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Overview of Public health emergency response under Department of Disease Control (DDC / MOPH) . DDC / MOPH 14 August 2012. Outline . MOPH structure, highlighting offices involved in PHER PHE encountered in past decade Evolution of ICS over the past decade

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overview of public health emergency response under department of disease control ddc moph

Overview of Public health emergency response under Department of Disease Control (DDC / MOPH)

DDC / MOPH

14 August 2012

outline
Outline
  • MOPH structure, highlighting offices involved in PHER
  • PHE encountered in past decade
  • Evolution of ICS over the past decade
  • Major lessons learned: building on existing capacities
slide4

Ministryof

PublicHealth

Professional Councils

Professional Councils

Professional Councils

NationalHealthBoard

OfficeoftheMinister

Permanent

Secretary

ClusterofMedicalServiceDevelopment

DeputyPermanentSecretary

ClusterofPublicHealthDevelopment

DeputyPermanentSecretary

ClusterofPublicHealthServiceSupport

DeputyPermanentSecretary

OfficeofthePerm. Secretary

DepartmentofMedicalServices

DepartmentofDiseaseControl

DepartmentofHealthServiceSupport

ProvincialAdministration

DepartmentofThaiTraditionalandAlternativeMedicineDevelopment

DepartmentofHealth

DepartmentofMedicalSciences

FoodandDrugAdministration

DepartmentofMentalHealth

StructureofMinistryofPublicHealth

slide5

Departmentof

DiseaseControl

AdministrationDevelopmentSystemSection

InternalAuditorSection

Officeofthesecretary

PersonnelDivision

Finance Division

PlanningDivision

BamrasnaraduraInstitute

(Infectious Hospital)

RajprachasamasaiInstitute

(Leprosy Hospital)

Office of Disease Prevention and Control 1-12

Bureau of Epidemiology

BureauofOccupationalandEnvironmentDiseases

BureauofGeneralCommunicableDiseases

Bureau of Vector-Borne Diseases

BureauofNon-CommunicableDiseases

BureauofAIDSandSTDs

StructureofDepartmentofDiseaseControl

Bureau of Emerging

Infectious Diseases

Bureau of Public Relations

Bureau of

TB control

phes we are facing
PHEs we are facing

Outbreaks of infectious diseases

Natural disasters

Public Health Emergency (PHEs)

Wars and violence

Man-made disasters

slide7

Major events encountered since 1962

  • Super Typhoon Karen, Nov.-Dec. 1962; killed ~900
  • Flood Southern, November 1963; killed 374
  • Typhoon Gay Southern, November 1989; killed >600
  • LPG Explosion, Bangkok, September 1989; Killed 81
  • Doll Factory on fire, May 1993; killed 188
  • Hotel Collapse, Korat, August 1993; killed 132
  • SARS Dec. 03 – Jun. 2004; economic loss $ 4.5 bm.
  • Tsunami, December 2004; killed >5,400
  • Avian Influenza 2004; Pandemic threat, etc.
top 10 natural disasters in thailand n umbers of people killed
Top 10 Natural Disasters in Thailand:Numbers of people killed

http://www.unisdr.org/eng/country-inform/thailand-disaster.htm

top 10 natural disasters in thailand n umbers of people affected
Top 10 Natural Disasters in Thailand:Numbers of people affected

http://www.unisdr.org/eng/country-inform/thailand-disaster.htm

slide10

Anthrax mail hoaxes in Thailand

(16 Oct 01 - 22 Feb 02)

Anthrax tests on 217 suspected letters/ objects were all negative !

Public confidence in public security was finally restored.

slide12

Nipah inMalaysia, 1999

Social loss :

283 human cases

110 deaths

Economic loss :

Pig destruction

(1.4 mil.)

US$ 400 million

sars 2003
SARS 2003

21 Aug 07

slide15

Stronghold of SARS control

Surveillance, investigation and infection control in the hospital and the community

slide16

2006

2005

2004

2007

slide17

Disibution of avian influenza in poultry and human cases, Thailand 2004-2007

2007

2006

2008

2004 2nd round

2005

2004 1st round

Confirmed case

Suspect case

Poultry outbreak

Total 25 cases/ 17 deaths during 2004-2007, Since Jan 2008: 2 confirmed poultry outbreaks, no human infection found.

