RS/2013/GE/15(CHN)
English only
REPORT REGIONAL WORKSHOP TO STRENGTHEN CORE CAPACITIES AT DESIGNATED POINTS OF ENTRY UNDER THE INTERNATIONAL HEALTH REGULATIONS (2005)
23-26 April 2013 Ningbo, China
Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC
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Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines
January 2014
NOTE The views expressed in this report are those of the participants of the Regional Workshop to Strengthen Core Capacities at Designated Points of Entry under the International Health Regulations (2005) and do not necessarily reflect the policies of the World Health Organization.
This report has been printed by the Regional Office for the Western Pacific of the World Health Organization for the participants of the Regional Workshop to Strengthen Core Capacities at Designated Points of Entry under the International Health Regulations (2005), which was held in Ningbo, China from 23 to 26 April 2013.
SUMMARY
A Regional Workshop to Strengthen Core Capacities at Designated Points of Entry under the International Health Regulations (2005) was held in Ningbo, China from 23 to 26 April 2013. The objectives of the workshop were: (1) (2) to introduce the updated WHO guidelines related to the IHR core capacities at designated points of entry; to review Member States' experiences and lessons learnt in establishing and strengthening institutional systems for the IHR core capacities at designated points of entry; and to develop adequate skills by demonstrating the practical application of the guidelines through a site visit during the workshop.
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The workshop was attended by participants from 12 countries and areas in the Western Pacific Region, observers from the Ministry of Health and the General Administration of Quality Supervision Inspection and Quarantine (AQSIQ) of China, WHO staff members and temporary advisers. The International Health Regulations (2005), or IHR (2005), entered into force in June 2007, and set out the obligations for Member States in meeting IHR requirements, including core capacities at points of entry in both routine public health functions and emergency preparedness and response. All Member States in the Region have strengthened their capacities at points of entry through the implementation of the Asia Pacific Strategy for Emerging Diseases, or APSED (2010), in recent years. However, 14 Member States in the Region requested two-year extensions, from the initial deadline of June 2012, for meeting IHR core capacity requirements. Based on the results of the 2012 IHR monitoring questionnaire, overall point-of-entry capacities remain weak in the Region. The workshop introduced to the participants the WHO technical guidelines, handbooks and training manuals designed to help accelerate IHR implementation at the country level. The participants enhanced their skills and knowledge through demonstrations and practical application of the WHO guidelines and tools, site visits and group work. Best practices, country experiences and lessons learnt were shared to review the national priority actions at designated points of entry and establish effective long-term mechanisms to further develop and sustain core capacities at airports, ports and ground crossings.
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At the close of the four-day workshop, the participants agreed that effective implementation of national IHR/APSED workplans, with sustainable collaboration with relevant stakeholders, was the key to successful achievement of IHR core capacities at designated points of entry. Member States that have sought extensions to the initial IHR deadline in 2012 were strongly advised to take urgent actions to ensure the designated points of entry meet the core capacity requirements by 2014, while others may continue their efforts to maintain and further strengthen IHR core capacities at points of entry and provide support to countries that require external assistance.
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TABLE OF CONTENTS Page
SUMMARY………..……………………………………………………………………..i 1. INTRODUCTION ....................................................................................................... 1 1.1 Background.........................................................................................................1 1.2 Objectives .......................................................................................................... 1 1.2 Opening remarks................................................................................................ 2 1.3 Appointment of Chairman, Vice Chairman and Rapporteur ............................. 3 2. PROCEEDINGS ......................................................................................................... 4 2.1 Plenary 1 – IHR (2005) implementation ........................................................... 4 2.2 Plenary 2 – WHO point-of-entry guidance and tools ........................................ 6 2.3 Plenary 3 – Country updates and experience with core capacity at POE .......... 7 2.4 Poster session: Core capacity building at points of entry ................................ 10 2.5 Plenary 4: Ship inspection and issuance of sanitation certificates .................. 12 2.6 Plenary 5: Vector surveillance and control at POE ......................................... 12 2.7 Plenary 6: Public health emergency preparedness and response at POE..........14 2.8 Breakout session 1: Scenario-based discussion on public health emergency planning…………………………………………………………………… ... 16 2.9 Field visits: Hands-on and skills demonstration .............................................. 16 2.10 Breakout session 2: Case study.........................................................................16 2.11 Breakout session 3: Country action................................................................. .16 3. CONCLUSIONS AND RECOMMENDATIONS ................................................... 22 3.1 Conclusions ..................................................................................................... 20 3.2 Recommendations ........................................................................................... 20 ANNEXES: ANNEX 1 ANNEX 2 ANNEX 3 ANNEX 4 ANNEX 5 ANNEX 6 PROGRAMME OF ACTIVITIES LIST OF PARTICIPANTS DAY 1 - POSTER SESSION: CORE CAPACITY-BUILDING AT POE DAY 2 – SHIP INSPECTION AND ISSUANCE OF SANITATION CERTIFICATES DAY 2 – BREAKOUT SESSION: SCENARIO-BASED DISCUSSION ON PUBLIC HEALTH EMERGENCY PLANNING AT POE DAY 2 – BREAKOUT SESSION 1: SCENARIO-BASED DISCUSSION ON PUBLIC HEALTH EMERGENCY PLANNING
ANNEX 7 ANNEX 8 ANNEX 9
DAY 3: FIELD VISIT – HANDS-ON AND SKILLS DEMONSTRATION TIMETABLE DAY 3: FIELD VISIT HANDS-ON AND SKILLS DEMONSTRATION DAY 3: BREAKOUT SESSION 2 – CASE STUDY
ANNEX 10 DAY 3: BREAKOUT SESSION 2 – CASE STUDY GROUP 2 EVENT MANAGEMENT IN AIR TRAVEL
Keywords Communicable diseases/Emerging/Public health – organization and administration/Guidelines/Disaster planning - Standards
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1. INTRODUCTION
1.1
Background
A Regional Workshop to Strengthen Core Capacities at Designated Points of Entry under the International Health Regulations (2005) was held in Ningbo, China from 23 to 26 April 2013. The workshop was attended by participants from 12 countries and areas in the Western Pacific Region, observers from the Ministry of Health and the General Administration of Quality Supervision Inspection and Quarantine (AQSIQ) of China, WHO staff members and temporary advisers. The International Health Regulations (2005), or IHR (2005), set out the obligations for Member States in meeting IHR core capacity requirements by June 2012, with a mechanism in place for an extension for those countries that needed more time to meet the deadline. These requirements include core capacities at designated points of entry in both routine public health functions and emergency preparedness and response. Effective public health measures at points of entry contribute to national, regional and global health security. Since June 2007, when IHR (2005) entered into force, all Member States in the Western Pacific Region have strengthened their capacities at points of entry through the implementation of the Asia Pacific Strategy for Emerging Diseases, or APSED (2010). Member States continued their efforts in developing and strengthening routine public health functions and readiness for public health emergency response at points of entry through the implementation of the APSED workplan and the recommendations of the Meeting on Points of Entry Capacity and Preparedness for Public Health Emergency Response under the International Health Regulations (2005), held from 26 to 28 October 2011 in Manila, Philippines. Fourteen Member States in the Region requested two-year extensions to the June 2012 deadline for meeting IHR core capacity requirements. Based on the results of IHR core capacity monitoring in 2012, the overall point-of-entry capacities remain weak in the Region. A number of new WHO technical guidelines, handbooks and training manuals related to points of entry have been developed to support IHR implementation at the country level. The workshop aimed to facilitate the implementation of these guidelines and the sharing of country best practices in order to enhance the core capacities at designated points of entry to meet the next IHR (2005) deadline in 2014.
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1.2
Objectives (1) (2) To introduce the updated WHO guidelines related to the IHR core capacities at designated points of entry. To review Member States' experiences and lessons learnt in establishing and strengthening institutional systems for IHR core capacities at designated points of entry. To develop adequate skills by demonstrating the practical application of the guidelines through a site visit during the workshop.
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Opening remarks
Dr Chin Kei Lee, Team Leader, Emerging Disease Surveillance and Response, Division of Health Securities and Emergencies, WHO Regional Office for the Western Pacific The opening remarks of Dr Shin Young-soo, WHO Regional Director for the Western Pacific, were delivered by Dr Chin Kei Lee, Team Leader, Emerging Disease Surveillance and Response, Division of Health Securities and Emergencies, WHO Regional Office for the Western Pacific. Dr Lee welcomed the participants and observers to Ningbo and to the Regional Workshop to Strengthen Core Capacities at Designated Points of Entry under the International Health Regulation (2005). He noted that IHR (2005) was a global legal instrument that was binding for all WHO Member States with the aim to prevent the spread of diseases, while avoiding unnecessary interference with international travel and commerce. Since IHR (2005) entered into force in June 2007, progress has been made in strengthening routine public health functions and public health emergency response at points of entry in the Region. APSED (2010) has been used as a common regional framework for Member States to develop national and local capacities, including increasing readiness for public health emergency response at points of entry. He acknowledged the significant challenges that remained in the Western Pacific Region – more than half of the countries had requested two-year extensions in meeting the IHR (2005) core capacity requirements. These countries were urged to take immediate action towards meeting the minimum requirements, including those at points of entry, by the second deadline in June 2014. Dr Lee emphasized that point-of-entry preparedness for public health emergencies was a continuing process. He highlighted that points of entry experience first-hand the impact of globalization on public health. As health security threats continue globally and in the Western Pacific Region, countries need to improve their readiness for future public health emergencies at POEs.
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He ended by saying that the workshop would provide a forum to review Member States' experiences and lessons learnt in establishing and strengthening institutional systems and to discuss the development of core capacities at designated points of entry. Moreover, the workshop would offer a vital opportunity to discuss and agree on recommended next steps in the Western Pacific Region. Vice-Minister Liu Pingjun, General Administration of Quality Supervision, Inspection and Quarantine, China Vice-Minister Liu Pingjun noted that the Port of Ningbo has been at the forefront of core capacity-building in China. As the competent authority of implementing IHR (2005) at points of entry, the General Administration of Quality Supervision, Inspection and Quarantine (AQSIQ) has been actively promoting core capacity-building in accordance with the Regulations, through the assessment of health situations at the international ports in China and development of programmes to support core capacitybuilding. The core capacities of the ports in China have been significantly strengthened in the past years. As of April 2013, 109 of 285 international ports have fulfilled core capacity requirements. All international ports in China are scheduled to meet the IHR requirements by 15 June 2014. He highlighted China’s progress in developing capacities in responding to public health emergencies at points of entry. During the influenza A(H1N1) pandemic in 2009, 46% of imported cases were successfully detected at points of entry in China. From 2011 to 2012, a total of 3081 cases of infectious disease were reported at points of entry, including influenza A(H1N1), malaria, dengue and chikungunya. He noted China’s ongoing efforts in prevention and control of avian influenza A(H7N9) at all points of entry. Mr Hong Jiaxiang, Vice-Mayor, Ningbo Municipal People’s Government, Ningbo, China Mr Hong Jiaxiang presented Ningbo as a city of culture and a gateway to the world. Today, the Port of Ningbo offers more than 230 international routes to some 100 countries. In 2012, the cargo throughput of Ningbo Port ranked fifth in the world, and the container throughout ranked sixth. In addition, the city of Ningbo has 20 special economic zones, such as free trade, free trade port, export processing, and economic and technological development, as the city leads the development of Zhejiang Province. The Port of Ningbo aims to establish itself as the international sanitary port, with strong focus on fulfilling IHR core capacities. All five international ports in Ningbo have met the IHR core capacity requirements. Ningbo continues its efforts to maintain and further develop capacities at points of entry. Mr Zhao Zhenshuan, Director General, Ningbo Enter-Exit Inspection and Quarantine Bureau, China Mr Zhao Zhenshuan highlighted the significant increase in the undertaking of Ningbo Entry-Exit Inspection and Quarantine Bureau (NBCIQ) in recent years, owing to the rapid development of a regional open economy. In the past five years, the total
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business volume of NBCIQ has grown rapidly, by 25% annually, which ranks seventh among the 35 inspection and quarantine bureaus directly under AQSIQ. In 2012, NBCIQ inspected 1.4 million batches of commodities, the total value of which reached US$ 121.1 billion. In addition to entry-exit commodity inspection, NBCIQ is responsible for entry-exit health quarantine. He noted that the core capacities at points of entry in Ningbo have been developed in close collaboration with the departments of health, port, port administrative affairs, frontier defence, and municipal government. The achievements made to date and ongoing efforts were presented in the video entitled “Core Capacity Building at Designated Points of Entry in China”. 1.4 Appointment of Chairperson, Vice-Chairperson and Rapporteur
Dr Sok Touch, Director, Communicable Disease Control Department, Ministry of Health, Cambodia, was appointed Chairperson for the workshop. Dr Fang Zhiqiang, Division Director, Division of Sanitary Supervision, Department of Supervision on Health Quarantine, General Administration of Quality Supervision, Inspection and Quarantine, China, was appointed Vice-Chairperson. Mr John Gardner, Senior Adviser, Environmental and Border Health, Public Health, Ministry of Health, New Zealand was appointed Rapporteur. 2. PROCEEDINGS
2.1
Plenary 1: IHR (2005) implementation
Dr Sok Touch, Director, Communicable Disease Control Department, Ministry of Health, Cambodia, introduced the session. 2.1.1 IHR (2005) implementation in the Western Pacific Region Dr Chin Kei Lee, Team Leader, Emerging Disease Surveillance and Response, WHO Regional Office for the Western Pacific The IHR (2005) has been a global legal framework for public health security since it entered into force on 15 June 2007. As of April 2013, IHR (2005) has been legally binding for 195 States Parties around the globe. The IHR (2005) provides an agreed framework for the collective international management of infectious disease outbreaks and other public health emergencies while minimizing disruption to travel, trade and economies. The key obligations of IHR (2005) include: (1) public health event communications between the National IHR Focal Points and WHO IHR Contact Points for reporting of specific diseases and any event of potential international public health concern; (2) establishing core capacities in surveillance and response for all countries at all levels including points of entry; and (3) developing global and regional systems of collaboration and decision-making for public health event management.
