Communicable Diseases in the Western Pacific Region - · PDF filen Current situation of communicable diseases in the Western Pacific Region ... • SARS • Avian Influenza ... Malaysia

Inaugural Ceremony of the Scientific Advisory Structure of theInaugural Ceremony of the Scientific Advisory Structure of theCentre for Health Protection, Department of Health, Hong KongCentre for Health Protection, Department of Health, Hong Kong

Communicable Diseases in theCommunicable Diseases in theWestern Pacific RegionWestern Pacific Region

Hitoshi OSHITANIHitoshi OSHITANIWestern Pacific Regional Office Western Pacific Regional Office

WHOWHO

nn Current situation of communicableCurrent situation of communicablediseases in the Western Pacific Regiondiseases in the Western Pacific Region•• HIV / AIDSHIV / AIDS•• TBTB•• Vaccine Preventable DiseasesVaccine Preventable Diseases•• Vector borne diseasesVector borne diseases

nn New communicable diseases challenges inNew communicable diseases challenges inthe Western Pacific Regionthe Western Pacific Region•• SARSSARS•• Avian InfluenzaAvian Influenza•• Other emerging diseasesOther emerging diseases

nn Roles of Hong Kong SAR in regional andRoles of Hong Kong SAR in regional andglobal effortsglobal efforts

Outline of the PresentationOutline of the Presentation

Western Pacific Region of WHOWestern Pacific Region of WHO

WHO Western PacificRegional Office (WPRO)

Estimates of yearly AIDS deaths in 2000 & 2005in 4 selected Western Pacific countries

ChinaCambodiaViet NamMalaysia

20002000 20052005

6000

35,000 deaths35,000 deaths 120,000 deaths120,000 deaths

11000

24000

11000

20000

80000

Measurable,fixed targettowardsthe goalof universalaccess to ART

What is the “3 by 5” Initiative?

An initiative to to make ARV treatmentavailable to 3 million people by 2005

400,000 people receive treatment today

WHO/UNAIDS global treatment initiative for AIDS“Addressing a global public health emergency”

A voluntary process§ driven by country§ supported by regional offices§ with stewardship of HQ

Others5%

Cambodia3%

Republic of Korea

4%

China57%

Japan4%

Viet Nam12%

Philippines15%

Distribution of notified TB cases inDistribution of notified TB cases inWestern Pacific Region (2002)Western Pacific Region (2002)

Case Detection Rate (CDR) andCase Detection Rate (CDR) andDOTS coverage in 7 High BurdenDOTS coverage in 7 High Burden

Countries in WPRCountries in WPR

0

1020

30

40

5060

70

80

90100

PNG CHN LAO CAM PHL MON VTN

CDR

DOTS

70% CD

Measles cases and coverageWPR 1974-2002

-

500

1,000

1,500

2,000

2,500

3,000

3,500

1974 1978 1982 1986 1990 1994 1998 2002

Year

Cases (in thousands)

0%

20%

40%

60%

80%

100%

Coverage

Countries that have interruptedmeasles transmission

Countries where measlestransmission was reestablished

Measles-endemic countries

Measles control status by countryMeasles control status by country

*According to 2003 data

HBV Carriage Rate (pre-vaccine)HBV Carriage Rate (pre-vaccine)

>12% (9)

8% - 12% (13)

2% - 7% (11)

< 2% (2)

No Data (1)

Introduction of Hep B vaccineIntroduction of Hep B vaccine

0%

20%

40%

60%

80%

100%

1983 1985 1987 1989 1991 1993 1995 1997 1999 2001Year of Introduction

% of Countries

(cumulative)

Number of reported dengue casesNumber of reported dengue cases20032003

%U%U

%U

Viet Nam

Cambodia

Philippines

Laos PDR

Brunei

China

Viet Nam

Malaysia

Philippines

Brunei

Singapore

Macau

Hong Kong

74

(9,300)

(6,260)

(16,978)

(11,635)

(15,816)

(2,341)

128

Guangzhou

Dengue cases 20031 - 10001001 - 50005001 - 1000010001 - 20000

SARS cases by region1 November 2002 – 7 August 2003

SARS cases by region SARS cases by region1 November 2002 1 November 2002 –– 7 August 2003 7 August 2003

