Presentation on theme: "Global Health Security"— Presentation transcript:
1Global Health Security US efforts towards more rapid and effective responseJeff N. BorchertHealth Scientist, Division of Vector-Borne DiseasesGlobal Health Security Demonstration ProjectCenters for Disease Control and Prevention - Uganda5th Annual AFENET Conference,Addis Ababa, November 2013
2Biological threats, whether naturally occurring, intentionally produced or the result of laboratory accident, constitute a growing international threat to humans and the global economyI want to start with the following statement. It reads…….
3I wanted to tell you about something that happened about a year ago in a village in Uganda very near the border of DRC.Tragically, a young child got sick and died.The mother took the body of the child to a nearby village in DRC for the funeral
4More than 100 people attended the funeral for this boy. On the way back the mother also became ill as well as another woman, a friend who cared for the child.The friend also died and the mother was admitted into the hospital.
5A local team from the Uganda Virus Research Institute invested the cases They performed a rapid test and culture the mothers blood.The mother then died as well. 3 people deadThe tests were positive for plague, pneumonic plague – the most dangerous and contagious form of the disease. Pneumonic plague can be transmitted to others in close contact by coughing.
6The UVRI Plague Station mobilized and within 12 hours over 130 people, who had been expose were treated with antibiotics to prevent them from developing potential infection. Within 24 hours, the plague team visited every hut in the villages and sprayed them with insecticide, because plague is spread from rats, to fleas to people. There were no further cases
7So what happened here??Did the victims get on a bus and travel to Kampala or worse to the airport to Europe or elsewhere?It didn’t even make it into the newspapers.Was this the world’s next big outbreak of disease or international public health emergency.NoSo what happened? Something worked. Something worked on a very basic level prevented further casesAt its heart this is really what Global Health Security is.Disease outbreaks remind us that we are all connected, in some-ways all at risk. An outbreak anywhere can be a risk for people everywhere.
8Global Health Risks are Increasing Emergence and Spread of New PathogensGlobalization of Travel, Food and MedicinesRise of Drug ResistanceIntentional Engineering of MicrobesRecombinant TechnologiesAnthraxMRSAXDR TBFood SupplyToday;s health security threats arise from at least 5 sources:Emergence and spread of new mircrobes, or reemerged microbesGlobalization of travel and food supplyRise of drug resistanceAccelleration of biological science capabilitiesContinued concern about terrorist acquisition of biological agentsSome repots suggest that new diseases are emerging at about 1/year: better technology to detect, better epi, more awarenessAvian FluHIV
9Our friends at USAID produce a monthly map on outbreaks that have pandemic potential These events happen often and it is easy to see how what affects one area of the world can affect othersRemember that SARS caused 8,273 cases, 775 deaths and economic damage in the billions of dollars.MERS-CoV has already infected over 270 people and killed more than 100
10Rapidly detecting and reporting outbreaks Global Health Security – A world safe and secure from global health threats posed from infectious diseases by:Preventing or mitigating naturally occurring outbreaks and intentional or accidental releases of dangerous pathogens,Rapidly detecting and reporting outbreaksEmploying an interconnected global network that can respond effectively to limit spread of infectious diseaseMitigating human suffering, loss of life and economic impactSo what is Global Health Security?IHR is THE STANDARD by which the world measures preparedness for emerging disease threats and bioterrorist events.Country IDSR plans are the implementation of this
113 Pillars of CDC’s Approach to Global Health Security Detect…threats earlyRespond…rapidly and effectivelyThere are 3 basic pillars of Global Health Security:1. Detect threats earlyImprove surveillance systems and rapid reporting of outbreaksStrengthen laboratory systemsTrain field epidemiologistsBuild facilities to investigate outbreaksEmbed staff and mentors in Ministries of Health2 Respond to outbreaks rapidly and effectively:Create interconnected emergency operations centersBuild local emergency response expertiseImprove border safety and quarantine measuresEstablish or strengthen the public health workforceScale-up information management and technology infrastructure to support executive decision-making3. Prevention entails:Creating safer, more secure labs working with dangerous pathogensEnsure a safer food and drug supplyPrevent the emergence and spread of antimicrobial drug resistance and emerging zoonotic diseaseImmunize against epidemic-prone diseasesPromote evidence-based policies and decision-making which reduce the magnitude of infectious disease outbreaksGuide implementation and prevention measures…avoidable catastrophesand epidemicsPrevent
12CDC Global Health Security Demonstration Projects CDC sought to develop a model approach of rapid GHS capacity upgrades that could be implemented, improved and duplicatedUganda and VietnamMarch – September 2013Engagement with MoH and Stakeholders (AFENET)Mechanism to accelerate country progress toward IHR goals
13GHS Objectives in Uganda (April-Sept 2013)Strengthen the disease surveillance system’s capacity for detection, specimen referral and laboratory confirmation of:MDR-TB and XDR-TBCholeraVHF- EbolaEstablish a functional public health Emergency Operations CenterEnhance information systems to enable real-time monitoring of epidemics and response by integrating data sources from the disease surveillance and EOCThe remainder of my talk is about the CDC MoH demonstration project in Uganda.The MoH chose three priority disease to focus on: MDR-TB, Cholera and Ebola as a model for VHFs
