WHO/CDS/CSR/2000.3 Global Outbreak Alert and Response. Report of a WHO meeting Geneva, Switzerland 26-28 April 2000 World Health Organization Department of Communicable Disease Surveillance and Response This document has been downloaded from the WHO/EMC Web site. The original cover pages and lists of participants are not included. See http://www.who.int/emc for more information. © World Health Organization This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced and translated, in part or in whole, but not for sale nor for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors. The mention of specific companies or specific manufacturers' products does no imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. WHO/CDS/CSR/2000.3 Contents Executive Summary ………………………………………………………………………… 1 1. Introduction …………………………………………………………………………… 3 1.1 Opening ceremony ……………………………………………………………… 3 1.2 Participants and agenda ……………………………………………………….… 3 1.3 Global review …………………………………………………………………………. 3 2. Proceedings …………………………………………………………………………… 5 2.1 Outline of daily sessions …………………………………………………….. 5 2.2 Session 1: Outbreak Alert Systems ………………………………………….. 5 2.2.1 Outbreak Alert and Specialized Surveillance Networks …………………….. 5 2.2.2 Global Public Health Intelligence Network(GPHIN) ……………………….. 5 2.2.3 FluNet ………………………………………………………………………... 5 2.2.4 PACNET …………………………………………………………………….. 6 2.2.5 CDC Alert Systems ………………………………………………………….. 6 2.2.6 Outbreak Alert and Response at WHO …………………………………….... 6 2.2.7 IHR: A Mechanism for International Reporting ……………………………... 6 Key points from discussion ………………………………………………………….. 7 2.3 Session 2: Coordination of Outbreak response ……………………………… 7 2.3.1 Existing mechanisms for cooperation in outbreak response ………………... 7 2.3.2 Outbreak alert and reponse in emergencies …………………………………. 7 2.3.3 Rift Valley fever outbreak - Kenya/Somalia - 1997/8 ………………. 8 2.3.4 Nipah virus outbreak - Malaysia/Singapore 1999 …………………… 8 2.3.5 Experience with Amazonia and Southern Cone Surveillance Networks ……………………………………………. 8 2.3.6 International outbreak response - Afghanistan: a country perspective ……………………………………………... 9 2.4 Session 3: From Response to Preparedness ……………………………..…… 9 2.4.1 From response to preparedness: how can better international coordination lead to better epidemic preparedness at regional and national levels? …………………………………………………… 9 2.4.2 International Coordinating Group (ICG) on vaccine provision for epidemic meningitis ……………………………………………… 10 2.4.3 Sub-regional approaches - West Africa ………………………………. 10 2.4.4 Sub-regional approaches - the Mekong Delta Project ………………… 10 2.4.5 Epidemiology Training Programmes - a resource for preparedness and response (TEPHINET) ………………………….. 10 2.4.6 Early warning and response network (EWARN), Southern Sudan ….. 11 2.4.7 Global Salm-Surv (GSS) - building capacity through surveillance networks …………………………………………………………….. 11 2.5 Reports from the Working Groups …………………………………………… 12 2.5.1 Working Group 1 …………………………………………………….. 12 2.5.2 Working Group 2 …………………………………………………….. 13 2.5.3 Working Group 3 …………………………………………………….. 14 2.5.4 Working Group 4 …………………………………………………….. 15 3. Recommendations ……………………………………………………………………. 17 Annex 1: Agenda ……………………………………………………………………….. 19 Annex 2: Abstracts ……………………………………………………………………… 21 Annex 3: Participants …………………………………………………………………… 36 Global Outbreak Alert and Response: Report of a WHO meeting i WHO/CDS/CSR/2000.3 Executive Summary At the beginning of the 21st century, the world is still confronted with: • the emergence of new or newly recognized pathogens • the recurrence of well-characterized epidemic-prone diseases • the potential for accidental or deliberate release of biological agents Contributing factors are poverty, widening development gaps, collapse of public health infrastructure, urbanization, civil strife, new use and development of biological products, environmental change and degradation, and globalization of travel and trade. Whereas traditional approaches to containing outbreaks were defensive, trying to secure borders from the entry of infectious diseases, modern solutions, in addition to the development of new anti-infective drugs and vaccines, are built on a combination of early warning surveillance systems, epidemic preparedness plans, stockpiles of essential materials, speedy communications and information sharing through networks to rapidly contain epidemic threats. WHO, with its international mandate, including the International Health Regulations, and with its unique experience with and privileged access to countries, is in a unique position to coordinate