Europe0.4 %

SE Asia0.16%

Others0.1%

Americas3.4%

WesternPacific95.9 %

Global Total：

8096 cases

774 deaths

WPR Total:

7768 cases(95.9. %)

727 deaths(93.9 %)

Epidemio logy C o m m

JulJulJul

ChinaChina

LaboratoryInfect ion Contro l Logist ics Env i ron

Hong Kong Hong Kong ((China)China)

FebFeb

Viet NamViet Nam

PhilippinesPhilippines

SingaporeSingapore

Taiwan Taiwan ((China)China)

M a rM a rM a rM a r A p rA p rA p rA p r MayMayMay JunJunJunJunJunJun Aug

Tota l : 77

Tota l : 17

Tota l : 22

Tota l : 28

Tota l : 11

Total : 9

AugAug

Tota l : 77Tota l : 77


Tota l : 22

Tota l : 28

Tota l : 11

Total : 9




Total : 9Total : 9 TOTAL: TOTAL:

164164Others

WHO consultants for affectedWHO consultants for affectedcountriescountries

SARS cases by week of onsetSARS cases by week of onset

First cases inFirst cases inGuangdongGuangdong

Outbreak inOutbreak inGuangdongGuangdong

M HotelM Hotelin HKin HK All areasAll areas

removed fromremoved fromthe listthe list

MultiMulti-country Outbreaks-country Outbreaks

GlobalGlobalAlertAlert

AmoyAmoy Garden Garden

Lessons learned from SARSLessons learned from SARSLessons learned from SARS

nn Timely and transparent informationTimely and transparent informationsharingsharing

nn National sovereignty and protection ofNational sovereignty and protection ofglobal public healthglobal public health

nn Economic impactEconomic impact

nn Lack of surge capacity at country andLack of surge capacity at country andregional levelregional level

nn Poor public health infrastructurePoor public health infrastructure

nn Inadequate infection control practices inInadequate infection control practices inhealth care settingshealth care settings

nn Multi-Multi- sectoralsectoral coordination coordination

nn Risk communicationRisk communication

§§ High level of leadership and commitmentHigh level of leadership and commitment

§§ The dedication and hard work of publicThe dedication and hard work of publichealth staffhealth staff

§§ Unprecedented worldwide collaborationUnprecedented worldwide collaborationamong governments and the scientificamong governments and the scientificcommunitycommunity

However, there are still issues that need toHowever, there are still issues that need tobe addressedbe addressed ……

Key elements for success in globalcontainment of SARS

Key elements for success in globalcontainment of SARS

One year after SARS outbreakOne year after SARS outbreak

nn Remaining issuesRemaining issues

•• Ecology of SARS Ecology of SARS CoVCoV in in

environment (natural reservoir)environment (natural reservoir)

•• Vaccine and antiviral developmentVaccine and antiviral development

•• Diagnostic kitsDiagnostic kits

nn New issuesNew issues

•• Laboratory safety and containmentLaboratory safety and containmentnn Laboratory acquired cases in Singapore,Laboratory acquired cases in Singapore,

Taiwan, BeijingTaiwan, Beijing

Avian influenza (H5N1) in Asia as of 10 March2004

Confirmed human cases of avian influenzaConfirmed human cases of avian influenzaA(H5N1) as of 17 March 2004A(H5N1) as of 17 March 2004

15152222VietViet Nam Nam

23233434TotalTotal

881212ThailandThailand

DeathsDeathsCasesCases

Status of H5N1 cases by age groupStatus of H5N1 cases by age groupThailand and Viet Nam (N= 34)Thailand and Viet Nam (N= 34)

0 2 4 6 8 10 12 14

40+

31-40

21-30

11-20

0-10

Age

gro

up

(ye

ars)

No. of Cases

Dead

Alive

Human Public Health RiskHuman Public Health Risk

n Human cases in affected areas•• St i l l smal l number of conf i rmed casesSt i l l smal l number of conf i rmed cases

