 A/Brevig Mission/1/1918 0.01 Figure 19. A phylogenetic tree of HA A(H1) gene of inﬂ uenza viruses isolated in Mongolia (in red) in comparison with the reference strains

53 B5265G1 Annual Report - 2010/2011

A/Ulaanbaatar/3849/2010 A/Ulaanbaatar/3805/2010 A/Uvurkhangai/3970/2010 A/Ulaanbaatar/3887/2010 A/Uvurkhagai/3970/2010 A/Dornogobi/4067/2010 A/Dornogobi/3875/2010 A/Ulaanbaatar/3380/2010 A/Ulaanbaatar/3920/2010 A/Dornogobi/4064/2010 A/Ulaanbaatar/3893/2010 A/PERTH/10/2010 A/Perth/16/2009 A/Ulaanbaatar/4320/2010 A/Ulaanbaatar/1600/2008 A/Sainshand/0643/2008 A/Ulaanbaatar/0598/08 A/Brisbane/10/2007 A/ULAANBAATAR/2164/2005 A/ULAANBAATAR/1922/2005 A/KHOVD/269/2006 A/CHOIBALSAN/2083/2005 A/KHOVD/262/2006 A/SUKHBAATAR/1568/2005 A/ULAANBAATAR/1599/2005 A/New_York/55/2004 0.01 Figure 20. A phylogenetic tree of HA A(H3) gene of inﬂ uenza viruses isolated in Mongolia (in red) in comparison with the reference strains

B/Brisbane/60/2008 B/Ulaanbaatar/289/2010 B/Ulaanbaatar/878/2010 B/Ulaanbaatar/943/2010 B/Sainshand/917/2010 B/Ulaanbaatar/930/2010 B/Ulaanbaatar/935/2010 B/Ulaanbaatar/954/2010 B/Ulaanbaatar/956/2010 B/Ulaanbaatar/881/2010 B/Ulaanbaatar/905/2010 B/Ulaanbaatar/2202/2007 B/Sukhbaatar/2488/2007 B/Ulaanbaatar/1924/2007 B/Ulaanbaatar/2263/2007 B/Ulaanbaatar/2232/2007 B/Malaysia/2506/2004 B/Ulaanbaatar/1247/2008 B/ULAANBAATAR/2808/2008 B/Ulaanbaatar/0856/2008 B/Orchon/2505/2007 B/Sukhbaatar/1733/2007 B/Ulaanbaatar/1885/2007 B/Brisbane/3/2007 B/Arvaikheer/2476/2007 B/Ulaanbaatar/2373/2007 B/Orkhon/2536/2008 B/Ulaanbaatar/2481/2008 B/Yamagata/16/88 B/Victoria/2/87 0.01 Figure 21. A phylogenetic tree of HA B gene of inﬂ uenza viruses isolated in Mongolia (in red) in comparison with the reference strains

Since 1997 NIC, Mongolia has started also the anti-viral resistance sercening of the infl uenza viruses isolated in Mongolia and found: 1) amandadine resistance -100% Since 2006, and 2) oseltamivir resistance -2-3% Since 2010 (Tables 11 and 12). On the request of MoH, Mongolia, in 2009-2010 NIC, Mongolia has collected serum samples for testing of sero-prevalence of pandemic infl uenza virus and studies have been performed in MN and HI on collabration of Department of Virology, Tohoku University, Sendai, Japan and China CDC, Beijing, China with fi nancial support of WHO WPRO and ADB Infl uenza project (Tables 22 and 23).

54 Cooperative Agreement Implementation

Table 11. Results of resistance to amantadine screening of inﬂ uenza viruses isolated in Mongolia (1997-2011)

subtypes A(H1N1) A(H3N2) Pdm A(H1N1) resistant to resistant to resistant to years tested tested tested amantadine amantadine amantadine 1997 2 0(0%) - - - - 1998 2 0(%) - - - - 1999 ------2000 ------2001 ------2002 ------2003 ------2004 8 0(%) 2 0(0%) - - 2005 2 0(0%) 12 12(100%) - - 2006 10 10(100%) - - - - 2007 9 9(100%) 2 1(50%) - - 2008 ------2009 - - - - 7 7(100%) 2010 ------2011 - - - - 1 1(100%)

Table 12. Results of resistance to oseltamivir screening of inﬂ uenza viruses isolated in Mongolia (2007-2011)

subtypes A(H1N1) A(H3N2) Pdm A(H1N1) B resistant to resistant to resistant to resistant to years tested tested tested tested oseltamivir oseltamivir oseltamivir oseltamivir 2007 37 1(2.7%) ------2008 ------2009 - - - - 228 0(0%) 18 0(0%) 2010 - - - - 34 1(2.94%) - - 2011 - - 2 0(0%) 30 0(0%) - -

55 B5265G1 Annual Report - 2010/2011

Figure 22. Proportion of seroconversion (antibody titer increase by 4 fold or more) by age groups against A/California/07/2009pdm before (June 2009) and after (November 2009) the ﬁ rst inﬂ uenza A (H1N1) pandemic wave in Selenghe province, Mongolia

Figure 23. Results of a sero-surveillance in Ulaanbaatar City with serum samples collected in June 2009 [I] , Nov. 2009 [II] and June 2010 [III] for HI antibodies against A/California/07/2009 (H1N1) pnd strain

VL, NCCD, Mongolia has started participating in WHO EQAP from the beginning of 2007. The ﬁ rst panel was not received due to difﬁ culties encountered with transportation of samples. VL has received in 2009/2010 season the Panels

56 Cooperative Agreement Implementation

7-8 for the detection of infl uenza virus type A and B by PCR in the coded samples prepared in the Virology Division, Centre for Health Protection, Public Health Laboratory Center, Hong Kong SAR, China. The results of the Panels have shown 100% concordance. VL has received dried RNA and infl uenza virus samples of the Panels 9 and 10 of the WHO External Quality Assessment Programm for the detection of Infl uenza Virus Type A by PCR which conducted by Virology Division, Centre for Health Protection, Public Health Laboratory Center, Hong Kong SAR, China in February and July 2011 and tested by rt RT-PCR. Our laboratory performance were 100% for 9th Panel and received the certifi cate completion (Figure 24). The VL, NCCD, Mongolia is also participating in Infl uenza Performance Evaluation Program conducting by US CDC, Atlanta since September, 2011. Our performance of the fi rst panel of the program was 100 % (Figure 25).

Figure 24. WHO External Quality Assessment Certiﬁ cate issued to NIC, Mongolia (2011)

57 B5265G1 Annual Report - 2010/2011

Figure 25. Final result of VL, NIC, NCCD Mongolia with the samples for EQC sent from CDC, USA, Atlanta (September 27, 2011)

In 2009/2010 and 2010/2011 ﬁ scal years totally around 665,000 US$ (78.3% of the funds released) has been allocated for purchase of laboratory and ofﬁ ce equipment, devices, reagents from the Collaborative Agreement Funding (Annexes 10-13).

3.3.3. Ensuring sustainable development of inﬂ uenza surveillance network by good and transparent management

Open access to the epidemiological and virological surveillance results and to the decisions taken by MoH, and other Government ministries and agencies have been granted by placing them on NIC, Mongolia website www. ﬂ u.mn (pictures on the outer side of the rear page of this booklet) real-time in Mongolian and English starting February 2009. Now it is well established system (Figures 26-38). During the pandemics period (from October 2009 upto May 2010) also printed Information Bulletin has been issued weekly and distributed to the main stakeholders of the inﬂ uenza control in Mongolia. During the peak period of the pandemics (from October 2009 upto February 2010) daily short (30-60 min) audio-conferences have been organized within NCCD concerned departments and audio-conferences have been extended covering some aimaks and MoH Working groups in case of needs, or on request of the medical society.

58 Cooperative Agreement Implementation

Since the establishment of the website www.ﬂ u.mn the Mongolian version has been hit by over 211,000 visitors and became a quite popular website among Government ministries and agencies, and mass media. The English version was hit also by around 90,000 visitors, and WHO HQ Epidemiology Working Group was using often the website, sometimes sending questions and comments on our data.

180

160

140

120

100

60 ILI morbidity per 10000 per morbidity ILI

0 1 1 40 50 10 20 30 40 50 10 20 30 40 2009 2010 2011

Lower tolerance limit Upper tolerance limit 2008/09-2009/10 2010/2011

Figure 26. Registered ILI country-wide per 10,000 population on the website ILI surveillance information for the 36th week of 2011 (Sept. 5-11, 2011)

20 Number of Number of 100 detected viruses specimens

15 75

10 50

5 25

0 0 405011020304050110203040

2009 2010 2011

B AH1 AH3 Unsubtyped Parainfluenza- RSV HuMPV Rhino- Enter o- Adeno- Corona- HBoV Micoplasma Number of specimens

Figure 27. Number of the screened specimens and detected viruses in the outpatient visits in all ISSSs (the 36th week of 2011)

59 B5265G1 Annual Report - 2010/2011

Figure 28. ILI morbidity per 10,000 population by provinces (www.ﬂ u.mn surveillance report of the 36th week of 2011)

Figure 29. ILI prevalence (%) among outpatient visits by provinces (www.ﬂ u.mn surveillance report of the 36th week of 2011)

60 Cooperative Agreement Implementation

40%

35%

30%

25%

20%

15%

10%

0% w27 w28 w29 w30 w31 w32 w33 w34 w35 w36

0-11 months 1-4 yrs 5-9 yrs 10-15 yrs 16-24 yrs 25-44 yrs 45-64 yrs 65+

Figure 30. Registered ILI in the different age groups in all ISSSs (www.ﬂ u.mn surveillance report of the 36th week of 2011)

10% 15 Percentage Deaths 9%

8% 12 7% 6% 9

5% 4% 6 3% 2% 3

0% 0 1 30 40 50 10 20 30 2010 2011 Deaths Percentage of patients w ith pneumonia among all hospitalized patients in average Percentage of patients w ith pneumonia among hospitalized Figure 31. Prevalence of patients with pneumonia among hospitalized patients (based on 37 hospital-based surveillance sites, www.ﬂ u.mn surveillance report of the 36th week of 2011)

61 B5265G1 Annual Report - 2010/2011

20 Number of Number of 100 detected viruses specimens

15 75

10 50

5 25

0 0 30 40 50 1 10 20 30

2010 2011 B AH1 AH3 Unsubtyped Parainfluenza- RSV HuMPV Rhino- Enter o- Adeno- Corona- HBoV Micoplasma Number of specimens

Figure 32. Number of the screened specimens and detected viruses of patients with pneumonia (www.ﬂ u.mn surveillance report of the 36th week of 2011)

250

200

10000 150

100 ILI morbidityper

0 50 10 20 30 40 50 10 20 30 40 2009 2010 2011

Lower tolerance limit Upper tolerance limit 2008/09-2009/10 2010/2011

Figure 33. ILI per 10,000 population in Ulaanbaatar city (www.ﬂ u.mn surveillance report of the 36th week of 2011)

62 Cooperative Agreement Implementation

20 Number of Number of 100 detected viruses specimens

15 75

10 50

5 25

0 0 4050110203040501102030

2009 2010 2011

B AH1 AH3 Unsubtyped Parainfluenza- RSV HuMPV Rhino- Enter o- Adeno- Corona- HBoV Micoplasma Number of specimens

Figure 34. Number of the screened specimens and detected viruses in the outpatient surveillance sites in Ulaanbaatar city (www.ﬂ u.mn surveillance report of the 36th week of 2011)

Figure 35. ILI morbidity per 10,000 population in the districts of Ulaanbaatar city (www.ﬂ u.mn surveillance report of the 36th week of 2011)

63 B5265G1 Annual Report - 2010/2011

Figure 36. ILI prevalence (%) among outpatient visits in the districts of Ulaanbaatar city (www.ﬂ u.mn surveillance report of the 36th week of 2011)

10% 15 Percentage Deaths 9%

8% 12 7% 6% 9

5% 4% 6 3% 2% 3

0% 0 1 30 40 50 10 20 30 2010 2011 Deaths Percentage of patients w ith pneumonia among all hospitalized patients in average Percentage of patients w ith pneumonia among hospitalized

Figure 37. Prevalence of patients with pneumonia among hospitalized patients (based on 12 hospital-based surveillance sites) in Ulaanbaatar city (www.ﬂ u.mn surveillance report of the 36th week of 2011)

64 Cooperative Agreement Implementation

20 Number of Number of 100 detected viruses specimens

15 75

10 50

5 25

0 0 30 40 50 1 10 20 30 40

2010 2011

B AH1 AH3 Unsubtyped Parainfluenza- RSV HuMPV Rhino- Entero- Adeno- Corona- HBoV Micoplasma Number of specimens

Figure 38. Number of the screened specimens studied and detected viruses of patients with pneumonia in Ulaanbaatar city (www.ﬂ u.mn surveillance report of the 36th week of 2011)

Since February 2010, NIC, Mongolia is working to develop on-line information system covering all ISSSs. In collaboration of the local software engineering company Engineersoft, Co., Ltd. NIC, Mongolia has developed a special program (FIS-Flu Information System) and than have organized an initial workshop for trainers on 14 April, 2010 at the NCCD, Ulaanbaatar, Mongolia (Annex 14-15). The project team has developed also a Infl uenza Reporting assessment tool to assist the participating ISSSs (Annex 16). In collaboration with the National Emergency Management Agency, Mongolia (NEMA) and the fi nancial assistance of the World Bank in the framework of “Avian infl uenza control and human infl uenza pandemic preparedness response” project it has been organized an Infl uenza Reporting System Assessment nationwide. 5 teams consisting of 15 trainers have visited all provinces from 26 April to 22 May 2010. The team members have visited 186 Health Departments and General Hospitals, 122 FGPs, and 5 Reference centers. During their visit, they have made assessments the capability of internet reporting system and technical provision of all ISSSs and trained 370 epidemiologists and statisticians how to use FIS software (Annex 17-20). After this broad testing of FIS pogram, refi nements were made to the program and the Director General, NCCD has issued a special order to

65 B5265G1 Annual Report - 2010/2011 introduce FIS. On the basis of this order NIC, Mongolia has organized the second training workshops for FIS. The fi rst group training have covered ISSSs’ epidemiologists and statisticians of Ulaanbaatar city (Annex 21). This training was organized on 22-23 September, 2010 with 70 participants. The second group training was organized for 16 aimaks specialists on 6 October, 2010 with the 35 participants (Annex 22). During the training all participants have been provided with 63 fl ash-disks containing FIS Programme and 87 microphones for audio conferencing with Skype. For the establishment of good and transparent management of the project we are trying to organize the assessment exercises of the activities of ISSSs more open and with broader participation of concerned personnel. The project team has developed an assessment tool for ISSSs depending on their service responsibilities and the quarterly and yearly assessment (Annexes 23-40) are openly discussed on the ISSSs meeting and training workshops (Annexes 41-43) and then placed on www.fl u.mn website and in the “Mongolian Journal of Infectious Disease Research”. Weekly audio-conferences have been organized 25 times since November 2010 covering all ISSSs of Ulaanbaatar city and 21 aimaks. The fi rst ISSSs training workshop organized on September 8-9, 2011 at the NCCD. The main goal of this workshop was to improve the collaboration among ISSSs. (Annex 42) The workshop was attended by 250 participants including directors, deputy directors of the Health Departments of 21 provinces, epidemiologists, statisticians of UB and all provinces Mongolia and representatives of FGPs (Annex 43). During the ISSSs training workshop some training have been organized separately: The fi rst group: training for FIS: It has covered epidemiologists, statisticians and nurses of Ulaanbaatar city and provinces (Annex 44). This training was organized on 9 September, 2011 with 125 participants (Annex 45). The second group: training for laboratory: This group training was organized for laboratory doctors and assistants on 8 September, 2011 with the 5 participants (Annex 46-47). The third group: training for the participant of the pneumonia surveillance in cooperation with Merieux Foundation, France. This training was organized on 8 September, 2011 with 16 paticipants (Annex 48-49). The fourth group: training for the infl uenza transmission surveillance in cooperation with Tohoku University, Sendai, Japan This training was organized on 8 September, 2011 with the 15 pariticipants (Annex 50-51).

66 Cooperative Agreement Implementation

During the training workshop some equipment and devices with total value of 30,600.00 USD + 25,270,105.00 (Annex 52) have been transferred to the participanting local health facilities from the Project Team.

3.3.4. International Collaboration

On the request of MoH, Mongolia a team consisting Dr. T. Kasai, WHO WPRO Regional Advisor on infectious diseases, Dr. M.Tashiro, Head, WHO CC on infl uenza at NIID, Tokyo, Japan, Prof. H. Oshitani and Ass. Prof. T. Kamigaki, Department of Virology, Graduate School of Medicine, Tohoku University, Sendai, Japan has visited Mongolia on 25 October to 8 November 2009 to assist the control measures of the infl uenza pandemics. They have supported measures started by MoH and Government of Mongolia following the technical guidance of NIC, Mongolia and gave important recommendations to shift the control measures from containment to mitigation. Prof. H. Oshitani, Drs N. Nukiwa, A. Suzuki and O. Ayumi from Virology Department, Graduate School of Medicine, Tohoku University, Sendai, Japan have visited Mongolia on December 15-22, 2009 supporting initial epidemiological analysis of pandemics and sequencing of pandemic infl uenza strains. With this on-the-job training the sequencing skills of researchers in NIC, Mongolia laboratory have been improved substancially and now the sequencing became the routine activity of the laboratory. A team including MoH, NCCD and District Hospital staff visited the China border city Erlian health facilities and Border Infection Control Department to study the experiences of pandemics control on November 10- 11, 2009. A team of MoH, China has visited back Mongolia on January 19- 23, 2010, and offered lectures and molecular biology reagents acutely needed that time. Dr. Ts.Naranzul, MD, VL has participated in the “Neuraminidase Inhibitor Susceptibility Testing Workshop” on November 9-13, 2009, Melbourne, Australia. On his return he has established NA susceptibility testing in NIC, Mongolia VL and so far it has been tested 317 strains and found 2 resistant strains. Dr. B. Darmaa, Head, Virology Laboratory, NCCD, Mr. B. Gantsooj, Data-manager Web master, NIC, NCCD, and Mrs. P. Batmunkh, Programmer, EngineerSoft Co., Ltd, Mongolia have visited on March 22- 26, 2010 the National Institute for Viral Disease Control and Prevention, CNIC at CDC, Beijing, China to study their experiences of on-line infl uenza information system which was very useful for the development of our own

67 B5265G1 Annual Report - 2010/2011

FIS program. A CDC team consisting Mrs. T. Turski, Drs S. Epperson, B. Shu and R. Ireland has visited Mongolia on June 20-25, 2010 and worked with Mongolian counterparts on 3 assessments: - Laboratory assessment, - Assessment epidemiological surveillamce, and - IPPP re-assessment and gave valuable recommendations to improve our capacities. Dr. A. Burma and Ms. S. Tsatsral have worked for a month in May 2010 in Department of Virology, Graduate School of Medicine, Tohoku University, Sendai, Japan and tested in microneutralization and HIT the initial part of the sera (670) collected in Selenghe aimak in June and November 2009 to follow-up the antibody profi le against pandemic infl uenza virus. This study was fi nanced by the World Bank Project. Also Dr. A. Burma and G. Nyama have worked again a month in July 2010 in the China CDC, to study the sero-prevalence against pandemic infl uenza in more than 5.000 sera collected in June and November 2009, and May 2010 in Ulaanbaatar City, Selenghe and Dornogobi aimaks. The analysis of this study has not yet fi nished, however, the initial results have shown the pandemic virus was introduced into Mongolia in October 2010. This study has fi nancially supported by China CDC and WHO WPRO. Professors Jiang Wei Wang, Yuanlu Zhang, Fan Yang and Dr. Jianguo Li from the Institute of Pathogen Biology, Chinese Academy of Medical Sciences (IPB/CAMS) have visited Mongolia on July 8-12, 2010 and agreed upon to develop collaboration on detection and diagnosis of non-infl uenza respiratory viruses. Dr. Jianguo Li has worked for 2 weeks in extension with researchers of VL, NCCD with own test-system on detection of rhinovirus C and bocaviruses in 240 archived samples collected from mongolian patients. Participation with poster presentations of our researchers in international scientifi c conferences and congresses are increasing. Dr. R. Tuul, project manager and Mrs. D. Enkhsaikhan have participated in the “CDC Infl uenza Division International Partners and Disease Burden Meeting” on July 9-11, 2010 and attended the “ICEID 2010” July 11-14, 2010 in Atlanta, CDC, USA with 3 poster presentations. Prof. P. Nymadawa, Mrs. D. Enkhsaikhan, Mrs. S. Tsatsral and Dr. Ts. Naranzul have participated in the Options VII Conference in Hong Kong, China SAR, on September 3-7, 2010 with 4 other poster presentations. Prof. P. Nymadawa PI/Project Director, has been invited to deliver lectures on infl uenza control in Mongolia to several international meetings, namely:

68 Cooperative Agreement Implementation

- Pandemic Infl uenza Senior Leaders Symposiums, October 12-15, 2009, Phnom Pehn, Cambodia and October 8-9, 2011 Jakarta, Indonesia organized by the US Pacifi c Military Force, - WHO Consultation on Infl uenza Vaccine Composition for the Northern Hemisphere in 2010/2011 season, February 14-15, 2010, Geneva, Switzerland, - International Symposium on Infl uenza Pandemics in Asia 23-24, 2010 Tokya, Japan organized by Sasakawa Peace Foundation/NIID, and - 2nd International Infl uenza Meeting, September 12-14, 2010, Muenster, Germany, organized by Westphalia Wilhelm University, Germany. He has been also re-elected to the Board Member, ISIRV on the Annual Meeting of it, hold during the Options VII in Hong Kong in September 2010. With the WHO support: • Mrs. Mina Nakauchi, PhD, Infl uenza Virus Research Center, National Institute of Infectious Diseases, Tokyo, Japan (NIID) on November 16-19, 2010 has worked in VL, NCCD. She has assisted in the introduction of new method developed in NIID, for screening of NAI resistant mutation of the A(H1) 2009 pandemic strains. • Prof. P.Nymadawa, PI/Project Director has attended the WHO GISN (Global Infl uenza Surveillance Network) 3rd Global NIC (National Infl uenza Center) Meeting in Hammamet, Tunisia on November 30 to December 3, and presented a perspective of NIC, Mongolia development in the near future. • Dr A. Burmaa, Epidemiology Team Leader, NIC, Mongolia has attended the WHO Consultation on Global Tools and Surveillance Manual on Infl uenza in Switzerland, Geneva on March 8 – 10, 2011 and had a presentation on the “Calculation of tolerant limits of ILI morbidity and its utilization in the sentinel surveillance (Experience of the NIC, Mongolia)”. • Dr. B.Darmaa, Head, Virology Laboratory, NCCD has participated in Regional Meeting on Reviewing and Strengthening Pandemic Infl uenza Preparedness and Response which was held in Beijing, China, on March 14 – 16, 2011. • Dr A. Burmaa and Mrs S. Tsatsral have attended the Workshop on Scientifi c Writing in Seoul, Republic of Korea on April 4-8, 2011.

