Communicable Diseases in the Western Pacific Region · Roles of Hong Kong in global & regional...
Transcript of Communicable Diseases in the Western Pacific Region · Roles of Hong Kong in global & regional...
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 theCommunicable Diseases in theWestern Pacific RegionWestern Pacific Region
Hitoshi OSHITANIHitoshi OSHITANIWestern Pacific Regional Office Western Pacific Regional Office
WHOWHO
nn Current situation of communicableCurrent situation of communicablediseases in the Western Pacific Regiondiseases in the Western Pacific Region•• HIV / AIDSHIV / AIDS•• TBTB•• Vaccine Preventable DiseasesVaccine Preventable Diseases•• Vector borne diseasesVector borne diseases
nn New communicable diseases challenges inNew communicable diseases challenges inthe Western Pacific Regionthe Western Pacific Region•• SARSSARS•• Avian InfluenzaAvian Influenza•• Other emerging diseasesOther emerging diseases
nn Roles of Hong Kong SAR in regional andRoles of Hong Kong SAR in regional andglobal effortsglobal efforts
Outline of the PresentationOutline of the Presentation
Western Pacific Region of WHOWestern Pacific Region of WHO
WHO Western PacificRegional 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 targettowardsthe goalof universalaccess to ART
What is the “3 by 5” Initiative?
An initiative to to make ARV treatmentavailable 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 country§ supported by regional offices§ with stewardship of HQ
Others5%
Cambodia3%
Republic of Korea
4%
China57%
Japan4%
Viet Nam12%
Philippines15%
Distribution of notified TB cases inDistribution of notified TB cases inWestern Pacific Region (2002)Western Pacific Region (2002)
Case Detection Rate (CDR) andCase Detection Rate (CDR) andDOTS coverage in 7 High BurdenDOTS coverage in 7 High Burden
Countries in WPRCountries in WPR
0
1020
30
40
5060
70
80
90100
PNG CHN LAO CAM PHL MON VTN
CDR
DOTS
70% CD
Measles cases and coverageWPR 1974-2002
-
500
1,000
1,500
2,000
2,500
3,000
3,500
1974 1978 1982 1986 1990 1994 1998 2002
Year
Cases (in thousands)
0%
20%
40%
60%
80%
100%
Coverage
Countries that have interruptedmeasles transmission
Countries where measlestransmission was reestablished
Measles-endemic countries
Measles control status by countryMeasles control status by country
*According to 2003 data
HBV Carriage Rate (pre-vaccine)HBV Carriage Rate (pre-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
(cumulative)
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 region SARS cases by region1 November 2002 1 November 2002 –– 7 August 2003 7 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 %)
Epidemio logy C o m m
JulJulJul
ChinaChina
LaboratoryInfect ion Contro l Logist ics Env i ron
Hong Kong Hong Kong ((China)China)
FebFeb
Viet NamViet Nam
PhilippinesPhilippines
SingaporeSingapore
Taiwan Taiwan ((China)China)
M a rM a rM a rM a r A p rA p rA p rA p r MayMayMay JunJunJunJunJunJun Aug
Tota l : 77
Tota l : 17
Tota l : 22
Tota l : 28
Tota l : 11
Total : 9
AugAug
Tota l : 77Tota l : 77
Tota l : 17Tota l : 17
Tota l : 22
Tota l : 28
Tota l : 11
Total : 9
Tota l : 22Tota l : 22
Tota l : 28Tota l : 28
Tota l : 11Tota l : 11
Total : 9Total : 9 TOTAL: TOTAL:
164164Others
WHO consultants for affectedWHO consultants for affectedcountriescountries
SARS cases by week of onsetSARS cases by week of onset
First cases inFirst cases inGuangdongGuangdong
Outbreak inOutbreak inGuangdongGuangdong
M HotelM Hotelin HKin HK All areasAll areas
removed fromremoved fromthe listthe list
MultiMulti-country Outbreaks-country Outbreaks
GlobalGlobalAlertAlert
AmoyAmoy Garden Garden
Lessons learned from SARSLessons learned from SARSLessons learned from SARS
nn Timely and transparent informationTimely and transparent informationsharingsharing
nn National sovereignty and protection ofNational sovereignty and protection ofglobal public healthglobal public health
nn Economic impactEconomic impact
nn Lack of surge capacity at country andLack of surge capacity at country andregional levelregional level
