Implementation of Effective Policies on Emerging Infectious Diseases

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Implementation of Effective Policies on Emerging
Infectious Diseases

• LEE DUKHYOUNG, MD. PhD.
• KOREA CDC

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BACKGROUND
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Joseph Malik Peiris (The Lancet Infectious
Diseases website)
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(No Transcript)
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(No Transcript)
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Emerging zoonoses
Contrary to "lingering" zoonoses, public
awareness of "emerging" zoonoses is very high.
The WHO/FAO/OIE joint consultation on emerging
zoonotic diseases held in Geneva, 3-5 May 2004,
defined an emerging zoonosis as "a zoonosis that
is newly recognized or newly evolved, or that has
occurred previously but shows an increase in
incidence or expansion in geographical, host or
vector range". Emerging zoonotic diseases have
potentially serious human health and economic
impacts and their current upwards trends are
likely to continue.
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WHO Alert Response A Global Strategy
World Health Assembly ReportWHA54.9
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Key Changes of IHR

• Real time event management system
• National core surveillance capacities
• Notification for public health emergencies of
  international concern
• - algorithm and diseases list
• Support Member States with technical assistance
  at their request
• IHR national focal points

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H5N1 Human to Human Infection
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10. WHO will alert the world when the pandemic
threat increases. WHO works closely with
ministries of health and various public health
organizations to support countries' surveillance
of circulating influenza strains. A sensitive
surveillance system that can detect emerging
influenza strains is essential for the rapid
detection of a pandemic virus. Six distinct
phases have been defined to facilitate pandemic
preparedness planning, with roles defined for
governments, industry, and WHO. The present
situation is categorized as phase 3 a virus new
to humans is causing infections, but does not
spread easily from one person to another.
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Cumulative Number of Confirmed Human Cases of AI
(H5N1) Reported to WHO
9 December 2005
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• Richard Falkenrath
• Flu pandemic is the most dangerous
• threat the United States faces today
• Its a bigger threat than terrorism.
• In fact its bigger than anything
• I dealt with when I was in government.

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(No Transcript)
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LOCAL SITUATION
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Communicable Diseases in the 80s

• Improving in Hygiene, Economic Development,
  Urbanization
• Epidemiological Transition from communicable
  diseases to NCD

Typhoid fever, Pertussis Measles ,Mumps
Typhoid fever, Pertussis, Measles Mumps, Japanese
encephalitis
Typhoid fever, Pertussis Measles, Malaria
Pertussis Measles,Mumps
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Fever Check
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Avian Flu Outbreak in Poultry

• First case Chicken farm in Chungbuk province
  Dec. 11. 2003
• Last case Chicken farm in Gyeonggi province
  Mar. 20. 2004
• 19 poultry farms in 10 counties or cities were
  affected
• About 5million poultry were culled in 392 farms

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Avian Flu Outbreak in Poultry
160,000
140,000
120,000
100,000
80,000
60,000
40,000
20,000
0
2003.12.10
2003.12.17
2003.12.24
2003.12.31
2004.01.07
2004.01.14
2004.01.21
2004.01.28
2004.02.04
2004.02.11
2004.02.18
2004.02.25
2004.03.03
2004.03.10
2004.03.17
National Veterinary Qurantine Service
Ministry of Agriculture
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Map of Avian Flu Outbreak in Poultry
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SHORT RANGE MEASURES
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Review of Communicable Disease Control System

• Legal basis
• Surveillance system
• Mandatory notification
• Sentinel
• Outbreak Investigation
• Field epidemiologists
• Laboratory experts

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Class 3
Communicable diseases which need to monitor
consistently
Malaria, Tuberculosis, Hansen's disease(Leprosy),
STI, Scarlet fever, Meningococcal meningitis,
Legionellosis, Vibrio vulnificus sepsis, Epidemic
typhus, Murine typhus, Scrub typhus,
Leptospirosis, Brucellosis, Anthrax, Rabies,
Hemorrhagic fever with renal syndrome, Influenza,
AIDS
Class 4
Emerging and Imported infectious disease
Yellow fever, Dengue fever, Marburg fever, Ebola
fever, Lassa Fever, Leishmaniasis, Babesiosis,
African Trypanosomiasis, Cryptosporidiosis,
Schistosomiasis, Yaws, Pinta, Newly Emerging
infectious disease

