Communicable Diseases in theCommunicable Diseases in the Western Pacific RegionWestern Pacific Region

InaugInauguural Ceremony of the Scientific Advisory Structure of theral Ceremony of the Scientific Advisory Structure of the Centre for Health Protection, DeCentre for Health Protection, Department of Health, Hong Kongpartment of Health, Hong Kong

Hitoshi OSHITANIHitoshi OSHITANI Western Pacific Regional OfficeWestern Pacific Regional Office

WHOWHO

Outline of the PresentationOutline of the Presentation

1.1. Current situation of communicableCurrent situation of communicable diseases in the Western Pacific Regiondiseases in the Western Pacific Region •• HIV / AIDSHIV / AIDS •• TBTB •• Vaccine Preventable DiseasesVaccine Preventable Diseases •• Vector borne diseasesVector borne diseases

2.2. New communicable diseases challenges inNew communicable diseases challenges inthe Western Pacific Regionthe Western Pacific Region •• SARSSARS •• Avian InfluenzaAvian Influenza •• Other emerging diseasesOther emerging diseases

3.3. Roles of Hong Kong SAR in regional andRoles of Hong Kong SAR in regional andglobal effortsglobal efforts

Western Pacific Region of WHOWestern Pacific Region of WHO

WHO Western Pacific Regional Office (WPRO)

6000

Estimates of yearly AIDS deaths in 2000 & 2005 in 4 selected Western Pacific countries

China Cambodia Viet Nam Malaysia

20002000 20052005 35,000 deaths35,000 deaths 120,000 deaths120,000 deaths

11000

24000

11000

20000

80000

Measurable, fixed target towards the goal of universal access to ART

What is the “3 by 5” Initiative?

An initiative to to make ARV treatment available to 3 million people by 2005

400,000 people receive treatment today

WHO/UNAIDS global treatment initiative for AIDS “Addressing a global public health emergency”

A voluntary process � driven by country � supported by regional offices

� with stewardship of HQ

Others 5%

Cambodia 3%

Republic of Korea

4%

China 57%

Japan 4%

Viet Nam 12%

Philippines 15%

Distribution of notified TB cases inDistribution of notified TB cases in Western Pacific Region (2002)Western Pacific Region (2002)

Case Detection Rate (CDR) andCase Detection Rate (CDR) and DOTS coverage in 7 High BurdenDOTS coverage in 7 High Burden

Countries in WPRCountries in WPR

0 10 20 30 40 50 60 70 80 90

100

PNG CHN LAO CAM PHL MON VTN

CDR

DOTS

70% CD

Measles cases and coverage WPR 1974-2002

-

500

1,000

1,500

2,000

2,500

3,000

3,500

1974 1978 1982 1986 1990 1994 1998 2002 Year

Cases (in thousands)

0%

20%

40%

60%

80%

100%

Coverage

Countries that have interrupted measles transmission

Countries where measles transmission was reestablished

Measles-endemic countries

Measles control status by countryMeasles control status by country

*According to 2003 data

HBV Carriage Rate (preHBV Carriage Rate (pre--vaccine)vaccine)

>12% (9)

8% - 12% (13)

2% - 7% (11)

< 2% (2)

No Data (1)

( l i )

Introduction of Hep B vaccineIntroduction of Hep B vaccine

100%

80%

60%

% of Countries

40%

20%

0%

1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 Year of Introduction

Number of reported dengue casesNumber of reported dengue cases 20032003

China 74 Guangzhou

%% UU Hong Kong128

Macau Laos PDR

(16,978)

ViVietet NN aamm PPhhiilliippippineness

Cambodia (9,300) (15,816)

(11,635)

BBrrununeiei Dengue cases 2003Malaysia 1 -10 00

(6,260) 1001 - 5000Singapore %U 5001 - 10000 (2,341) 10001 -20 000

SARS cases by region1 November 2002 – 7 August 2003

SARS cases by regionSARS cases by region 1 November 20021 November 2002 –– 7 August 20037 August 2003

