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PPacific acific PPublic ublic HHealth ealth SSurveillance urveillance NNetwork: etwork:
Framework 2006 Framework 2006
PPHSNPPHSN is a is a voluntary network of voluntary network of countries/territories and institutions/ countries/territories and institutions/ organisationsorganisations
Dedicated to the promotion ofDedicated to the promotion of public public health surveillance & responsehealth surveillance & response
Current focus onCurrent focus on CDs: epidemic ones CDs: epidemic ones first first
PPHSNPPHSN Goal is Goal is to improve public health to improve public health surveillance in the Pacific Islands, in a surveillance in the Pacific Islands, in a sustainable waysustainable way
WhatWhat is the is the PPHSNPPHSN??
Core:Core:22 MoHs22 MoHs
LaboratoriesLaboratories
TrainingTraininginstitutionsinstitutions
Aid donors, Aid donors, ProjectsProjects
Networks & Networks & AssociationsAssociations
International International agenciesagencies
Coordinating-BodyCoordinating-Body+ Focal Point+ Focal Point
PPHSN PPHSN IInstitutional frameworknstitutional framework
Operational stepsOperational steps
Alert Alert && CommunicationCommunication
Verification Verification && IdentificationIdentification
Investigation & Investigation & ResponseResponse
Infection controlInfection control
PPHSN servicesPPHSN services
• PacNetPacNet
• LabNetLabNet
• EpiNetEpiNet
• PICNetPICNet
PPHSNPPHSN: Networking ServicesNetworking Services
Alert Alert && Communication CommunicationPacPacNetNet
E-mail (and fax) E-mail (and fax) listserverlistserverNetwork of health professionalsNetwork of health professionals
Early warning systemEarly warning system for epidemic threats for epidemic threats
Awareness & Awareness & preparednesspreparedness
Access to Access to resourcesresources, including expertise, including expertise
Overall Overall communicationcommunication and and coordinationcoordination
Complemented by Complemented by PacPacNetNet-restricted-restricted
SPC3%
Others10%
Training Institutions
9%
WHO11%
Laboratories6%
Health Depts SPC
member countries
61%P@CNETP@CNET
E-mail subscriber by resource E-mail subscriber by resource institution as at 31 November institution as at 31 November 20052005
n = 636n = 636
Number of messages posted Number of messages posted by month, by month, AAppril 97-30 Nov. ril 97-30 Nov. 20052005
0
1020
3040
5060
70
8090
100110
120
Apr
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Oct
Dec
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eb.
Apr
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Oct
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Feb
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June
Aug
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Dec
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Oct
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Feb
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June
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.31
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.27
-Feb
30-A
pr30
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n31
-Aug
31 O
ct.
influenzainfluenzaarbovirusesarboviruses
measlesmeaslesdenguedengue
denguedenguedenguedengue
(+ measles)(+ measles)
Source : Public Health Surveillance & Communicable Diseases Control Section,
Secretariat of the Pacific Community
NipahNipah(Malaysia)(Malaysia)
denguedengue(+ influenza(+ influenza))
choleracholeratyphoidtyphoid
denguedengue
SARSSARS
denguedengue HPAIHPAI
1997 1998 1999 2000 2001 2002 2003 2004 2005
(+ rubella, measles)(+ rubella, measles)
HPAIHPAIinfluenzainfluenza
Dengue Dengue SARSSARS
Operational stepsOperational steps
Alert Alert && CommunicationCommunication
Verification Verification && IdentificationIdentification
Investigation & Investigation & ResponseResponse
Infection controlInfection control
PPHSN servicesPPHSN services
• PacNetPacNet
• LabNetLabNet
• EpiNetEpiNet
• PICNetPICNet
PPHSNPPHSN: Networking ServicesNetworking Services
PPHSNPPHSN LabNet LabNet
Three-tier network of public health Three-tier network of public health laboratory services providing access laboratory services providing access to distance diagnostic facilities to distance diagnostic facilities throughout the Pacific: throughout the Pacific:
Level 1:Level 1: national labsnational labs
Level 2:Level 2: (sub-)regional labs, having (sub-)regional labs, having accepted to provide services for accepted to provide services for PPHSN target CDs to other PPHSN target CDs to other countries/territoriescountries/territories
Level 3:Level 3: reference (… WHO ref reference (… WHO ref centres)centres)
What do we aim at?
