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Infectious Diseases : personal protection in Manila and abroad Interactive Session on Preparedness and Response 29 September 2015 ADB Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.

PRESENTATION: Preparedness & Response Infectious Diseases

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Last 29 September, the ADB Medical Center conducted a training on infectious disease preparedness and response. This includes disease such as Avian flu, MERS-CoV, and EBOLA. Many infectious diseases and pandemic threats might hit you wherever you are in our global world. Dr. Philippe Guibert, Medical Director at International SOS in Singapore explains how to protect yourself, on the workplace, on travel, or at home.

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Infectious Diseases : personal protection in Manila and abroad

Interactive Session on Preparedness and Response29 September 2015ADB Disclaimer: The views expressed in this paper/presentation are the views of the author and do not

necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.

Looking back

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Over the past years, the world has seen different virus &/or diseases emerging and the impact to businesses is very real

A/H5N1 (Avian Bird Flu)• 1st case reported in Hong Kong in 1997 (18 cases and 6 fatalities)• Started spreading to other countries in 2003 – Still active today• During the 1st wave (Dec03 to Apr04), Thailand/Vietnam reported 35 cases of which 14 were fatal• Virus is now genetically different and it can survive longer in the environment + infect an expanding range of animals

H1N1 (Swine Flu)• 1st case reported in Mexico in Apr09• By Jun09, it had spread across the world• A total of 600,000 (18,000 fatalities) were confirmed

by the time WHO declared the pandemic over in Aug 2010

1997 2009 2010 2013 to present

MERS-CoV (Corona virus)• 1st case reported in 2012 (Arabian Peninsula)• As of June 2015, reported in 26 countries

H7N9 (Avian Bird Flu)• 1st case reported in Feb13 (China)

Ebola virus• 1st case in Dec13 (Guinea)

There will be the emergence of a new disease,

How prepared you to handle such situations?

Pandemic & Infectious DiseasesRisks That We Are Facing Today

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AVIAN INFLUENZA H5N1 CASES SINCE 2003The threat of avian flu H5N1 has not diminished. It is probably entrenched in birds in a number of countries, including China

• Confirmed H5N1Human Cases = 676 (15 Countries) • Confirmed H5N1Human Deaths = 398

“It is therefore to be expected that more avian influenza A(H5N1), A(H7N9), and a variety of other influenza subtypes and reassortant influenza viruses will be detected in humans and animals over the coming months.”

WHO - Influenza at the human-animal interfaceSummary and assessment as of 5 May 2014

© 2014 AEA International Holdings Pte. Ltd. All rights reserved.Unauthorized copy or distribution is prohibited.

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Anytime, anywhere, of any sort

•“We are only as safe as the most fragile states to find, stop and

prevent health threats”. Pr David Heyman

• Exotic diseases become global health security issues

• More real cases and false alarms expected

• From rural to urban

• Acceleration ?

Likely risks to traveller health

The most likely danger to traveler health in most countries would be vehicular travel

Extreme sports are responsible for many accidents

Air travel is still the safest means of transport

Local diseases and local vectors of these diseases, and the quality of health care

Environmental risks

Likely risks to traveller health

The reality of travelers

Based on study of health problems experienced by 100,000 individuals who travelled to a developing country for 1 month, the following could be expected to occur:

1 in 2 will develop some health problem

1 in 13 will see a doctor

1 in 20 will be confined to bed

1 in 90 will be incapacitated in their work

1 in 2,000 will be admitted to a hospital

1 in 3,300 will be evacuated

1 will die

Source: Steffen, R. et al.: "Health Problems After Travel to Developing Countries",Journal of Infectious Disease (1987) 156, 84

Top 10 causes of serious medical casesBusiness Travellers

# Cause% of serious

cases

1 Accident & Injury 21%

2 Cardiovascular & CirculatorySystem Diseases

15%

3 Gastrointestinal Disorders 15%

4 Ill Defined Symptoms - Minor 9%

5 Infectious Diseases - Major 8%

6 Musculoskeletal Disorders 7%

7 Urinary System Disorders 4%

8Gastrointestinal InfectiousDiseases

4%

9 Nervous System Disorders 3%

10 Referrals, Tests & Checkups 3%

Expatriates

# Cause% of serious

cases

1 Pregnancy 13%

2 Gastrointestinal Disorders 12%

3 Ill Defined Symptoms - Minor 12%

4 Accident & Injury 12%

5 Infectious Diseases - Major 8%

6 Cardiovascular & CirculatorySystem Diseases

8%

7 Musculoskeletal Disorders 7%

8 Gynaecological & ReproductiveSystem Disorders

4%

9 Referrals, Tests & Checkups 4%

10 Urinary System Disorders 4%

Serious case = Any case that results in in-patient, evac/repat or RMRSource: International SOS, 2010

