ハーバード人道援助プログラムの概要 及び 緊急援助におけるデング熱ラピッド アセスメント手法案

1. ハーバード人道援助プログラムの概要及び緊急援助におけるデング熱ラピッドアセスメント手法案ハーバード人道援助プログラムの概要及び緊急援助におけるデング熱ラピッドアセスメント手法案 厚生労働省 難波江　功二 ２００３年９月２２日　災害班

2. Who is this guy? • １９９８－１９９９　東京災害医療センター研修医 • １９９９　東京医療センター総合診療部研修医 • １９９９－２０００　厚生省 • ２０００－２００２　経済企画庁→内閣府 • ２００２－２００３　ハーバード大学公衆衛生大学院 • ２００３　WHO西太平洋事務局インターン • ２００３－　厚生労働省

3. 本日のトピック • ハーバード大学公衆衛生大学院及び公衆衛生学修士課程（ＭＰＨ）の概略 • Humanitarian Studies Initiatives Programの概要 • （時間があれば） 　　緊急援助におけるデング熱ラピッドアセスメント手法の提案

4. ハーバード大学 • １６３６年設立 • Undergraduateと１０の大学院で構成 • ケンブリッジ市とボストン市にキャンパスがある。 ケンブリッジ Faculty of Arts and Sciences Harvard Business School Graduate School of Design Harvard Divinity School Graduate School of Education JFK School of Government Harvard Law School ボストン School of Public Health Harvard Medical School School of Dental Medicine

5. Harvard School of Public Health • Established in 1922　（Rockefellerからの多額の寄付） • 学生数　約９００、　日本人１０人強 • MPH（１年）　→　過半数が医師 • MS（１年、２年）　　　　　　　　　　　　　 • SD

6. Master of Public Health • 40単位取得で修了 • 入学には既にGraduate Levelの学位が必要 • ７つの分野から専攻を選択 • Clinical Effectiveness • Family and Community Health • Health Care Management • International Health • Law and Public Health • Occupational and Environmental Health • Quantitative Methods

7. MPH/International Health • 義務課目（約２０単位） • 生物統計、疫学、医療経済、国際保健入門、倫理、社会疫学、環境保健 • 選択課目（約２０単位） Humanitarian Studiesの必須科目（約１０単位）

8. Humanitarian Studies Initiatives • Harvard, MIT, Tuftsの共管プログラム。 • 2001年にスタート。 • 各大学から約７名の学生が参加。

9. Humanitarian Studies Initiative趣旨 　“This innovative inter-university program is designed for graduate students seeking an education in the evolving and multidisciplinary field of humanitarian studies. Humanitarian studies represent a new and evolving interdisciplinary arena. To cover the diverse topic areas in adequate depth at the graduate level requires expertise and curriculum offerings in a broad range of disciplines, including anthropology, history, political science, agriculture, nutrition, public health, demography, epidemiology, biostatistics, ethics, international law, human rights, and issues of field operations and logistics.”

10. Humanitarian Studies Initiatives３つのRequirements • 約１０単位の必須課目 • 例）　People in War (Complex Humanitarian Emergencies), Disaster Management, Water and Sanitation, HIV/AIDS in developing countries, Nutrition….. • 毎週金曜日のHumanitarian Seminarへの出席 • ３ヶ月のフィールドワーク／インターン

11. Humanitarian Seminar例 • International Humanitarian Law • Reporting on Field Visits • Negotiation Skills • Rapid Public Health Assessment

12. Humanitarian Seminar例 続き • Politics and Complex Humanitarian Emergencies • Professionalism and Humanitarian • Cross Cultural Issues • Fundraising in the NGO World • Safety and Security • Civil Military Interaction • Human Rights Assessment • Food Security • Psychological Dimensions of Trauma • How Aid Can Support Peace or War

13. フィールドワーク／インターン例（３ヶ月間）フィールドワーク／インターン例（３ヶ月間） • アフガンの建築プロジェクト参加 • アフリカ諸国における保健NGOプロジェクト参加 • WHO西太平洋事務局インターン （デング熱対策）

