WHO s activities to assist countries to manage biological threats Williamina Wilson Preparedness for Deliberate Epidemics Department of Communicable Disease Surveillance and Response World Health Organization Bath, United Kingdom, 14 15 September 2003
WHO s Mandate Global public health response to natural occurrence, accidental release or deliberate use of biological and chemical agents or radionuclear material that affect health Urges Member States to: - treat any deliberate use as a global public health threat - respond by sharing expertise, supplies and resources... Resolution WHA55.16 18 May 2002 Requests the Director-General to: - strengthen global surveillance - provide tools and support for Member States, with regard to emergency preparedness and response plans - continue to issue international guidance and technical information - examine the possible development of new tools
Global Health Security E P I D E M I C A L E R T & R E S P O N S E I N T E R N A T I O N A L H E A L T H R E G U L A T I O N S Contain known risks Respond to the unexpected Improve preparedness Resolution WHA54.14 21 May 2001 G L O B A L P A R T N E R S H I P
Global partnership CBW Working Group (WHO HQ and regional offices) Health Action in Crises; International Programme on Chemical Safety; Food Safety; Communicable Disease Surveillance and Response CBW Scientific Advisory Group (being established) Biosafety Advisory Group WHO programme on biosafety Formal and informal Informal networks: 100+CBW experts, who contributed to 2nd edition of the Public health response to biological and chemical weapons: WHO guidance 250+CBW disarmament experts and diplomats Disease-specific networks: experts and laboratory Informal exchange with other organizations
Contain known risks Selected biological agents Bacteria Anthrax (Bacillus anthracis) Brucellosis (Brucella abortus, Brucella suis and Brucella melitensis) Glanders (Burkholderia mallei) Melioidosis (Burkholderia pseudommallei) Tularaemia (Francisella tularensis) Plague (Yersinia pestis) Q Fever (Coxiella burnetii) Typhus Fever (Rickettsia prowazeki) Fungi Coccidioidomycosis (Coccidiodes immitis) Viruses Venezuelan equine encephalomyelitis Smallpox (Variola virus)
WHO publications and guidelines Interactive and searchable e-library Compilation of relevant WHO publications and guidelines in English, French, Spanish, Russian, Chinese, and Arabic (depending on availability) Interface available in English, French, and Spanish
Respond to the unexpected Intelligence Verification Alert and response operations Response Follow-up
Respond to the unexpected GOARN: a network of networks 110 institutions and other networks, who mobilize and pool resources for outbreak alert and response Rapid identification, verification and communication of outbreaks Appropriate technical assistance to affected state(s) Contribute to long-term outbreak preparedness
Respond to the unexpected Information management and dissemination
Improve preparedness More than 100 experts from all WHO regions, acting in their personal capacities International organizations and NGOs (FAO, ICRC, OIE, OPCW, WFP, UN, Harvard Sussex Program, Pugwash) Policy guidance on CBW 9 informal meetings between February 1998 and November 2002 Final publication expected 2003
Improve preparedness Strengthening national health preparedness for and response to CBW threats Current gap: technical tools and mechanisms for supporting Member States in implementing the policy guidance provided by the 2nd edition Public health response to biological and chemical weapons: WHO guidance. Tools for assessing national CBW preparedness and response programmes Objective: to respond to the increased number of requests for technical assistance by the health sector of selected Member States for the assessment of their national CBW preparedness and response programmes and capacity building. Outputs: Guidelines (assessment tool) Network of experts Training
Improve preparedness 3 rd cohort Russia Ukraine Belarussia R. Moldova Romania Bulgaria Turkey Laboratory and epidemiology strengthening CSR Lyon, France 1 st cohort Cape Verde Chad Congo Comoros Equatorial Guinea Central African Republic Democratic Republic of Congo 2 nd cohort Jordan Lebanon Yemen Syria Sudan Iran Iraq
