Surveillance Strategies in African Surveillance Strategies in - - PowerPoint PPT Presentation

Surveillance Strategies in African Surveillance Strategies in African Refugees in their Country of Asylum Refugees in their Country of Asylum

National Center for Emerging and Zoonotic Infectious Diseases Division of Global Migration and Quarantine

Maurice Ope, MBChB, MPH, MSc Maurice Ope, MBChB, MPH, MSc Immigration Health Immigration Health - Africa Field Program Africa Field Program Division of Global Migration and Quarantine Division of Global Migration and Quarantine International Conference on International Conference on Migration Health Migration Health October 1 October 1-3, 2018 3, 2018

Photo credit: Ben Curtis/ Associated press Photo credit: International Organization for Migration

Why cross Why cross-border border collaboration? (1/3)

• llaboration? (1/3)

 Several Regional

Several Regional Economic conomic Communities (RECs) in Africa Communities (RECs) in Africa

 Common Market Established

Common Market Established by RECs by RECs

• Intended to foster economic

growth and social development

• Free movement of goods, labor,

and services

 Ill travelers may seek care

Ill travelers may seek care across international borders across international borders

Why Why cross cross-border collaboration? (2/3) border collaboration? (2/3)

 Port health staff in official

Port health staff in official crossings crossings

• More unofficial than official

crossings

• Volume of travelers may be

higher in unofficial crossings

 Purpose of travel

Purpose of travel

• Seek health care
• Mortuary services
• Pasture

Source: The East African Online (http:// www.theeastafrican.co.ke )

Why Why cross cross-border border collaboration? (3/3)

• llaboration? (3/3)

 Routes and destination

Routes and destination

• f travel
• f travel

 Volume of movement at

Volume of movement at the borders the borders

 Health services

Health services available at borders available at borders

Strengthening Strengthening cross ross-border border collaboration (1/2) collaboration (1/2)

 Need a framework for collaboration across borders

Need a framework for collaboration across borders

• Sensitivities on information sharing
• Who has authority to share information
• Agreement of local and national governments

 Identify stakeholders and their roles at borders

Identify stakeholders and their roles at borders

 Map and understand border characteristics

Map and understand border characteristics

Strengthening Strengthening cross ross-border border collaboration (2/2) collaboration (2/2)

 Joint

Joint response planning and training response planning and training

• Trainings, tabletop and field simulation

exercises including communities

• Cross
• border meetings

 Binational information

Binational information sharing sharing

Acute Refugee Acute Refugee Crisis (1/4) Crisis (1/4)

 Multiple factors promote

Multiple factors promote disease transmission disease transmission

• High influx of refugees
• Overcrowding
• Inadequate infrastructure
• Poor nutritional status
• Overwhelmed public health

system

Photo credit: CARE Australia

Acute Refugee Acute Refugee Crisis (2/4) Crisis (2/4)

 Focus

Focus is on is on disease prevention disease prevention and control and control

• Site

planning

• Clean water
• Vaccination
• Vector control
• Personal

protection

 Data

Data are needed to are needed to

• Detect epidemics
• Determine the quality,

coverage and effectiveness of response programs

• Prioritize interventions

Acute Refugee Acute Refugee Crisis (3/4) Crisis (3/4)

 Priority

Priority diseases diseases

• Diarrheal illness
• R

espiratory illness

• Measles
• Malaria
• Meningitis
• Other epidemic-prone diseases

 Identify health needs

Identify health needs of

• f

arriving arriving refugees refugees

Photo credit: Africa Field Program, Dr Rachel Eidex

 Syndromic surveillance to detect outbreaks

Syndromic surveillance to detect outbreaks

• Inadequate laboratory services
• False outbreak alarms for diseases with nonspecific symptoms

Acute Acute Refugee Refugee Crisis (4/4) risis (4/4)

 Set

Set up refugee screening sites up refugee screening sites

• Transit centers located at borders
• Reception centers at the camps

 Disease

Disease

• utbreaks still likely
• utbreaks still likely
• Undetected infectious disease incubating among newly arriving

refugees

• Prepare

communities to ensure timely detection and response

Stable Refugee Situation (1/5) Stable Refugee Situation (1/5)

 Focus

Focus

• n
• n infrastructure improvement and capacity

infrastructure improvement and capacity building building

• Providing safe water and improving sanitation
• Monitoring morbidity and mortality
• Detecting disease outbreaks

 Some events increase likelihood of disease outbreaks

Some events increase likelihood of disease outbreaks

1000 2000 3000 4000 5000 6000 7000 8000 9000 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031323334353637383940414243444546474849505152

