Public health emergency: International Concern

PUBLIC HEALTH EMERGENCY:
INTERNATIONAL CONCERN
AMO: Wellness Focus Professional for Quality Healthcare
National Assistant Medical Officer Conference
Berjaya Waterfront Hotel, Johor Bharu
4th May 2017
Dr Azlan Helmy Abd Samat
Emergency Physician & Lecturer
Emergency Dept PPUKM

Figure 1. Serial photographs of a sneeze extracted from the video image.
Nishimura H, Sakata S, Kaga A (2013) A New Methodology for Studying Dynamics of Aerosol Particles in Sneeze and Cough Using
a Digital High-Vision, High-Speed Video System and Vector Analyses. PLOS ONE 8(11): e80244.
https://doi.org/10.1371/journal.pone.0080244
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0080244

Objectives
▸ Discuss Public Health Emergency
among other healthcare professionals
▸ Demonstrate understandings of PHE
and to incorporate them in daily
practice
▸ Disseminate the correct information
to general public

OUTLINE
▸ Story of King Alfonso XIII
▸ Story of Prof Liu Jianlun
▸ Story of baby Emile
▸ Story of Olympic
6

“If you know the enemy and know yourself,
you need not fear the result of a hundred
battles
If you know yourself but not the enemy, for
every victory gained you will also suffer a
defeat.
If you know neither the enemy nor yourself,
you will succumb in every battle
Sun Tzu
Art of War

(WHO) INTERNATIONAL HEALTH REGULATIONS ?
▸ The International Health Regulations, or IHR (2005), represent an agreement
between 196 countries including all WHO Member States to work together
for global health security.
▸ Through IHR, countries have agreed to build their capacities to detect,
assess and report public health events. WHO plays the coordinating role in
IHR and, together with its partners, helps countries to build capacities.
▸ IHR also includes specific measures at ports, airports and ground crossings
to limit the spread of health risks to neighboring countries, and to prevent
unwarranted travel and trade restrictions so that traffic and trade disruption
is kept to a minimum.
9

1.
Transition headline
Let’s start with the first set of slides
10 AMO: Wellness Focus Professional for Quality Healthcare

PUBLIC HEALTH EMERGENCY?
▸An Emergency Need for healthcare services to
respond to a disaster, significant outbreak of an
infectious disease, bioterrorist attack, or other
significant catastrophic event
11

▸ PHIEC – Public Health Emergency
of International Concern
▸ An extraordinary event which is
determined, as provided in these
Regulations:
i. to constitute a public health risk to other
Member States through international
spread of disease and
ii. to potentially require a coordinated
international response.
The Director General -WHO declares PHEIC

The expansive definitions of "disease", "event", "public health
risk" the IHR (2005) cover a wide range of public health risks of
potential international concern:
• whether biological, chemical or radio nuclear in origin or
source, and
• whether potentially transmitted by:
persons (e.g. SARS, influenza, polio, Ebola),
goods, food, animals (including zoonotic disease risks),
vectors (e.g. plague, yellow fever, West Nile fever), or the
environment (e.g. radio nuclear releases, chemical spills or
other contamination).

Alert and Response Operations
Detection
Verification
Risk assessment
Response
Events that may constitute a
Public Health Emergency of International Concern need:

Event notification and determination
under IHR (2005)
WHO DG
Various disease &
event surveillance
systems within a country
National IHR
Focal Points
WHO IHR
Contact Points
Emergency
Committee
Other competent
Organizations
Detect and report any
urgent or unexpected
events
Consult events or
notify WHO of any
events that may
constitute a PHEIC
Receive, assess and
respond to events
notified
Ministries/
Sectors
Concerned
Determine whether an
event constitutes a
PHEIC and recommend
measures
External
advice
Coordinate
Communicate
Report

Decision Instrument
1. Is the public health impact of the event serious?
2. Is the event unusual or unexpected?
3. Is there a significant risk of international spread?
4. Is there a significant risk of international travel or trade restrictions?
Answering "yes" to any two of the criteria
requires a member state to notify WHO
Criteria for assessment

Pre Pre requisite for pandemic for
pandemic
▸(1) the identification of a novel viral subtype
in animal populations such as swine or poultry
▸(2)viral replication causing disease in
humans, and
▸(3) efficient human-to-human transmission.

100 000 000Spanish Flu Pandemic 1918 killed an
estimated 50-100 million people
24

Influenza may have killed as many as
25 million people in its first 25 weeks
Mortality 20% as opposed to 0.1%
usual flu epidemic
Killed more people in 24 weeks than
AIDS killed in 24 years
25
▸Knobler, S.; Mack, A.; Mahmoud, A.; et al. The Story of Influenza; The Threat of Pandemic Influenza: Are We Ready? Workshop
Summary (2005), Washington DC, The National Academic Press, p 60-61
▸Knobler, S.; Mack, A.; Mahmoud, A.; et al. The Story of Influenza; The Threat of Pandemic Influenza: Are We Ready? Workshop Summary (2005),
Washington DC, The National Academic Press, p 60-61
Wiped out 5% of world population

284 000Death Toll from 2009 H1N1 Pandemic
28

2009 Pandemic Could Have Been Worse……
Onset
-A pandemic virus strain was
first detected in North America
-emergence during end seasonal
influenza epidemic
Vaccine
-Widely Available
-And residual immunity among
older adults
Antiviral
Tamiflu availability
Circulating virus strains
susceptible to neuraminidase
inhibitor
31
Communication
-Mass Media such as television,
radio ,internet and newspaper
were widely used
-Rapid dissemination of
virological, epid and clinical data
to global community
Awareness
Public more alert and aware of
ILI symptoms
Virulence
Virus detected not as virulent as
previous strain

