[全球衛生] 修課筆記20201029

2003 passed in 56th WHA in geneva

2005 took place

convention based on scientific evidence

sugar tax??

COP

conference of the Parties

trade and health

article8 : protection on exposure of smoke, public area

article9,10:

artile 11: packaging and labelling

artile 12: education, trade

article 13: tabacco advertisement and sponsorship

article 14: demand reduction measures

[全球衛生] 修課筆記20201028

Management of Drug-Resistant TB

Green-light countries; 6 regioal committee

resistant, susceptible organism

conentional DST, LPA

Milestone

2014 GHSA, G7

2011 PIP framework

2014-2016 Ebola outbreak

2016 JEE: voluntary collarborative process to assess a countrry's capacity under the IHR(2005), Self-evaluation plus external evaluation

2016 WHE: WHO Helath Emergencies

2018 SPAR: State party Self-assessment annual reporting tool

2020 Taiwan is going to conduct 2nd voluntary Jee assessment(1st 2016or2017)

8 core capacities

10 core capacities: POE, radioactive

1.national legistration:2

2.National focal point:2

3.Seuveillaince:2

4.Response:4

5.preparedness

6.communication

7.huamn resources

8.lab service

20 indicators

https://www.cdc.gov.tw/File/Get/5b8gmJMzQapsSv8YLgcyuA

AAR: https://www.who.int/ihr/procedures/after-action-review/en/

only 20% countires have fulfilled their core capacity by 2012 deadline

69 countries are currently activemembers of GHSA

global health security agenda

monitor and identify, respond earlier

AP leaders: develop ad maitain the Action Package framework

Prevent, Detect, Respond

Nationawide lab network, real-time information system, emergency operation centers

Prevent:

1. prevent emergence and spread of antimicronial drus resistant organisms

2. promote national biosafety

3. reduce

>>>>>biosafety and biosecurity, immunization

Detect

4.Launch, strengthen

5.strengthen the global norm of rapid reporting

6.develop and deploy novel diagnostics

7.train surveillance team

Respond

8. develop an interconnected global network

9.improve blobal access to medical and non-medical

GHSA action package generic layout

5 year target

measuring indicator

desired national impact

country commitments to AP

five year action items

baseline assessment and planning activities

monitoring and evaluation activities

JEE country-specific status

priority actions 19 technical areas

integral part of a continuous process of strengthening capacities for the implementation of the IHR

8 national core capacities, POE, zoonosis, food safety, chemical radionuclear

IHRMT average, IHRMT average 2, JEE average

Tsai FJ, Health Security, 16(5), 304-310

IHR MEF, monitoring and evaluation framework

SPAR

JEE

AAR

SimEx

Status of IHR capacities for health security

Risk profiling

other assessments

IHR-MEF

National action paln for health security

one health

strategic partnership; universities?

Stattus of IHR capacities for health security

HSS: heath systems stengthening in high vulnerability countries

health promotio core competencies

program planning, implementattion and evaluation,

partneership building

cimmunication and report writing

technology

knowledge

diversity and inclusiveness

university role

education and capacities

evidence and research

awareness and engagement

innovative ideas

Keiji Fukuda

JEE, GHSA

[全球衛生] 修課筆記20201022

Importation tax domestic tax packaging, and labelling eudcation, communication, training and public awareness tabacco advertising promotion, sponsorship demand reduction measures concerning tabacco dependence and cessation illicit trade in tabacco product sales to and by minor provision of support for economically viable protection of the environmenta and health of persons liability research, surveillance, exchange of information reporting and exchange of information

[全球衛生] 修課筆記20201021

Known infection spreading to geographic areas or population: Dengue, Ebola

previously unrecognized infections appearing in areas undergoing ecologic transformation: west nile virus, Zika virus

old infection reemerging as a result of antimicrobial resistance in known agents: MRSA, MDR-TB

micronial adaptation

human demographics and behavior

international travel

increased interaction with animals

economic development

breakdown of public health, poverty and cosial inequality

war and famine

bioterrorism

climate and weather change

dam and irrigation system construction

centralized commanding system

cetnral epidemic control center CECC

develop national influenza pandemic preparedness plan

stockpile of antiviral and personal protective equipment PPE

set-up "communicable disease control medical network"

PPE preparedness

[全球衛生] 修課筆記20201020

Mycobacterium tuberculosis complex; M tuberculosis, M bovis, M africanum, M canettii, M microti, M pinnipedii, M caprae

Non-tuberculosis mycobacterium(NTM), also called MOTT

Genus: mycobacteria

Family: Mycobacteriaceae

Ghon complex, Ranke complex

hematogenous spread: simon's foci

isoniazide:activation of bacterial catalyze perozidase

KatG mutation

Rifampicin

interefere with the synthesis of mRNA by binding to the bacterial DNA-dependant RNA polymerase