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Since its inception in 2005, APSED has provided a common framework for countries in the Western Pacific Region to strengthen generic capacities at national and local levels required for managing all emerging infectious diseases and public health emergencies. The updated APSED (2010), with its expanded scope and workplan for 2011–2015, continues to serve as a road map for Member States to build core capacities required by IHR (2005) and beyond. APSED (2010) emphasizes the importance of public health emergency preparedness, including the development of routine and response capacities at points of entry. It is recommended that the links between points of entry and existing national and local public health systems and services be well established and utilized to support point-of-entry public health functions. States Parties of the IHR (2005) were obligated to meet the core capacity requirements by June 2012, but a two-year extension was offered to countries that needed more time to meet the deadline. The 14 States Parties in the Western Pacific Region that have been granted an extension to the initial 2012 deadline were advised to identify gaps and effectively implement national workplans that incorporate point-of-entry activities. Technical and financial support will need to be mobilized to build core capacities and ensure full compliance to IHR (2005) by June 2014. Those States Parties that have already met core capacity requirements should continue their in-country efforts and accelerate their inter-country support in building, strengthening and maintaining the IHR core capacities beyond 2014. Overview of IHR (2005) implementation at points of entry at the global level Dr Daniel Menucci, Team Leader, Department of Global Capacities Alert and Response, Support to IHR Capacity Development, Ports, Airports and Ground Crossings, WHO Lyon Dr Menucci began his presentation by addressing key provisions for implementing IHR (2005) at points of entry for both States Parties and WHO, and by reviewing the status of point-of-entry core capacity development including the submission of lists of authorized ports. He then introduced WHO’s point-of-entry technical guidance, training and learning programme, networking tools, as well as the technical resources that could be utilized by countries. 2.1.3 Overview of the APSED (2010) workplan: point-of-entry preparedness Dr Luo Dapeng, Team Leader, Emerging Disease Surveillance and Response, WHO Country Office for Lao People's Democratic Republic Within the expanded scope of APSED (2010), point-of-entry preparedness is included in Focus Area 6: public health emergency preparedness. Dr Dapeng presented the vision of point-of-entry preparedness under APSED (2010): “As part of the overall national and regional public health emergency preparedness and response systems, POEs, especially designated international airports and ports in all Member States of the Western Pacific Region, are better prepared for and capable of appropriate response to potential or declared public health emergencies of international concern (PHEIC) in line with IHR (2005).” 2.1.2
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The IHR (2005) requires countries to develop capacities at designated points of entry to carry out routine public health functions and respond to events that may constitute a PHEIC. At all times, points of entry should provide medical services for ill travellers, a safe environment for travellers, and personnel for inspection and vector control. Designated points of entry should establish and maintain a public health emergency contingency plan (PHECP); make arrangements with existing facilities for assessment; carry out quarantine, isolation and treatment services, as needed; make arrangements and update guidelines for applying recommended measures – disinfection, disinsection and decontamination; and prepare entry or exit controls. In the Western Pacific Region, good progress has been made in developing capacities at points of entry. To date, a total of 351 points of entry have been designated for core capacity-building, including 203 seaports, 125 airports and 23 ground crossings. Routine public health functions and measures are in place in most designated points of entry, with ongoing efforts in public health emergency contingency planning. The presentation highlighted some key issues of capacity development at points of entry in the Region, including: • • • • • • • • • • 2.2 prioritizing designation of points of entry; utilizing existing national and local public health systems and services to support public health functions at points of entry; utilizing existing global and regional tools/guidelines developed by WHO; incorporating point-of-entry activities in the national workplan (i.e. IHR/APSED workplan); engaging point-of-entry stakeholders in the national-level planning and review process; ensuring participation of point-of-entry stakeholders in annual IHR core capacity assessment (IHR Monitoring Questionnaire); organizing stakeholder meetings for public health emergency contingency planning at designated points of entry; ensuring enhanced collaboration through Member States’ sharing of information and lessons learnt; WHO’s sustainable technical support and high-level advocacy for resource mobilization; and achieving and maintaining IHR core capacities beyond June 2014. Plenary 2: WHO point-of-entry guidance and tools
The Session Chairperson, Ms Tsolmongerel Tsilaajav, Director, Department of Policy Planning, Ministry of Health, Mongolia, introduced the session.
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2.2.1
Overview of the point-of-entry training tools
Dr Philippe Eric Gasquet, Team Leader, Human Resources Development and Training, Department of Global Capacities Alert and Response, Support to IHR Capacity Development, WHO Lyon One of the functions of the WHO Department of Global Capacities Alert and Response is to support education and training on IHR (2005). It is currently looking at how to develop and promote sustainable approaches to learning, that is, approaches that would remain valid beyond June 2014. Two teams within the WHO Department of Global Capacities Alert and Response – namely, Ports, Airports and Ground Crossings and Human Resources Development and Training – have developed an innovative approach to learning for port health inspectors with regards to the issuance of ship sanitation certificates under IHR (2005). The learning programme is made up of three separate elements or events: (1) (2) An e-learning course requires 10 to 15 hours of work online and should be completed prior to participating in the second event. A face-to-face workshop provides an opportunity for learners to review theoretical components of the online course as well as put into practice their newly acquired knowledge and skills through a simulation exercise and real ship inspections. A follow-up phase focused on the transfer of knowledge and skills in the working environment is typically conducted three to six months following the end of the face-to-face course.
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2.2.2
Tools for capacity assessment
Dr Wang Ninglan, Technical Officer, Department of Global Capacities Alert and Response, Support to IHR Capacity Development, Ports, Airports and Ground Crossings, WHO Lyon The IHR (2005), under Article 20.1, prescribes that States Parties must designate airports and ports (and may designate ground crossings) that will develop, strengthen and maintain core capacities at all times and in response to events that may constitute a PHEIC. The routine core capacity requirements, as outlined in Annex 1B, include assessment and medical care, staff and equipment; equipment and personnel to transport ill travellers; trained personnel for inspection of conveyances; ensuring a safe environment (e.g. water, food, waste); and trained staff and a programme for vector control. Capacity requirements for responding to a PHEIC include, among others, a PHECP and the application of recommended measures to disinsect, disinfect and decontaminate baggage, cargo, goods, etc. The assessment tool for core capacity requirements was devised to assist countries in assessing existing capacities and capacity gaps at points of entry, in the light of IHR (2005) Article 20.1 and Annex 1B. The tool includes a checklist and an Excel
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Spreadsheet File Model that enable countries to identify core capacities at points of entry and document assessment results, including numerical results. With this information, countries can develop a workplan and monitor of its implementation. To this end, an overview of the tool followed by a demonstration of the Excel Spreadsheet File Model were delivered to familiarize the participants with its utilization. 2.3 Plenary 3: Country updates on core capacities at POE
The Session Chairperson, Dr Kazunori Umeki, Deputy Director, Tuberculosis and Infectious Disease Control Division, Health Service Bureau, Ministry of Health, Labour and Welfare, Japan introduced the session. 2.3.1 Cambodia
Dr Sok Touch, Director, Communicable Disease Control Department, Ministry of Health, Cambodia Cambodia has 16 points of entry: one international seaport, one international river port, three international airports and 11 international ground crossings. As the competent authority of points of entry, the Quarantine Bureau of the Communicable Disease Control Department of the Ministry of Health supervises quarantine activities in Cambodia. A National IHR Focal Point has been established in the Communicable Disease Control Department of the Ministry of Health since March 2008. The following key achievements have been made to date: (1) a stakeholders' workshop was organized to identify gaps, roles and responsibilities of each sector in February 2012; (2) an assessment has been completed on medical service, safe environment for travellers, and arrangements of existing facilities for assessment, quarantine, isolation and treatments for ill travellers; and (3) the Ministry of Health has provided health quarantine units at points of entry with up-to-date information and guidelines for prevention and control of disease outbreaks both within and outside Cambodia. The following key challenges need to be addressed: (1) the Communicable Disease Law is in an early stage of development; (2) the official designation of two points of entry, one seaport and one airport, for IHR core capacity development has yet to take place; (3) the vector control teams at points of entry have yet to be established; and (4) the local laboratory capacity is still limited. The Communicable Disease Control Department is seeking approval for the official designation of points of entry for IHR core capacity development. It will hold a workshop on PHECP for the designated port (Sihanouk Ville Port) in November 2013.
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2.3.2
China
Dr Xue Yong Lei, Deputy Director, Division of Quarantine Inspection, Department of Supervision on Health Quarantine, General Administration of Quality Supervision, Inspection and Quarantine, China The States Parties to IHR (2005) are obligated to develop, strengthen and maintain core capacities at points of entry. Core capacity-building at points of entry is complex as it requires collaboration among the local government, port operating units, and the local inspection and quarantine bureau. The tripartite collaboration covers four major aspects: the joint prevention and communication mechanism at local, intermediate and national levels; adequate space and infrastructure at points of entry; facilities and equipment; and trained personnel and professional staffing. The Government of China expects that all 285 international points of entry in China will have fulfilled IHR core capacity requirements by 2014. As the competent authority of points of entry in China, AQSIQ is responsible for implementing four major tasks: assessment of capacities at points of entry; advocacy for core capacity-building; development of standards for core capacity-building; and strengthening cooperation and joint support. The three key areas of core capacity-building are coordination and communication, routine capacities and response to PHEIC. China’s experience in core capacity-building at points of entry indicated that strong leadership is needed from the local inspection and quarantine bureau. In addition, it is essential to have unwavering support from the local government and port operating units, technical guidance from the local inspection and quarantine bureau and an integrated programme for promoting core capacity-building at all points of entry. In China, a total of 109 points of entry have already met the IHR core capacity requirements, while the capacity to respond to PHEIC has significantly increased. 2.3.3 Malaysia Dr Affendi Bin Ahmad, Health Officer, International Point of Entry, Kota Kinabalu Area Health Office, Malaysia Malaysia has achieved IHR core capacity requirements at its points of entry and will continue to follow this important issue closely. To date, Malaysia’s designated points of entry include eight international airports, seven seaports and five ground crossings spread across the country. Examples of public health activities conducted at points of entry include: • • • • communicable disease control; surveillance, assessment and response; public health emergency preparedness; vector control;
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food safety and quality control; environmental sanitation; safe water supply; noncommunicable disease control; health promotion; occupational safety and health; inspectorate activities and public health law enforcement; and monitoring of activities related to the importation and exportation of human remains, human tissues, microorganism and pathogenic substances, etc.
Malaysia has used APSED (2010) as a tool to coordinate and monitor the implementation of IHR (2005). The aim has been to ensure effective preparedness planning, as well as the establishment and maintenance of core capacities in dealing with the emerging diseases and other public health emergencies. It was highlighted that an effective public health emergency response at points of entry will require the participation of various agencies, with emphasis on the importance of and need for coordination, communication and information sharing between the National IHR Focal Point and the competent authority and with relevant sectors, including operational and liaison links between public health authorities, relevant stakeholders (including operators of ports, airports, ships and aircraft) and the National IHR Focal Point. In addition, it is important to have good networking, collaboration and smart partnerships with neighbouring countries to tackle related cross-border health issues. 2.3.4 Mongolia Ms Tsolmongerel Tsilaajav, Director, Department of Policy Planning, Ministry of Health, Mongolia In Mongolia, 15 border inspection departments and units are being operated at the 26 border points with over 300 state inspectors. In 2002, the General Agency for Specialized Inspection was established to unite all control and inspection agencies and units that operated at the State’s borders. The core capacities at points of entry were assessed using the IHR checklist at three border points in 2010 and 2011. As a result, the organizational emergency preparedness and response plans were revised, and the roles and responsibilities of respective agencies were included in the special plan for the prevention and control of highly infectious disease such as influenza A(H1N1). A cooperation protocol and treaty have been established to improve prevention and control of emerging and re-emerging diseases and risk communication.