CONCLUSION 1. Cooperative agreement project has reached the planned aims. 2. The main achievements of the 2010-2011 budget year were: - the whole country coverage for ILI surveillance for the whole

69 B5265G1 Annual Report - 2010/2011

year has developed into routine activity ; - routine real time on-line ILI surveillance reporting through website www.fl u.mn; - Start of multifl ex rt-PCR screening of the representative samples for non-infl uenza respiratory pathogens.

70 Annexes

FOUR. ANNEXES

ANNEX 1

Recommendation from the Fifth National Inﬂ uenza Workshop

We, the participants of the Fifth National Infl uenza Workshop, are expressing our satisfaction to the successful implementation of the recommendations proposed from the previous National Infl uenza Workshops. Also, we concern about that the A (H1N1) infl uenza has become pandemic causing health and economical losses; even there is a high probability to last for 2 to 3 years as a wave. In order to overcome the infl uenza pandemic with less loss, we emphasize that the close cooperation of the governmental and non-governmental organizations and individuals, and the active participation of each citizen are vitally important. Considering the aforesaid, we are proposing the following recommendations: 1. Refl ect the comments from the participants of the National Infl uenza Workshop to the amendment of the National plan for the measures to be taken during the infl uenza pandemic, and have approved by the Government and implement promptly; 2. In order to increase the participation of private institutions in improvement of the supply of preventive and therapeutic drugs, preparations and facilities, utilize economical motivators such as customs and other tax exemption during pandemic; 3. Institutions elaborate business contingency plan for pandemic period, vitaminize, build up and make healthy their staffs and employees; 4. In order to overcome the infl uenza pandemic with less loss, each individual is deeply conscious of the vital importance of the protection himself/herself, his/her family and children, and makes the simple preventive measures against infl uenza behavioral; 5. Organize intensive public information, training and propaganda on the prevention from infl uenza; 6. Study and introduce the traditional healing and therapeutic recipes possible to be used during the infl uenza pandemic;

PARTICIPANTS OF THE FIFTH NATIONAL INFLUENZA WORKSHOP Ulaanbaatar, 08 October 2009

71 B5265G1 Annual Report - 2010/2011

ANNEX 2

Programme of the Mongolia-IPPP re-assessment workshop, June 23-24, 2010

Time Activities Moderator Responsible person Wednesday, 23 June, 2010 Opening G.Surenkhand Opening remarks D. 9:00-09:10 Nyamkhuu Self-introduction of 9:10-9:30 participants Brief information on the 9:30-10:30 results of the previous assessments (P.Nymadawa) 10:30-11:00 Tea/coffee break Session 1 P.Nymadawa S.Togsdelger, D.Narangerel, 10:30-11:00 Capability 1: National Plan V.Delgermaa, Ts.Purevkhuu D.Narangerel, Capability 2: Research and Altankhuu, 11:00-11:30 inter-sectoral collaboration V.Delgermaa, Ts.Purevkhuu L.Dashtseren, 11:30-12:00 Capability 3: Communications V.Garmaa Capability 4: Epidemiologic G.Surenkhand, 12:00-12:30 Capability А.Аmbaselmaa 12:30-14:00 Lunch Session 2 S.Togsdelger B.Darmaa, Capability 5: Laboratory 14:00-14:30 D.Tserennorov, Capability Sh.Tserendorj Capability 6: Routine 14:30-15:00 А.Burmaa, B.Gantsooj Inﬂ uenza Surveillance Capability 7: National G.Surenkhand, 15:00-15:30 Respiratory Disease Ch.Monkhtsetseg Surveillance and Reporting 15:30-16:00 Tea/coffee break

72 Annexes

Session 3 Ya.Amarjargal Capability 8: Outbreak А.Аmbaselmaa, 16:00-16:30 Response Ts.Oyunchimeg А.Аmbaselmaa, Capability 9: Resources for 16:30-17:30 Ts.Oyunchimeg, Containment Ganbaatar Thursday, 24 June, 2010 Session 4 G.Surenkhand Wrap up information for 9:00-09:30 R.Tuul Day 1 Capability 10: Community- А.Аmbaselmaa, 9:30-10:30 based Interventions V.Delgermaa 10:30-11:00 Tea/coffee break Assesment 5 S.Togsdelger Capability 11: Infection J.Nyamsuren, 10:30-11:00 Control L.Dashtseren, Ya.Amarjargal, Capability 12: Health Sector 11:00-11:30 D.Narangerel, Pandemic Response G.Surenkhand 11:30-12:30 Discussion P.Nymadawa 12:30-14:00 Lunch Assesment 6 P.Nymadawa Summing up discussion and 14:00-15:30 consensus building 15:30-16:00 Tea/coffee break

73 B5265G1 Annual Report - 2010/2011

ANNEX 3

Participants list of the workshop on IPPP re-assessment, June 23-24, 2010

Nî Name Organization Position 1 P. Nymadawa NCCD Project director Head, Public Health Policy Planning 2 S. Togsdelger MoH Division Deputy Head, Health service Management 3 Ya. Amarjargal MoH Division Senior offi cer, Public Health Policy 4 D. Narangerel MOH Planning Division 5 D. Nyamkhuu NCCD Director General 6 G. Surenkhand NCCD Deputy director for surveillance 7 Ts. Oyunchimeg NCCD Deputy director for hospital services 8 Luo Dapeng WR Offi cer 9 R. Tuul NCCD Project manager 10 A. Ambaselmaa NCCD Head, Surveillance department 11 B. Ganbaatar NCCD Head, Immunization Department 12 M. Altankhuu NCCD Head, United laboratory department 13 B. Darmaa NCCD Head, laboratory for respiratory virology 14 J. Nyamsuren NCCD Head, Nosocomial infection division 15 L. Dashtseren NCCD Epidemiologist 16 A. Burmaa NCCD Epidemiologist 17 Ch. Urtnasan NCCD Epidemiologist 18 B. Delgermaa NEMA Offi cer 19 V. Garmaa NCHD Offi cer 20 Ts. Purevkhuu MoFALI Offi cer in charge 21 S. Sugar CVL Expert 22 V. Surenchimeg UNICEF Project offi cer 23 O. Ariuntuya WHO Offi cer 24 D. Oyunchimeg SPIA Head, Health Inspection Division 25 U. Munkhchuluun World Bank Project offi cer 26 O. Bolortuya World Bank Project offi cer 27 N. Amgalan World Bank Project offi cer 28 D. Tserennorov NCIDNF Deputy director 29 Sh. Tserendorj CVR Deputy director 30 B. Gantsooj NCCD Project data-manager

74 Annexes

31 Ch. Monkhtsetseg NCCD Epidemiologist General Hospital 32 O. Chuluunbaatar Head, Emergency Department No1 33 Sh. Enkhtor MCHRC Deputy director General Hospital 34 Sh. Zorig Deputy director No3 BZ District 35 N. Jantsan Chief medical ofﬁ cer Hospital 36 B. Sarantuya “Manal Uils” FGP Head

75 B5265G1 Annual Report - 2010/2011

ANNEX 4

Results of IPPP re-assessment in comparison to the previous assessments

Score Capabilities Nî Average 2008 2010 Capability 1. Country Plan 2008 2010 1.1 Status of plan 2 2 1.2 Dissemination and training 2 2 1.3 Exercises 2 2 1.60 1.90 Coordination and resources for implementation of 1.4 1 1.5 country plan Capability 2. Research and use of fi ndings for pandemic infl uenza preparedness 2.1 Collaboration between human and animal health 1 2 2.2 Research priorities 1 2 Environment of support for research and use of 2.3 121.00 2.00 fi ndings Use of data by decision makers for pandemic 2.4 12 infl uenza preparedness Capability 3. Communications 3.1 Status of implementation of communications plan 2 2 3.2 Messaging 3 3 2.25 2.25 3.3 Dissemination 2 2 3.4 Staffi ng 2 2 Capability 4. Epidemiologic Capability 4.1 Operational status 0 0 4.2 Epidemiologists and fi eld epidemiologists 2 2 1.25 1.5 4.3 Quality of public health epidemiologists 1 2 4.4 Training 2 2 Capability 5. Laboratory Capability 5.1 national infl uenza laboratory network 1 2 5.2 Biosaftey level (bsl) and routine testing of specimens 2 2 1.75 2.0 5.3 Methods 2 2 5.4 Participation in who system 2 2 Capability 6. Routine Infl uenza Surveillance

76 Annexes

Integration of virologic and epidemiologic 6.1 23 surveillance 6.2 Data publication 3 3 2.50 3.0 6.3 Timeliness 2 3 6.4 Case defi nitions 3 3 Capability 7. National Respiratory Disease Surveillance and Report 7.1 Awareness of need to report 2 3 7.2 Rumor reporting 0 1 1.25 1.75 7.3 Cross-notifi cation 1 1 7.4 Timeliness 2 2 Capability 8. Outbreak Response 8.1 Human resources for outbreak response 1 2 8.2 Logistical resources for outbreak response 0 1 1.00 1.75 8.3 Exercises or response 1 2 8.4 Activation of team 2 2 Capability 9. Resources for Containment 9.1 Availability of antivirals 0 0 9.2 Storage facilities 1 1 0.25 0.75 9.3 Exercises and practice 0 1 9.4 Distribution of materials 0 1 Capability 10. community-based interventions to prevent the spread of infl uenza 10.1 Social distancing 2 2 10.2 Critical infrastructure 0 1 1.50 2.0 10.3 Voluntary isolation and quarantine 1 2 10.4 Percent of districts with plan 3 3 Capability 11. Infection Control Standards of infection control by level of health care 11.1 22 system 11.2 Human resources 2 2 0.75 1.5 11.3 Logistical resources 1 0 11.4 Institutionalization of infection control efforts 2 2 Capability 12. Health Sector Pandemic Response 12.1 Surge capacity – human resources 0 1 12.2 Surge capacity –physical facilities and equipment 0 0.5 0.5 0.88 12.3 Surge capacity – clinical management guidelines 2 2 12.4 Surge capacity –care of deceased 0 0 Total average 1.38 1.77

77 B5265G1 Annual Report - 2010/2011

ANNEX 5

Programme of the workshop for moderators on table top exercises of “Emergency Measures Implemented during inﬂ uenza pandemics” NIW 6, October 5, 2010

Nî Topic Time Responsible Opening (workshop objective, its expected result, 1 14.00-14.10 Prof. P. Nymadawa general issue of TTX organization, moderator and group schedule) Public health emergency measures during 2 14.10-14.30 Dr. Burmaa inﬂ uenza pandemics and future objectives Health service emergency measures 3 by hospitals of all levels and future 14.30-14.50 Dr. Ts.Oyunchimeg objectives 4 Tea/coffee break 14.50-15.00 Multi-Sector Cooperation during 5 15.00-15.20 Ms. B.Delgermaa inﬂ uenza pandemics and future objectives 6 Discussion 15.20-16.00 Prof. P. Nymadawa 7 Wrap up 16.00-16.20 Prof. P. Nymadawa

ANNEX 6

Participants’ list of the workshop for TTX moderators on NIW-6, October 5, 2010

No Participants Organization Position 1. P. Nymadawa NCCD, Project team PI and Project director 2. R.Tuul NCCD, Project team Project manager 3. Ts. Oyunchimeg NCCD Deputy director for hospital services 4. L. Enkhbaatar NCCD, Project team Outreach supervisor 5. A. Burmaa NCCD, Project team Epidemiology team leader 6. O.Chuluunbaatar General Hospital No1, Head, Emergency department Senior Captain, Head, Training and policy 7. B.Uuganbayr NEMA division Second Captain, Senior ofﬁ cer for 8. B. Delgermaa NEMA communicable diseases, Senior Captain, Head, Communication 9. D.Ariundalai NEMA Information and Technology Devision 10 Sh.Enkhtor MCHRC Deputy director Head, “Manal Uils” Family Group Practices 11. B.Sarantuya, Khan-Uul District (FGP), Ulaanbaatar

78 Annexes

ANNEX 7 Program of the Sixth National Inﬂ uenza Workshop (NIW6), October 07-08, 2010, Ulaanbaatar, Mongolia

Venue: “Sunjin Grand” Hotel OCTOBER 07, 2010, THURSDAY

08:00-09:00 Registration

Opening Session, Chairpersons: Ass.Prof. N.Khurelbaatar, MD, PhD State Secretary, Ministry of Health, Government of Mongolia (MoH)

09:00-09:10 Opening Speech and Introduction of the Guests Ass.Prof. Dr.N.Khurelbaatar, MD, PhD State Secretary, MoH

09:10-09:20 Inaugural Speech H.E.Mr. M.Enkhbold, Vice Prime Minister, Government of Mongolia

09:20-9:30 Greeting H.E. Mr. S. Lambaa, PhD, Minister of Health, Government of Mongolia

09:30-09:40 Greeting Mr. N. Hill, Deputy Chief of Mission, US Embassy in Mongolia

09.40-09.50 Greeting Dr. Wiwat Rojanapithayakorn, MD, PhD WHO Representative in Mongolia,

09.50-10.20 Update on global Inﬂ uenza situation Dr. J. Partridge WHO, WPRO

79 B5265G1 Annual Report - 2010/2011

10:20-10:50 Announcements and Photo Session

10:50-11:20 Tea/Coffee Break

Plenary Session I Moderators: - Dr. D.Оrgil, DSc(Vet) Deputy Director, Department of Veterinary and Animal Breeding, Ministry of Food, Agriculture and Light Industry - Dr. D.Narangerel,MD, Public health care policy implementation and coordination department, MoH

11:20-11:50 Epidemiological surveillance results of A(H1N1) 2009 inﬂ uenza pandemics in Mongolia - Dr. D.Nyamkhuu, MD, PhD, Director, NCCD

11:50-12:20 Emergency actions by the Government of Mongolia to control A(H1N1) 2009 inﬂ uenza pandemics and future objectives - Mr. T.Badral, Commissioner, Deputy Chief, National Emergency Management Agency, Mongolia (NEMA)

12:20-12:50 Medical care emergency measure implemented during the inﬂ uenza pandemic by MoH - Dr. Ya.Аmarjargal, MD, Deputy-Director. Medical care policy implementation and coordination department, MoH

12:50-13:20 Modeling spread of inﬂ uenza in Mongolia- Identifying key determinant of transmission and optimal strategy for disease control - Dr.Jodie McVernon The University of Melbourne,Consultant, World Bank Project

80 Annexes

“Avian inﬂ uenza control and human pandemic inﬂ uenza” preparedness and response”

13:30-14:30 Lunch

14:30-18:00 Plenary Session II Moderator: Dr. D.Nyamkhuu, MD, PhD Director,NCCD

14:30-15:00 Medical care emergency measures during the inﬂ uenza pandemic on the recommendations of a WHO consultant - Dr. Sh.Enkhtor, MD Deputy director, MCHRC

15:00-15:30 Emergency measures implemented during the inﬂ uenza pandemics by the Health Department Selenghe Province and future objectives - Dr. J.Od,MD, Head, Health Department, Selenghe province

15:40-16:00 Emergency measures implemented during the inﬂ uenza pandemics by the Khan-Uul District Hospital, Ulaanbaatar and future objectives - Dr. D.Tsevelmaa, MD Chief medical ofﬁ cer, General Hospital, Khan- Uul District, Ulaanbaatar

16:00-16:30 Tea/Coffee Break

16:30-18:00 Plenary Session III Moderator: - Dr. D.Otgonbaatar , MD, PhD Director,NCNF

16:30-16:50 Internal and external quality assurances of inﬂ uenza laboratory activities, NCCD - Dr. B.Darmaa, MD,PhD Deputy Head, National Inﬂ uenza Center, Mongolia

81 B5265G1 Annual Report - 2010/2011

16:50-17:20 Inﬂ uenza Pandemic Preparedness Plan (IPPP) assessment results and future objectives - Dr. G.Surenkhand,MD Deputy director, NCCD

17:20-17:40 Avain inﬂ uenza A(H5N1) surveillance results in Mongolia - Mr. D.Batchuluun, Central Veterinary Laboratory, MoFALI, Mongolia

17:40-18:00 Discussion (Q/A)

OCTOBER 08, 2010, FRIDAY

9:00-14:00 TABLE TOP EXERCISES OF “EMERGENCY MEASURES IMPLEMENTED DURING INFLUENZA PANDEMICS”

I group: Public health emergency measures during inﬂ uenza pandemics and future objectives

Moderators: - Dr. G.Surenkhand, MD, Deputy director, NCCD - Dr. A. Burma, MD, MSc(Med), NCCD

II group: Health service emergency measures by hospitals of all levels and future objectives

Moderators: - Dr. Ts.Oyunchimeg, MD, Deputy Director, NCCD, - Dr. O.Chuluunbaatar, MD, General Hospital No1, Ulaanbaatar - Dr.Sh.Enkhtor, MD, MCHRC - Dr. B.Sarantuya, Head, ”Manal Uils” Family Group Practices (FGP), Ulaanbaatar

82 Annexes

III group: Multi-Sector Cooperation during inﬂ uenza pandemics and future objectives

Moderators: - Mr. B.Uuganbayr, Senior Captain, Head, Training and policy division, NEMA - Ms. B.Delgermaa, Second Captain, Senior ofﬁ cer for communicable diseases, NEMA - Mr. D.Ariundalai, Senior Captain, Head, Communication Information and Technology Devision, - Mr. G.Enk-Amar, Senior Leuitenent, Secretary National Emergency Comission, NEMA 11:00-11:30 Tea/Coffee Break

11:30-14:00 TABLE TOP EXERCISES OF “EMERGENCY MEASURES IMPLEMENTED DURING INFLUENZA PANDEMICS” (continuation)

14:00-15:00 Lunch

15:00-17:00 Plenary Session IY

Discussion on the Table Top Exercises (Q/A)

Моderator: - Dr. G.Surenkhand,MD Deputy director, NCCD - Mr. B.Uuganbayr, Senior Captain, Head, Ttraining and policy division, NEMA

17:00-17:30 Tea/Coffee Break

17:30-18:00 Closing Session

Discussion and adoption of the NIW6 Recommendations

Moderators: - Ass.Prof. N. Khurelbaatar, MD, PhD

83 B5265G1 Annual Report - 2010/2011

State Secretary, MoH - Dr. D.Nyamkhuu, MD, PhD Director,NCCD - Dr. D.Otgonbaatar , MD, PhD Director,NCNF - Mr.T.Badral, Commissioner,Vice Chief, NEMA, Mongolia

84 Annexes

ANNEX 8 Participants` list of the NIW5 October 7-8, 2010, Ulaanbaatar No Participant`s name organization Position S.Lambaa Ministry of health Minister of health N.Khurelbaatar Ministry of health State secretary Head, Public Health Policy Planning S.Tugsdelger Ministry of health Division Sh.Enkhbat Ministry of health Head D.Narangerel Ministry of health Senior offi cer, Policy Planning Division Deputy head, Health service Manage- Ya.Amarjargal Ministry of health ment Division Ch.Munkhdelger Ministry of health Director S.Enkhbold Ministry of health Director Wiwat R WHO Luo Dapeng WHO Medical offi cer O.Ariuntuya WHO Offi cer J.Partridge WHO B.Adyajav UB PIA M.Lkhagvasuren UB PIA D.Oyunchimeg NPIA Director A.Enkhtuya NPIA Inspector G.Bazardorj NPIA Inspector USA Embassy in D.Batsuvd Physician, Health division Mongolia USA Embassy in K.Burnett Head, Health division Mongolia USA Embassy in N.Hill Deputy Chief of Mission Mongolia USA Embassy in S. Russell Offi cer Mongolia USA Embassy in P.Darisuren Economic assistant Mongolia USA Embassy in V. D.Spera Economic/ Commercial Section Chief Mongolia National Emergency Ts.Amgalanbayar High Commissioner,Chief Management Agency National Emergency T.Badral Deputy chief Management Agency National Emergency B.Davaadorj Offi cer Management Agency National Emergency B.Delgermaa Offi cer Management Agency National Emergency S.Tsogtbaatar Chief of Division Management Agency

85 B5265G1 Annual Report - 2010/2011

National Emergency B.Uuganbayar Chief of Division Management Agency National Emergency D.Ariundalai Information technology Management Agency G.Enkh-Amar National Emergency Secretary Management Agency National Emergency U.Munkhchuluun Project offi cer Management Agency National Emergency N.Amgalan Project offi cer Management Agency National Emergency Project offi cer P.Bolortuya Management Agency National Emergency A.Enkhbat Offi cer Management Agency Capital Emergency Kh.Batbileg Management Head Department State Central Laboratory D.Batchuluun of Veterinary and Expert Hygiene State Central Laboratory Ts.Erdene-Ochir of Veterinary and Head Hygiene State Central Laboratory B.Bodisaikhan of Veterinary and Doctor Hygiene State Central Laboratory Sh.Tserendorj of Veterinary and Deputy Chief Hygiene State Central Laboratory S.Sugar of Veterinary and Laboratory Doctor Hygiene Animal breeding D.Orgil Offi cer department Animal breeding B.Bayartungalag Offi cer department Animal breeding D.Purevkhuu Offi cer department Veterinary Research J.Bekh-Ochir Scientist, Veterinary Research Institute Institute Veterinary Research B.Sarantuya Head, Virology laboratory Institute Veterinary Research J.Erdenebaatar Deputy director Institute D.Otgonbaatar NCIDNF Director D.Tserennorov NCIDNF Deputy director

86 Annexes

D.Tungalag NCIDNF Deputy director J.Oyunbileg PHI Director B.Saikhanchimeg PHI Head, Virology laboratory Mongolian Academy of B.Burmaa Scientifi c Secretary Science Mongolian Academy of D.Enkh-Amgalan Referent Science P.Bolor UNICEF Ch.Tungalag World bank Offi cer E.Altantulga MRCS Offi cer L.Oyun Health Department Chief of Division Capital Health S.Tuul Director Department Capital Health B.Oyunchimeg Epidemiologist Department Sh.Davaa DHL General manager N.Altantsetseg Air trans Offi cer Kh.Altankhuyag Air Mongolia Offi cer B.Selenge CIA Offi cer A.Sarantuya Media Education TV Ch.Bold Media Today newspaper Kh.Tsend-Ayush Media Daily newspaper M.Khangal Media True newspaper Yu.Gantumur Media Mongolian National TV B.Byambadorj General Hospital No1 Deputy Director D.Chuluunbaatar General Hospital No1 Head, Emergency Department Sh.Zorigoo General Hospital No3 Deputy Director G.Sanjdorj MCHRC Deputy Director for Hospital services Sh.Enkhtur MCHRC Deputy Director G.Navchaa National Cancer Center Deputy Director for Hospital services D.Altantsetseg Railway GH Deputy Director for Hospital services N.Nyamsuren Railway GH Epidemiologist D.Nyamkhuu NCCD General Director Ts.Oyunchimeg NCCD Deputy Director for Hospital services G.Surenkhand NCCD Deputy Director for Surveillance B.Tsatsralt-Od NCCD Deputy Director P.Nymadawa NCCD Project Director N.Tsend NCCD Consultant R.Oyungerel NCCD Scientifi c secretary M.Altankhuu NCCD Head, United laboratory dept D.Abmed NCCD Deputy head, United laboratory dept Ch.Munkhtsetseg NCCD Head A.Ambaselmaa NCCD Head, Surveillance dept

