Pacific Public Health
Surveillance Network:
Framework 2006
What is the PPHSN?
PPHSN is a voluntary network of
countries/territories and institutions/
organisations
Dedicated to the promotion of public
health surveillance & response
Current focus on CDs: epidemic ones
first
PPHSN Goal is to improve public
health surveillance in the Pacific
Islands, in a sustainable way
PPHSN Institutional framework
Training
institutions
Networks &
Associations
Laboratories
Core:
22 MoHs
International
agencies
Coordinating-Body
+ Focal Point
Aid donors,
Projects
PPHSN: Networking Services
Operational steps
PPHSN services
Alert &
Communication
• PacNet
Verification &
Identification
• LabNet
Investigation &
Response
• EpiNet
Infection control
• PICNet
Alert & Communication
PacNet
E-mail (and fax) listserver
Network of health professionals
Early warning system
for epidemic threats
Awareness & preparedness
Access to resources, including expertise
Overall communication and coordination
Complemented by PacNet-restricted
E-mail subscriber by resource
institution as at 31 November
2005
Laboratories
6%
Health Depts
SPC
member
countries
61%
P@CNET
WHO
11%
n = 636
SPC
3%
Others
10%
Training
Institutions
9%
Number of messages posted by
month, April 97-30 Nov. 2005
SARS
J une
Aug .
O ct.
Aug t.
Apri l
J une
2003
2004
.
27-Fe
b
30-Ap
r
30-Ju
n
31-Au
g
31 O c
t.
2002
31 De
c
2001
Aug .
O ct.
Feb.
Apri l
J une
Dec .
Aug .
O ct.
Feb.
Apri l
J une
Dec .
Aug .
O ct.
Dec .
Feb.
Apri l
J une
2000
O ct
Dec -0
3
Feb
Apri l
1999
Aug .
O ct.
Feb.
Apri l
J une
Dec .
Aug .
O ct.
Feb.
Apri l
J une
Dec .
1998
Dec -0
2
Feb.
1997
Aug .
O ct
Apri l
J une
120
110
100
90
80
dengue
influenza
(+ influenza)
70arboviruses
dengue
60
measles
Dengue HPAI
50
dengue
SARS influenza
dengue
cholera
HPAI
dengue
40 dengue
(+ measles) Nipah
typhoid
30
(Malaysia)
(+ rubella, measles)
20
10
0
2005
Source : Public Health Surveillance & Communicable Diseases Control Section,
Secretariat of the Pacific Community
PPHSN: Networking Services
Operational steps
PPHSN services
Alert &
Communication
• PacNet
Verification &
Identification
• LabNet
Investigation &
Response
• EpiNet
Infection control
• PICNet
PPHSN LabNet
What do we aim at?
Three-tier network of public health
laboratory services providing access
to distance diagnostic facilities
throughout the Pacific:



