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 Photo credit: Ben Curtis/ Photo credit: International Associated press Organization for Migration 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 National Center for Emerging and Zoonotic Infectious Diseases Division of Global Migration and Quarantine

Why cross Why cross-border border collaboration? (1/3) ollaboration? (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) ollaboration? (3/3)  Routes and destination Routes and destination of travel of 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 of Photo credit: Africa Field Program, arriving arriving refugees refugees 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 outbreaks still likely outbreaks 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 on on 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 Malaria in Kakuma Refugee Camp: Jan - Dec 2016 9000 8000 Number of malaria cases 7000 6000 5000 4000 3000 2000 1000 0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031323334353637383940414243444546474849505152 Epidemiological week

Stable Refugee Situation (2/5) Stable Refugee Situation (2/5) Photo credit: John W. Burton -UNHCR  Floods Floods destroying destroying infrastructure infrastructure

Stable Refugee Situation Stable Refugee Situation (3/5) (3/5)  Movement between ovement 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 of origin of origin  Factors like drought, worsening insecurity may force influx into the camps  Maintain contact with partners working in country of origin

Stable Refugee Situation (4/5) Stable Refugee Situation (4/5)  Ebola virus Ebola virus  Vaccine Vaccine-derived derived polio virus type polio virus type 2  Measles Measles  Cholera Cholera  Monkeypox Monkeypox  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): departure Period (1/3 ) Immediate Pre Immediate Pre-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 Photo credit: Africa Field Program  Complex medical Complex medical conditions stabilized and conditions stabilized and prepared for travel prepared for travel

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 of medications used  Priority diseases Priority diseases that that pose serious threat to pose serious threat to Photo credit: IOM travel travel

USRAP Immediate USRAP Immediate Pre Pre-departure Period (3/3 departure Period (3/3 )  Monitor closely disease Monitor closely disease outbreaks in refugee outbreaks 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 Multidrug -resistant TB Pertussis Photo credit: International Organization Polio 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