87 B5265G1 Annual Report - 2010/2011

J.Nyamsuren NCCD Head. Nosocomial infection division Ts.Enkhbayar NCCD Head, information technology team G.Tsetsegmaa NCCD Head of Division G.Tserendolgor NCCD Head of Division L.Enkhbaatar NCCD Project manager B.Gantsooj NCCD Project data manager R.Tuul NCCD Project manager A.Burmaa NCCD Head, ID Surveillance and research dept Ch.Urtnasan NCCD Epidemiologist Ts.Tagaandari NCCD Physician L.Dashtseren NCCD Epidemiologist B.Darmaa NCCD Head, Virology laboratory D.Enkhsaikhan NCCD Virologist S.Oyungerel NCCD Epidemiologist L.Oyuntsetseg NCCD Statistician Ts.Naranzul NCCD Virologist D.Tuul NCCD Financier N.Enkhtsetseg NCCD Doctor assistant E.Oyuntuya NCCD Doctor assistant D.Oyungerel NCCD Epidemiologist Ch.Maitsetseg NCCD Virologist U.Naranchimeg NCCD Laboratory assistant D.Otgonbayar NCCD Laboratory assistant S.Ganbaatar NCCD Inﬂ uenza project Health Science Ya.Dagvadorj Lecturer University Health Science G.Zulkhuu Lecturer University Health Science N.Khorolsuren Lecturer University Health Science S.Tsogtsaikhan Lecturer University Health Science O.Baatarkhuu Lecturer University D.Dagvasumberel Arkhangai province Head, Provincial Health Department N.Baasan Arkhangai province Epidemiologist J.Ariunaa Arkhangai province Head, Ar Mungun Chagnuur FGP A.Ariuntuya Arkhangai province Ofﬁ cer S.Saritex Bayan-Ulgii province Deputy Director N.Batai Bayan-Ulgii province Head, Provincial Health dept R.Bolat Bayan-Ulgii province Epidemiologist N.Bakhatan Bayan-Ulgii province Head, Neirm FGP D.Munkhsaihan Bulgan province Deputy Director

88 Annexes

S.Narantuya Bulgan province Head, Provincial Health dept S.Ariunaa Bulgan province Epidemiologist Deputy Director for Provincial Ya.Altankhundaga Bulgan province Emergency Management Branch B.Myadagkhand Bulgan province Head, Jargakhui FGP Sh.Toivgoo Bayankhongor province Deputy Director D.Algaa Bayankhongor province Head, Provincial Health dept B.Altanchimeg Bayankhongor province Epidemiologist N.Tserenkhorloo Bayankhongor province Head, Otoch nomgon FGP D.Dorjdagva Govi-Altai province Deputy Director S.Tsagaanbaatar Govi-Altai province Head, Provincial Health dept G.Suvdaa Govi-Altai province Epidemiologist D.Oyunchimeg Govi-Altai province Head, Enerelt-Altai FGP N.Khishigt Govi-Sumber province Deputy Director B.Tsetsegmaa Govi-Sumber province Head, Provincial Health dept B.Narantsetseg Govi-Sumber province Epidemiologist D.Puntsagkhorloo Govi-Sumber province Head, Enkh tus dem FGP D.Batsukh Darkhan-Uul province Deputy Director E.Enkhjargal Darkhan-Uul province Head, Provincial Health dept Ch.Ulziibayar Darkhan-Uul province Epidemiologist Г.Батбаяр Deputy Director, provincial emergency Darkhan-Uul province G.Batbayar management branch D.Byamba-Erdene Darkhan-Uul province Head, Virology laboratory D.Ganbold Darkhan-Uul province Head, Family clinic N.Doljin Dornod province Deputy Director D.Bolor Dornod province Epidemiologist Deputy Director, provincial emergency N.Narmandakh Dornod province management branch L.Khishigtogtokh Dornod province Deputy Ts.Azzaya Dornod province Head, Yagaan tseene FGP Ch.Tsetsegmaa Dornogovi province Chief G.Enkhtsetseg Dornogovi province Head, Provincial Health dept N.Ulziijargal Dornogovi province Epidemiologist B.Baigal Dornogovi province Head, Misheelt mana FGP S.Budjav Dundgovi province Deputy Director Ts.Enkhsaikhan Dundgovi province Head, Provincial Health dept N.Munguntsetseg Dundgovi province Epidemiologist J.Byambatsoo Dundgovi province Head, Ulziit manal FGP L.Lhamsuren Zavkhan province Deputy Director B.Dashdondov Zavkhan province Head, Provincial Health dept R.Chinzorig Zavkhan province Epidemiologist G.Otgonchimeg Zavkhan province Head, Durvun onoo FGP G.Bat-Ochir Uvs province Deputy Director

89 B5265G1 Annual Report - 2010/2011

D.Chimgee Uvs province Deputy director for hospital services G.Altantsoo Uvs province Epidemiologist Deputy Director, provincial emergency D.Ulziit Uvs province management branch B.Sumya Uvs province Head, Bat urjihui FGP S.Burenbat Selenge province Deputy Director G.Tugsjargal Selenge province Deputy Director N.Erdenedolgion Selenge province Epidemiologist D.Chimgee Selenge province Head, Nomt khaan FGP P.Tseren Tuv province Deputy Director L.Altantsetseg Tuv province Head, Provincial Health dept C.Nansalmaa Tuv province Epidemiologist L.Bujmaa Tuv province Ofﬁ cer D.Namsrai Khentii province Deputy Director R.Baigalmaa Khentii province Head, Provincial Health dept D.Baasandorj Khentii province Epidemiologist Ts.Khongorzul Khentii province Head, Kherlen dom FGP M.Ochirkhuyag Khuvsgul province Deputy Director L.Damdinsuren Khuvsgul province Head, Provincial Health dept B.Batdorj Khuvsgul province Epidemiologist D.Gereltuya Khuvsgul province Head, Family clinic J.Tsend-Ayush Khovd province Deputy Director B.Oyuntsetseg Khovd province Head, Provincial Health dept S.Bat-Ulzii Khovd province Epidemiologist M.Tsagaach Khovd province Head, Bugat FGP D.Khosbayar Sukhbaatar province Deputy Director B.Erdenetuya Sukhbaatar province Head, Provincial Health dept Ts.Gundegmaa Sukhbaatar province Epidemiologist N.Enkhmaa Sukhbaatar province Head, Temuulen FGP O.Batjargal Uvurkhangai province Deputy Director G.Narantsetseg Uvurkhangai province Deputy Director R.Narantsetseg Uvurkhangai province Epidemiologist Ya.Oyuntsetseg Uvurkhangai province Head, Tushig dulguun FGP Ch.Bayarjargal Umnugovi province Head, Provincial Health dept B.Byambajav Umnugovi province Epidemiologist A.Tsetsegmaa Umnugovi province Head, Enkhiin khuslen FGP D.Munhtulga Umnugovi province Deputy Director Kh.Purevdagva Orkhon province Deputy Director Deputy Director, provincial emergency G.Ganbaatar Orkhon province management branch G.Otgonbileg Orkhon province Epidemiologist B.Jargalsaikhan Orkhon province Head, Munkh sundrel FGP G.Gankhuyag Orkhon province Head, Provincial Health dept

90 Annexes

E.Erdenejargal Orkhon province Head, Virology laboratory O.Byambaa Sukhbaatar district Head, District Health Department G.Marziya Sukhbaatar district Epidemiologist Deputy Director, provincial emergency Yo.Amarbayasgalan Sukhbaatar district management branch T. Byuаnjargal Sukhbaatar district Deputy Director D.Pagma Sukhbaatar district Head, Enkhsunder FGP B.Altansuvd Sukhbaatar district Head, Sankoll FGP D.Tsetsegmaa Sukhbaatar district Head, Tegsh mend FGP Ts.Lkhagvaa Chingeltei district Deputy Director S.Tungalag Chingeltei district Head, District Health Department N.Bolor Chingeltei district Epidemiologist Deputy Director, provincial emergency A.Damdindorj Chingeltei district management branch D.Tsetsegsaikhan Chingeltei district Head, Tegsh ulzii FGP B.Otgonbayar Chingeltei district Head, Uils negten FGP E.Tserendolgor Chingeltei district Head, Shijiddvg FGP Songinokhairkhan O. Enkhtyua Deputy Director district Songinokhairkhan A.Erdenetuya Head, District Health Department district Songinokhairkhan Sh.Narantuya Epidemiologist district A.Dugardorj Songinokhairkhan Deputy Director, provincial emergency district management branch Songinokhairkhan D.Altantsetseg Head, Buyant manal FGP district Songinokhairkhan Ch.Unursaikhan Head, Enkh-elberel FGP district Songinokhairkhan N.Sugarsuren Head, Unu-achit FGP district N.Oyunmend Bayangol district Deputy Director E.Boditsetseg Bayangol district Head, District Health Department S.Ulziijargal Bayangol district Epidemiologist Deputy Director, provincial emergency P.Battogtokh Bayangol district management branch T.Khishigsuren Bayangol district Head, Gurvan sanchir FGP A.Tsend-Ayush Bayangol district Head, Itgel ugtakh FGP J.Lkhagvasuren Bayangol district Head, Shar degd FGP N. Jantsan Bayanzurkh district Deputy director for hospital services P.Puntsag Bayanzurkh district Head, District Health Department B.Oyunchimeg Bayanzurkh district Epidemiologist Deputy Director, emergency J.Ganzorig Bayanzurkh district management branch

91 B5265G1 Annual Report - 2010/2011

M.Altankhuyag Bayanzurkh district Head, Eruul urkh FGP N.Bayarmaa Bayanzurkh district Head, Amgalan itgekhui FGP Ch.Tserennadmid Bayanzurkh district Head, Nasan urt FGP S.Tsevelmaa Khan-uul district Deputy director for hospital services E.Buyanmandakh Khan-uul district Head, District Health Department I.Oyunchimeg Khan-uul district Epidemiologist Deputy Director, emergency O.Ganbat Khan-uul district management branch D.Narantsetseg Khan-uul district Head, Enkh titem FGP B.Sarantuya Khan-uul district Head, Manal uils FGP D.Tuul Khan-uul district Head, Amin tus FGP B.Ulziisaikhan Nalaikh district Head, District Health Department Sh.Yanjmaa Nalaikh district Epidemiologist Deputy Director, emergency Kh.Damjin Nalaikh district management branch D.Chuluuntsetseg Nalaikh district Head, Ami erdene FGP S.Gereltsetseg Baganuur district General physician T.Bolormaa Baganuur district Head, District Health Department Ts.Khandtsoo Baganuur district Epidemiologist Deputy Director, emergency S.Tsendsuren Baganuur district management branch R.Ganchimeg Baganuur district Head, Enerelt ulzii FGP Ch.Erdenechimeg Baganuur district Head, Bivaangird FGP Kh.Unurjargal Baganuur district Head, Enkh urkh FGP Yo.Tsetsegee Baganuur district Head, Ach elberel FGP I.Od Baganuur district General physician, Enerelt ulzii FGP Kh.Ganbat Bagakhangai district Head, District Health Department Deputy Director, emergency M.Dashpuntsag Bagakhangai district management branch

92 Annexes

ANNEX 9

National Inﬂ uenza Workshop 6 (NIW 6) recommendations

We, the participants of NIW6, - expressing our satisfaction with the measures taken by the Government and its concerned institutions, especially the hard work of the health care sector to overcome challenges of the current infl uenza pandemics; - thanking international organizations and foreign Governments that rendered timely support for pandemic preparedness and measures to control public health emergencies during pandemics; and - concerning the continuing shortfalls of emergency medical resources in regards to public health emergencies in the country; are recommending: 1. to continue with analysis of the outcomes of measures taken during the pandemic, including health and economic consequences, to extract lessons for addressing possible future public health emergencies; 2. to improve step-by-step the emergency medical services for respiratory failure shortcomings which have been uncovered during the pandemics; 3. to ensure the sustainable development of the established capacity and infrastructure for sentinel surveillance of infl uenza and for pandemic preparedness, and to use its examples for the development of surveillance capacities for other emerging and re-emerging infectious diseases; 4. to improve risk communication, 5. to consider developing sound policy for seasonal infl uenza vaccination, 6. to continue the surveillance of infl uenza viruses circulating among wild and domesticated birds, pigs and other animals, which have a well-documented role in the emergence of highly pathogenic new reassortant viruses; Participants of the NIW6, Ulaanbaatar, Mongolia, 8 October 2010

93 B5265G1 Annual Report - 2010/2011

ANNEX 10

Laboratory reagents and other consumables received in Inﬂ uenza Laboratory in the ﬁ scal year of 2009/2010

Total price, No Description Quantity USD 1. QIAGEN QIAamp OneStep RT-PCR kit for 100 reaction 40 30,960.0 Invitrogen (SuperScript TM III One-Step RT-PCR with 2. 32 24,864.0 Platinum® Tag) for 100 reaction 3. QIAGEN QIAamp Viral RNA Mini kit (250) 7 9,261.0 HealthLink UTM medium for the transport of viruses, with 4. 36 7,200.0 swab (50) HIGH FIVE, A+Aloe Powder-Free Nitrile Exam Gloves, 5. 20 500.0 box of 100, M HIGH FIVE, A+Aloe Powder-Free Nitrile Exam Gloves, 6. 20 500.0 box of 100, L 7. Thermolyne, Type 37600 Mixer, Vortex 2 950.0 8. QIAGEN, VacConnectors (500) 3 534.0 9. AccuPower Quantitative PCR kits 3 2,395.8 10. AccuPrep Viral RNA Kit 20 8,998.00 11. AccuPrep Viral DNA Kit 4 1,799.6 12. Isoprophinal 2 41.8 Dry Bath and shaker MS-100 with heating bloks: 13. 96x0.2ml, 54x0.5 ml, 35x1.5ml, 35x2.0ml, 15x0.5 3 9,570.00 ml+20x1.5ml, 24xDia.≤φ12mm tube, 12x15ml Falcon 14. Primers 95 9,032.10 15. Rapid test for AB, 25 test 100 17,600.00 16. AccuPrep PCR Puriﬁ cation Kit 4 255.20 17. ExiPrep Viral DNA/RNA Kit Lot 0941K 40 27,280.00 The NA-Star® Influenza Neuraminidase Inhibitor 18. Resistance Detection Kit, 960 tests, with 10x96 well 5 14,025.00 microplates 19. FTD respiratory pathogens test 2 8,140.00 20. FTD FLU test 2 3,146.00 Enzyme FTD kits, AgPath-ID TM One-step RT-PCR 21. 2 6,270.00 reagent, 1000 tests 22. R-Mix ready cell 55 7,260.00 23. E-Mix ready cell 38 10,450.00

94 Annexes

24. MicroAmp Optical 96-Well Reaction Plate 10 2,277.00 25. Electronic Pipettor, Single-channel (5-100) 1 691.90 26. Electronic Pipettor, Eight-channel (5-100) 1 1,278.20 27. PCR machine 1 7,700 28. Polymer POP 07 For 3130 x 1.28ml 2 2,420.0 29. Invitrogen, Rnase OUT Ribonuclease inhibitor 3 1,419.0 Dulbecco’s Modifi ed Eagle Medium (D-MEM) high 30. glucose (1X), liquid, with L-glutamine, without sodium 5 1,575.0 pyruvate 31. Fetal Bovine Serum, ES Cell-Qualifi ed 2 1,470.0 32. Trypsin, 0.05% (1X) with EDTA 4Na, liquid 25 500.0 33. Penicillin-Streptomycin, liquid 10 360.0 34. Gentamicin Reagent Solution (10 mg/ml), liquid 1 185.0 35. DyeEx 2.0 Spin Kit (50) 15 4,650.0 36. QIAamp Viral RNA Mini Kit 4 7,760.0 37. 100 bp DNA ladder 3 600.0 Corning® cell culture fl ask, 25 cm2, Working volume 38. 5 3,650.0 10ml, canted neck, vented cap, sterile 39. Brand PCR-sealing mat, for 96-well plates 5 pcs/pack, TPE 20 880.00 40. FTD Respiratory Pathogens kit 11 44,770.0 41. 24 well cell culture plate 2 550.0 42. Brand Pipette tips (2-20μl) 5 605.0 43. RNaseOUT Ribonuclease Inhibitor 1 430.0 3х1x2 44. GLB /5ml/ 480.0 /4-6/ 45. 100-bp Plas Ladder 3 1440.0 46. Gentamycin (10ml) 2 440.0 47. Fungizone (100ml) 1/5 250 1 48. Paper Reorder #89-0038-01 4 Rolls (BioImaging system) 330.0 4/1 HIGH FIVE, A+Aloe Powder-Free Nitrile Exam Glove, 49. 15 600.0 box of 100, M HIGH FIVE, A+Aloe Powder-Free Nitrile Exam Glove, 50. 10 400.0 box of 100, L . Total 288,743,60

95 B5265G1 Annual Report - 2010/2011

ANNEX 11

Laboratory and ofﬁ ce equipment received in VL/NCCD in the ﬁ scal year of 2009/2010

Total price, No Description Quantity USD 1. Mini refrigerator 45 5,850.00 2. PCR machine 1 7,700.00 3. Thermometer 50 210.00 4. Electric cord 3 38.00 5. Printer cartridge 16 721.00 6. PC mouse 1 9. 00 Computer (DELL 760MTV, 19” Wide LCD DELL, 7. 1 1,361.54 C2D 3.0Ghz, 250Gb HDD SATA, 2Gb RAM) 8. Microphon (SALAR M8) 2 13.00 9. USP (OPTI DS3000B-RM UPS, On-Line) 1 1,039.00 10. Bookcase 1 184.50 11. Bookcase (base) 1 109.00 12. Bookcase (glass) 1 118.00 13. Chair 4 230.00 14. Refrigerator 1 461.00 15. Copier (CANON iR2018) 1 2,055.00 16. UPS (OPTI PS2200B/ 2200В) 1 660.00 17. Switch (16 port, TP-Link) 1 55.00 18. FDF 1 89.00 19. Optic converter 1 155.00 20. Firewall (Linksys BEFSX41) 1 150.00 21. Rack 1 70.00 22. Transfer hard disk (320Gb, StoreJet) 2 278.00 23. UPS (OPTI PS2200B/ 2200В) 2 1,128.40 24. UPS (OPTI TS1000B UPS / 1000В) 1 85.60 25. Bookstand 1 179.00 26. Microwave oven 1 107.00 27. Paper 70 300.00 28. Stationary - 63.00 29. Payment of ABI maintenance service 1 23,452.00 30. Electrical connection of VL with generator - 2,374.00 TOTAL, USD 46,870.64

96 Annexes

ANNEX 12 Laboratory and offi ce equipment received in VL/NCCD in the fi scal year of 20101/2011 Total price No Description Quantity USD 7500 Fast Real-Time PCR System with Dell™Tower 1 7500 Fast Real-Time PCR Sequence Detection Software and 1 75,000.00 Spectral Dye Calibration Kit 1 2 Table for ABI 7500 rtPCR 1 123.00 3 ACER M275 computer 1 653.00 4 UPS 2 228.00 5 Table 1 58.00 6 Dell L13 Notebook 1 1,800.00 7 DVD reader+writer (Transcend, external USB, TS8XDVDRW) 1 76.00 8 Earphone with microphone (Panasonic, RP-HM221GU) 1 22.00 9 Mouse (Geniue, Micro traveler 300LS) 1 29.00 10 ACER table computer 1 746.00 11 Paper 110 508.00 12 L-550 centrifuge motor 1 392.00 13 Printer cartridge 16 615.00 14 Color Printer cartridge 4 400.00 15 Dell Optilex PC 1 1,076.00 16 UPS 1 73.00 17 Switch 1 69.00 18 Wireless router 1 30.00 19 RJ45 Connector 1 4.00 20 Dell PC computer 1 915.00 21 UPS 1 100.00 22 DELL Vostro notebook 1 1077.00 23 Laptop case 1 42.00 34 USB mouse 1 16.00 35 Offi ce table 4 862.00 36 Offi ce chair 5 289.00 37 Book shelf 4 219.00 38 Lock 2 28.00 39 Electric cord 4 56.00 40 TOTAL - 85,506.00

97 B5265G1 Annual Report - 2010/2011

ANNEX 13 Laboratory reagents and other consumables received in Inﬂ uenza Laboratory in the ﬁ scal years of 2010/2011 Total price No Description Quantity USD 1 FTD Respiratory Pathogens kit 11 44,770.00 2 24 well cell culture plate 2 550.00 3 Brand Pipette tips (2-20μl) 5 605.00 U12: CTG ATC TAG ACC TGC AGG CTC AGC AAA AGC 4 1 33.00 AGG U13: CGT GGT ACC ATG GTC TAG AGT AGT AGA AAC 5 1 33.00 AAGG 6 RNaseOUT Ribonuclease Inhibitor 1 430.00 7 GLB /5ml/ 3х1x2 480.00 8 100-bp Plas Ladder 3 1,440.00 9 Gentamycin (10ml) 2 440.00 10 Fungizone (100ml) 1/5 250.00 11 Paper Reorder #89-0038-01 4 Rolls (BioImaging system) 4/1 330.00 HIGH FIVE, A+Aloe Powder-Free Nitrile Exam Glove, box of 12 15 600.00 100, M HIGH FIVE, A+Aloe Powder-Free Nitrile Exam Glove, box of 13 10 400.00 100, L SuperScript III Platinum One-Step Quantitative RT-PCR 14 6 17,653.68 System (500rxn) 15 One-Step RT-PCR kit (100rxn) 10 3,088.80 16 ExiPrep Viral DNA/RNA kit 20 12,387.32 17 24 well cell culture plate 1 275.00 18 Brand Pipette tips (2-20μl) 10 1,210.00 19 Binding column tubes for K-3033, 100ea, 2ml/1.5ml 40 6,606.60 20 Isopropanol 500ml 3 62.70 21 Flexible NP minitip, 50pcs*1 10 2,621.74 22 Inf.A Real-time RT-PCR kit, 96test 4 3,430.24 23 New Inf.A Real-time RT-PCR kit, 96test 4 4,580.56 24 H1N1 Real-time RT-PCR kit, 96test 4 3,430.24 25 H3N2 Real-time RT-PCR kit, 96test 4 3,430.24 26 MyGenie 96 Gradient Thermal Block 1 8,800.00 HIGH FIVE, A+Aloe Powder-Free Nitrile Exam Glove, box of 27 15 600.00 100, M HIGH FIVE, A+Aloe Powder-Free Nitrile Exam Glove, box of 28 10 400.00 100, L 29 NucliSENS Magnetic Extract Reagent 48 tests 5 1,875.00 30 NucliSENS Lysis Buffer 48 tests 5 650.00 31 NucliSENS Microtubes 1.5 ml with caps 500 pcs 1 222.00 32 FTD Respiratory Pathogens kit 21 11 53,595.60 33 AgPath-ID™ One-Step RT-PCR kit 1 2,495.78 34 Bigdye Terminator v3.1 Cycle Sequencing Kit 3 5,149.09 35 10X Genetic Analysis buffer with EDTA 1 733.86

