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My brief

Lessons from abroad - What can be learnt from outbreak investigations in other countries? Donald Campbell Principal Advisor (Public Health). My brief. Review sentinel international outbreaks. Consider recommendations and implications for New Zealand

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My brief

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  1. Lessons from abroad - What can be learnt from outbreak investigations in other countries?Donald CampbellPrincipal Advisor (Public Health)

  2. My brief • Review sentinel international outbreaks. • Consider recommendations and implications for New Zealand • Identify key areas for further development in New Zealand surveillance, investigation and control of VTEC

  3. Lessons from abroad - What can be learnt from outbreak inquiries in other countries?Donald CampbellPrincipal Advisor (Public Health)

  4. Types of Inquiries • Coroners / Fatal Accident • Outbreak Control Team • Administrative • Outbreak • Public Health • Public

  5. Areas Considered • Time and place of death • The cause of death • Any precautions that may have avoided death • Any defects in the system that may have avoided death • Any other relevant considerations

  6. Major Inquiries Central Scotland 1996 (512 / 22) Walkerton 2000 (1346 / 6) (South Wales) 2005 (157 / 1)

  7. No Inquiries Oregon 1982 (25) (South Australia 1995 (23)) Japan 1997 (12,000 / 3) USA 2006 (205 / 3)

  8. Central Scotland • Pennington Report • A relatively simple breakdown in hygiene can have serious public health consequences • The importance of a HACCP approach • Training of food handlers • Effective enforcement

  9. Walkerton • O’Connor Inquiry • Monitors at Well 5 • Guidelines and Directives not followed • Approvals and inspections programme failures • PUC commissioners not aware of operators practices • Concealment of monitoring results • Insufficient dissemination of water advisory • Laboratory provision issues

  10. South Wales • Inquiries still ongoing • Outbreak Control report • Review commissioned by CMO • Pennington

  11. Farms and Livestock • Farm workers • Education/awareness • Slurry • Abattoirs • GHP • High risk premises • Enforcement

  12. Meat production and Butchers • HACCP • Regulation clarity • Separation of raw and cooked (? Staff)

  13. Point of consumption • Schools • Retail • Vulnerable groups

  14. Enforcement • Policy • Staff • Funding • Designation

  15. Surveillance • Stool testing • Primary care • Laboratories • Case definition • Outbreak reporting • Minimum data set • Publishing

  16. Research • Standard approval but appropriate weight on threat to public health

  17. Outbreak management • Personnel • MOsH • HPOs/EHOs • Laboratories • Central • Time • Skills

  18. Communication • Lead • Public • Interagency • Commentators • “Tell it all, tell it straight”

  19. Collaboration “Our communication was very good and we had a very strong team approach” “…they just send us out to do the inspection and don’t keep us informed …”

  20. Public Health • Medical Officers of Health • Auditing of PHUs • Clarity of roles • Liaison meetings • Information sharing • Response protocols

  21. Sounds familiar ? Users • “It’s a pain to weed through all the irrelevant lessons to get to the few ‘jewels’” • “We seem to learn some lessons over and over again” Managers • “Despite the processes and procedures in place to capture and share lessons learned, I see no evidence that lessons are being applied towards future success” Raytheon

  22. Risk Factor Identification: What is the cause? Surveillance: What is the problem? Public Health Approach Implementation: How do you do it? Intervention Evaluation: What works? Problem Response

  23. A plea Good surveillance does not necessarily ensure the making of right decisions but it reduces the chances of making wrong ones Alexander D Langmuir

  24. DALYs Disability Adjusted Life Years DALY = YLL +YLD • Campylobacteriosis 1554 • Norovirus infection 536 • Listeriosis 255 • Salmonellosis 186 • E coli O157 infection 91

  25. Questions • Priority • Would we recognise an outbreak? • Could we respond? • How quickly would we find cause? • How quickly could we implement control measures? • Communication • Public confidence • Public Inquiry!

  26. Final thought There’s a lot of it out there

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