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
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
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
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
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
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
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