98 Annexes

36 3130 POP-7 Performance Optimized Polymer 2 1,668.02 37 DyeEx 2.0 Spin Kit 1 1,259.46 38 50-cm 3130xl Capillary Array 1 2,445.04 39 NA-Star Detection Microplates 10x96-well 6 1,450.45 40 H3N2 Real time RT-PCR kit 6 4,705.70 41 New Inf.A(H1N1) Real time RT-PCR kit 6 6,300.87 42 Inﬂ uenza A Real time RT-PCR kit 8 6,282.80 43 AccuPrep Viral RNA Kit 6 2,414.97 44 Isoprophinal 2 41.80 45 ExiPrep Viral DNA/RNA kit 15 8,591.12 46 Brand Pipette tips (0.5-10μl) 10 2,035.00 47 Brand Pipette tips (2-20μl) 10 2,035.00 48 Brand Pipette tips (5-200μl) 10 2,035.00 49 Accu-Jet pro pipete controlier 2 1,553.61 50 Platinum® Blue PCR SuperMix 2 531.83 51 QIAamp DNA Mini Kit (250) 1 1,102.70 52 10 mM dNTP Mix 2 259.01 53 FluA Forward(5’-GAC CRA TCC TGT CAC CTC TGA C-3’) 1 220.00 54 FluA Reverse(5’-GGCATTYTGGACAAAKCGTCTAC-3’) 1 220.00 55 H1 Forward(5’-AGCAAAAGCAGGGGAAAATAA-3’) 1 220.00 56 H1 Reverse(5’-GCTATTTCTGGGGTGAATCT-3’) 1 220.00 57 B Forward(5’-AGCAGAAGCGTTGCATTTTC-3’) 1 220.00 58 B Reverse(5’-ACCAGCAATAGCTCCGAAGA-3’) 1 220.00 59 H3 Forward(5’-AGCAAAAGCAGGGGATAATTC-3’) 1 220.00 60 H3 Reverse(5’-TGCCTGAAACCGTACCAACC-3’) 1 220.00 61 Forward 5' -TGT AAA ACG ACG GCC AGT -3' 1 220.00 62 Reverse 5' -CAG GAA ACA GCT ATG ACC -3' 1 220.00 63 24 well tissue culture plate 2 515.41 64 15 mL centrifuge tubes 10 8,682.85 65 Cry tube 1 660.94 66 Trypsin EDTA (0,05%) Trypsin /100ml/ 4 77.62 67 100bp DNA Ladder 2 172.97 68 Cell culture freezing medium /50ml/ 4 1,149.04 69 Dimethyl sulfoxide minimum 99,5GC /100ml/DMSO 1 135.80 70 MEM (1x) Minimum Essential medium 500ml 5 301.00 71 L-Glutamine-200 mM 2 26.67 HIGH FIVE, A+ Aloe Powder- Free Nitrile Exam Glove, Box 72 10 643.57 of 100,M HIGH FIVE, A+ Aloe Powder- Free Nitrile Exam Glove, Box 73 10 643.57 of 100,L 74 Effendorf tube (1.8ml x 1 x 500) 10 572.00 75 TOTAL 244,153.27

99 B5265G1 Annual Report - 2010/2011

ANNEX 14

Programme of training of trainers for “Flu Information System” software, April 14, 2010

No Topic Time Responsible person

1. Registeration 08:30-09:00 B.Gantsooj

2. Opening 09:00-09:10 P.Nymadawa

3. Instruction of FIS 09:10-09:30 P.Batmunkh

4. Entry specimens data 09:30-10:30 P.Batmunkh

5. Entry ILI data 10:30-11:30 P.Batmunkh

6. Cofee/tea break 11:30-11:50 B.Gantsooj

7. Entry sARI data 11:50-13:00 P.Batmunkh

8. Lunch 13:00-14:00 B.Gantsooj

9. Reportong system 14:00-15:00 P.Batmunkh

10. Practice 15:00-17:00 P.Batmunkh

100 Annexes

ANNEX 15

Participants list of the training of trainers on the “Flu Information System” software April 14, 2010

Nî Name Organization Position 1. Ts. Naranzul NIC virologist 2. S. Tsatsral NIC virologist 3. B. Gantsooj NCCD Project data manager 4. B. Munkhabayar NCCD Computer engineer 5. A. Tsoggerel NCCD Computer engineer 6. Ts. Batsuuri NCCD Information engineer 7. N. Bayasgalan NIC Technician 8. B. Bold-Erdene NCCD Assistant epidemiologist 9. B. Oyuntuya NCCD Assistant epidemiologist 10. Ch. Maitsetseg NIC Virologist 11. G. Nyamaa NIC Virologist 12. U. Naranchimeg NCCD Lab assistant 13. B. Uyanga NCCD Virologist 14. J. Soyolmunkh NCCD Lab assistant 15. R. Tuul NCCD Project manager 16. L. Enkhbaatar NCCD Project outreach manager 17. A. Burmaa NCCD Epidemiologist 18. Ch. Urtnasan NCCD Epidemiologist 19. B. Darmaa NIC Head, laboratory

101 B5265G1 Annual Report - 2010/2011 ANNEX 16 uenza Center, Center, uenza fl percent and services legitimate units information to the distribute web-site and distribute them of aimak center and Used every day and administrative unites to other organizations to other organizations Reports received from Receive feedback from Timeliness of reporting Timeliness appropriate departments accounts for more than 95 National In more than 95 percent of all uenza Center uenza fl units level of organization Receive feedback from Timeliness of reporting Timeliness Used ones a week at the and distribute them to the local health organizations National In Reports received from 80– 95 percent of all legitimate accounts for 90–95 percent LEVEL uenza Center, Center, uenza fl units level of organization to other organizations to other organizations Used sometimes at the Receive feedback from Timeliness of reporting Timeliness but do not distribute them National In Reports received from 50– 80 percent of all legitimate accounts for 50–90 percent 1 uenza Reporting Assessment tools uenza Reporting uenza fl fl In 0123 Center percent Do not use legitimate units accounts for up to 50 up to 50 percent of all Reports received from Timeliness of reporting Timeliness from National In Do not receive feedback (B) (D) (A) (C) Feedback INFLUENZA INFLUENZA Flu.mn web site use

Timeliness of reporting Timeliness

CAPABILITY 1: CAPABILITY Completeness of report Completeness of report SURVEILLANCE Indicators Family group practices, soum hospitals, other organizations 1

102 Annexes ected fl line system into budget. information. ected into budget. fl conference (Skype). update and use them re with computer use are Internet connects with constantly. There is an constantly. appropriate programme Communicates with cell constantly, Costs related constantly, They have data base and high speed and functions Report by web-based on- Also, the organize audio- Also, the organize that arranges the data and with internet are re have computers that meet requirements. Costs related phone, telephone or e-mail. More than 90% of all sitess b/sec for more than 50 computers. К . 5 , but not 4 ciently. ciently. fi constantly (not on-line) requirements. Report by e-mail cient speed cient fi computers that meet use them suf to lack of appropriate Internet connected with 80-90% of all sites have Communicates with cell They have data base and suf However, many users do However, not use the data base due programme that arranges the data and information. phone, telephone or e-mail LEVEL LEVEL b/sec for 11-50 computers, and 1024 b/sec for 11-50 . К 3 ciently fi suf requirements Report by e-mail Internet connected should have internet but can not use them phone and telephone They have data base, of all computers meet computers. Up to 70% with low speed, but not constantly. Persons who constantly. 50-80% of all sites have Communicates with cell connection do not have it. b/sec for 1-10 computers, 512 К cient when it did not function more than one time for longer 5 days during last 3 months. fi 0123 0123 Not exists have computers. 2 Report by telephone, sites Up to 50 percent of all No internet connection cient as follows: 256 written format (by post) fi They have any data base

(B) (B) (A) (C) (A) Internet Data base Communication Reporting system Computer provision CAPABILITY 2: CAPABILITY CAPABILITY 3: CAPABILITY

REPORTING SYSTEM REPORTING Indicators TECHNICAL CAPACITY TECHNICAL Indicators Internet speed will be considered suf All ISSSs of aimaks. If the computers are purchased during last 5 years, it will be considered that they meet requirements. Internet connection will be considered not suf 2 3 4 5

103 B5265G1 Annual Report - 2010/2011

ANNEX 17

Programme of Training Seminar for the Team Members of Inﬂ uenza Reporting Assessment, April 23, 2010

Responsible Nî Topic Time person 1 Registration 13:30 – 14.00 L.Enkhbaatar 2 Opening 14:00-14:10 P.Nymadawa Introduction of assessment guidelines and 3 14.10-14.30 L.Enkhbaatar preliminary work plan in all aimaks and districts Assessment procedure and methodology of 4 14:30-15:00 L.Enkhbaatar IBIRS at the ISSSs Assessment results of ISSSs activities in 2009 5 15.00-15.30 R.Tuul and the ﬁ rst quarter of 2010 Guidelines regarding the implementation of 6 15.30-16.00 B.Gantsooj IBIRS software. 7 Open Discussion, questions / answers 16.00-16.30 P.Nymadawa

ANNEX 18

Participants list of Training Seminar for Inﬂ uenza Reporting Assessment, April 23, 2010

Nî Name Organization Position 1 A.Burmaa NCCD, Respiratory disease surveillance unit Head 2 B.Darmaa NIC, Laboratory Head 3 L.Dashtseren NCCD Epidemiologist 4 N.Tsend NCCD Consultant 5 Ts.Oyunchimeg NCCD Deputy director 7 B.Gantsooj NIC Data manager 8 U.Munkhchuluun NEMA Ofﬁ cer 9 Ch.Urtnasan NCCD Epidemiologist 10 TS.Naranzul NIC, Laboratory Virologist 11 G.Nyamaa NIC, Laboratory Virologist 12 Ts.Batsuuri NCCD, communication unit Engineer 13 A.Tsoggerel NCCD, National surveillance unit Data manager 14 B.Munkhbayar NCCD, information technology unit Program mist 15 L.Enkhbaatar NIC Outreach manager

104 Annexes

ANNEX 19

The list of Assessment Team Members groups

Names and Occupations of the Duration of Groups Assessment sites Team Members assessment time Ch. Urtnasan (Group leader, Govi-Altai, NCCD, epidemiologist) Khovd, Bayan- L. Enkhbaatar (Project outreach May 12–22, 2010, Group 1 Ulgii, Uvs, manager) 11 days Zavkhan, B. Gantsooj (Project data manager, Tosontsengel web master) Khentii, Ts. Naranzul (Group leader, NCCD, Dornod, virologist) Sukhbaatar, May 12–22, 2010, Group 2 G. Nyamaa (NCCD, virologist) Dorno-Gobi, 11 days B. Munkhbayar (NCCD, Govi-Sumber, Information Technology Unit) Zamiin-Uud Ts. Naranzul (Group leader, NCCD, Darkhan-Uul, ВСЛ) Selenghe, April 26 to May 6, Group 3 N. Tsend (NCCD, consultant) Orkhon, 2010, 11 days A. Tsoggerel (NCCD, National Bulgan, Surveillance Unit) Khuvsgul B. Darmaa (Group leader, NCCD, Tuv, Dund-Gobi, Head, Inﬂ uenza laboratory) Umnu-Gobi, April 26 to May 8, Group 4 L. Dashtseren (NCCD, Bayan-khongor, 2010, 13 days epidemiologist) Uvurkhangai, Ts. Batsuuri (NCCD, engineer) Arkhangai

Ch.Urtnasan (Group leader, NCCD, epidemiologist) 9 districts of April 26-29, 2010, Group 5 L. Enkhbaatar (outreach manager) Ulaanbaatar city 3 days B. Gantsooj (data manager, web master)

105 B5265G1 Annual Report - 2010/2011

ANNEX 20

Detailed Inﬂ uenza Reporting Capacity Assessment results nationwide, 2010

Capability 2 Capability 1 Capability 3 Reporting Inﬂ uenza surveillance Technical capacity system

Aimaks and Health Districts organizations use report Repor Internet reporting provision Feedback Data-base Computer ting system Timeliness of Timeliness Flu.mn web site Communication Completeness of Health 2.00 2.00 1.00 1.00 0.00 1.00 0.00 0.00 1.00 Department General Arkhangai 2.00 2.00 1.00 1.00 0.00 1.00 1.00 1.00 1.00 Hospitals Family Group 2.20 2.20 0.40 0.20 0.00 1.00 0.00 0.00 1.00 Practices Average 2.14 2.14 0.57 0.43 0.00 1.00 0.14 0.14 1.00 Health 2.00 3.00 2.00 3.00 0.00 0.00 2.00 2.00 1.00 Department General Bayan-Ulgii 2.00 3.00 2.00 0.00 0.00 0.00 0.00 0.00 1.00 Hospitals Family Group 3.00 3.00 0.00 0.00 0.00 0.00 1.50 0.00 1.00 Practices Average 2.67 3.00 0.67 0.50 0.00 0.00 1.33 0.33 1.00 Health 3.00 2.00 2.00 3.00 0.00 1.00 0.00 2.00 2.00 Department Bayan- General 2.00 2.00 2.00 1.00 0.00 1.00 1.00 1.00 2.00 khongor Hospitals Family Group 3.00 2.33 0.17 0.67 0.17 1.00 1.00 0.17 1.50 Practices Average 2.88 2.25 0.63 1.00 0.13 1.00 0.88 0.50 1.63 Health 3.00 3.00 2.00 2.00 0.00 2.00 2.00 0.00 1.00 Department General Bulgan 2.00 3.00 0.00 1.00 0.00 2.00 2.00 1.00 1.00 Hospitals Family Group 3.00 1.00 1.00 0.67 0.00 0.33 0.67 0.67 1.00 Practices Average 2.80 1.80 1.00 1.00 0.00 1.00 1.20 0.60 1.00

106 Annexes

Health 3.00 2.00 2.00 3.00 0.00 2.00 0.00 2.00 2.00 Department General Gobi-Altai 3.00 3.00 1.00 1.00 0.00 2.00 2.00 2.00 1.00 Hospitals Family Group 1.25 2.50 1.00 1.25 0.00 1.75 2.00 1.25 1.00 Practices Average 1.83 2.50 1.17 1.50 0.00 1.83 1.67 1.50 1.17 Health 3.00 3.00 1.00 1.00 0.00 0.00 0.00 1.00 2.00 Department General Gobisumber 3.00 2.00 1.00 1.00 0.00 0.00 0.00 0.00 2.00 Hospitals Family Group 3.00 2.50 0.00 1.00 0.00 0.00 1.00 0.50 1.50 Practices Average 3.00 2.50 0.50 1.00 0.00 0.00 0.50 0.50 1.75 Health 3.00 3.00 1.00 1.00 0.00 2.00 3.00 3.00 1.00 Department General Darkhan-Uul 3.00 3.00 0.00 2.00 0.00 2.00 2.00 1.00 2.00 Hospitals Family Group 2.80 2.60 1.60 0.80 0.20 1.00 1.00 1.40 1.60 Practices Average 2.86 2.71 1.29 1.00 0.14 1.29 1.43 1.57 1.57 Health 3.00 3.00 3.00 2.00 0.00 2.00 1.00 1.00 2.00 Department General Dornogobi 3.00 3.00 2.00 3.00 0.00 3.00 3.00 3.00 2.00 Hospitals Family Group 3.00 2.40 2.80 1.80 0.20 1.00 0.40 1.60 1.80 Practices Average 3.00 2.57 2.71 2.00 0.14 1.43 0.86 1.71 1.86 Health 3.00 3.00 3.00 3.00 0.00 2.00 2.00 3.00 2.00 Department General Dornod 3.00 3.00 2.00 3.00 0.00 1.00 1.00 2.00 2.00 Hospitals Family Group 3.00 3.00 2.33 1.00 0.00 0.00 2.00 0.67 1.33 Practices Average 3.00 3.00 2.40 1.80 0.00 0.60 1.80 1.40 1.60 Health 2.00 2.00 2.00 2.00 0.00 1.00 2.00 2.00 2.00 Department General Dundgobi 3.00 3.00 1.00 0.00 0.00 1.00 0.00 1.00 1.00 Hospitals Family Group 2.33 3.00 1.00 0.33 0.00 1.00 0.67 0.00 1.00 Practices Average 2.40 2.80 1.20 0.60 0.00 1.00 0.80 0.60 1.20

107 B5265G1 Annual Report - 2010/2011

Health 3.00 2.00 1.00 3.00 0.00 3.00 0.00 3.00 2.00 Department General Zabkhan 3.00 2.50 0.00 0.00 0.00 0.50 1.00 1.00 1.00 Hospitals Family Group 2.86 2.86 0.00 0.14 0.00 0.00 1.43 0.14 1.00 Practices Average 2.90 2.70 0.10 0.40 0.00 0.40 1.20 0.60 1.10 Health 2.00 2.00 2.00 0.00 0.00 2.00 1.00 1.00 2.00 Department General Orkhon 3.00 3.00 1.00 0.00 0.00 2.00 2.00 2.00 2.00 Hospitals Family Group 2.75 2.00 1.83 1.75 0.00 1.17 0.33 0.92 1.25 Practices Average 2.71 2.07 1.79 1.50 0.00 1.29 0.50 1.00 1.36 Health 3.00 3.00 2.00 2.00 0.00 2.00 1.00 1.00 2.00 Department General Uvurkhangai 3.00 2.50 1.50 1.50 0.00 1.00 1.00 1.50 2.00 Hospitals Family Group 2.67 2.83 0.67 0.83 0.00 1.33 1.17 0.67 1.00 Practices Average 2.78 2.78 1.00 1.11 0.00 1.33 1.11 0.89 1.33 Health 3.00 2.00 2.00 2.00 0.00 1.00 1.00 1.00 2.00 Department General Umnu-gobi 2.00 2.00 2.00 0.00 0.00 1.00 1.00 0.00 1.00 Hospitals Family Group 2.33 2.67 0.00 0.00 0.00 1.00 1.00 0.00 1.00 Practices Average 2.40 2.40 0.80 0.40 0.00 1.00 1.00 0.20 1.20 Health 2.00 2.00 2.00 2.00 0.00 2.00 1.00 1.00 3.00 Department General Sukhbaatar 3.00 3.00 0.00 0.00 0.00 0.00 0.00 0.00 1.00 Hospitals Family Group 2.67 2.33 2.33 0.00 0.00 0.00 0.00 0.00 1.00 Practices Average 2.60 2.40 1.80 0.40 0.00 0.40 0.20 0.20 1.40 Health 3.00 3.00 1.00 1.00 0.00 2.00 2.00 1.00 2.00 Department General Selenghe 3.00 3.00 1.00 1.00 0.00 2.00 3.00 3.00 1.00 Hospitals Family Group 2.83 3.00 1.00 0.17 0.00 0.00 1.67 0.17 1.33 Practices Average 2.88 3.00 1.00 0.38 0.00 0.50 1.88 0.63 1.38

108 Annexes

Health 2.00 2.00 2.00 2.00 0.00 1.00 1.00 0.00 0.00 Department General Tuv 3.00 2.00 2.00 2.00 0.00 1.00 1.00 1.00 2.00 Hospitals Family Group 2.50 1.50 1.50 0.00 0.00 1.00 0.25 0.00 1.00 Practices Average 2.50 1.67 1.67 0.67 0.00 1.00 0.50 0.17 1.00 General 3.00 2.00 1.00 2.00 0.00 1.00 2.00 3.00 2.00 Hospitals Family Group Uvs 3.00 3.00 0.00 1.00 0.00 1.00 2.00 1.00 1.00 Practices Health 2.25 2.75 0.00 0.00 0.00 0.50 0.75 0.25 1.00 Department Average 2.50 2.67 0.17 0.50 0.00 0.67 1.17 0.83 1.17 Family Group 3.00 3.00 2.00 2.00 0.00 1.00 1.00 2.00 1.00 Practices Health Khovd 3.00 3.00 2.00 2.00 0.00 1.00 2.00 1.00 1.00 Department General 3.00 3.00 1.00 0.00 0.00 0.00 1.20 0.40 1.00 Hospitals Average 3.0 3.00 1.29 0.57 0.00 0.29 1.29 0.71 1.00 Health 3.00 2.00 2.00 0.00 0.00 1.00 1.00 2.00 1.00 Department General Khuvsgul 3.00 3.00 0.00 1.00 1.00 2.00 3.00 3.00 2.00 Hospitals Family Group 2.67 2.67 1.67 0.17 0.00 0.67 1.17 1.50 1.50 Practices Average 2.75 2.63 1.50 0.25 0.13 0.88 1.38 1.75 1.50 General 3.00 2.00 2.00 2.00 0.00 0.00 1.00 2.00 2.00 Hospitals Family Group Khentii 3.00 2.00 2.00 0.00 0.00 0.00 1.00 1.00 1.00 Practices Health 3.00 3.00 2.33 1.33 0.00 0.00 1.00 0.67 1.33 Department Average 3.00 2.60 2.20 1.20 0.00 0.00 1.00 1.00 1.40 Average of aimaks 2.71 2.52 1.20 0.88 0.03 0.85 1.03 0.83 1.31 District Health 3.00 3.00 3.00 1.00 0.00 1.00 2.00 2.00 1.00 Center District Bayangol Hospital Family Group 3.00 3.00 1.00 0.33 0.00 0.00 1.67 1.33 1.00 Practices Average 3.00 3.00 1.50 0.50 0.00 0.25 1.75 1.50 1.00

109 B5265G1 Annual Report - 2010/2011

District Health 3.00 2.00 0.00 0.00 0.00 0.00 2.00 3.00 2.00 Center District Bayanzurkh 3.00 3.00 3.00 1.00 0.00 2.00 3.00 3.00 2.00 Hospital Family Group 3.00 3.00 1.67 1.00 0.00 0.67 1.67 2.00 1.67 Practices Average 3.00 2.80 1.60 0.80 0.00 0.80 2.00 2.40 1.80 District Health 3.00 3.00 3.00 0.00 0.00 1.00 0.00 0.00 1.00 Center District Sukhbaatar 3.00 3.00 2.00 2.00 0.00 1.00 3.00 3.00 1.00 Hospital Family Group 3.00 3.00 3.00 1.33 0.00 0.33 1.00 1.33 1.33 Practices Average 3.00 3.00 2.80 1.20 0.00 0.60 1.20 1.40 1.20 District Health 3.00 3.00 2.00 0.00 0.00 2.00 0.00 2.00 1.00 Center District Chingeltei 3.00 3.00 0.00 1.00 0.00 0.00 1.00 0.00 1.00 Hospital Family Group 3.00 2.00 1.67 0.33 0.00 1.00 0.33 0.00 1.00 Practices Average 3.00 2.40 1.40 0.40 0.00 1.00 0.40 0.40 1.00 District Health 3.00 3.00 2.00 2.00 0.00 0.00 1.00 2.00 2.00 Center District Khan-Uul 3.00 3.00 2.00 2.00 0.00 0.00 2.00 2.00 2.00 Hospital Family Group 3.00 3.00 1.00 1.00 0.00 0.00 1.67 1.00 1.00 Practices Average 3.00 3.00 1.40 1.40 0.00 0.00 1.60 1.40 1.40 District 3.00 3.00 2.00 3.00 0.00 2.00 2.00 2.00 1.00 Hospital Songino- Family Group 3.00 3.00 1.00 2.00 0.00 2.00 3.00 3.00 3.00 Khairkhan Practices District Health 3.00 2.33 1.00 0.00 0.00 0.33 1.67 1.00 1.00 Center Average 3.00 2.60 1.20 1.00 0.00 1.00 2.00 1.60 1.50 Family Group 3.00 3.00 2.00 2.00 0.00 0.00 0.00 1.00 1.00 Practices District Health Baganuur 3.00 3.00 3.00 3.00 0.00 2.00 0.00 1.00 1.00 Center District 2.75 2.75 2.00 1.50 0.00 0.50 1.50 1.25 1.25 Hospital Average 2.83 2.83 2.17 1.83 0.00 0.67 1.00 1.17 1.17