22 May08

slide19

Main partners in AI responses

Foreign affairs

Animal health authorities

Education

Wildlife

Finance

Commerce

Public health authorities

Labour

Security

Public Com.

Education

Other

2004 botulism outbreak response
2004 Botulism outbreak response

Botulism Outbreak (163 cases) from Canned Bamboo shoot, Nan, 2006

slide22

Case study: Pandemic influenza

  • Prevention (mitigation)
  • Risk assess. & capability analysis
  • Prevention measures

Preparedness

  • Planning & coordination
  • Simulation exercises
  • Control
  • Animal outbreaks
  • Human infections
  • Recovery

Warning of the birds

National Strategic Plan on AI & PI Preparedness and Response (2005 – 2010)

Goals:

  • Build sustainable capacity for the preparedness and response to pandemics and other public health emergencies
  • Mitigate impact from avian and pandemic influenza
slide23

Case study: Pandemic influenza

The Cabinet

National Committee on AI & PIP

Public sector

Semi-gov. & Private

Functional

drills

76

Table-top

exercise

Provincial Committees on AI & PIP

Public sector

Semi-gov. & Private

Central

level

Provincial

level

Service center level

  • National Strategic Plan providing framework for multi-sectors corporate / agency planning and budgeting
  • Multi-sector simulation exercises carried out in all provinces.
  • BCP introduced and adopted in many commercial business settings and in essential service sector.
  • Prevention (mitigation)
  • Risk assess. & capability analysis
  • Prevention measures

Preparedness

  • Planning & coordination
  • Simulation exercises
  • Control
  • Animal outbreaks
  • Human infections
  • Recovery
slide24

Case study: Pandemic influenza

  • Prevention (mitigation)
  • Risk assess. & capability analysis
  • Prevention measures

Preparedness

  • Planning & coordination
  • Simulation exercises
  • Control
  • Animal outbreaks
  • Human infections
  • Recovery

Capacities built

  • Hospital capacities of public hospitals and many private hospitals have been escalated to manage influx of patients with acute respiratory infection.
  • Hospital infection control has been strengthened in all public hospitals.
  • Standard guidelines / training on case management
  • Periodic simulation exercises
slide25
Capacities built

Stockpiling

National stockpiles of antiviral drugs and PPE have been established and expanded.

Production of drug & vaccine

Oseltamivir production by GPO, from imported API

R&D of pandemic influenza vaccine under WHO support

Influenza vaccine production approved by the government, now under construction

Case study: Pandemic influenza

  • Prevention (mitigation)
  • Risk assess. & capability analysis
  • Prevention measures

Preparedness

  • Planning & coordination
  • Simulation exercises
  • Control
  • Animal outbreaks
  • Human infections
  • Recovery
slide26

Case study: Pandemic influenza

  • Prevention (mitigation)
  • Risk assess. & capability analysis
  • Prevention measures

Preparedness

  • Planning & coordination
  • Simulation exercises
  • Control
  • Animal outbreaks
  • Human infections
  • Recovery

Capacities built

  • Risk communication network was established to support public communication through media.
  • Community-based communication supported by health volunteers, community leaders and local NGOs.
  • Business continuity planning (BCP) for pandemic preparedness and simulation exercises have been introduced in public and private sectors.
slide27

Case study: Pandemic influenza

  • Prevention (mitigation)
  • Risk assess. & capability analysis
  • Prevention measures

Preparedness

  • Planning & coordination
  • Simulation exercises
  • Control
  • Animal outbreaks
  • Human infections
  • Recovery

The whole world sharing pandemic risk

slide28

Case study: Pandemic influenza

H1N1 2009 cases

H1N1 2009 deaths

Reported influenza

Number of deaths

Number of cases

2009

2010

Week of on set

  • Prevention (mitigation)
  • Risk assess. & capability analysis
  • Prevention measures

Preparedness

  • Planning & coordination
  • Simulation exercises
  • Control
  • Animal outbreaks
  • Human infections
  • Recovery

1

3

2

Source: Bureau of Epidemiology, MOPH

slide29

Case study: Pandemic influenza

Ventilation support

AV treatment

1

3

Isolation room

Response

strategies

2

Staying home when ill

Screening at OPD

Use of face mask

Hand hygiene

Fever clinic

1 Dec 2010

  • Prevention (mitigation)
  • Risk assess. & capability analysis
  • Prevention measures

