Transcript Slide 1

ประชุมวิชาการกล่ มุ ภารกิจด้ านสนับสนุนงานบริ การสุขภาพ ครั้ งที่ 3 ปี 2548
การบรรยายเรื่ อง
ระบบเตือนภัยทางห้ องปฏิบัติการ
ในระดับสากล
• นายแพทย์ สมชาย พีระปกรณ์
• [email protected]
• สานักงานผู้แทนองค์ การอนามัยโลกประจาประเทศไทย
• 2 กันยายน 2548; 09.00-09.30
Slide 1
Scope:
• บทเรี ยนจากการควบคมุ ป้ องกันโรคระบาดใน
ระดับสากล (กรณี SARS, etc.)
• WHO กับการประสานความร่ วมมือระหว่ าง
ประเทศในการเฝ้ าระวังและสร้ างระบบเตือน
ภัยโรคที่อันตรายร้ ายแรง
Slide 2
V. SARS:
lessons from a new disease
3
Exhibit 3:
SARS – SERIOUS NEW THREAT
Severe Acute Respiratory Syndrome
• Caused by new coronavirus
• Incubation period of 2-7 days
• Spread by close person-to-person contact,e.g. respiratory secretions
• Characterized by fever, cough, shortness of breath and pneumonia
• Reported cases of asymptomatic carriers
Treatment
• No known treatment to date – currently only supportive care including
steroids, antiviral drugs and ventilation devices
• Isolation and quarantine used to prevent spread
Epidemiology
• High mortality rates of 15%* versus <1% for ordinary influenza
• Worldwide spread due to globalization, e.g. mass air travel
• First global health emergency of 21st century
* Mortality rates vary by age group 6% (25-44 years), 15% (45-64 years) and >50% (>65 years)
Source: WHO; CDC; CNN
4
Exhibit 4:
DISEASE WITH NO BORDERS
“In the world today, an infectious disease in one country is a threat to us all.”
– Dr. Gro Harlem Brundtland, Director-General, WHO
0 confirmed cases
1-100 cases
101-1,000 cases
1,001-5,000+ cases
Source: WHO
5
Exhibit 6:
DEADLY IMPACT OF SARS WORLDWIDE
Severe social impact
• Over 8,400 cases and 800
Tremendous economic cost to economy
Estimates of
global impact
US$Billion
Estimates of Asian
impact
US$Billion
deaths in 30 regions*
• High mortality rates, up to
$30
$30
50% for patients over 60
• Disruption of services (e.g
$12-28
$17
$20-25
$11
schools, hospitals,
government services)
• Public panic (e.g.
hoarding, price hikes)
* Estimates as of June 20, 2003
Source: WHO; World Bank; Wall Street Journal; Asia Development Bank; Merrill Lynch; UK Partnership for Health
6
Exhibit 9:
MISSING A SINGLE CASE CAN FIRE UP NEW OUTBREAK
• April 30 – Toronto taken off
WHO travel advisory list
• May 22 – 60+ new cases, due
to one misdiagnosed hospital
patient
• “…Authorities dropped their
vigilance in May in a rush to
proclaim Toronto safe”
– CNN
• “SARS has demonstrated an
ability to come back with a
knock-out punch”
– Dr. James Hughes,
Infectious Disease at CDC
Source: Washington Post; Wall Street Journal; CNN
7
Exhibit 10:
TAKES ONLY ONE PATIENT TO TRIGGER AN EPIDEMIC
SARS “Patient Zero” from China triggered a global epidemic
Index case’s wife, sister,
daughter and brother-in-law
infected
Over 4,000 cases
attributable to
index case
1 doctor and 5
nurses infected in
Kwong Wah Hospital
Infects mother, father
and pastor
Three women from
Singapore at hotel
Infects 198 other
Singaporeans
Infects 36 health workers
in Hanoi French hospital
Over 27 more
infected,
including
WHO’s Carlo
Urbani
U.S. businessman
travels to Vietnam
Infects 7 factor workers
Index case from
Guangzhou
contracts SARS;
checks into Hong
Kong Metropole
Hotel
Canadian citizen flew to
Toronto
HK airport
worker infected
Other hotel guests and
visitors infected
Source: WHO; Washington Post; The Wall Street Journal; Time;
5 family members
are infected
Infects 50
doctors and
nurses at
hospital
Kidney
patient
Beijing
visitor
Over 300
infected in
Amoy garden
Infected 17
Air China
passengers
Infected group of
Beijing medical
workers
8
Exhibit 11:
SECOND SARS OUTBREAK IS POSSIBLE IN WINTER
• Respiratory viruses and coronaviruses
show a seasonal pattern, reemerging in
the winter (e.g. 1918 Spanish flu returned
with a 10X higher mortality rate)
Epidemic curve
ILLUSTRATIVE
• This fall, every flu patient will need to be
New
cases
initially treated as if they may have SARS!
Such a high numbers may lead to lower
vigilance and increased risk of missing
SARS infections
SARS ?
1918
Spanish
flu
SARS ?
Time
Source: Washington Post; Wall Street Journal; CNN; PBS; WHO
• “In just 6 short months, we will see a
resurgence of SARS that could far
exceed our experience to date.”
–Michael Osterholm, Director of
Center
for Infectious Disease at Univ. of
Minnesota
• “I don’t think SARS is going away.”
–Tommy Thompson, U.S. Health and
Human Services Secretary
9
The WHO response to SARS
2002
1st known
case occurs
in
Guangdong,
China
2003
China formally
reports outbreak
with 305 cases &
5 deaths;
WHO Beijing
alerts GOARN
GPHIN picks
up rumour of
“flu outbreak”
in China
16
27 Nov. 11 Feb.
WHO issues
second alert
and sets out
guidelines
for SARS
WHO
issues first
global alert
12 Mar. 15
First recommendation to
postpone
travel to
certain areas
WHO issues
more stringent
advice to
travellers and
airlines
27
Guidelines
for
infection
control
issued
WHO lab
network
identifies
causative
agent
2 Apr. 16
WHA
adopts a
SARS
resolution
Recommendation for lab.
testing issued
24
29
WHO says
the outbreak
is contained
27 May
5 Jul.
10
SARS: 7 lessons learnt