Serious cases are 4.5 times more likely to result in evacuation in extreme risk countries, compared to a low risk countries

4.5 times higher

Serious case = Any case that results in in-patient, evac/repat or RMRSource: International SOS, 2012

One scenario

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Case Study ADB

10 October 2015

Channel News Asia reported a suspected case of MERS COV in Mumbai

from 2 travelers returning from Oman. They are being admitted to the local

hospital.

You are a Manager in Manila, some of your employees are scheduled for

a trip in Mumbai. Your reaction would be:

(a) Google on the Internet for more information

(b) Contact the ADB manager in Mumbai

(c) Do nothing and wait for MERS COV confirmation by India Ministry of Health and WHO

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Case Study 1.2

ADB has scheduled for 3 Business Travelers to travel to Mumbai for

important meeting with city officials on some important issues concerning

environment (Meeting Date 12 October 2015 morning)

3 Business travelers scheduled to depart on 11 October 2015. What

criteria would you use to decide for travel to proceed?

(a) Confirmation of MERS COV infection

(b) Importance of meeting

(c) Health status of 3 travellers

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Case Study 1.3

ADB decided for travelers to proceed as advised by WHO and Ministry of

Health Singapore (no restriction on travel to Mumbai). 3 Travelers have

proceeded with travel and arrived to Mumbai on 11 October 2015

12 October 2015. Mumbai Health Officials has confirmed the diagnosis

of MERS COV on the 2 Travelers from Oman

Your reaction:

(a) Instruct the 3 travelers to return back to Manila Immediately

(b) Instruct the Branch Manager to issue Masks

(c) Activate the Company Pandemic Plan

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Case Study 1.4

18 October 2015. Mumbai Health Officials has reported 10 hospital staffs

and related personnel has been quarantined. There was not report that the

MERS COV patient was located in which hospital.

19 October 2015. Mumbai Health Official reported that 2 hotel staff, 1

Taxi Driver and 4 hospital staff (Contacts of Index Cases) has fever and

cough and admitted to the hospitals

Your reaction:

(a) Advise the Expatriates to return home with their families

(b) Screen all workers for Temperature before work

(c) Try to contact Health Authority Mumbai for more information and ask Ministry of Health Singapore for advice

What are the best practices ?

Best Practices

A successful traveller risk management model

Pre-departure

Prepare. Educate. Awareness

Travel or Assignment

Track. Assist. Inform.

Emergency

Advise. Recommend. Act.

• Copy of Documents

• Plans

• Luggage

• Travel arrangements

• Local knowledge

• Money & passport

• Medications

1. Prepare

Six Principles of Personal Health

2. Be Aware

• Health condition may change just because of a different environment

• Ongoing or anticipated health issues: outbreaks, water availability, environmental event (i.e. heat wave)

• Confidentiality of medical information and privacy may differ a lot

• Healthcare quality sometimes unpredictable (corruption, counterfeit drugs, etc.)

Six Principles of Personal Health

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Assistance_App_Video.mp4

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Quiz International SOS App

Which languages are spoken at the Intl. SOS clinic in Beijing ?

Who can find more information on Haze ?

What is your membership number?

Is there malaria in Vietnam ?

Which vaccinations are needed for India?

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3. Have the Correct Profile

• Vaccinations

• Prescriptions, in case of long term treatment

• Dentist

• Contraception

• Pregnancy

Six Principles of Personal Health

4. Be Fit

• Objective : to ensure health status is compatible with destination’s risks

• Yearly / one month before departure

• Focus on cardiovascular fitness

• Health passport useful to carry

Six Principles of Personal Health

5. Create and stick to your health routine

• Wash your hands regularly

• Avoid drinking tap water

• Use your mosquito net

• Take your chemoprophylaxis

Six Principles of Personal Health

6. Communicate

• Seek early for assistance / advice even for minor health issues: complications may happen

• Keep regular contact with your office through the trip

• Share personal information with relatives – do not hide

Six Principles of Personal Health

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Thank you for your attention !