•• Not enough informat ion to assess publ ic heal thNot enough informat ion to assess publ ic heal th

impactimpact

n Emergence of a new influenza virus

•• Efficient human to human transmissionEfficient human to human transmission

•• Vast majority of people no immunity to H5Vast majority of people no immunity to H5

•• Pandemic with huge morbidity and mortality impactPandemic with huge morbidity and mortality impact

Lessons learned from avian influenzaLessons learned from avian influenzaoutbreak in Asiaoutbreak in Asia

§§ Need to strengthen surveillance capacitiesNeed to strengthen surveillance capacities§§HumanHuman

§§AnimalAnimal

§§ Better coordination between human publicBetter coordination between human publichealth and agriculture sectorshealth and agriculture sectors§§National LevelNational Level

§§Regional / Global LevelsRegional / Global Levels

§§ Human public health Human public health vsvs impact on economy impact on economy§§Reluctance to report poultry outbreakReluctance to report poultry outbreak

Other emerging disease threatsOther emerging disease threats

§§ NipahNipah / / HendraHendra

§§ EnterovirusEnterovirus 71 71

§§ West Nile VirusWest Nile Virus

§§ HantavirusHantavirus

§§ Other Other zoonoseszoonoses

§§ Antimicrobial resistanceAntimicrobial resistance

§§ Newly emerging diseasesNewly emerging diseases

Emerging communicable diseasesEmerging communicable diseasesWhy now?Why now?

nn GlobalizationGlobalization

•• Mass movement of people and goodsMass movement of people and goods

nn Rapid developmentRapid development

•• Urbanization (ex. TB)Urbanization (ex. TB)

•• Deforestation (ex. Ebola)Deforestation (ex. Ebola)

nn Over-consumption of animal productsOver-consumption of animal products

•• Animal husbandry practices Animal husbandry practices –– intensive farming intensive farming

•• Wild animal marketsWild animal markets

nn Failure of health systemsFailure of health systems

•• Heavy focus on curative careHeavy focus on curative care

•• Neglect of public healthNeglect of public health

•• Excessive antibiotic useExcessive antibiotic use

Global and Regional Alert andGlobal and Regional Alert andResponse NetworksResponse Networks

nn RationalRational

•• None of countries and areas has al l necessaryNone of countries and areas has al l necessaryexpertise / capacity to respond to publicexpertise / capacity to respond to publichealth emergencies l ike SARShealth emergencies l ike SARS

•• Gaps between developed and developingGaps between developed and developing

countries: e.g. laboratory, epidemiology etc.countries: e.g. laboratory, epidemiology etc.

•• Rapid and transparent information exchangeRapid and transparent information exchangeis critical to prevent international spread ofis critical to prevent international spread ofdiseasedisease

Global Outbreak Alert and ResponseGlobal Outbreak Alert and ResponseNetworkNetwork

ElectronicDiscussion

sites

Media

N G O s

MilitaryLaboratoryNetworks

WHO Collaborat ing Centres/Laboratories Epidemiology and

Survei l lance Networks

WHO Regional& Country Offices

Countries/National Disease Control

Centres

UNSister Agencies

F O R M A LF O R M A L

GPHIN

INFORMALINFORMAL

InternationalInternational

HealthHealth

Regulations =Regulations =

Global legalGlobal legal

framework toframework to

protect the worldprotect the worldfrom publicfrom public

health threatshealth threats

Why have IHR?Why have IHR?

nn Serious and unusual diseaseSerious and unusual diseaseevents are inevitableevents are inevitable

nn Globalisation - problem in oneGlobalisation - problem in onelocation is everybodylocation is everybody’’s problems problem

nn An agreed code of conductAn agreed code of conductPROTECTS against:PROTECTS against:

11 the spread of serious risks to publicthe spread of serious risks to publichealthhealth

22 the unnecessary or excessive use ofthe unnecessary or excessive use of

restrictions in traffic or trade forrestrictions in traffic or trade forpublic health purposespublic health purposes

