Preventing disease Promoting and protecting health CARPHA A New - - PowerPoint PPT Presentation

Preventing disease Promoting and protecting health

Preventing disease, promoting and protecting health

CARPHA

A New Caribbean Public Health Agency: Responding to public health emergencies

Dr Babatunde Olowokure Director Surveillance, Disease Prevention & Control Division CARPHA

CARIB RISK CLUSTER 4 June 2014 Martinique

Preventing disease, promoting and protecting health

OVERVIEW

• General description of CARPHA
• Responding to public health emergencies:

– Flooding - St Lucia – Emerging disease - Chikungunya

• Vector control
• Take home messages

Preventing disease, promoting and protecting health

The Agency

• The Caribbean Public Health Agency (CARPHA) is the new single

regional public health agency for the Caribbean.

• Legally established in July 2011 by an Inter-Governmental Agreement

(IGA) signed by Caribbean Community (CARICOM) Member States and began operation in January 2013.

• CARPHA combines the functions of five previous Caribbean Regional

Health Institutes (RHIs) into a single agency:

– Caribbean Environmental Health Institute (CEHI) – Caribbean Epidemiology Centre (CAREC) – Caribbean Food and Nutrition Institute (CFNI) – Caribbean Health Research Council (CHRC) – Caribbean Regional Drug Testing Laboratory (CRDTL)

• CARPHA is an institute of CARICOM and addresses public health issues

requiring regional response and, where appropriate coordination.

Preventing disease, promoting and protecting health

Member Countries: 24

• Dominica
• Grenada
• Haiti
• Guyana
• Jamaica
• Montserrat
• St. Kitts & Nevis
• St. Lucia
• St. Maarten
• St. Vincent & the Grenadines
• Suriname
• Trinidad & Tobago
• Turks & Caicos Islands
• Anguilla
• Antigua & Barbuda
• Aruba
• Bahamas
• Barbados
• Belize
• Bermuda
• BES Islands (Bonaire, Saba

& St Eustatius)

• British Virgin Islands
• Cayman Islands
• Curacao

Preventing disease, promoting and protecting health

Our Mission

• To provide strategic direction in analysing,

defining and responding to public health priorities

• f CARICOM, in order to prevent disease,

promote health and respond to public health emergencies.

• To support solidarity in health, as one of the

principal pillars of functional cooperation, in the Caribbean Community.

Preventing disease, promoting and protecting health

CARPHA: EMERGENCY PREPAREDNESS AND RESPONSE

Preventing disease, promoting and protecting health

Emergency response to flooding in St. Lucia and St Vincent & the Grenadines:

• On the 24th of December 2013, heavy rains from a low-

pressure trough caused significant damage in the Eastern Caribbean Islands of St. Vincent, Dominica and St. Lucia

• Most of the damages caused were as a result of flooding

especially in the low lying areas.

• Assistance was provided by CARPHA St Lucia in

facilitating access to emergency water treatment solutions to these countries in the aftermath of the storm through contributions from Operation Blessing, the US Centers for Disease Control and Prevention and Procter and Gamble.

Preventing disease, promoting and protecting health

Emergency response to flooding in St. Lucia and St Vincent & the Grenadines:

• Operation Blessing dispatched an engineer to St. Lucia to

reactivate a portable water treatment system for field deployment

• US CDC supplied a total of 28 residual chlorine field test kits

(20 to St Lucia and 8 to St Vincent) and Procter and Gamble supplied 3 boxes (720) water disinfection sachets to St Vincent.

• The St Lucia team also participated in a field assessment

along with a PAHO assessment team.

• A lessons learned meeting has been proposed by CARPHA to

MOH St Lucia – to include review of vector control measures

Preventing disease, promoting and protecting health

Preventing disease, promoting and protecting health

The emergence of CHIK in the Caribbean

• The Caribbean Public Health Agency (CARPHA) received

reports of cases of chikungunya on the island of Saint Martin in early December 2013.

• This was the first time that locally transmitted

chikungunya (CHIK) had been identified in the region.

• Additional cases have since been reported in other

countries/territories in the Region

• As at 2 June 2014 there have been 5,252

confirmed/probable cases reported by 18 countries/territories in the region

• Experience elsewhere suggests long-term health impacts

Preventing disease, promoting and protecting health

CHIKINGUNYA CASES: 2 June 2014

**Includes 2 death indirectly related to Chikungunya and seven deaths whose relation to Chikungunya fever is being determined ***Includes one death indirectly related to Chikungunya due to co-morbidities and one death whose relation with Chikungunya fever could not be established (EW 09 2014)

Country/Territory # Confirmed/Probable Cases # Suspected Cases Anguilla 33 N/A Antigua & Barbuda 4 N/A Aruba 1 N/A British Virgin Islands 20 N/A Dominica 122 1,817 Dominican Republic 17 38,639 French Guiana 222 N/A Guadeloupe 1,328 (1) 23,100 Guyana 2 N/A Haiti 632 N/A Martinique 1,515 (9**) 29,200 Puerto Rico 1 N/A

• St. Barthelemy

135 520

• St. Kitts and Nevis

22 N/A

• St. Lucia

5 N/A

• St. Vincent & the Grenadines

57 110 Sint Maarten 343 N/A

• St. Martin

793 (3***) 3,320

Preventing disease, promoting and protecting health

CHIK – CARPHA response

Coordination

• CARPHA quickly established an incident management team to coordinate

the response among member states, and with partners

• The response was multidisciplinary and multifaceted
• CARPHA - important role in catalyzing and coordinating the response.