14Demo - Build Upon Existing Efforts Ministry of Health (MOH), UgandaCentral Public Health Laboratory (CPHL)Uganda Virus Research Institute (UVRI)National TB Reference Laboratory (NTRL)PEPFAR InvestmentsEnhance District Health Information System-2 (DHIS-2); a web-supported, password protected data baseSupport MOH district surveillance officers to investigate and report credible events via short message service (SMS) alerts through DHIS-2Utilize Early Infant ‘HIV’ Diagnosis (EID) specimen referral hub system to transport, using motorcycles and postal service, biologic specimens for laboratory testingAugment NTRL’s TB GeneXpert roll-out and testing schemeWHO AFRO and AFRICHOLSupport culture-based confirmation of Vibrio cholerae at regional hospitals andAFENET UgandaAFENET: We partnered with AFENET to implement this program with MoH. Capitalized on their
16Uganda - Laboratory Systems GHS Uganda pathogens of interestEbola: Suspect cases isolated, specimens collected and transported to UVRI via hub network and Posta UgandaCholera: Rapid diagnostic tests pre-positioned at 17 district health facilities with specimen referral to regional referral hospital or CPHL via Posta Uganda for cultureMDR TB: Sputum transported to a GeneXpert site via EID transportation hubs; rifampin-resistant TB specimens sent to NTRL via Posta Uganda for culture and drug resistance testingNotificationLaboratory results interlinked via EOC through SMS; online reporting and tracking via DHIS-2GHS improvements capitalized on existing PEPFAR transportation hubs for EID HIV samples.Partnering with govt supported bus system; this network will be the foundation for National Surveillance ProgramDHIS-2 is an online system accessible to all locations with internetToll free SMS serviceWe demonstrated that improvements in transport, laboratory diagnostics and sample tracking/reporting decreased the amount of time for accurate diagnosis.
17Uganda - Emergency Operations Center Obtained physical space for interim EOCLink with Ministry of Health (MoH) Resource Center (PEPFAR)Permanent facility with National Health Laboratory and Resource Center compound in Port Bell (vision for a NPHI)Organized a visit for senior MoH leaders to CDCProvided emergency management training for operationsSupported the EOC manager position
18Uganda - Information Systems Improve real-time detection, monitoring and confirmation through improved connectivity, timely data collection and access within the District Health Information System (DHIS2)Develop disease-specific mobile tools for data capture and use during outbreaks (Epi-Info based)Improve lab data quality, timeliness and use through a centralized specimen tracking system and expand availability of resultsBuild an integrated data system using the EOC as the hubDevelop dashboards and reports for access by health system stakeholders at all levels on a “need to know” basisAll of these improvements will be available to health system stakeholders and multiple levels.
19Accomplishments SOPs and protocols established Exercise drill completed Sept 2013Evaluated specimen transport, SMS communication, DHIS-2 tracking, and EOC management of mock responseUsed GHS Uganda system components:Crimean-Congo hemorrhagic fever outbreak in Agago District: Referral hub transported suspect VHF specimens within 24 hrsSuspect case of XDR-TB at Mulago Hospital’s isolation ward had sputum collected, tracked and transported to NTRL (extracted M. tuberculosis DNA for sequencing in Atlanta)Besides EOC, key achievements in three areas: 1) communications, 2) specimen transportation and 3) diagnostic capabilityVisit to CDC EOC by MOH senior staff June 2013Visit by CDC Director to Uganda including EOC – July 2013The rapid upgrades of the pilot project (EOC + key achievements above) have rapidly increased UG’s compliance with IHR
20EOC Activations Pilgrims returning from Hajj Solar Eclipse in Pakwatch, NW UgandaeMTCT HIV
21Next Steps - ResponseConduct Incident Command Structure training for key staffTrain rapid response teams and develop disease-specific district SOPs for outbreak responseTrain village health teams in disease containment and reportingRe-administer lab assessment tool to identify GHS improvements and maintain continuous quality improvementExpand GHS model beyond 17 pilot districts; add 23 districts/yearPerform 2014 exercise drill focused on response capabilitiesUltimate goal is to establish surveillance network down to village levelPlan to add 23 district per year covering all districts within 5 yearsMoH considering activation of EOC for eMTCTeMTCT activation will mark the opening of the EOC with high level of engagement from First LadyThis high level opening will allow MoH to start marketing the EOC to press and UgandaUganda GHS project may serve as a model for other countries in it’s entirety or at least some elements are replicable in other countries.
22Most effective roll out of GHS Replicable model of GHS capacity upgradesMulti partner engagementInternational partnershipsDifferent in every country“…we must come together to prevent, and detect and fight every kind of biological danger - whether it’s a pandemic like H1N1, or a terrorist threat or a treatable disease.”President Barack Obama, 2011Mulitparty engagement – nations to nations, donor to recipients, stakeholdersNuances are different in every country. Must always consider the unique need of host countriesCurrently USG invests ~$2.7 billion in GHS objectives – about ½ to improve GHS capacity and ½ for research
23Thank you US DoD Defense Threat Reduction Agency AFENET Uganda Uganda Ministry of HealthUganda Virus Research InstituteCDC AtlantaCDC Fort Collins