WHO/USAID/GOARN Framework - PowerPoint Presentation

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WHO/USAID/GOARN Framework

for Preparedness and Response to a

Public Health Event of Initially Unknown Etiology

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Welcome back

https://www.youtube.com/watch?v=gJ9ybOumITg

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Return to work being able to

Use WHO decision criteria to determine whether or not a suspect case is a PHE of concern

Adopt a One Health approach to preparing and responding to PHEs of initially unknown etiology

Identify roles and responsibilities at the country-level of the Emergency Management Committee (EMC) and Rapid Response Teams (RRT)

Differentiate steps and or activities in preparing and responding to a public health event (PHE) of initially unknown etiology with steps for a known etiology.

Apply the three phases of the PHE framework -- preparedness, response, and monitoring and evaluation -- to a simulation of an outbreak of initially unknown etiology in Western Africa.

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Agenda

Day Three

Day

Two

Day Three

Morning

Experience Circle

EMCs

and RRTsSimulationAfternoonPreparing and Responding to a PHE of Unknown EtiologyMonitoring and Responding to a PHEof Unknown EtiologyDebriefing the SimulationReflections, Applications and Planning

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Experience circle

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Experience circle

Share a PHE in which you participated or were impacted by

What was done well and the outcomes

What were the challenges and the impact of these challenges

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Experience circle

What do you see as common themes that can lead to success?

Or lead to failure?

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Responding to a PHE requires

A One Health approach

Planning and preparation

Coordination and management

Good communication

Culturally sensitive approaches

Inclusion of local leaders

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Known versus unknown

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Public Health Event



Results in serious illness



Has the capacity to spread



Require a coordinated response

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CAUSE

Etiology means

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Unknown etiology means

we do not know the cause

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Steps in responding to a PHE

Disease

Surveillance

Case Definition

Reporting

Rapid Response Team

Field Investigation

Isolation and Infection Prevention

Contact Tracing

Diagnosis

Case Management

Communication

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With an unknown etiology

We do not have a

Case Definition

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With an unknown etiology we need to:

Develop a case definition

Determine the mode of transmission and source of the illness

Need to determine if illness is associated with high mortality, or a high rate of hospitalization

Make decisions about the need for isolation, contact tracing, level of personal protection, and other infection control measures

Determine if the PHE should be reported to WHO as a Public Health Emergency of International Concern (PHEIC).

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Break

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The way you stop an outbreak

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Remember, a case definition

Purpose is to locate other cases that may be related

Should include person, place, time, and clinical featuresStarts broad and narrows as you collect more data

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A 40 year old farmer presented to the health post with complaints of a high fever for 3 days and mental confusion. His wife provided most of the history. Also reported was an itchy rash on his ears and thumbs, loss of appetite, and blue urine. He appeared to be seriously ill, and his blood pressure was very low despite the fact that he reported no vomiting or diarrhea and did not appear dehydrated. Blood specimens were drawn but no results are available yet. He has most recently been harvesting produce and in the past two weeks has only left his farm to bring goods to market. All family members and other farm workers are healthy. The only unusual contact with animals has been a couple of tick bites and migratory birds that stopped at the pond on his farm for a few days last week.

Case Definition #1

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Three cases have presented to a health facility in District A and two more in District B.

District A

Case #1: A 1 year old girl developed sudden onset of severe vomiting and watery diarrhea 5 days ago and was hospitalized. She had a fever that has ended, no cough, no rash and no other symptoms. She improved after 2 days of re-hydration and will be going home soon. Two other family members are sick.

Case #2: A 45 year old man was admitted to the same hospital the next day with similar symptoms. It turns out he is the father of Case #1. He became ill one day after his son.

Case #3: The 10 year old brother of Case #1. He became ill at the same time as his brother, but had only mild fever, diarrhea and vomiting that stopped within hours. He feels well now.

District B

Case #4: An 8 year old girl with sudden onset of severe vomiting and watery diarrhea that began last night. She has a fever, no cough, no rash and no other symptoms. One other family member sick.

Case #5: Older sister of Case#4, similar symptoms that began at the same timeCase Definition #2

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Within the past month, there were 2 outbreaks with high mortality in 2 intensive poultry farms, one in East and the other West Africa.

Two weeks ago another country reported a poultry die off in a government farm. The farm supplies live birds to traders and poultry meat that is transported across the country. The initial investigation found no human cases. However, yesterday a poultry worker was hospitalized with signs of acute, severe respiratory distress but recovers.

The affected birds died suddenly with showing gross pathological signs. Birds that did not die showed ruffled feathers, stop drinking or eating, were very lethargic and many died in 24 hours of initial symptoms were present. There was blood in the stools but no apparent hemorrhage or ecchymosis on the surface of the body.

The humans affected showed high fever, cough and other respiratory symptoms, requiring immediate hospital admission or severe pneumonia would occur, often fatal.

