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Overview of Public health emergency response under Department of Disease Control (DDC / MOPH)

Overview of Public health emergency response under Department of Disease Control (DDC / MOPH) . DDC / MOPH 14 August 2012. Outline . MOPH structure, highlighting offices involved in PHER PHE encountered in past decade Evolution of ICS over the past decade

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Overview of Public health emergency response under Department of Disease Control (DDC / MOPH)

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  1. Overview of Public health emergency response under Department of Disease Control (DDC / MOPH) DDC / MOPH 14 August 2012

  2. Outline • MOPH structure, highlighting offices involved in PHER • PHE encountered in past decade • Evolution of ICS over the past decade • Major lessons learned: building on existing capacities

  3. Multi-sector preparedness and response to disasters

  4. Ministryof PublicHealth Professional Councils Professional Councils Professional Councils NationalHealthBoard OfficeoftheMinister Permanent Secretary ClusterofMedicalServiceDevelopment DeputyPermanentSecretary ClusterofPublicHealthDevelopment DeputyPermanentSecretary ClusterofPublicHealthServiceSupport DeputyPermanentSecretary OfficeofthePerm. Secretary DepartmentofMedicalServices DepartmentofDiseaseControl DepartmentofHealthServiceSupport ProvincialAdministration DepartmentofThaiTraditionalandAlternativeMedicineDevelopment DepartmentofHealth DepartmentofMedicalSciences FoodandDrugAdministration DepartmentofMentalHealth StructureofMinistryofPublicHealth

  5. Departmentof DiseaseControl AdministrationDevelopmentSystemSection InternalAuditorSection Officeofthesecretary PersonnelDivision Finance Division PlanningDivision BamrasnaraduraInstitute (Infectious Hospital) RajprachasamasaiInstitute (Leprosy Hospital) Office of Disease Prevention and Control 1-12 Bureau of Epidemiology BureauofOccupationalandEnvironmentDiseases BureauofGeneralCommunicableDiseases Bureau of Vector-Borne Diseases BureauofNon-CommunicableDiseases BureauofAIDSandSTDs StructureofDepartmentofDiseaseControl Bureau of Emerging Infectious Diseases Bureau of Public Relations Bureau of TB control

  6. PHEs we are facing Outbreaks of infectious diseases Natural disasters Public Health Emergency (PHEs) Wars and violence Man-made disasters

  7. Major events encountered since 1962 • Super Typhoon Karen, Nov.-Dec. 1962; killed ~900 • Flood Southern, November 1963; killed 374 • Typhoon Gay Southern, November 1989; killed >600 • LPG Explosion, Bangkok, September 1989; Killed 81 • Doll Factory on fire, May 1993; killed 188 • Hotel Collapse, Korat, August 1993; killed 132 • SARS Dec. 03 – Jun. 2004; economic loss $ 4.5 bm. • Tsunami, December 2004; killed >5,400 • Avian Influenza 2004; Pandemic threat, etc.

  8. Top 10 Natural Disasters in Thailand:Numbers of people killed http://www.unisdr.org/eng/country-inform/thailand-disaster.htm

  9. Top 10 Natural Disasters in Thailand:Numbers of people affected http://www.unisdr.org/eng/country-inform/thailand-disaster.htm

  10. Anthrax mail hoaxes in Thailand (16 Oct 01 - 22 Feb 02) Anthrax tests on 217 suspected letters/ objects were all negative ! Public confidence in public security was finally restored.

