Transcript Using the Modified Haddon Matrix to Deal with Infectious Disease

Using the Modified Haddon Matrix to
Deal with Infectious Disease
Outbreaks
Kai-Lit Phua, PhD FLMI
Associate Professor
Medicine & Health Sciences
Monash University (Sunway Campus)
Biographical details
Kai-Lit Phua received his BA (cum laude) in Public Health
& Population Studies from the University of Rochester
and his PhD in Sociology (medical sociology) from Johns
Hopkins University. He also holds professional
qualifications from the insurance industry.
Prior to joining academia, he worked as a research
statistician for the Maryland Department of Health and
Mental Hygiene and as an Assistant Manager for the
Managed Care Department of a leading insurance
company in Singapore. He was awarded an Asian Public
Intellectual Senior Fellowship by the Nippon Foundation
in 2003.
Lecture Objectives
Brief overview of the Haddon Matrix
 The Haddon Matrix as a useful tool in the
analysis and control of disease outbreaks
 Example of the use of the Haddon Matrix

The Haddon Matrix
William H. Haddon, Jr., came up with a
Matrix to systematically analyze car crashes
 The aim was to derive effective injury
prevention and control strategies
 The original Matrix was a 3 X 3 table
 It was later expanded to a 3 X 4 table

Haddon Matrix
Agent
Pre-event
During the
event
Post-event
Host
Physical
Social
Environment Environment
Using the Haddon Matrix (based
on Cassens 1992)
Agent
e.g.
car
Host
e.g.
driver
Physical
Social
Environment Environment
Before the
event
(crash)
Good
brakes, car
properly
maintained
Good vision,
alert
Welldesigned
roads and
highways
Penalize
drunk
driving
heavily
During the
event
Airbags,
anti-lock
brakes
Motorcycle
helmet,
seatbelt
Non-rigid
roadside
poles, crash
barriers
Mandate the
use of safety
glass in
windows
After the
event
BurnEmergency
resistant
medical care
fabrics in car
cabin
Effective
emergency
transport
system
Support
medical and
rehabilitation
services
Successful Use of the
Haddon Matrix in Injury Control

The Haddon Matrix was successfully used in
the control of car crash injuries. It was later
used to control other injuries too.
Can the Haddon Matrix Be Used
for Infectious Disease Control?
The Haddon Matrix forces us to think
systematically about the particular health
problem we are dealing with
 Dan Burnett proposed that the Haddon
Matrix be used against SARS
 Phua modified and expanded the Haddon
Matrix and proposed its use against Nipah
virus. (He also proposed its use against
natural disasters such as tsunamis).

Phua’s “Modified Haddon Matrix” to Study Infectious Disease Outbreaks
& Natural Disasters
Agent
Factors leading to the event
(before the event)
Factors affecting severity, rate of spread, and
extent of impact (during the event)
Reactions to the event (during the event)
Short-term and long-term effects
(after the event)
Intermediate
host
“Host”
(I)Affected
individual
(II)Individual’s
family
(III)Affected
community
(IV)The larger
society
Environment
Using the “Modified Haddon Matrix” to Analyze Avian Influenza :
Action to be Taken Against Factors Identified Below
Agent
Intermediate host
“Host”
Environment
(I)Affected individual
(II) Family members
(III)Affected
community
(IV) Larger society
Factors leading to the event
(before the event)
Agent can
cause disease
in humans
Avian influenza virus
present in wild,
migratory birds
(I) Close contact with &
eating of sick birds
(III) Raising chickens is
important economic
activity
Close proximity of
people & birds e.g.
rearing backyard
chickens
Factors affecting severity,
rate of spread,
and extent of impact (during
the event)
Agent does
not spread
easily
between
humans
Can spread from wild to
domestic birds; wild bird
migration patterns in
Europe and Asia
(I) Mobility of infected
individual
(II) Close contact
(III) Community
dependent on raising
chickens
(IV) Chicken exports to
foreign countries
Sale and smuggling
of infected birds is
not stopped quickly
(III) Fear (IV) Mass
culling; active
monitoring by WHO &
Ministry of Health
Tourist arrivals
affected
(I) High mortality
(II) Deaths affect family
members
(III) & (IV) Economic
losses
Boon for drug
companies; fear of
more virulent
strains appearing
Reactions to the event
(during the event)
Short-term and long-term
effects (after the event)
Evidence that H5N1 can
also affect non-human
animals
References

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
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Burnett DJ et al. The Application of the Haddon Matrix to Public
Health Readiness and Response Training. Environ Health Perspect.
2005; 113(5): 561-66
Cassens BJ. Preventive Medicine and Public Health. 2nd ed. 1992.
Philadelphia: Harwal Publishing.
Haddon W. On the Escape of Tigers: An Ecologic Note. Am J Pub
Health. 1970; 60: 2229-34.
Haddon W. Options for the Prevention of Motor Vehicle Crash Injury.
Isr Med J. 1980; 16: 45-65.
Phua KL, Lee LK. Meeting the Challenge of Epidemic Disease
Outbreaks: An Agenda for Research. J of Pub Health Policy. 2005;
26(1): 122-32.
Phua KL. A Model for Lessening the Impact of Natural Disasters and
Infectious Disease Outbreaks. J of Emergency Management. 2006;
4(5): 69-74.
Phua KL. Post-Disaster Victimization: How Survivors of Disasters Can
Continue to Suffer After the Event is Over. New Solutions. 2008;
18(2): 221-31.
Thank You