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Global Health Security Emerging and Re-Emerging Infectious Diseases

Global Health Security Emerging and Re-Emerging Infectious Diseases. Felice M Apter , PhD OLLI Part II 2018. Emerging Infectious Diseases: Multisectoral Everything is Inter-related. Part I Quick Review of Class I. Basic D e f i n i ti o ns.

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Global Health Security Emerging and Re-Emerging Infectious Diseases

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  1. Global Health Security Emerging and Re-EmergingInfectious Diseases Felice M Apter, PhD OLLI Part II 2018

  2. Emerging Infectious Diseases: MultisectoralEverything is Inter-related

  3. Part IQuick Review of Class I

  4. Basic Definitions • Emerging Infectious Disease- disease recognized in a human host for the firsttime • Re-emerging Infectious Disease- disease that have historically occurred in human hosts, but arenow: • New geographicalarea • New resistance to medicalcountermeasures (AMR) • Reappear after apparent control orelimination (VPD)

  5. One Health – Public health as partof the“ecosystem” Human Cases Wild Animal DomesticAnimal Animal Amplification C A S E S Wildlife Surveillance/ Forecasting EarlyDetection and Control Opportunities TIME Emerging ThreatsProgram

  6. Early Detection and Mitigation isCrucial Source: WHO, The World Health Report2007. A Safer Future: global public health security in the 21stcentury

  7. Part IIPrevent, Detect, Respond

  8. Response and Solutions: • At the start of an EIDOutbreak: • WHO – Is Sick – Index Case • WHAT – Is causing the illness – • Pathogen+ Other Impacting Dimensions: Stochastic Process • HOW – Is it spreading • WHERE – Did it come from? • How – is it spread? • epi curve, epi map, R0, finding cases • WHY – Did the Pathogen Emerge

  9. Prevent • Infrastructure – Safe Water • Food Safety • Nutritional Status • Immune Status • Vaccines 3 Dimensions of the Immune System – • Recognizes Self from Other • Attacks Other • Has Memory

  10. - The Challenge - Communicating the Miracle of Vaccines: Myths and Misinformation

  11. Detection • Early Days – Differential Diagnosis based on Symptoms, usually advanced symptoms • TB (consumption), Syphilis, Plague (Yersinia Pestis), Whooping Cough (Pertussis) • Visual Identification of Pathogen and Differential Media • Bacteria (light microscopes), Viruses (electron microscopes) • Immunological Identification • Antibodies • Molecular Diagnostics

  12. Cholera in London Birth of Public Health: John Snow • Coordination Response • Communication Response • Epidemiology – mapping the epidemic and acting on information • Medical Response • A continuum of Basic to Sophisticated Medical Care • Quarantine, Isolation • Drugs • Vaccines – special case of Emerging Disease ***Link to Local, National and International Decision Makers***

  13. Part IIIEvolution of Global Health Security

  14. Evolution of International Sanitary Regulations Table by Fidler

  15. Frameworks for infectious disease control Frameworks for EID

  16. IHR revision process (1995-2005)The Balancing Act “…to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks and which avoid unnecessary interference with international traffic and trade’’ • All 196 Member States have Signed On!

  17. International Health Regulations (2005) Goal: Respond to events effectively before they become international public health crises.

  18. Early Detection and Mitigation isCrucial Source: WHO, The World Health Report2007. A Safer Future: global public health security in the 21stcentury

  19. What did States Parties agree to do? (Articles 4, 5, 13, 44 and Annex 1)

  20. Annex 1 defines IHR (2005) core capacity requirements • Epidemiological, laboratory, logistical support • Containment and control measures • Coordination with other ministries • Information sharing • Operational national public health emergency response plan • Deployable rapid response teams • Detect unexpected disease or deaths • Assess reports within 48 hours • Notify WHO • Support or implement control measures National Intermediate • Detect unexpected disease or deaths • Assess and confirm reported events • Report to national level • Support or implement control measures Local • Detect unexpected disease or deaths • Assess events immediately • Report essential information to appropriate level • Implement preliminary control measures

  21. Event detected by national surveillance system • An event involving the following diseases shall always lead to utilization of the algorithm, because they have demonstrated the ability to cause serious public health impact and to spread rapidly internationally: • Cholera • Pneumonic plague • Yellow fever • Viral hemorrhagic fevers (Ebola, Lassa, Marburg) • Other diseases that are of special national or regional concern, e.g. dengue fever, West Nile fever, Rill Valley fever, and meningococcal disease. Any event of potential international public health concern, including those involving other events or diseases than those listed in the box on the left and the box on the right shall lead to utilization of the algorithm. • A case of the following diseases has serious public health impact and is unusual or unexpected, and thus shall be notified: • Smallpox • Poliomyelitis due to wild-type polio virus • Influenza with pandemic potential • Severe acute respiratory syndrome (SARS) OR OR Is the public health impact of the event serious? Yes No Is the event unusual or unexpected? Is the event unusual or unexpected? No Yes Yes No Is there a significant risk of international spread? Is there a significant risk of international spread? Yes No Yes No Is there a risk for international trade restrictions? Not notified at this stage. Reassess when more information becomes available. Yes No Event shall be notified to WHO under the International Health Regulations

  22. Slide from HHS/ASPR

  23. PHEIC’s to Date

  24. IHR (2005) – new strategies Goal Respond to events effectively before they become international public health crises.

