Global Alert and ResponsehttpAssets)/D00F1FB674698609C... · Global Alert and Response GLEWS:...

Global Alert and Response


Guangdong Province,

China

A

A

Hotel M Hong Kong

B

J

H

Hospital 2 Hong Kong

A

H

J

B

4 other Hong Kong

Hospitals

C D E


Hospital 1 HK


2 family members

C D E

34 HCWs

HCW

B Germany

Bangkok

Singapore

United States

I

I L§

M§

Vietnam

K † Ireland K †

37 HCWs

HCW

0 HCWs

28 HCWs

156 close contacts of HCWs and

patients

F G †

Canada

G †

F

4 family members 10 HCWs

37 close contacts

99 HCWs (includes 17 medical students)

4 HCWs*

3 HCWs

HCW

HCW

2 family members

Unknown number

close contacts

2 close contacts

* Health-care workers; † All guests except G and K stayed on the 9th floor of the hotel. Guest G stayed on the 14th floor, and Guest K stayed on the 11th floor; § Guests L and M (spouses) were not at Hotel M during the same time as index Guest A but were at the hotel during the same times as Guests G, H, and I, who were ill during this period.

Chain of transmission among guests at Hotel M—Hong Kong, 2003

Data as of 3/28/03


International Health Security IHR(2005), a paradigm shift

From control at borders to containment at source

From diseases list to all threats

From preset measures to adapted response


Is the public health impact of the event serious? Is the event unusual or unexpected?

ask

1. Is there a significant risk of international disease spread?

2. Is there a significant risk of travel or trade restrictions?

Events detected by the national surveillance system

If yes to any of these 2 questions

Notify WHO under the IHR (2005)

Four notifiable diseases Any public health event of potential international public health concern

Important epidemic-prone diseases

The IHR (2005) came into force on 15 June 2007


Response Operations

Risk Assessment

Event Verification

Initial Screening

Informal Sources Formal Sources

Information Sharing


Ever increasing number of search engines – information overload Challenges

–  Boost signal, reduce noise –  Improve positive predictive value of incoming information –  Move from threat detection to systematic and scientific risk assessment –  ICT innovations for epidemic threat detection, data retrieval and

synthesis –  Disciplines and tools for decision support


  Hazard, exposure and vulnerability assessments, including proxy measures of disease activity e.g. social disruption

  Other concommittant events/conditions which may affect interpretation –  e.g. climate/ occupational/population movements (human and/or animal/

entomological/cultural practices

  Historical data for the zone Drawing together current and contextual information and expertise

from multiple groups and sources to make a coherent and composite analysis


Risk analysis

Options analysis

Decide and plan

Implement

Review and Modify

Risk

com

mun

icatio

n Monitoring and evaluation


By WHO region Jan 2001 – Dec 2008


Epidemic Intelligence

Epidemiological Verification and Risk Assessment

Public Health Response

Follow-up


No single institution has all the capacity!

–  a global technical network of (from 70 to 140) partner institutions and networks

Focus and coordinate global resources - local > regional > global

–  Coordinated/supported by WHO to provide rapid international team support to countries for outbreak response


 Assist countries with disease control efforts by ensuring rapid appropriate technical support to affected populations

  Investigate and characterize events and assess risks of rapidly emerging epidemic disease threats

 Support national outbreak preparedness by ensuring that responses contribute to sustained containment of epidemic threats


Access to resources, information exchange and sharing of best practice, technology transfer.

Reduce vulnerability and strengthen resilience, provide redundancy.

Alleviate costs, by improving the use/mobilization of resources, and providing surge capacity.

Strengthen transparency and credibility, enhance dialogue and build trust.


Equitable and appropriate participation in field missions

Early Alert and Request for Assistance

Clear Terms of Reference for International Missions

Clear Terms of Reference for Experts

Rapid, transparent, consistent decision-making

Professional administration and contracting

Dependable field logistics and consistent operational support


Ground transportation and air liaison; 6 vehicles

Radio communication, IT and satellite system provision

Stockpiling and deployment of essential outbreak response equipment and supplies

Field security and domestic equipment provision: 4 trailers


How to activate a GOARN response, to coordinate response in the field, to evaluate and follow-up outbreaks of international importance.

Provides framework for coordinated international outbreak response and streamlining operational issues

With the Code of Conduct ……….seek to promote the highest standards of professional performance in the field.