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Challenges in capacity development at points of entry include the lack of integrated information and communication system among the border points, functional devices and equipment and qualified human resources. Further actions planned to enhance the capacity include the sharing of experience through joint training with neighbouring countries, the establishment of an integrated information system as part of an e-government project, and an assessment of the other local border control points for the identification of priority actions. 2.3.5 Viet Nam Dr Ha Huy Toan, Deputy Chief, Border Health Quarantine Division, General Department of Preventive Medicine, Viet Nam Located in South-East Asia, Viet Nam is bordered by China to the north, the Lao People’s Democratic Republic and Cambodia to the west, and the East Sea to the east. Viet Nam has 47 major points of entry, including 22 international ground crossings, 17 seaports and eight international airports. Of these, three international ground crossings, one seaport and three international airports have been designated to fulfil IHR (2005) core capacity requirements. Regular activities at designated points of entry include supervision of passengers, conveyances and cargo and surveillance of vectorborne diseases. Ill passengers detected at points of entry are isolated or transferred to hospitals. Any contaminated conveyances or cargo are disinfected before entering or exiting the point of entry. Appropriate health measures are implemented when the index vectorborne diseases exceed the threshold at points of entry. An evaluation conducted at the end of 2012 found that all points of entry in Viet Nam had not achieved the minimum core capacities required by IHR (2005). The core capacities need to be further strengthened in the development of procedures for supervision, detection and medical treatments of ill passengers, contaminated conveyances and cargo, and establishing a mechanism for information-sharing between competent authority and relevant stakeholders. 2.4 Poster session: Core capacity-building at POE
All participating countries and areas were requested to prepare and present a poster that described their experiences and lessons learnt in establishing and strengthening institutional systems for the development of IHR core capacities at designated points of entry. They were also asked to share their best practices (Annex 3). Participants were divided into three groups to discuss the best practices. A summary of discussions was presented in the plenary. The group feedback session was chaired by Dr Norhayati bt Rusli, Deputy Director of Disease Control (Surveillance), Disease Control Division, Ministry of Health, Malaysia.
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The best practices were identified as follows: • • • Capacity-building efforts are backed by political commitment and advocacy. Relevant legislation is in place to support IHR implementation and core capacity-building requirements. An integrated/common national workplan for points of entry is being effectively implemented. A lead agency is providing leadership and guidance, and the roles and responsibilities of stakeholders are clearly defined. Effective coordination and communication among stakeholders are facilitated with clear procedures. All stakeholders are aware of the IHR core capacity requirements. Training tools and guidelines are developed and well utilized. A public health emergency preparedness plan is in place with key stakeholders and necessary resources clearly identified for mobilization. Cross-border collaboration exists.
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Key challenges in building core capacities at points of entry are: • • • • lack of established institutional responsibility; difficulty in ensuring multisectoral engagement, where the National IHR Focal Point is designated within the Ministry of Health; limited resources available for securing trained workforce, equipment and infrastructure; and low surge capacity during pandemic and other public health emergencies.
The following recommendations for remedial action were made: • • • • • • Enhance political commitment. Establish a legislative framework to support IHR implementation. Develop and monitor the implementation of an integrated national workplan. Explore the option of appointing a National IHR Focal Point outside the Ministry of Health to facilitate intersectoral collaboration. Develop sustainable human resources through training and skills development. Ensure effective passenger tracking and surveillance systems are in place.
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• • • 2.5
Install a more robust monitoring system at points of entry to identify non-symptomatic carriers. Actively share surveillance data with neighbouring countries. Enhance inter-country assistance to Member States in need. Plenary 4: Ship inspection and issuance of sanitation certificates
The Session Chairperson, Dr Sibauk Vivaldo Bieb, Executive Manager, Public Health, Health Department, Papua New Guinea, introduced the session. 2.5.1 Overall introduction to ship inspection and ship sanitation certificates Dr Daniel Menucci, Team Leader, Department of Global Capacities, Alert and Response, Support to what the roles of inspectors are, how to prepare for and carry out ship inspections and how to issue ship sanitation certificates, etc. Lessons learnt were also presented. A brief introduction to IHR Capacity Development, Ports, Airports and Ground Crossings, WHO Lyon Dr Menucci introduced ship inspection and ship sanitation certificates under the IHR framework by explaining what ship sanitation certificates stand for, who can issue ship sanitation certificates, WHO’s handbook for inspection of ships and issuance of ship sanitation certificates was provided. The handbook provides guidance for preparing and performing ship inspections, formulating ship inspection certificates, and applying public health measures in the context of IHR. 2.5.2 Group work: Fact finding The exercise addressed the technical areas that are the main focuses of an inspection and issues related to risk assessment principles and inspection of ship sanitation (Annex 4). 2.6 Plenary 5: Vector surveillance and control at POE
The Session Chairperson, Dr Sibauk Vivaldo Bieb, Executive Manager, Public Health, Health Department, Papua New Guinea, introduced the session. 2.6.1 Prevention and control of vectorborne disease at points of entry Dr Rabindra Abeyasinghe, Technical Officer (Malaria), WHO Country Office for Papua New Guinea To preserve global health, the capacity to detect patients at points of entry who are infected with or carrying microorganisms causing vectorborne diseases is as important as preventing the entry/exit of vectors capable of transmitting these diseases through points of entry. Therefore, prevention and control of vectorborne diseases at points of entry has been identified as a core capacity that should be available under IHR (2005).
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Important vectorborne diseases that could be introduced to a country and/or spread to other countries through a point of entry are those that are caused by viruses (e.g. yellow fever, dengue, chikungunya, encephalitis and rabies), bacteria (e.g. plague, leptospirosis, relapsing fever and tularaemia), protozoa (e.g. malaria, Chagas disease, leishmaniasis), rickettsial diseases (typhus, rickettsial pox) and infestations by arthropods (e.g. pediculosis, scabies and myasis). The IHR (2005) stipulates the need to maintain all designated POE and a 400-metre buffer zone surrounding all designated points of entry that is free of vectors. For this purpose, it may be necessary to strengthen not only legislation regarding points of entry, but also public health legislation. In addition, it may be necessary to establish/strengthen surveillance capacity to detect vectors and control them. Surveillance for this purpose may be classified as routine, spot checks and emergency. The intensity of surveillance operations should be decided by the importation/exportation risk of the disease, status of suspected or confirmed outbreaks, presence or absence of exotic vector species, and suitability of climatic conditions for vector survival and multiplication. The method of surveillance at points of entry is dependent upon the type of conveyance, whether it’s cargo or containers, and the type of baggage. Optimal surveillance methods, frequency of implementation and intensity of control activities will be dependent upon the nature of the disease, potential public health threat and climatic conditions. In addition, surveillance should be used to monitor the effectiveness of control measures. Vector control should be based on an Integrated Vector Management strategy, which should provide for environmental management and mechanical control activities, which in the long term will reduce the dependence on and need for extensive use of potentially harmful chemicals. However, the use of chemical insecticides will be necessary in most situations to ensure a vector-free zone at points of entry and in the immediate vicinity. Products recommended by the WHO Pesticide Evaluation Scheme should be used in such situations, with mandatory evaluation of vector control operations to prevent the development of vector resistance to insecticides. The basic requirements necessary for implementation of an effective vector control programme requires the presence of adequate numbers of trained staff, sufficient stocks of insecticides and necessary equipment, support of mechanical and engineering departments to carry out structural changes, and insecticide susceptibility kits. Plans to evaluate the impact of control activities should be made available to stakeholders. Vector control operations will also be defined by the nature of the need to control a potential situation, i.e. routine or emergency need. The special needs associated with controlling vectors and rodents in airports, planes and ports are also important aspects that need to be considered.
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2.6.2 Introduction of WHO technical guide Dr Rabindra Abeyasinghe, Technical Officer (Malaria), WHO Country Office for Papua New Guinea The IHR (2005) identifies the capacity for surveillance of disease vectors and their control as a core capacity to be established at designated points of entry. WHO is developing a handbook on vector surveillance and control at ports, airports and ground crossings to assist Member States in acquiring this capacity. The handbook is expected to help Member States meet the obligations required in this respect under IHR (2005). The handbook will also provide technical advice on developing a comprehensive programme for systemic monitoring of vectors and for integrated vector control at points of entry. It is believed that the handbook will be used by port health officers, regulators, operators and other competent authorities responsible for establishing core capacities in vector surveillance and control under IHR (2005). The handbook contains technical guidance and will be useful for service providers (including travellers, conveyances, containers, cargo and postal parcels) and multiple partners (within and between Member States). The handbook describes vectorborne diseases that are potentially important to points of entry, the vectors that transmit these diseases, and effective surveillance and control methods. Surveillance methods for arthropod vectors (including mosquitoes) and non-arthropod vectors (including rodents) are described in detail. The handbook calls for the establishment of a detailed vector surveillance plan at points of entry, including details of surveillance types and details regarding surveillance for different vector species. The handbook clearly describes types of breeding and resting sites found at points of entry and suggests measures to control vector breeding in these sites. The handbook details the IHR (2005) requirement to maintain a 400-metre buffer zone surrounding all designated points of entry that is free of vectors. The handbook classifies vector surveillance as routine, spot checks and emergency. The intensity of surveillance operations should be decided by the importation/exportation risk of the disease, status of suspected or confirmed outbreaks, presence or absence of exotic vector species, and suitability of climatic conditions for vector survival and multiplication. The draft handbook was distributed to participants at the meeting. They were encouraged to provide comments and or suggestions for further improvement of the product. 2.7 Plenary 6: Public health emergency preparedness and response at POE
The Session Chairperson, Dr Alwyn Asuncion, Quarantine Medical Officer, Bureau of Quarantine, Department of Health, Philippines introduced the session.
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2.7.1 Public health emergency management and introduction to the WHO guide on public health emergency contingency planning at points of entry Mr John Gardner, Senior Adviser, Environmental and Border Health, Public Health, Ministry of Health, New Zealand (1) A guide for public health emergency contingency planning at designated points of entry Given the ubiquitous nature of public health events, it is essential that states set up a PHECP so that effective responses can be made if or when a public health emergency arises. There are six core themes and associated guiding principles that are central to creating and enabling effective and appropriate plans for designated points of entry. As outlined in the guide, the core themes are simplicity; proportionality and practicality; minimal disruption; collaboration; communication; and the 3 R’s of emergency management – readiness, response and recovery. As guiding principles, PHECPs should be flexible to suit a range of public health emergencies; ensure harmonization with existing plans; prepare for “surge capacity” on an “as required” basis; place equal emphasis on readiness, recovery and response; ensure adequate budgeting for developing, exercising and refreshing/updating plans; and ensure full respect for dignity, human rights and freedoms as per IHR (2005). Key planning considerations, as outlined in the guide, are communication; relationships; command and control structures; decision support; people and resources; interoperability of plans; and other planning considerations including risk profiles, legislative envelopes and other requirements. The guide goes on to describe a series of steps that should be followed when conducting planning: establish a planning team; prepare for the planning phase; initiate the planning phase; write the plan; review the plan; test the plan; obtain stakeholder signoff; publish and communicate the plan; brief and train required response personnel; schedule regular exercises; and review, update and maintain the plan as required. The guide recommends a structure for all PHECPs: Introduction; Operational response including command and control structures; and Supporting information. The strength of the PHECP will depend on the robustness of its command and control structures. The emergency operations centre is the nerve centre of response operations, and particular attention needs to be paid to ensuring that the arrangements for the emergency operations centre are appropriate to meet the circumstances. Mr Gardner stressed that a plan by itself is no guarantee of success. After the plan has been developed, it must be tested and reviewed. Also, stakeholders need to take ownership of the plan, and enduring relationships among the players must be developed and sustained.
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(2)
Exercising public health emergency response plans
A response plan cannot be assumed to be effective until it has been tested. Conducting regular exercises is an efficient method of testing a plan and ascertaining the following: • • • the currency of the plan, policies and procedures; weaknesses of the plan; the level of interagency coordination and communication;
• the competencies of the participants in fulfilling their roles and in carrying out their tasks in the response; • • • • improvements needed from individual performances; resource requirements; the level of recognition and support from officials; and if the plan will satisfy regulatory requirements.
The exercise programme should follow a training cycle that starts at the lowest level (e.g. single-agency exercise) and culminates with a complex exercise that tests the maximum number of personnel and organizations that resources will allow (e.g. multi-agency exercise at national level). The levels of exercise are: individual training; team drills; table-top exercises and war games; functional exercise; and full-scale exercise. Note: Before commencing the exercise programme, participants need to be briefed through orientation seminars and walkthroughs. Evaluation of the exercise is an indispensable part of the exercise process. Evaluation is the process of observing and recording exercise activities, comparing the performance of the participants against the objectives, and identifying strengths and weaknesses. The final phase of conducting an exercise is the generation of a post-exercise report. This document will confirm the strengths and weaknesses of the plan and will provide recommendations on what remedial action is required. 2.8 Breakout session 1: Scenario-based discussion on public health emergency planning The session was designed for the participants to evaluate their current emergency response plans and capabilities for responding to an unknown disease detected in Country A and spreading to other countries (Annexes 5 and 6).
