Using the Modified Haddon Using the Modified Haddon Matrix to Deal with Infectious Matrix to Deal with Infectious

Disease Outbreaks Disease Outbreaks

Kai-Lit Phua, PhD FLMIKai-Lit Phua, PhD FLMIAssociate Professor Associate Professor

Medicine & Health Sciences Medicine & Health Sciences Monash University (Sunway Monash University (Sunway

Campus) Campus)

Biographical detailsBiographical details Kai-Lit Phua received his BA (cum laude) in Public Kai-Lit Phua received his BA (cum laude) in Public

Health & Population Studies from the University of Health & Population Studies from the University of Rochester and his PhD in Sociology (medical Rochester and his PhD in Sociology (medical sociology) from Johns Hopkins University. He also sociology) from Johns Hopkins University. He also holds professional qualifications from the insurance holds professional qualifications from the insurance industry.industry.

Prior to joining academia, he worked as a research Prior to joining academia, he worked as a research

statistician for the Maryland Department of Health statistician for the Maryland Department of Health and Mental Hygiene and as an Assistant Manager and Mental Hygiene and as an Assistant Manager for the Managed Care Department of a leading for the Managed Care Department of a leading insurance company in Singapore. He was awarded insurance company in Singapore. He was awarded an Asian Public Intellectual Senior Fellowship by the an Asian Public Intellectual Senior Fellowship by the Nippon Foundation in 2003.Nippon Foundation in 2003.

Lecture Objectives Lecture Objectives

Brief overview of the Haddon MatrixBrief overview of the Haddon MatrixThe Haddon Matrix as a useful tool in The Haddon Matrix as a useful tool in

the analysis and control of disease the analysis and control of disease outbreaksoutbreaks

Example of the use of the Haddon Example of the use of the Haddon MatrixMatrix

The Haddon Matrix The Haddon Matrix

William H. Haddon, Jr., came up with a William H. Haddon, Jr., came up with a Matrix to systematically analyze car Matrix to systematically analyze car crashes crashes

The aim was to derive effective injury The aim was to derive effective injury prevention and control strategies prevention and control strategies

The original Matrix was a 3 X 3 tableThe original Matrix was a 3 X 3 table It was later expanded to a 3 X 4 table It was later expanded to a 3 X 4 table

Haddon MatrixHaddon Matrix

AgentAgent HostHost PhysicalPhysical

EnvironmeEnvironmentnt

Social Social EnvironmeEnvironme

ntnt

Pre-eventPre-event

During the During the eventevent

Post-eventPost-event

Using the Haddon Matrix Using the Haddon Matrix (based on Cassens 1992) (based on Cassens 1992)

Agent Agent

e.g. e.g.

carcar

HostHost

e.g. e.g.

driverdriver

PhysicalPhysical

EnvironmeEnvironmentnt

Social Social EnvironmeEnvironme

ntnt

Before theBefore the

event event (crash)(crash)

Good Good brakes, car brakes, car properly properly maintained maintained

Good Good vision, vision,

alert alert

Well-Well-designed designed roads and roads and highwayshighways

Penalize Penalize drunk drunk driving driving heavilyheavily

During the During the eventevent

Airbags, Airbags, anti-lock anti-lock brakes brakes

Motorcycle Motorcycle helmet, helmet, seatbeltseatbelt

Non-rigidNon-rigid

roadside roadside poles, poles, crash crash barriersbarriers

Mandate Mandate the use of the use of safety safety glass in glass in windowswindows

After the After the eventevent

Burn-Burn-resistant resistant fabrics in fabrics in car cabincar cabin

Emergency Emergency medical medical carecare

Effective Effective emergency emergency transport transport systemsystem

Support Support medical medical and and rehabilitatirehabilitation serviceson services

Successful Use of the Successful Use of the Haddon Matrix in Injury Haddon Matrix in Injury

ControlControl

The Haddon Matrix was successfully The Haddon Matrix was successfully used in the control of car crash injuries. used in the control of car crash injuries. It was later used to control other It was later used to control other injuries too. injuries too.

Can the Haddon Matrix Be Can the Haddon Matrix Be Used for Infectious Disease Used for Infectious Disease

Control?Control?The Haddon Matrix forces us to think The Haddon Matrix forces us to think systematically about the particular systematically about the particular health problem we are dealing withhealth problem we are dealing with

Dan Burnett proposed that the Dan Burnett proposed that the Haddon Matrix be used against SARSHaddon Matrix be used against SARS

Phua modified and expanded the Phua modified and expanded the Haddon Matrix and proposed its use Haddon Matrix and proposed its use against Nipah virus. (He also against Nipah virus. (He also proposed its use against natural proposed its use against natural disasters such as tsunamis).disasters such as tsunamis).