110 Annexes

District Health 3.00 3.00 2.00 1.00 0.00 0.00 1.00 0.00 1.00 Center Nalaikh Family Group 3.00 3.00 2.00 2.00 1.00 1.00 2.00 3.00 1.00 Practices Average 3.00 3.00 2.00 1.50 0.50 0.50 1.50 1.50 1.00 District Health Bagakhangai 2.00 2.00 1.00 1.00 0.00 1.00 2.00 2.00 1.00 Center Reference Centers 3.00 3.00 1.40 2.00 0.00 0.40 2.00 2.60 2.20 Average of Ulaanbaatar 2.95 2.81 1.70 1.19 0.02 0.60 1.49 1.56 1.38

Total average 2.76 2.59 1.32 0.95 0.03 0.80 1.14 1.00 1.33

111 B5265G1 Annual Report - 2010/2011

ANNEX 21

Programme of the FIS Software training, September 22-23, 2010

No Topic Time Responsible person

1 Registeration 8.30-9.00 B.Gantsooj Introduction of NCCD Director’s order 2 9.00-9.30 L.Enkhbaatar NoA/67 3 About FIS software 9.30-10.00 B.Gantsooj

4 Drills 10.00-11.00 B.Gantsooj

5 Coffee break 11.00-11.15 U.Naranchimeg

6 Drills 11.15-12.00 B.Gantsooj

7 Lunch 12.00-13.00 U.Naranchimeg

8 Drills 13.00-15.00 B.Gantsooj

9 Coffee break 15.00-15.15 U.Naranchimeg

10 Skype software utilization 15.15-16.00 B.Gantsooj

112 Annexes

ANNEX 22

Participants list of the FIS Software training, September 22-23, 2010

No Name District Organization Position 1 M.Munkhjargal BGD Shar degd FGP Nurse 2 J.Lkhagvasuren BGD Shar degd FGP Head of FGP 3 S.Erdenechimeg BGD Itgel ugtakh Nurse 4 S.Battsetseg BGD Itgel ugtakh Doctor 5 T.Khishigsuren BGD Gurvansanchir Head of FGP 6 D.Dangaasuren BGD Gurvansanchir Nurse 7 S.Bayarmaa BZD Amgalan itgelkhui Head of FGP 8 G.Bolormaa BZD Amgalan itgelkhui Nurse 9 Ch.TSerenchimed BZD Nasan urt Head of FGP 10 Ch.Azjargal BZD Nasan urt Statistician 11 M.Altankhuyag BZD Eruul urkh Head of FGP 12 E.Baigalmaa BZD Eruul urkh Statistician 13 S.Enkhjargal SBD Tegsh mend Doctor 14 D.Jargalsaikhan SBD Tegsh mend Nurse 15 Pagma SBD Enkhsunder Head of FGP 16 Tod SBD Enkhsunder Nurse 17 B.Altansuvd SBD Sanкoll Head of FGP 18 B.Dulmaa SBD Sanкoll Nurse 19 J.Dolgormaa KhUD Manal uils Nurse 20 D.Erdenetuyaa KhUD Manal uils Nurse 21 Munkhtsetseg KhUD Amin tus Doctor 22 Bolormaa KhUD Amin tus Nurse 23 P.Ankhtuyaa KhUD Enkhtitem Doctor 24 S.Ichinkhorloo KhUD Enkhtitem Nurse 25 A.Tugssain SkhD Buyant mandal Doctor 26 A.Munkhtsetseg SkhD Buyant mandal Nurse 27 G.Narantsatsral SkhD Enkhelberel Doctor 28 B.Baasansuren SkhD Enkhelberel Nurse 29 J.Durevnyam SkhD Unu achit Doctor 30 Udval SkhD Unu achit Nurse 31 TS.Dorjkhand ChD Uils negten Doctor 32 Baigalmaa ChD Uils negten Nurse 33 Ts.Tserendolgor ChD SHejid-dug Head of FGP 34 J.Gerelmaa ChD SHejid-dug Nurse

113 B5265G1 Annual Report - 2010/2011

35 D.Tsetsegsaikhan ChD Tegsh ulzii Doctor 36 Ts.Bayarmaa ChD Tegsh ulzii Nurse 37 Bayan BGD Hospital Epidemiologist 38 Naran BGD Hospital Statistician 39 Shinekhuu BGD Hospital Epidemiologist 40 Batzayaa BGD Hospital Statistician 41 Oyunchimeg BZD Hospital Epidemiologist 42 Oyungerel BZD Hospital Statistician 43 Javzan BZD Hospital Epidemiologist 44 Saikhantuv BZD Hospital Statistician 45 T.Marziyaa SBD Hospital Epidemiologist 46 E.Tungalag SBD Hospital Statistician 47 Otgonbaatar SBD Hospital Epidemiologist 48 Odgerel SBD Hospital Statistician 49 Oyuunchimeg KhUD Hospital Epidemiologist 50 Tuyaa KhUD Hospital Statistician 51 Bolormaa KhUD Hospital Epidemiologist 52 Munkhtsetseg KhUD Hospital Statistician 53 Narantuya SkhD Hospital Epidemiologist 54 Baigalmaa SkhD Hospital Statistician 55 A.Delgerbayar SkhD Hospital Epidemiologist 56 G.Delgersuren SkhD Hospital Statistician 57 Ch.Battsetseg ChD Hospital Epidemiologist 58 Ganshur ChD Hospital Statistician 59 Z.TSetsegmaa ChD Hospital Epidemiologist 60 Tsevelmaa ChD Hospital Statistician 61 D.Myadagmaa UB General hospital No1 Epidemiologist 62 U.Oyuunchimeg UB General hospital No1 Statistician 63 Amartuvshin UB General hospital No3 Epidemiologist 64 Bolormaa UB General hospital No3 Statistician 65 D.Erdenetsetseg UB NCC Epidemiologist 66 J.Batsaikhan UB NCC Statistician 67 Otgonchimeg UB MCHRC Epidemiologist 68 Gantuyaa UB MCHRC Statistician 69 Oyuungerel UB NCCD Epidemiologist 70 Oyuuntsetseg UB NCCD Statistician

114 Annexes

ANNEX 23

Assessment results of the FGP-based ISSSs in the capital city and provinces, in 2009

Sent Virus Viruses samples detected Nî FGPs samples ILI cases % % Number of Number Mean scores score score score Result of 2008 number

1 “Manal uils” KhUD 383 86 27 3 22.5 4 31.4 4 2.25 3.31 2 “Uils negten” ChD 1332 161 49 5 12.1 2 30.4 4 2.25 3.31 3 “Hadan khui” Selenge 360 109 22 3 30.3 5 20.2 3 1.75 3.19 4 “Emnekh” Selenge 148 51 13 2 34.5 5 25.5 3 2.63 3.16 5 “Shardegd” BGD 389 122 19 2 31.4 5 15.6 2 3.25 3.06 6 “Amgalan Itgehui” BZD 698 159 22 3 22.8 4 13.8 2 3.25 3.06 7 “Enerelt ulzii” BND 1097 125 29 3 11.4 2 23.2 3 3.50 2.88 8 “Tegsh mend” SBD 998 151 26 3 15.1 3 17.2 2 3.00 2.75 9 “Itgel ugtah” BGD 539 144 12 2 26.7 4 8.3 1 3.50 2.63 10 “Bivaangird” BND 904 109 25 3 12.1 2 22.9 3 2.50 2.63 11 Nasan Urt” BZD 1495 183 34 4 12.2 2 18.6 2 2.25 2.56 12 “Amin tus” KhUD 1140 136 23 3 11.9 2 16.9 2 3.25 2.56 13 “Buyant manal” SHD 1586 153 24 3 9.6 2 15.7 2 2.88 2.47 14 “Shijed dug” ChD 1618 186 23 3 11.5 2 12.4 2 2.63 2.41 15 “Nomt khan” Selenghe 329 49 14 2 14.9 3 28.6 3 1.63 2.41 16 “Enkh sunder” SBD 1161 223 18 2 19.2 3 8.1 1 3.38 2.35 17 “Ach Elberel” BND 1149 101 29 3 8.8 1 28.7 3 2.13 2.28 18 “Rashaant” Khovd 213 10 3 1 4.7 1 30.0 4 3.13 2.28 19 “Tegsh ulzii” ChD 1477 110 21 3 7.4 1 19.1 2 3.00 2.25 20 “Enh urh” BND 425 55 16 2 12.9 2 29.1 3 2.00 2.25 “Narny dush” 21 515 90 10 2 17.5 3 11.1 2 1.88 2.22 Uvurkhangai 22 “Enkh elberel” SHD 1156 139 15 2 12.0 2 10.8 2 2.63 2.16 “Enkhiin khurd” 23 1222 87 22 3 7.1 1 25.3 3 1.63 2.16 Uvurkhangai 24 “Enerelt naran” Darhan 942 134 14 2 14.2 2 10.4 2 2.50 2.13 25 “Enkh titem” KhUD 1187 236 11 2 19.9 3 4.7 1 2.50 2.13 26 “Sancoll” SBD 1083 95 28 3 8.8 1 29.5 3 1.25 2.06 27 “Jargalant” Khovd 214 2 1 1 0.9 0 50.0 5 2.13 2.03 28 “Ami erdene” ND 2102 188 22 3 8.9 1 11.7 2 1.75 1.94

115 B5265G1 Annual Report - 2010/2011

29 “Gurvan sanchir” BGD 2014 107 17 2 5.3 1 15.9 2 2.25 1.81 30 “Unu achit” CHD 1467 114 18 2 7.8 1 15.8 2 2.25 1.81 31 “Eruul urkh” BZD 1180 88 15 2 7.5 1 17.0 2 2.00 1.75 “Misheelt mana” 32 572 64 9 1 11.2 2 14.1 2 1.88 1.72 Dornogobi 33 “Itgeliin ereld” Orkhon 407 42 6 1 10.3 2 14.3 2 1.88 1.72 34 “Bugat” Khovd 544 14 5 1 2.6 0 35.7 4 1.88 1.72 35 “Anhnii och” Orkhon 340 39 5 1 11.5 2 12.8 2 1.63 1.66 36 “Baatarkhairkhan” Khovd 422 12 4 1 2.8 0 33.3 4 1.63 1.66 37 “Gereltei” Darkhan 954 133 3 1 13.9 2 2.3 1 2.50 1.63 “Tushigdulguun” 38 1403 93 13 2 6.6 1 14.0 2 1.38 1.60 Uvurkhangai 39 “Niitsel “Orkhon 371 37 5 1 10.0 2 13.5 2 1.25 1.56 40 “Zuvlukh bag” Selenghe 356 37 7 1 10.4 2 18.9 2 1.25 1.56 “Uyan setgel” 41 1705 154 14 2 9.0 1 9.1 1 2.00 1.50 Uvurkhangai 42 “Tuvshinkholboo” Darkhan 1658 138 10 2 8.3 1 7.2 1 1.75 1.44 43 “Uchraltbayar” Orkhon 717 25 6 1 3.5 0 24.0 3 1.75 1.44 44 “Gerelt mandakh” Orkhon 649 32 4 1 4.9 1 12.5 2 1.75 1.44 45 “Aminholboo” Darkhan 1161 138 3 1 11.9 2 2.2 1 1.63 1.41 46 “Tumur zam” Dornogobi 1153 35 9 1 3.0 0 25.7 3 1.38 1.35 47 “Gos hot” Darkhan 3062 178 6 1 5.8 1 3.4 1 2.25 1.31 48 “Agatova” Dornogobi 1029 71 6 1 6.9 1 8.5 1 2.25 1.31 49 “Munkhiin gerel” Orkhon 992 66 4 1 6.7 1 6.1 1 2.13 1.28 50 “Mendbulag” Orkhon 478 41 3 1 8.6 1 7.3 1 1.75 1.19 51 “Goyomend” Dornogobi 810 69 5 1 8.5 1 7.2 1 1.50 1.13 52 “Munkhsundrer” Orkhon 1242 61 5 1 4.9 1 8.2 1 1.50 1.13 53 “Khoschagnuur” Orkhon 547 26 1 1 4.8 1 3.8 1 1.38 1.10 54 “Uilsbadrakh” Orkhon 1864 107 9 1 5.7 1 8.4 1 1.25 1.06 55 “Achlalt nar” Orkhon 1075 25 3 1 2.3 0 12.0 2 1.25 1.06 56 “Dornii ireedui” Dornod 1711 22 4 1 1.3 0 18.2 2 1.13 1.03 57 “Tseene tsetse” Dornod 801 11 2 1 1.4 0 18.2 2 1.00 1.00 “Myanganjargalan” 58 814 14 2 1 1.7 0 14.3 2 1.00 1.00 Dornod 59 “Buyant” Khovd 261 10 0 1 3.8 0 0.0 1 1.75 0.94 60 “Asralt uils” Dornod 638 21 2 1 3.3 0 9.5 1 1.63 0.91 61 “Elberelt uils” Orkhon 1112 46 2 1 4.1 0 4.3 1 1.50 0.88 62 “Eruul zun” Dornod 735 20 1 1 2.7 0 5.0 1 1.13 0.78 63 “Yagaan tseene” Dornod 1867 17 1 1 0.9 0 5.9 1 1.13 0.78 Total 61973 5501 781 8.9 14.2

116 Annexes

ANNEX 24

Assessment results of the ISSSs of the province and district hospitals in 2009

Number of Virus Viruses samples detected Result Mean Nî Hospitals of 2008 scores score score score number number number HU, District General 1 302 5 27 4 8.9 1 3.75 3.44 Hospital 2 BZ, DGH 295 5 24 4 8.1 1 3.38 3.35 3 DO, AGH 89 1 32 5 36.0 5 1.63 3.16 4 DA, AGH 77 1 33 5 42.9 5 1.38 3.10 5 SE, AGH 166 3 30 5 18.1 2 2.00 3.00 6 BN, DGH 109 2 23 4 21.1 3 2.75 2.94 7 DG, AGH 159 3 18 3 11.3 1 3.75 2.69 8 SB, DGH 209 4 10 1 4.8 1 3.50 2.38 9 KhO, AGH 126 2 24 4 19.0 2 1.38 2.35 10 UV, AGH 162 3 16 2 9.9 1 3.13 2.28 11 Ch, DGH 111 2 19 3 17.1 2 1.50 2.13 12 SH, DGH 122 2 15 2 12.3 1 2.50 1.88 13 BG, DGH 49 1 9 1 18.4 2 1.25 1.31 14 OR, NE 87 1 8 1 9.2 1 1.38 1.10 Total 2063 288 14.0

117 B5265G1 Annual Report - 2010/2011

ANNEX 25

Assessment results of the I category FGP-based ISSSs in the capital city and provinces in the ﬁ rst quarter, 2010

Sent Virus Viruses samples detected FGPs of Districts and ILI No Provinces cases samples % % Number of Number Mean scores Mean scores score score score Result of 2008 number Uvurkhangai, Narnii 1 319 27 17 5 8.5 1 63.0 5 2.22 3.31 dush Uvurkhangai, 2 1100 32 17 5 2.9 0 53.1 5 2.13 3.03 Enhiin khurd 3 BGD, Shardegd 277 19 10 3 6.9 1 52.6 5 3.06 3.02 4 Darkhan, Gereltei 520 29 11 4 5.6 1 37.9 4 1.63 2.66 5 KhUD, Amintus 784 34 11 4 4.3 1 32.4 3 2.56 2.64 6 Orhon, Uchralt bayar 391 15 12 4 3.8 0 80.0 5 1.44 2.61 7 KhUD, Manal Uils 275 14 6 2 5.1 1 42.9 4 3.31 2.58 8 BGD, Gurvansanchir 873 14 7 3 1.6 0 50.0 5 1.81 2.45 9 BZD, Eruul urh 1326 18 9 3 1.4 0 50.0 5 1.75 2.44 10 Uvurhangai, Uyan setgel 1199 28 12 4 2.3 0 42.9 4 1.5 2.38 11 Darhan, Amin holboo 768 32 13 4 4.2 0 40.6 4 1.41 2.35 12 ChD, Shijiddug 525 33 8 3 6.3 1 24.2 3 2.41 2.35 13 SBD, Enkhsunder 375 26 9 3 6.9 1 34.6 3 2.35 2.34 14 SHD, Enkh elberel 709 20 8 3 2.8 0 40.0 4 2.16 2.29 15 BZD, Amgalan itgekhui 722 35 7 3 4.8 1 20.0 2 3.06 2.27 16 Orkhon, Uils badrakh 1404 14 7 3 1.0 0 50.0 5 1.06 2.27 17 Khovd, Bugat 499 4 4 2 0.8 0 100.0 5 1.72 2.18 18 Orkhon, Anhnii och 281 5 5 2 1.8 0 100.0 5 1.66 2.17 19 BZD, Nasan Urt 879 23 8 3 2.6 0 34.8 3 2.56 2.14 20 Orkhon, Itgeliin gerel 323 6 3 1 1.9 0 50.0 5 1.72 1.93 21 BGD, Itgel ugtah 186 21 3 1 11.3 2 14.3 2 2.63 1.91 Uvurkhangai, Tushig 22 1085 23 8 3 2.1 0 34.8 3 1.6 1.90 dulguun 23 SHD, Buyant manal 1263 38 9 3 3.0 0 23.7 2 2.47 1.87 24 Orkhon, Munhiin gegee 663 4 2 1 0.6 0 50.0 5 1.28 1.82 25 Orkhon, Mendbulag 414 13 5 2 3.1 0 38.5 4 1.19 1.80 26 SkhD, Unu achit 580 13 4 2 2.2 0 30.8 3 1.81 1.70 27 ChD, Uilsnegten 603 13 2 1 2.2 0 15.4 2 3.31 1.58 28 Khovd, Rashaant 379 4 1 1 1.1 0 25.0 3 2.28 1.57 29 Dornogobi, Goyomend 654 8 3 1 1.2 0 37.5 4 1.13 1.53

118 Annexes

Nalaikh 30 665 25 4 2 3.8 0 16.0 2 1.94 1.49 Ami Erdene 31 BND, Enerelt Ulzii 456 12 2 1 2.6 0 16.7 2 2.88 1.47 32 SBD, Tegsh mend 329 13 3 1 4.0 0 23.1 2 2.75 1.44 33 Khovd, Baatarhairhan 249 10 3 1 4.0 0 30.0 3 1.66 1.42 34 Darkhan, Tuvshin holboo 1037 9 3 1 0.9 0 33.3 3 1.44 1.36 35 Darkhan, Gos hot 2426 30 5 2 1.2 0 16.7 2 1.31 1.33 36 BND, Ach elberel 629 14 2 1 2.2 0 14.3 2 2.28 1.32 37 ChD, Tegsh ulzii 659 21 3 1 3.2 0 14.3 2 2.25 1.31 38 Selenghe, Hadan hui 131 2 0 1 1.5 0 0.0 1 3.19 1.30 39 Selenghe, Emneh bag 69 2 0 1 2.9 0 0.0 1 3.16 1.29 40 Darkhan, Enerelt naran 595 25 3 1 4.2 0 12.0 2 2.13 1.28 41 KhUD, Enkh titem 920 21 3 1 2.3 0 14.3 2 2.13 1.28 42 Khovd, Buyant 311 3 1 1 1.0 0 33.3 3 0.94 1.24 43 Orkhon, Elberelt uils 750 10 3 1 1.3 0 30.0 3 0.88 1.22 44 BND, Bivaangird 680 10 1 1 1.5 0 10.0 1 2.63 1.16 45 Selenghe, Zuvlukh 236 6 1 1 2.5 0 16.7 2 1.56 1.14 46 Selenghe, Nomt khan 162 1 0 1 0.6 0 0.0 1 2.41 1.10 47 Dornogobi, Agatova 613 5 1 1 0.8 0 20.0 2 1.31 1.08 48 BND, Enkh urkh 378 9 1 1 2.4 0 11.1 1 2.25 1.06 49 SBD, Sankoll 562 21 2 1 3.7 0 9.5 1 2.06 1.02 50 Khovd, Jargalant 120 0 0 1 0.0 0 1 2.03 1.01 Dornogobi, Misheelt 51 344 2 0 1 0.6 0 0.0 1 1.72 0.93 mana 52 Orkhon, Niitsel 273 1 0 1 0.4 0 0.0 1 1.56 0.89 53 Orkhon, Gerelt mandakh 145 0 0 1 0.0 0 1 1.44 0.86 Dornogobi, 54 752 0 0 1 0.0 0 1 1.35 0.84 Tumur zam 55 Orkhon, Munh syndrel 659 0 0 1 0.0 0 1 1.13 0.78 Orkhon, 56 155 0 0 1 0.0 0 1 1.1 0.78 Khos chagnuur Orkhon, 57 407 0 0 1 0.0 0 1 1.06 0.77 Achlalt nar 58 Dornod, Dornii ireedui 133 0 0 1 0.0 0 1 1.03 0.76 Dornod, 59 753 0 0 1 0.0 0 1 1 0.75 Myngan jargalan 60 Dornod, Tseene tsetseg 21 0 0 1 0.0 0 1 1 0.75 61 Dornod, Asralt uils 626 0 0 1 0.0 0 1 0.91 0.73 62 Dornod, Eruul zon 75 0 0 1 0.0 0 1 0.78 0.70 63 Dornod, Yagaan tseene 1376 0 0 1 0.0 0 1 0.78 0.70 64 Orkhon, Tsagaan agi 334 0 0 1 0.0 0 1 0.67 Total 37406 817 262 2.2 32.1

119 B5265G1 Annual Report - 2010/2011

ANNEX 26

Assessment results of the II category FGP-based ISSSs in the capital city and provinces in the ﬁ rst quarter, 2010

Sent Virus Viruses samples detected ILI Nî FGPs cases samples % % Number of Number Mean scores score score score Results of 2009 number

1 Bulgan, Tsoojid 288 20 8 5 6.9 1 40.0 5 2.33 3.33 2 Bulgan, Jargakhui 450 15 7 5 3.3 0 46.7 5 2.33 3.08 3 Bulgan, Emiin tsetseglen 425 15 8 5 3.5 0 53.3 5 1.33 2.83 Dundgobi, Borjigon 5 718 4 2 2 0.6 0 50.0 5 3.67 2.67 mandal 4 Tuv, Nomt enerelt ach 409 14 5 4 3.4 0 35.7 4 2.67 2.67 8 Tuv, Delgerlaks 630 3 3 2 0.5 0 100.0 5 1.67 2.17 6 Umnugobi, Shine bileg 582 2 2 2 0.3 0 100.0 5 1.33 2.08 9 Dundgobi, Ulziit mandal 722 2 1 1 0.3 0 50.0 5 2 2.00 7 Tuv, Binderya 628 3 2 2 0.5 0 66.7 5 1 2.00 10 Khentii , Oyunii shim 1204 6 2 2 0.5 0 33.3 4 1.33 1.83 Gobisumber, Enkh tus 11 559 8 2 2 1.4 0 25.0 3 2 1.75 dem 12 Tuv, Baruun zuun mod 491 3 1 1 0.6 0 33.3 4 1.33 1.58 13 Khentii, Ach manal 771 4 1 1 0.5 0 25.0 3 0.67 1.17 14 Khentii, Kherlen dom 1039 5 1 1 0.5 0 20.0 3 0.67 1.17 Dornogobi, Zamiin uud 16 1592 0 0 1 0.0 0 1 2.33 1.08 ambulatori Khar Khorin, 24 213 0 0 1 0.0 0 1 2.33 1.08 Enerelt ach 15 Gobisumber, Tumur zam 412 0 0 1 0.0 0 1 1.33 0.83 Dundgobi, Suvraga 17 334 0 0 1 0.0 0 1 0.67 0.67 erdene 18 Umnugobi, Unu orshih 458 0 0 1 0.0 0 1 0.67 0.67 Umnugobi, Enkhiin 19 661 0 0 1 0.0 0 1 0.67 0.67 khyslen 20 Selenghe, Batuu 467 0 0 1 0.0 0 1 0.67 0.67 21 Selenghe, Bayan 437 0 0 1 0.0 0 1 0.67 0.67