Case Definition #3

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In a major PHE

Every minute lost is critical

AND

You need to be mindful of how you use resources…you might need them later

Every new case

is a potential outbreak

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EMCs & RRTs

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EMCs and RRTs

What kinds of teams do you need to respond to a PHE?

What are the roles and responsibilities of each team?Who should be on the team?

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EMC is responsible for

National Epidemic and PHE preparedness and response plans

Crisis communication plans

RRT rosters and deployment

Financial resources to support response activities, including RRT personnel, equipment and supplies

Assist ministries with risk mapping, disease surveillance, and establishing priorities

Conduct simulations, regular training or continuing education, and routine after action reviews to understand challenges and discuss lessons learned

Revise plans as needed based on after action reviews

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An EMC

Finance

Disaster Management

National Laboratories

Communications

Trade and Commerce

Logistics

Police and Civil Defense

International Donors Humanitarian Agencies Public SectorAdditional members might include:

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RRT



Team

Is not a team

It is roster

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What skills do you need to:

Upon receiving report of an unusual PHE, initiate a multisectoral discussion among Ministries to communicate and share initial information, observations

Verify the report of a possible outbreak

Communicate with and inform responsible province and district officials who can assist RRTs, provide introductions to local leaders, health professionals (human, animal & environmental), non-governmental groups and the private sector

Through interviews with clinicians, cases, families -- characterize illness and provide descriptive epidemiology

Protect people—staff, contacts, general population

Implement immediate containment activities

Conduct active case-finding together with community leaders and volunteers

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What skills do you need to:

Identify and follow-up contacts to identify possible illness

Safely and properly collect specimens for laboratory confirmation

Investigate source of infection or reservoir (look for human, animal or environmental sources)

Complete, concise report of activities and findings to higher authorities

Request additional assistance and support as needed

Communicate with community leaders and members to restore trust, minimize panic, and engage them in active disease control activities

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There have been several confirmed cases of highly pathogenic avian influenza (HPAI) in poultry and humans in various regions of the world, mainly in Asia (where most of the cases were confirmed) and a few in Africa and Europe.

The mortality rate in humans is around 40%. Although at this time transmission is limited to animal to human transmission, there has been one case of a family member who cared for a sick relative where human to human transmission is suspected to have occurred, but not confirmed.

Migratory season has started and many wild bird species have migrated to Africa. Within the past month, there were 2 confirmed cases of HPAI in 2 intensive poultry farms, one in East and the other West Africa. The cases have been controlled as per the methods adopted in the country and endorsed by international bodies and no further cases were suspected. Economic losses were tremendous, mainly for the poor communities affected by the disease, directly due to poultry die off or indirectly due to trade restrictions. Two weeks ago another country reported a poultry die off in a government farm. The farm supplies live birds to traders and poultry meat that is transported across the country. The initial investigation found no human cases. However, yesterday a poultry worker from the impacted farm was hospitalized with signs of acute, severe respiratory distress.

As a group, answer the following questions:

How would you select a RRT to address this issue?

Who should be on the RRT?

What role you think the EMC should play?

Who would you think should be involved in the coordinated response?Poultry Die Off

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The capital city of Abuongo is served by a major international airport. The discovery of vast natural resources in the northern district has resulted in a large numbers of people arriving from Southeast Asia and Europe. The mining area is along a border with another country, and about 6 hours by bus from the capital. The city has sections of high-end hotels and restaurants to serve the tourist trade and well off residents, but is largely a composed of sprawling informal settlements, without adequate infrastructure.

Three days ago, a miner from the northern district arrived at the main hospital in the city. He had been well until the day before when he suddenly developed a high fever and cough. He had been clearing a section of the land, and discovered a large quantity of dead chickens. No one seemed to know anything about them, so he incinerated them and continued to clear the land. When he got sick, he immediately took a bus to the city because he had heard a rumor that there was a case of Ebola in the area.

As a group, answer the following questions:

How would you select a RRT to address this issue?

Who should be on the RRT?

What role you think the EMC should play?

Who would you think should be involved in the coordinated response?

Outbreak at a Center

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The government of Abuongo is well aware of the risk of lead (Pb) toxicity, due to this toxic, heavy metal contaminating the environment in areas involved in processing ore for gold. Lead toxicity was highly publicized during gold mining in an area of Nigeria during 2010, and the outbreak resulted in the deaths of hundreds of children. Lead (Pb) is toxic in very low concentrations, and can cause kidney failure, severe anemia, seizures, coma and death; children are the group most severely affected. Experts from WHO, Nigerian technical experts who worked on the crisis there, and other international experts have been meeting with the government for months, and have mitigation plans in place. Word has come from the district that clean up and disposal is lagging behind production at this time and large landfills of contaminated soil and ore are accumulating. Of particular concern is the heavy rainfall the area has been experiencing in recent weeks, which is causing Pb contamination of wells and other water sources for humans and animals. The national disease surveillance system has identified a cluster of cases of possible Pb-related seizures and coma in the area among children that concerns local officials. The EMC is concerned about the health risks to the population and wants to investigate.