global outbreak alert and response. The success of these endeavours will be guaranteed through WHO's partners - national (ministries of health, scientific institutes) and international (networks, other organizations, NGOs) with WHO support and coordination. The Department of Communicable Disease Surveillance and Response (CSR), organized a major international meeting on "Global Outbreak Alert and Response" in Geneva, April 26-28, 2000. This meeting brought together 121 representatives from 67 key partner institutions in global epidemic surveillance and response to discuss the challenge of epidemic-prone and emerging diseases faced by the world as we enter the 21st century and the need to build a global network on existing partnerships to deal with these threats. The participants addressed: • current and potential epidemic threats with risk for international spread, humanitarian repercussions or significant impact on travel and trade • existing initiatives in global outbreak alert and response • the establishment of a global outbreak alert and response network The participants expressed the need for the establishment of a "Global Outbreak Alert and Response Network" and agreed on a series of principles and functions for the network. General principles: • The Network will focus on maintaining global public health security by ensuring coordinated mechanisms for outbreak alert and response • It will consist of a technical partnership between existing institutions and networks • It will complement and strengthen existing networks Global Outbreak Alert and Response: Report of a WHO meeting 1 WHO/CDS/CSR/2000.3 Functions: • The network will work to combat the international spread of outbreaks by rapid identification, verification and communication of threats leading to coordinated response • It will ensure that the appropriate technical assistance reaches affected states rapidly and leads to reduced morbidity and mortality and prevention of further disease spread • It will contribute to long-term outbreak preparedness and capacity building by ensuring that acute responses lead to longer-term technical assistance • It will constantly evaluate international efforts to contain outbreaks Structure: • The network will consist of a global alliance of technical partner institutions and networks which will be supported by: - a "Steering Committee" consisting of network partners - an operational support team (OST) based in WHO • The “Steering Committee” will have an oversight and planning function for the network and will have wide geopolitical and organizational representation • The OST will consist of a minimum of 5-6 WHO full-time equivalent staff from Headquarters (HQ), WHO Regional Office staff, and will be supplemented with secondments from partners • Task forces/working groups will be established to deal with specific issues (e.g. drafting a code of practice for international outbreak response) • In the start up process, the “Steering Committee” should consist of a small interim committee, with WHO deciding on the initial membership (not more than 12 months) and based on complementary skills and experience Financing of the Network: • The proposed activities of the network represent WHO core business, and this should be recognized through support with an investment from WHO funds, supplemented by extra-budgetary sponsorship • The network partners should support the network through activity support and staff secondments where possible • A budget proposal for Network activities will be developed by WHO Next Steps in creating a functional global alert and response network: • Finalization of the framework document for a Global Outbreak Alert and Response Network (May/June 2000) • Establishment of a small "interim committee" based on complementary skills and experience (June/July 2000) • Establishment of an event management system with real time information exchange (October 2000) • Inventory of the partners’ capacities in an interactive global database of experts (December 2000) • Establishment of a Code of Practice for Network operations, for field operations and for conflict resolution. The drafts of the Code of Practice will be coordinated by WHO and approved by all partners (October 2000). 2 Global Outbreak Alert and Response: Report of a WHO meeting WHO/CDS/CSR/2000.3 1. Introduction 1.1 Opening ceremony Dr DL Heymann, Executive Director of the Cluster of Communicable Diseases, welcomed the participants and opened the meeting on behalf of the Director-General of WHO, Dr GH Brundtland. The objectives of the meeting were outlined as follows: • To review current outbreak