PRESENTATION: Preparedness & Response Infectious Diseases

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Last 29 September, the ADB Medical Center conducted a training on infectious disease preparedness and response. This includes disease such as Avian flu, MERS-CoV, and EBOLA. Many infectious diseases and pandemic threats might hit you wherever you are in our global world. Dr. Philippe Guibert, Medical Director at International SOS in Singapore explains how to protect yourself, on the workplace, on travel, or at home.

Transcript of PRESENTATION: Preparedness & Response Infectious Diseases

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Infectious Diseases : personal protection in Manila and abroadInteractive Session on Preparedness and Response29 September 2015ADB

Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.Looking backOver the past years, the world has seen different virus &/or diseases emerging and the impact to businesses is very realA/H5N1 (Avian Bird Flu) 1st case reported in Hong Kong in 1997 (18 cases and 6 fatalities) Started spreading to other countries in 2003 Still active today During the 1st wave (Dec03 to Apr04), Thailand/Vietnam reported 35 cases of which 14 were fatal Virus is now genetically different and it can survive longer in the environment + infect an expanding range of animalsH1N1 (Swine Flu) 1st case reported in Mexico in Apr09 By Jun09, it had spread across the world A total of 600,000 (18,000 fatalities) were confirmed by the time WHO declared the pandemic over in Aug 20101997200920102013 to presentMERS-CoV (Corona virus) 1st case reported in 2012 (Arabian Peninsula) As of June 2015, reported in 26 countriesH7N9 (Avian Bird Flu) 1st case reported in Feb13 (China)Ebola virus 1st case in Dec13 (Guinea)There will be the emergence of a new disease,How prepared you to handle such situations?Pandemic & Infectious DiseasesRisks That We Are Facing Today#


The threat of avian flu H5N1 has not diminished. It is probably entrenched in birds in a number of countries, including ChinaConfirmed H5N1Human Cases = 676 (15 Countries) Confirmed H5N1Human Deaths = 398

It is therefore to be expected that more avian influenza A(H5N1), A(H7N9), and a variety of other influenza subtypes and reassortant influenza viruses will be detected in humans and animals over the coming months.WHO - Influenza at the human-animal interfaceSummary and assessment as of 5 May 2014 2014 AEA International Holdings Pte. Ltd. All rights reserved.Unauthorized copy or distribution is prohibited.#7CFR 59%8

Anytime, anywhere, of any sortWe are only as safe as the most fragile states to find, stop and prevent health threats. Pr David Heyman

Exotic diseases become global health security issues

More real cases and false alarms expected

From rural to urban

Acceleration ?#Some diseases will mimic the symptoms of others

South Korea last measures : hospitals will be required to separate their emergency departments and areas for patients who need to be isolated from other hospital wards,

Kwon Deok-cheol, a senior health ministry official, said the government will expand national health insurance coverage for people who have infectious diseases, along with those who need to be isolated in negative-pressure rooms in hospitals, theKorea Heraldreported today.He said national health insurance would also cover the installation of more negative-pressure rooms and maintain the ones that are already in operation. He added that the MERS outbreak showed that South Korea has a severe shortage of negative-pressure rooms and that some of the existing ones haven't been properly maintained.

10Likely risks to traveller healthThe most likely danger to traveler health in most countries would be vehicular travel

Extreme sports are responsible for many accidentsAir travel is still the safest means of transport1111Objective : The most likely danger to traveler health in most countries would be vehicular travel,

Air travel has featured in the news in the region recently but is still the safest means of transport

The quality of roads, vehicles and drivers in the region can differ greatly from country to country and represents probably the number one threat to life.

Extreme sports are also responsible of many accidents, particularly when practiced in places where healthcare is challenging.

Local diseases and local vectors of these diseases, and the quality of health careEnvironmental risks

Likely risks to traveller health1212Objectives : Risks are related to environment (fauna, flora), local diseases and local vectors of these diseases, and the quality of health careThe reality of travelers Based on study of health problems experienced by 100,000 individuals who travelled to a developing country for 1 month, the following could be expected to occur:

1 in 2 will develop some health problem1 in 13 will see a doctor1 in 20 will be confined to bed1 in 90 will be incapacitated in their work1 in 2,000 will be admitted to a hospital1 in 3,300 will be evacuated1 will die