  11. Nipah Virusencephalitis 1998-99

  12. Nipah inMalaysia, 1999 Social loss : 283 human cases 110 deaths Economic loss : Pig destruction (1.4 mil.) US$ 400 million

  13. SARS 2003 21 Aug 07

  14. 2003

  15. Stronghold of SARS control Surveillance, investigation and infection control in the hospital and the community

  16. 2006 2005 2004 2007

  17. Disibution of avian influenza in poultry and human cases, Thailand 2004-2007 2007 2006 2008 2004 2nd round 2005 2004 1st round Confirmed case Suspect case Poultry outbreak Total 25 cases/ 17 deaths during 2004-2007, Since Jan 2008: 2 confirmed poultry outbreaks, no human infection found. 22 May08

  18. 2004 Avian Flu epidemic

  19. Main partners in AI responses Foreign affairs Animal health authorities Education Wildlife Finance Commerce Public health authorities Labour Security Public Com. Education Other

  20. 2004 Botulism outbreak response Botulism Outbreak (163 cases) from Canned Bamboo shoot, Nan, 2006

  21. 26thDecember2004TSUNAMIin Thailand8,457 injured 5,388 died 3,120 missed

  22. Case study: Pandemic influenza • Prevention (mitigation) • Risk assess. & capability analysis • Prevention measures Preparedness • Planning & coordination • Simulation exercises • Control • Animal outbreaks • Human infections • Recovery Warning of the birds National Strategic Plan on AI & PI Preparedness and Response (2005 – 2010) Goals: • Build sustainable capacity for the preparedness and response to pandemics and other public health emergencies • Mitigate impact from avian and pandemic influenza

  23. Case study: Pandemic influenza The Cabinet National Committee on AI & PIP Public sector Semi-gov. & Private Functional drills 76 Table-top exercise Provincial Committees on AI & PIP Public sector Semi-gov. & Private Central level Provincial level Service center level • National Strategic Plan providing framework for multi-sectors corporate / agency planning and budgeting • Multi-sector simulation exercises carried out in all provinces. • BCP introduced and adopted in many commercial business settings and in essential service sector. • Prevention (mitigation) • Risk assess. & capability analysis • Prevention measures Preparedness • Planning & coordination • Simulation exercises • Control • Animal outbreaks • Human infections • Recovery

  24. Case study: Pandemic influenza • Prevention (mitigation) • Risk assess. & capability analysis • Prevention measures Preparedness • Planning & coordination • Simulation exercises • Control • Animal outbreaks • Human infections • Recovery Capacities built • Hospital capacities of public hospitals and many private hospitals have been escalated to manage influx of patients with acute respiratory infection. • Hospital infection control has been strengthened in all public hospitals. • Standard guidelines / training on case management • Periodic simulation exercises

  25. Capacities built Stockpiling National stockpiles of antiviral drugs and PPE have been established and expanded. Production of drug & vaccine Oseltamivir production by GPO, from imported API R&D of pandemic influenza vaccine under WHO support Influenza vaccine production approved by the government, now under construction Case study: Pandemic influenza • Prevention (mitigation) • Risk assess. & capability analysis • Prevention measures Preparedness • Planning & coordination • Simulation exercises • Control • Animal outbreaks • Human infections • Recovery

  26. Case study: Pandemic influenza • Prevention (mitigation) • Risk assess. & capability analysis • Prevention measures Preparedness • Planning & coordination • Simulation exercises • Control • Animal outbreaks • Human infections • Recovery Capacities built • Risk communication network was established to support public communication through media. • Community-based communication supported by health volunteers, community leaders and local NGOs. • Business continuity planning (BCP) for pandemic preparedness and simulation exercises have been introduced in public and private sectors.

  27. Case study: Pandemic influenza • Prevention (mitigation) • Risk assess. & capability analysis • Prevention measures Preparedness • Planning & coordination • Simulation exercises • Control • Animal outbreaks • Human infections • Recovery The whole world sharing pandemic risk

  28. Case study: Pandemic influenza H1N1 2009 cases H1N1 2009 deaths Reported influenza Number of deaths Number of cases 2009 2010 Week of on set • Prevention (mitigation) • Risk assess. & capability analysis • Prevention measures Preparedness • Planning & coordination • Simulation exercises • Control • Animal outbreaks • Human infections • Recovery 1 3 2 Source: Bureau of Epidemiology, MOPH

