PPacific acific PPublic ublic HHealth ealth SSurveillance urveillance NNetwork: etwork:

Framework 2006 Framework 2006

PPHSNPPHSN is a is a voluntary network of voluntary network of countries/territories and institutions/ countries/territories and institutions/ organisationsorganisations

Dedicated to the promotion ofDedicated to the promotion of public public health surveillance & responsehealth surveillance & response

Current focus onCurrent focus on CDs: epidemic ones CDs: epidemic ones first first

PPHSNPPHSN Goal is Goal is to improve public health to improve public health surveillance in the Pacific Islands, in a surveillance in the Pacific Islands, in a sustainable waysustainable way

WhatWhat is the is the PPHSNPPHSN??

Core:Core:22 MoHs22 MoHs

LaboratoriesLaboratories

TrainingTraininginstitutionsinstitutions

Aid donors, Aid donors, ProjectsProjects

Networks & Networks & AssociationsAssociations

International International agenciesagencies

Coordinating-BodyCoordinating-Body+ Focal Point+ Focal Point

PPHSN PPHSN IInstitutional frameworknstitutional framework

Operational stepsOperational steps

Alert Alert && CommunicationCommunication

Verification Verification && IdentificationIdentification

Investigation & Investigation & ResponseResponse

Infection controlInfection control

PPHSN servicesPPHSN services

• PacNetPacNet

• LabNetLabNet

• EpiNetEpiNet

• PICNetPICNet

PPHSNPPHSN: Networking ServicesNetworking Services

Alert Alert && Communication CommunicationPacPacNetNet

E-mail (and fax) E-mail (and fax) listserverlistserverNetwork of health professionalsNetwork of health professionals

Early warning systemEarly warning system for epidemic threats for epidemic threats

Awareness & Awareness & preparednesspreparedness

Access to Access to resourcesresources, including expertise, including expertise

Overall Overall communicationcommunication and and coordinationcoordination

Complemented by Complemented by PacPacNetNet-restricted-restricted

SPC3%

Others10%

Training Institutions

9%

WHO11%

Laboratories6%

Health Depts SPC

member countries

61%P@CNETP@CNET

E-mail subscriber by resource E-mail subscriber by resource institution as at 31 November institution as at 31 November 20052005

n = 636n = 636

Number of messages posted Number of messages posted by month, by month, AAppril 97-30 Nov. ril 97-30 Nov. 20052005

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influenzainfluenzaarbovirusesarboviruses

measlesmeaslesdenguedengue

denguedenguedenguedengue

(+ measles)(+ measles)

Source : Public Health Surveillance & Communicable Diseases Control Section,

Secretariat of the Pacific Community

NipahNipah(Malaysia)(Malaysia)

denguedengue(+ influenza(+ influenza))

choleracholeratyphoidtyphoid

denguedengue

SARSSARS

denguedengue HPAIHPAI

1997 1998 1999 2000 2001 2002 2003 2004 2005

(+ rubella, measles)(+ rubella, measles)

HPAIHPAIinfluenzainfluenza

Dengue Dengue SARSSARS

Operational stepsOperational steps

Alert Alert && CommunicationCommunication

Verification Verification && IdentificationIdentification

Investigation & Investigation & ResponseResponse

Infection controlInfection control

PPHSN servicesPPHSN services

• PacNetPacNet

• LabNetLabNet

• EpiNetEpiNet

• PICNetPICNet

PPHSNPPHSN: Networking ServicesNetworking Services

PPHSNPPHSN LabNet LabNet

Three-tier network of public health Three-tier network of public health laboratory services providing access laboratory services providing access to distance diagnostic facilities to distance diagnostic facilities throughout the Pacific: throughout the Pacific:

Level 1:Level 1: national labsnational labs

Level 2:Level 2: (sub-)regional labs, having (sub-)regional labs, having accepted to provide services for accepted to provide services for PPHSN target CDs to other PPHSN target CDs to other countries/territoriescountries/territories

Level 3:Level 3: reference (… WHO ref reference (… WHO ref centres)centres)

What do we aim at?

PPHSNPPHSN LabNet LabNet

Common challenges and development goalsCommon challenges and development goals To provide access to distance diagnostic facilities To provide access to distance diagnostic facilities throughout the Pacificthroughout the Pacificquarantine regulations, Airlines requirements, on-quarantine regulations, Airlines requirements, on-going funding mechanismsgoing funding mechanisms

To ensure a secure and efficient specimen and To ensure a secure and efficient specimen and information flowinformation flowconfidentiality, Bio-ethics and intellectual property confidentiality, Bio-ethics and intellectual property rightsrights

To maintain reliable and sustainable servicesTo maintain reliable and sustainable services on-going capacity building i.e. training, appropriate on-going capacity building i.e. training, appropriate equipment, Q.C.equipment, Q.C.

