Global and Regional Disease Surveillance Networks’

Convergence at the National Level

Joint Presentation By The Republic of Georgia and The United States of America

Georgia• Located in Southeastern Europe • Borders the Black Sea between Russia to the North

and Turkey, Azerbaijan, and Armenia to the South• About 69,700 sq km, mostly mountainous land with

1/3 covered by forest• Population: 4,615,807 (July 2009 est.)

Getty Images

Considerations in national preparedness

Potential Consequence

Thre

at S

ophi

stic

atio

n

Low Medium HighLo

wM

ediu

mH

igh

CutaneousAnthrax

FoodborneSalmonella

Agro terror

Anthraxaerosol

Antibiotic-resistantplague

Contagious, non-treatable,e.g. “engineered viruses”

• Endemic diseases• Natural outbreaks or

pandemics • Accidents involving

biological agent release

• Bioterrorism attacks• Biological warfare

A need for a robust, quick-response, and adaptive public health systemthat will provide early warning and an efficient medical response

The unknown biological threat

Disease surveillance: system requirements

• Sensitive (detect intended health events)• Specific (low false positive/negative reporting)• Representative• Timely• Simple (easy to understand and implement)• Flexible (customizable)• Acceptable

Implementation of the consistent policies, operating procedures and the operational and technical capacity required by the

WHO International Health Regulations will help ensure early warning and efficient international management of a biological incident,

whether naturally occurring or deliberate in nature.

National Center for DiseaseControl and Public Health (NCDC)

• Surveillance on communicable and non-communicable diseases

• Disease control and prevention• Health promotion activities• Collection and processing of

medical statistical data• Biomedical research• Houses the Georgian national

collection of especially dangerous pathogens

Network of 11 regional and 66 district (rayon)Centers for Public Health

GEOEPID software: an important tool in the public health decision-making process

• Process the disease surveillance-related data

• Identify short-term and long-term trends in communicable disease morbidity and mortality

• Characterize and compare the epidemiological situation per region and per country

• Analyze distribution of cases by age groups

• Assess lab results confirmation• Store the data electronically for future

reference• Assess the impact of case/outbreak

control actions and performance improvement measures

“…the document is intended to give countries ideas for how to create their own software systems. It is thus directed primarily at policymakers in countries planning to strengthen their surveillance systems, donor organizations that can support such reforms, and agencies working in these technical areas”.

Report available online at: http://pdf.usaid.gov/pdf_docs/PNADG823.pdf

GEOEPID: powerful tool for informing public health policy decisions

• Development of a new public health law

• Advocacy for increased surveillance program funding, supplementary immunization activities

• Development and dissemination of health education materials related to priority infectious diseases

• Feedback to and analysis of individual district performance

Congruence of regional and global disease surveillance networks

GeorgiaNCDCCPHs

DIPNET

ESEN

EISS

European Surveillance Networks

WHO Surveillance Networks

FluNet/GISN

Global Polio Lab Network

GlobalSalm-Surv

network GlobalRotavirusLabNetwork etc

etc

Examples of US-funded, pathogen-specific research projects on

disease surveillance and control• Surveillance and Response on Avian and

Pandemic Influenza Outside USA by National Health Care Institutions

• Development of Surveillance System and Control Strategy for Leishmaniasis in Georgia by means of Epidemiological and Strengthening of Laboratory capacities

• Application of Molecular Fingerprinting to Geographical Characterization and Epidemiological Surveillance of Natural Foci Yersinia pestis and Francisella tularensis

• Countermeasures for the Control of African Swine Fever in the Republic of Georgia

Laboratory of the Ministry of Agriculture (LMA) Zonal Diagnostic Lab (ZDL)

Kutaisi Regional Veterinary Lab (RVL) ZDL

Integration of human and veterinary surveillance systems and coordination of human-animal health monitoring could provide early warning signs for emerging diseases.

