Global Health Security
US efforts towards more rapid and effective response
Jeff N. Borchert
Health Scientist, Division of Vector-Borne Diseases
Global Health Security Demonstration Project
Centers for Disease Control and Prevention - Uganda
5th Annual AFENET Conference,
Addis Ababa, November 2013
Biological threats, whether naturally
occurring, intentionally produced or the
result of laboratory accident, constitute a
growing international threat to humans
and the global economy
Global Health Risks are Increasing
Recombinant
Technologies
Anthrax
MRSA
XDR TB
Food Supply
HIV
Globalization
of Travel,
Avian Flu
Food and
Medicines
Emergence
and Spread
of New
Pathogens
Rise of
Drug
Resistance
Intentional
Engineering
of Microbes
Global Health Security – A world safe and
secure from global health threats posed
from infectious diseases by:
• Preventing or mitigating naturally
occurring outbreaks and intentional or
accidental releases of dangerous
pathogens,
• Rapidly detecting and reporting
outbreaks
• Employing an interconnected global
network that can respond effectively to
limit spread of infectious disease
• Mitigating human suffering, loss of life
and economic impact
3 Pillars of CDC’s Approach to
Global Health Security
Detect
…threats early
Respond
…rapidly and effectively
Prevent
…avoidable catastrophes
and epidemics
CDC Global Health Security
Demonstration Projects
• CDC sought to develop a model approach of rapid
GHS capacity upgrades that could be implemented,
improved and duplicated
• Uganda and Vietnam
• March – September 2013
• Engagement with MoH and Stakeholders (AFENET)
• Mechanism to accelerate country progress toward
IHR goals
GHS Objectives in Uganda
(April-Sept 2013)
• Strengthen the disease surveillance system’s
capacity for detection, specimen referral and
laboratory confirmation of:
• MDR-TB and XDR-TB
• Cholera
• VHF- Ebola
• Establish a functional public health Emergency
Operations Center
• Enhance information systems to enable real-time
monitoring of epidemics and response by integrating
data sources from the disease surveillance and
EOC
Demo - Build Upon Existing Efforts
• Ministry of Health (MOH), Uganda
• Central Public Health Laboratory (CPHL)
• Uganda Virus Research Institute (UVRI)
• National TB Reference Laboratory (NTRL)
• PEPFAR Investments
• Enhance District Health Information System-2 (DHIS-2); a websupported, password protected data base
• Support MOH district surveillance officers to investigate and report
credible events via short message service (SMS) alerts through DHIS2
• Utilize Early Infant ‘HIV’ Diagnosis (EID) specimen referral hub
system to transport, using motorcycles and postal service, biologic
specimens for laboratory testing
• Augment NTRL’s TB GeneXpert roll-out and testing scheme
• WHO AFRO and AFRICHOL
•
Support culture-based confirmation of Vibrio cholerae at regional
hospitals and
• AFENET Uganda
Districts and Hubs
Uganda - Laboratory Systems
• GHS Uganda pathogens of interest
• Ebola: Suspect cases isolated, specimens
collected and transported to UVRI via hub network
and Posta Uganda
• Cholera: Rapid diagnostic tests pre-positioned at
17 district health facilities with specimen referral to
regional referral hospital or CPHL via Posta
Uganda for culture
• MDR TB: Sputum transported to a GeneXpert site
via EID transportation hubs; rifampin-resistant TB
specimens sent to NTRL via Posta Uganda for
culture and drug resistance testing
• Notification
• Laboratory results interlinked via EOC through
SMS; online reporting and tracking via DHIS-2
Uganda - Emergency Operations Center
• Obtained physical space for interim EOC
• Link with Ministry of Health (MoH) Resource Center
(PEPFAR)
• Permanent facility with National Health Laboratory and
Resource Center compound in Port Bell (vision for a NPHI)
• Organized a visit for senior MoH leaders to CDC
• Provided emergency management training for operations
• Supported the EOC manager position
Uganda - Information Systems
•
Improve real-time detection, monitoring and
confirmation through improved connectivity,
timely data collection and access within the
District Health Information System (DHIS2)
•
Develop disease-specific mobile tools for data
capture and use during outbreaks (Epi-Info
based)
•
Improve lab data quality, timeliness and use
through a centralized specimen tracking system
and expand availability of results
•
Build an integrated data system using the EOC
as the hub
•
Develop dashboards and reports for access by
health system stakeholders at all levels on a
“need to know” basis
Accomplishments
•
SOPs and protocols established
•
Exercise drill completed Sept 2013
• Evaluated specimen transport, SMS
communication, DHIS-2 tracking, and EOC
management of mock response
•
Used GHS Uganda system components:
• Crimean-Congo hemorrhagic fever outbreak
in Agago District: Referral hub transported
suspect VHF specimens within 24 hrs
• Suspect case of XDR-TB at Mulago Hospital’s
isolation ward had sputum collected, tracked
and transported to NTRL (extracted M.
tuberculosis DNA for sequencing in Atlanta)
EOC Activations
• Pilgrims returning from Hajj
• Solar Eclipse in Pakwatch, NW Uganda
• eMTCT HIV
Next Steps - Response
• Conduct Incident Command Structure training for key staff
• Train rapid response teams and develop disease-specific
district SOPs for outbreak response
• Train village health teams in disease containment and
reporting
• Re-administer lab assessment tool to identify GHS
improvements and maintain continuous quality improvement
• Expand GHS model beyond 17 pilot districts; add 23
districts/year
• Perform 2014 exercise drill focused on response capabilities
Most effective roll out of GHS
• Replicable model of GHS capacity upgrades
• Multi partner engagement
• International partnerships
• Different in every country
“…we must come together to prevent, and
detect and fight every kind of biological
danger - whether it’s a pandemic like H1N1, or
a terrorist threat or a treatable disease.”
President Barack Obama, 2011
Thank you
US DoD Defense Threat Reduction Agency
AFENET Uganda
Uganda Ministry of Health
Uganda Virus Research Institute
CDC Atlanta
CDC Fort Collins