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2.9
Field visits: Hands-on and skills demonstration
A field trip to Daxie Port was organized for all participants in the morning of Day 3 of the workshop. In the afternoon, the participants were divided into two groups. Group 1 visited a container ship to observe ship sanitation inspection and issuance of ship sanitation certificates. Group 2 proceeded to Lishe International Airport (Annexes 7 and 8). 2.10 Breakout session 2: Case study Group 1: Event management on board ship Group 1 consisted of the participants who visited the container ship on Day 3 of the workshop. The exercise highlighted the main IHR legal framework with references to specific IHR articles and annexes as a decision-making aid for the port health officers (Annex 9). Through the exercise, the participants acquired an understanding of the specific requirements for procedures, communication and collaboration needed by the competent authority at each port for routine surveillance and response to events, and for communication and collaboration needed among the competent authority, the national surveillance systems and the National IHR Focal Point. Group 2: Event management in air travel A scenario-based exercise was conducted to elicit constructive discussion on event management in air travel (Annex 10). The case study helped participants walk through various capacities that would be employed in public health emergency preparation and response, notably contingency plan at an airport, roles and responsibilities of public health authority, aviation section and other stakeholders in responding to public health events at airport; communication and collaboration for routine surveillance and response to public health events at airport, specifically for integration of point of entry, national surveillance systems and the National IHR Focal Point, etc. Twenty-one participants and observers from 10 countries were involved in the air travel case study. In small groups, participants discussed the case study material in five steps. After each step, rapporteurs reported the groups' responses and facilitators summarized all the views before moving on to the next step of the exercise. In the course of case study, thought-provoking queries were raised and experiences were exchanged among the participants and facilitators. 2.11 Breakout session 3: Country action The participants were divided into three groups based on their country’s core capacity at points of entry. The objectives of the session were: (1) to assist countries in recognizing the gaps, strengths and key measures in core capacity-building at points of entry;
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(2) to support countries that have requested an extension to formulate a revised remedial action plan at points of entry, and ensure that the IHR requirements are met; and (3) to facilitate collaboration among countries in sustaining and further developing core capacities at points of entry and in providing support to countries that need external assistance. Each group was requested to answer six guiding questions (see Table 1). A summary of the discussion was presented in the plenary. Table 1. Core capacities at points of entry by country Group D Group E Group F Malaysia Cambodia China Papua New Guinea Lao People’s Democratic Hong Kong (China) Philippines Republic Japan Viet Nam Mongolia Singapore (1) Identify the key elements within the core capacity at points of entry that are important to your country for further development as part of your priority action plan. Most of the countries - Resources - Leadership, ownership represented in this group and coordination - Collaboration with other had already established the stakeholders through - Better legislation to core capacity at their regular meetings ensure smooth process POEs. - Training and personnel development - Improved infrastructure and better linkage with existing public health system - Training to enhance knowledge of IHR and technical capacitybuilding for implementation - Maintaining the standard of already established emergency response plans - Effective intersectorial communication - International collaboration
(2) What are some of the challenges you foresee (from your own country experience)? The key challenges - Turnover of trained - Government associated with maintaining staff commitment the standard of emergency - Future development or - Leadership response plans are: expansion of points of - Integration of - Resources entry information and collaboration among - Information - Sustainability local, intermediate and national levels in real situations
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- Surge of newly emerging diseases - Resources and capacity constraints
- Active participation and coordination among stakeholders - Increasing volume of passengers - Emerging diseases - Surveillance capacity (Field Epidemiology Training Programme)
- Promotion of effective two-way communication between points of entry and local surveillance
(3) How can you implement these key elements in your country and how do you intend to incorporate routine service and emergency response into your system or utilize the existing resources to implement them? - Continuous training - Advocacy and - Develop a programme leadership comprehensive emergency response - Engagement with other - Regular capacity plan with detailed stakeholders assessments among standard operating stakeholders procedures (SOPs) at - High-level commitment points of entry. and bilateral - Identification of gaps at arrangements with points of entry - Clearly define bordering countries for institutional - Development of a “road sharing of resources responsibilities. map” with all stakeholders to achieve - Formalize training for the core capacity staff of points of entry requirements across the country. - Phase-by-phase approach (milestones, prioritized activities) - Legislation - Conduct regular drills and exercises to identify problems and gaps in communication.
(4) What key action plans are needed in order to ensure the smooth emergency response operations at points of entry? (Remember that this is a multisectoral operation.) - Conduct table-top - National emergency - Regular review of the exercises and replan emergency response training. plan to make sure the - Public health contact list is updated - Create and maintain emergency regular communication preparedness and among stakeholders. response plan
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- Raise awareness of SOPs and action plan among health staff and other stakeholders.
- Point-of-entry emergency preparedness and response plan - All the plans linked together with clear communication and command-and-control structure
- Regular drills and exercises to enable relevant staff to familiarize themselves with their roles and responsibilities in emergency response and to evaluate operational capability of implementing the emergency response plan
(5) What resources can be provided to support those countries that most need external assistance to build core capacities at points of entry? - Sharing of experiences - Regional workshops for - Training (e.g. ship and information sharing information and inspection) experiences - Cross-border - Sharing of SOPs collaboration - Capacity-building - Sharing of technical (professional skills) on - Training, joint visits and expertise and tools (e.g. emergency management development of staff sharing of expertise for vector control and from external sources - Technical assistance online platform for vector identification) (6) What is your country’s priority action in terms of core capacity-building at designated points of entry to meet the requirements of IHR (2005) before the next deadline of June 2014? The key challenge identified - Development of SOPs - Completion of core in maintaining the and guidelines at points capacity assessment or established core capacities of entry re-assessment at points of entry was - Development of an - Organization of maintaining the knowledge action plan and setting advocacy meetings and skills in organizations of deadlines for among stakeholders where staff members are achieving core capacity required to rotate to other - Development of a road- services regularly. requirements map and action plan - Procurement of - Having a mechanism in - Official designation or equipment place to ensure that all prioritization of points new staff receives of entry adequate training. - Provision of technical training
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3. CONCLUSIONS AND RECOMMENDATIONS
3.1
Conclusions
(1) Participants recognized that States Parties to IHR (2005) in the Western Pacific Region should make vigorous efforts to fulfil the obligations of IHR (2005). Countries that requested extensions, in particular, should be encouraged to utilize existing resources to meet core capacity requirements by 2014. (2) APSED (2010) serves as a common regional framework for Member States in the WHO South-East Asia and Western Pacific regions to develop IHR national core capacities, including readiness and response at points of entry. (3) Efforts are being made to strengthen routine public health requirements and functions, as well as preparedness for public health emergencies, at points of entry. Further significant efforts are required in some countries to ensure that core capacities at designated points of entry will meet the IHR requirements. (4) Effective implementation of national IHR (2005) and APSED (2010) workplans is the key to successful achievement of IHR core capacities at designated points of entry. This will require the collaboration and/or participation of public health authorities (or equivalent) and various agencies, including those involved in the areas of ship sanitation, vector surveillance and control at points of entry, and public health emergency contingency planning. (5) This regional workshop provided an opportunity to share good practices, experiences and lessons learnt from Member States in developing routine public health functions, public health emergency preparedness and response capacities at designated points of entry. The workshop participants enhanced their skills through demonstration and practical application of the WHO guides, tools and technical documents related to points of entry. These will help participants to review and further strengthen national priority actions at designated points of entry. 3.2 Recommendations
(1) Member States are advised to establish effective, long-term mechanisms to develop and sustain the core capacity requirements at designated points of entry. (a) Member States should make every effort to utilize existing national structures, resources, facilities and capacities. (b) Member States should institutionalize and embed point-of-entry activities within their national plans. Relevant stakeholders should be engaged in the overarching IHR/APSED planning and review process. (c) Operational, communication and coordination links should be established among relevant stakeholders (including operators of designated ports, airports,
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ground crossings, ships, aircraft and ground transport), public health authorities, national surveillance/response systems and the National IHR Focal Points. (d) Member States should collaborate through the existing WHO mechanisms to enhance capacity in selected areas including human resources development. (2) States Parties to the IHR (2005) in the Western Pacific Region that have sought extensions to the initial IHR deadline in 2012 are strongly advised to take urgent actions to ensure the designated points of entry meet the core capacity requirements by 2014. Actions include continuing to implement recommendations of the Meeting on Points of Entry Capacity and Preparedness for Public Health Emergency Response under the IHR (2005), 26 to 28 October 2011, Manila, Philippines, such as: (a) (b) (c) (d) prioritize the identification of designated points of entry; implement necessary and operational links to national public health authorities (or the equivalent); utilize existing global and regional tools and guidelines; and develop and exercise PHECPs using the WHO guide.
(3) States Parties that have not requested an extension may continue efforts to maintain and further strengthen IHR core capacities at points of entry and provide support to those countries that require external assistance. (4) States Parties that have not identified authorized ports to issue ship sanitation certificates, when applicable, are encouraged to develop ship sanitation inspection programmes, prepare a ports list, and inform WHO about ports authorized to issue ship sanitation certificates. (5) WHO, under the APSED framework, may continue to provide technical support for State Parties to meet the IHR core capacity requirements at points of entry before and beyond 2014. WHO may continue to facilitate collaboration and human resources development among Member States through the mobilization of regional experts for sustainable technical support.
ANNEX 1 PROGRAMME OF ACTIVITIES
Day 1 – Tuesday, 23 April 2013 08:30 – 09:00 09:00 – 10:00 Registration Opening session Welcome and opening remarks - Dr Chin Kei Lee, Team Leader, Emerging Disease Surveillance and Response, WHO Regional Office for the Western Pacific (WHO/WPRO) - Vice Minister Liu Pingjun, General Administration of Quality Supervision, Inspection and Quarantine, China - Mr Hong Jiaxiang, Vice Mayor, Ningbo Municipal People’s Government - Mr Zhao Zhenshuan, Director General, Ningbo Enter-Exit Inspection and Quarantine Bureau, China Video presentation Self-introductions Overview of objectives and agenda Nomination of Chairs Administrative announcements Group photo 10:00 – 10:30 10:30 – 12:00 10:30 – 10:45 10:45 – 11:30 11:30 – 11:45 11:45 – 12:00 12:00 – 13:00 13:00 – 14:00 Coffee break Plenary 1: IHR (2005) implementation IHR implementation in the Western Pacific Region - Dr Chin Kei Lee, WHO/WPRO Overview of the IHR implementation of POE at the global level - Dr Daniel Menucci, WHO/HQ Overview of the APSED (2010) workplan: POE preparedness - Dr Luo Dapeng, WHO/Lao People's Democratic Republic Questions and clarification Lunch break Plenary 2: WHO POE guidance and tools