Partnership with PAHO/WHO

• CARPHA working closely with PAHO in response to the outbreak

– Joint outbreak response to St Maarten – Coordinated supply of bednets to Dominica for use in hospitals – Support reporting by CMS to PAHO/WHO IHR NFP – Discussions on vector control, insecticide resistance and environmental sanitation – Regular bimonthly teleconferences – Ad hoc calls and conferences as required on technical issues as they arise

Preventing disease, promoting and protecting health

CHIK – CARPHA response

Field response

• CARPHA has deployed teams to the field to support CMS in:

– St Maarten (jointly with PAHO/WHO) and Dominica

Laboratory response

• CARPHA provides diagnostic testing for member states
• A network of laboratories in the Caribbean, including those of

CARPHA, US CDC, and Institut Pasteur in French Guiana are conducting appropriate diagnostic tests to confirm the presence

• f the chikungunya virus in suspected patients.
• Assesses insecticide resistance of vector

Preventing disease, promoting and protecting health

CHIK – CARPHA response

Communication

• CARPHA has a dedicated chikungunya page on its website –

including:

– Weekly updates to reflect changes in the number of reported cases. – Media statements – Vector control

• Regular and ad hoc teleconferences with Member States to:

– share information – provide technical advice

• Regular teleconferences are held with:

– Representatives from: Institute Pasteur – Cayenne; ECDC; Public Health England; US CDC; Public Health Agency of Canada (PHAC); PAHO and others.

Preventing disease, promoting and protecting health

Chikungunya – vector control … coming to a place near you soon… …are you prepared?

Preventing disease, promoting and protecting health

Preparedness and Response

Preventing disease, promoting and protecting health

Preparedness and Response

Preventing disease, promoting and protecting health

Importance of Vector Control

• No vaccines or treatment available for vector-

borne diseases such as dengue and chikungunya

• Most effective tool for prevention and control
• f these diseases is vector control through

Integrated Vector Management (IVM)

Preventing disease, promoting and protecting health

CARPHA’S Role in Vector Control

• Provide technical advice and assistance to countries in

preparedness for and response to outbreaks of vector-borne diseases

• Provide assistance to countries in the development of IVM

plans as part of the Integrated Management Strategy for Dengue (IMS-Dengue) prevention and control (partnership with PAHO)

• Build capacity in countries through training of Environmental

Health and Vector Control Officers in:

– Basic microscopic identification of mosquitoes of public health importance – Methods of vector control – Vector surveillance

Preventing disease, promoting and protecting health

CARPHA’S Role in Vector Control

• Conduct needs assessments and evaluations of vector control

programmes, and make recommendations for improvements

• Provide guidance to countries in monitoring and evaluation of

vector control programmes

• Provide assistance to countries in the development of research

protocols and execution of research projects

• Conduct evaluations of “new” vector control tools
• Provide services such as:
• Microscopic identification of arthropods of public health importance
• Insecticide Resistance Testing (Aedes aegypti) – use WHO Bioassay

methods

Preventing disease, promoting and protecting health

Vector control measures - CHIK

• Preparedness
• Advice - combine dengue and CHIK prevention

and control

• Vector control operations - surveillance
• Integrated Vector Management

– Environmental management = breeding sites – Chemical control = spraying, bednets

• Communication

– Community engagement – Educational materials

• Individual protection
• Household protection

Preventing disease, promoting and protecting health

Vector control - challenges

• Surveillance

– Monitoring vector populations and at-risk populations – Communication with local epidemiology units, and others

• Vector Control

– Elimination of larval habitats – Community engagement – Fogging method – Insecticide resistance – Human resource capacity and capability – Sustained commitment

Preventing disease, promoting and protecting health

Vector control - challenges

• Personal/Household protection

– Individual protection – Storage drums – Environmental sanitation

• Monitoring and evaluation

– Lack of M&E culture

• Multisectoral coordination and collaboration

– Requires strengthening

• Research

– Lack of evidence-base

• Development of sustainable vector control methods
• Burden of illness studies
• Effectiveness of vector control methods
• Resistance testing

Preventing disease, promoting and protecting health

Take home messages…

• Recent events have demonstrated the value of CARPHA in

responding to major regional public health events;

• CARPHA will coordinate and collaborate regional response

to major public health events - CHIK response;

• Sustained commitment - substantial challenges ahead;
• Strengthen epidemiological and laboratory surveillance

systems, and vector control response capability;

• Use a coordinated multisectoral approach;
• Provide timely and accurate information to help avoid

confusion or miscommunication;

• Educate the public, and visitors on the importance of

protecting themselves from being bitten by mosquitoes;

Preventing disease, promoting and protecting health

Take home messages…

• Protect – individuals, households, communities;
• Encourage individuals and communities to take

responsibility;

• Leverage opportunity provided by chikungunya to strengthen

health systems and prepare for long-term morbidity;

• Combine CHIK and dengue control efforts;
• Conduct - operational research, monitoring and evaluation;
• CARPHA will organize an Expert consultation on

chikungunya in the Caribbean;

• CARPHA in partnership with CARICOM and PAHO to

establish an annual ‘Caribbean Mosquito Awareness Week’.

Preventing disease, promoting and protecting health

Acknowledgements

• GC Martinique
• CARPHA Member States
• Institute Pasteur – Cayenne
• PAHO/WHO
• US CDC;
• CARPHA CHIK IMT

Preventing disease, promoting and protecting health

http://carpha.org/

THANK YOU