  29. Case study: Pandemic influenza Ventilation support AV treatment 1 3 Isolation room Response strategies 2 Staying home when ill Screening at OPD Use of face mask Hand hygiene Fever clinic 1 Dec 2010 • Prevention (mitigation) • Risk assess. & capability analysis • Prevention measures Preparedness • Planning & coordination • Simulation exercises • Control • Animal outbreaks • Human infections • Recovery Source: Bureau of Epidemiology, MOPH

  30. Case study: Pandemic influenza • Prevention (mitigation) • Risk assess. & capability analysis • Prevention measures Preparedness • Planning & coordination • Simulation exercises • Control • Animal outbreaks • Human infections • Recovery Pandemic impact (2009-10) 36,927 cases reported 225 deaths reported Economic loss - huge? Socio-political impact – profound? Could have been much worse without the preparedness Source: Bureau of Epidemiology, MOPH

  31. PHE management cycle Impact Post- impact Pre- impact

  32. Incident command system at the central and local levels ICS Central level ICS local level First responder Team First responder Team First responder Team First responder Team The Incident

  33. Surveillance and rapid response teams : the first responders in disease control SRRT

  34. Roles of Surveillance and Rapid Response Team (SRRT) • Surveillance of severe, rapidly spread infectious disease. • Detection of public health emergency • Rapid & effective outbreak investigation • Outbreak control • Report and surveillance data exchange 0ver 1,000 SRRTs at central, regional, provincial and district levels

  35. Organization of DDC’s incident command system (ICS) Incident commander Coordinator PR Note taker Tech. Officer Organization Logistics Unit Operation Unit Planning & Intelligence Unit Budget & Admin. Unit Public Relations Unit Events Atomic Biological Chemical Disaster

  36. Call center Clinical team Bamras Adjustment of DDC’s ICS in 2011 flood response Surveillance team BOE / FETP ICC DDG D-BOE D-PRO D-GCD D-BEID D-NCD D-VBD PHER (sec) Logistics & operation support team BGCD Risk Com team B-PR SAG Senior staff

  37. WHO / IHR MOPH’s ICC PSO Call center MOPH Call center MOPH’s clinical WG DMS Clinical team Bamras Adjustment of DDC’s ICS in 2011 flood response MOF, Embassies TUC / CDC Surveillance team BOE / FETP ? Laboratory team DMSc ICC DDG D-BOE D-PRO D-GCD D-BEID D-NCD D-VBD PHER (sec) Logistics & operation support team BGCD Risk Com team B-PR MOPH’s risk com team SAG Senior staff Expert committee

  38. Boxes MOPH budget MOPH budget MOPH budget JICS GPO-A-Flu GPO-A-Flu Tamiflu Tamiflu Stockpiling and logistics for Pandemic (H1N1) 2009 : Oseltamivir

  39. Stockpiling and logistics for Pandemic (H1N1) 2009 : PPE • Central stockpiles: 2 sites • DDC, MOPH, Nonthaburi • KDC Co. Ltd., Chachoengsao

  40. Emergency and Risk Communication (ERC)

  41. ? Building on existing strengths.

  42. Put to test in pandemic H1N1 2009 response Improved flu surveillance 2005-2009 under pandemic influenza preparedness . AI surveillance 2004-2008 ARI + history of exposure to sick or dead birds / contact with pneumonia pt. + lab. SARS surveillance 2003 pneumonia + history of travel to affected areas / contact with pneumonia pt. Syndromic approach, Improved reporting coverage Lab. tests, SRRT, improved coverage, PH-AH cooperation SRRT, ILI & severe pneumonia.surveill., sentinel provinces SRRT, lab.test estimated baseline flu burden Surveillance capacity Flu & pneumonia surveillance Under routine disease reporting (506 report) countrywide.

  43. Evolution of EID preparedness & response

  44. Evolution of EID preparedness & response

  45. Evolution of EID preparedness & response Dengue, bioterorism, chemical accident, any PHE

  46. Observed strength of response to disaster among MOPH departments

  47. Capacity building need • Policy & strategy • Management • Model & guideline • Communicationskill • Training & information exchange

  48. Collaboration

  49. Thank you

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