early warning system in tunisia: evolution, challenges and place of environment and modeling

Pr ofessor Nissaf Bouafif ép Ben Alaya General Director Observatory of New and Emerging Diseases

Early Warning System in Tunisia: Evolution, Challenges and place of Environment and

Modeling

Timeline

1 •Presentation of Tunisian national surveillance system

2 •Examples of emerging diseases surveillance system implemented in Tunisia

3 •Challenges to improve Health surveillance in Tunisia

4 •Implementation of IHR capacities and health hazards in Tunisia

5 •Evaluation of Tunisian surveillance system 2013-2014 and priorities

6 •German partnership program in Tunisia

7 •Perspectives

Local level

Organization of national surveillance system of Infectious Diseases in Tunisia

National Level

Moh

DMSU DSSB ONMNE DHMPE

Regional level

Departement of preventive medecine

Early Warning Unit Rapid Response Team

CSB ER Laboratories GP Hospitals Others

ShocRoom

National Public Health Surveillance System for Infectious Diseases (IDs)

Disease monitoring To guide intervention and control programs To give evidence for policy making To allow Appropriate allocation of resources

Structured data Routinely produced Passively collected With established case definitions

Sources of data Health-care facilities Laboratories Death registers

IBS: Indicator-based surveillance

DSSB

Objectives of National Public Health Surveillance System for Infectious Diseases (IDs)

Disease monitoring To guide intervention

and control programs To give evidence for

policy making To allow Appropriate

allocation of resources

Early detection of acute public health events To ensure rapid

detection and investigation

To implement appropriate response and control of events

DSSB ONMNE

Timeline







7 •Perspectives

Human Geographic distribution of 2012 outbreak

Predicted distribution according to animal surveillance

West Nile surveillance Multidisciplinary approach

Risk assessment and appropriate management

Prepare documents Preparation of the

national response to a possible outbreak of human infection with the MERS-Cov

Information for travelers Technical data sheet

Prepardness plan for MERS-CoVin Tunisia

20 M

arch

The index c

ase tra

velled to

Qatar

29 M

arch

The index c

ase tra

velled to

Saudi Arabia

04 A

pril

The index ca

se ca

me back to

Qatar

28 A

pril

The index ca

se ca

me back to

Tunisia

01 M

ay

Symptom onse

t

04 M

ay

1st vis

it to emergency

06 M

ay

Hospita

lizatio

n resp

iratory

distress

10 M

ay

Death

15 M

ay

Sampling from co

ntacts

20 M

ay

Confirmatio

n MERS-C

ov contacts

Period of exposure of the index case

Period of exposure of

contacts

Confirmation of MERS-Cov index cas

Investigation of the MERS- CoV cluster in Tunisia

Oct

ober

Timeline







7 •Perspectives

Advantages

Highly valuable for Known diseases, Stable context Good access to

healthcare / laboratory facilities

Specificity

Disadvantages

Scope Often communicable diseases Fixed list of diseases & syndromes

Timeliness Delays for Reporting procedure /data

analysis & biological confirmation Reactivity

Fixed case definitions, procedures…. Emergency situation

Coverage Uneven accessibility to healthcare Hard to reach areas &population

IBS for EWAR

Timeline







7 •Perspectives

● Paradigm shift Disease-based surveillance All hazards All sources of information

● Core surveillance capacities : Detection Assessment Notification/reporting Response

● IHR requirements Early detection based on health reporting is not enough Needs to develop access to other sources of information

International Context : IHR

WHO evaluation of IHR capacities and health hazards Implementation Global Level - 2013

Legis

lation

Coordi

natio

n

Surveil

lance

Respo

nse

Prepare

dnes

s

Risk C

om

Human

Res

ource

s

Labo

ratory PoE

Zoono

ses

Food s

afety

Chemica

l

Radio-

nucle

ar0

10

20

30

40

50

60

70

80

90

100

7073

80 79

63

72

60

76

54

81

71

52 51

Tunisia is under the global Level ?