120 Annexes

Selenghe, Mandal 22 48 0 0 1 0.0 0 1 0.67 0.67 ambulatori 23 Selenghe, Tokhuugos 348 0 0 1 0.0 0 1 0.67 0.67 Kharhorin, 25 284 0 0 1 0.0 0 1 0.67 0.67 Enerelt kharkhorin 26 Khuvsgul, Buyan 608 0 0 1 0.0 0 1 0.67 0.67 27 Khuvsgul, Dalai elberel 995 0 0 1 0.0 0 1 0.67 0.67 28 Khuvsgul, Delger murun 974 3 0 1 0.3 0 0.0 1 0.67 0.67 29 Khuvsgul, Tulga 570 0 0 1 0.0 0 1 0.67 0.67 30 Khuvsgul, Enerel 794 0 0 1 0.0 0 1 0.67 0.67 31 Khuvsgul, Erchim 467 0 0 1 0.0 0 1 0.67 0.67 Total 18582 112 45 0.6 40.2

121 B5265G1 Annual Report - 2010/2011

ANNEX 27

Assessment results of the III category FGP-based ISSSs in the capital city and provinces in the ﬁ rst quarter, 2010

Result Number Number of report of IV Mean Nî FGPs of week quarter, average Number Persent Score 2009 1 Uvs, Bat-Urjikhui 12 12 100.0 5 1.33 3.17 2 Baynkhongor, Narmandal 12 11 91.7 4 2 3.00 Baynkhongor, Otoch 3 12 11 91.7 4 2 3.00 nomgon 4 Baynkhongor, Enkhburd 12 11 91.7 4 2 3.00 5 Bayn-Ulgii, Jansayan 12 12 100.0 5 0.67 2.84 6 Bayn-Ulgii, Neirm 12 12 100.0 5 0.67 2.84 7 Bayn-Ulgii, Ravan 12 12 100.0 5 0.67 2.84 8 Bayn-Ulgii, Chinagen 12 12 100.0 5 0.67 2.84 9 Baynkhongor, Suprisor 12 11 91.7 4 1.67 2.84 10 Zavkhan, Binder garav 12 12 100.0 5 0.67 2.84 11 Zavkhan, Namchin namba 12 12 100.0 5 0.67 2.84 12 Zavkhan, Tos ambulatori 12 12 100.0 5 0.67 2.84 13 Uvs, Dun tsagaan 12 12 100.0 5 0.67 2.84 14 Uvs, Munkhbishrelt 12 12 100.0 5 0.67 2.84 15 Uvs, Elbeg uguuj 12 12 100.0 5 0.67 2.84 16 Arkhangai, Armandal 12 11 91.7 4 0.67 2.34 Arkhangai, Ar mungun 17 12 11 91.7 4 0.67 2.34 chagnuur 18 Arkhangai, Ar munkhjin 12 11 91.7 4 0.67 2.34 19 Arkhangai, Ar rashaant 12 11 91.7 4 0.67 2.34 20 Arkhangai, Ar enkhjin 12 11 91.7 4 0.67 2.34 Baynkhongor, Otoch 21 12 11 91.7 4 0.67 2.34 mandal 22 Baynkhongor, EBSU 12 11 91.7 4 0.67 2.34 23 Sukhbaatar, Temuulen 12 11 91.7 4 0.67 2.34 24 Gobi-Altai, Jargalan altai 12 10 83.3 3 0.67 1.84 25 Gobi-Altai, Maral Altai 12 10 83.3 3 0.67 1.84

122 Annexes

26 Gobi-Altai, Enerel Altai 12 10 83.3 3 0.67 1.84 27 Zavkhan, Durvun Onoo 12 10 83.3 3 0.67 1.84 Zavkhan, Naran munkhiin 28 12 10 83.3 3 0.67 1.84 alba 29 Sukhbaatar, Enerel 12 10 83.3 3 0.67 1.84 30 Sukhbaatar, Enkhjin 12 9 75.0 2 0.67 1.34 31 Gobi-Altai, Enkh altai 12 8 66.7 1 0.67 0.84 32 Zavhan, Mezkall 12 8 66.7 1 0.67 0.84 33 Zavkhan, Nad sel mamba 12 8 66.7 1 0.67 0.84 Zavkhan, Enh khugjil 34 12 8 66.7 1 0.67 0.84 naran Total 408 365 89.5

ANNEX 28

Assessment results of the I category ISSSs of the province and district hospitals in the ﬁ rst quarter, 2010

Virus Samples Viruses detected Result Mean Nî Hospitals of scores 2009 % score Score Score Score number number 1 Dornogobi AGH 69 5 23 5 33.3 5 3 4.42 2 BZ DGH 70 5 18 4 25.7 4 3 4.09 3 Orkhon AGH 44 3 16 4 36.4 5 1 3.28 4 HU DGH 64 5 8 2 12.5 2 3 3.11 5 SB DGH 46 4 10 3 21.7 3 2 3.10 6 SH DGH 42 3 12 3 28.6 4 2 2.97 7 Dornod, AGH 22 2 6 2 27.3 4 3 2.79 8 Selenghe, AGH 34 3 6 2 17.6 3 3 2.75 9 Khovd, AGH 33 3 5 2 15.2 3 2 2.59 10 Ch DGH 28 2 5 2 17.9 3 2 2.28 11 Darkhan-Uul, AGH 13 1 3 1 23.1 4 3 2.28 12 BN, DGH 14 1 2 1 14.3 2 3 1.74 13 Uvurkhangai, AGH 8 1 0 1 0.0 1 2 1.32 14 BG, DGH 12 1 0 1 0.0 1 1 1.08 Total 47 4 5 2 10.6 2

123 B5265G1 Annual Report - 2010/2011

ANNEX 29

Assessment results of the II category ISSSs of the province and district hospitals in the ﬁ rst quarter, 2010

Virus Samples Viruses detected Result Mean Nî Hospatals of 2009 scores % score Score Score Score number number 1 Dundgobi, AGH 41 5 16 5 39.0 4 2 4.08 2 Umnugobi, AGH 13 2 5 2 38.5 4 3 2.67 3 Kharkhorin, GH 2 1 1 1 50.0 5 2 2.17 4 Govisumber, AGH 6 1 2 1 33.3 3 4 2.17 5 Tuv, AGH 22 3 3 1 13.6 1 3 1.92 6 Khuvsgul, AGH 7 1 2 1 28.6 3 2 1.83 7 Khentii, AGH 4 1 1 1 25.0 2 3 1.67 8 Bulgan, AGH 8 1 2 1 25.0 2 1 1.33 Total 103 32 31.1

ANNEX 30

Assessment results of the III category ISSSs of the province and district hospitals in the ﬁ rst quarter, 2010

Virus Samples Viruses detected Result Mean Nî Hospitals of 2009 scores % score Score Score Score number number 1 Sukhbaatar, AGH 7 5 5 5 71.4 5 2.67 4.42 2 Zavkhan, AGH 0 1 0 1 1 4.67 1.92 3 Arkhangai, AGH 2 2 0 1 0.0 1 3.33 1.83 4 Uvs, AGH 0 1 0 1 1 3.00 1.50 5 Bayan-Ulgii, AGH 0 1 0 1 1 3.00 1.50 6 Gobi-Altai, AGH 2 2 0 1 0.0 1 1.33 1.33 7 Bayankhongor, AGH 0 1 0 1 1 1.67 1.17 Total 11 5 45.5

124 Annexes

ANNEX 31

Assessment results of the Reference Centers, in 2009

Virus Samples Viruses detected Mean Reference Result of Nî scores Centers 2008

Score Score Score percent percent Number Number

1 NCCD 1290 5 442 5 34,3 5 1,38 4,10 2 MHCRC 348 2 46 1 13,2 2 4,50 2,38 3 Total 1638 - 488 -29,8 - - -

ANNEX 32

Assessment results of the Reference Centers, in the ﬁ rst quarter of 2010

Virus Samples Viruses detected Reference Result Mean Nî Centers of 2009 scores Score Score Score percent percent Number Number 1 NCCD 183 5 41 5 22,4 5 4,10 4,77 2 MCHRC 119 4 24 3 20,2 5 2,38 3,59 3 NCC412150,0 5 2,33 2,33 4 General clinic No3 10 1 2 1 20,0 5 1,67 2,17 5 General clinic No1 16 1 3 1 18,8 1 3,67 1,67 6 Total 332 72 21,7

125 B5265G1 Annual Report - 2010/2011

ANNEX 33 Assessment results of the I category FGP-based ISSSs in the capital city and provinces in 2010/2011) 2010 2011 IV II District and III quarter I quarter FGPs quarter quarter province Average Mean Place Place Place Place Place Score Score Score Score BND Ach elberel 1.07 19-20 2.74 5 2.99 4 3.23 3 2.51 4 Bivaangird 1.16 15 2.19 14 2.07 25 1.83 24 1.81 22 Enkh urkh1.06 21 2.75 4 2.82 8 3.23 2 2.47 5 Enerelt ulzii1.22 14 3.83 1 3.00 3 3.47 1 2.88 1 BGD Gurvan sanchir 0.95 29-30 2.00 22 1.87 31 2.24 15 1.77 25 Itgel urtakh2.41 2 2.59 6 2.65 10 2.41 11 2.51 3 Shar degd1.52 8 2.14 16 2.25 20 2.54 9 2.11 10 Amgalan BZD itgeekhui 1.27 13 2.50 8 3.21 2 2.14 19 2.28 7 Nasan urt1.14 16 1.87 25 2.85 7 2.03 21 1.97 12 Ervvl urkh0.94 31 1.34 49 2.50 14 1.29 53 1.52 35 SKhD Unu achit 0.95 29-30 1.56 36 0.99 60 0.64 60 1.03 60 Buyant manal1.12 17 2.31 11 2.94 5 2.33 12 2.17 8 Enkh elberel1.04 22-23 2.23 13 2.00 26 1.65 30 1.73 27 SBD Sankoll 1.02 26 1.64 33 1.77 34 2.81 5 1.81 23 Tegsh mend3.69 1 1.65 32 1.12 59 0.79 59 1.81 21 Enkhsunder 2.09 3 2.39 10 2.00 27 0.92 58 1.85 20 KhUD Amin tus 1.64 6 3.02 2 2.55 13 2.65 8 2.47 6 Manal uils1.58 7 2.86 3 3.49 1 2.17 17 2.52 2 Enkh titem1.03 24-25 1.79 29 1.74 38 2.16 18 1.68 28 ChD Uils negten 1.83 5 2.47 9 2.08 23 2.19 16 2.14 9 Shejiddvg 1.85 4 2.24 12 1.69 41 1.18 56 1.74 26 Tegsh ulzii1.31 9 1.84 28 1.86 32 2.84 4 1.96 13 Nalaikh Ami erdene 0.99 28 2.53 7 2.37 16 1.93 22 1.95 14 Dornod Asralt uils 0.74 55 2.16 15 1.43 52 1.45 44 1.45 40 Myangan 47- jargalan 0.72 57-58 1.35 46 1.32 56 1.42 48 1.20 58 47- Yagaan tseene0.72 57-58 1.95 23 1.92 29 1.42 48 1.50 36 Darkhan Amin kholboo 0.85 45 1.39 45 1.61 45 2.71 7 1.64 29 Gos khot0.83 47-48 1.19 57 1.28 57 1.58 33 1.22 55

126 Annexes

Gereltei 0.91 37 1.34 47 1.47 49 1.68 29 1.35 47 Tuvshin kholboo0.86 42-44 1.28 54 1.68 42 1.48 40 1.32 49 Enerelt naran1.03 24-25 1.85 26 2.31 18 2.54 10 1.93 17 Dornogovi Agatova 0.83 47-48 1.63 34 1.75 36 1.44 45 1.41 42 Goyo mend0.78 51 2.11 18 1.45 51 1.46 43 1.45 39 Misheelt mana0.93 32-34 1.49 41 1.98 28 1.79 25 1.55 33 Tumur zam0.84 46 1.34 48 1.47 50 1.47 41 1.28 53 Orkhon Uils badrakh 0.77 53-54 1.47 42 1.71 39 1.44 46 1.34 48 Achlalt nar0.77 53-54 1.17 59 1.74 37 1.57 35 1.31 52 Ankhnii och0.92 35-36 1.32 50 1.55 47 1.49 39 1.32 50 Gerelt mandakh0.86 42-44 1.88 24 2.07 24 1.52 38 1.58 30 Itgeliin erel0.93 32-34 1.24 55 2.35 17 1.38 52 1.48 38 Niitsel 0.89 39-40 1.30 52 1.39 53 1.27 54 1.22 56 Munkhiin gegee0.82 49 1.51 39 1.34 55 1.61 32 1.32 51 Munkhsundrel 0.72 59-60 1.14 60 1.82 33 1.22 55 1.23 54 Mend bulag0.80 50 1.76 31 2.16 21 1.42 49 1.53 34 Uchralt bayar0.86 42-44 1.50 40 1.65 43 1.53 37 1.39 44 Khos chagnuur0.78 52 1.18 58 1.21 58 1.10 57 1.07 59 Elberelt uils0.72 59-60 1.20 56 2.28 19 1.39 51 1.40 43 Selenge Zuvlukh 0.89 39-40 1.29 53 1.90 30 1.47 42 1.39 45 Nomt khan1.10 18 1.84 27 2.86 6 1.71 27 1.88 19 Khadan khui1.30 11 1.61 35 2.59 12 2.05 20 1.89 18 Emnekh 1.29 12 2.01 21 2.64 11 1.84 23 1.94 16 Uvurkhangai Narnii dush 1.31 10 2.13 17 2.70 9 2.30 13 2.11 11 Tushig dulguun0.90 38 1.41 44 2.15 22 1.77 26 1.56 31 Uyan setgel0.88 41 1.78 30 1.75 35 2.77 6 1.79 24 Enkhiin khurd1.04 22-23 2.05 20 2.41 15 2.29 14 1.95 15 Khovd Baatarkhairkhan 0.92 35-36 2.06 19 1.69 40 1.55 36 1.55 32 Jargalant 1.01 27 1.53 38 1.56 46 1.64 31 1.43 41 Bugat 0.93 32-34 1.46 43 1.50 48 1.57 34 1.37 46 Buyant 0.74 56 1.31 51 1.36 54 1.42 50 1.21 57 Rashaamt 1.07 19-20 1.56 37 1.63 44 1.69 28 1.49 37

First place 3 Middle place Cellar 3

127 B5265G1 Annual Report - 2010/2011

ANNEX 34 Assessment results of the II category FGP-based ISSSs in the provinces in 2010/2011 2010 2011 III quarter IV quarter I quarter II quarter Province FGPs Average Mean place Place Place Place Place Score Score Score Score Bulgan Jargakhui 1.44 2-4 2.05 6 2.01 7 2.14 6 1.91 8 Tsoojid 1.44 2-4 2.21 5 2.12 5 2.19 4 1.99 7 Emiin 1.11 9-12 1.85 8 3.11 2 1.92 10 2.00 6 tsetseglen Govi Tumur zam 1.11 9-12 1.48 21 1.71 21 1.90 14 1.55 16 sumber Enkh tus dem 1.33 5-7 3.76 1 2.39 4 1.87 15 2.34 1 Dundgovi Ulziit mandal 1.33 5-7 3.09 2 2.10 6 2.05 8 2.14 5 Borjgon 1.89 1 2.25 4 2.51 3 2.47 3 2.28 2 mandal Suvraga- 0.89 16-27 1.50 20 1.76 19 1.72 19-23 1.47 25 Erdene Selenge Batuu 1.00 13-15 1.17 27 1.90 8 1.91 11-13 1.49 22 Mandal Bayan 1.00 13-15 1.46 22 1.86 12 1.91 11-13 1.56 14 Achit bag1.00 13-15 1.44 24 1.75 20 1.91 11-13 1.52 21 Umnugovi Unu orshikh 0.89 16-27 1.62 18 1.70 22-23 1.68 25-26 1.47 24 Shim bileg1.11 9-12 1.80 9 1.87 10 1.85 16 1.66 11 Enkhiin 0.89 16-27 1.63 16 1.70 22-23 1.68 25-26 1.47 23 khuslen Baruun zuun Tuv 1.33 5-7 1.63 17 3.97 1 2.10 7 2.26 3 mod Binderya zuun 1.11 8 1.46 23 1.79 18 1.92 9 1.57 12 mod Khuvsgul Dalai elberelt 0.89 16-27 1.76 11 1.80 14 1.72 19-23 1.54 17 Buyan 0.89 16-27 1.75 12-14 1.79 15-17 1.72 19-23 1.54 18-19 Delger murun0.89 16-27 1.75 12-14 1.79 15-17 1.70 24 1.53 20 Tulga 0.89 16-27 1.75 12-14 1.82 13 1.74 17 1.55 15 Erchim 0.89 16-27 1.77 10 1.86 11 1.72 19-23 1.56 13 Enerel 0.89 16-27 1.74 15 1.79 15-17 1.73 18 1.54 18-19 Khentii Ach manal 0.89 16-27 1.32 26 1.63 24 1.61 27 1.36 27 Oyunii shim1.11 9-12 2.46 3 1.58 25 3.66 1 2.20 4 Kherlen dom0.89 16-27 1.33 25 1.56 26 3.45 2 1.81 10 Khar Enerelt ach 1.44 2-4 1.94 7 1.89 9 2.15 5 1.86 9 khorin Enerelt khar 0.89 16-27 1.51 19 1.46 27 1.72 19-23 1.39 26 khorin

128 Annexes

ANNEX 35 Assessment results of the III category FGP-based ISSSs in the provinces in 2010/2011 2010 2011 III IV quarter I quarter II quarter Province FGPs quarter Average Mean place Place Place Place Place Score Score Score Score Ar rashaant 0.89 2-33 1.33 11-18 1.52 19-21 1.50 24-26 1.31 16 Ar manal 0.89 2-33 1.33 11-18 1.51 22-23 1.49 27 1.31 17 Ar mungun Arkhangai 0.89 2-33 1.33 11-18 1.53 16-18 1.50 24-26 1.31 14-15 chagnuur Ar munkhjin 0.89 2-33 1.33 11-18 1.53 16-18 1.50 24-26 1.31 14-15 Ar enkhjin 0.89 2-33 1.33 11-18 1.53 16-18 1.51 23 1.32 12 Shipager 0.89 2-33 1.33 11-18 1.35 30-33 1.86 2-5 1.36 6-8 Bayan- Jansaya 0.89 2-33 1.34 10 1.35 30-33 1.86 2-5 1.36 5 Ulgii Ravan 0.89 2-33 1.33 11-18 1.35 30-33 1.86 2-5 1.36 6-8 Merim 0.89 2-33 1.33 11-18 1.35 30-33 1.86 2-5 1.36 6-8 Naranmandal 0.89 2-33 1.35 4-9 1.37 27-29 1.45 31-32 1.27 23-24 Otoch mandal 0.89 2-33 1.35 4-9 1.41 24 1.47 28-30 1.28 20 Bayan- Otoch nomgon 0.89 2-33 1.35 4-9 1.37 27-29 1.45 31-32 1.27 23-24 khongor Supersor 0.89 2-33 1.35 4-9 1.38 25-26 1.47 28-30 1.27 21-22 EBSU 0.89 2-33 1.35 4-9 1.38 25-26 1.47 28-30 1.27 21-22 Enkhburd 0.89 2-33 1.35 4-9 1.37 27-29 1.44 33 1.26 25 Jargalan Altai 0.89 2-33 1.29 19-22 1.52 19-21 1.59 19-20 1.32 10-11 Maral Altai 0.89 2-33 1.29 19-22 1.52 19-21 1.59 19-20 1.32 10-11 Govi-Altai Enkh Altai 0.89 2-33 1.29 19-22 1.54 15 1.58 21 1.33 9 Enerel Altai 0.89 2-33 1.29 19-22 1.51 22-23 1.57 22 1.32 13 Temuulen 0.89 2-33 1.39 2 1.71 5 1.66 17 1.41 3 Sukhbaatar Enkhjin 0.89 2-33 1.38 3 1.70 6-8 1.69 12-14 1.41 2 Enerel 0.89 2-33 1.43 1 1.69 9-10 1.67 15-16 1.42 1 Bindergarav 0.89 2-33 0.67 24-33 1.66 11 1.67 15-16 1.22 33 Durvun onoo 0.89 2-33 0.67 24-33 1.70 6-8 1.69 12-14 1.24 27-28 Nad sel mamba 0.89 2-33 0.67 24-33 1.76 3 1.79 7 1.28 19 Medical 0.89 2-33 0.67 24-33 1.70 6-8 1.69 12-14 1.24 27-28 Zavkhan Naranmunkhiin 0.89 2-33 0.67 24-33 1.80 1 1.84 6 1.30 18 alba Namchin mamba 0.89 2-33 0.67 24-33 1.72 4 1.61 18 1.22 32 Enkh khugjil 0.89 2-33 0.67 24-33 1.69 9-10 1.75 8-11 1.25 26 naran Bat urchikhui 1.11 1 0.83 23 1.79 2 1.92 1 1.41 4 Dun tsagaan 0.89 2-33 0.67 24-33 1.62 12-14 1.75 8-11 1.23 29-31 Uvs Munkhbishrelt 0.89 2-33 0.67 24-33 1.62 12-14 1.75 8-11 1.23 29-31 Elbeg uguuj 0.89 2-33 0.67 24-33 1.62 12-14 1.75 8-11 1.23 29-31

129 B5265G1 Annual Report - 2010/2011

ANNEX 36 Assessment results of the I category ISSSs of the province and district hospital in 2010/2011 2010 2011 III quarter IV quarter I quarter II quarter Hospitals Average Mean place Place Place Place Place Score Score Score Score BZD DGH 1.84 3 3.60 3 3.73 1 4.56 1 3.43 1 BGD DGH 0.83 13 2.41 8 2.72 9 2.60 10 2.14 11 KhUD DGH 1.36 6 4.02 1 3.57 3 3.57 2 3.13 2 SKhD DGH 1.97 1 2.08 10 3.38 4 2.19 13 2.40 7 SBD DGH 1.60 4 1.81 12 2.17 12 3.11 5 2.17 9 ChD DGH 1.28 9 1.84 11 1.84 14 2.62 9 1.90 14 BND DGH 1.24 12 3.66 2 2.34 10 2.66 7 2.47 6 Darkhan-Uul AGN 1.28 10 2.20 9 2.17 11 2.82 6 2.12 12 Orkhon AGN 0.78 14 1.77 13 3.65 2 2.42 12 2.15 10 Uvurkhangai AGN 1.57 5 2.92 5 1.99 13 2.66 8 2.28 8 Selenge AGN 1.25 11 2.43 7 3.21 6 3.31 3 2.55 5 Dornogovi AGN 1.92 2 3.35 4 2.98 7 2.55 11 2.70 3 Dornod AGN 1.29 8 2.53 6 3.36 5 3.19 4 2.59 4 Khocd AGN 1.34 7 1.49 14 2.98 8 2.09 14 1.97 13