14. HSI私が参加した理由 • 学生時代の経験 • 研修医時代のNGO参加（台湾震災） • 行政官としての責務（有珠山噴火等） 災害対応、人道援助、危機管理を公衆衛生の 側面から系統的に学びたい欲求

15. ＨＳＩ私の結論 • 概念的・思想的な講義が多い。 • 机上において、人道援助の技術的事項はほとんど学べない（除くフィールドワーク／インターン）。 • Practice Makes Perfect! 現場経験豊富な医療従事者・行政官が、更に飛躍する にはお勧めのプログラム

16. Rapid Assessment and Control of Dengue Outbreaks in Humanitarian Operations WHO/WPRO/MVP Intern Koji Nabae

17. Dengue risks in disaster/emergency • Stagnant water is a breeding site for vectors of Dengue • Stagnant water can be created by weather change. • Stagnant water can also be created with improper waste management and water drainage. • Disaster caused by weather change; floods and hurricanes; and refugees/IDPs camps pose high potentials for dengue epidemics. Rapid Assessment and Control is crucial to reduce burden of Dengue

18. Rapid Assessment “The collection of subjective and objective information, limited in time, performed during acute situation, which requires immediate actions to be taken to respond to the affected population.” Source: Dr. Eric Noji, Office of the US Surgeon General Washington, D.C.

19. Dengue - Transmission • Dengue viruses are transmitted to humans through the bites of infective female Aedes mosquitoes. • Mosquitoes generally acquire the virus while feeding on the blood of an infected person. • After virus incubation for 8-10 days, an infected mosquito is capable, during probing and blood feeding, of transmitting the virus, to susceptible individuals for the rest of its life. Source: WHO Fact Sheet No. 117

20. Dengue – Clinical Manifestation • Dengue fever is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death. • Infants and young children may have a non-specific febrile illness with rash. Older children and adults may have either a mild febrile syndrome or the classical incapacitating disease with abrupt onset and high fever, severe headache, pain behind the eyes, muscle and joint pains, and rash. • Dengue haemorrhagic fever is a potentially deadly complication that is characterized by high fever, haemorrhagic phenomena—often with enlargement of the liver—and in severe cases, circulatory failure. Source: WHO Fact Sheet No. 117

21. Flow of Actions Case Detection Active Case Finding Active Vector Finding Vector Control

22. Active Case Finding • Once a Dengue case is detected, send health professionals to his/her residence and neighbours. • Look for people with fever. • Assess and follow them up as potential dengue cases.

23. Active Vector Finding • Larval Surveys • House Index • Number of houses infested • Number of houses inspected • Container Index • Number of positive containers • Number of containers inspected • Breteau Index • Number of positive containers • Number of houses inspected X 100 X 100 X 100

24. Active Vector Finding Indices are useless in such a place!

25. Black Can Wooden Paddle Active Vector Finding Water Use Ovitraps/Larvitraps

26. Place Ovitraps/Larvitraps

27. Pick up 5 days later

28. Identify Positive or Negative

29. Vector Controls • Chemical • Biological • Environmental Management • Personal protection

30. Space spraying with portable thermal fogger for emergency adulticiding Source: Dr Raman Velayudhan, WR Philippines

31. Conditions for space spraying • Precise location to be sprayed • Distribution of case house(s) • The case history [when is the first case (index case), movement pattern of cases, probable source of infection] • Type of vector (Aedes aegypti vs Aedes albopictus or both) • Major breeding sites • Adequate trained supervisors • Number of trained spray men available for mobilization • Availability of serviceable spray machines and accessories • Availability of insecticide formulations and diluents • Availability of protective cloth and accessories • Health information and communication back up • Capability of monitoring and assessment of the post-intervention Source: Dr Raman Velayudhan, WR Philippines

32. Do’s and Don’t in space spraying • Do it early in the morning or late in the afternoon. • Contain mosquito by spraying from 360 degrees. • Don’t spread mosquito away. They escape fast.

33. ‘Packaged’ larvicide (temephos) for treatment of household water storage jars Source: Dr Raman Velayudhan, WR Philippines

34. ConclusionAssessment and Control Process Identify Dengue Risks Collect Data Control Vectors Design Control Measures Analyse and Interpret