Water-related disease surveillance and response Roger Aertgeerts Program manager WHO Regional Office for Europe

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 2 Targets are team work Manage resources Provide water and sanitation Survey diligently Detect outbreaks Implement contingency plans Live and learn, and pass it on…

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 3 Agenda Water use –Target setting Access to water and sanitation –Target setting for water services Water-related diseases –Target setting for surveillance systems

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 4

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 5

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 6 Target setting Effective demand management can be an important contribution to climate change adaptation. Possible targets include –Reduction of unaccounted-for-water –Reduction of leaks –Introduction of metering systems

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 7 Agenda Water use –Target setting Access to water and sanitation –Target setting for water services Water-related diseases –Target setting for surveillance systems

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 8

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 9

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 10 Target setting in sanitation Legal, institutional and administrative set-up Issues of reliable information Issues of infrastructure Issues of economic capacity

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 11 Examples of target setting Finland –Universal centralized sewerage and wastewater treatment Czech Republic –Compliance with EU 91/271/EEC –Construction of wastewater treatment facilities in small settlements with less than 2,000 inhabitants, where sewerage exists

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 12

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 13

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 14 Target setting in access to safe water Legal, institutional and administrative setup Issues of reliable information Issues of quality Issues of economic capacity Awareness-raising, education and training

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 15 Examples of targets to safe water Hungary –Nation-wide survey on population without access to drinking water, and exploration of feasible solutions –Development of social subsidies Portugal –Affordability: 2% of family income as limit Czech Republic –Facilitation of connection of residences in suburbs and small villages to public supply

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 16 Agenda Water use –Target setting Access to water and sanitation –Target setting for water services Water-related diseases –Target setting for surveillance systems

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 17 “Water-related disease” means Any significant adverse effects on human health such as death, disability, illness and disorders, caused directly or indirectly by the condition, or changes in the quantity or quality, of any waters;

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 18 Classes of water-related diseases Classic water-related diseases –Cholera –Typhus Emerging water-related diseases –Cryptosporidiosis –Campylobacteriosis –Giardiasis –Legionellosis

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 19 Classic: Typhus - Viral hepatitis A Significant differences in incidence rate Inconsistent reporting Mostly decreasing trend

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 20 Emerging: Cryptosporidiosis Legionellosis Very uneven reporting system Repeated cases of outbreaks

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 21 Obligations under Art 6 par 2 (b) Parties shall establish and publish national and/or local targets for the standards and levels of performance that need to be achieved to realize The reduction of the scale of outbreaks and incidents of water-related disease;

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 22 Aspects in target setting Legal and administrative set-up Availability and reliability of information on the water quality Issues of water-related disease surveillance Economic sustainability

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 23 Obligations under Art 8 Comprehensive national and/or local surveillance and early-warning systems established that –Identify outbreaks or incidents of wrd –Provide prompt and clear notification –Recommend preventive and remedial action –Plan response to outbreaks

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 24 Target setting: focus and structure Priority diseases – is the activity a real priority for the country? Structure – is the structure of the national system effective and efficient?

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 25 Target setting: processes and capacity Detection (identifying cases and outbreaks) Registration Confirmation (epi and lab confirmation) Reporting (early warning and routine) Analysis and interpretation

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 26 Targets: response capacity Response –Control / response –Outbreak investigation –Programme adjustment –Changes in policy and planning Feedback Evaluation and monitoring

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 27 Surveillance targets: support functions Setting standards Training Supervision Communication systems Human resources Material resources Financial resources

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 28 Assessing, mapping and communication Laboratories –Availability, functionality and level of sophistication –Accreditation –Electronic data management and reporting Health mapping –National capacity or at least database preparation

Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 29