IHR are not newIHR are not new

nn Notification Notification :: to WHO, of a case of cholera , to WHO, of a case of cholera ,

p lague or yel low fever , not i fy WHO when the areaplague or yel low fever , not i fy WHO when the area

is f ree f rom infect ion - narrow focusis f ree f rom infect ion - narrow focus

nn Health Organization Health Organization :: ports, airports and frontier ports, airports and frontier

posts are adequate ly equipped to apply the IHRposts are adequate ly equipped to apply the IHR

measures - aga in focussed on 3 d iseases andmeasures - aga in focussed on 3 d iseases and

outdatedoutdated

nn Health Measures Health Measures:: The max imum measures The max imum measures

applicable to international traff ic, which a stateapplicable to international traff ic, which a state

may require for the protection of i ts terr i torymay require for the protection of i ts terr i tory

against cholera, plague and yel low fever - r igidagainst cholera, plague and yel low fever - r igid

and punit iveand punit ive

In rev is ing we needed to overcome theseIn rev is ing we needed to overcome these

l imitat ionsl imitat ions

The Proposed RevisionThe Proposed Revision

•• Notification: Public health emergencyNotification: Public health emergencyof international concernof international concern

•• Use information coming from sourcesUse information coming from sources

other than official member stateother than official member statenotificationsnotifications

•• Temporary recommendationsTemporary recommendations

•• IHR emergency committeeIHR emergency committee

•• Based on risk assessmentBased on risk assessment

•• National focal pointNational focal point

•• Minimum core capacityMinimum core capacity•• Capacity buildingCapacity building

Major milestones in the revisionMajor milestones in the revision

2004• report to EB 113 - green l ight• Regional Consultation Meetings

(WPRO: April 28-30)• Amended draft revision proposals• Intergovernmental Working Group (Nov 2004)• Final regulatory draft

2005 � report to EB 115� W H A

Roles of Hong Kong in global &Roles of Hong Kong in global &regional effortregional effort

nn Participation in global and regional networksParticipation in global and regional networks

•• SurveillanceSurveillance

•• LaboratoryLaboratory

•• On-site supportOn-site support

nn Capacity building in neighbouring countriesCapacity building in neighbouring countries

•• TrainingTraining


nn SurveillanceSurveillance

•• Rapid dissemination of information on CD fromRapid dissemination of information on CD fromHong KongHong Kong

•• Initiate discussions and information sharing withInitiate discussions and information sharing withthe regionthe region


nn Laboratory networksLaboratory networks

•• Laboratories in Hong Kong play crit ical roles asLaboratories in Hong Kong play crit ical roles asregional and global reference laboratoriesregional and global reference laboratories

nn SARS (3 / 11: Hong Kong labs)SARS (3 / 11: Hong Kong labs)

nn Influenza H5N1 (2/6: Hong Kong labs)Influenza H5N1 (2/6: Hong Kong labs)

nn Specimens were sent to labs in Hong Kong for:Specimens were sent to labs in Hong Kong for:

•• SARS (Mainland China, Jan 2004)SARS (Mainland China, Jan 2004)

•• H5N1 (Human, Viet Nam, Jan 2004)H5N1 (Human, Viet Nam, Jan 2004)

•• H5N1 (Animal , Viet Nam, Feb 2004)H5N1 (Animal , Viet Nam, Feb 2004)

•• H5N1 (Animal, Mainland China, Apr 2004)H5N1 (Animal, Mainland China, Apr 2004)

•• SARS (Mainland China, Apr 2004)SARS (Mainland China, Apr 2004)


nn On-site SupportOn-site Support

•• Clinical team to Viet Nam on H5N1 (Feb 2004)Clinical team to Viet Nam on H5N1 (Feb 2004)

•• More potentialMore potentialnn Various expertise in Hong KongVarious expertise in Hong Kong

nn Practical experiencePractical experience


nn Capacity buildingCapacity building

•• Each country should have core capacity to containEach country should have core capacity to contain

disease in early stagedisease in early stage

•• TrainingTrainingnn LaboratoryLaboratory

nn EpidemiologyEpidemiology

nn Infection control etc.Infection control etc.

Thank youThank youThank you

Documents

Communicable Diseases in the Western Pacific Region - · PDF filen Current situation of communicable diseases in the Western Pacific Region ... • SARS • Avian Influenza ... Malaysia