13:00 –13:20 13:20 – 13:50 13:50 – 14:00 14:00 – 15:30 14:00 – 14:15 14:15 – 14:30 14:30 – 14:45 14:45 – 15:00 15:00 – 15:15 15:15 – 15:25 15:25 – 15:30 15:30 – 16:00 16:00 – 17:00
Overview of the POE training tools - Dr Philippe Eric Gasquet, WHO/HQ Tools for capacity assessment - Dr Wang Ninglan, WHO/HQ Questions and clarification Plenary 3: Country updates and experience with core capacity at POE Cambodia China Malaysia Mongolia Viet Nam Questions and clarification Introduction to poster presentations Coffee break Poster session: Core capacity-building at POE - Group 1 - Group 2 - Group 3 Welcome reception
18:00 –19:30
Day 2 – Wednesday, 24 April 2013 08:30 – 09:00 08:30 – 08:40 08:40 – 08:50 08:50 – 09:00 09:00 – 12:00 09:00 – 10:00 10:00 – 10:30 Group feedback from poster session - Group 1 - Group 2 - Group 3 Plenary 4: Ship inspection and issuance of sanitation certificates Overall introduction to ship inspection/ship sanitation certificates - Dr Daniel Menucci, WHO/HQ Coffee break
10:30 – 12:00 12:00 – 13:00 13:00 – 14:00 13:00 – 13:25 13:25 – 13:50 13:50 – 14:00 14:00 – 15:00 14:00 – 14:45
Group work: Fact finding Lunch break Plenary 5: Vector surveillance and control at POE Prevention and control of vectorborne disease at POE - Dr Rabindra Abeyasinghe, WHO/ Papua New Guinea Introduction of WHO technical guide - Dr Rabindra Abeyasinghe, WHO/ Papua New Guinea Questions and clarification Plenary 6: Public health emergency preparedness and response at POE Public health emergency management and introduction to WHO guide on public health emergency contingency planning at POE - Mr John Gardner, WHO Temporary Adviser Questions and clarification Introduction to breakout session Coffee break Breakout session 1: Scenario-based discussion on public health emergency planning - Group A - Group B - Group C
14:45 – 14:55 14:55 – 15:00 15:00 – 15:30 15:30 – 16:30
16:30 – 17:00
Feedback from breakout session - Group A - Group B - Group C Questions and clarifications
Day 3 – Thursday, 25 April 2013 08:00 – 12:00 12:00 – 13:00 Field visit: Hands-on and skills demonstration - Visit to Daxie Port Lunch break
13:00 – 18:00
Field visit: Hands-on and skills demonstration (continued) - Group 1: Ship inspection and issuance of ship sanitation certificate - Group 2: Visit to Lishe International Airport
Day 4 – Friday, 26 April 2013 08:00 – 08:30 08:00 – 08:10 08:10 – 08:20 08:20 – 08:25 08:25 – 08:30 08:30 – 10:00 Feedback from field visit - Group 1: Port - Group 2: Airport Questions and clarification Introduction to breakout session Breakout session 2: Case study - Group 1: Event management on board ship - Group 2: Event management in air travel Feedback from breakout session - Group 1 - Group 2 Questions and clarification 10:15 – 10:30 10:30 – 12:00 Coffee break Breakout session 3: Country action - Group D - Group E - Group F Feedback on country action - Group D - Group E - Group F Lunch break Plenary 7: Conclusions and recommended next steps Closing session
10:00 – 10:15
12:00 – 12:30 12:00 - 12:10 12:10 – 12:20 12:20 – 12:30 12:30 – 14:00 14:00 – 15:30
ANNEX 2
LIST OF PARTICIPANTS, TEMPORARY ADVISERS, OBSERVERS AND SECRETARIAT 1. PARTICIPANTS CAMBODIA Dr Sok Touch, Director, Communicable Disease Control Department, Ministry of Health, No. 151-153 Kampuchea Krom Avenue, Phnom Penh. Tel. No.: (855 12) 856 848. Fax No.: (855 23) 882 317, E-mail: touch358@online.com.kh, chhanly@yahoo.com Dr Chhy Sokhom, Vice Chief of Health Quarantine Bureau Ministry of Health, No. 151-153 Kampucheakrom Boulevard Phnom Penh. Tel. No.: (855 12) 842 872 E-mail: sokhomchhy@yahoo.com Mr May Chanvuthy, Quarantine Staff, Communicable Disease Department, No. 151-153 Kampucheakrom Boulevard, Phnom Penh. Tel. No.: (855 77) 232 577 E-mail: maychanvuthy@gmail.com CHINA Dr Xue Yong Lei, Deputy Director, Division of Quarantine Inspection, Department of Supervision on Health Quarantine General Administration of Quality Supervision, Inspection and Quarantine, No 9, Madiandonglu, Haidang District Beijing. Tel. No.: (8610) 8226 1878. Fax No.: (8610) 8226 0150. E-mail: xueyl@aqsiq.gov.cn Dr Shi Fang, Deputy Director of the Division for Supervision on Health, Shanghai Entry-Exit Inspection and Quarantine Bureau, No 1208, Minsheng Road, Pudong, Shanghai Tel. No.: (8621) 3862 0196. Fax No.: (8621) 6854 4584 E-mail: shif@shciq.gov.cn HONG KONG (CHINA) Dr Lam Man Chung, Senior Port Health Officer Department of Health. Suite 1101, 11/FA/A Kowloon Tower, Landmark East. 100 How Ming St., Kwun Tong Kowloon. Tel. No.: (852) 3904 9302. Fax No.: (852) 2833 0132 E-mail: mannylam@dh.gov.hk Dr Lam Chong, Coordinator, Control of Communicable Diseases, CDC-NDIV, Health Bureau, Government of the Macao Special Administrative Region, 7th Floor, Building “Hot Line”, No 335-341, Alameda Dr Carlos d’Assumpcao Macao. Tel. No.: (853) 2853 3525. Fax No.: (853) 2853 3524. E-mail: lamc@ssm.gov.mo
MACAO (CHINA)
JAPAN
Dr Kazunori Umeki, Deputy Director, Tuberculosis and Infectious Disease Control Division, Health Service Bureau Ministry of Health, Labour and Welfare, 1-2-2 Kasumigaseki Chiyoda-ku, Tokyo 100 8916. Tel. No.: (813) 5253 1111 Fax No.: (813) 3581 6251. E-mail: umeki-kazunori@mhlw.go.jp Dr Mie Kasamatsu, Head, Quarantine Section, Kansai Airport Quarantine Station, 4F CIQ Building, 1 Senshu-Kuko Naka Tajiri-cho, Sennan-gun, Osaka 549 0011. Tel. No.: 81(72) 455 1282. Fax No.: 81(72) 455 1288 E-mail: kasamatsu-mie@keneki.go.jp
LAO PEOPLE'S DEMOCRATIC REPUBLIC
Dr Bouaphanh Khamphaphongphane, Chief, Epidemiology Division, National Center for Laboratory and Epidemiology Ministry of Health, Km 3, Thaduae Road, Vientiane. Tel. No.: (856) 21 212 351. Fax No.: (856) 21 350 209 E-mail: bkhamphaphongphane@gmail.com Dr Affendi Bin Ahmad, Health Officer, International Point of Entry, Kota Kinabalu Area Health Office, Lot No 21-25, 2nd Floor, Block C, Plaza Heritage, Off Jalan Lintas Luyang 88300 Kota Kinabalu, Sabah. Tel. No.: (6016) 350 0169 Fax No.: (6088) 413 411. E-mail: affendiahmad@hotmail.com Ms Tsolmongerel Tsilaajav, Director, Department of Policy Planning, Ministry of Health, Olympic Street-2, Government Building 8, Sukhbaatar District 14210, Ulaanbaatar. Tel. No.: 976) 5126 0808. Fax No.: (976) 9912 7005 E-mail: tsolmongerel@moh.mn; tsooomoo@yahoo.com Dr Tumurbaatar Tegshbayar, State Senior Inspector for Sanitation and Infection Control at Points of Entry State Border Specialized Department Division of State Professional Inspection Agency, Ulaanbaatar 211238 Tel. No.: (976) 1 263150. Fax No.: (976) 1 263975 E-mail: ferrum3510@yahoo.com
MALAYSIA
MONGOLIA
PAPUA NEW GUINEA
Dr Sibauk Vivaldo Bieb, Executive Manager, Public Health Health Department, Level 3, Aopi Centre, Waigani Tel. No.: (675) 301 3703. Fax No.: (675) 323 9710 E-mail: svbieb@gmail.com Dr Alwyn Asuncion, Quarantine Medical Officer VII Bureau of Quarantine, Department of Health, 25th corner Delgado Street, Port Area, Manila. Tel. No.: (632) 320 9102 Mobile.: (63) 917 584 7858. Fax No.: (632) 527 4678 E-mail: alwyn_asuncion@yahoo.com Dr Diosdado Amargo, Jr, Quarantine Medical Officer III,
PHILIPPINES
Bureau of Quarantine, Department of Health, Unit 1 & 2 Luciu’s Inn, Airport Road, Barangay Pook Kalibo, Aklan. Mobile No: (63) 916 525 7755 Fax No.: (6336) 500 8301. E-mail: dodz_ajr@yahoo.com
Dr Omar Aranan, Jr, Quarantine Medical Officer IV, Bureau of Quarantine, Department of Health, 2nd Floor, Rajdja Building, Gov. Camins, Zamboanga City 7000 Mobile No : (63) 917 711 4737. Fax No.: (6362) 991 5019 E-mail: aranan67@gmail.com SINGAPORE Ms Su Wen Phoebe Lee, Public Health Officer, Ministry of Health, 16 College Road, Singapore 169854. Tel. No.: (65) 6325 9215. Fax No.: (65) 6325 4679 E-mail: phoebe_lee@moh.gov.sg Dr Ha Huy Toan, Deputy Chief, Border Health Quarantine Division, General Department of Preventive Medicine, 135/I Nui Truc Alley, Ba Dinh District, Hanoi. Tel. No.: (844) 3846 4415. Fax No.: (844) 3736 7853 E-mail: toanytdpvn@gmail.com
VIET NAM
2. TEMPORARY ADVISERS Mr John Gardner, Senior Advisor, Biosecurity (Environment Team), Environmental and Border Health, Public Health, Ministry of Health, Wellington, New Zealand. Tel. No.: (644) 816 3925. Fax No.: (644) 816 4479. E-mail: john.gardner@moh.govt.nz Dr Norhayati bt Rusli, Deputy Director of Disease Control (Surveillance), Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia. Tel. No. : (603) 8883 4118. Fax No.: (603) 888 6277. E-mail: dr_norhayati@moh.gov.my Dr Fang Zhiqiang, Director, Division of Sanitary Supervision, Department of Health Quarantine General Administration of Quality Supervision, Inspection and Quarantine, No 9, Maidan Donglu, Haidan District, Beijing 100088, China. Tel. No.: (8610) 8226 1873. Fax No.: (8610) 8226 0649. E-mail: fangzq@aqsiq.gov.cn
3. CONSULTANT Dr Zheng Jianning, Director, Department of Science and Technology, Ningbo Entry-Exit Inspection and Quarantine Bureau, No. 9 Mayuan Road, Ningbo 315012, China. Tel. No.: (86 574) 8702 2525. Fax No.: (86 574) 8714 5357. E-mail : zhengjn@nbciq.gov.cn
4. OBSERVERS BEIJING ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA Dr Sun Jilun, Deputy Director, No.566-2, ShunPing Rd., Shun Yi District, Beijing, China. Tel. No.: (8610) 6453 0045. Fax no: (8610) 6453 0049 E-mail: sunjl@bjciq.gov.cn Dr Wang Kanglin, Section Chief, No. 6,TianShuiYuan St., Chao Yang District, Beijing, China. Tel. No.: (8610) 5861 9049. Fax No.: (8610) 5861 9030 E-mail: 22948564@qq.com CHONGQING ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA Dr Feng Xiangyu, Deputy Director, Health Quarantine Department, No. 5 Honghuang Road, Jiangbei District, Chongqing, China. Tel. No: (86) 236 775 7909 Fax No.: (86) 236 775 7909 E-mail: fengxy76@163.com Dr Wu Da, Deputy Director, Jiayuguan East Road, Chenguan District, Lanzhou, China Tel. No.: (86) 139 9317 1071. Fax No.: (86) 931 8658 201. E-mail: 1052702678@qq.com Dr Gao Yunxia, Senior Staff, A Tower, No. 66 Hua Cheng Avenue, Guangzhou, China. Tel. No.: (86) 20 3829 0773. Fax No.: (86) 20 3829 0720 E-mail: gaoyx@gdciq.gov.cn Dr Hu Huining, Section Chief, No. 38 binhu route, Nanning, Guangxi, China. Tel. No.: (86) 771 5512 896 Fax No.: (86) 771 5511 939. E-mail: hnhugx@163.com Dr Jin Kun, Officer, Officer, Longdongbao Airport, Guiyang, Guizhou, China. Tel. No.: (86) 851 677 4330 Fax No.: (86) 851 677 4330. E-mail: 25409946@qq.com Dr Hou Yong, Director, No. 9, Ganshui Road Xiangfang District, Harbin, Heilongjiang, China Tel. No.: (86) 45 136136 76256 Fax No.: (86) 45 18233 7582 E-mail: lemon_hy2003@126.com Dr Zhang Shuyu, Deputy Director, No. 69 JiChang Road, Zhengzhou, China. Tel. No.: (86) 371 5519 6070 Fax No.: (86) 371 6568 5904 E-mail: zhangsy@haciq.gov.cn
GANSU ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
GUANGDONG ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
GUANGXI ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA GUIZHOU ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA HEILONGJIANG ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
HENAN ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
INNER MONGOLIA ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
Dr Zhang Sheng, Director, No. 12 Erdos Street, Hohhot, Inner Mongolia, China. Tel. No.: (8647) 143 40836. Fax No.: (8647) 143 40835 E-mail: yilalita@sohu.com Dr Tian Wenzhi, Section Chief, Huashanjie, Manzhouli, China. Tel. No.: (8647) 0626 7552. Fax No.: (8647) 0626 7011 E-mail: tianwz@qq.com
JIANGXI ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
Dr Huang Zhiyong, Officer, No. 2666, Ganjiangnan Dadao, Honggutan District, Nanchang , Jiangxi, China Tel. No.: (86) 791 8365 8551. Fax No.: (86) 791 8365 8003. E-mail: hzy1007@163.com Dr Wen Tian, Vice-Section Chief, No. 2666, Ganjiangnan Dadao, Honggutan District Nanchang Jiangxi, China. Tel. No.: (86) 791 8396 0893. Fax No.: (86) 791 8396 0890 E-mail: went@jxciq.gov.cn
JILIN ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
Dr He Chen, Section chief. No. 1301, Pu Yang Street, Changchun, Jilin, China Tel. No.: (86) 1868 642 7568 Fax No.: (86) 4318 760 7726 E-mail: hec@jlciq.gov.cn Dr Xiao Kai Ti Yi Ming, Section Chief, 354 South Jiefang Road, Kashi, China. Tel. No:(86) 189 9909 1681 Fax No.: (86) 998 2659 691. E-mail: 18999091@163.com Dr Zhang Hongbing, Deputy Director, No. 60, Changjiang East Rd, Zhongshan District, Dalian, China. Tel. No.: (86) 1399 850 5662 Fax No.: (86) 411 8263 5362 E-mail: zhb0622@sohu.com Dr Zhang Xiaoxiao, Officer, No. 60, Changjiang east Rd. Zhongshan District, Dalian, China. Tel. No.: (86) 137 0409844, 411 879 60037 Fax No.: (86) 411 87960034 E-mail: xiaoxiaozh1984@163.com
KASHI ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
LIAONING ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
NINGBO ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
Dr Qiu Jiong-liang, Deputy Director, No.9 Mayuan Road, Ningbo, China. Tel. No.: (86) 574 8702 2519 Fax No.: (86) 574 8714 6206. E-mail: qiujl@nbciq.gov.cn
QINHUANGDAO ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