EWAR and EBS are not well defined and implemented

Not all events (not only communicable diseases) are detected timely and comprehensively

Preparedness plan are limited to some diseases Laboratories capacities are to improve Risk Communication strategy is not available

Timeline







7 •Perspectives

IBS is implemented but is not optimal because of lack of resources, Trained staff

and turn over Operating budget:

implementation and supervision of activities

Tools and equipment Electronic transmission of data

EBS is not well defined Access to other sources of

information, multisectoral collaboration and processes are not systematized/formalized

National Evaluation of Tunisian surveillance system, 2013-2014Priorities

To improve surveillance with the establishment of Epidemic intelligence Integration of EBS and IBS Rapid reporting of events using

regular epidemiological conference « EpiTec » tool

To improve crisis communication To improve preparednessDelays in detection, reporting,

analysis, and response

Priorities

Epidemic intelligence

Systematic collection, analysis, and communication of information to:

Detect Verify Assess Investigate

Integrates IBS and EBS

Events and health risks with an EWAR objective

• Outbreak Investigation

• Field Research

• Support through Communicating results of Assessments

• Targeted recommendations

• Surveillance• EBS

• GP Networking• ER Networking

• Diseases Specific surveillance

• Field Research• Program Evaluation

Evaluation &

Monitoring

Event Detection

Risk AssessmentPrevention

& Control Measures

Epidemic Intelligence for Risk Management Cycle

Epid

emic

Inte

llige

nce

Risk management cycle

Event Detection

risk assessment (formal and rapid)

Control measures and prevention

Monitoring and evaluation

Communication des risques Epidemiological

intelligence

Prevention Preparedness Response Resilience

Early Warning System

Assessment and management of public health threats

Institutes and Public Health Departments

other Partnersnational experts

Ministry of HealthOther parteners

Assessment

Management

Timeline







7 •Perspectives

24

Goals of the project

03.05.2023

Reduce biological security risks Enhance Tunisian health capacities Foster international scientific exchange and qualify scientific

personnel Contribute to the fight against dangerous diseases Support the safe and secure conduct with dangerous

pathogens and toxins

Crisis communication Strategy development and media trainingJoint training for epidemiologists and laboratory EpiLab

Support the establishment of an “Epidemic Intelligence Committee”•EBS implementation•EpiTec implementation

Support of the development of a Tunisian epidemic preparedness plan

Improvement of P3 capacities

Improvement of biosafety & diagnostics of highly pathogenic viruses

Training Biosafety and Biosecurity & Biorisk Management

• EpiTec• Networking

Tools

• IBS• EBS

EWRS• Procedures, SOPs• Risk communication

strategy and media training• Prepardness plan 2P2R

Preparedness and response plan

Activities implemented by the project

Tab simulation exercice

Field Simulation exercice

Activities implemented by the project

Timeline







7 •Perspectives

Elaboration of action plan (national and regional) Development of

standardized protocols, SOPs & guides

Preparation of records of data collection

Computerized monitoring system and electronic transmission of information

Conduct more simulation

exercises

Next steps for strengthening of EWAR

Establishment of an environmental warning system Climate warning system Animal and entomological

system Connection to other partners

(other administrative database)

Human resources capacity development and training

Data collectionGeo-referencing Data entry

Common database for the EWRS

What are the challenges for the development of health Surveillance EWRS

Political vision for the organization of health systems in the coming decades The legal framework and review of the different institutions Missions Strengthening public health institutions Convergence of different epidemiological surveillance networks in Tunisia The governance of epidemic warning tools

Organization of health surveillance Operating the health alert system The development of health warning tools

The strengthening of health surveillance systems Human resources Logistic Funding

The development of international cooperation and networks (InVs, ECDC, RKI,GIZ, ACDC, CDC)

Thanks

early warning system in tunisia: evolution, challenges and place of environment and modeling

Health & Medicine