The Development of a Multisectoral National Strategy for the Control of Leptospirosis in Fiji

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GRF 2nd One Health Summit 2013: Presentation by REID, Dr. Simon Andrew, The University of Queensland

GRF 2nd One Health Summit 2013: Presentation by REID, Dr. Simon Andrew, The University of Queensland

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  • 1. A MULTISECTORAL NATIONAL STRATEGY FOR THE CONTROL OF LEPTOSPIROSIS IN FIJI Associate Professor Simon Reid School of Population Health University of Queensland Brisbane, Australia CRICOS Provider No 00025B
  • 2. The process • MoH initiated a planning process to develop a national strategy for leptospirosis in 2011 • 2 one-day workshops were held in 2011 to facilitate a discussion between different sectors/disciplines • ~46 participants from 6 ministries, NGO’s, industry • 4 subgroups were formed: – – – – Clinical Management Laboratories Agriculture Environmental Health and Health Promotion • Final step was an experts meeting with a multidisciplinary panel supported by WHO CRICOS Provider No 00025B
  • 3. Fiji national strategy PURPOSE: • Reduce the incidence (morbidity and mortality) due to leptospirosis in Fijian communities COMPONENT OBJECTIVES: 1. Reduce the mortality rate in the human population 2. Strengthen laboratory capacity 3. Implement a structured program to reduce leptospirosis in livestock 4. Strengthen community-based programs to control reservoir species and exposure to leptospires
  • 4. Agriculture • Determine the impact of leptospirosis on livestock enterprise in Fiji • Strengthen stray dog control in urban and rural communities • Develop and implement a structured strategic communication program for livestock farmers and animal owners in high risk areas • Develop and implement strategies to enhance crosssectoral communication • Develop and implement strategies to ensure joint surveillance and outbreak investigation is undertaken
  • 5. Clinical management • Early detection and presentation of cases (rapid tests / case definition) • Determine evidence base for enhanced clinical management protocols • Standardise treatment protocols • Training to improve case detection and management using standardised protocols • Strengthen communication with clinical departments • Determine major risk factors for infection and severe disease • Strengthen communication campaigns to improve early presentation
  • 6. Env. Health/Health communication • Develop and implement a program to monitor rodent populations • Develop strategies to review and strengthen enforcement of legislation with regards rodent control • Enhance collaboration and communication with other stakeholders (MPI, MoH) • Develop a climate based Early Warning System
  • 7. Laboratories • Develop capacity for testing clinical and surveillance specimens from humans and domestic animals (ELISA and PCR) • Develop framework for collaborative strengthening of AH and PH laboratory capacity • Develop protocols for multiple disease testing of samples (panel of disease approach) • Improve report dissemination
  • 8. Governance framework GOVERNANCE NTCOPD Clinical Management Surveillance Capacity building/training Monitoring and evaluation Control
  • 9. MAJOR OBJECTIVES REDUCE FATALITY RATE OF LEPTOSPIROSIS • IMPROVE CLINICAL Mgmt OF AFI REDUCE INCIDENCE AND BURDEN OF LEPTOSPIROSIS • REDUCE LEPTOSPIROSIS TRANSMISSION STRATEGIES • SHORT TERM • LONG TERM
  • 10. Improve clinical management of febrile illness Reduce leptospirosis transmission Develop/Implement new clinical guidelines for aggressive initial management and referral of cases Identify reservoir hosts and other risk factors Improve management of severe cases Develop appropriate strategies to reduce the size of the reservoir (i.e. livestock/dog vaccination, rodent management as appropriate) Improve health seeking behaviours (i.e. early presentation) Improve outreach/communication messages to reduce frequency of risky behaviours
  • 11. Reduce transmission Short term 6-9 months Retrospective analysis of surveillance data and linked information from clinical records and environmental health officer reports from case investigation Initial surveys of rodents/livestock and humans in hotspot areas Sero-survey or a separate activity that requires work on rodents/mongoose reservoirs
  • 12. Medium/long Term 6-18 Months • Development of longer term research program to characterize risk factors/reservoir hosts • Ongoing development of health promotion activities based on findings from research and feedback from evaluations • Improve surveillance and health information systems
  • 13. Lessons learnt • Lack of formal and informal structures for inter-sectoral communication/collaboration • Poor understanding of cross-sectoral issues (i.e. public health staff do not understand the agricultural sectors needs) • Need for increased capacity in environmental health • Animal health capacity is a limiting factor • Importance of the strategy document for institutional advocacy • One health in this context is the leadership and coordination of the whole program
  • 14. ONE HEALTH SHORT COURSE Brisbane, Australia 14-18 July, 2014 CRICOS Provider No 00025B