Dr Nie Weizhong, Deputy Director No.51, Haibin Rd, Qinhuangdao, 066002 Hebei, China. Tel. No.: (86) 335 599 7890. Fax No.: (86) 335 599 7896 E-mail: nieweizhong001@163.com Dr Xiao Qilin, Section Chief, No 312 Hudong Road, Fuzhou, China. Tel. No.: 0591 87065327. Fax No.: 0591 87065320. E-mail: huaxi91xiao@163.com Dr Li Jiyu, Section Chief, No.2 Zhongshan Rd, Shinan District, Qingdao, China. Tel. No.: (86) 532 8088 6096 Fax No.: (86) 532 8088 6100 E-mail: jiyu.li@139.com Dr Wang Zhiyi, Doctor-in-charge, No.888 Qihang Road, Shanghai, China. Tel. No.: (86) 1391 700 4067. Fax No.: (86) 2168 340 440 E-mail: wzyppz@yahoo.com.cn Dr Liu Maohua, Officer, No. 855 Chang Zhong Road, Shanghai, China. Tel. No.: (86) 1580 187 4277 Fax No.: (86) 2156 819 590 E-mail: liumh@shciq.gov.cn
FUJIAN ENTRY EXIT INSPECTION AND QUARANTINE, CHINA SHANDONG ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA SHANGHAI ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
SHANTOU ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
Dr Li Canbin, Deputy Section Chief, 5th Floor, CIQ Building, Chaoyang Zhuang Jinshadong Road, Shantou, Guandong, China. Tel. No.: (86) 754 8893 9890 Fax No.: (86) 754 8893 9829 E-mail: canbin_lee@163.com Dr Han Feng, Senior Staff, No. 8, Street Yifen, Taiyuan, Shanxi, China. Tel. No.: (8635) 1616 3932 Fax No.: (8635) 1616 5902 E-mail: liye2000hanppy@126.com Dr Zhoo Chun Zhong, Vice Professor, No. 1011 Fuqiang Road, Futian District, Shenzhen, Guangdong, China. Tel. No.: (86) 755 8339 1344 Fax No.: (86) 755 8339 4162 E-mail: 1928827@99.com Dr Zhou Licheng, Section Chief, No.1011 Fuqiang Road, Futian District, Shenzhen, Guangdong, China. Tel. No.: (86) 755 8388 6150 Fax No.: (86) 755 8337 6687 E-mail: zlc@szciq.gov.cn
SHANXI ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA SHENZHEN ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
SICHUAN ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
Dr He Wei, Deputy Chief, Health Quarantine Department, No. 28, South 4th Section, Yihuan-Road, Chengdu, Sichuan, China Tel. No.: (86) 288 2998 092 Fax No.: (86) 288 2998 095 E-mail: heweiiv@yahoo.com
TIANJIN ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
Dr Lang Shaowei, Officer, Second Street No.51 A1411, Tianjin, China. Tel. No.: (8615) 8229 24441 Fax No.: (8622) 6566 1103. E-mail: langsw@tjciq.gov.cn Dr Zheng Xiaomin, Officer, Shipping Service Center, Bohai, 15 St., Lingang Economic District, Tianjin, China. Tel. No.: (8613) 8211 71509 Fax No.: (8622) 6536 7311 E-mail: zhengxm@tjciq.gov.cn Dr Zuo Feng, Laboratory Technician, Shipping Service Center, Bohai, 15 St, Lingang Economic District, Tianjin, China. Tel. No.: (8613) 5120 42253 Fax No.: (8622) 6670 6385 E-mail: zuof@tjciq.gov.cn
XIAMEN ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
Dr Yang Qingshuang, Section Director No. 118, Dongdu Road, Xiamen, Fujian, China Tel. No.: (86) 592 5675 560 Fax No.: (86) 592 5675 549 E-mail: yangqs@xmciq.gov.cn Dr Qi Runzi, Section Chief, No. 126 Fu Chun Road, Hangzhou, China. Tel. No.: (86) 571 8110 0502 Fax No.: (86) 571 8110 0720. E-mail: qrz@ziq.gov.cn Dr Houang Sheng, Chief Section Member No. 1144 East Jiuzhou Boulevard Zhuhai , Guangdong, China. Tel. No.:(86) 756 3231 310. Fax No.: (86) 756 3219 278 E-mail: zhhuangsheng@126.com
ZHEJIANG ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA ZHUHAI ENTRY-EXIT INSPECTION AND QUARANTINE, CHINA
5. SECRETARIAT WHO WESTERN PACIFIC REGIONAL OFFICE Dr Chin Kei Lee, Team Leader, Emerging Disease Surveillance and Response, World Health Organization Regional Office for the Western Pacific, P.O. Box 2932 1000 Manila, Philippines. Tel. No.: (632) 528 9944 Fax No.: (632) 521 1036. E-mail: leec@wpro.who.int Ms Satoko Kiyota, Technical Officer, Emerging Disease Surveillance and Response, World Health Organization Regional Office for the Western Pacific, P.O. Box 2932 1000 Manila, Philippines. Tel. No.: (632) 528 8001 Fax No.: (632) 521 1036. E-mail: kiyotas@wpro.who.int
WHO CAMBODIA
Dr Reiko Tsuyuoka, Team Leader, Emerging Disease Surveillance and Response, World Health Organization No 177-179 corner Streets Pasteur (51) and 254 P.O. Box 1217, Sangkat Chaktomouk, Khan Daun Penh Phnom Penh, Cambodia. Tel. No.: (85523) 216 610 Fax No.: (85523) 216 211 E-mail: tsuyuokar@wpro.who.int Dr Luo Dapeng, Team Leader, Emerging Disease Surveillance and Response, World Health Organization 125 Saphangthong Road, Unit 5, Ban Saphangthongtai, Sisattanak District, Vientiane Capital, Lao People's Democratic Republic Tel. No.: (856) 2135 3902. Fax No.: (856) 2135 3905 E-mail: luod@wpro.who.int Dr Rabindra Abeyasinghe, Technical Officer (Malaria), World Health Organization, 4th Floor, AOPI Centre Waigani Drive, Port Moresby, Papua New Guinea Tel. No.: (675) 325 7827. Fax No.:(675) 325 0568 E-mail: abeyasingher@wpro.who.int Dr Nguyen Thi Phuc, Technical Officer, Avian and Pandemic Influenza, World Health Organization, 63 Tran Hung Dao Street, Hoan Kiem District Hanoi, Socialist Republic of Viet Nam. Tel. No.: (844) 3 943 3734. Fax No.: (844) 3 943 3740 E-mail : phucn@wpro.who.int Dr Daniel Lins Menucci, Team Leader, Global Capacities, Alert & Response, Support to IHR Capacity Development (SID), Ports, Airports and Ground Crossings, World Health Organization, 58, Avenue Debourg, 69007 Lyon, France. Tel. No.: (334) 7271 5167. Fax No.: (334) 7271 6471 E-mail : menuccid@who.int Dr Wang Ninglan, Technical Officer, Global Capacities, Alert & Response, Support to IHR Capacity Development (SID), Ports, Airports and Ground Crossings, World Health Organization, 58, Avenue Debourg 69007 Lyon, France. Tel. No. : (334) 7271 6499. Fax No.: (334) 7271 6471, E-mail: wangn@who.int
WHO LAO PEOPLE’S DEMOCRATIC REPUBLIC
WHO PAPUA NEW GUINEA
WHO VIET NAM
WHO HEADQUARTERS GCR – SID LYON
Mr Philippe Eric Gasquet, Team Leader, Human Resources Development and Training (HRT) Support to IHR Capacity Development (SID), Global Capacities Alert and Response, World Health Organization, 58, Avenue Debourg, 69007 Lyon France. Tel. No.: (334) 47271 6479. Fax No.: (334) 7271 6471. E-mail: gasquetp@who.int
ANNEX 3 Day 1: Poster session Core capacity-building at points of entry Facilitator’s guide for the poster presentations
In order to capture succinctly the key points, lessons learnt and best practices from core capacity-building at points of entry in each country and area, a plenary and a poster presentation have been organized for all country participants during the workshop. The poster session will enable participants to not only describe their experiences and lessons learnt in establishing and strengthening institutional systems for IHR core capacities at designated points of entry in their countries, but also share best practices on core capacitybuilding at points of entry. During the session, participants will exchange information on how they utilize existing resources and mechanisms to enhance core capacities at designated points of entry to meet IHR requirements. Objectives of the session (1) Provide an overview of the implementation of the national IHR action plan (or equivalent) as well as of action plans for individual points of entry designated to establish core capacities. (2) Review the progress of national core capacity-building at points of entry, including general obligations, routine public health functions, and public health emergency preparedness and response at points of entry. (3) Highlight the best practices in core capacity-building at points of entry. (4) Identify key achievements, main challenges and gaps related to core capacitybuilding at points of entry. (5) Share the experiences and lessons learnt from the past practice. The review and discussion of core capacity-building at points of entry will provide a good basis for moving forward in building core capacities, and will help participants to revise and strengthen national priority actions at points of entry. Format of the session Country participants will be divided into three groups. Posters will be displayed in clusters and according to group assignments. For each group, members are to: (1) nominate a rapporteur who will lead the poster presentation, facilitate questions and discussion within the group, and present a summary of the discussion in plenary; and (2) nominate participants to present posters for their countries.
Nominated country participants will present their posters to their group (about 10 minutes each). Each presentation will be followed by questions and discussions within the group. At the end of the country presentations, the facilitator will prompt further discussion in the groups.
Proposed questions for discussion within the group (1) What are key points of effective implementation of national workplans in core capacitybuilding? (2) What are challenges, strengths and weakness of core capacity-building at points of entry? How can remedial actions be taken in your country? (3) What are your suggestions for updating/developing a plan of action to strengthen existing core capacities and to address gaps at points of entry? (4) What are main roles and responsibility of stakeholders in public health emergency preparedness and response at points of entry? How can you coordinate the relevant sectors in the prevention, detection and response to events that may constitute a public health emergency of international concern at points of entry? Wrap-up instructions for the facilitator At the end of the presentations and discussion, wrap up by highlighting best experiences and lessons learnt from the country poster presentations and discussion in the group. Highlight key points that may be important for future action to enhance core capacity-building at points of entry. At the conclusion of the session, encourage participants to view poster presentations of the other countries.
ANNEX 4 Day 2: Ship inspection and issuance of sanitation certificates Group work – Fact-finding This group exercise addressed the technical areas associated with ship inspection and issues related to risk assessment principles and inspection of ship sanitation. The participants were divided into four groups. Four facilitators who were responsible for different technical areas rotated among the groups. Each group conducted a virtual ship inspection using the photographs presented to them by the facilitators on their laptops. The participants were asked to identify the issues/areas of concern, assess the risk of each inspection finding, and discuss control measures and corrective actions.
Technical area 1: Galley, pantry, service areas and stores Major risk factors that contribute to foodborne outbreaks on board ships are primarily associated with temperature control of perishable food, infection of food handlers, crosscontamination, heat treatment of perishable food, contamination of raw ingredients, and use of non-potable water in the galley. Some diseases can be transmitted from one country to another by infectious agents or contaminants due to poor control measures on board. Therefore, detecting contamination in the sources, during the preparation and processing of food, as well as in the service of food in restaurants and mess halls, is crucial for the prevention and control of foodborne disease.
Technical area 2: Quarters and medical facilities Crew quarters should comply with existing International Labour Organization (ILO) conventions on crew accommodation and food and catering. Factors contributing to the occurrence of public health risks on board include the design, construction, management and operation of quarters. Medical facilities are important for the on-board surveillance and control of disease. However, they also contribute to the occurrence of public health risks, as unsanitary conditions within medical facilities can cause the spread of communicable diseases. Ill passengers or crew members may pose a public health risk on board and ashore. Prerequisites for the control of public health risks on board include training of dedicated staff, development of appropriate operational manuals and protocols, establishment of facilities for diagnosis and treatment, and timely notification of public health risks to the competent authority of the nearest point of entry. All ships subject to the regulations of the International Maritime Organization (IMO) and ILO are required to follow training standards and carry a medicine chest. The IMO/WHO/ILO Medical First Aid Guide for Use in Accidents Involving Dangerous Goods names specific medications and equipment that are mandatory for ships carrying dangerous goods. Technical area 3: Sewage Sewage is a type of wastewater that can potentially pollute potable water with infectious agents. Unsafe management and disposal of sewage can readily lead to adverse health consequences. Black water may harbour many different harmful substances, such as chemicals, pharmaceuticals and biological agents. The main risk is disease spread by contaminated and insufficiently treated sewage that has been discharged into the surrounding water. Cross-contamination of potable water, accidents (e.g. leakage or overflow) and acquired infections during maintenance work are some of the additional health risks. Technical area 4: Potable water Ships may be equipped with two or three different water systems: potable water; non-potable water used for other operational procedures; and water for firefighting. Improperly managed water on ships is a common route for infectious disease transmission. Most waterborne outbreaks involve ingestion of water contaminated with pathogens derived from human or animal excreta. Contamination is associated with spoiled bunkered water, cross-connections between potable and non-potable water, improper loading procedures, poor design and construction of potable water storage tanks, and inadequate disinfection. For example, unsafe handling and inappropriate use of materials (for example, firefighting hoses) may lead to contamination. It is crucial to know where risks exist, and it is necessary to implement good handling practices concerning potable water hoses and the bunkering procedure.