Europe 0.4 %

SE Asia 0.16%

Others 0.1%

Americas 3.4%

Western Pacific 95.9 %

Global Total：

8096 cases

774 deaths

WPR Total:

7768 cases (95.9. %)

727 deaths (93.9 %)

WHO consultants for affectedWHO consultants for affected countriescountries

FebFeb MarMarMarMar AprAprAprApr MayMayMay JulJulJulJunJunJunJunJunJun AugAugAug

ChinaChina

Total : 77Total : 77Total : 77

Hong KongHong Kong((China)China)

Total : 22Total : 22Total : 22Total : 22

TaiwaTaiwann Total : 17Total : 17Total : 17((China)China)

Viet NamViet Nam Total : 28Total : 28Total : 28Total : 28

PhilippinesPhilippines Total : 11Total : 11Total : 11Total : 11

SingaporeSingapore Total : 9Total : 9Total : 9Total : 9 TOTAL:TOTAL: 164164

Epidemiology Infection Control Laboratory Comm Logistics Environ Others

SARS cases by week of onsetSARS cases by week of onset

First cases inFirst cases inGuangdongGuangdong

Outbreak inOutbreak inGuangdongGuangdong

M HotelM Hotelin HKin HK All areasAll areas

removed fromremoved fromthe listthe list

MultiMulti--country Outbreakscountry Outbreaks

GlobalGlobalAlertAlert

Amoy GardenAmoy Garden

Lessons learned from SARSLessons learned from SARSLessons learned from SARS

�� Timely and transparent informationTimely and transparent informationsharingsharing

�� National sovereignty and protection ofNational sovereignty and protection ofglobal public healthglobal public health

�� Economic impactEconomic impact �� Lack of surge capacity at country andLack of surge capacity at country and

regional levelregional level �� Poor public health infrastructurePoor public health infrastructure �� Inadequate infection control practices inInadequate infection control practices in

health care settingshealth care settings �� MultiMulti--sectoralsectoral coordinationcoordination �� Risk communicationRisk communication

Key elements for success in globalKey elements for success in global containment of SARScontainment of SARS

�� High level of leadership and commitmentHigh level of leadership and commitment �� The dedication and hard work of publicThe dedication and hard work of public

health staffhealth staff �� Unprecedented worldwide collaborationUnprecedented worldwide collaboration

among governments and the scientificamong governments and the scientificcommunitycommunity

However, there are still issues that need toHowever, there are still issues that need to be addressed…be addressed…

One year after SARS outbreakOne year after SARS outbreak

�� Remaining issuesRemaining issues •• Ecology of SARSEcology of SARS CoVCoV inin

environment (natural reservoir)environment (natural reservoir) •• Vaccine and antiviral developmentVaccine and antiviral development •• Diagnostic kitsDiagnostic kits

�� New issuesNew issues •• Laboratory safety and containmentLaboratory safety and containment

�� Laboratory acquired cases in Singapore,Laboratory acquired cases in Singapore, Taiwan, BeijingTaiwan, Beijing

Avian influenza (H5N1) in Asia as of 10 March 2004

Confirmed human cases of avian influenzaConfirmed human cases of avian influenza A(H5N1) as of 17 March 2004A(H5N1) as of 17 March 2004

15152222Viet NamViet Nam

23233434TotalTotal

881212ThailandThailand DeathsDeathsCasesCases

Status of H5N1 cases by age groupStatus of H5N1 cases by age group Thailand and Viet Nam (N= 34)Thailand and Viet Nam (N= 34)

40+

31-40

21-30

11-20

0-10

Age

gro

up (y

ears

)

Dead Alive

0 2 4 6 8 10 12 14

No. of Cases

Human Public Health RiskHuman Public Health Risk

� Human cases in affected areas •• Still small number of confirmed casesStill small number of confirmed cases •• Not enough information to assess public healthNot enough information to assess public health

impactimpact � Emergence of a new influenza virus

•• Efficient human to human transmissionEfficient human to human transmission

•• Vast majority of people no immunity toVast majority of people no immunity to H5H5 •• PandemicPandemic with huge morbiditywith huge morbidity and mand m oortality impactrtality impact