As a group, answer the following questions:

How would you select a RRT to address this issue?

Who should be on the RRT?

What role you think the EMC should play?

Who would you think should be involved in the coordinated response?

Lead (Pb) Toxicity

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Lunch

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Using the framework

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Preparedness & Response

Study your assigned section in the framework

Summarize key steps and activities

Create recommendations for broadening the framework to take a One Health approach

Prepare a 30 minutes lesson

P

hase II: Respond

Pages 18 - 29

Group 2

Group 1

P

hase I: Preparedness

Pages 14 - 17

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Reflections and applications

Which activities in preparing and responding to a PHE do you need to gain proficiency?

How can you developing the skills knowledge you need to gain proficiency?

How might you use the PHE framework when preparing and responding to a PHE of unknown etiology?

What support do you need to be able to use the framework?

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Monitoring and evaluation

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Below is a table that visually links the terms inputs, activities, outputs, outcomes and impacts.

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Monitoring and evaluation is

The systematic collection, analysis and interpretation of data on preparedness and response activities

Used as a basis to plan, implement and improve your public health strategy

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Monitoring in the framework focuses on

Routine and continuous tracking of EMC and RRT preparedness and response capacities

Efficiency and effective of response action including

Alert management

Field investigation

Field response

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Monitoring checks for compliance

What services were delivered?

What population was served and what numbers were served?

What staffing and resources were used?

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Evaluation asks how are we doing

How well are the EMCs and RRTs doing in…

modifying high risk behaviors?reducing population’s exposure to the causal agent?

providing early, optimal clinical care for those infected?

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Differences

Monitoring

Evaluation

Frequency

Continuous

Episodic

Objective

Describing

Explaining

Method

Follows trends, compares actual performance with expected

Compares achievements with counterfactual

Performed by

Mostly internal

Internal and External

Uses

Alerts when to take action

Provides detailed information on what types of actions to take

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Indicators

The key to monitoring and evaluation

Measurable - whole numbers, ratios, percentages

Valid - accuracy of measurement

Reliable - consistency of measurement

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Two types of indicators

Process - measure program and activity performance

Number of times

the EMC meet each

year?

Number of times

the EMC met during

the Ebola crisis?

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Two types of indicators

Process - measure program and activity performance

Outcome indicators - measure how well the EMC or RTT initiative is accomplishing its objectives

How much have health determinants within a defined population improved over monthly intervals after the field investigation and response stages?

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M&E quiz!

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What do you think?

What experiences do you have with monitoring and evaluation in your work?

Why do you think monitoring and evaluation might be important during and after a PHE?

What type of indicators would you suggest?

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Application and reflection

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Think about

Which activities in preparing and responding to a PHE do you need to gain proficiency?

How can you develop the skills and knowledge you need to gain proficiency?

How might you use the PHE framework when preparing and responding to a PHE of unknown etiology?

What support do you need to be able to use the framework?

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Welcome back

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Day Three

Preparing for the Simulation

Simulation

Debriefing the Simulation

Reflections, Application and Planning

Morning

Afternoon

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Preparing for the simulation

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A simulation…

Is a learning experience

There are no right and wrong answersDraw on your experienceThink One HealthHave fun

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Evaluation criteria

Team effectiveness

Using a One Health Approach

Effectively using the framework

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Simulation

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Message #1

What are the risk factors for a public health event among this population?

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Message #2

What would you be concerned about at this point in terms of infectious diseases?

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Message #3

Is there reason to suspect Ebola and alert the EMC?

What other illnesses should be considered?

What immediate actions should be taken?

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Message #4

What are the likely barriers to case detection?

How could the camp have prevented this situation and the unnecessary request of the RRT during a time of crisis in the country?

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Message #5

From the case investigation reports, develop a case definition for the illness.

Do you think this is Ebola?

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Message #6

What are the most important immediate steps to take?

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Message #7

What else is needed to contain the spread of the illness?

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Message #8

But is it?

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Lunch

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Zooming out…

. . . where could you have intervened to protect animals, people and the environment?

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Debrief of the simulation

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How did you do?

Take a few minutes to complete the self-evaluation

How was the overall team collaboration and communication?

What did you and your team do well?

What would you have improved on?

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How did we do?

What are some lessons learned for how you will collaborate and communicate:

Back on the job?When preparing for a PHE?When responding for a PHE?

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Reflections, application, planning

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Reflections, Application and Planning

What were some key learnings over the last three days?

How can you apply the learning?

How could taking a One Health approach make you more effective in your role preparing for and mitigating the impact of PHEs?

What would you like to learn more about related to One Health and preparing and responding to PHEs of unknown etiology?

What information are you going to share with your colleagues after this class?

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A bit of feedback on the course

1

thing you liked

1

thing you would change

Thank

you

Merci

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