PPHSNPPHSN LabNet LabNet
Common challenges and development goalsCommon challenges and development goals To provide access to distance diagnostic facilities To provide access to distance diagnostic facilities throughout the Pacificthroughout the Pacificquarantine regulations, Airlines requirements, on-quarantine regulations, Airlines requirements, on-going funding mechanismsgoing funding mechanisms
To ensure a secure and efficient specimen and To ensure a secure and efficient specimen and information flowinformation flowconfidentiality, Bio-ethics and intellectual property confidentiality, Bio-ethics and intellectual property rightsrights
To maintain reliable and sustainable servicesTo maintain reliable and sustainable services on-going capacity building i.e. training, appropriate on-going capacity building i.e. training, appropriate equipment, Q.C.equipment, Q.C.
Operational stepsOperational steps
Alert Alert && CommunicationCommunication
Verification Verification && IdentificationIdentification
Investigation & Investigation & ResponseResponse
Infection controlInfection control
PPHSN servicesPPHSN services
• PacNetPacNet
• LabNetLabNet
• EpiNetEpiNet
• PICNetPICNet
PPHSNPPHSN: NetworkingNetworking ServicesServices
Network of national/territorial well-Network of national/territorial well- defined defined multidisciplinary outbreak response teams: themultidisciplinary outbreak response teams: the “EpiNet “EpiNet teams”teams” (clinical medicine, data management, epidemiology & (clinical medicine, data management, epidemiology & field investigation, lab, PH management)field investigation, lab, PH management)
Aim: to provideAim: to provide immediate public health response to immediate public health response to outbreaks and outbreak threatsoutbreaks and outbreak threats
Core teamCore team, linking with other key stakeholders , linking with other key stakeholders according to the outbreak faced (e.g. EPI coordinator)according to the outbreak faced (e.g. EPI coordinator)
ClearClear counterparts counterparts forfor PPHSN activities & PPHSN activities & development, development, incl.incl. capacity-building capacity-building
To build up aTo build up a pool of regional expertise pool of regional expertise
PPHSNPPHSN EpiNetEpiNet
Operational stepsOperational steps
Alert Alert && CommunicationCommunication
Verification Verification && IdentificationIdentification
Investigation & Investigation & ResponseResponse
Infection controlInfection control
PPHSN servicesPPHSN services
• PacNetPacNet
• LabNetLabNet
• EpiNetEpiNet
• PICNetPICNet
PPHSNPPHSN: NetworkingNetworking ServicesServices
Launched in Feb 2006Launched in Feb 2006
ObjectivesObjectives
Within the framework of the PPHSN:Within the framework of the PPHSN:
1.1. To set the To set the minimum standards minimum standards for infection control in PICTs, with for infection control in PICTs, with adapted evidence-based/best practicesadapted evidence-based/best practices
2.2. To develop infection control To develop infection control capacitycapacity in PICTs. in PICTs.
3.3. To raising To raising awarenessawareness of infection control issues. of infection control issues.
4.4. To develop and maintain infection control links with health (and To develop and maintain infection control links with health (and other) entities (e.g. other governmental and non-governmental other) entities (e.g. other governmental and non-governmental agencies, donors).agencies, donors).
5.5. To develop a To develop a strategic planstrategic plan for PICNet. for PICNet.
6.6. Future objective: To develop and maintain standardized Future objective: To develop and maintain standardized healthcare associated infection (HAI) healthcare associated infection (HAI) surveillance and responsesurveillance and response mechanisms.mechanisms.
PPHSNPPHSN PICNetPICNet
MembershipMembership
Core members Core members
All health professionals with interest in infection control with one All health professionals with interest in infection control with one national focal point for each SPC member country or territory.national focal point for each SPC member country or territory.
Allied membersAllied members
Health professionals with interest in infection control from Health professionals with interest in infection control from Australia and New Zealand Australia and New Zealand
International organizations: WHO, SPC International organizations: WHO, SPC
Training institutions, including Schools of Nursing, Schools of Training institutions, including Schools of Nursing, Schools of Medicine, Schools of Oral HealthMedicine, Schools of Oral Health
DonorsDonors
ActivitiesActivities
Support and advocacy for capacity building for infection control Support and advocacy for capacity building for infection control professionals (ICPs). professionals (ICPs).
Strengthen institutional linkages with regional and national expert Strengthen institutional linkages with regional and national expert bodies.bodies.