Level 1: national labs
Level 2: (sub-)regional labs, having
accepted to provide services for
PPHSN target CDs to other
countries/territories
Level 3: reference (… WHO ref
centres)
PPHSN LabNet
Common challenges and development goals
To provide access to distance diagnostic facilities
throughout the Pacific
quarantine regulations, Airlines requirements, ongoing funding mechanisms
To ensure a secure and efficient specimen and
information flow
confidentiality, Bio-ethics and intellectual property
rights
To maintain reliable and sustainable services
on-going capacity building i.e. training,
appropriate equipment, Q.C.
PPHSN: Networking Services
Operational steps
PPHSN services
Alert &
Communication
• PacNet
Verification &
Identification
• LabNet
Investigation &
Response
• EpiNet
Infection control
• PICNet
PPHSN EpiNet
Network of national/territorial welldefined multidisciplinary outbreak response teams:
the “EpiNet teams” (clinical medicine, data management,
epidemiology & field investigation, lab, PH management)
Aim: to provide immediate public health response to
outbreaks and outbreak threats
Core team, linking with other key stakeholders
according to the outbreak faced (e.g. EPI coordinator)
Clear counterparts for PPHSN activities &
development, incl. capacity-building
To build up a pool of regional expertise
PPHSN: Networking Services
Operational steps
PPHSN services
Alert &
Communication
• PacNet
Verification &
Identification
• LabNet
Investigation &
Response
• EpiNet
Infection control
• PICNet
PPHSN PICNet
Launched in Feb 2006
Objectives
Within the framework of the PPHSN:
1.
To set the minimum standards for infection control in PICTs,
with adapted evidence-based/best practices
2.
To develop infection control capacity in PICTs.
3.
To raising awareness of infection control issues.
4.
To develop and maintain infection control links with health (and
other) entities (e.g. other governmental and non-governmental
agencies, donors).
5.
To develop a strategic plan for PICNet.
6.
Future objective: To develop and maintain standardized
healthcare associated infection (HAI) surveillance and response
mechanisms.
PPHSN PICNet (ctd)
Membership
Core members
All health professionals with interest in infection control with one
national focal point for each SPC member country or territory.
Allied members
Health professionals with interest in infection control from
Australia and New Zealand
International organizations: WHO, SPC
Training institutions, including Schools of Nursing, Schools of
Medicine, Schools of Oral Health
Donors
Activities
Support and advocacy for capacity building for infection control
professionals (ICPs).
Strengthen institutional linkages with regional and national expert
bodies.
PPHSN Priority CDs
= “Epidemic” CDs
Primary list
Cholera
Dengue
Influenza
Leptospirosis
Measles
Typhoid fever
Progressively added
AFP, NT
AFR (measles and
rubella)
SARS
HIV
PPHSN Priority CDs
Surveillance requirements
For all (except HIV):
Any suspected case should immediately be reported and
investigated
Implementation of public health measures must be
immediately started
HIV:
2nd generation HIV surveillance



Pregnant women
At-risk groups
Behavioural surveillance (youth)
All require:
Response team
Procedures: guidelines and protocols
Some PPHSN support
… preparedness
PPHSN Priority CDs
Regional information sharing
Established
PacNet
Inform’Action
PPHSN website: www.spc.int/phs/PPHSN
To be redeveloped:
Regional CD database