Finalization of Field Information Management System (FIMS) for investigation of clusters of cases with integrated management of case, contact, laboratory, clinical, and GIS data.


Support and facilitate the WHO Organization-wide event management process -

Inform and document key decisions.

Accommodate and promote IHR(2005) specific activities and reporting.

Analysis Response Surveillance and Risk Assessment


WHO is assisting the UN Office for Disarmament Affairs with the enhancement of the UNSG Mechanism for Investigation of Alleged Use

Exchange of letters between UNODA and WHO, and road map approved in March 2009

Share information on the technical, operational, logistical, and health & safety related aspects of response activities


Farm Table

Anim

al

Slaughter

Processing

Food product

Handling

Markets

Markets

Markets

Global Early Warning System for Major Animal Diseases,

including Zoonoses (GLEWS)

International Food Safety Authorities

Network (INFOSAN)


A global network of national food safety authorities which…

Promotes the exchange of important food safety information globally

Helps countries strengthen their capacity to manage food safety risks

Responds to international food safety events with the goal of preventing foodborne disease

As of today, there are 169 country members of INFOSAN


January February March April May June July August September October November December

Angola – in-country assistance

Salmonella in Peanut Butter – alert to 70 countries

Arsenic in mineral water– alert sent to all countries

HPAI H5N1

Possible C.Botulinum in baby food – alert sent to all countries

HPAI H5N1

Plastic in chocolate – alert to 8 countries

Melamine in protein-enrichment for pet food – alert sent to all countries

Salmonella outbreak – technical assistance

Glass in marmalade – alert to 1 country

Salmonella in Veggie Snacks – alert sent to all countries

Possible C.Botulinum in canned food – alert sent to 8 countries

Guidance on Dioxin sent to all countries

Shigella in baby corn – alert sent to 3 countries

Metal pieces in yoghurt – alert sent to 8 countries

Rift Valley Fever and risk of importing live animals – alert sent to 5 countries

HPAI H5N1


GLEWS: formalized FAO/ OIE/ WHO initiative –  GLEWS builds on the added value of combining and coordinating the

alert mechanisms of FAO, OIE and WHO for the international community and stakeholders to assist in forecasting, prevention and control of zoonotic diseases through sharing of information, epidemiological and risk analysis.

An early warning system that formally brings together human and veterinary public health systems

Desired outcome: –  Triggers appropriate action –  Timely, information driven decision making –  Decreased zoonotic disease burden –  Coherent messages from participating organizations


Seasonal influenza

Pandemic Influenza (H1N1 pdm)

H5N1 Avian Influenza (human cases)

Surveillance through above mechanisms, and through specialized network for influenza surveillance – the Global Influenza Surveillance Network


A global network of laboratories •  118 National Influenza Centres in 89 countries

•  4 WHO Collaborating Centres for Reference and Research on Influenza

•  3 key national reference laboratories involved in WHO vaccine virus selection and development

•  1 WHO Collaborating Centre for Studies on the Ecology of Influenza in Animals

Monitor the circulation of influenza viruses and epidemics and provide recommendations for influenza preparedness and response –  Including vaccines, diagnosis, antivirals and continuing risk

assessment.

Serve as a global alert mechanism for the emergence of influenza viruses with pandemic potential


Face severe challenges in detection and reporting : –  Private sector and traditional medicine are often not included –  A large proportion of the population do not access formal health care (can

be as high as 60%) –  Often multiple surveillance systems collecting data from the same people,

using slightly different reporting time frames and data formats –  Over the last 15 years there have been numerous attempts to overhaul

surveillance systems –  has sometimes led to some confusion and a feeling at the grassroots level that

the system is always changing and does not really work

Many of the routine reporting systems are quite fragile and are unlikely to be used for any research purposes.


Face severe challenges in linking surveillance with response and providing adequate feedback •  Ability to investigate limited by resources/skills/infrastructure •  Training materials may be pitched at too high a level •  Too few staff work at the clinical and public health level •  Health care staff are often low paid and therefore have several

jobs – leaving very little time for surveillance activities •  Lack of diagnostic capacity often means inability to respond

with correct control measures at early stage in the event •  *Need rapid, multivalent, diagnostics at national and

local levels*


THANK YOU

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