1. Pacific Public Health Surveillance Network: Framework 2006

2. 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 What is the PPHSN?

3. Core: 22 MoHs Laboratories Traininginstitutions Aid donors, Projects Networks & Associations International agencies Coordinating-Body + Focal Point PPHSN Institutional framework

4. Operational steps Alert & Communication Verification & Identification Investigation & Response Infection control PPHSN services PacNetPacNet LabNetLabNet EpiNetEpiNet PICNetPICNet PPHSNNetworking Services PPHSN: Networking Services

5. 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

6. P@CNET E-mail subscriber by resource institution as at 31 November 2005 n = 636

7. Number of messages posted by month, April 97-30 Nov. 2005 influenzaarboviruses measlesdengue dengue dengue (+ measles) Source : Public Health Surveillance & Communicable Diseases Control Section, Secretariat of the Pacific Community Nipah(Malaysia) dengue (+ influenza ) choleratyphoid dengue SARS dengue HPAI 199719981999200020012002200320042005 (+ rubella, measles) HPAIinfluenza Dengue SARS

8. Operational steps Alert & Communication Verification & Identification Investigation & Response Infection control PPHSN services PacNetPacNet LabNetLabNet EpiNetEpiNet PICNetPICNet PPHSNNetworking Services PPHSN: Networking Services

9. PPHSN LabNet 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) What do we aim at?

10. PPHSN LabNet Common challenges and development goals To provide access to distance diagnostic facilities throughout the Pacific To provide access to distance diagnostic facilities throughout the Pacific quarantine regulations, Airlines requirements, on- going funding mechanisms To ensure a secure and efficient specimen and information flow To ensure a secure and efficient specimen and information flow confidentiality, Bio-ethics and intellectual property rights To maintain reliable and sustainable services To maintain reliable and sustainable services on-going capacity building i.e. training, appropriate equipment, Q.C. on-going capacity building i.e. training, appropriate equipment, Q.C.

11. Operational steps Alert & Communication Verification & Identification Investigation & Response Infection control PPHSN services PacNetPacNet LabNetLabNet EpiNetEpiNet PICNetPICNet PPHSN Networking Services PPHSN: Networking Services

12. Network of national/territorial well- defined 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 PPHSNEpiNet PPHSN EpiNet

13. Operational steps Alert & Communication Verification & Identification Investigation & Response Infection control PPHSN services PacNetPacNet LabNetLabNet EpiNetEpiNet PICNetPICNet PPHSN Networking Services PPHSN: Networking Services

14. Launched in Feb 2006 Launched in Feb 2006Objectives 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. PPHSNPICNet PPHSN PICNet

15. 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 Activities Support and advocacy for capacity building for infection control professionals (ICPs). Strengthen institutional linkages with regional and national expert bodies. PPHSNPICNet (ctd) PPHSN PICNet (ctd)

16. PPHSN Priority CDs Primary list CholeraDengueInfluenzaLeptospirosisMeasles Typhoid fever Progressively added AFP, NT AFR (measles and rubella) SARSHIV = “Epidemic” CDs

17. 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: 2 nd generation HIV surveillance Pregnant women Pregnant women At-risk groups At-risk groups Behavioural surveillance (youth) Behavioural surveillance (youth) All require: Response team Procedures: guidelines and protocols Some PPHSN support … preparedness

18. PPHSN Priority CDs Regional information sharing EstablishedPacNetInform’Action PPHSN website: www.spc.int/phs/PPHSN www.spc.int/phs/PPHSN To be redeveloped: Regional CD database Background: SPEHIS Background: SPEHIS Existing routine data Existing routine data Other information: scientific articles Other information: scientific articles

19. First regional EpiNet workshop Sep 2003 PPHSN Strategic Framework 2003- 2006

20. PPHSN-CB 10, 2 nd regional EpiNet workshop Jun 2004, EpiNet team consultation General recommendations & Proposed PoA 2004- 2006

21. 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.

22. 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.

23. 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.

24. Samoa Commitment Achieving Healthy Islands Recommendations involving the PPHSN

25. 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.

26. 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.

27. 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.

28. 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.

29. 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.

30. 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 Outbreak investigation Surveillance development Surveillance development Training Training … PPHSN services … PPHSN services

31. THANK YOU!!