Number of malaria cases Epidemiological week

Malaria in Kakuma Refugee Camp: Jan - Dec 2016

Stable Refugee Situation (2/5) Stable Refugee Situation (2/5)

 Floods

Floods destroying destroying infrastructure infrastructure

Photo credit: John W. Burton

• UNHCR

Stable Refugee Situation Stable Refugee Situation (3/5) (3/5)

 Movement between

• vement between country of origin and

country of origin and refugee camps refugee camps

• Insecurity in country of origin then health infrastructure remains

poor

• Unvaccinated arrivals
• Multidrug -resistant infections

 Maintain situational awareness of conditions in country

Maintain situational awareness of conditions in country

• f origin
• f origin
• Factors like drought, worsening insecurity may force influx into the

camps

• Maintain contact with partners working in country of origin

Stable Refugee Situation Stable Refugee Situation (4/5) (4/5)

 Ebola virus

Ebola virus

 Measles

Measles

 Monkeypox

Monkeypox

 Vaccine

Vaccine-derived derived polio virus type polio virus type 2

 Cholera

Cholera

 Yellow fever

Yellow fever

Stable Refugee Situation Stable Refugee Situation (5/5) (5/5)

 Additional priority diseases

Additional priority diseases

• Tuberculosis
• HIV

 Surveillance strategies

Surveillance strategies

• Syndromic surveillance
• Laboratory-based surveillance
• Including drug resistance
• Sentinel surveillance

Africa Field Program staff photo in a refurbished camp laboratory

US Refugee Admission Program (USRAP): US Refugee Admission Program (USRAP): Immediate Pre Immediate Pre-departure Period (1/3 departure Period (1/3 )

 Ensuring safe travel

nsuring safe travel

• Protect the health of refugee

during travel

• Protect other travelers
• Prevent

importation of disease to final destination

 Known applicant since

Known applicant since migration health migration health assessment done assessment done

 Complex medical

Complex medical conditions stabilized and conditions stabilized and prepared for travel prepared for travel

Photo credit: Africa Field Program

USRAP Immediate USRAP Immediate Pre Pre-departure departure Period (2/3) eriod (2/3)

 Protection to refugee

rotection to refugee from known diseases from known diseases

• Vaccination against

Measles, Mumps, Rubella, polio, tetanus

• Presumptive treatment for

intestinal parasites

 Counterfeit medicines

Counterfeit medicines

• Routine testing of samples
• f medications used

 Priority diseases

Priority diseases that that pose serious threat to pose serious threat to travel travel

Photo credit: IOM

USRAP Immediate USRAP Immediate Pre Pre-departure Period (3/3 departure Period (3/3 )

 Monitor closely disease

Monitor closely disease

• utbreaks in refugee
• utbreaks in refugee

camps camps

 Check departing refugees

heck departing refugees daily for signs of illness daily for signs of illness

 Duration of surveillance

Duration of surveillance depends depends

• Incubation period
• Resources available

Photo credit: Africa Field Program

Response to Public Health Events 2007 Response to Public Health Events 2007–2018 2018

Pertussis Multidrug -resistant TB Polio

Photo credit: International Organization for Migration

Conclusion Conclusion

 Strong cross

Strong cross-border collaboration is essential border collaboration is essential

• For disease prevention and control prior to acute refugee crisis
• To determine prevalence of priority diseases and immediate needs

for newly arriving refugees

 Surveillance strategies should take into account the

Surveillance strategies should take into account the priorities and disease transmission factors priorities and disease transmission factors

 Deliberate measures can ensure uninterrupted

Deliberate measures can ensure uninterrupted resettlement despite public health threats resettlement despite public health threats

For more information please contact Centers for Disease Control and Prevention For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1

• 800-CDC
• INFO (232
• 4636)/TTY: 1
• 888-232-6348

E

• mail: cdcinfo@cdc.gov

Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for Emerging and Zoonotic Infectious Diseases National Center for Emerging and Zoonotic Infectious Diseases Division of Global Migration and Quarantine Division of Global Migration and Quarantine

Thank You! Thank You!

Pharmacy wall, Dadaab Refugee Camp

Definitions Definitions

Asylum seeker Asylum seeker

• Claims refugee status but claim has not yet been

definitively evaluated

Refugee Refugee

• Well-founded fear of persecution based on race,

religion, nationality, membership in a particular social group, or political opinion

• Outside their home country

Migrant Migrant

• Decision

to migrate is taken freely