communicable diseases in the western pacific region · health organization: ports, airports and...
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Inaugural Ceremony of the Scientific Advisory Structure of theInaugural Ceremony of the Scientific Advisory Structure of theCentre for Health Protection, Department of Health, Hong KongCentre for Health Protection, Department of Health, Hong Kong
Communicable Diseases in the Communicable Diseases in the Western Pacific RegionWestern Pacific Region
Hitoshi OSHITANIHitoshi OSHITANIWestern Pacific Regional Office Western Pacific Regional Office
WHOWHO
1.1. Current situation of communicable Current situation of communicable diseases in the Western Pacific Regiondiseases in the Western Pacific Region•• HIV / AIDSHIV / AIDS•• TBTB•• Vaccine Preventable DiseasesVaccine Preventable Diseases•• Vector borne diseasesVector borne diseases
2.2. New communicable diseases challenges in New communicable diseases challenges in the Western Pacific Regionthe Western Pacific Region•• SARSSARS•• Avian InfluenzaAvian Influenza•• Other emerging diseasesOther emerging diseases
3.3. Roles of Hong Kong SAR in regional and Roles of Hong Kong SAR in regional and global effortsglobal efforts
Outline of the PresentationOutline of the Presentation
Western Pacific Region of WHOWestern Pacific Region of WHO
WHO Western Pacific Regional Office (WPRO)
Estimates of yearly AIDS deaths in 2000 & 2005in 4 selected Western Pacific countries
ChinaCambodiaViet NamMalaysia
20002000 20052005
6000
35,000 deaths35,000 deaths 120,000 deaths120,000 deaths
11000
24000
11000
20000
80000
Measurable, fixed targettowards the goal of universalaccess to ART
What is the “3 by 5” Initiative?
An initiative to to make ARV treatment available to 3 million people by 2005
400,000 people receive treatment today
WHO/UNAIDS global treatment initiative for AIDS “Addressing a global public health emergency”
A voluntary process driven by countrysupported by regional offices with stewardshipof HQ
Others5%
Cambodia3%
Republic of Korea
4%
China57%
Japan4%
Viet Nam12%
Philippines15%
Distribution of notified TB cases in Distribution of notified TB cases in Western Pacific Region (2002)Western Pacific Region (2002)
Case Detection Rate (CDR) and Case Detection Rate (CDR) and DOTS coverage in 7 High Burden DOTS coverage in 7 High Burden
Countries in WPRCountries in WPR
0102030405060708090
100
PNG CHN LAO CAM PHL MON VTN
CDR
DOTS
70% CD
Measles cases and coverage WPR 1974-2002
-
500
1,000
1,500
2,000
2,500
3,000
3,500
1974 1978 1982 1986 1990 1994 1998 2002Year
Cases (in thousands)
0%
20%
40%
60%
80%
100%
Coverage
Countries that have interrupted measles transmission
Countries where measles transmission was reestablished
Measles-endemic countries
Measles control status by countryMeasles control status by country
*According to 2003 data
HBV Carriage Rate (preHBV Carriage Rate (pre--vaccine)vaccine)
>12% (9)
8% - 12% (13)
2% - 7% (11)
< 2% (2)
No Data (1)
Introduction of Hep B vaccineIntroduction of Hep B vaccine
0%
20%
40%
60%
80%
100%
1983 1985 1987 1989 1991 1993 1995 1997 1999 2001Year of Introduction
% of Countries
( l i )
Number of reported dengue casesNumber of reported dengue cases20032003
%U%U
%U
Viet Nam
Cambodia
Philippines
Laos PDR
Brunei
China
Viet Nam
Malaysia
Philippines
Brunei
Singapore
Macau Hong Kong
74
(9,300)
(6,260)
(16,978)
(11,635)
(15,816)
(2,341)
128
Guangzhou
Dengue cases 20031 - 10001001 - 50005001 - 1000010001 - 20000