Improve preparedness Main goal To identify laboratory diagnostic capacities for targeted epidemic-prone diseases to determine how to increase and sustain the competencies of the participating laboratories. Partners NHLS, Johannesburg, South Africa United States CDC USAID Laboratory strengthening programme in Africa Types of pathogens plague enterics bacterial meningitis
Improve preparedness WHO Biosafety programme Coordination of global biosafety issues WHO Biosafety Advisory Group (BAG) 5 WHO Collaborating Centres (US (CDC, NIH), Canada, Sweden and Australia) http://www.who.int/csr/labepidemiology/projects/biosafety/en/ UN model regulations Transport of infectious substances http://www.unece.org/trans/danger/danger.htm Technical assistance to Member States e.g. training (3 cohorts) Biosafety inspections Smallpox repositories laboratories (WHA33.4 8 May 1980)
International Health Regulations 1969 The purpose of the IHR is to ensure maximum security against international spread of diseases with minimum interference with world traffic and trade. 1. Notification of cases Member States are obliged to notify WHO for a single case of cholera, plague or yellow fever, occurring in humans in their territories and give further notification when the area is free from infection. Notifications are reported in WHO s WER. 2. Health-related rules for international travel and trade 3. Health organization: measures for deratting, disinfecting, and disinsecting international conveyances (ships, aircraft, etc.) are to be implemented at points of arrival and departure (ports, airports and frontier posts). 4. Health documents required
International Health Regulations Updating existing measures of the current IHR Proposed key changes and benefits to Member States: Expanded scope: notification for public health emergencies of international concern National core surveillance capacities Revision Real-time event management system: linked to established mechanism for response actions Support Member States with technical assistance at their request IHR national focal points
International Health Regulations public health emergencies of international concern could include events related to possible CBW use or threat of use. WHO needs to maintain neutrality and to focus its action on the public health component of response only. Revision: some key issues WHO has no mandate to assess the deliberate nature of an event, which would be responsibility of the UN (BW) or OPCW (CW); however, the UN could request WHO technical support in case of investigation of alleged BW use or threat of use.
WHO Alert and Response Communication Communication E P I D E M I C A L E R T & R E S P O N S E I N T E R N A T Travel-related I Travel-related O N A L H E A Recommendations Recommendations L T H R E G U L A T I O N S Contain known risks Respond to the unexpected Improve preparedness Detecting and responding to SARS Global Global Influenza Influenza Programme Programme Epidemic Epidemic Intelligence Intelligence GOARN GOARN Regional G L O B A L P A R T N E R S H I P Regional Offices: Offices: WPRO, WPRO, AMRO, AMRO, EURO EURO Biosafety Biosafety WR WR Viet Viet Nam Nam WR WR China China WR WR Thailand Thailand WR WR Singapore Singapore......
Contain known risks Selected biological agents Bacteria Anthrax (Bacillus anthracis) Brucellosis (Brucella abortus, Brucella suis, and Brucella melitensis) Glanders (Burkholderia mallei) Melioidosis (Burkholderia pseudommallei) Tularaemia (Francisella tularensis) Plague (Yersinia pestis) Q fever (Coxiella burnetii) Typhus fever (Rickettsia prowazeki) Fungi Coccidioidomycosis (Coccidiodes immitis) Viruses Venezuelan equine encephalomyelitis Smallpox (Variola virus)
Disease- specific networks Mission statement To strengthen global disease-specific networks of experts and laboratories able to provide technical support to response activities in Member States, particularly developing countries, related to the natural occurrence, accidental release, or deliberate use of biological agents that affect health.