ANNEX 37 Assessment results of the II category ISSSs of the province and district hospital in 2010/2011 2010 2011 III quarter IV quarter I quarter II quarter Hospitals Average Mean place Place Place Place Place Score Score Score Score Bulgan AGN 1.11 8 2.17 6 3.55 3 2.67 3 2.37 5 Govisumber AGN 1.89 1 3.35 2 2.97 5 3.98 1 3.05 1 Dundgovi AGN 1.44 5-6 2.48 5 4.07 2 1.87 10 2.46 4 Umnugovi AGN 1.56 2-4 2.55 4 2.56 6 2.61 4 2.32 6 Tuv AGN 1.56 2-4 2.05 7 4.10 1 2.43 5 2.53 3 Khuvsgul AGN 1.44 5-6 2.60 3 2.53 7 2.37 6 2.23 7 Khentii AGN 1.56 2-4 4.15 1 3.53 4 2.93 2 3.04 2 Zuun kharaa AGN 1.00 9-10 1.50 9-10 2.27 8-9 2.33 7-8 1.78 8-9 Khar khorin AGN 1.22 7 1.54 8 1.93 10 2.17 9 1.72 10 Zamiin uud AGN 1.00 9-10 1.50 9-10 2.27 8-9 2.33 7-8 1.78 8-9

130 Annexes

ANNEX 38 Assessment results of the III category ISSSs of the province and district hospital in 2010/2011 2010 2011 III quarter IV quarter I quarter II quarter Hospitals Average Mean place Place Place Place Place Score Score Score Score Arkhangai AGN 1.78 2 2.68 2 2.45 6 3.04 5 2.49 5 Bayankhongor AGN 1.22 6 1.43 7 3.80 2 3.03 6 2.37 6 Bayan-Ulgii AGN 1.67 3-4 3.00 1 2.85 4 3.30 4 2.70 3 Govi-Altai AGN 1.11 7 1.63 6 1.96 7 2.93 7 1.91 7 Sukhbaatar AGN 1.56 5 2.47 3 3.66 3 3.37 3 2.76 2 Zavkhan AGN 2.22 1 2.05 5 4.20 1 3.88 1 3.09 1 Uvs AGN 1.67 3-4 2.23 4 2.50 5 3.84 2 2.56 4

ANNEX 39 Assessment results of the I category Reference Centers in 2010/2011 2010 2011 Reference centers III quarter IV quarter I quarter II quarter Average

Score Place Score Place Score Place Score Place Mean place NCCD 1.525 2 3.119231 1 3.984615 1 4.35 1 3.24 1 MHCRC 1.345 1 2.659487 2 2.80906 2 3.36 2 2.54 2

ANNEX 40 Assessment results of the II category Reference Centers in 2010/2011 2010 2011 Reference III quarter IV quarter I quarter II quarter centers Average Mean place Place Place Place Place Score Score Score Score General clinic No 3 1.22 3 3.15 2 2.92 3 3.80 1 2.77 2 NCC 1.44 2 2.25 3 3.67 2 1.87 3 2.31 3 General clinic No 1 1.89 1 3.42 1 4.57 1 2.63 2 3.13 1

131 B5265G1 Annual Report - 2010/2011

ANNEX 41

Participants list of the workshop on 2009 year and ﬁ rst quarter, 2010 activities ISSSs in the capital city, April 16, 2010

No Participants Organization Title 1. B.Enkhjargal NCCD Nurse 2. Ts.Jambaldorj NCCD Physician 3. S.Enkhtuya NCCD Nurse 4. L.Oyuntsetseg NCCD Physician 5. S.Oyungerel NCCD Epidemiologist 6. Otgonchimeg MCHRC Epidemiologist 7. Gantuya MCHRC Physician 8. Odonchimeg MCHRC Physician 9. Ariungerel MCHRC Nurse 10. G.Amar MCHRC Physician 11. Oyunchimeg General hospital No1 Physician 12. Ulziijargal General hospital No1 Physician 13. Myadagmaa General hospital No1 Epidemiologist 14. Ariuntuya General hospital No1 Physician 15. Sarantsetseg General hospital No1 Nurse 16. Bolormaa General hospital No3 Physician 17. Amartuvshin General hospital No3 Epidemiologist 18. Narantuya General hospital No3 Nurse 19. Tserenkhand General hospital No3 Physician 20. Erdenetsetseg NCC Epidemiologist 21. Duurenjargal NCC Nurse 22. Batsaikhan NCC Physician 23. Bolormaa KhU DGH Epidemiologist 24. Tsevelmaa KhU DGH Deputy director 25. Monkhtsetseg KhU DGH Nurse 26. Enkhtuya SKh DGH Deputy director 27. G.Delgersuren SKh DGH Physician 28. Chuluuntsetseg SKh DGH Nurse 29. Bayan BG DGH Epidemiologist 30. Rira BG DGH Physician 31. Shinekhuu BG DGH Physician 32. Ts.Lkhagva Ch DGH Deputy director 33. Z.Tsetsegmaa Ch DGH Nurse 34. D.Tsetsegmaa Ch DGH Epidemiologist 35. N.Monkhzul BZ DGH Epidemiologist 36. Jantsan BZ DGH Physician

132 Annexes

37. Tsevelmaa BZ DGH Physician 38. S.Gereltsetseg BN DGH Physician 39. Baljmaa BN DGH Nurse 40. Khandtsoo BN DGH Epidemiologist 41. Odgerel SB DGH Physician 42. Otgonbaatar SB DGH Epidemiologist 43. Buyanjargal SB DGH Deputy director 44. Bold-Erdene NCCD Statistician 45. Narantsetseg “Enkhtitem” FGP Physician 46. Mongontsetseg “Enkhtitem” FGP Physician 47. Sarantuya Manal-Uils FGP Physician 48. Dolgormaa Manal-Uils FGP Nurse 49. Tuul AminTus FGP Physician 50. Erdenetsetseg AminTus FGP Head 51. Togssain Buyant Manal FGP Physician 52. Altantsetseg Buyant Manal FGP Physician 53. Bolormaa Enkh-Elberel FGP Physician 54. Unursaikhan Enkh-Elberel FGP Physician 55. Norjmaa Unu-Achit FGP Physician 56. Sugarsuren Unu-Achit FGP Physician 57. Tsend-Ayush Itgelt-ugtah FGP Physician 58. Gantuya Itgelt-ugtah FGP Nurse 59. Khishigsuren Gurvan sanchir FGP Physician 60. Erdenechimeg Gurvan sanchir FGP Nurse 61. Lkhagvasuren Shar degd FGP Physician 62. Mokhjargal Shar degd FGP Nurse 63. Bayarmaa Amgalan itgehui FGP Physician 64. Bolormaa Amgalan itgehui FGP Nurse 65. Tserennadmid Nasan urt FGP Physician 66. Tersaikhan Nasan urt FGP Nurse 67. Altankhuyag Eruul urh FGP Physician 68. Baljinnyam Eruul urh FGP Nurse 69. Fagma Enkhsunder FGP Physician 70. Todbat Enkhsunder FGP Nurse 71. Gantuya Sankoll FGP Physician 72. Altansuvd Sankoll FGP Physician 73. Otgonbayar Uils negten FGP Physician 74. Javzanorlom Uils negten FGP Nurse 75. Enkhjargal Tegshmend FGP Physician 76. Tsetsegmaa Tegshmend FGP Head 77. Furevdorj Tegsh-Ulzii FGP Head 78. Erdenesuren Tegsh-Ulzii FGP Nurse

133 B5265G1 Annual Report - 2010/2011

79. Tserendolgor Shijid dug FGP Physician 80. Furevee Shijid dug FGP Nurse 81. Naranchimeg Enerelt-Ulzii FGP Nurse 82. Od Enerelt-Ulzii FGP Physician 83. Erdenechimeg Bivaangard FGP Physician 84. Lkhagvasuren Bivaangard FGP Nurse 85. Onorjargal Enkh-Urh FGP Physician 86. Khadchimeg Enkh-Urh FGP Nurse 87. Tsetsegee Ach elberel FGP Physician 88. Garmaa Ach elberel FGP Nurse 89. Chuluuntsetseg Ami-Erdene FGP Physician 90. Tsetsegmaa Ami-Erdene FGP Nurse

134 Annexes

ANNEX 42 Programm of the ISSSs training workshop 1, September 8-9,2011

Thursday, 8 September, 2011 8.30-9.00 Registration

9.00-9.10 Opening Session, Prof. P.Nymadawa

9.10-9.50 Results of virus isolation, specimen collection of ISSSs and epidemiology and future objectives on 2010/2011 Dr. B.Darmaa MD, PhD 9.50-10.10 Results of ISSSs announced by internet and future objectives. B.Gantsooj, Data manager, web master

10.10-10.40 Assessment results of ISSSs activities in 2010/2011 B.Gantsooj, Data manager 10.40-11.00 Result of audio conferences in Skype and objectives and schedules in 2011/2012 season L.Enkhbaatar, PhD

11.00-11.20 Coffee/tea break

11.20-11.50 Implementation of activities of the ISSS in the “Amin tus” FGP, Khan-Uul district, Ulaanbaatar D.Tuul, “Amin tus ” FGP

11.50-12.25 Implementation of hospital-based surveillance in Bayanzurkh District Hospital N.Jantsan, Deputy Director , Bayanzurkh district hospital

12.25-13.00 Emergency measures implemented during the inﬂ uenza season by MCHRC and future objectives T.Enkhtur, MCHRC

13.00-14.00 Lunch

14.00-16.00 Group training

135 B5265G1 Annual Report - 2010/2011

1. Group training 1: FIS, Flu.mn (Main lecture hall of NCCD) Moderator: B.Gantsooj, Data manager, web master - www.ﬂ u.mn use - FIS use

2. Group training 2: Laboratory training (Virology Laboratory of NCCD) Moderator: B.Darmaa, MD PhD - Instruction result of external quality assurances of province laboratories - Questions / answers - Discussion about assessment procedure of activities for province laboratories - Questions / answers

3. Group training 3: Training for Hospital-based pneumonia surveillance in cooperation with Merieux Foundation, France (Scientiﬁ c Council room of NCCD ) Moderator: Prof. P.Nymadawa - Instruction on study methods Instruction on Informed consent statement and Case report form

4. Group training 4: Training for inﬂ uenza transmission surveillance in cooperation with Tohoku University, Sendai, Japan (training room of NCCD) Moderators: Ch.Urtnasan, epidemiologist and N.Bayasgalan, virologist - Introduction about inﬂ uenza transmission surveillance - Surveillance objectives and methodology - Instruction of rapid tests and drills - Discussion

16.00-17.00 Coffee/tea break, poster presentations and discussions

17.00-18.00 Final Brieﬁ ng

136 Annexes

ANNEX 43 ParticipantsŴ list of the ISSSs training workshop 1, September 8-9, 2011 No Participants Organization Title 1 N.Jantsan BZD hospital Physician 2 J.Javzan BZD hospital Epidemiologist 3 T.Tsevelmaa BZD hospital Statistician 4 A.Oyungerel BZD hospital Statistician 5 B.Oyunchimeg BZD hospital Epidemiologist 6 U.Tuul BZD hospital Pediatrician 7 Yu.Batsaikhan BZD hospital Physician 8 Ch.Narankhuu BZD hospital Physician 9 T.Enkh-Amgalan BZD hospital Nurse 10 D.Munkhtsetseg BZD hospital Nurse 11 T.Chimgee BZD hospital Physician 12 T.Munkhtogtoh BZD hospital Physician 13 D.Udaanjargal BZD hospital Laboratory assistant 14 O.Enkhtuya SKhD hospital Deputy director 15 O.Tseezmaa SKhD hospital Epidemiologist 16 R.Baigalmaa SKhD hospital Statistician 17 A.Delgerbayar SKhD hospital Epidemiologist 18 D.Uranchimeg SKhD hospital Statistician 19 Ts.Lkhagva ChD hospital Deputy director 20 N.Bolor ChD hospital Epidemiologist 21 Ts.Iderbat ChD hospital Epidemiologist 22 S.Ganshur ChD hospital Statistician 23 D.Ninjmaa ChD hospital Assistant statistician 24 Myagmarsuren BGD hospital Director in charge of quality 25 S.Ulziijargal BGD hospital Epidemiologist 26 B.Shinekhuu BGD hospital Physician 27 P.Ariungerel BGD hospital Assistant statistician 28 T.Buyanjargal SBD hospital Deputy director 29 Saikhangerel SBD hospital Physician 30 B.Odgerel SBD hospital Statistician 31 O.Otgonbaatar SBD hospital Epidemiologist 32 E.Buyanmandakh KhUD hospital Head of hospital 33 Ichinkhorloo KhUD hospital Epidemiologist 34 S.Tsevelmaa KhUD hospital Deputy director 35 Sunjee KhUD hospital Physician 36 J.Munkhtsetseg KhUD hospital Statistician 37 Ts.Khandtsoo BND hospital Epidemiologist 38 S.Altantsetseg BND hospital Deputy director 39 Baljmaa BND hospital Assistant epidemiologist 40 D.Oyunchimeg BND hospital Assistant statistician 41 I.Od BND hospital Physician 42 Sevjid BND hospital Head of children ward

137 B5265G1 Annual Report - 2010/2011

43 N.Oyuntsetsteg BND hospital Physician 44 D.Nyamkhuu NCCD Director General 45 Ts.Oyunchimeg NCCD Deputy director for hospital services 46 G.Surenkhand NCCD Deputy director for surveillance 47 P.Nyamdavaa NCCD Project director 48 N.Tsend NCCD Consultant 49 R.Oyungerel NCCD Scientiﬁ c secretary 50 A.Ambselmaa NCCD Head, Surveillance department 51 G.Tsetsegmaa NCCD Head,re-emerging infectious ward 52 L.Enkhbaatar NCCD Project manager 53 B.Gantsooj NCCD Project data- manager 54 Ch.Urtnasan NCCD Epidemiologist 55 Ts.Tsagaan-Dari NCCD Physician 56 L.Dashtseren NCCD Epidemiologist 57 B.Darmaa NCCD Head, laboratory for respiratory virology 58 D.Enkhsakhan NCCD Virologist 59 S.Oyungerel NCCD Epidemiologist 60 Bat-Undral NCCD Statistician 61 Ganbaatar NCCD Head, Immunization department 62 Ts.Naranzul NCCD Virologist 63 D.Tuul NCCD Project ﬁ nancier 64 E.Oyuntuya NCCD Doctor assistant 65 Ch.Maitsetseg NCCD Virologist 66 N.Bayasgalan NCCD Virologist 67 G.Nyamaa NCCD Virologist 68 U.Naranchimeg NCCD Laboratory assistant 69 D.Otgonbayar NCCD Laboratory assistant 70 B.Uyanga NCCD Physician 71 B.Batsukh NCCD Head emergency ward 72 B.Davaakhuu NCCD Head, 3th ward 73 M.Oyungerel NCCD Director in charge of quality 74 A.Sarantsetseg NCCD Head, 6th ward 75 O.Sumiya NCCD Quality manager 76 M.Tunsag NCCD Physician, 8th ward 77 S.Undarmaa NCCD Head, 1st ward 78 Ts.Chinbayar NCCD Head, intensive care unit 79 D.Chimednorov NCCD Head, 4th ward 80 B.Enkhjargal NCCD Head, 8th ward 81 D.Gantulga NCCD Physician, Immunization department 82 B.Norov General hospital No1 Deputy director 83 Ts.Battsengel General hospital No1 Statistician 84 B.Myadagmaa General hospital No1 Epidemiologist 85 Sh.Enkhtur MCHRC Director General 86 B.Otgonchimeg MCHRC Epidemiologist 87 M.Baljinnyam MCHRC Physician 88 Odmaa MCHRC Statistician 89 T.Gantuya MCHRC Head, Information technology team

138 Annexes

90 T.Riza MCHRC Operator 91 D.Oyunbaatar MCHRC Quality manager 92 P.Erkhembulgan MCHRC Deputy director 93 D.Altantsetseg Cancer center Director in charge of quality 94 D.Erdenetsetseg Cancer center Epidemiologist 95 J.Batsaikhan Cancer center Statistician 96 Battsetseg General hospital No3 Director in charge of quality 97 Amartuvshin General hospital No3 Epidemiologist 98 Bolormaa General hospital No3 Statistician 99 N.Naranbat Gyals center Director 100 Unursaikhan Gyals center Virologist 101 Oliga Gyals center Physician 102 Ts.Byambadorj Gyals center Virologist 103 G.Zulkhuu HSUM Lecturer 104 N.Khorolsuren HSUM Lecturer 105 Ya.Davgadorj HSUM Lecturer 106 O.Baatarkhuu HSUM Lecturer 107 Davaalkham HSUM Lecturer 108 D.Otgonbaatar NCIDNF Director General 109 D.Tserennorov NCIDNF Deputy director 110 J.Dulamjav NCIDNF Head, laboratory for NCIDNF, virologist 111 N.Tserenbvjid NCIDNF Director in charge of quality 112 Sh.Lkhagvasuren BGD, Shar degd Head 113 A.Tsend-Ayush BGD, Itgel ugtakh Head 114 T.Khishigsuren BGD, Gurvan sanchir Head 115 S.Bayarmaa BZD, Amgalan itgehui Head 116 Ch.Tserennadmid BZD, Nasan urt Head 117 M.Altanhuyag BZD, Eruul urkh Head 118 D.Battsengel SBD, Tegsh mend Head 119 T.Ganchimeg SBD, Enkhsunder Head 120 B.Altansuvd SBD, Sankoll Head 121 B.Sarantuya KhUD, Manal uils Head 122 D.Tuul KhUD, Amin tus Head 123 T.Munkhtuya KhUD, Enkhtitem Head 124 O.Udvaltsetseg SKhD, Buyant manal Head 125 Ch.Unursaikhan SKhD, Enkh elberel Head 126 N.Sugarsuren SKhD, Unu achit Head 127 M.Otgonbayar ChD, Uils negten Head 128 I.Myagmarsuren ChD,Shijiddvg Head 129 M.Purevdorj ChD, Tegsh ulzii Head 130 Tsetsegee BND, Ach elberel Head 131 Erdenechimeg BND, Bivaangird Head 132 Unurjargal BND, Enh urh Head 133 R.Ganchimeg BND, Enerelt ulzii Head 134 Ts.Narantuya BND, Enerelt ulzii Head 135 Kh.Chantsal-Erdene BND, Enerelt ulzii Nurse 136 Ch.Naranchimeg BND, Enerelt ulzii Nurse

139 B5265G1 Annual Report - 2010/2011

137 Ts.Tserendolgor Arkhangai province Deputy Provincial Health Department 138 Narmandakh Arkhangai province Head, Provincial Health Department 139 Z.Oyungerel Arkhangai province Assistant statistician 140 E.Byambatsogt Arkhangai province Epidemiologist 141 S.Tsendmaa Arkhangai province Assistant doctor 142 J.Ariunaa Arkhangai province Head, "Ar mungunchagnuur" FGP 143 Kh.Umirgvl Bayan-Ulgii province Director Provincial Health Department 144 R.Bolat Bayan-Ulgii province Epidemiologist 145 S.Imenkhand Bayan-Ulgii province Statistician 146 Z.Aisimbat Bayan-Ulgii province Statistician 147 U.Kabel Bayan-Ulgii province Deputy Provincial Health Department 148 M.Almagul Bayan-Ulgii province Head, "Shipager" FGP 149 B.Tserenkhand Bayankhongor province Epidemiologist 150 N.Ontsgerel Bayankhongor province Head, "Enkhbvrd" FGP 151 Ts.Enkhbileg Bayankhongor province Statistician 152 D.Zoljargal Bayankhongor province Statistician 153 Ch.Javzan Bayankhongor province Deputy director for hospital services 154 D.Narantuya Bulgan province Deputy director 155 B.Tsolmon Bulgan province Deputy director for hospital services 156 S.Ariunaa Bulgan province Epidemiologist 157 Urangavaa Bulgan province Statistician 158 Mungunchimeg Bulgan province Statistician 159 T.Doljinsuren Bulgan province Head "Tsoojid" FGP 160 G.Suvdaa Govi-Altai province Epidemiologist 161 G.Munkhzul Govi-Altai province Family clinic 162 Tsengelmaa Govi-Altai province Statistician 163 E.Byambasuren Govi-Altai province Statistician Provincial emergency management 164 E.Gerelmaa Govi-Sumber province division 165 Sh.Altantsetseg Govi-Sumber province Epidemiologist 166 Ts.Enkhsaruul Govi-Sumber province Family clinic 167 B.Narantsetseg Govi-Sumber province Statistician 168 B.Kherlenchimeg Govi-Sumber province Statistician 169 B.Battsengel Darkhan uul province Deputy director 170 B.Byamba-Erdene Darkhan uul province Virologist 171 B.Erdenetsetseg Darkhan uul province Epidemiologist 172 P.Enkhzul Darkhan uul province Statistician 173 D.Batmandakh Darkhan uul province Deputy director for hospital services 174 D.Ganbold Darkhan uul province Head, "Gos khot" FGP 175 E.Baasankhuu Darkhan uul province Statistician 176 P.Erdene-Ochir Darkhan uul province Laboratory assistant 177 N.Otgonsuvd Dornogovi province Epidemiologist 178 U.Otgonbayar Dornogovi province Epidemiologist 179 J.Nominchimeg Dornogovi province Head, "Agatova" FGP 180 Ts.Tungalag Dornogovi province Statistician 181 N.Munkhzaya Dornogovi province Epidemiologist

