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Lessons from Global Outbreak Investigations: Insights for New Zealand's Public Health Strategy

In this presentation, Donald Campbell, Principal Advisor in Public Health, reviews international outbreak inquiries to extract valuable lessons for New Zealand. He examines various inquiry types, including coroner and outbreak control inquiries, and highlights major cases such as Walkerton and Central Scotland. Key insights revolve around the need for improved surveillance, effective enforcement, and communication protocols to bolster public health response. This session aims to identify areas for further development in New Zealand's VTEC investigation and control practices based on lessons learned from abroad.

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Lessons from Global Outbreak Investigations: Insights for New Zealand's Public Health Strategy

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  1. Lessons from abroad - What can be learnt from outbreak investigations in other countries?Donald CampbellPrincipal Advisor (Public Health)

  2. My brief • Review sentinel international outbreaks. • Consider recommendations and implications for New Zealand • Identify key areas for further development in New Zealand surveillance, investigation and control of VTEC

  3. Lessons from abroad - What can be learnt from outbreak inquiries in other countries?Donald CampbellPrincipal Advisor (Public Health)

  4. Types of Inquiries • Coroners / Fatal Accident • Outbreak Control Team • Administrative • Outbreak • Public Health • Public

  5. Areas Considered • Time and place of death • The cause of death • Any precautions that may have avoided death • Any defects in the system that may have avoided death • Any other relevant considerations

  6. Major Inquiries Central Scotland 1996 (512 / 22) Walkerton 2000 (1346 / 6) (South Wales) 2005 (157 / 1)

  7. No Inquiries Oregon 1982 (25) (South Australia 1995 (23)) Japan 1997 (12,000 / 3) USA 2006 (205 / 3)

  8. Central Scotland • Pennington Report • A relatively simple breakdown in hygiene can have serious public health consequences • The importance of a HACCP approach • Training of food handlers • Effective enforcement

  9. Walkerton • O’Connor Inquiry • Monitors at Well 5 • Guidelines and Directives not followed • Approvals and inspections programme failures • PUC commissioners not aware of operators practices • Concealment of monitoring results • Insufficient dissemination of water advisory • Laboratory provision issues

  10. South Wales • Inquiries still ongoing • Outbreak Control report • Review commissioned by CMO • Pennington

  11. Farms and Livestock • Farm workers • Education/awareness • Slurry • Abattoirs • GHP • High risk premises • Enforcement

  12. Meat production and Butchers • HACCP • Regulation clarity • Separation of raw and cooked (? Staff)

  13. Point of consumption • Schools • Retail • Vulnerable groups

  14. Enforcement • Policy • Staff • Funding • Designation

  15. Surveillance • Stool testing • Primary care • Laboratories • Case definition • Outbreak reporting • Minimum data set • Publishing

  16. Research • Standard approval but appropriate weight on threat to public health

  17. Outbreak management • Personnel • MOsH • HPOs/EHOs • Laboratories • Central • Time • Skills

  18. Communication • Lead • Public • Interagency • Commentators • “Tell it all, tell it straight”

  19. Collaboration “Our communication was very good and we had a very strong team approach” “…they just send us out to do the inspection and don’t keep us informed …”

  20. Public Health • Medical Officers of Health • Auditing of PHUs • Clarity of roles • Liaison meetings • Information sharing • Response protocols

  21. Sounds familiar ? Users • “It’s a pain to weed through all the irrelevant lessons to get to the few ‘jewels’” • “We seem to learn some lessons over and over again” Managers • “Despite the processes and procedures in place to capture and share lessons learned, I see no evidence that lessons are being applied towards future success” Raytheon

  22. Risk Factor Identification: What is the cause? Surveillance: What is the problem? Public Health Approach Implementation: How do you do it? Intervention Evaluation: What works? Problem Response

  23. A plea Good surveillance does not necessarily ensure the making of right decisions but it reduces the chances of making wrong ones Alexander D Langmuir

  24. DALYs Disability Adjusted Life Years DALY = YLL +YLD • Campylobacteriosis 1554 • Norovirus infection 536 • Listeriosis 255 • Salmonellosis 186 • E coli O157 infection 91

  25. Questions • Priority • Would we recognise an outbreak? • Could we respond? • How quickly would we find cause? • How quickly could we implement control measures? • Communication • Public confidence • Public Inquiry!

  26. Final thought There’s a lot of it out there

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