PPHSNPPHSN PICNet PICNet (ctd)(ctd)
PPHSN Priority CDsPPHSN Priority CDs
Primary listPrimary list
CholeraCholera
DengueDengue
InfluenzaInfluenza
LeptospirosisLeptospirosis
MeaslesMeasles
Typhoid fever Typhoid fever
Progressively addedProgressively added
AFP, NTAFP, NT
AFR (measles and AFR (measles and rubella)rubella)
SARSSARS
HIVHIV
= “Epidemic” CDs= “Epidemic” CDs
PPHSN Priority CDsPPHSN Priority CDsSurveillance requirementsSurveillance requirements
For all (except HIV): For all (except HIV): Any suspected case should immediately be reported and Any suspected case should immediately be reported and investigatedinvestigatedImplementation of public health measures must be Implementation of public health measures must be immediately startedimmediately started
HIV:HIV:22ndnd generation HIV surveillance generation HIV surveillance
Pregnant womenPregnant women At-risk groupsAt-risk groups Behavioural surveillance (youth)Behavioural surveillance (youth)
All require:All require:Response team Response team Procedures: guidelines and protocolsProcedures: guidelines and protocolsSome PPHSN support Some PPHSN support
… … preparednesspreparedness
PPHSN Priority CDsPPHSN Priority CDsRegional information sharingRegional information sharing
EstablishedEstablishedPacNetPacNetInform’Action Inform’Action PPHSN website:PPHSN website: www.spc.int/phs/PPHSNwww.spc.int/phs/PPHSN
To be redeveloped:To be redeveloped:Regional CD databaseRegional CD database Background: SPEHISBackground: SPEHIS Existing routine dataExisting routine data Other information: scientific articlesOther information: scientific articles
First regional First regional EpiNet workshop EpiNet workshop Sep 2003Sep 2003
PPHSN Strategic Framework 2003-2006
PPHSN-CB 10, 2PPHSN-CB 10, 2ndnd regional EpiNet regional EpiNet workshop Jun 2004, workshop Jun 2004, EpiNet team EpiNet team consultationconsultation
General recommendations & Proposed PoA 2004-2006
GENERAL RECOMMENDATIONS AND PROPOSED PLAN OF ACTION 2ND REGIONAL EPINET WORKSHOP, 7TH -11TH JUNE 2004, SPC NOUMEA.
GENERAL RECOMMENDATIONS
1. To establish and maintain strong collaboration between human and animal health services both in country and at regional level.
2. To develop and strengthen capacity on influenza surveillance in PICTs to facilitate swift detection of an outbreak, and to undertake
responsibility of preparedness to influenza pandemic threat or occurrence.
3. To explore and develop feasible options for the assessment of the burden of influenza in PICTs.
4. To develop and strengthen laboratory capacities to facilitate efficient surveillance especially influenza virologic surveillance in PICTs.
5. To further develop and improve surveillance systems in the PICTs by optimising use of scarce resources for PPHSN expanded list of priority
diseases.
6. To undertake training in Epidemiology to facilitate the improvement in surveillance and response to communicable disease threats and events
in the Pacific Region.
7. To promote a good understanding of the new international health regulation (IHR) and related issues, and integrate IHR into the framework of
the PPHSN.
8. To review and improve on the infection control measures in PICTs by establishing and formalising the Pacific regional infection control
network under the umbrella of PPHSN.
9. To formalise and operationalise the Regional EpiNet team with its clear roles and functions, including funding implications, for endorsement
from Health Ministers' meeting in Samoa, 2005.
PROPOSED PLAN OF ACTION 2004-2006
General recommendations General recommendations 2004-20062004-2006
1. To establish and maintain strong collaboration between human and animal health services both in country and at regional level.2. To develop and strengthen capacity on influenza surveillance in PICTs to facilitate swift detection of an outbreak, and to undertake responsibility of preparedness to influenza pandemic threat or occurrence.3. To explore and develop feasible options for the assessment of the burden of influenza in PICTs.
General recommendations General recommendations 2004-2006 (2)2004-2006 (2)
4. To develop and strengthen laboratory capacities to facilitate efficient surveillance especially influenza virologic surveillance in PICTs.5. To further develop and improve surveillance systems
in the PICTs by optimising use of scarce resources for PPHSN expanded list of priority diseases.6. To undertake training in Epidemiology to facilitate the
improvement in surveillance and response to communicable disease threats and events in the Pacific Region.
General recommendations General recommendations 2004-2006 (3)2004-2006 (3)
7. To promote a good understanding of the new international health regulation (IHR) and related issues, and integrate IHR into the framework of the PPHSN. 8. To review and improve on the infection control measures in PICTs by establishing and formalising the Pacific regional infection control network under the umbrella of PPHSN.9. To formalise and operationalise the Regional EpiNet team with its clear roles and functions, including funding implications, for endorsement from Health Ministers' meeting in Samoa, 2005.
