EEppiiddeemmiicc AAlleerrtt aanndd RReessppoonnssee iinn EEmmeerrggeenncciieess Dr. Mike Ryan, Director Dep artm ent of E p id em ic and P and em ic A lert and Res p ons e C om m u nicab le Dis eas e C lu s ter 2 7 th N ov em b er 2 0 0 6 Epidemic and Pandemic Alert and Response OOVVEERRVVIIEEWW BB aacckkgg rroouu nndd aanndd PP rriinncciipp lleess ooff EE pp iidd eemm iicc AA lleerrtt aanndd RReess pp oonnss ee PP rreepp aarreedd nneess ss PP llaannnniinngg EE pp iidd eemm iicc DDeetteeccttiioonn,, IInnvv eess ttiigg aattiioonn aanndd RReess pp oonnss ee IInntteerrnnaattiioonnaall AA ss pp eeccttss Epidemic and Pandemic Alert and Response EEppiiddeemmiiccss aanndd PPaannddeemmiiccss hhaavvee sshhaappeedd oouurr hhiissttoorryy…… 1stMillenium SpreadM ofi d19d18le In Aflugenezsa Pandemic in USA Epidemic and Pandemic Alert and Response TThheeyy ccoonnttiinnuuee ttoo tthhrreeaatteenn uuss.... …and place sudden intense demands on national and international health systems ….on some occasions have brought systems to the point of collapse W HO has verified more than 1240 events between January 2001 and October 2006 Epidemic and Pandemic Alert and Response EEppiiddeemmiicc CCoonnttrrooll RReeqquuiirreess…… 1 . S trong national p u b lic h ealth s ys tem s and cap acity 2 . S p ecific p rep ared nes s for key p riority d is eas e th reats (e.g . S O P s , d iag nos tics , d ru g s , v accines , p rotectiv e eq u ip m ent, containm ent m eas u res ) 3 . A n effectiv e international s ys tem and p artners h ip for coord inated alert and res p ons e Epidemic and Pandemic Alert and Response WW hhaatt iiss aann oouuttbbrreeaakk//eeppiiddeemmiicc?? A n u nu s u al occu rrence of m ore cas es of d is eas e th an ex p ected in a g iv en area am ong a s p ecific g rou p of p eop le ov er a p articu lar p eriod of tim e A p u b lic h ealth em erg ency A n econom ic em erg ency A p olitical em erg ency S u rv eillance failu re C ontrol failu re A n ev ent req u iring rap id and coord inated action (…a s tres s tes t for th e p u b lic h ealth s ys tem !!) A n op p ortu nity ! Epidemic and Pandemic Alert and Response SSppeecciiffiicc ddeemmaannddss ww hheenn iinnvveessttiiggaattiinngg oouuttbbrreeaakkss • Unexpected event • Need to act quickly • Need for rapid control • Many players Systematic approach Epidemic and Pandemic Alert and Response EEppiiddeemmiicc FFiieelldd OOppeerraattiioonnss -- FFuunnccttiioonnss Traditional Medical Burial Screening Clinical Teams healers Anthropology IN / OUT trials Posters Psycho Social Case Barrier Radio Social Nursing Mobilization and support Management Community Discussion Health Education W ater Sanitation Media Coordination Environment Mobile Contact Teams Surveillance Tracing Logistics Roads Case and Security Epidemiology Finding Police Laboratory Sample Data Collection Transports Reporting Salaries Management Vehicles Results Testing Epidemic and Pandemic Alert and Response OOuuttbbrreeaakk AAlleerrtt aanndd RReessppoonnssee First Late Delayed Case Detection Response 90 80 70 60 CASES 50 Opportunity 40 for control 30 20 10 0 1 4 7 0 3 6 9 2 5 8 1 4 7 0 1 1 1 1 2 2 2 3 3 3 4 DAY Epidemic and Pandemic Alert and Response OOuuttbbrreeaakk AAlleerrtt aanndd RReessppoonnssee Early Rapid Detection Response 90 80 70 Control 60 CASES 50 Opportunity 40 30 20 10 0 1 4 7 0 3 6 9 2 5 8 1 4 7 0 1 1 1 1 2 2 2 3 3 3 4 DAY Epidemic and Pandemic Alert and Response OObbjjeeccttiivveess ooff EEppiiddeemmiicc PPrreeppaarreeddnneessss,, AAlleerrtt aanndd RReessppoonnssee 1.Prevention/Anticipation/prediction • so that epidemics be prevented (e.g. measles) 2. Early detection • to know when there is a problem (e.g. EW ARS) 3.Rapid Response • SOPs/ staff/supplies (in place before epidemic) 4. Effective Response • appropriate control methods • good co-ordination • adequate resources and logistics • after-action evaluation Epidemic and Pandemic Alert and Response EEppiiddeemmiicc AAlleerrtt aanndd RReessppoonnssee AA nnttiicciipp aattiioonn PP rreevv eennttiioonn PP rreepp aarreedd nneess ss DDeetteeccttiioonn RRiiss kk AA ss ss eess ss mm eenntt RRiiss kk CC oomm mm uu nniiccaattiioonn RReess pp oonnss ee EE vv aalluu aattiioonn Epidemic and Pandemic Alert and Response PPrreevveennttiioonn PPrreeppaarreeddnneessss PPllaannnniinngg Epidemic and Pandemic Alert and Response AAnnttiicciippaattiioonn aanndd PPrreevveennttiioonn K1 nnooww nn RRiiss kkss E p id em iolog ical P rofile (h is torical p rofile of ep id em ic th reats ) S p ecific ep id em ic th reats related to th e ev ent (flood /T s u nam i v s d is p lacem ent) PP rreevv eennttiioonn E d u cation/s ocial m ob ilis ation Im m u nis ation W ater/S anitation/H yg iene L iv ing cond itions /cam p d es ig n Epidemic and Pandemic Alert