SARS cases by region1 November 2002 – 7 August 2003
SARS cases by regionSARS cases by region1 November 2002 1 November 2002 –– 7 August 20037 August 2003
Europe0.4 %
SE Asia0.16%
Others0.1%
Americas3.4%
WesternPacific95.9 %
Global Total:
8096 cases
774 deaths
WPR Total:
7768 cases (95.9. %)
727 deaths (93.9 %)
Epidemiology Comm
JulJulJul
ChinaChina
LaboratoryInfection Control Logistics Environ
Hong Kong Hong Kong ((China)China)
FebFeb
Viet NamViet Nam
PhilippinesPhilippines
SingaporeSingapore
Taiwan Taiwan ((China)China)
MarMarMarMar AprAprAprApr MayMayMay JunJunJunJunJunJun Aug
Total : 77
Total : 17
Total : 22
Total : 28
Total : 11
Total : 9
AugAug
Total : 77Total : 77
Total : 17Total : 17
Total : 22
Total : 28
Total : 11
Total : 9
Total : 22Total : 22
Total : 28Total : 28
Total : 11Total : 11
Total : 9Total : 9 TOTAL: TOTAL: 164164
Others
WHO consultants for affected WHO consultants for affected countriescountries
SARS cases by week of onsetSARS cases by week of onset
First cases in First cases in GuangdongGuangdong
Outbreak in Outbreak in GuangdongGuangdong
M Hotel M Hotel in HKin HK All areas All areas
removed from removed from the listthe list
MultiMulti--country Outbreakscountry Outbreaks
Global Global AlertAlert
Amoy GardenAmoy Garden
Lessons learned from SARSLessons learned from SARSLessons learned from SARSTimely and transparent information Timely and transparent information sharingsharingNational sovereignty and protection of National sovereignty and protection of global public healthglobal public healthEconomic impactEconomic impactLack of surge capacity at country and Lack of surge capacity at country and regional level regional level Poor public health infrastructurePoor public health infrastructureInadequate infection control practices in Inadequate infection control practices in health care settingshealth care settingsMultiMulti--sectoralsectoral coordinationcoordinationRisk communicationRisk communication
High level of leadership and commitmentHigh level of leadership and commitmentThe dedication and hard work of public The dedication and hard work of public health staffhealth staffUnprecedented worldwide collaboration Unprecedented worldwide collaboration among governments and the scientific among governments and the scientific community community
However, there are still issues that need to However, there are still issues that need to be addressed…be addressed…
Key elements for success in global containment of SARS
Key elements for success in global containment of SARS
One year after SARS outbreakOne year after SARS outbreak
Remaining issuesRemaining issues•• Ecology of SARS Ecology of SARS CoVCoV in in
environment (natural reservoir)environment (natural reservoir)•• Vaccine and antiviral developmentVaccine and antiviral development•• Diagnostic kitsDiagnostic kits
New issuesNew issues•• Laboratory safety and containmentLaboratory safety and containment
Laboratory acquired cases in Singapore, Laboratory acquired cases in Singapore, Taiwan, BeijingTaiwan, Beijing
Avian influenza (H5N1) in Asia as of 10 March 2004
Confirmed human cases of avian influenza Confirmed human cases of avian influenza A(H5N1) as of 17 March 2004A(H5N1) as of 17 March 2004
15152222Viet NamViet Nam
23233434TotalTotal
881212ThailandThailandDeathsDeathsCasesCases
Status of H5N1 cases by age groupStatus of H5N1 cases by age groupThailand and Viet Nam (N= 34)Thailand and Viet Nam (N= 34)
0 2 4 6 8 10 12 14
40+
31-40
21-30
11-20
0-10
Age
gro
up (y
ears
)