Operational stepsOperational steps

Alert Alert && CommunicationCommunication

Verification Verification && IdentificationIdentification

Investigation & Investigation & ResponseResponse

Infection controlInfection control

PPHSN servicesPPHSN services

• PacNetPacNet

• LabNetLabNet

• EpiNetEpiNet

• PICNetPICNet

PPHSNPPHSN: NetworkingNetworking ServicesServices

Network of national/territorial well-Network of national/territorial well- defined defined multidisciplinary outbreak response teams: themultidisciplinary outbreak response teams: the “EpiNet “EpiNet teams”teams” (clinical medicine, data management, epidemiology & (clinical medicine, data management, epidemiology & field investigation, lab, PH management)field investigation, lab, PH management)

Aim: to provideAim: to provide immediate public health response to immediate public health response to outbreaks and outbreak threatsoutbreaks and outbreak threats

Core teamCore team, linking with other key stakeholders , linking with other key stakeholders according to the outbreak faced (e.g. EPI coordinator)according to the outbreak faced (e.g. EPI coordinator)

ClearClear counterparts counterparts forfor PPHSN activities & PPHSN activities & development, development, incl.incl. capacity-building capacity-building

To build up aTo build up a pool of regional expertise pool of regional expertise

PPHSNPPHSN EpiNetEpiNet

Operational stepsOperational steps

Alert Alert && CommunicationCommunication

Verification Verification && IdentificationIdentification

Investigation & Investigation & ResponseResponse

Infection controlInfection control

PPHSN servicesPPHSN services

• PacNetPacNet

• LabNetLabNet

• EpiNetEpiNet

• PICNetPICNet

PPHSNPPHSN: NetworkingNetworking ServicesServices

Launched in Feb 2006Launched in Feb 2006

ObjectivesObjectives

Within the framework of the PPHSN:Within the framework of the PPHSN:

1.1. To set the To set the minimum standards minimum standards for infection control in PICTs, with for infection control in PICTs, with adapted evidence-based/best practicesadapted evidence-based/best practices

2.2. To develop infection control To develop infection control capacitycapacity in PICTs. in PICTs.

3.3. To raising To raising awarenessawareness of infection control issues. of infection control issues.

4.4. To develop and maintain infection control links with health (and To develop and maintain infection control links with health (and other) entities (e.g. other governmental and non-governmental other) entities (e.g. other governmental and non-governmental agencies, donors).agencies, donors).

5.5. To develop a To develop a strategic planstrategic plan for PICNet. for PICNet.

6.6. Future objective: To develop and maintain standardized Future objective: To develop and maintain standardized healthcare associated infection (HAI) healthcare associated infection (HAI) surveillance and responsesurveillance and response mechanisms.mechanisms.

PPHSNPPHSN PICNetPICNet

MembershipMembership

Core members Core members

All health professionals with interest in infection control with one All health professionals with interest in infection control with one national focal point for each SPC member country or territory.national focal point for each SPC member country or territory.

Allied membersAllied members

Health professionals with interest in infection control from Health professionals with interest in infection control from Australia and New Zealand Australia and New Zealand

International organizations: WHO, SPC International organizations: WHO, SPC

Training institutions, including Schools of Nursing, Schools of Training institutions, including Schools of Nursing, Schools of Medicine, Schools of Oral HealthMedicine, Schools of Oral Health

DonorsDonors

ActivitiesActivities

Support and advocacy for capacity building for infection control Support and advocacy for capacity building for infection control professionals (ICPs). professionals (ICPs).

Strengthen institutional linkages with regional and national expert Strengthen institutional linkages with regional and national expert bodies.bodies.