and Response PPrreeppaarreeddnneessss K1 nnooww tthh ee rriiss kkss SS eett PP rriioorriittiieess PP llaann CC oo--oorrdd iinnaattee IImm pp lleemm eenntt Epidemic and Pandemic Alert and Response PPrriioorriittyy SSeettttiinngg W hat are the major epidemic prone diseases ? W hat is the risk of an epidemic ? • time since last outbreak, frequency of outbreaks W hat would be the likely impact of an epidemic ? • Potential number of cases/deaths, likelihood of spread Control measures ? • Are effective and affordable measures available ? Resources ? • Do you have adequate resources ? Epidemic and Pandemic Alert and Response Priority setting - II Epidemic Risk Impact Control Resources prone disease measures Cholera High High X Meningitis Low High Measles Low Low JE High Low X Low High Malaria X Low Low Viral HF Epidemic and Pandemic Alert and Response EEppiiddeemmiicc PPrreeppaarreeddnneessss PPllaannnniinngg List the priority diseases Define the surveillance, preparedness and response measures to be implemented Identify responsibilities (who does what) Identify co-ordination mechanisms (leadership) Specify resources available for preparedness and response (budget) Epidemic and Pandemic Alert and Response EEppiiddeemmiicc PPrreeppaarreeddnneessss PPllaannnniinngg W hat should be done ? W ho should do it ? W hat resources or supplies will be required ? Epidemic and Pandemic Alert and Response CCoonnttrrooll mmeeaassuurreess aarree bbaasseedd oonn kknnoowwlleeddggee ooff:: DDiisseeaassee ttrraannssmmiissssiioonn reservoir, sources, routes IInnffeeccttiioouuss pprroocceessss exposure, infection, disease PPaatthhooggeenneessiiss ooff ddiisseeaassee ssttaattee target organs, virulence, immune response NNaattuurraall hhiissttoorryy EEffffeeccttiivveenneessss ooff ccoonnttrrooll mmeeaassuurreess Epidemic and Pandemic Alert and Response MM aajjoorr ttrraannssmmiissssiioonn rroouutteess Insects Vector borne Droplet Animals Sexual Food Direct Environmental Blood W ater Skin to skin Drop. nuclei Other Airborne Dust Epidemic and Pandemic Alert and Response DDooeess aa ppootteennttiiaall ccoonnttrrooll mmeeaassuurree rreedduuccee TTrraannssmmiissssiioonn EExxppoossuurree IInnffeeccttiioonn DDiisseeaassee ? DDeeaatthh DDiissaabbiilliittyy Epidemic and Pandemic Alert and Response PPrriinncciipplleess ooff ccoonnttrrooll P rev ent ex p os u re P rotect s u s cep tib les from infection P rev ent p rog res s ion from infection to d is eas e T reat cas es P re v e n t d e a th a n d d is a b ility œ P re v e n t fu rth e r tra n s m is s io n Interru p t trans m is s ion œ E n v iro n m e n ta l œ S o c ia l/b e h a v io u ra l œ L e g a l Epidemic and Pandemic Alert and Response Pathways of Disease Transmission HOST Exposure PATHOGEN D V E i e n r c v t Incubation e i c o r Period t r PATHOGEN Infection Disease Epidemic and PDaenatdhemic AleRret caonvedr yResponse Exposure HOST D V E Susceptibility i e n - previous exposure r c v - immunity e t i - compromise c o r - prophylaxis t r Infection Disease Death Recovery Epidemic and Pandemic Alert and Response Exposure HOST D V E i e n r c v e t i c o r t r General health Nutrition Infection Immunity Virulence Immune response Prophylaxis Disease Death Recovery Epidemic and Pandemic Alert and Response Exposure HOST D V E i e n r c v e t i c o r t r Infection Disease Treatment Death Recovery Epidemic and Pandemic Alert and Response Control W here does it fit in? Epidemic and Pandemic Alert and Response Points for control m easures Exposure 7 D V E i e n r c v 1 e 6t i c o r t r Infection 4 2 5 Disease 3 Death Recovery Epidemic and Pandemic AleDrti saanbdili tRyesponse Points for control m easures Exposure D V E i e n r c v Vaccination 1 e t i c o r t r Infection Disease Death Recovery Epidemic and Pandemic AleDrti saanbdili tRyesponse Points for control m easures Exposure D V E i e n r c v e t i c o r t r Infection Prophylaxis 2 Disease Death Recovery Epidemic and Pandemic AleDrti saanbdili tRyesponse Points for control m easures Exposure D V E i e n r c v e t i c o r t r Infection Treatment Disease Rehabilitation 3 Death Recovery Epidemic and Pandemic AleDrti saanbdili tRyesponse Points for control m easures Exposure D V E i e n r c v e t i c o r t r Isolation Infection 4 Treatment 5 Disease Death Recovery Epidemic and Pandemic AleDrti saanbdili tRyesponse Points for control m easures Exposure D V E 6 i e n r c v t Infection control e i o Vector mgt c r t r W ater treatment Infection Disease Death Recovery Epidemic and Pandemic AleDrti saanbdili tRyesponse Points for control Repellents m easures Exposure 7 Bednets D V E i e n r c v e t i c o r t r Infection Isolation Disease Death Recovery Epidemic and Pandemic AleDrti saanbdili tRyesponse Points for control