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?

Washington Post Source: World Health Organization/CDC The SARS Outbreak: May 6, 2003

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 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 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,

Internet Use in APEC Economies Source: Nua Ltd. and others, 2001,

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 Seattle Scenario- December 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: Accession numberAge/SexDate of OnsetHospitalRelationship to Index 00135/male11/29/03CountyIndex 00232/female12/14/03CountySister 00316/female12/14/03CountyNeice 00414/male12/15/03CountyNephew 00567/female12/13/03Hospital ANeighbor 00636/male12/13/03Hospital BNeighbor 00737/male12/14/03Hospital BNeighbor

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