1. Using the Modified Haddon Matrix to Deal with Infectious Disease Outbreaks Kai-Lit Phua, PhD FLMI Associate Professor Medicine & Health Sciences Monash University (Sunway Campus)

2. Biographical details Kai-Lit Phua received his BA (cum laude) in Public Health & Population Studies from the University of Rochester and his PhD in Sociology (medical sociology) from Johns Hopkins University. He also holds professional qualifications from the insurance industry. Kai-Lit Phua received his BA (cum laude) in Public Health & Population Studies from the University of Rochester and his PhD in Sociology (medical sociology) from Johns Hopkins University. He also holds professional qualifications from the insurance industry. Prior to joining academia, he worked as a research statistician for the Maryland Department of Health and Mental Hygiene and as an Assistant Manager for the Managed Care Department of a leading insurance company in Singapore. He was awarded an Asian Public Intellectual Senior Fellowship by the Nippon Foundation in 2003. Prior to joining academia, he worked as a research statistician for the Maryland Department of Health and Mental Hygiene and as an Assistant Manager for the Managed Care Department of a leading insurance company in Singapore. He was awarded an Asian Public Intellectual Senior Fellowship by the Nippon Foundation in 2003.

3. Lecture Objectives Brief overview of the Haddon Matrix Brief overview of the Haddon Matrix The Haddon Matrix as a useful tool in the analysis and control of disease outbreaks The Haddon Matrix as a useful tool in the analysis and control of disease outbreaks Example of the use of the Haddon Matrix Example of the use of the Haddon Matrix

4. The Haddon Matrix William H. Haddon, Jr., came up with a Matrix to systematically analyze car crashes William H. Haddon, Jr., came up with a Matrix to systematically analyze car crashes The aim was to derive effective injury prevention and control strategies The aim was to derive effective injury prevention and control strategies The original Matrix was a 3 X 3 table The original Matrix was a 3 X 3 table It was later expanded to a 3 X 4 table It was later expanded to a 3 X 4 table

5. Haddon Matrix AgentHostPhysicalEnvironment Social Environment Pre-event During the event Post-event

6. Using the Haddon Matrix (based on Cassens 1992) Agente.g.carHoste.g.driverPhysicalEnvironment Social Environment Before the event (crash) Good brakes, car properly maintained Good vision, alert Well- designed roads and highways Penalize drunk driving heavily During the event Airbags, anti-lock brakes Motorcycle helmet, seatbelt Non-rigid roadside poles, crash barriers Mandate the use of safety glass in windows After the event Burn- resistant fabrics in car cabin Emergency medical care Effective emergency transport system Support medical and rehabilitation services

7. Successful Use of the Haddon Matrix in Injury Control The Haddon Matrix was successfully used in the control of car crash injuries. It was later used to control other injuries too. The Haddon Matrix was successfully used in the control of car crash injuries. It was later used to control other injuries too.

8. Can the Haddon Matrix Be Used for Infectious Disease Control? The Haddon Matrix forces us to think systematically about the particular health problem we are dealing with The Haddon Matrix forces us to think systematically about the particular health problem we are dealing with Dan Burnett proposed that the Haddon Matrix be used against SARS Dan Burnett proposed that the Haddon Matrix be used against SARS Phua modified and expanded the Haddon Matrix and proposed its use against Nipah virus. (He also proposed its use against natural disasters such as tsunamis). Phua modified and expanded the Haddon Matrix and proposed its use against Nipah virus. (He also proposed its use against natural disasters such as tsunamis).

9. Phua’s “Modified Haddon Matrix” to Study Infectious Disease Outbreaks & Natural Disasters AgentIntermediate host “Host” (I)Affected individual (II)Individual’s family (III)Affected community (IV)The larger society Environment Factors leading to the event (before the event) Factors affecting severity, rate of spread, and extent of impact (during the event) Reactions to the event (during the event) Short-term and long-term effects (after the event)

10. Using the “Modified Haddon Matrix” to Analyze Avian Influenza : Action to be Taken Against Factors Identified Below AgentIntermediate host “Host” (I)Affected individual (II) Family members (III)Affected community (IV) Larger society Environment Factors leading to the event (before the event) Agent can cause disease in humans Avian influenza virus present in wild, migratory birds (I) Close contact with & eating of sick birds (III) Raising chickens is important economic activity Close proximity of people & birds e.g. rearing backyard chickens Factors affecting severity, rate of spread, and extent of impact (during the event) Agent does not spread easily between humans Can spread from wild to domestic birds; wild bird migration patterns in Europe and Asia (I) Mobility of infected individual (II) Close contact (III) Community dependent on raising chickens (IV) Chicken exports to foreign countries Sale and smuggling of infected birds is not stopped quickly Reactions to the event (during the event) (III) Fear (IV) Mass culling; active monitoring by WHO & Ministry of Health Tourist arrivals affected Short-term and long-term effects (after the event) Evidence that H5N1 can also affect non-human animals (I) High mortality (II) Deaths affect family members (III) & (IV) Economic losses Boon for drug companies; fear of more virulent strains appearing

11. References Burnett DJ et al. The Application of the Haddon Matrix to Public Health Readiness and Response Training. Environ Health Perspect. 2005; 113(5): 561-66 Burnett DJ et al. The Application of the Haddon Matrix to Public Health Readiness and Response Training. Environ Health Perspect. 2005; 113(5): 561-66 Cassens BJ. Preventive Medicine and Public Health. 2 nd ed. 1992. Philadelphia: Harwal Publishing. Cassens BJ. Preventive Medicine and Public Health. 2 nd ed. 1992. Philadelphia: Harwal Publishing. Haddon W. On the Escape of Tigers: An Ecologic Note. Am J Pub Health. 1970; 60: 2229-34. Haddon W. On the Escape of Tigers: An Ecologic Note. Am J Pub Health. 1970; 60: 2229-34. Haddon W. Options for the Prevention of Motor Vehicle Crash Injury. Isr Med J. 1980; 16: 45-65. Haddon W. Options for the Prevention of Motor Vehicle Crash Injury. Isr Med J. 1980; 16: 45-65. Phua KL, Lee LK. Meeting the Challenge of Epidemic Disease Outbreaks: An Agenda for Research. J of Pub Health Policy. 2005; 26(1): 122-32. Phua KL, Lee LK. Meeting the Challenge of Epidemic Disease Outbreaks: An Agenda for Research. J of Pub Health Policy. 2005; 26(1): 122-32. Phua KL. A Model for Lessening the Impact of Natural Disasters and Infectious Disease Outbreaks. J of Emergency Management. 2006; 4(5): 69-74. Phua KL. A Model for Lessening the Impact of Natural Disasters and Infectious Disease Outbreaks. J of Emergency Management. 2006; 4(5): 69-74. Phua KL. Post-Disaster Victimization: How Survivors of Disasters Can Continue to Suffer After the Event is Over. New Solutions. 2008; 18(2): 221-31. Phua KL. Post-Disaster Victimization: How Survivors of Disasters Can Continue to Suffer After the Event is Over. New Solutions. 2008; 18(2): 221-31.

12. Thank You