ANNEX 5
Day 2: Breakout Session 1 Scenario-based discussion on public health emergency planning at points of entry This session was designed for the participants to evaluate their current emergency response plans and capabilities to respond to the emergence of an unknown disease and its spread to other countries. The discussion focused on key public health emergency responders at national points of entry, critical decisions, and the integration of other response sectors necessary to carry out preventive public health measure at points of entry. This session was designed for countries and areas to: • identify issues, priorities and responsibilities; • • • evaluate the effectiveness of their current emergency response plans at points of entry; develop priorities in responding to unexpected events; and update and revise their emergency response plans after the discussion.
Participants were divided into three groups to discuss the different scenarios (see Annex 6). Group decisions and actions were then discussed in the plenary. Group A
Based on Scenario A, if the number of cases escalates, the first step was risk assessment. In view of the fatality rate being 8%, and the sudden escalation of cases with unknown pathogen, it would be an unusual and serious event. The event should be notified to the National IHR Focal Point. Further investigation of five cases in the airport should be done, and the existing points-of-entry emergency plan should be activated. In times of health emergencies, the Ministry of Health (or equivalent department) should take the following responsibilities: define roles and responsibilities; identify resources; coordinate surveillance and risk assessment; initiate rapid containment and ensure timely and transparent communication. Strengthening routine capacity, in particular risk assessment and
communication, are essential to a rapid containment operation. Using the existing national surveillance structure, districts and provinces would collect data on new cases from private practice physicians and community health care agencies. The key elements within the information-sharing framework identified by this group were number of cases, date of onset, source of infection, mode of transmission, and travel history. This information would be shared with points of entry and the animal health department, as stakeholders in the development of the preparedness plan. At this stage, some of the challenges would be met based on the country’s experiences, for example, completeness of data, timeliness of data collection, capability of laboratory diagnosis, and control measures for unknown pathogens in the country. At the time of health emergencies, the Ministry of Health (or equivalent department) should be the commander and technical leader to advise on public health response. Public health measures would be taken in the following: • exit screening, health declaration and thermal scanner; • • • advice to the public on delaying international travel to avoid exporting the virus; isolation of ill travellers and their transfer to the designated hospital; stockpile of personal protective equipment (PPE) and necessary antivirals at points of entry; disinfection of patient’s room, personal belongings, ambulance, etc.; and arrangements for adequate food, water and appropriate medical treatment, and notification to the next airport or National IHR Focal Point when the ill travellers fly, subject to the national law.
• •
Group B
The important issues and/or areas for improvement in the country plan identified by this group were risk assessment, communication and coordination, core capability at points of entry and national response plan.
Which agency or department takes the lead on decision-making depends on the national plan. The ministry of health (or equivalent department) often plays the leadership and decisionmaking role, and organizes a national committee that includes the ministry of agriculture, health quarantine, zoonotic agency, immigration agency and customs, etc. Risk assessment, as a key component of an effective, evidence-based decision-making process, enables countries to adopt an integrated, multidisciplinary approach to public health emergencies and to build capacities in surveillance and response. Evidence-based, decisionmaking practice through risk assessment provides policy-makers with defensible proof for their decisions and actions, which enables them to cope better with public pressure and the unpredictability and uncertainty of public health events. Communication and coordination with stakeholders are very important during the emergency response. For ensuring information-sharing, equally important is setting up a communications team for the event (based on existing protocols and plans), identifying channels of communications, planning the content and timing of the messages. Well-defined roles and responsibility of stakeholders are essential in the emergency response plan. The priority tasks during a public health emergency include a revision of legislation to enable the modification of the quarantine disease list, the issuance of technical guidance for case definition, and the management of symptomatic cases and of contacts. Based on risk assessment, some recommended measures may be implemented at points of entry, such as issuing health advice and alerts for travellers; using the Health Part of the Aircraft General Declaration (IHR (2005), Annex 9), health declaration and/or passenger locator form/card; introducing visual screening, temperature screening and other initial assessments; on-board identification of suspected cases; managing symptomatic travellers and exposed travellers; international travel advisory and/or travel restriction; and border closure (partial and fully). The group agreed that the following actions should be taken as next steps in countries: • Review existing contingency plans. • • Organize exercises and training. Prepare health infrastructure (laboratories, medical supplies, medical equipment, quarantine facilities).
Group C
The priorities of response identified by this group were identification of all stakeholders (for example, call existing stakeholders to identify missed agencies); risk communication (update/test contacts); review of surge capacity; strengthening of local government support; identification of gaps in policy or legislation; review of exit control; and insurance policy and coverage (revision of requirements). Risk assessment and communication with stakeholders are important parts of health emergency preparedness and response. Mechanisms should be put in place to foster coordination among stakeholders. As the situation develops and more scientific information of the unknown disease becomes available, a reassessment and change of preventive measures should be done timely. The ministry of health (or equivalent department) should organize risk assessment; support preparedness, evidence-based decision-making and proactive action; and implement mechanisms to engage stakeholders. The Ministry of Health (or equivalent department) should lead health surveillance at different levels, including national, state and district, and at points of entry. Temperature screening should be introduced to detect persons with fever at points of entry. The immigration department may be involved in providing details of travellers, their movements and addresses, while the airlines could provide passenger lists and information on flights. Sentinel surveillance in hospitals, schools and community clinics should be strengthened. The health promotion, risk communication with the public, and health advice for international travellers at points of entry should be implemented. The activation of the national pandemic influenza preparedness and response plan involves the designated agencies. Rapid containment is an extraordinary and intense operation. Country experiences have confirmed that effective collaboration among stakeholders is an essential requirement of a rapid containment operation. The hospital nearest to the point of entry is designated to provide medical services and manage patients. If a small number of travellers need to be quarantined, it is possible to arrange at designated or pre-arranged facilities. For a large number of travellers, home quarantine with health card for contact would be a better choice. Patients should be transported to the designated hospital for treatment by ambulance. District or local health authorities should arrange for laboratory sampling and the transport of specimens to the designated laboratory for testing if the hospital has no capacity. The national-level laboratory should be the main coordinator to identify suspected biological agents, but if unable, it should coordinate with WHO or any appropriate agencies to do tests at a facility overseas.
Emergency preparedness and response planning is a continuous cycle of development, updating from current knowledge and validating through exercises and revisions. A critical part of preparedness is strengthening of routine capacities, which can be used in response to other public health emergencies.
ANNEX 6
Day 2: Breakout Session 1 Scenario-based discussion on public health emergency planning at points of entry
Scenario A: In Country A Situation briefing: An unusual increase in the number of human cases with acute respiratory symptoms in a hospital in Area B, Country A has been reported to the Disease Control Division (DCD) – A total of 150 cases including 12 deaths have been reported over the past two weeks. Many cases occurred among previously healthy young adults. Five of them were workers in the international airport in Area B. New cases continue to occur. – The main symptoms and signs included high fever (>38 °C), headache, cough and difficulty breathing. Some cases had severe diarrhoea. Eight fatal cases appeared to have severe pneumonia. – Specimens were collected for laboratory diagnosis testing at a national reference laboratory. So far, the causative agent has yet to be identified. Some specimens have been sent abroad (a regional reference laboratory) for further testing. – Field investigation showed that most cases developed symptoms between seven and 10 days after their exposure to patients with similar symptoms or sick poultry. – It was unclear if there were any asymptomatic cases. Facilitated discussion: At this stage, we will focus on case identification and investigation, and event verification. Information sharing between the local health department and points of entry is very important. Questions: (1) If the number of cases escalates, what actions will be taken to manage the increase in cases at the airport in Area B, given a scenario in which the scale of the public health emergency has not yet been defined in your country? (2) Are there provisions for collecting data on new cases from private practice physicians and community health care agencies? How will this information be shared with points of entry? (3) What key elements within the information-sharing framework are important to your country for further development as part of your preparedness plan? (4) What challenges do you foresee (from your own country experience)?
Situation update: An increased number of patients have died due to severe pneumonia of unknown etiology in the hospital. This has been reported to DCD. – The preliminary investigation shows that an outbreak of respiratory illness involving severe pneumonia is occurring in the hospital. More than 50 suspected cases including 10 deaths have been reported over the past week. – One of the fatal cases had close contact with one of the patients who died due to respiratory failure in Area B, Country A. – At least two contacts of this patient developed high fever and respiratory symptoms over the past three days. – Laboratory testing in the country has so far failed to identify the unknown etiology among the previously identified influenza viruses. Specimens have been sent to a WHO collaborating centre for further laboratory analysis. – A number of domestic and international media have now reported the event – telling the world that a new disease is occurring and killing many people in the country. – Two countries have advised their citizens to avoid non-essential travel to Country A. – Three countries have started temperature screening all passengers from Country A. – Several countries are requesting information from WHO and/or Country A on point-of-entry measures being implemented in your country (especially international border measures). – After receiving a request from the Ministry of Health, WHO mobilized the Global Outbreak Alert and Response Network (GOARN) to provide technical support in outbreak investigation to identify the cause of the unusual outbreak and to assist disease control. – Preliminary results of laboratory analysis from both the WHO collaborating centre and the regional reference laboratory showed that the disease might be caused by a new virus. Further analysis is ongoing. – New cases and deaths continue to occur. There is no similar event/cases officially reported from other countries yet. – WHO is recommending Country A to take every effort to contain the disease at the source and to prevent international spread (for example, exit screening), although no global, standard point-of-entry measure has been recommended by WHO and other United Nations agencies at this stage. Facilitated discussion: At this stage, we will focus on rapid response and assessment.
Questions: Regarding the command-and-control structure for point-of-entry response: Who will be the incident commander or coordinator at the airport? Who will be the technical leader to advise public health response? How will operations be set up (for example, assessment of affected travellers)? Scenario B: International spread Situation briefing: Multi-country outbreaks of a potentially new disease have been reported. – More than 500 suspected cases of acute respiratory infection, including 50 deaths, have now been reported from five countries over the past two to three weeks. Many cases occurred among previously healthy young adults, and others had international travel history. New cases continue to occur. – The main symptoms and signs included higher fever (>38 °C), headache, cough and difficulty breathing. Some cases had severe diarrhoea. Most fatal cases appeared to have severe pneumonia. – Specimens were collected from the affected countries for laboratory diagnosis testing at both national reference laboratories and two WHO collaborating centres. So far, the causative agent has yet to be identified. – Field investigation showed that most cases developed symptoms between three and five days after their exposure to patients with similar symptoms or sick poultry. – It was unclear if a new virus or bacteria caused the disease and if there were any asymptomatic cases. Facilitated discussion: At this stage, we will focus on risk assessment. Questions: Regarding coordination, communication and links: Which agency will be part of the national command-and-control structure for public health emergency response? Which agency will provide technical advice on overall public health response at points of entry? How can we coordinate and communicate with relevant sectors? How can we communicate and link with other points of entry? Are there any contact points? How can we communicate internationally (with WHO and point-of-entry public health authorities in other countries)?
Situation update: No similar case has been detected and reported in your country so far. – The Department of Health has advised and alerted all the local surveillance units to strengthen their surveillance activities to detect suspected cases. – Arrangements have been made for laboratory testing at the WHO collaborating centre in Melbourne. – Hospitals and health centres are alerted to detect and report acute severe respiratory illness and pneumonia of unknown cause or any cluster of such suspected cases. – The Department of Health is expected to advise point-of-entry measures to prevent entry of the disease. – The point-of-entry competent authority has been advised to implement border measures to detect and report any suspected travellers who are arriving from the affected countries. – International media have now reported the event widely – telling the world that a new disease is occurring and killing many people in several countries. – Several countries have advised their citizens to avoid non-essential travel to the affected countries, and five countries are currently implementing temperature screening of all passengers from the affected countries. – Many countries are requesting information from WHO and the affected countries on point-of-entry measures being implemented. – WHO has mobilized GOARN to provide the affected countries with technical support in outbreak investigation and to identify the cause of the unusual outbreak. – Preliminary results of laboratory analysis from the WHO collaborating centre showed that the disease might be caused by a new virus. Further analysis is ongoing. – New cases and deaths continue to occur in the affected countries. – At this stage, no global, standard point-of-entry measure has been recommended by WHO. Facilitated discussion: At this stage, we will focus on risk assessment and decision-making, for example, public health measures taken at points of entry. Questions: (1) What will be the decision-making process for various border intervention options based on assessed situations? (2) What mechanisms/agencies are responsible for making decisions and implementing recommended measures? Consider the following: Health advice and alerts for travellers Health Part of the Aircraft General Declaration – IHR (2005), Annex 9
Passenger manifest Health declaration and/or passenger locator form/card Visual screening, temperature screening and other initial assessment On-board identification of suspected cases Managing symptomatic travellers (medical assessment, laboratory test, isolation, treatment and contact tracing, etc.) Managing exposed travellers (self health monitoring, illness reporting, home quarantine and institutional quarantine, etc.) International travel advisory and/or travel restriction Border closure (partial and fully) Scenario C: International spread to your country Situation briefing: Multi-country outbreaks of a potentially new disease have been reported – More than 500 suspected cases of acute respiratory infections, including 50 deaths, have now been reported from five countries over the past two to three weeks. Many cases occurred among previously healthy young adults, and others had international travel history. New cases continue to occur. – The main symptoms and signs included high fever (>38 °C), headache, cough and difficulty breathing. Some cases had severe diarrhoea. Most fatal cases appeared to have severe pneumonia. – Specimens were collected from the affected countries for laboratory diagnosis testing at national reference laboratories and two WHO collaborating centres. So far, the causative agent has yet to be identified. – Field investigation showed that most cases developed symptoms between three and five days after their exposure to patients with similar symptoms or sick poultry. – It was unclear if the disease is caused by a new virus or bacteria and if there were any asymptomatic cases. – International media have now reported the event widely – telling the world that a new disease is occurring and killing many people in several countries. – Several countries have advised their citizens to avoid non-essential travel to the affected countries, and five countries are currently implementing temperature screening of all passengers from the affected countries. – The Department of Health has alerted all the local surveillance units to strengthen their surveillance activities to detect suspected cases.