Background: SPEHIS
Existing routine data
Other information: scientific articles
First regional EpiNet
workshop Sep 2003
PPHSN Strategic
Framework 20032006
PPHSN-CB 10, 2nd
regional EpiNet
workshop Jun 2004,
EpiNet team
consultation
General
recommendations &
Proposed PoA 20042006
GENERAL RECOMMENDATIONS AND PROPOSED PLAN OF ACTION
2ND REGIONAL EPINET WORKSHOP, 7TH -11TH JUNE 2004, SPC NOUMEA.
GENERAL RECOMMENDATIONS
1. To establish and maintain strong collaboration between human and animal health services both in country and at regional level.
2. To develop and strengthen capacity on influenza surveillance in PICTs to facilitate swift detection of an outbreak, and to undertake
responsibility of preparedness to influenza pandemic threat or occurrence.
3. To explore and develop feasible options for the assessment of the burden of influenza in PICTs.
4. To develop and strengthen laboratory capacities to facilitate efficient surveillance especially influenza virologic surveillance in PICTs.
5. To further develop and improve surveillance systems in the PICTs by optimising use of scarce resources for PPHSN expanded list of priority
diseases.
6. To undertake training in Epidemiology to facilitate the improvement in surveillance and response to communicable disease threats and events
in the Pacific Region.
7. To promote a good understanding of the new international health regulation (IHR) and related issues, and integrate IHR into the framework of
the PPHSN.
8. To review and improve on the infection control measures in PICTs by establishing and formalising the Pacific regional infection control
network under the umbrella of PPHSN.
9. To formalise and operationalise the Regional EpiNet team with its clear roles and functions, including funding implications, for endorsement
from Health Ministers' meeting in Samoa, 2005.
PROPOSED PLAN OF ACTION 2004-2006
General recommendations
2004-2006
1. To establish and maintain strong collaboration
between human and animal health services both in
country and at regional level.
2. To develop and strengthen capacity on influenza
surveillance in PICTs to facilitate swift detection of
an outbreak, and to undertake responsibility of
preparedness to influenza pandemic threat or
occurrence.
3. To explore and develop feasible options for the
assessment of the burden of influenza in PICTs.
General recommendations
2004-2006 (2)
4. To develop and strengthen laboratory capacities to
facilitate efficient surveillance especially influenza
virologic surveillance in PICTs.
5. To further develop and improve surveillance systems
in the PICTs by optimising use of scarce resources
for PPHSN expanded list of priority diseases.
6. To undertake training in Epidemiology to facilitate the
improvement in surveillance and response to
communicable disease threats and events in the
Pacific Region.
General recommendations
2004-2006 (3)
7. To promote a good understanding of the new
international health regulation (IHR) and related
issues, and integrate IHR into the framework of the
PPHSN.
8. To review and improve on the infection control
measures in PICTs by establishing and formalising
the Pacific regional infection control network under
the umbrella of PPHSN.
9. To formalise and operationalise the Regional EpiNet
team with its clear roles and functions, including
funding implications, for endorsement from Health
Ministers' meeting in Samoa, 2005.
Samoa Commitment
Achieving Healthy Islands
Recommendations involving the PPHSN
Samoa Commitment –
Recommendations (I)
The Regional EpiNet Team (RET) should be
established by creating a pool of experts and
professionals among the countries and territories
in the Pacific in order to support national and
territorial responses to outbreaks and to build
capacity.
The establishment of a regional outbreak and
emergency response fund should be explored.
PPHSN mechanisms should be utilized for IHR
Implementation such as notification, verification
and capacity strengthening wherever possible.
Samoa Commitment –
Recommendations (II)
The Strategic Framework of PPHSN should
include surveillance and response capacity
assessment and development for the Pacific
Islands.
Capacity building should be enhanced at the
peripheral level in the Pacific Islands for good
surveillance and response.
The IHR focal point should be a member of the
national EpiNet team or an equivalent
communicable disease response team or
taskforce at the national level, and where
possible that person should be the chair of the
team.
Samoa Commitment –
Recommendations (III)
PPHSN, incl. WHO, SPC and other partners, should continue
to provide technical support to assist PICTs to develop and
implement national pandemic preparedness plans.
At national level, development of national pandemic
preparedness plan led or coordinated by MoH:


multisectoral task force.
based on existing plans and mechanisms e.g.:
involvement of the national disease preparedness group
linkage with the national disaster preparedness plan.

Community participation and mobilization.
PPHSN should expand its scope to include functions of
noncommunicable disease surveillance as networked
surveillance and data pooling mechanisms.
Samoa Commitment –
Recommendations (IV)
Strengthen HIV and STI surveillance.
Countries should join together through PPHSN in
a Pacific initiative to improve national capacities
to prevent and control epidemic dengue.
Community-based vector control should be a key
component of all national dengue control
programmes.
It is no longer sufficient to simply educate and provide
information about dengue; programmes should aim at
key behavioural changes that result in reduced dengue
transmission.
Samoa Commitment –
Recommendations (V)
To sustain polio-free status, Pacific nations
should ensure that key programme functions
such as AFP surveillance and routine
immunization coverage are maintained at the
high levels required. Preparedness plans should
be available and coordinated by the EpiNet team
for response to the importation of wild poliovirus
and circulating vaccine-derived poliovirus.
Field achievements
Various and multiple
Depend on individual PPHSN members,
therefore difficult to list!
AFP, NT & AF&R – HBAS
Various support to PICTs

Outbreak investigation

Surveillance development

Training

… PPHSN services
THANK YOU!!