One thing human race have learned…..
32

STORY OF PROF LIU JIANLUN33
Hong Kong

Superspreader and the social aftermath
34

10% of SARS victims died
21% of these were healthcare workers
38
World Health Organization. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31
July 2003. 2003 Sep 26 [cited 2005 Apr 28]. Available from http://www.who.int/csr/sars/country/table2003_09_23/en/

Jasmine Shimin Chung et al, ‘Debate on MERS-CoV respiratory precautions surgical mask or
N95 respirators? Singapore Med J 2014, 55(6): 294-297

Airborne
▸Aerosolized droplet
<5microns
▸Remain in the air
longer hence longer
exposure
▸Measles,
Tuberculosis
Droplet
▸Droplets > 5microns
▸Sprayed in the air but
fall short of 3 feet
▸Expose less beyonf
this range
▸Influenza, Pertussis,
Mumps
41

STORY OF BABY EMILE43
Liberia, Guinea,
Sierra Leone,
Nigeria

FRUIT BAT
▸Natural reservoir for
the virus is fruit bat.
▸But also found
porcupines, primates,
antelopes.
▸Human DO NOT carry
EBOLA  Infection is
incidental
50

1976 The first EBOLA outbreak in Yambuku, Zaire (Congo)
11310
Mortality Rate for EBOLA
28616 Cases of EBOLA reported in 2014 (the worst outbreak)
56
15227 Lab confirmed EBOLA cases 2014
Death reported from EBOLA 2014
50-90%

3. ZIKA Virus▸A global public health emergency
▸Brazil hardest hit by the Zika
complications, 4000 babies born with
microcephaly since October last 2016.
▸The virus, which in most people causes only
mild symptoms such as fever, rash, and
conjunctivitis, has been reported in 25
countries in the Americas.

▸What we know Zika is spread mostly by the
bite of an infected Aedes species mosquito
(Ae. aegypti and Ae. albopictus).
▸These mosquitoes bite during the day and
night.
▸Zika can be passed from pregnant mom to
fetus which may cause birth defect
▸No vaccine or medicine for ZIKA for now
62

PREVENTION IS
BETTER THAN CURE
63

NSC Directive No. 20
▸A serious disruption of community functions
causing widespread human, material or environmental
losses which exceed the ability of the affected
community to cope using its own resource.
▸Any threat to public safety and public health where
local government and emergencyservices are unable
to meet immediate needs of the community
66

NSC Directive No. 20
▸“ an incident that occurs unexpectedly, complex in
nature, resulting in the loss of lives and damage to
properties and the environment as well as interfering
in daily activities of the local community. The incident
requires the management which involves resources,
equipment, extensive manpower from various
agencies as well as effective coordination and the
possibility of taking complex action over long period
of time”
67

Previous Incidents in Malaysia
1991
Fireworks factory explosion and
fire- Sg Buloh
1647 Injured, 22 death
1993
Highland Towers condominium
collapse
48 death
1995
Landslide Genting Highlands
20 death, 22 injured
68
1998
Nipah Virus/ Viral encephalitis
outbreak
283 cases/ 109 deaths
Economic Losses
2003
SARS
5 probable cases
2009
Pandemic H1N1
14 912 cases
88 Death
2014
Bah Kuning Kelantan
202 000 victims displaced
Worst Flood in Kelantan history

Which phase are we now?
RECOVERYRESPONSE MITIGATION
70
PREPAREDNESS

EMERGENCY OPERATION CENTRE
▸Known as Crisis Preparedness and
Response Centre (CPRC)
▸Since May 2007
▸Established under 9th Malaysia Plan
(2005-2010) to manage disasters,
outbreaks, crises and emergencies (DOCE)
related to health
▸2013 expanded to include all hazards
71
ASEAN EOC NEWSLETTER, Disease Control Division, Ministry of Health Malaysia, Dec 2016, vol 1, (1) pg 2-3

EOC
▸Command centre MOH : National Crisis
Preparedness and Response Centre
(NCPRC)
▸Central point for command, control and
coordination of DOCE
▸State CPRC required to submit DOCE
report to national CPRC daily.
72

CPRC OBJECTIVES & ACTIVITIES
▸Monitor DOCE events
▸Organize effective and immediate public
health response and disseminate info to
higher MOH authorities
▸Effective communication amongst
ASEAN members (ASEAN-EOC) for regional
surveillance and response.
73

CPRC ACTIVITIES
▸Passive surveillance mode daily for DOCE
▸Once activated, Operation room opened to
monitor identified DOCE
▸Daily report sent to all related stakeholders.
▸Had been successful as C&C centre for
H1N1 2009, Massive flood 2014,Avian
Influenza 2013(H7N9), Missing of MH 370, MH
17 crashed, Zika Virus 2016
74

Take Home Messages
▸ Public Health Emergency is a real threat
▸ Awareness of the threat triggers
preparedness
▸ Wellness focus personnel encompasses
knowledge and powerful imagination to
provide solutions
75

77
THANKS!
Any questions?
You can find me at
azlanhelmy@ukm.edu.my

Public health emergency: International Concern

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