Field Epidemiology Training Programs (FETP)

• Program offered by the US Department of Health and Human Services / Centers for Disease Control and Prevention / Division of Global Public Health Capacity Development (DGPHCD)

• Competency-based training and service program in applied epidemiology and public health that builds public health systems capacity in the countries in which it is implemented

• Collaboration with non-profit network organizations to share resources and best practices among FETPs:

– The Training Programs in Epidemiology and Public Health Interventions Network Inc (TEPHINET) http://www.tephinet.org

– The African Field Epidemiology Network (AFENET) http://www.afenet.org

• Field Epidemiology and Laboratory Training Program (FELTP) features an added laboratory component aiming to build and strengthen the bridging between laboratory services and epidemiology and thus improve surveillance and outbreak response

• Southern Caucasus Field Epidemiology and Laboratory Training Program (SCFELTP) includes Georgia, Armenia, and Azerbaijan

World Health Assembly Resolutions related to Laboratory Biosafety

• World Health Assembly resolution 55.16 (2002)– "Global public health response to natural occurrence, accidental

release or deliberate use of biological and chemical agents or radionuclear material that affect health”

• World Health Assembly resolution 58.3 (2005)– "Prevention and control of the international spread of disease

and public health risks"• World Health Assembly resolution 58.29 (2005)

– "Enhancement of laboratory biosafety"

“Quality laboratory services and efficient biosafety measures are integral part of core capacity to implement the

International Health Regulations (2005)”- Dr. Phillip Duboise, WHO/Lyon

“Recognizing that biosafety and biosecurity measures contribute to preventing the development, acquisition or use of BTW and are appropriate means of

implementing the BWC, States Parties agreed on the value of…

international cooperation on biosafety and biosecurity at the bilateral, regional and international levels”

“Pursuing biosafety and biosecurity measures could also contributeto the fulfillment of [State Parties] other respective

international obligations and agreements, such as the revised International Health Regulations of the World Health Organization…”

2008 BWC Meeting of State Parties

Biological Threat Reduction Program in Georgia

• Prevent the sale, theft, diversion or accidental release of biological materials, technology, and expertise

• Consolidate especially dangerous pathogens (EDPs) into safe and secure central reference laboratories

• Improve Georgia’s capabilities to detect and respond to EDP disease outbreaks

• Integrate Georgian scientists into the international scientific community

• Network of sentinel medical facilities throughout the country

• Central Reference Laboratory • National response teams that

will identify, investigate, and respond to natural or deliberate biological outbreaks or incidents

Biological Threat Reduction Program Components

• Implement technical enhancements in phases to meet and maintain BS&S standards

• Create a personnel reliability program to reduce the threat of pathogens being stolen or released

• Assess risk from insider and outsider threats associated with transportation, storage, and handling of EDPs

• Create a safer work environment for personnel

• Provide enhanced reporting, detection, and response capability for human and veterinary EDPs

• Provide modern laboratory diagnostic capabilities

• Train and equip epidemiological teams to investigate human and veterinary EDP outbreaks

• Consolidate EDPs into a secure repository at the Central Reference Laboratory (CRL)

• Provide dedicated transport• Georgia will have one CRL, seven

Epidemiological Monitoring Modules (EMM), and two Mobile Outbreak Response Units (MORU)

• Promote integration of Georgian scientists into the international community• Promote openness and ethical conduct• Train scientists in modern molecular diagnostics, biosafety, biosecurity, & bioethics

Biosecurity and Biosafety (BS&S)

Cooperative Biological Research (CBR)

Threat Agent Detection & Response

NCDC before renovation

NCDC after renovation

NCDC repository

Infectious diseases know no geographic boundaries, neither should we on combating them

Speakers’ contact information:

Lela Bakanidze, Ph.D.Deputy HeadDepartment of Especially Dangerous InfectionsNational Center for Disease Control and Public Health of GeorgiaTbilisi, Georgiathreatred@ncdc.ge

Dana Perkins, Ph.D.Senior Science AdvisorOffice of the Assistant Secretary for Preparedness and ResponseUS Department of Health and Human ServicesWashington, DC, USAdana.perkins@hhs.gov