140 Annexes

Deputy director for hospital services 182 J.Altanshagai Dornogovi province (Zamiin vd) 183 Ganhuyag Dornogovi province Deputy director for hospital services 184 N.Nasan-Ulzii Dornogovi province Statistician 185 Ts.Munkhbaatar Dornod province Statistician 186 D.Gereltuya Dornod province Expert 187 Yo.Oyuntsetseg Dornod province Deputy director for hospital services 188 B.Bayarmaa Dornod province Statistician 189 Z.Sarantuya Dornod province Assistant statistician 190 S.Altantuya Dornod province Head "Asralt-uils" FGP 191 G.Suvdaa Dundgovi province Deputy director 192 M.Munguntsetseg Dundgovi province Epidemiologist 193 D.Enkhtsetseg Dundgovi province Head, "Ulziit mandal" FGP 194 Ts.Raashgunchin Dundgovi province Assistant doctor 195 D.Oyunbat Dundgovi province Statistician 196 D.Munkh-Od Dundgovi province Epidemiologist 197 Osorjamaa Zavkhan province Physician "Toson tsengel" sum 198 G.Dashdavaa Zavkhan province Epidemiologist 199 N.Sainbileg Zavkhan province Head, "Nad sel mamba" FGP 200 B.Odonchimeg Zavkhan province Statistician 201 N.Alimjims Zavkhan province Statistician 202 D.Javzmaa Zavkhan province Deputy director for hospital services 203 G.Ganhuyag Orkhon province Head, Provincial health department 204 B.Batsukh Orkhon province Deputy director for hospital services 205 E.Erdenejargal Orkhon province Virologist 206 M.Munkhzaya Orkhon province Laboratory assistant 207 Ts.Oyunbal Orkhon province Epidemiologist 208 T.Burmaa Orkhon province Statistician 209 M.Burmaa Orkhon province Statistician 210 Jargalsaikhan Orkhon province Head, Family clinics 211 J.Burmaa Uvurkhangai province Assistant doctor 212 B.Khorolsuren Uvurkhangai province Head, Inﬂ uenza surveillance team 213 Ts.Mandakh Uvurkhangai province Epidemiologist 214 B.Narantsetseg Uvurkhangai province Statistician 215 D.Zagarsuren Uvurkhangai province Statistician 216 J.Bundjav Uvurkhangai province Head, "Enkhiin khurd" FGP 217 Myagmar Uvurkhangai province Physician "Khar khorin" Hospital Assistant statistician "Khar khorin" 218 D.Davaasuren Uvurkhangai province Hospital 219 Dvvmaam Umnugovi province Head of nurses 220 M.Bumantsetseg Umnugovi province Deputy director for hospital services 221 B.Byambajav Umnugovi province Epidemiologist 222 D.Gantogtokh Umnugovi province Assistant statistician 223 N.Khuukhenkhuu Umnugovi province Assistant statistician 224 L.Lkhagvasuren Umnugovi province Head, Family clinics 225 Ts.Sukhbaatar Sukhbaatar province Deputy director 226 L.Javzmaa Sukhbaatar province Assistant doctor

141 B5265G1 Annual Report - 2010/2011

227 Ts.Urtnasan Sukhbaatar province Epidemiologist 228 S.Unurstsetseg Sukhbaatar province Head, Enerel FGP 229 Nyamgerel Sukhbaatar province Statistician 230 U.Gantsetseg Sukhbaatar province Statistician Provincial emergency management 231 T.Enkhmaa Selenge province division 232 P.Selenge Selenge province Head, Immunization department 233 M.Oljmedekh Selenge province Assistant doctor 234 D.Unur Selenge province Head information technology team 235 P.Bayanjargal Selenge province Head, Mandal sum hospital 236 G.Tungalag Selenge province Physician 237 B.Munkhdavaa Selenge province Statistician 238 B.Oyunbat Selenge province Statistician 239 N.Naimanjin Selenge province Assistant statistician, Altanbulag sum 240 Ya.Tsetsegmaa Tuv province Provincial health department 241 S.Nansalmaa Tuv province Head, Surveillance department 242 R.Dulmaa Tuv province Deputy director 243 N.Myagmarsuren Tuv province Statistician 244 Lkhagva Tuv province Statistician 245 Khishigt Tuv province Head family clinic 246 V.Toiruul Uvs province Deputy director 247 G.Oyun Uvs province Epidemiologist 248 J.Chimgee Uvs province Statistician 249 P.Tuvshinjargal Uvs province Assistant doctor 250 Erdenechimeg Uvs province Head, Munkhbishrelt FGP 251 Sanaa-Amar Uvs province Statistician 252 Oyunchimeg Khovd province Deputy director 253 S.Bat-Ulzii Khovd province Epidemiologist 254 M.Dungaamaa Khovd province Head, Surveillance department 255 Kh.Boloroo Khovd province Statistician 256 D.Odontuya Khovd province Statistician 257 S.Nina Khovd province Head family clinic 258 L.Damdinsuren Khuvsgul province Deputy director 259 B.Batdorj Khuvsgul province Epidemiologist 260 M.Ganbold Khuvsgul province Deputy director for hospital services 261 J.Sunjidmaa Khuvsgul province Head, Tulga FGP 262 P.Sergelen Khuvsgul province Statistician 263 P.Nyamjav Khuvsgul province Statistician 264 B.Naranmichid Khentii province Statistician 265 D.Baasandorj Khentii province Epidemiologist 266 B.Erdenetsetseg Khentii province Head. Achmanal FGP 267 L.Mendbayar Khentii province Deputy director for hospital services 268 B.Sarantuya Khentii province Assistant doctor 269 B.Narmandakh Khentii province Assistant doctor

142 Annexes

ANNEX 44 Programme of training for FIS software, Sep 9, 2011 No Topic Time Group 1: Statisticians of GH and FGP 1 Registration 8.30-9.00 2 Use and entry data in FIS 9.00-10.00 3 Practice of create audio conference in Skype 10.00-10.30 4 Question and answer 10.30-11.00 Group 2: Statisticians and epidemiologists of Health departments 1 Registration 14.30-15.00 2 Use and entry data in FIS 15.00-16.00 3 Practice of create audio conference in Skype 16.00-16.30 Question and answer 16.30-17.00

143 B5265G1 Annual Report - 2010/2011

ANNEX 45 Participants’ list of the training for FIS software, Sep 9, 2011 No Organization Participants name Position 1 BGD Shar degd Ts.Munkhjargal Nurse 2 BGD Itgel ugtakh S.Erdenechimeg Nurse 3 BGD Gurvansanchir L.Dolgorsuren Nurse 4 BZD Amgalan itgekhui Bolormaa Nurse 5 BZD Nasan urt Ch.Azjargal Nurse 6 BZD Eruul urkh E.Baigalmaa Nurse 7 SBD Tegsh mend Z.Bolortsetseg Doctor 8 SBD Enkhsunder Todbat Nurse 9 SBD Sankoll B.Dulmaa Nurse 10 KhUD Manal uils D.Mendjargal Nurse 11 KhUD Amin tus Sh.Enkhjargal Nurse 12 KhUD Enkhtitem T.Munguntsetseg Nurse 13 SKhD Buyant manal O.Udvaltsetseg Doctor 14 SKhD Enkhelberel G.Narantsatsral Nurse 15 SKhD Unu-Achit Tumenjargal Nurse 16 ChD Uilsnegten Baigalmaa Nurse 17 ChD Shijiddug Gerelmaa Nurse 18 ChD Tegsh-Ulzii Erdenesuren Nurse 19 BND Ach elberel Oyunbat Nurse 20 BND Bivaangird Erdenetsetseg Nurse 21 BND Enkh urkh Khadchimeg Nurse 22 BND Enereltulzii Naranchimeg Nurse 23 NAD Ami erdene Sanjidmaa Nurse 24 BZD GH T.Tsevelmaa Statistician 25 SBD GH B.Odgerel Statistician 26 KhUD GH J.Munkhtsetseg Statistician 27 SKhD GH D.Uranchimeg Statistician 28 ChD GH S.Ganshur Statistician 29 BND GH D.Oyunchimeg Statistician 30 NAD GH T.Enkhmaa Statistician 31 UB GH No1 U.Oyunchimeg Statistician 32 UB GH No3 Bolormaa Statistician 33 UB NCC J.Batsaikhan Statistician 34 UB MCHRC T.Riza Statistician 35 UB NCCD B.Undral Statistician 36 Arkhangai GH L.Gerelmaa Statistician 37 Bayan-Ulgii GH A.Asenbet Statistician 38 Bayankhongor GH D.Zoljargal Statistician 39 Bulgan GH Mungunchimeg Statistician 40 Govi-Altai GH E.Byambasuren Statistician 41 Govisumber GH B.Kherlenchimeg Statistician 42 Dankhan-Uul GH B.Tugsuu Statistician 43 Dornogovi GH Ts.Tungalag Statistician

144 Annexes

44 Dornogovi GH N.Otgonsuvd Epidemiologist 45 Dornod GH B.Bayarmaa Statistician 46 Dundgovi GH D.Oyunbat Statistician 47 Zavkhan GH N.Alimjims Statistician 48 Orkhon GH M.Burmaa Statistician 49 Uvurkhangai GH D.Naranchimeg Statistician 50 Uvurkhangai Kharkhorin GH D.Davaasuren Statistician 51 Umnugovi GH N.Khuukhenkhuu Statistician 52 Sunkhbaatar GH A.Azjargal Statistician 53 Selenge GH B.Munkhdavaa Statistician 54 Selenge Manal GH V.Oyunbat Statistician 55 Selenge Altanbulag GH N.Naimanjin Statistician 56 Tuv GH Lkhagva Statistician 57 Uvs GH Sanaa-Amar Statistician 58 Khovd GH D.Odontuya Statistician 59 Khuvsgul GH G.Nomin Statistician 60 Khentii GH B.Narmandakh Statistician 61 BGD GH Health Department P.Ariungerel Statistician 62 BGD GH Health Department S.Ulziijargal Epidemiologist 63 BZD GH Health Department A.Oyuntsetseg Statistician 64 BZD GH Health Department B.Oyunchimeg Epidemiologist 65 BND Health Department Baljmaa Statistician 66 BND Health Department Ts.Khandtsoo Epidemiologist 67 NAD GH Sh.Yanjmaa Epidemiologist 68 SKhD GH Health Department R.Baigalmaa Statistician 69 SKhD GH Health Department O.Tseezmaa Epidemiologist 70 SKhD GH Health Department O.Otgonbaatar Epidemiologist 71 KhUD GH Health Department Z.Tuya Statistician 72 KhUD GH Health Department I.Oyunchimeg Epidemiologist 73 ChD Health Department Ts.Iderbat Epidemiologist 74 ChD Health Department D.Ninjmaa Epidemiologist 75 UB GH No1 B.Myadagmaa Epidemiologist 76 UB MCHRC B.Otgonchimeg Epidemiologist 77 UB NCC D.Erdenetsetseg Epidemiologist 78 UB GH No3 Amartuvshin Epidemiologist 79 Arkhangai Health Department S.Tsendmaa Statistician 80 Arkhangai Health Department E.Byambatsogt Epidemiologist 81 Bayan-Ulgii Health Department S.Imenkhand Statistician 82 Bayan-Ulgii Health Department R.Bolat Epidemiologist 83 Bayankhongor Health Department Ts.Enkhbileg Statistician 84 Bayankhongor Health Department B.Tserenkhand Epidemiologist 85 Bulgan Health Department Urangavaa Statistician 86 Bulgan Health Department S.Ariunaa Epidemiologist 87 Govi-Altai Health Department D.Dolgorsuren Statistician 88 Govi-Altai Health Department G.Suvdaa Epidemiologist 89 Govisumber Health Department B.Narantsetseg Statistician

145 B5265G1 Annual Report - 2010/2011

90 Govisumber Health Department Sh.Altantsetseg Epidemiologist 91 Dankhan-Uul Health Department P.Enkhzul Statistician 92 Dankhan-Uul Health Department B.Erdenetsetseg Epidemiologist 93 Dornogovi Health Department N.Nasan-Ulzii Statistician 94 Dornogovi Health Department U.Otgonbayar Epidemiologist 95 Dornod Health Department Z.Sarantuya Statistician 96 Dornod Health Department Ts.Munkhbaatar Statistician 97 Dornod Health Department D.Gereltuya Epidemiologist 98 Dundgovi Health Department O.Enkhtsetseg Statistician 99 Dundgovi Health Department Ts.Raashgunchin Statistician 100 Dundgovi Health Department M.Mungutsetseg Epidemiologist 101 Zavkhan Health Department V.Odonchimeg Statistician 102 Zavkhan Health Department G.Dashdavaa Epidemiologist 103 Orkhon Health Department T.Burmaa Statistician 104 Orkhon Health Department Ts.Oyunbal Epidemiologist 105 Uvurkhangai Health Department B.Narantserseg Statistician 106 Uvurkhangai Health Department J.Burmaa Statistician 107 Uvurkhangai Health Department M.Zolzaya Epidemiologist 108 Umnugovi Health Department D.Gantogtokh Statistician 109 Umnugovi Health Department B.Byambajav Epidemiologist 110 Sunkhbaatar Health Department B.Erdenetuya Statistician 111 Selenge Health Department D.Unur Statistician 112 Selenge Health Department M.Oljmedekh Statistician 113 Selenge Health Department P.Selenge Epidemiologist 114 Tuv Health Department N.Myagmarsuren Statistician 115 Tuv Health Department S.Nansalmaa Epidemiologist 116 Uvs Health Department J.Chimgee Statistician 117 Uvs Health Department R.Tuvshinjargal Statistician 118 Uvs Health Department G.Oyun Epidemiologist 119 Khovd Health Department Kh.Boloroo Statistician 120 Khovd Health Department S.Bat-Ulzii Epidemiologist 121 Khuvsgul Health Department P.Nyamjav Statistician 122 Khuvsgul Health Department B.Batdorj Epidemiologist 123 Khentii Health Department B.Sarantuya Statistician 124 Khentii Health Department B.Naranmichid Statistician 125 Khentii Health Department D.Baasandorj Epidemiologist

146 Annexes

ANNEX 46 Program of the training for laboratory activities, Sep 8, 2011 Responsible No Topic Time person Instruction result of external quality assurances of 1 14:00-14:45 Ts.Naranzul section laboratory B.Darmaa, 2 Open Discussion/questions/ answers 14:45-15:00 Ts.Naranzul Discussion about assessment procedure of activities 3 15:00-15:45 B.Darmaa branch laboratory B.Darmaa, Open Discussion/questions/ answers 15:45-16:00 Ts.Naranzul

ANNEX 47 Participants’ list of the training for laboratory activities, Sep 8, 2011 No Participants name Organization Title 1 B.Byamba-Erdene Darkhan-Uul province Virology laboratory doctor 2 E.Erdenejargal Orkhon province Virology laboratory doctor 3 J.Dulamjav NCIDNF Head, Laboratory of NCIDNF, Virologist 4 N.Tserenbvjid NCIDNF Head, Quality assurance dept for laboratory 5 B.Uyanga NCCD HIV laboratory doctor

147 B5265G1 Annual Report - 2010/2011

ANNEX 48 Program of the training for hospital-based pneumonia surveillance in cooperation with Merieux foundation, France, September 8, 2011 No Topic Time Responsible person 1 Instruction of study 8 method 14:00-14:30 Ch.Maitsetseg Instruction of Informed consent statement, Case 2 14:30-15:00 N.Naranbat report form 3 Open Discussion 15:00-16:00 P.Nymadawa

ANNEX 49 Participants’ list of the for hospital-based pneumonia surveillance workshop in cooperation with Merieux foundation, France, September 8, 2011 No Participants' name Title Bayanzurkh hospital 1 N.Jantsan General doctor 2 J.Javzan Epidemiologist 3 U.Tuul Physician 4 T.Bayasgalan Physician 5 Ch.Narankhuu Physician, laboratory 6 T.Enkh-Amgalan Nurse 7 D.Munkhtsetseg Nurse 8 T.Chimgee Physician 9 T.Munkhtogtokh Physician, laboratory 10 D.Udaanjargal Laboratory assistant “Gyals” Center 1 N.Naranbat Director 2 Unursaikhan Virologist 3 Oliga Physician, laboratory 4 Ts.Byambadorj Laboratory assistant NCCD 1 P.Nymadawa Project Director 2 Ch.Maitsetseg Virologist

148 Annexes

ANNEX 50 Program of the training for inﬂ uenza transmission surveillance in cooperation with Tohoku University, Sendai Japan, September 8, 2011

Responsible No Topic Time Organization person Introduction about inﬂ uenza Tohoku surveillance study to contacting in 1 14.00 – 14.30 university, Kh.Oshitani cooperation with Tohoku university, Sendai Japan Sendai Japan 2 Study methodology, objectives 14.30 – 15.00 NCCD Ch.Urtnasan 3 Instruction of rapid test 15.00 – 15.30 NCCD N.Bayasgalan 3 Discussion 15.30 – 16.00 Participants

ANNEX 51 Participants’ list of the training workshop for inﬂ uenza transmission surveillance in cooperation with Tohoku University, Sendai Japan, September 8, 2011 No Participants’ name Title Selenge province 1 T.Enkhmaa Director, hospital services 2 P.Selenge Expert of Immunization dept 3 M.Oljmedekh Assistant doctor 4 D.Unur Expert of Information technology dept 5 P.Bayanjargal Head, FGP 6 B.Munkhdavaa Statistician 7 G.Tungalag Head of Children ward 8 Selenge Physician, Children ward Baganuur district 1 Ts.Khandtsoo Epidemiologist 2 Baljmaa Assistant epidemiologist 3 D.Oyunchimeg Assistant statistician 4 I.Od Expert for FGPs 5 S.Altantsetseg Deputy Director 6 Sevjid Head of Children ward 7 N.Oyuntsetseg Physician, Children ward

149 B5265G1 Annual Report - 2010/2011

ANNEX 52 List of equipment transferred from the Project Team to the ISSSs in 2011 No Description Quantity Total price, USD Nissan x-trail car 1 30.600$ TOTAL 30.600 USD

Descriptions

Province\ District Hospitals\ FGPs name name Total price, (₮) Mini Ice box refrigerator Tube stands Tube Electric cord Thermometer Enkh elberel 1 1 1 1 197,700.00 Bivaangird 1 1 1 1 197,700.00 Baganuur district Enkh urkh 1 1 1 1 197,700.00 Enerelt-ulzii 1 1 1 1 197,700.00 District hospital 11111 245,700.00 Gurvan sanchir 1 1 1 1 197,700.00 Itgel ugtakh 1 1 1 1 197,700.00 Bayangol district Shar degd 1 1 1 1 197,700.00 District hospital 11111 245,700.00 Amgalan itgekhui 1 1 1 1 197,700.00 Nasan urt 1 1 1 1 197,700.00 Bayanzurkh district Eruul urkh 1 1 1 1 197,700.00 District hospital 11111 245,700.00 Unu achit 1 1 1 1 197,700.00

Songinokhairkhan Buyant manal 1 1 1 1 197,700.00 district Enkh elberel 1 1 1 1 197,700.00 District hospital 11111 245,700.00 Sankoll 1 1 1 1 197,700.00 Tegsh mend 1 1 1 1 197,700.00 Sukhbaatar district Enkh sunder 1 1 1 1 197,700.00 District hospital 11111 245,700.00

150 Annexes

Amin tus 1 1 1 1 197,700.00 Manal uils 1 1 1 1 197,700.00 Khan-uul district Enkh titem 1 1 1 1 197,700.00 District hospital 11111 245,700.00 Uils negten 1 1 1 1 197,700.00 Shejiddug 1 1 1 1 197,700.00 Chingeltei district Tegsh ulzii 1 1 1 1 197,700.00 District hospital 11111 245,700.00 Nalaikh district Ami erdene 11111 245,700.00 Asralr uils 1 1 1 1 166,405.00 Myangan jargalan 1 1 1 1 197,700.00 Dornod province Yagaan tseene 1 1 1 1 197,700.00 Provincial 11111 245,700.00 hospital Amin kholboo 1 1 1 1 197,700.00 Gos khot 1 1 1 1 197,700.00 Gereltei 1 1 1 1 197,700.00 Tuvshin kholboo 1 1 1 1 197,700.00 Darkhan province Enerelt naran 1 1 1 1 197,700.00 Provincial 11111 245,700.00 hospital Health 1 1 1 1 197,700.00 department Agatova 1 1 1 1 197,700.00 Goyo mend 1 1 1 1 197,700.00 Misheelt mana 1 1 1 1 197,700.00 Dornogovi province Rail way 1 1 1 1 197,700.00 Provincial 11111 245,700.00 hospital Zamiin uud 1111 240,700.00 hospital

151 B5265G1 Annual Report - 2010/2011

Uils badrakh 1 1 1 1 197,700.00 Achlalt nar 1 1 1 1 197,700.00 Ankhnii och 1 1 1 1 197,700.00 Gerelt mandakh 1 1 1 1 197,700.00 Itgeliin erel 1 1 1 1 197,700.00 Niitsel 1 1 1 1 197,700.00 Munkhiin gegee 1 1 1 1 197,700.00 Munkh sundrel 1 1 1 1 197,700.00 Orkhon province Mend bulag 1 1 1 1 197,700.00 Donnosa 1 1 1 1 197,700.00 Uchraltbayar 1 1 1 1 197,700.00 Khos chagnuur 1 1 1 1 197,700.00 Elberelt uils 1 1 1 1 197,700.00 Provincial 1 1 1 1 197,700.00 hospital Health 11111 245,700.00 department Zuvlukh 1 1 1 1 197,700.00 Nomt khan 1 1 1 1 197,700.00

Selenge province Khandankhui 1 1 1 1 197,700.00 Emnekh 1 1 1 1 197,700.00 Provincial 11111 245,700.00 hospital Narnii dush 1 1 1 1 197,700.00 Tushig dulguun 1 1 1 1 197,700.00 Uvurkhangai Uyan setgel 1 1 1 1 197,700.00 province Enkhiin khurd 1 1 1 1 197,700.00 Provincial 11111 245,700.00 hospital

152 Annexes

Baatarkhairkhan 1 1 1 1 197,700.00 Jargalant 1 1 1 1 197,700.00 Bugat 1 1 1 1 197,700.00 Khovd province Buyant 1 1 1 1 197,700.00 Rashaant 1 1 1 1 197,700.00 Provincial 11111 245,700.00 hospital Jargakhui 1 1 1 192,700.00 Tsoojid 1 1 1 192,700.00 Bulgan province Emiin tsetseglen 1 1 1 192,700.00 Provincial 1111 240,700.00 hospital Rail way 1 1 1 192,700.00 Govisumber Enkh tus dem 1 1 1 192,700.00 province Provincial 1111 240,700.00 hospital Ulziit manal 1 1 1 192,700.00 Borjigon manal 1 1 1 192,700.00 Dundgovi province Suvraga-Erdene 1 1 1 192,700.00 Provincial 1111 240,700.00 hospital Unu orshikh 1 1 1 192,700.00 Shim bileg 1 1 1 192,700.00 Unmugovi province Enkhiin khuslen 1 1 1 192,700.00 Provincial 1111 240,700.00 hospital Baruun zuun mod 1 1 1 192,700.00 Binderya 1 1 1 192,700.00 Delger 1 1 1 192,700.00 Tuv province Nomt enerelt ach 1 1 1 192,700.00 Zuun mod 1 1 1 192,700.00 Provincial 1111 240,700.00 hospital

153 B5265G1 Annual Report - 2010/2011

Dalai elberelt 1 1 1 192,700.00 Buyan 1 1 1 192,700.00 Delgermurun 1 1 1 192,700.00

Khuvsgul province Tulga 1 1 1 192,700.00 Erchim 1 1 1 192,700.00 Enerel 1 1 1 192,700.00 Provincial 1111 240,700.00 hospital Achh manal 1 1 1 192,700.00 Oyunii shim 1 1 1 192,700.00 Khentii province Kherlen dom 1 1 1 192,700.00 Provincial 1111 240,700.00 hospital Enerelt ach 1 1 1 192,700.00 Enerelt khar 1 1 1 192,700.00 kharkhorin province khorin Provincial 1111 240,700.00 hospital Bayan 1 1 1 192,700.00 Batu 1 1 1 192,700.00 Mandal sum, Selenge province Tokhuu gos 1 1 1 192,700.00 Provincial 1 1 1 192,700.00 hospital NCCD 11111 245,700.00 MCHRC 11111 245,700.00 Generel hospital 1111 240,700.00 No3 National cancer 11111 245,700.00 center Generel hospital 1111 240,700.00 No1 TOTAL 25,270,105,00 ₮

154