Preparedness

  • Planning & coordination
  • Simulation exercises
  • Control
  • Animal outbreaks
  • Human infections
  • Recovery

Source: Bureau of Epidemiology, MOPH

slide30

Case study: Pandemic influenza

  • Prevention (mitigation)
  • Risk assess. & capability analysis
  • Prevention measures

Preparedness

  • Planning & coordination
  • Simulation exercises
  • Control
  • Animal outbreaks
  • Human infections
  • Recovery

Pandemic impact (2009-10)

36,927 cases reported

225 deaths reported

Economic loss - huge?

Socio-political impact – profound?

Could have been much worse

without the preparedness

Source: Bureau of Epidemiology, MOPH

slide31

PHE management cycle

Impact

Post-

impact

Pre-

impact

incident command system at the central and local levels
Incident command system at the central and local levels

ICS

Central level

ICS

local level

First responder

Team

First responder

Team

First responder

Team

First responder

Team

The Incident

roles of surveillance and rapid response team srrt
Roles of Surveillance and Rapid Response Team (SRRT)
  • Surveillance of severe, rapidly spread infectious disease.
  • Detection of public health emergency
  • Rapid & effective outbreak investigation
  • Outbreak control
  • Report and surveillance data exchange

0ver 1,000 SRRTs at central, regional, provincial and district levels

slide35

Organization of DDC’s incident command system (ICS)

Incident commander

Coordinator

PR

Note taker

Tech. Officer

Organization

Logistics Unit

Operation Unit

Planning & Intelligence Unit

Budget & Admin. Unit

Public Relations Unit

Events

Atomic

Biological

Chemical

Disaster

slide36

Call center

Clinical team

Bamras

Adjustment of DDC’s ICS in 2011 flood response

Surveillance team

BOE / FETP

ICC

DDG

D-BOE

D-PRO

D-GCD

D-BEID

D-NCD

D-VBD

PHER (sec)

Logistics & operation support team

BGCD

Risk Com team

B-PR

SAG

Senior

staff

slide37

WHO / IHR

MOPH’s ICC

PSO

Call center

MOPH Call center

MOPH’s clinical WG

DMS

Clinical team

Bamras

Adjustment of DDC’s ICS in 2011 flood response

MOF, Embassies

TUC / CDC

Surveillance team

BOE / FETP

?

Laboratory team

DMSc

ICC

DDG

D-BOE

D-PRO

D-GCD

D-BEID

D-NCD

D-VBD

PHER (sec)

Logistics & operation support team

BGCD

Risk Com team

B-PR

MOPH’s risk com team

SAG

Senior

staff

Expert

committee

slide38

Boxes

MOPH

budget

MOPH

budget

MOPH

budget

JICS

GPO-A-Flu

GPO-A-Flu

Tamiflu

Tamiflu

Stockpiling and logistics for Pandemic (H1N1) 2009 : Oseltamivir

slide39

Stockpiling and logistics for Pandemic (H1N1) 2009 : PPE

  • Central stockpiles: 2 sites
  • DDC, MOPH, Nonthaburi
  • KDC Co. Ltd., Chachoengsao
slide41

?

Building on existing strengths.

slide42

Put to test

in pandemic H1N1 2009

response

Improved flu surveillance 2005-2009 under pandemic influenza preparedness .

AI surveillance 2004-2008 ARI + history of exposure to sick or dead birds / contact with pneumonia pt. + lab.

SARS surveillance 2003 pneumonia + history of travel to affected areas / contact with pneumonia pt.

Syndromic approach, Improved reporting coverage

Lab. tests, SRRT, improved coverage, PH-AH cooperation

SRRT, ILI & severe pneumonia.surveill., sentinel provinces

SRRT, lab.test estimated baseline flu burden

Surveillance capacity

Flu & pneumonia surveillance Under routine disease reporting (506 report) countrywide.

evolution of eid preparedness response2
Evolution of EID preparedness & response

Dengue, bioterorism, chemical accident, any PHE

capacity b uilding need
Capacity building need
  • Policy & strategy
  • Management
  • Model & guideline
  • Communicationskill
  • Training & information exchange