No. of Cases
DeadAlive
Human Public Health RiskHuman Public Health Risk
Human cases in affected areas•• Still small number of confirmed casesStill small number of confirmed cases•• Not enough information to assess public health Not enough information to assess public health
impactimpactEmergence of a new influenza virus•• Efficient human to human transmissionEfficient human to human transmission
•• Vast majority of people no immunity to H5Vast majority of people no immunity to H5
•• Pandemic with huge morbidity and mortality impactPandemic with huge morbidity and mortality impact
Lessons learned from avian influenza Lessons learned from avian influenza outbreak in Asiaoutbreak in Asia
Need to strengthen surveillance capacitiesNeed to strengthen surveillance capacitiesHumanHumanAnimalAnimal
Better coordination between human public Better coordination between human public health and agriculture sectorshealth and agriculture sectors
National LevelNational LevelRegional / Global LevelsRegional / Global Levels
Human public health Human public health vsvs impact on economyimpact on economyReluctance to report poultry outbreakReluctance to report poultry outbreak
Other emerging disease threatsOther emerging disease threats
NipahNipah / / HendraHendraEnterovirusEnterovirus 7171West Nile VirusWest Nile VirusHantavirusHantavirusOther Other zoonoseszoonosesAntimicrobial resistanceAntimicrobial resistanceNewly emerging diseasesNewly emerging diseases
Emerging communicable diseases Emerging communicable diseases Why now?Why now?
GlobalizationGlobalization•• Mass movement of people and goodsMass movement of people and goods
Rapid developmentRapid development•• Urbanization (ex. TB)Urbanization (ex. TB)•• Deforestation (ex. Ebola)Deforestation (ex. Ebola)
OverOver--consumption of animal productsconsumption of animal products•• Animal husbandry practices Animal husbandry practices –– intensive farmingintensive farming•• Wild animal marketsWild animal markets
Failure of health systemsFailure of health systems•• Heavy focus on curative careHeavy focus on curative care•• Neglect of public health Neglect of public health •• Excessive antibiotic useExcessive antibiotic use
Global and Regional Alert and Global and Regional Alert and Response NetworksResponse Networks
RationalRational•• None of countries and areas has all necessary None of countries and areas has all necessary
expertise / capacity to respond to public expertise / capacity to respond to public health emergencies like SARShealth emergencies like SARS
•• Gaps between developed and developing Gaps between developed and developing countries: e.g. laboratory, epidemiology etc.countries: e.g. laboratory, epidemiology etc.
•• Rapid and transparent information exchange Rapid and transparent information exchange is critical to prevent international spread of is critical to prevent international spread of diseasedisease
Global Outbreak Alert and Response Global Outbreak Alert and Response NetworkNetwork
Electronic Discussion
sitesMedia
NGOs
MilitaryLaboratoryNetworks
WHO Collaborating Centres/Laboratories Epidemiology and
Surveillance Networks
WHO Regional & Country Offices
Countries/National Disease Control
Centres
UNSister Agencies
FORMALFORMAL
GPHIN
INFORMALINFORMAL
International International Health Health
Regulations =Regulations =Global legal Global legal framework to framework to
protect the world protect the world from public from public
health threatshealth threats
Why have IHR?Why have IHR?