PPHSNPPHSN PICNet PICNet (ctd)(ctd)

PPHSN Priority CDsPPHSN Priority CDs

Primary listPrimary list

CholeraCholera

DengueDengue

InfluenzaInfluenza

LeptospirosisLeptospirosis

MeaslesMeasles

Typhoid fever Typhoid fever

Progressively addedProgressively added

AFP, NTAFP, NT

AFR (measles and AFR (measles and rubella)rubella)

SARSSARS

HIVHIV

= “Epidemic” CDs= “Epidemic” CDs

PPHSN Priority CDsPPHSN Priority CDsSurveillance requirementsSurveillance requirements

For all (except HIV): For all (except HIV): Any suspected case should immediately be reported and Any suspected case should immediately be reported and investigatedinvestigatedImplementation of public health measures must be Implementation of public health measures must be immediately startedimmediately started

HIV:HIV:22ndnd generation HIV surveillance generation HIV surveillance

Pregnant womenPregnant women At-risk groupsAt-risk groups Behavioural surveillance (youth)Behavioural surveillance (youth)

All require:All require:Response team Response team Procedures: guidelines and protocolsProcedures: guidelines and protocolsSome PPHSN support Some PPHSN support

… … preparednesspreparedness

PPHSN Priority CDsPPHSN Priority CDsRegional information sharingRegional information sharing

EstablishedEstablishedPacNetPacNetInform’Action Inform’Action PPHSN website:PPHSN website: www.spc.int/phs/PPHSNwww.spc.int/phs/PPHSN

To be redeveloped:To be redeveloped:Regional CD databaseRegional CD database Background: SPEHISBackground: SPEHIS Existing routine dataExisting routine data Other information: scientific articlesOther information: scientific articles

First regional First regional EpiNet workshop EpiNet workshop Sep 2003Sep 2003

PPHSN Strategic Framework 2003-2006

PPHSN-CB 10, 2PPHSN-CB 10, 2ndnd regional EpiNet regional EpiNet workshop Jun 2004, workshop Jun 2004, EpiNet team EpiNet team consultationconsultation

General recommendations & Proposed PoA 2004-2006

GENERAL RECOMMENDATIONS AND PROPOSED PLAN OF ACTION 2ND REGIONAL EPINET WORKSHOP, 7TH -11TH JUNE 2004, SPC NOUMEA.

GENERAL RECOMMENDATIONS

1. To establish and maintain strong collaboration between human and animal health services both in country and at regional level.

2. To develop and strengthen capacity on influenza surveillance in PICTs to facilitate swift detection of an outbreak, and to undertake

responsibility of preparedness to influenza pandemic threat or occurrence.

3. To explore and develop feasible options for the assessment of the burden of influenza in PICTs.

4. To develop and strengthen laboratory capacities to facilitate efficient surveillance especially influenza virologic surveillance in PICTs.

5. To further develop and improve surveillance systems in the PICTs by optimising use of scarce resources for PPHSN expanded list of priority

diseases.

6. To undertake training in Epidemiology to facilitate the improvement in surveillance and response to communicable disease threats and events

in the Pacific Region.

7. To promote a good understanding of the new international health regulation (IHR) and related issues, and integrate IHR into the framework of

the PPHSN.

8. To review and improve on the infection control measures in PICTs by establishing and formalising the Pacific regional infection control

network under the umbrella of PPHSN.

9. To formalise and operationalise the Regional EpiNet team with its clear roles and functions, including funding implications, for endorsement

from Health Ministers' meeting in Samoa, 2005.

PROPOSED PLAN OF ACTION 2004-2006

General recommendations General recommendations 2004-20062004-2006

1. To establish and maintain strong collaboration between human and animal health services both in country and at regional level.2. To develop and strengthen capacity on influenza surveillance in PICTs to facilitate swift detection of an outbreak, and to undertake responsibility of preparedness to influenza pandemic threat or occurrence.3. To explore and develop feasible options for the assessment of the burden of influenza in PICTs.

General recommendations General recommendations 2004-2006 (2)2004-2006 (2)

4. To develop and strengthen laboratory capacities to facilitate efficient surveillance especially influenza virologic surveillance in PICTs.5. To further develop and improve surveillance systems

in the PICTs by optimising use of scarce resources for PPHSN expanded list of priority diseases.6. To undertake training in Epidemiology to facilitate the

improvement in surveillance and response to communicable disease threats and events in the Pacific Region.

General recommendations General recommendations 2004-2006 (3)2004-2006 (3)

7. To promote a good understanding of the new international health regulation (IHR) and related issues, and integrate IHR into the framework of the PPHSN. 8. To review and improve on the infection control measures in PICTs by establishing and formalising the Pacific regional infection control network under the umbrella of PPHSN.9. To formalise and operationalise the Regional EpiNet team with its clear roles and functions, including funding implications, for endorsement from Health Ministers' meeting in Samoa, 2005.

