Enhancing Field Epidemiology Workforce in Thailand for Disease Control

1. Thailand’sField Epidemiology Workforce development

2. Outline “Burden of disease” in Thailand DDC Vision and mandate for disease prevention & control Current “Field Epi” training programs in Thailand by MoPH Co-ordination between clinicians and field epidemiologist Importance of “Field Epi” concepts for clinicians

3. Double burden of Disease ““Noncommunicable diseases are imposing a growing burden upon low- and middle-income countries, which have limited resources and are still struggling to meet the challenges of existing problems with infectious diseases,” said Dr Catherine Le Galès-Camus, Assistant Director General at WHO’s department of Noncommunicable Diseases and Mental Health.” Developing countries face double burden of disease. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622909/pdf/15500291.pdf

4. “Injury” Double burden of disease in Thailand Ischemic Heart Disease • General CDs • Pneumonia • Diarrhea • Dengue “Existing problems of infectious diseases” “Env/Occ” “NCDs” Stroke • Re-emerging diseases • Diphtheria • Pertussis • Measles Mental Health • Chronic infection • HIV/AIDS • TB Chronic lung diseases • Emerging diseases • MERS • Ebola • Yellow fever • MDRs Cancer

5. Role under the IHR, GHSA and ASEAN+3 FETN

6. GHSA Action Package & ASEAN+3 FETN

7. DDC 20 years milestone

8. Thailand’s Strategies for Field Epidemiology Workforce Development 4. Networking & Support 2. Training Quality Ultimate Goal Sufficient workforce and strong network for disease surveillance, prevention and control as well as public health emergency response 3. Retention of mentors 1. Active recruitment

9. “Field Epidemiology” Defining Field Epidemiology Richard A. Goodman, James W. Buehler, and Joshua A. Mott https://www.cdc.gov/eis/field-epi-manual/chapters/Defining-Field-Epi.html The application of epidemiology under the following general conditions: • The timing of the problem is unexpected. • A timely response is demanded. • Public health epidemiologists must travel to and work in the field to solve the problem. • The extent of the investigation is likely to be limited because of the imperative for timely intervention and by other situational constraints on study designs or methods.

10. Current Field Epidemiology Training Courses by MoPH in Thailand FETP 2-yr full-time on-the-job Advance Full-time on-the-job FETH FEMT Part-time 2 assignments Intermediate SRRT/CDCU 3-5 day classroom Basic บุคลากรสาธารณสุขในหลักการ One Health

11. Problems from the field Clinicians did not aware of their role in public health Co-ordination between clinician, field epidemiologist and others Working as a team at community level

12. Co-ordination between clinicians and field epidemiologist The Roles of Clinicians in Notifiable Disease Reporting Detection of suspected cases of notifiable diseases Immediate reporting of detected cases Provide support to designated surveillance officers during case investigation Case management using the recommended treatment protocol especially as specified in the national technical guideline Isere EE, Fatiregun AA, Ajayi IO. An overview of disease surveillance and notification system in Nigeria and the roles of clinicians in disease outbreak prevention and control. Niger Med J. 2015;56(3):161–168. doi:10.4103/0300-1652.160347

13. IHR core capacities for surveillance and response Current trainings by MoPH mainly involve local epidemiologists/public health officers, butfew physicians. Bulletin of the World Health Organization | March 2008, 86 (3)

14. Clinicians as outbreak detectors http://www.boe.moph.go.th/Annual/AESR2015/aesr2558/WESR_2558%20CD/wk58_07%20%20Klebsiella%20บึงกาฬ.pdf

15. Summary FieldEpidemiologists are essential for outbreaks and health threats detection and response. Clinicians need to recognize their important role in public health, especially detection and report of diseases under surveillance. Collaboration/Co-ordination between clinicians and field epidemiologists would help strengthen public health network for disease prevention and control.

16. Thank you for your attention

17. Co-ordination between clinicians and field epidemiologist “The success of measles surveillance is largely dependent on the proper and timely collection of clinical data and samples by clinicians and public health professionals upon initial contact with a patient suspected of having measles.” Paediatr Child Health Vol 4 No 1 January/February 1999

18. Co-ordination between clinicians and field epidemiologist Delayed reporting vs Early reporting Impact of delayed reporting of infectious diseases by clinicians on disease outbreak control and prevention Impact of early reporting of infectious diseases by clinicians on disease outbreak control and prevention Isere EE, Fatiregun AA, Ajayi IO. An overview of disease surveillance and notification system in Nigeria and the roles of clinicians in disease outbreak prevention and control. Niger Med J. 2015;56(3):161–168. doi:10.4103/0300-1652.160347

19. However, Gaps still remain..

20. Numbers of outbreaks* in Thailand, 2018 The Top 10 events in 2018 1,147 events *Outbreaks = Events recorded by 13 ODPCs in Event-based surveillance system, DDC, MoPH