Serious and unusual disease Serious and unusual disease events are inevitableevents are inevitableGlobalisation Globalisation -- problem in one problem in one location is everybody’s problem location is everybody’s problem An agreed code of conduct An agreed code of conduct PROTECTS against:PROTECTS against:1.1. the spread of serious risks to public the spread of serious risks to public
healthhealth2.2. the unnecessary or excessive use of the unnecessary or excessive use of
restrictions in traffic or trade for restrictions in traffic or trade for public health purposespublic health purposes
IHR are not newIHR are not newNotificationNotification:: to WHO, of a case of cholera, to WHO, of a case of cholera,
plague or yellow fever, notify WHO when the area plague or yellow fever, notify WHO when the area is free from infection is free from infection -- narrow focus narrow focus
Health OrganizationHealth Organization:: ports, airports and frontier ports, airports and frontier posts are adequately equipped to apply the IHR posts are adequately equipped to apply the IHR measures measures -- again focussed on 3 diseases and again focussed on 3 diseases and outdatedoutdated
Health MeasuresHealth Measures:: The maximum measures The maximum measures applicable to international traffic, which a state applicable to international traffic, which a state may require for the protection of its territory may require for the protection of its territory against cholera, plague and yellow fever against cholera, plague and yellow fever -- rigid rigid and punitiveand punitiveIn revising we needed to overcome these In revising we needed to overcome these limitationslimitations
The Proposed RevisionThe Proposed Revision•• Notification: Public health emergency Notification: Public health emergency
of international concernof international concern•• Use information coming from sources Use information coming from sources
other than official member state other than official member state notificationsnotifications
•• Temporary recommendations Temporary recommendations •• IHR emergency committeeIHR emergency committee•• Based on risk assessmentBased on risk assessment
•• National focal pointNational focal point•• Minimum core capacityMinimum core capacity
•• Capacity buildingCapacity building
Major milestones in the revisionMajor milestones in the revision
2004• report to EB 113 - green light • Regional Consultation Meetings
(WPRO: April 28-30)• Amended draft revision proposals• Intergovernmental Working Group (Nov 2004)• Final regulatory draft
2005 report to EB 115W H A
Roles of Hong Kong in global & Roles of Hong Kong in global & regional effortregional effort
Participation in global and regional networksParticipation in global and regional networks•• SurveillanceSurveillance•• LaboratoryLaboratory•• OnOn--site supportsite support
Capacity building in neighbouring countriesCapacity building in neighbouring countries•• TrainingTraining
Roles of Hong Kong in global & Roles of Hong Kong in global & regional effortregional effort
SurveillanceSurveillance•• Rapid dissemination of information on CD from Rapid dissemination of information on CD from
Hong KongHong Kong•• Initiate discussions and information sharing with Initiate discussions and information sharing with
the regionthe region
Roles of Hong Kong in global & Roles of Hong Kong in global & regional effortregional effort
Laboratory networksLaboratory networks•• Laboratories in Hong Kong play critical roles as Laboratories in Hong Kong play critical roles as
regional and global reference laboratoriesregional and global reference laboratoriesSARS (3 / 11: Hong Kong labs)SARS (3 / 11: Hong Kong labs)Influenza H5N1 (2/6: Hong Kong labs)Influenza H5N1 (2/6: Hong Kong labs)Specimens were sent to labs in Hong Kong for:Specimens were sent to labs in Hong Kong for:
•• SARS (Mainland China, Jan 2004)SARS (Mainland China, Jan 2004)•• H5N1 (Human, Viet Nam, Jan 2004)H5N1 (Human, Viet Nam, Jan 2004)•• H5N1 (Animal, Viet Nam, Feb 2004)H5N1 (Animal, Viet Nam, Feb 2004)•• H5N1 (Animal, Mainland China, Apr 2004)H5N1 (Animal, Mainland China, Apr 2004)•• SARS (Mainland China, Apr 2004) SARS (Mainland China, Apr 2004)
Roles of Hong Kong in global & Roles of Hong Kong in global & regional effortregional effort
OnOn--site Supportsite Support•• Clinical team to Viet Nam on H5N1 (Feb 2004)Clinical team to Viet Nam on H5N1 (Feb 2004)•• More potentialMore potential
Various expertise in Hong KongVarious expertise in Hong KongPractical experiencePractical experience
Roles of Hong Kong in global & Roles of Hong Kong in global & regional effortregional effort
Capacity buildingCapacity building•• Each country should have core capacity to contain Each country should have core capacity to contain
disease in early stagedisease in early stage•• TrainingTraining
LaboratoryLaboratoryEpidemiologyEpidemiologyInfection control etc.Infection control etc.
Thank youThank youThank you