Anthrax 1 To establish a global network of anthrax experts and laboratories with defined anthrax capabilities Project objectives 2 To establish standard procedures relating to anthrax and disseminate information 3 To set up and implement training and quality assurance
Anthrax objective 1a A global network of anthrax experts Working Group members provide: advice on reference public health and veterinary laboratories key people responsible for dangerous public health pathogens existing networks questionnaire, guidelines, training materials strategy technical assistance
Anthrax objective 1b A global network of laboratories with defined anthrax capabilities Develop an inventory of capabilities of reference public health and veterinary laboratories in Member States Obtain an understanding of the current gaps Support activities to fill them, particularly in laboratories in developing countries Identify international and regional reference laboratories Improve collaboration with existing networks Encourage the exchange of information
Anthrax objective 1b 1. Contact details Name of laboratory Address City Postal code Country Telephone Fax Email Web site World Health Organization Communicable Disease Surveillance and Response Global Alert and Response Disease-Specific Networks: Anthrax Questionnaire for Laboratories World Health Organization Global Alert and Response Communicable Disease Surveillance and Response Disease-Specific Networks: Anthrax Questionnaire for Laboratories An inventory of capabilities Name of director of the laboratory Title Telephone Fax Email Name of person responsible for anthrax activities Title Telephone Fax Email 2. Your laboratory is affiliated to: Ministry of Health Ministry of Agriculture Other ministries (please specify) Universities Private laboratories Other (please specify) 3. Which of the following are used for identification of B. anthracis in your laboratory? Capsule visualization in clinical specimens India ink stain Polychrome methylene blue stain Direct fluorescence assay Other (please specify) Spore visualization in environmental samples Phase contrast Malachite green Other (please specify) Routine and confirmatory culture Haemolysis Motility Penicillin sensitivity Gamma phage lysis Capsule production in blood (in vitro) Capsule production on bicarbonate/serum agar plates Other (please specify) Antimicrobial sensitivity tests Multi-disk MICs Other (please specify) Advanced technology tests Specific (toxin) antigen ELISA Time-resolved fluorescence (TRF) testing Polymerase chain reaction (PCR) Molecular characterization Other (please specify) 1. Contact details Name of laboratory Address City Post code Country Telephone Email Fax Web site Director of the laboratory Title (Prof., Dr, Mr, Mrs, Miss) Telephone Fax Email Person responsible for anthrax activities Title (Prof., Dr, Mr, Mrs, Miss) Telephone 2. Your laboratory is affiliated to: Fax Email Ministry of Health Ministry of Agriculture Other ministries (please specify) Universities Private laboratories Other (please specify) Disease-specific networks: improving public health preparedness for and response to the threat of epidemics Mission statement To strengthen global disease-specific networks of experts and laboratories able to provide technical support to response activities in Member States, particularly developing countries, related to the natural occurrence, accidental release, or deliberate use of biological agents that affect health. World Health Organization Global Alert and Response Communicable Disease Surveillance and Response
Anthrax objective 1b Office international des épizooties WHO Global Salm-Surv Food and Agriculture Organization of the United Nations Reaching the laboratories PAHO EURO HQ EMRO SEARO WPRO AFRO WHO CSR Lyon WHO Collaborating Centres
Anthrax objective 2 Standard procedures relating to anthrax and disseminating information ANTHRAX Fact Sheet N 264 October 2001 Overview Anthrax is primarily a disease of herbivorous mammals, although other mammals and some birds have been known to contract it. Humans generally acquire the disease directly or indirectly from infected animals, or occupational exposure to infected or contaminated animal products. Control in livestock is therefore the key to reduced incidence. There are no documented cases of person to person transmission. The disease s impact on animal and human health can be devastating. WHO has produced Guidelines for the surveillance and control of anthrax in humans and animals. The causative agent of anthrax is the bacterium, Bacillus anthracis, the spores of which can survive in the environment for years or decades, awaiting uptake by the next host. The disease still exists in animals and humans in most countries of sub-sahelian Africa and Asia, in several southern European countries, in the Americas, and certain areas of Australia. Disease outbreaks in animals also occur sporadically in other countries. There are 3 types of anthrax in humans: cutaneous anthrax, acquired when a spore enters the skin