• Red Sentinel surveillance diseases
• Blue Newly designated diseases

STI Syphilis, Gonorrhea, Chlamydial Infection,
Chancroid, NGU, Genital herpes,
Condyloma acuminata
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(No Transcript)
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Communicable Disease Surveillance and Control
International Public Health Services
National Reference Laboratory
NCD Surveillance and Research
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Emerging Infectious Diseases
Reinforcing Infrastructure
Restructuring Organization
Manpower Development
Stockpiling
Redesign Policy and Law
Information
Research and Development
Strengthening Capability to Address Threat
Surveillance
Outbreak Investigation
Public Laboratory
Disease Control
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Computerized Reporting System by EDI
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Communicable Disease Information System
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Reporting System of Sentinel Surveillance(1)Viral
Hepatitis, Influenza, STI
Sentinel physician
Report (Tel/Fax)
Feedback
Specimen Referral
Feedback
Public Health center (District level)
Report (EDI)
Feedback
Div. of Health (Provincial level)
Provincial RIHE
Report (EDI)
Feedback
Specimen Referral
Feedback
KCDC
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Reporting System of Sentinel Surveillance(2)VRSA
, Imported Infectious Diseases, CJD
Sentinel physician
Report (Tel/Fax)
Feedback
KCDC
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Influenza SentinelSurveillance System
KCDC
Data analysis Result feedback
Provincial Health Dept.
PHERI
Result reporting
Sample refer Result reporting
Internet DB Server
Information sharing
Information sharing
Reporting
Reporting
Result reporting
Public Health Center
Private Sentinel Surveillance organ
Sample refer
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Sentinel Surveillance - Clinical ILI Surveillance
-
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Sentinel Surveillance - Laboratory Surveillance -
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WHO Global Alert and Response Operations
Formal WHO laboratory networks, (sub-)regional
networks, WROs MoH, UNOs
Informal Global Public Health Intelligence
Network (media), NGOs
Epidemic Intelligence
Verification
Other sources e.g. NGOs, WHO CCs
Country Official Sources e.g. MoH
Risk Assessment
HQRegional Offices WROs
Response
Global Outbreak Alert and Response Network
Coordination
Logistics
Communication
Security
Admin/Finances
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Fever Check
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Influenza Pandemic Impact
(Million)
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• blessed are they that have not
• seen, and yet have believed.
• Jn 20.29

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Plan for Influenza Pandemic

• Prepare the protocol for Influenza pandemic
  state
• Improvement and reinforcement of early
  surveillance system
• Stockpiling of resources
• Enlargement of stockpiling of antiviral drug
  (Tamiflu)
• Personal Protective equipment amount of 30 days
  for hospital medical team

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Annual Amount of Flu Vaccine Distributed in the
Market
Distributed Doses
15million
17million
11 million
10 million
8 million
Season
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WHO Alert Response A Global Strategy
World Health Assembly ReportWHA54.9
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LONGER TERM MEASURES
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Field Epidemiologist Training Program
Central Education
Appointment of Officer -Central, Provincial level
On-The Job Training
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Field Management Training Program
Evaluation of Training Teachers training
Web-based education
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Key Changes of IHR

• Real time event management system
• National core surveillance capacities
• Notification for public health emergencies of
  international concern
• - algorithm and diseases list
• Support Member States with technical assistance
  at their request
• IHR national focal points

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Pandemic influenza vaccine issues
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New Goal Global Partnership
Contribution in Global Society
Information Sharing with Global Society
Bilateral and Multilateral Collaboration
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• Margaret Hamburg
• Our best defense is a robust and global
• system for public health both its science and
  its practice.
• Success will require political and public
• health leadership new investments in people,
• facilities and programs new partnerships.
• and importantly, sustained commitment and
• continual vigilance.