nn Poor public health infrastructurePoor public health infrastructure
nn Inadequate infection control practices inInadequate infection control practices inhealth care settingshealth care settings
nn Multi-Multi- sectoralsectoral coordination coordination
nn Risk communicationRisk communication
§§ High level of leadership and commitmentHigh level of leadership and commitment
§§ The dedication and hard work of publicThe dedication and hard work of publichealth staffhealth staff
§§ Unprecedented worldwide collaborationUnprecedented worldwide collaborationamong governments and the scientificamong governments and the scientificcommunitycommunity
However, there are still issues that need toHowever, there are still issues that need tobe addressedbe addressed ……
Key elements for success in globalcontainment of SARS
Key elements for success in globalcontainment of SARS
One year after SARS outbreakOne year after SARS outbreak
nn 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
nn New issuesNew issues
•• Laboratory safety and containmentLaboratory safety and containmentnn Laboratory acquired cases in Singapore,Laboratory acquired cases in Singapore,
Taiwan, BeijingTaiwan, Beijing
Avian influenza (H5N1) in Asia as of 10 March2004
Confirmed human cases of avian influenzaConfirmed human cases of avian influenzaA(H5N1) as of 17 March 2004A(H5N1) as of 17 March 2004
15152222VietViet Nam Nam
23233434TotalTotal
881212ThailandThailand
DeathsDeathsCasesCases
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
(ye
ars)
No. of Cases
Dead
Alive
Human Public Health RiskHuman Public Health Risk
n Human cases in affected areas•• St i l l smal l number of conf i rmed casesSt i l l smal l number of conf i rmed cases
•• Not enough informat ion to assess publ ic heal thNot enough informat ion to assess publ ic heal th
impactimpact
n Emergence 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 influenzaLessons learned from avian influenzaoutbreak in Asiaoutbreak in Asia
§§ Need to strengthen surveillance capacitiesNeed to strengthen surveillance capacities§§HumanHuman
§§AnimalAnimal
§§ Better coordination between human publicBetter coordination between human publichealth and agriculture sectorshealth and agriculture sectors§§National LevelNational Level
§§Regional / Global LevelsRegional / Global Levels
§§ Human public health Human public health vsvs impact on economy impact on economy§§Reluctance to report poultry outbreakReluctance to report poultry outbreak
Other emerging disease threatsOther emerging disease threats
§§ NipahNipah / / HendraHendra
§§ EnterovirusEnterovirus 71 71
§§ West Nile VirusWest Nile Virus
§§ HantavirusHantavirus
§§ Other Other zoonoseszoonoses
§§ Antimicrobial resistanceAntimicrobial resistance
§§ Newly emerging diseasesNewly emerging diseases
Emerging communicable diseasesEmerging communicable diseasesWhy now?Why now?
nn GlobalizationGlobalization
•• Mass movement of people and goodsMass movement of people and goods
nn Rapid developmentRapid development
•• Urbanization (ex. TB)Urbanization (ex. TB)
•• Deforestation (ex. Ebola)Deforestation (ex. Ebola)
nn Over-consumption of animal productsOver-consumption of animal products
•• Animal husbandry practices Animal husbandry practices –– intensive farming intensive farming
•• Wild animal marketsWild animal markets
nn Failure of health systemsFailure of health systems
•• Heavy focus on curative careHeavy focus on curative care
•• Neglect of public healthNeglect of public health
•• Excessive antibiotic useExcessive antibiotic use
Global and Regional Alert andGlobal and Regional Alert andResponse NetworksResponse Networks
nn RationalRational
•• None of countries and areas has al l necessaryNone of countries and areas has al l necessaryexpertise / capacity to respond to publicexpertise / capacity to respond to publichealth emergencies l ike SARShealth emergencies l ike SARS
•• Gaps between developed and developingGaps between developed and developing
countries: e.g. laboratory, epidemiology etc.countries: e.g. laboratory, epidemiology etc.
