2. Health Security Challenges in The Republic of Macedonia Learning Objectives:  To give background information about health challenges in the country  To emphasize the important of Early Warning Rapid Alert System (EWARS) for communicable disease  To initiate development of Integrated EWARS in light of International Health regulation (IHR-2005)  To stress the significance of improvement of knowledge and experience  This lecture was presented during the ANSER Policy Forum which was held on April 6, 2009

3. Health Security Challenges in The Republic of Macedonia Elisaveta Stikova Present position –1991-Present, Professor, University “Ss. Cyril and Methodius”, Medical faculty, Skopje, Macedonia (courses taught: Occupational Health, Public Health, Medical Ecology, Hygiene –1994 – Present, Director and Advisor, National Public Health Institute, Skopje, Macedonia –2009 – Fulbright Visiting Scholar, Pittsburg University, Graduate School of Public Health – New Educational Pathway for Global Public Heath Security

5. Where is The Republic of Macedonia? Area: 25 713 km2 Population: 2.048.000

7. Typhus in Republic of Macedonia Извор : РЗЗЗ, 2005

8. Vaccination introduced POLIOMYELITIS IN THE REPUBLIC OF MACEDONIA 1956-1987

9. Measles in Republic of Macedonia vaccination revaccination

10. Network of Public Health Institutes in Macedonia Today

11. The Impact of 21st Century: Health Security Challenges in Macedonia

12. Public health threats are many and diverse, they are multiplying and moving faster than even before going far beyond the national borders They present new challenges and require an urgent and collaborative response Strengthening of public health preparedness, planning and timely response are ultimate goals to minimize human suffering caused by global public health threats Public Health Threats – New Challenges

13. Emerging and epidemic prone diseases Environmental changes and natural disasters Human-made (technological) disasters Chemical, biological and radiological terror threats International crises and humanitarian emergencies Global Public Health Threats in 21th Century

14. Where Are Public Health Threats Coming From? Speed and volume of travel and trade Occurrence of new and reemerging pathogens Environmental degradation Natural disasters Terrorism

15. Key Elements of Public Health Preparedness Program Identifying the types or nature of events Planning activities in advance to prevent the occurrence of the events or ensure a coordinate response Building capabilities for effective response to the consequences of the events Recovering from the events

16. Classification of Natural Disaster 1483 events reported between 1990-2006 42 millions affected; 98119 killed people More than 130 billion euros economic lost

17. Natural Disasters Around the World, 2007

18. Background Information: Health Consequences of Floods in Europe

19. 3 millions displaced persons 300 000 deaths 200 000 missed persons Background Information: Do Not Forget Crises and Humanitarian Emergencies

20. Background Information: Do not Forget Chronic Diseases-Epidemiological Transition

21. Background Information: Climate Changes

22. EWARS – Early Warning Rapid Alert System for Communicable Diseases Surveillance, Macedonia -Data Flow-

23. EWARN global database

24. Surveillance System in Republic of Macedonia

25. –8 groups of conditions/suspicions are reported, –Case definition is based on symptoms or syndromes, –Weekly reporting on a regional and central level, –Rapid data analysis, –Receiving necessary information for undertaking measures and activities, –Timely and functional feed-back information. Basic Principles of Syndromic Surveillance System

26. 10 geographical regions of the country included Regions of: Tetovo,Kumanovo, Skopje, Ohrid, Bitola, Prilep, Kocani, Strumica, Stip, Veles 1014 surveillance unit 40% coverage by EWARS 1.2 million people EWARS – Data Flow

27. REPORTING UNITS Primary Health Institution Medical Center Institutions for health care of workers Institutions for health care of students Private health institutions SURVEILLANCE UNITS REGIONAL IHP REPUBLIC IHP MINISTRY OF HEALTH Health Care/Reported Units Data Flow

28. Skopje Region Example – Data Flow

29. = Data Collecting and Data Processing

30. LIST OF CLINICAL DEFINITIONS TO BE REPORTED 1.Suspicion of an upper respiratory tract infection 2.Suspicion of an lower respiratory tract infection 2-a Suspicion of acute lower respiratory tract infection in children <5 years

31. LIST OF CLINICAL DEFINITIONS TO BE REPORTED 3.Suspicion of rash fevers, excluding varicellae 4.Suspicion of meningitis/meningo- encephalitis 5.Acute watery diarrhoea

32. LIST OF CLINICAL DEFINITIONS TO BE REPORTED 6.Acute bloody diarrhoea 7.Suspicion of acute infective hepatitis 8.Suspicion of acute hemorrhagic fever

33. EWARS – Data Sources and outputs Alerts Tables Graphics/charts Maps Coverage

34. EWARS – Early Warning Alert Rapid System for Communicable Diseases Surveillance = Is there anything more?

35. EWARS – Early Warning Alert Rapid System for Communicable Diseases Surveillance

37. IHR (2005) – Area of Work and Goals

39. A case of any of the following diseases: Smallpox Poliomyelitis due to wild type poliovirus Human influenza caused by a new subtype Severe Acute Respiratory Syndrome Any event that is a Potential public health emergency of international concert, including those of unknown causes of sources A case of any of the following diseases: cholera pneumonic plague yellow fever Viral hemorrhagic fevers (Ebola, Lassa and Marburg) West Nile fever Apply the criteria in the decision algorithm 1.Is the public health impact of the event serious 2.Is the event unusual of unexpected? 3.Is there a significant risk of international spread? 4.Is there a significant risk of international restrictions on travel or trade? Yes to any two of these criteria Event shall be notified to WHO under IHR (2005)

44. www.pitt.edu/~super1/ Question! How can we improve public health preparedness education worldwide? Answer! Get better lectures Why don’t we share our most exciting PowerPoint lectures for free?

45. Supercourse is highly valuable tools presenting: –network of 64000 scientists from 174 countries –set of 3623 lecture in 26 languages 270 Disaster Lectures –50 countries –1 Nobel Prize winner –75% full professors –52 countries http://www.pitt.edu/~super1/SEE/see.htm

46. Improve Access to Knowledge and Experience!

48. Center for Public Health Preparedness New challenges need new professional profiles: –health preparedness coordinator? –emergency management analyst? –emergency preparedness health planner? –bio terrorism/chemical epidemiologist? –CME of medical and public health professionals? –Graduated/certified program? –BDLS/ADLS?

49. What is the solution? New educational pathway for global public health security Establishment of Regional Public Health Preparedness Center Do we have experience and good practices? –US-CDC Network of Public Health Preparedness Centers –Research, joint projects and cooperative agreements

50. NEW EDUCATION PATHWAYS FOR GLOBAL PUBLIC HEALTH SECURITY: US-MACEDONIAN COLLABORATION IN HIGHER EDUCATION