Transcript A Vision for APEC

APEC Network of Networks
Initiative: In Support of Infectious
Disease Surveillance
Enhancement in the InterSARS period
Ann Marie Kimball, MD., MPH
School of Public Health and
Community Medicine
University of Washington
Human Disease as Travelers on the
Global Express- How Can We Keep
Up?
The SARS Outbreak: May 6, 2003
Washington Post
Source: World Health
Organization/CDC
The Asia Pacific Economic
Community
• Accomplishments in combating emerging
infections
• Challenges that remain
• Networking as a part of our strategy
• New frontiers in networking
APEC- What is it?
• Founded in 1989, “Health” initiative begun
in 1995.
• 21 member economies (includes Taipei), 2.5
billion people
• Combined GDP $19 trillion, 47% of global
trade
• First Health Ministers meeting July
28,2003, related to SARS.
APEC Leaders Summit
October 2001, Beijing
Leaders Declaration Los Cabos, 2002
• “We instructed Ministers to build on work
underway to establish a regional public
health surveillance network and an early
warning system to monitor and respond to
critical disease outbreaks in the region and
critical threats such as bio-terrorism.”
Six Strategic Action Areas
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Electronic networking
Surveillance
Outbreak response
Capacity building
Partnering across sectors
Political and economic leadership
APEC Networking: Assets and
Threats
• ASSETS: Numerous
networks established
• High level of internet
use
• General strong
technical competence
• Political will
• THREATS: Pace of
trade, outbreaks
increasing rapidly
• Diverse region,
• Limited penetration of
APEC leaders
declaration to working
levels.
Internet Use in APEC Economies
1997
Source: Nua Ltd. and others, 1997, http://www.nua.ie/surveys/how_many_online
Internet Use in APEC Economies
1999-2001
Source: Nua Ltd. and others, 2001, http://www.nua.ie/surveys/how_many_online
APEC EINet Trade/Commerce Participation
Inter-country Surveillance Network
APEC Einet What have we learned?
• Human networks are key
to effective networking
• The internet is potential a
powerful training tool for
Asia Pacific
• We can foster intersectoral
discussion through our
user group
• Information accuracy is
central to success
SARS An Emergent Infection
Amplified by Travel
• Coincident urgent biomedical research,
disease control requirements for
information exchange
• WHO served “Fair Broker” role for
facilitating these processes.
• Technologies in use adequate, perhaps not
optimal
• Networks can synergize for preparedness
Frontiers in Networking
 Strong working
relationships within
country, among countries
 Reliable accurate
laboratory
 Real time outbreak
collaboration
 High Quality Network
performance
Outbreak Area 1, epi data
From the Public Health Manager
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Seattle Scenario- December 15 2003
The Communicable Disease Epidemiologist has been notified of seven cases of
probable SARS in the last 24 hours by infection control personnel in three city
hospitals. Six of these are family members or neighbors of an index case who
arrived to visit his relatives from Outbreak 1 Area on December 1,2003. He
arrived by air, feverish and ill. He was hospitalized in the County Hospital on
December 5 after becoming increasingly ill with shortness of breath, and
increasing weakness. Two of the family members who are now among the
cases waited with him in the Emergency Room for 2 hours the evening of his
admission. The hospital instituted SARS protective measures upon his
admission, and he is in strict isolation in the Intensive Care unit where his
condition is deteriorating at this time. All of the six other probable cases have
also been hospitalized in three facilities: the County Hospital, Private Hospital
A, Private Hospital B. All are located in downtown Seattle within 2 miles of
one another.
Number of probable cases of SARS, by
date of onset—Seattle, USA, 2003
The Epidemiologist has compiled a line listing of these
cases:
5
Accession
number
Age/Sex
Date of Onset
Hospital
Relationship to Index
001
35/male
11/29/03
County
Index
002
32/female
12/14/03
County
Sister
16/female
12/14/03
County
Neice
004
14/male
12/15/03
County
Nephew
005
67/female
12/13/03
Hospital A
Neighbor
36/male
12/13/03
Hospital B
Neighbor
37/male
12/14/03
Hospital B
Neighbor
003
4
006
No. cases
007
3
2
1
0
11/28
11/30
12/2
12/4
12/6
12/8
Date
12/10
12/12
12/14
12/16
Seattle, spatial location of cases
•Figure 1:
The APAN/TransPAC Networks
APEC Region- Virtual Tabletop
• Strong Political
endorsement for
control of Emergent
Disease at highest
level of APEC
• Rapidly increasing
speed, access of
internet in region
• Table top exercise can
identify multisectoral
response prospectively
• Populating tabletop
has value for partners
individually
• Collectively partners
benefit from sharing
common exercise