all bacteria acheie resistance to RMP by mutation in RNA polymerase subunit B

PZA pyrazinamide

coverted to pyrazinoic acid by PZase

Ethambutol EMB

Bedaquiline

diarylquinoline drug

target based resistance

non-target based resistance

Rv0678 mutants: clofazimine, bedaquiline

[全球衛生] 20201014 修課筆記

Ratio 3:3

Proportion 50%

Barriers to IHR 2005 surveillance

Technical

Resource

Governance

Legal

Political

IHR H5N1 virus sharing, Indonesia case

GHSA

JEE

WHE

Enhancing role of universities

Detect, Assess(annex2), Report, Respond

Self-assessment since 2010

Level <1: foundational

Level 1: inputs and process in place

Level 2: outputs and some outcome demonstrated

Level 3: capacities beyond the state’s borders

6.Appropriate communication of risks

Mechanism for effective risk communications

7.Human resource

Human resource are available to implement IHR core capacity requirements

8.Adequate laboratory services

Coordinating mechanism

LABORATORY SERVVICES available

INFLUENZA surveillance

System for collection, packaging and transport

Laboratory biosafety and biosecurity

Laboratory based surveillance

unusual ealth events: detect, assess, report, respond

core capacity assessment

[全球衛生] 20201007 修課筆記

Ending AIDS 2030

1.7 million new infection in 2019

25% new infection subsaharan, young women

90-90-90

38 million people living with HIV: 81% konw, 2/3 get treat, 59% undetected viremia

90% get test

90% get treat

90% are virally suppressed; undetected viremia

unprotected sexual intercourse

vertical transmission

contaminated equippment

World: 3% sex worker,

ME and north africa: 38% inject drug

West E North A: 57% gay

East and south Africa: 79% rest of population

relative risk of HIV acquisition

transgender

MSM

inject drug

sex worker

Taiwan: 80% MSM; >30,000 people with HIV

demend reduction, supply reduction, harm reduction

2004/06 awareness and inspiration

2005/01 action plan completed

2005/03 plan approved by premier

start pilot project in 1 city and 4 counties

free needle through pharmacy

Methadone 13000/day

testing strategy

ART initiation and retension

PrEP

1951 ISR

1969 IHR

2003 SARS

2005 IHR

PHEIC

1969 cholera, plague, yellow fever, small pox, tetanus, replasing fever

1981 cholera, plague, yellow fever

1978 smallpox eradication

1995 revision: WHA 48.7, 48.13

2001 revision: WHA 54.14 global health security

2002 revision: WHA 55.16 natual occurence, accidental release or deliberate use of biological chemical agents or radoactive material

PHEIC

national response capacity

reporting mechanism

national focal point

food security

zoonotic

emergent disease

chemical

radionuclear

inormation-gathering prerogative

national focal point

GHSA

new: WHO may use and share information from non-official sources

EMS: event management system

EIS: password-protected event information

GOARN 2000

[全球衛生] 修課筆記20201006

tropical disease:malaria, leishmaniasis, schistosomiasis, onchocerciasis, filariasis, chagas, trypanosomiasis, dengue

ASTMH american society of tropical medicine and hygiene

Eradication: zero disease globally

Elimination: zero case in a defined geographic area

NEJM 2013: disease eradication

Guinea worm eradication program:dog, chimpamzee

MDA Mass drug administration

APOC african programme for onchocerciasis control

Global fund : HIV TB malaria

Clinton Health Access Initiatice CHAI

Gates foundation

GSK malaria vaccine

Wuchereria bancrofti

brugia malayi

brugia timoria

masonella ozzardi

masonella perstans

loa loa:west africa

ochocerca volvuvus

mansonella streptocrca

rhodnius prolixus

tsetse fly

microfilariasis, oviparous

culex quinquefasciatus 南方家蚊

Melanization and excapsulation response

Productio of AMPs

inflmmatory acute stage filariasis

lymphoedema

filarial fever

tropical pulmonary eosinophilia TPE

high IgE, no circulating microfilaria, high eosinophilia

elphantiasis

chyluria

initial acute response, granulomatous reaction(release endo-cytoplasmic bacteria)

daytime occult filariais: malayi, bancrofti

night time good for culex quinquefasciatus (10pm-4am)

diural perodic form: loa loa

Ag detection

molecular diagnosis

Ab detection: not recommended due to cross reactivity

DEC diethylcarbamazine, Hetrazan

Ivermectin: paralyzed microfilaria

albendazole

doxycycline

community based ivermectin or DEC

vector control

GPELF: global programme to eliminate lymphatic filariasis, eliminate filiariasis by 2020

loa loa african eye worm, mango fly chrysops

loa loa:west africa

ochocerca volvuvus

mansonella streptocrca

chrysops silicea, chrysops dimidiata

loa loa, calabar swelling, upper limb swelling

Rapid assessment procedure for loa loa

prophylaxis DEC 300mg/week

treatment DEC 2mg/kg for 21 days(fatal encephalitis, renal lesion); ivermectin

prevention, prophylaxis, community-based control using albendazole have been tried with limited success

river blindness, 2nd commonest filarial infection; onchocerca volvulus; black fly(small)

leuckart(receive sample from Mason)

daytime feeder

high water speed, more ozygen; attach on grass or rock

sowda(seen in sudan and Yemen), darkened skin; edema, thickening of dermis

kidney, lung, liver, other organs

*onchocercomata*

africa: lower trunk and limbs

central america: head thorax neck

erysipela de la costa: face

down regulate Th-1 type mmune response

symbiotic wolbachia

nodding syndrome: neurological disorder in Uganda and its neiboring conuntry, long-term mental disabilities

Mazzotti test, 50mg DEC

Patch test

ivermectin, DEC, doxycycline followed by ivermectin, target wolbachia

malaria: artemisin+quinine