1. 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

2. Human Disease as Travelers on the Global Express- How Can We Keep Up?

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

4. The Asia Pacific Economic Community Accomplishments in combating emerging infections Challenges that remain Networking as a part of our strategy New frontiers in networking

5. 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.

7. APEC Leaders Summit October 2001, Beijing

8. 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.”

9. Six Strategic Action Areas Electronic networking Surveillance Outbreak response Capacity building Partnering across sectors Political and economic leadership

10. 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.

11. Internet Use in APEC Economies 1997 Source: Nua Ltd. and others, 1997, http://www.nua.ie/surveys/how_many_online

12. Internet Use in APEC Economies 1999-2001 Source: Nua Ltd. and others, 2001, http://www.nua.ie/surveys/how_many_online

13. APEC EINet Trade/Commerce Participation

14. Inter-country Surveillance Network

15. 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

16. 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

17. Frontiers in Networking  Strong working relationships within country, among countries  Reliable accurate laboratory  Real time outbreak collaboration  High Quality Network performance

19. Outbreak Area 1, epi data

22. From the Public Health Manager 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.

23. 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

24. Seattle, spatial location of cases

25. Figure 1: The APAN/TransPAC Networks

26. 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