Source: Steffen, R. et al.: "Health Problems After Travel to Developing Countries",Journal of Infectious Disease (1987) 156, 84Top 10 causes of serious medical casesBusiness Travellers#Cause% of seriouscases1Accident & Injury21%2

Cardiovascular & CirculatorySystem Diseases15%3Gastrointestinal Disorders15%4Ill Defined Symptoms - Minor9%5Infectious Diseases - Major8%6Musculoskeletal Disorders7%7Urinary System Disorders4%8Gastrointestinal InfectiousDiseases4%9Nervous System Disorders3%10Referrals, Tests & Checkups3%Expatriates#Cause% of seriouscases1Pregnancy13%2Gastrointestinal Disorders12%3Ill Defined Symptoms - Minor12%4Accident & Injury12%5Infectious Diseases - Major8%6

Cardiovascular & CirculatorySystem Diseases8%7Musculoskeletal Disorders7%8

Gynaecological & ReproductiveSystem Disorders4%9Referrals, Tests & Checkups4%10Urinary System Disorders4%Serious case = Any case that results in in-patient, evac/repat or RMRSource: International SOS, 201014Serious cases are 4.5 times more likely to result in evacuation in extreme risk countries, compared to a low risk countries4.5 times higher

Serious case = Any case that results in in-patient, evac/repat or RMRSource: International SOS, 201215One scenarioCase Study ADB 10 October 2015Channel News Asia reported a suspected case of MERS COV in Mumbai from 2 travelers returning from Oman. They are being admitted to the local hospital. You are a Manager in Manila, some of your employees are scheduled for a trip in Mumbai. Your reaction would be:Google on the Internet for more informationContact the ADB manager in MumbaiDo nothing and wait for MERS COV confirmation by India Ministry of Health and WHO

#Case Study 1.2 ADB has scheduled for 3 Business Travelers to travel to Mumbai for important meeting with city officials on some important issues concerning environment (Meeting Date 12 October 2015 morning) 3 Business travelers scheduled to depart on 11 October 2015. What criteria would you use to decide for travel to proceed?Confirmation of MERS COV infectionImportance of meetingHealth status of 3 travellers

#Case Study 1.3 ADB decided for travelers to proceed as advised by WHO and Ministry of Health Singapore (no restriction on travel to Mumbai). 3 Travelers have proceeded with travel and arrived to Mumbai on 11 October 2015 12 October 2015. Mumbai Health Officials has confirmed the diagnosis of MERS COV on the 2 Travelers from Oman Your reaction:Instruct the 3 travelers to return back to Manila ImmediatelyInstruct the Branch Manager to issue MasksActivate the Company Pandemic Plan

#Case Study 1.4 18 October 2015. Mumbai Health Officials has reported 10 hospital staffs and related personnel has been quarantined. There was not report that the MERS COV patient was located in which hospital. 19 October 2015. Mumbai Health Official reported that 2 hotel staff, 1 Taxi Driver and 4 hospital staff (Contacts of Index Cases) has fever and cough and admitted to the hospitals Your reaction:Advise the Expatriates to return home with their familiesScreen all workers for Temperature before workTry to contact Health Authority Mumbai for more information and ask Ministry of Health Singapore for advice#What are the best practices ?Best Practices A successful traveller risk management modelPre-departurePrepare. Educate. AwarenessTravel or AssignmentTrack. Assist. Inform.EmergencyAdvise. Recommend. Act.22This slide details Intl.SOS TRM solution. As explained in the previous slides, a large part of the services is dedicated at mitigating risks. This basically means that your covered employees should not limit their using Intl.SOS services for emergency situations only. On the contrary, our services aim at preventing such emergency situation. This includes all preparation and education-related services before travel is done [Enumerate relevant services] as well as on-going advice and information while on business trip or assignment abroad [Enumerate relevant services]. We also provide the company and its managers with the right tools to track their travellers should anything happen, allowing better and smoother communication and reach to your travellers when they need it most. [Case studies are ideal here to showcase our services and capabilities stop planned trips (e.g. in case of a flooding at destination) / reach out to travellers (e.g. in case of heavy riots) / trace travel history (e.g. in case of a pandemic planning initiative]. While we aim at mitigating risks, emergencies cannot be fully prevented. We are therefore also by our members side when something wrong happens, be it for a phone advice / recommendation or for providing on the ground assistance when required. Our job does not end with an email advice, phone recommendation or on the ground help: we constantly review all actions undertaken with the objective of constantly improving services rendered and further mitiga