through a cut or an abrasion; gastrointestinal tract anthrax, contracted from eating contaminated food, primarily meat from an animal that died of the disease; and pulmonary (inhalation) anthrax from breathing in airborne anthrax spores. The cutaneous form accounts for 95% or more of human cases globally. All 3 types of anthrax are potentially fatal if not treated promptly. Prevention Prevention of anthrax in both humans and animals is based on control measures in livestock in endemic areas, such as the safe disposal of anthrax carcasses and vaccination of at-risk herds. The most efficient method of disposal is incineration in a manner that ensures heat sterilization of the underlying soil. In practice, local conditions in many endemic countries make these simple control measures difficult to implement. In industrialized countries, prevention lies in good agricultural and industrial hygiene. Vaccines are available for animals and humans. However in humans their use should be confined to high-risk groups, such as those occupationally exposed and in some military settings. Patient isolation is not required and there are no quarantine requirements. Dressings and other contaminated materials should be disposed of, preferably by incineration. Treatment Guidance on anthrax: frequently asked questions What is anthrax? What's happening right now? Is there just one type of anthrax? How is it treated or prevented? Is there a vaccine? Can I catch it from someone else? I feel like I have a cold. Could it be anthrax? Do I have to go to a hospital to get tests? I am worried about anthrax. Should I take antibiotics just in case? What do I do if I get a suspicious package or letter? What constitutes a suspicious letter or parcel? What should I do if I receive an anthrax threat by mail? Q. What is anthrax? A. Anthrax is a disease caused by a bacterium called Bacillus anthracis. It is a disease which has existed for hundreds of years and which still occurs naturally in both animals and humans in many parts of the world, including Asia, southern Europe, sub-sahelian Africa and parts of Australia. Anthrax bacteria can survive in the environment by forming spores. In its most common natural form, it creates dark sores on the skin, from which it derives its name. Anthrax is Greek for coal. Q. What's happening right now? A. WHO posts updated situation reports whenever there is an outbreak of anthrax or any other infectious disease on its Web site. Q. Is there just one type of anthrax? A. There are three types of anthrax, each with different symptoms: Cutaneous, or skin, anthrax is the most common form. It is usually contracted when a person with a break in their skin, such as a cut or abrasion, comes into direct contact with anthrax spores. The resulting itchy bump rapidly develops into a black sore. Some people can then develop headaches, muscle aches, fever and vomiting. Cutaneous anthrax must be treated quickly. Appropriate medical evaluation and treatment are essential. Gastrointestinal anthrax is caught from eating meat from an infected animal. It causes initial symptoms similar to food poisoning but these can worsen to produce severe abdominal pain, vomiting of blood and severe diarrhoea. Appropriate medical evaluation and treatment are essential. The most severe form of human anthrax is called inhalation or pulmonary anthrax. Though the rarest, it is the form of human anthrax causing the most current concern. This form of the disease is caused when a person is directly exposed to a large number of anthrax spores suspended in the air, and breathes them in. The first symptoms are similar to those of a common cold, but this can rapidly progress to severe breathing difficulties and shock. Appropriate medical evaluation and treatment are essential.
Anthrax objective 3 Develop training on laboratory handling of biological agents associated with possible deliberate use Develop training materials and field test them with 4th cohort of CSR Lyon programme Training Finalize training materials, produce CD-ROM, distribute it. Implement regional or sub/intra-regional training, according to requests received
Anthrax objective 3 Establish an international quality control/quality assurance system with trained laboratories Establish a reagent bank of selected anthrax diagnostic materials. Quality control/ quality assurance Help to develop research for new, relevant laboratory tests Develop a restricted-access web site for laboratories: communication, ordering of reagents, and reporting of external quality assurance results
Tularaemia Anthrax (Bacillus anthracis) Brucellosis (Brucella abortus, Brucella suis and Brucella melitensis) Glanders (Burkholderia mallei) Melioidosis (Burkholderia pseudommallei) Tularaemia (Francisella tularensis) Plague (Yersinia pestis) Q fever (Coxiella burnetii) Typhus fever (Rickettsia prowazeki) plan of work priorities responsibilities timelines resources
Preparedness for Deliberate Epidemics web site e-mail http://www.who.int/csr/delibepidemics/en/ E-mail: deliberate@who.int