Phua’s “Modified Haddon Matrix” to Study Infectious Disease Outbreaks & Natural Disasters

Agent Intermediate host

“Host”(I)Affected individual(II)Individual’s family(III)Affected community(IV)The larger society

Environment

Factors leading to the event (before the event)

Factors affecting severity, rate of spread, and extent of impact (during the event)

Reactions to the event (during the event)

Short-term and long-term effects (after the event)

Using the “Modified Haddon Matrix” to Analyze Avian Influenza : Action to be Taken Against Factors Identified Below

Agent Intermediate host “Host”(I)Affected individual(II) Family members(III)Affected community(IV) Larger society

Environment

Factors leading to the event (before the event)

Agent can Agent can cause disease cause disease in humans in humans

Avian influenza virus Avian influenza virus present in wild, migratory present in wild, migratory birdsbirds

(I) Close contact with & (I) Close contact with & eating of sick birdseating of sick birds

(III) Raising chickens is (III) Raising chickens is important economic important economic activityactivity

Close proximity of Close proximity of people & birds e.g. people & birds e.g. rearing backyard rearing backyard chickens chickens

Factors affecting severity, rate of spread, and extent of impact (during the event)

Agent does Agent does not spread not spread easily easily between between humanshumans

Can spread from wild to Can spread from wild to domestic birds; wild bird domestic birds; wild bird migration patterns in migration patterns in Europe and AsiaEurope and Asia

(I) Mobility of infected (I) Mobility of infected individualindividual

(II) Close contact(II) Close contact

(III) Community (III) Community dependent on raising dependent on raising chickenschickens

(IV) Chicken exports to (IV) Chicken exports to foreign countriesforeign countries

Sale and smuggling Sale and smuggling of infected birds is of infected birds is not stopped quicklynot stopped quickly

Reactions to the event (during the event)

(III) Fear (IV) Mass (III) Fear (IV) Mass culling; active culling; active monitoring by WHO & monitoring by WHO & Ministry of HealthMinistry of Health

Tourist arrivals Tourist arrivals affectedaffected

Short-term and long-term effects (after the event)

Evidence that H5N1 can Evidence that H5N1 can also affect non-human also affect non-human animalsanimals

(I) High mortality (I) High mortality

(II) Deaths affect family (II) Deaths affect family membersmembers

(III) & (IV) Economic (III) & (IV) Economic losseslosses

Boon for drug Boon for drug companies; fear of companies; fear of more virulent more virulent strains appearingstrains appearing

References References

Burnett DJ et al. The Application of the Haddon Matrix to Burnett DJ et al. The Application of the Haddon Matrix to Public Health Readiness and Response Training. Environ Public Health Readiness and Response Training. Environ Health Perspect. 2005; 113(5): 561-66Health Perspect. 2005; 113(5): 561-66

Cassens BJ. Preventive Medicine and Public Health. 2Cassens BJ. Preventive Medicine and Public Health. 2ndnd ed. ed. 1992. Philadelphia: Harwal Publishing.1992. Philadelphia: Harwal Publishing.

Haddon W. On the Escape of Tigers: An Ecologic Note. Am J Haddon W. On the Escape of Tigers: An Ecologic Note. Am J Pub Health. 1970; 60: 2229-34.Pub Health. 1970; 60: 2229-34.

Haddon W. Options for the Prevention of Motor Vehicle Crash Haddon W. Options for the Prevention of Motor Vehicle Crash Injury. Isr Med J. 1980; 16: 45-65.Injury. Isr Med J. 1980; 16: 45-65.

Phua KL, Lee LK. Meeting the Challenge of Epidemic Disease Phua KL, Lee LK. Meeting the Challenge of Epidemic Disease Outbreaks: An Agenda for Research. J of Pub Health Policy. Outbreaks: An Agenda for Research. J of Pub Health Policy. 2005; 26(1): 122-32. 2005; 26(1): 122-32.

Phua KL. A Model for Lessening the Impact of Natural Phua KL. A Model for Lessening the Impact of Natural Disasters and Infectious Disease Outbreaks. J of Emergency Disasters and Infectious Disease Outbreaks. J of Emergency Management. 2006; 4(5): 69-74.Management. 2006; 4(5): 69-74.

Phua KL. Post-Disaster Victimization: How Survivors of Phua KL. Post-Disaster Victimization: How Survivors of Disasters Can Continue to Suffer After the Event is Over. New Disasters Can Continue to Suffer After the Event is Over. New Solutions. 2008; 18(2): 221-31.Solutions. 2008; 18(2): 221-31.

Thank YouThank You