Lessons learned from avian influenzaLessons learned from avian influenza outbreak in Asiaoutbreak in Asia

�� Need to strengthen surveillance capacitiesNeed to strengthen surveillance capacities ��HumanHuman ��AnimalAnimal

�� Better coordination between human publicBetter coordination between human publichealth and agriculture sectorshealth and agriculture sectors ��National LevelNational Level ��Regional / Global LevelsRegional / Global Levels

�� Human public healthHuman public health vsvs impact on economyimpact on economy ��Reluctance to report poultry outbreakReluctance to report poultry outbreak

Other emerging disease threatsOther emerging disease threats

�� NipahNipah // HendraHendra �� EnterovirusEnterovirus 7171 �� West Nile VirusWest Nile Virus �� HantavirusHantavirus �� OtherOther zoonoseszoonoses �� Antimicrobial resistanceAntimicrobial resistance

�� Newly emerging diseasesNewly emerging diseases

Emerging communicable diseasesEmerging communicable diseases Why now?Why now?

�� GlobalizationGlobalization •• Mass movement of people and goodsMass movement of people and goods

�� Rapid developmentRapid development •• UrUrbanbaniization (ex.zation (ex. TB)TB) •• Deforestation (ex. Ebola)Deforestation (ex. Ebola)

�� OverOver--consumption of animal productsconsumption of animal products •• Animal husbandry practicesAnimal husbandry practices –– intensive farmingintensive farming •• Wild animalWild animal marketsmarkets

�� Failure of health systemsFailure of health systems •• Heavy focus on curative careHeavy focus on curative care •• Neglect of public healthNeglect of public health •• Excessive antibiotic useExcessive antibiotic use

Global and Regional Alert andGlobal and Regional Alert and Response NetworksResponse Networks

�� RationalRational •• None of countries and areas has all necessaryNone of countries and areas has all necessary

expertise / capacity to respond to publicexpertise / capacity to respond to public health emergencies like SARShealth emergencies like SARS

•• Gaps between developed and developingGaps between developed and developing countries: e.g. laboratory, epidemiology etc.countries: e.g. laboratory, epidemiology etc.

•• Rapid and transparent information exchangeRapid and transparent information exchange is critical to prevent international spread ofis critical to prevent international spread of diseasedisease

Global Outbreak Alert and ResponseGlobal Outbreak Alert and Response NetworkNetwork

Electronic Discussion

sites Media

NGOs

Military Laboratory Networks

WHO Collaborating Centres/Laboratories Epidemiology and

Surveillance Networks

WHO Regional & Country Offices

Countries/National Disease Control

Centres

UN Sister Agencies

FORMALFORMAL

GPHIN

INFORMALINFORMAL

InternationalInternational HealthHealth

Regulations =Regulations = Global legalGlobal legal framework toframework to

protect the worldprotect the world from publicfrom public

health threatshealth threats

Why have IHR?Why have IHR?

�� Serious and unusual diseaseSerious and unusual disease events are inevitableevents are inevitable

�� GlobalisationGlobalisation -- problem in oneproblem in one location is everybody’s problemlocation is everybody’s problem

�� An agreed code of conductAn agreed code of conduct PROTECTS against:PROTECTS against: 1.1. the spread of serious risks to publicthe spread of serious risks to public

healthhealth 2.2. the unnecessary or excessive use ofthe unnecessary or excessive use of

restrictions in traffic or trade forrestrictions in traffic or trade for public health purposespublic health purposes