•• Rapid and transparent information exchangeRapid and transparent information exchangeis critical to prevent international spread ofis critical to prevent international spread ofdiseasedisease
Global Outbreak Alert and ResponseGlobal Outbreak Alert and ResponseNetworkNetwork
ElectronicDiscussion
sites
Media
N G O s
MilitaryLaboratoryNetworks
WHO Collaborat ing Centres/Laboratories Epidemiology and
Survei l lance Networks
WHO Regional& Country Offices
Countries/National Disease Control
Centres
UNSister Agencies
F O R M A LF O R M A L
GPHIN
INFORMALINFORMAL
InternationalInternational
HealthHealth
Regulations =Regulations =
Global legalGlobal legal
framework toframework to
protect the worldprotect the worldfrom publicfrom public
health threatshealth threats
Why have IHR?Why have IHR?
nn Serious and unusual diseaseSerious and unusual diseaseevents are inevitableevents are inevitable
nn Globalisation - problem in oneGlobalisation - problem in onelocation is everybodylocation is everybody’’s problems problem
nn An agreed code of conductAn agreed code of conductPROTECTS against:PROTECTS against:
11 the spread of serious risks to publicthe spread of serious risks to publichealthhealth
22 the unnecessary or excessive use ofthe unnecessary or excessive use of
restrictions in traffic or trade forrestrictions in traffic or trade forpublic health purposespublic health purposes
IHR are not newIHR are not new
nn Notification Notification :: to WHO, of a case of cholera , to WHO, of a case of cholera ,
p lague or yel low fever , not i fy WHO when the areaplague or yel low fever , not i fy WHO when the area
is f ree f rom infect ion - narrow focusis f ree f rom infect ion - narrow focus
nn Health Organization Health Organization :: ports, airports and frontier ports, airports and frontier
posts are adequate ly equipped to apply the IHRposts are adequate ly equipped to apply the IHR
measures - aga in focussed on 3 d iseases andmeasures - aga in focussed on 3 d iseases and
outdatedoutdated
nn Health Measures Health Measures:: The max imum measures The max imum measures
applicable to international traff ic, which a stateapplicable to international traff ic, which a state
may require for the protection of i ts terr i torymay require for the protection of i ts terr i tory
against cholera, plague and yel low fever - r igidagainst cholera, plague and yel low fever - r igid
and punit iveand punit ive
In rev is ing we needed to overcome theseIn rev is ing we needed to overcome these
l imitat ionsl imitat ions
The Proposed RevisionThe Proposed Revision
•• Notification: Public health emergencyNotification: Public health emergencyof international concernof international concern
•• Use information coming from sourcesUse information coming from sources
other than official member stateother than official member statenotificationsnotifications
•• Temporary recommendationsTemporary 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 l ight• Regional Consultation Meetings
(WPRO: April 28-30)• Amended draft revision proposals• Intergovernmental Working Group (Nov 2004)• Final regulatory draft
2005 � report to EB 115� W H A
Roles of Hong Kong in global &Roles of Hong Kong in global ®ional effortregional effort
nn Participation in global and regional networksParticipation in global and regional networks
•• SurveillanceSurveillance
•• LaboratoryLaboratory
•• On-site supportOn-site support
nn Capacity building in neighbouring countriesCapacity building in neighbouring countries
•• TrainingTraining
Roles of Hong Kong in global &Roles of Hong Kong in global ®ional effortregional effort
nn SurveillanceSurveillance
•• Rapid dissemination of information on CD fromRapid dissemination of information on CD fromHong KongHong Kong
•• Initiate discussions and information sharing withInitiate discussions and information sharing withthe regionthe region
Roles of Hong Kong in global &Roles of Hong Kong in global ®ional effortregional effort
nn Laboratory networksLaboratory networks
•• Laboratories in Hong Kong play crit ical roles asLaboratories in Hong Kong play crit ical roles asregional and global reference laboratoriesregional and global reference laboratories
nn SARS (3 / 11: Hong Kong labs)SARS (3 / 11: Hong Kong labs)
nn Influenza H5N1 (2/6: Hong Kong labs)Influenza H5N1 (2/6: Hong Kong labs)
nn 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 ®ional effortregional effort
nn On-site SupportOn-site Support
•• Clinical team to Viet Nam on H5N1 (Feb 2004)Clinical team to Viet Nam on H5N1 (Feb 2004)
•• More potentialMore potentialnn Various expertise in Hong KongVarious expertise in Hong Kong
nn Practical experiencePractical experience
Roles of Hong Kong in global &Roles of Hong Kong in global ®ional effortregional effort
nn Capacity buildingCapacity building
•• Each country should have core capacity to containEach country should have core capacity to contain
disease in early stagedisease in early stage
•• TrainingTrainingnn LaboratoryLaboratory
nn EpidemiologyEpidemiology
nn Infection control etc.Infection control etc.
Thank youThank youThank you