Samoa Commitment Samoa Commitment

Achieving Healthy IslandsAchieving Healthy IslandsRecommendations involving the PPHSNRecommendations involving the PPHSN

Samoa Commitment – Samoa Commitment – Recommendations (I)Recommendations (I)

The Regional EpiNet Team (RET) should be The Regional EpiNet Team (RET) should be established by creating a pool of experts and established by creating a pool of experts and professionals among the countries and territories professionals among the countries and territories in the Pacific in order to support national and in the Pacific in order to support national and territorial responses to outbreaks and to build territorial responses to outbreaks and to build capacity.capacity.The establishment of a regional outbreak and The establishment of a regional outbreak and emergency response fund should be explored.emergency response fund should be explored.PPHSN mechanisms should be utilized for IHR PPHSN mechanisms should be utilized for IHR Implementation such as notification, verification Implementation such as notification, verification and capacity strengthening wherever possible.and capacity strengthening wherever possible.

Samoa Commitment – Samoa Commitment – Recommendations (II)Recommendations (II)

The Strategic Framework of PPHSN should The Strategic Framework of PPHSN should include surveillance and response capacity include surveillance and response capacity assessment and development for the Pacific assessment and development for the Pacific Islands.Islands.Capacity building should be enhanced at the Capacity building should be enhanced at the peripheral level in the Pacific Islands for good peripheral level in the Pacific Islands for good surveillance and response.surveillance and response.The IHR focal point should be a member of the The IHR focal point should be a member of the national EpiNet team or an equivalent national EpiNet team or an equivalent communicable disease response team or communicable disease response team or taskforce at the national level, and where taskforce at the national level, and where possible that person should be the chair of the possible that person should be the chair of the team.team.

Samoa Commitment – Samoa Commitment – Recommendations (III)Recommendations (III)

PPHSN, incl. WHO, SPC and other partners, should continue PPHSN, incl. WHO, SPC and other partners, should continue to provide technical support to assist PICTs to develop and to provide technical support to assist PICTs to develop and implement national pandemic preparedness plans. implement national pandemic preparedness plans. At national level, development of national pandemic At national level, development of national pandemic preparedness plan led or coordinated by MoH: preparedness plan led or coordinated by MoH:

multisectoral task force. based on existing plans and mechanisms e.g.:

• involvement of the national disease preparedness group • linkage with the national disaster preparedness plan.

Community participation and mobilization.

PPHSN should expand its scope to include functions of PPHSN should expand its scope to include functions of noncommunicable disease surveillance as networked noncommunicable disease surveillance as networked surveillance and data pooling mechanisms.surveillance and data pooling mechanisms.

Samoa Commitment – Samoa Commitment – Recommendations (IV)Recommendations (IV)

Strengthen HIV and STI surveillance.Strengthen HIV and STI surveillance.Countries should join together through PPHSN in Countries should join together through PPHSN in a Pacific initiative to improve national capacities a Pacific initiative to improve national capacities to prevent and control epidemic dengue.to prevent and control epidemic dengue.Community-based vector control should be a key Community-based vector control should be a key component of all national dengue control component of all national dengue control programmes. programmes.

It is no longer sufficient to simply educate and provide It is no longer sufficient to simply educate and provide information about dengue; programmes should aim at information about dengue; programmes should aim at key behavioural changes that result in reduced dengue key behavioural changes that result in reduced dengue transmission.transmission.

Samoa Commitment – Samoa Commitment – Recommendations (V)Recommendations (V)

To sustain polio-free status, Pacific nations To sustain polio-free status, Pacific nations should ensure that key programme functions should ensure that key programme functions such as AFP surveillance and routine such as AFP surveillance and routine immunization coverage are maintained at the immunization coverage are maintained at the high levels required. Preparedness plans should high levels required. Preparedness plans should be available and coordinated by the EpiNet team be available and coordinated by the EpiNet team for response to the importation of wild poliovirus for response to the importation of wild poliovirus and circulating vaccine-derived poliovirus.and circulating vaccine-derived poliovirus.

Field achievementsField achievements

Various and multipleVarious and multiple

Depend on individual PPHSN members, Depend on individual PPHSN members, therefore difficult to list!therefore difficult to list!

AFP, NT & AF&R – HBASAFP, NT & AF&R – HBAS

Various support to PICTsVarious support to PICTs Outbreak investigationOutbreak investigation Surveillance developmentSurveillance development TrainingTraining … … PPHSN servicesPPHSN services

THANK YOU!!THANK YOU!!