HCDCPinthemanagementofhealththreats

So4riosTsiodras,MD,MSc,PhD,FIDSA

Na$onal&KapodistrianUniversityofAthensMedicalSchool,HCDCP

Athens6June2018

AIM

• Toprovideashortreviewof…

• theGreekexperiencewithhealththreats

•  duringtherecentyears,Representa4veexamples

TheroleofHCDCP-PHthreatsfunc4onssupported

• Rapidrisk&needassessment

• PHsurveillance&response

• Clinical&laboratorysupport

• Recovery?

AH5N1&Pseudo-outbreaks↑awareness&casedefini4onissues

HumanInfluenza,2009-18observedcasesvs.es4mated

HumanInfluenza,Greece2009-18differenceinpredominanttype

0102030405060708090

100

2009-102010-11

2011-122012-13

2013-142014-15

2015-162016-17

2017-18

Influenzapredominanttypesperseason

AH1N1pdm09 AH3N2 B

HumanInfluenza,Greece2009-18significantburden…maybeevenmore!!!

Conflic4ng-mixedmessages&mi4ga4onmeasures

Deathlierwaveofinfec$oniscomingfromAsianextwinter-accordingtoWHO

Conflic4ngmessagesforspecificmeasuresThermalscanning!!!

Reasonstodecline

NSPH–HCDCPstudy2009onpublictrust&H1N1relatedinforma4on

Pandemic peak

NSPH–HCDCPstudy2009onpublictrust&H1N1relatedinforma4on

Pandemic peak

Pandemicpeak

24Feb2010

•  …over300millionpeoplehavenowbeenvaccinatedagainstpandemicinfluenzaand

•  …thesafetyrecordofthevaccinehasbeenexcellent.

•  …wehavenotseenanyunusualsafetyevents

0.97/100,000

1.14/100,000

1.58/100,000

0.22/100,000

0.37/100,000

0.32/100,000

Vaccine effectiveness 2017-18 5 European studies, similar in Greece

HumanInfluenza,Greece2009-18mainissues,challenges

•  Controversiesaboutseverity•  Riskcommunica$onissues

•  Lowvaccinecoverageforhighriskgroups•  HCWissue,↑campaignefforts,procurement&dona$on

•  Revisionofpandemicplan,surgecapacityissues,•  e.g.↑inICUbeds

MERS-CoV,2012-04/2018

2 216 cases -> 829 deaths, CFR: 37.4%

MERS,S.Arabia=epicenterexporttoEU/EEA,n=8countries

MERS-CoV,Greece2014thecaseoftheastuteclinician

•  Successfulcontrol->73contacts->NOspread!!!

Tsiodrasetal.Eurosurveillance2014

MERS-CoV,Korea&ChinaMay-July2015

16Healthcarefacili4es

186cases,36deaths

Malaria,historicallyimportantinGreece

SudreBetal,EmergInfDis2013;19(5)

Research & PH on the field MDA & zero cases in Laconia

Hospitalacquiredmalaria,2018n=6cases,1inGreece,?modeofTx

WestNilevirus,Europe2011-18

WNVGreece,2010-2017 2010 2011 2012

2013 2014 2017

ValiakosG,etal.PLoSONE9(5):e96935.

Thebigtrio&emergingsouvenirs!!!

l  Chikungunya-Dengue–Zika

l  50-100milpeople/year

EckerleIetalCMI2018

Dengue,Chikungunya,ZikaA.albopictusispresent

CourtesyofDPervanidou,VBDoffice,HCDCP

A. albopictus, Europe 2018

VHF–CrimeanCongo

Papa A et al. Euro Surveill. 2008 Aug 14;13(33)

Papa A et al. J Med Virol. 2015

VHF–Ebola,Greece2014-15entryscreening!!!

•  Thermalcameras,Healthdeclara$oncards

•  99,400passengersinNa$onalairports,3,500refugees

•  ?Sameprac$cesinotherEUcountries

•  e.g.France,Belgium,Spain,UK,Italy

EBOLAoutbreakDRC2018,Entryscreeningisnotconsideredtobeofany

publichealthorcost-benefitvalue

AMR

•  Importanthealthcare&communityissue

•  Endemicityinmajorter$arycenters,ICU

•  SpreadofMDRpathogens,therapeu$cdilemmas

•  Inabilitytoimplementpoliciesdespiteeffort

AMR

• Needenhanced,sustainedsurveillance,lab

support,infec4oncontrol,newmeds,evaluable

indices,poli4cal/financialsupport

Abx consumption, EU/EEA 2012-16 Community data

Abx consumption, EU/EEA 2012-16 Hospital data

Conclusions,Greece&PHthreats

•  SuccessfulresponsetoPHthreatsoverlast10yrs

– CrucialroleofMoH,HCDCP

•  Needforawareness,Poli4calsupportcrucial

•  Interna4onalcollabora4onextremelyvaluable

Keychallenges

•  Riskcommunica4on

•  Sustainabilityofresources&PHfunding

•  Con4nuityinplanningvs.adhocresponse

–  lapsesinsystema$cpreparednesstes$ng

Are we ready for Disease X ?

Multiple stakeholders - Collaborating partners thx to all !!!

•  Ministry of Health, A. Xanthos, GSPH, Y Baskozos, A. Kyrlesi, Karaoli, D. Stavrou & team

•  HCDCP, KEELPNO team

•  T. Rosenberg, T. Georgakopoulou, A. Baka, K Gkolfinopoulou, D. Pervanidou, A. Lambrou, K. Mellou, U. Kalkouni, T. Lytras, F. Kontopidou, A. Economopoulou, D. Iliopoulos, A. Pavli, H. Maltezou T. Panagiotopoulos, A. Terzidis, A. Pavli, R. Vorou, A. Balaska, H. Maltezou , G. Dougas, G. Saroglou,

•  NSPH, Dr Vatopoulos, T. Panagiotopoulos

•  EKEPY, Dr Papaefstathiou and team, NMA-EOF, IFET

•  Prefectures PH Directorates, tertiary care centers

•  Ministry of Migration Policy, C Botsi, K Kampourakis, Ministry of Interior, Ministry of Defense

•  UOA, A Tsakris, N. Spanakis, AUOT, Anna Pappa & team, UOT, C Hadjichristodoulou & team

•  Hellenic Pasteur Institute

•  EU, ECDC, CHAFEA

•  & many others

Thank you for your attention