Need to report, promptly and openly

Awareness raised by timely global alerts

Travel recommendations appear to be effective

International collaboration of world’s scientists, clinicians
and public health experts is necessary

Weak health systems allow infections to amplify and spread

Existing interventions help containing an outbreak

Risk communication
11
World Health Organization, Western Pacific Regional Office
Communicable Disease Surveillance and Response
12
FLU PANDEMIC, 1918:
How the virus spread via ships and trains
•
•
•
•
•
World population: 1.8 billion
Virus spread via troop ships
and trains
Spread around the globe
in 4 months
No vaccine available
Estimated death toll: 20 to 40
million
13
World Health Organization, Western Pacific Regional Office
Communicable Disease Surveillance and Response
14
World Health Organization, Western Pacific Regional Office
Communicable Disease Surveillance and Response
15
World Health Organization, Western Pacific Regional Office
Communicable Disease Surveillance and Response
16
World Health Organization, Western Pacific Regional Office
Communicable Disease Surveillance and Response
17
World Health Organization, Western Pacific Regional Office
Communicable Disease Surveillance and Response
18
>10 times higher mortality in October 1918
World Health Organization, Western Pacific Regional Office
Communicable Disease Surveillance and Response
19
Slide 20
Slide 21
Surveillance network epidemiology
and laboratory partners in Asia
APEC
FluNet
Mekong
Basin
Disease
Surveillance
(MBDS)
SEAMIC
SEANET
Pacific Public
Health Surveillance
Network (PPHSN)
ASEAN
EIDIOR
WHO COMMUNICABLE DISEASES • SARS, June 2003
22
Surveillance network electronic partner
in Canada: GPHIN
WHO COMMUNICABLE DISEASES • SARS, June 2003
23
Slide 24
Slide 25
Partnership for global alert and response to
infectious diseases: network of networks
WHO Regional
& Country Offices
WHO Collaborating
Centres/Laboratories
Countries/National
Disease Control
Centres
Epidemiology and
Surveillance Networks
Military
Laboratory
Networks
UN
Sister Agencies
GPHIN
NGOs
Media
Electronic
Discussion sites
WHO COMMUNICABLE DISEASES • SARS, June 2003
FORMAL
INFORMAL
26
Surveillance
Diagnosis
Lab
Treatment
Access
Quality
Slide 27
FluNet: Global surveillance of human
influenza, participating labs 2005
1 laboratory
> 1 laboratory
national net
Slide 28
WHO Influenza Network (FLUNET)
Initiated in 1947
Collaborating Centres for Influenza
ATLANTA
LONDON
MELBOURNE
TOKYO
Reports
WHO Geneva
National Influenza Centres
Diagnosis
114 Centres in
84 Countries
Slide 29
Role of lab in surveillance and response
• Early Detection and confirmation of aetiology of
outbreaks
• Monitoring trends and spread of infections
• Detection of new agents
• Detection of Agents of Biological Warfare /
Bioterrorism
• Elimination and eradication
Slide 30
Expected functions of laboratories
• Specimen collection
• Specimen processing
• Specimen transport
• Specimen testing
• Recording results
• Reporting results
• Establishment of baselines (Serology)
• Analysis of trends in isolation and identification
• Drug resistance Monitoring
• These functions are performed at various levels
Slide 31
Levels at which laboratories can be
involved
• Peripheral (PHC/CHC)
• Intermediate (District/Provincial/Med College)
• Regional laboratories (Intracountry)
• National Reference Laboratories
• Regional Reference Lab (Intercountry)
• International (Collaborating Centres)
Slide 32
“Surveillance” …
…... the systematic ongoing
collection, collation and analysis of
data for public health purposes and
the timely dissemination of public
health information for assessment
and public health response as
necessary.
(IHR2005)
Slide 33
Slide 34
สรุป
• กรณี SARS ความร่ วมมือระหว่ างวิชาชีพ และ
ระหว่ างประเทศนาความสาเร็จมาให้
• คนต้ องมีระบบสาธารณสุขทีเ่ ข้ มแข็งทุกหนแห่ ง
จึงจะรั บมือภัยคกุ คามจากเชื้อโรคได้
• IHR 2005 เป็ นพันธะสัญญาของทุกฝ่ ายเพือ่ สร้ าง
ระบบเตือนและต้ านภัยร่ วมกันของประชาคมโลก
Slide 35
ขอบคณ
ุ
Thanks
www.whothai.org
Slide 36