Samoa Commitment Samoa Commitment
Achieving Healthy IslandsAchieving Healthy IslandsRecommendations involving the PPHSNRecommendations involving the PPHSN
Samoa Commitment – Samoa Commitment – Recommendations (I)Recommendations (I)
The Regional EpiNet Team (RET) should be The Regional EpiNet Team (RET) should be established by creating a pool of experts and established by creating a pool of experts and professionals among the countries and territories professionals among the countries and territories in the Pacific in order to support national and in the Pacific in order to support national and territorial responses to outbreaks and to build territorial responses to outbreaks and to build capacity.capacity.The establishment of a regional outbreak and The establishment of a regional outbreak and emergency response fund should be explored.emergency response fund should be explored.PPHSN mechanisms should be utilized for IHR PPHSN mechanisms should be utilized for IHR Implementation such as notification, verification Implementation such as notification, verification and capacity strengthening wherever possible.and capacity strengthening wherever possible.
Samoa Commitment – Samoa Commitment – Recommendations (II)Recommendations (II)
The Strategic Framework of PPHSN should The Strategic Framework of PPHSN should include surveillance and response capacity include surveillance and response capacity assessment and development for the Pacific assessment and development for the Pacific Islands.Islands.Capacity building should be enhanced at the Capacity building should be enhanced at the peripheral level in the Pacific Islands for good peripheral level in the Pacific Islands for good surveillance and response.surveillance and response.The IHR focal point should be a member of the The IHR focal point should be a member of the national EpiNet team or an equivalent national EpiNet team or an equivalent communicable disease response team or communicable disease response team or taskforce at the national level, and where taskforce at the national level, and where possible that person should be the chair of the possible that person should be the chair of the team.team.
Samoa Commitment – Samoa Commitment – Recommendations (III)Recommendations (III)
PPHSN, incl. WHO, SPC and other partners, should continue PPHSN, incl. WHO, SPC and other partners, should continue to provide technical support to assist PICTs to develop and to provide technical support to assist PICTs to develop and implement national pandemic preparedness plans. implement national pandemic preparedness plans. At national level, development of national pandemic At national level, development of national pandemic preparedness plan led or coordinated by MoH: preparedness plan led or coordinated by MoH:
multisectoral task force. based on existing plans and mechanisms e.g.:
• involvement of the national disease preparedness group • linkage with the national disaster preparedness plan.
Community participation and mobilization.
PPHSN should expand its scope to include functions of PPHSN should expand its scope to include functions of noncommunicable disease surveillance as networked noncommunicable disease surveillance as networked surveillance and data pooling mechanisms.surveillance and data pooling mechanisms.
Samoa Commitment – Samoa Commitment – Recommendations (IV)Recommendations (IV)
Strengthen HIV and STI surveillance.Strengthen HIV and STI surveillance.Countries should join together through PPHSN in Countries should join together through PPHSN in a Pacific initiative to improve national capacities a Pacific initiative to improve national capacities to prevent and control epidemic dengue.to prevent and control epidemic dengue.Community-based vector control should be a key Community-based vector control should be a key component of all national dengue control component of all national dengue control programmes. programmes.
It is no longer sufficient to simply educate and provide It is no longer sufficient to simply educate and provide information about dengue; programmes should aim at information about dengue; programmes should aim at key behavioural changes that result in reduced dengue key behavioural changes that result in reduced dengue transmission.transmission.
Samoa Commitment – Samoa Commitment – Recommendations (V)Recommendations (V)
To sustain polio-free status, Pacific nations To sustain polio-free status, Pacific nations should ensure that key programme functions should ensure that key programme functions such as AFP surveillance and routine such as AFP surveillance and routine immunization coverage are maintained at the immunization coverage are maintained at the high levels required. Preparedness plans should high levels required. Preparedness plans should be available and coordinated by the EpiNet team be available and coordinated by the EpiNet team for response to the importation of wild poliovirus for response to the importation of wild poliovirus and circulating vaccine-derived poliovirus.and circulating vaccine-derived poliovirus.
Field achievementsField achievements
Various and multipleVarious and multiple
Depend on individual PPHSN members, Depend on individual PPHSN members, therefore difficult to list!therefore difficult to list!
AFP, NT & AF&R – HBASAFP, NT & AF&R – HBAS
Various support to PICTsVarious support to PICTs Outbreak investigationOutbreak investigation Surveillance developmentSurveillance development TrainingTraining … … PPHSN servicesPPHSN services
THANK YOU!!THANK YOU!!