IHR are not newIHR are not new �� NotificationNotification:: to WHO, of a case of cholera,to WHO, of a case of cholera, plague or yellow fever, notify WHO when the areaplague or yellow fever, notify WHO when the area is free from infectionis free from infection -- narrow focusnarrow focus �� Health OrganizationHealth Organization:: ports, airports and frontierports, airports and frontier posts are adequately equipped to apply the IHRposts are adequately equipped to apply the IHR measuresmeasures -- again focussed on 3 diseases andagain focussed on 3 diseases and outdatedoutdated �� Health MeasuresHealth Measures:: The maximum measuresThe maximum measures applicable to international traffic, which a stateapplicable to international traffic, which a state may require for the protection of its territorymay require for the protection of its territory against cholera, plague and yellow feveragainst cholera, plague and yellow fever -- rigidrigid and punitiveand punitive In revising we needed to overcome theseIn revising we needed to overcome these limitationslimitations

The Proposed RevisionThe Proposed Revision •• Notification: Public health emergencyNotification: Public health emergency

of international concernof international concern •• Use information coming from sourcesUse information coming from sources

other than official member stateother than official member state notificationsnotifications •• Temporary recommendationsTemporary recommendations

•• IHR emergency committeeIHR emergency committee •• Based on risk assessmentBased on risk assessment

•• National focal pointNational focal point •• Minimum core capacityMinimum core capacity

•• CapacityCapacity buildingbuilding

Major milestones in the revisionMajor milestones in the revision

2004

2005

• report to EB 113 - green light • Regional Consultation Meetings

(WPRO: April 28-30) • Amended draft revision proposals • Intergovernmental Working Group (Nov 2004) • Final regulatory draft

v report to EB 115 vW H A

Roles of Hong Kong in global &Roles of Hong Kong in global & regional effortregional effort

�� Participation in global and regional networksParticipation in global and regional networks •• SurveillanceSurveillance •• LaboratoryLaboratory •• OnOn--site supportsite support

�� Capacity building in neighbouring countriesCapacity building in neighbouring countries •• TrainingTraining

Roles of Hong Kong in global &Roles of Hong Kong in global & regional effortregional effort

�� SurveillanceSurveillance •• Rapid dissemination of information on CD fromRapid dissemination of information on CD from

Hong KongHong Kong •• Initiate discussions and information sharing withInitiate discussions and information sharing with

the regionthe region

Roles of Hong Kong in global &Roles of Hong Kong in global & regional effortregional effort

�� Laboratory networksLaboratory networks •• Laboratories in Hong Kong play critical roles asLaboratories in Hong Kong play critical roles as

regional and global reference laboratoriesregional and global reference laboratories �� SARSSARS (3 / 11: Hong(3 / 11: Hong Kong labs)Kong labs) �� Influenza H5N1 (2/6: Hong Kong labs)Influenza H5N1 (2/6: Hong Kong labs) �� Specimens were sent toSpecimens were sent to labs inlabs in Hong Kong for:Hong Kong for:

•• SARS (Mainland China, Jan 2004)SARS (Mainland China, Jan 2004) •• H5N1 (Human, Viet Nam, Jan 2004)H5N1 (Human, Viet Nam, Jan 2004) •• H5N1 (Animal, Viet Nam, Feb 2004)H5N1 (Animal, Viet Nam, Feb 2004) •• H5N1 (Animal, Mainland China, Apr 2004)H5N1 (Animal, Mainland China, Apr 2004) •• SARS (Mainland China, Apr 2004)SARS (Mainland China, Apr 2004)

Roles of Hong Kong in global &Roles of Hong Kong in global & regional effortregional effort

�� OnOn--site Supportsite Support •• Clinical team to Viet Nam on H5N1 (Feb 2004)Clinical team to Viet Nam on H5N1 (Feb 2004) •• More potentialMore potential

�� Various expertise in Hong KongVarious expertise in Hong Kong �� Practical experiencePractical experience

Roles of Hong Kong in global &Roles of Hong Kong in global & regional effortregional effort

�� Capacity buildingCapacity building •• Each country should have core capacity to containEach country should have core capacity to contain

disease in early stagedisease in early stage •• TrainingTraining

�� LaboratoryLaboratory �� EpidemioEpidemiologylogy �� Infection control etc.Infection control etc.

Thank youThank youThank you