  25. Declared PHEICs

  26. *=Emergency Committee Meeting ** * * * * * * *

  27. Meetings of IHR Emergency Committee Concerning MERS-CoV • 9 July 2013 (more info needed) • 17 July 2013 (serious, but not a PHEIC) • 25 September 2013 (no change, Hajj prep) • 4 December 2013 (camels, Hajj review, no change) • 14 May 2014 (worsening situation, but no PHEIC because no sustained human to human) • 17 June 2014 (drop in cases, no PHEIC, prep for Hajj) • 1 October 2014 (MERS might be seasonal, no PHEIC) • 5 Feb 2015 (need more surveillance, no PEHIC) • 17 June 2015 (no sustained transmission, under control, no PHEIC)

  28. States report meeting all core capacity requirements States report meeting all core capacity requirements OR OR Adopted by States Parties Entered into force Request extension Request 2nd extension 2005 2007 2009 2012 2014 States assess core capacities Plan/implement capacity building

  29. IHR Status as of 2016

  30. Core Challenges • Nations have not built core capacities under the IHR • Need for better metrics; external evaluations • Need for technical and financial resources • Transparency and better decision making at WHO • Stronger and faster response capacity • Sustainability

  31. Biological Weapons Convention

  32. Biological and Toxin Weapons Convention (BWC)

  33. Key provisions of the BWC Prohibition InternationalAssistance andCooperation

  34. The Convention has no monitoring or verification agency, no governing council, and no permanent secretariat. • Biological agents are inherently dual-use, know no borders, and are evolutionary, thus cannot be captured in a traditional treaty mechanism. • Benefits of its membership are not always apparent to non-State parties. This “weapons” treaty actually provides entrée to many inter-connected communities which together provide greater security against bio threats, whether natural, accidental or deliberate. • The BWC Implementation Support Unit (ISU) consists of three people who serve as a highly efficient clearing house. • The BWC “community” includes national security, health, law enforcement, preparedness, academia, industry and NGO members.

  35. The BWC: An Integrated Approach Law Enforcement BWC WHO OIE FAO 1540 BWC Intersessional Work Program Emergency Preparedness Industry Professional Associations Scientific Organizations

  36. In the News Lifting the Ban on Making Lethal Organisms https://www.nytimes.com/2017/12/19/health/lethal-viruses-nih.html

  37. Evolution of Frameworks to meet Common NeedsGlobal Health Security Agenda

  38. Accelerating progress toward a world safe and secure from infectious disease threats Global Health Security Agenda IHR Animal health, food safety, environment Biosecurity Regional frameworks Specific technical guidance OIE Performance of Veterinary Services Pathway, AMR, etc. BWC, UNSCR 1540

  39. Overlap Between GHSA and IHR GHSA IHR • Prevent AMR • Vaccination Programs • Nosocomial infection control • Regional biosurveillance hubs • Sample sharing • Novel diagnostics • Sharing medical countermeasures and personnel • Legislation, Policy & • Financing • Risk communication • Coordination and NFP • Communication • Points of Entry • Food Safety • Chemical Events • Radiological Emergencies • Surveillance • Laboratory • Preparedness • Response • Zoonotic diseases • Human Resources

  40. 11 action packages define specific GHSA targets

  41. Each GHSA Action Package includes milestones and targets for national use • 5-year targets (as measured by) • Desired national impact • Country commitments • Baseline Assessment and Planning Activities • Monitoring and Evaluation Activities

  42. Funding Sources for JEE and Country Plans

  43. USG Response: Ebola and Zika

  44. 2017 Status: Secretary of State Rex Tillerson • In October 2017, Secretary of State Rex Tillerson called the Global Health Security Agenda “one of the most vital initiatives for building global capacity to prevent, detect, and respond to infectious disease threats.” • Yet the administration hasn’t set aside money to sustain the program after the grant expires next year. And President Trump’s budget proposals have included heavy cuts to global infectious disease programs. • According to the Wall Street Journal, the CDC has picked the 10 countries it will continue to support through the Global Health Security Agenda— • India, Thailand, Vietnam, Kenya, Uganda, Liberia, Nigeria, Senegal, Jordan and Guatemala—on the basis of “strategic or regional importance.” BC, UNSCR 1540 Global Agenda Biosecurity IHR Animal health, food safety, environment Regional frameworks Specific technical guidance OIE Performance of Veterinary ervices Pathway, AMR, etc.

  45. Part VOur Modern World

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  47. Human

  48. GlobalExamplesofEmergingand Re-Emerging InfectiousDiseases Antimicrobial- r: ;:ntthreats -MRSA EnterovirusD68Cryptosporidiosis Ebolavirusdisease WestNile E.coliO104:H4 MERS-CoV Akhmetavirus Rift Valleyfever Typhoidfever SFTSV bunyavirus E.coli O157:H7 • C.difficile • N.gonorrhoeae • H3N2v influenza Cyclosporiasis • E.coliO157:H_7-_,l.-_-_-_-_-_:.:-::$5 • Human monkeypox • Listeriosis Bourbon • virus • 2009H1N1 • influenza • Adenovirus14 • Anthrax bioterrorism Qii : -- -==-- - - - ---+-- H10N8 influenza H7N9 influenza https://youtu.be/xOFH57Do2EM https://youtu.be/xOFH57Do2EM Hendra virus Enterovirus 71 Humanmonkeypox Ebola virusdisease Zikavirus Plague Hantavirus pulmonary syndrome Marburg hemorrhagicfever MDR / XDRtuberculosis Human Africantrypanosomiasis Newlyemerging Re-emerging/resurging • "Deliberatelyemerging" December2016 • CJj • • Georgetown University MedicalCcntct 8.9 J7

  49. Early Detection and Mitigation isCrucial Source: WHO, The World Health Report2007. A Safer Future: global public health security in the 21stcentury

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