Health Security Challenges in The Republic of Macedonia

Learning Objectives:To give background information about health

challenges in the countryTo emphasize the important of Early Warning Rapid

Alert System (EWARS) for communicable diseaseTo 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

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

Where is The Republic of Macedonia?

Area: 25 713 km2Population: 2.048.000

Typhus in Republic of Macedonia

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Извор : РЗЗЗ, 2005

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Vaccination introduced

POLIOMYELITIS IN THE REPUBLIC OF MACEDONIA 1956-1987

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Vovedena vakci naci ja

Vovedena r evakci naci ja

Measles in Republic of Macedonia vaccination

revaccination

Network of Public Health Institutes in Macedonia Today

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

• 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

• 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

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

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

Classification of Natural Disaster

• 1483 events reported between 1990-2006• 42 millions affected; 98119 killed people• More than 130 billion euros economic lost

Natural disasters

Biological Geophysical Climatological MeteorologicalHydrological

Epidemics Insects

infestationsAnimal attacks

EarthquakesVolcanoes

DroughtsHigh

temperaturesWildfires

FloodsMass

movementsStorms

Natural Disasters Around the World, 2007

Background Information: Health Consequences of Floods in Europe

3 millions displaced persons

300 000 deaths

200 000 missed persons

Background Information: Do Not Forget Crises and Humanitarian Emergencies

Background Information: Do not Forget Chronic Diseases-Epidemiological Transition

Background Information: Climate Changes

EWARS – Early Warning Rapid Alert System for

Communicable Diseases Surveillance, Macedonia

-Data Flow-

EWARN global database

Surveillance System in Republic of Macedonia

– 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

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

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 IHPREGIONAL IHP

REPUBLIC IHPREPUBLIC IHP

MINISTRY OF HEALTHMINISTRY OF HEALTH

Health Care/Reported Units Data Flow

Skopje Region Example – Data Flow

=

Data Collecting and Data Processing

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

LIST OF CLINICAL DEFINITIONS TO BE REPORTED

3. Suspicion of rash fevers, excluding varicellae

4. Suspicion of meningitis/meningo-

encephalitis

5. Acute watery diarrhoea

LIST OF CLINICAL DEFINITIONS TO BE REPORTED

6. Acute bloody diarrhoea

7. Suspicion of acute infective

hepatitis

8. Suspicion of acute hemorrhagic

fever

EWARS – Data Sources and outputs

• Alerts

• Tables

• Graphics/charts

• Maps

• Coverage

EWARS – Early Warning Alert Rapid System for Communicable Diseases Surveillance

=

Is there anything more?

EWARS – Early Warning Alert Rapid System for Communicable Diseases Surveillance

(I)EWARS – Integrated Early Warning Alert Rapid System for All Hazards and

Diseases Surveillance

IHR (2005) – Area of Work and Goals

IHR (2005) – Area of Work and Goals

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)

www.pitt.edu/~super1/

Question!• How can we improve public health preparedness

education worldwide?Answer!

• Get better lectures

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Improve Access to Knowledgeand Experience!

Improve Access to Knowledgeand Experience!

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?

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

NEW EDUCATION PATHWAYS FOR GLOBAL PUBLIC HEALTH SECURITY:

US-MACEDONIAN COLLABORATION IN HIGHER EDUCATION