– The points-of-entry competent authority has implemented border measures to detect and report any suspected travellers who are arriving from the affected countries. Situation update: After several days: – One international traveller who comes from an affected country presents with influenza-like symptoms and is detected at a point-of-entry in your country. – Two overseas students who come from different affected countries present with influenza-like symptoms and are reported by the hospital. – Samples are taken for investigation. – Preliminary results of laboratory analysis from your country showed that the disease might be caused by a new virus that. Further analysis is ongoing. – The authorities initiate a rapid containment operation. Facilitated discussion: At this stage, we will focus on event management, as well as prevention. Questions: (1) Are the area laboratories adequate to identify suspected biological agents? If not, where will you seek assistance? Who will coordinate this information? (2) Identify your agency’s established method of health surveillance. What other agencies will be involved in this effort? (3) Are there provisions for collecting data on new cases from private practice physicians and community health care agencies? How will this information be shared with points of entry? (4) Regarding arrangements for response measures: Is there any designated hospital for managing patients (e.g. medical services)? Is there any designated or pre-arranged facility for quarantines? Is there any arrangement of transportation of ill travellers? Is there any arrangement for laboratory diagnosis of ill travellers? Is there any arrangement for applying recommended measures, when relevant? (5) What are the key action plans needed in order to ensure the smooth rapid containment operations? (Remember that this is a multisectoral operation.)
Situation update: After rapid containment for one or two weeks, cases are spotted outside the initial containment zone in your country. Meanwhile, more people are turning up at the local medical centre reporting similar symptoms. The authorities, after doing a risk assessment, decided that the containment operation had not managed to contain the virus. Facilitated discussion: At this stage, we will strengthen exit screening and travel advice. Question: 1. Is it your country’s policy to support exit screening? ================================================ After the discussion, participants are asked to answer the following questions. 1. Based on today’s discussion, what important issues and/or areas for improvement should be in your plan? 2. What steps are needed to address the identified issues? For each step, rate it is a high, medium or low priority. 3. What action steps should be taken in your area of responsibility? 4. What policies, plans and procedures at points of entry should be reviewed, revised or developed? Indicate the priority level for each.
ANNEX 7
Day Three: Field visit Hands-on and skills demonstration Timetable
08:00–12:00 Field visit: Hands-on and skills demonstration (All country participants) 08:00–09:30 09:30–09:50 09:50–10:20 10:20–11:45 Depart from the hotel to Daxie Port Video presentations – Core capacity-building at Daxie Port Visit exhibition of core capacity-building at Daxie Port Skills demonstration – inspection of food supply – supervision of water supply to ship – vector surveillance and control Visit laboratory and examine exotic vector specimens Lunch (Daxie International Hotel)
11:45–12:00 12:00-13:00
13:00–18:30 Field visit: Hands-on and skills demonstration (continue) (All country participants) Group 1: Ship inspection and issuance of ship sanitation certificates 13:00–13:40 13:40–14:00 14:00–16:00 16:00–16:30 16:30–17:15 17:15–17:30 17:30–18:30 Depart from Daxie Port to a container or cargo ship Introduction to organizing a ship inspection, inspection principles and techniques On-board ship inspection Break (classroom) Formulation and issuance of ship sanitation certificate (group work) Debriefing (plenary) Back to the hotel
Group 2: Visit Lishe International Airport 13:00–14:30 14:30–14:45 14:45–15:30 15:30–15:55 15:55–16:15 Depart from Daxie Port to Lishe International Airport Status of core capacity-building at Lishe International Airport (PPT) Supervision and management of flight catering Water safety management Supervision and management of waste
16:15–16:45 16:45–17:15 17:15–17:30 17:30–18:00 18:00–18:30
Supervision of food service and indoor air quality detection Demonstration of the management of suspect infectious diseases traveller Demonstration of nuclear radiation monitoring Discussion and summary Back to the hotel
ANNEX 8
Day Three: Field visit Hands-on and skills demonstration Dixie Port
Group photo: Daxie Port Daxie Port is located in the middle of China’s coastline, approximately 40 kilometres (km) from Ningbo City. Today, it houses 37 berths within an area of 30.84 km2. Eighteen of the births can accommodate ships that weigh more than 10 000-tonnage, including a 100 000tonnage liquid chemical wharf, a 100 000-tonnage container berth and a 450 000-tonnage crude oil wharf, the largest in China. As the competent authority, the Daxie Entry-Exit Inspection and Quarantine Bureau carries out the routine work and public health emergency preparedness and response at the port. More than 1500 ships and 30 000 crew members enter and exit Daxie Port annually. In 2012, Daxie Port achieved a cargo volume of 71.8 million tonnes and a container capacity of about 2.02 million TEU (twenty-foot equivalent unit). Staff of the Daxie Entry-Exit Inspection and Quarantine Bureau introduced the field skills demonstration. The participants joined the demonstrations of vector surveillance and control,
potable water safety management, radioactive material detection and container fumigation for imported, recycled scrap materials. Exotic vectors do not respect national borders and are often unintended hitchhikers on cargo and other trade conveyances. The goal of vector surveillance at points of entry, therefore, is to detect any exotic vectors as early as possible. The intent is to make surveillance routine in order to enhance the capacity of vector identification, reporting and effective response to newly discovered exotic species.
Staff of the Daxie Entry-Exit Inspection and Quarantine Bureau demonstrated the equipment, tools and basic preventive measures used to control mosquitos on a daily basis. Important elements of potable-water safety management are supervision of water resources and regular inspection at the port, while enhancing handling procedures and personal hygiene.
Participants were shown a flowchart used for potable-water safety management (top left) and a sampling spot (top right). A demonstration of sampling and routine detection (bottom) followed. Recycled scrap materials are likely to hide vectors. Fumigation is used to kill vectors found in containers of imported, recycled scrap materials before they are unloaded. In addition, scrap materials undergo inspection for radioactive pollution.
Participants were introduced to a flowchart used for sanitation treatment (top left) and witnessed a demonstration of the process of fumigation and safety management. In the afternoon, the participants were divided into two groups. Group One visited a container ship for ship sanitation inspection and issuance of ship sanitation certificates. Group Two proceeded to Lishe International Airport.
Group One The visit to Hatsu Crystal, a container ship, was facilitated by Dr Daniel Menucci, Dr Wang Ninglan, Mr John Gardner and Dr Zheng Jianning. Before boarding the ship, the participants were briefed by staff of the Beilun Entry-Exit Inspection and Quarantine Bureau on the organization of a ship inspection, inspection principles and techniques. Once on board the ship, the participants met with the captain in the officers’ room. Dr Daniel Menucci introduced the process of reviewing ship documents, such as pratique/free pratique, maritime declaration of health, crew list, voyage memo, and ship sanitation certificate. Assisted by the captain, the participants were divided into three small groups that rotated among three technical areas with four facilitators. These technical areas focused on (1) galley, stores, quarters and medical facility; (2) deck (including vector control); and (3) engine room (including potable-water, sewage, and ballast-water management). After the inspection of the ship, the participants visited the office of the Beilun Entry-Exit Inspection and Quarantine Bureau for technical discussions on the issuance of ship sanitation certificates.
Group One: Hatsu Crystal
Reviewing the ship documents
Inspection of vector habitat (left) and waste management (right)
Discussions on the issuance of ship sanitation certificates
Group Two The visit to Lishe International Airport was facilitated by Dr Fang Zhiqiang, Mr Philippe Eric Gasquet and Dr Norhayati bt Rusli. Upon arrival, the participants were briefed on core capacity-building efforts at Lishe International Airport. The participants visited the flight catering facility, the water supply station, the waste management station and the vector laboratory. They then witnessed demonstrations of food service supervision, water quality and indoor air quality detection, management of travellers with suspected infectious diseases, and nuclear radiation monitoring.
Group Two and the staff of Ningbo Entry-Exit Inspection and Quarantine Bureau,China
Food safety management
Routine surveillance of food service (left) and indoor air quality (right)
Emergency preparedness room (left) and suspect case management (right)
ANNEX 9
Day 3: Breakout Session 2 Case Study Group 1: Event management on board ship Scenario: Diarrhoea on a ship Learning objectives Upon completion of the exercise, participants will be able to: (1) explain the need for a contingency plan at designated ports of entry in case of an event that may constitute a public health emergency of international concern as described in Annex1B of the International Health Regulations (2005), or IHR (2005); identify the specific requirements for procedures, communication and collaboration needed by the competent authority at each port for routine surveillance and response to events; understand the value of the Maritime Declaration of Health as a tool to facilitate epidemiological surveillance (e.g. routine surveillance); and explain the specific requirements for communication and collaboration among the competent authority at the point of entry, the national surveillance systems and the National IHR Focal Point.
(2)
(3)
(4)
Bibliography Heymann DL (Ed.). Control of Communicable Diseases Manual. Washington, DC, APHA, 2008. International Health Regulations (2005), Second edition. Geneva, WHO, 2008. Handbook for Inspection of Ships and Issuance of Ship Sanitation Certificates. Geneva, WHO, 2011. Assessment tool for IHR core capacity requirements at designated airports, ports and ground crossings. Geneva, WHO, 2009.
Instructions to participants This exercise will help you think about different aspects of travel and transport under IHR (2005) that are related to ports, including: (1) (2) (3) (4) ship sanitation certificates; core capacities required (for example, at a port); elements of event management; and communication and reporting (intra and international).
You will be split into two groups. You will receive a case-based exercise. The exercise is divided into six steps. For each step, you will have to answer one or more questions. The facilitators will address outstanding issues that come up in the group discussions. The timing for the exercise is 60 minutes. Important note This scenario-based exercise is an example and should be taken as such. Suggested modifications and/or proposals for alternate exercises are very welcome.
STEP 1 - Timeline: 14 October 2007 The cargo ship “MV Juan Pablo” calls on Porto Carina and requests for an inspection to renew its Ship Sanitation Exemption Certificate, which is about to expire. Porto Carina is an inland port that is authorized to issue Ship Sanitation Control Certificates and Ship Sanitation Exemption Control Certificates.
Question: How should Porto Carina’s port health authorities plan and prepare the inspection?
STEP 2 - Timeline: 15 October 2007 The inspection is carried out according to the WHO Handbook for Inspection of Ships and Issuance of Ship Sanitation Certificates.
The ship loads grain and prepares for its departure to Santa Clara Port on the following day. The competent authority issues a Ship Sanitation Exemption Control Certificate after conducting a full inspection. Timeline: 1 November 2007 The ship has been at sea for two days. Of the 50 crew members and three passengers, three crew members are ill with bloody diarrhoea and one of them seems to be in critical condition. The “MV Juan Pablo” radios the Santa Clara Port Health Authority and informs them that there is a diarrhoeal crisis on board. Santa Clara Port is authorized to issue Ship Sanitation Exemption Certificates only and is not designated to carry out public health measures under Annex 1B of IHR (2005). Questions: What are the obligations of the captain according to IHR (2005) in this context? What are the options for action of the Santa Clara Port Health Authority according to IHR (2005)? References: IHR (2005), Articles 27 and 28
STEP 3 - Timeline: 1 November 2007 The competent authority immediately arranges ambulance transportation of ill crew members to the nearest hospital. Since they do not have the capacity to take any control measures or investigate the event of gastroenteritis on board, the Santa Clara Port Health Authority advises the master of the ship to head to the next port of call that is authorized to issue ship inspection control certificates, Saint Luis Eugenio Port, which is two hours away. Questions: What capacities should be available at Saint Luis Eugenio Port to handle a public health emergency? When arriving in Saint Luis Eugenio Port, what ship document under IHR (2005) can be required from the master/surgeon or conveyance operator to assess the health conditions on board and help to decision-making process? References: IHR (2005), Articles 27, 28, 37, 39 and Annexes 1B, 3, 4, 8
STEP 4 - Timeline: 2 November 2007 Before arriving at the port, the master of ship provides a Maritime Declaration of Health that accurately describes the health situation on board to the competent authority for Saint Luis Eugenio Port. The Ship Sanitation Exemption Control Certificate issued on 5 October 2007 at Porto Carina is also provided. The certificate shows that no evidence of infection or contamination was found. The ship arrives at the Port of Saint Luis Eugenio. Two additional crew members have developed symptoms of diarrhoea. Since there was no previously identified hospital to send the ill crew members, the port authority had to call several hospitals in the surrounding localities. Investigation by the Saint Luis Eugenio Port Health Authority reveals that the ill crew members' symptoms are probably due to bacterial pathogen (there was blood in the stools of ill travellers). Stool samples are collected from both crew members and passengers. Further samples are collected from the potable water tank and from the food service on board. Timeline: 4 November 2007 Laboratory analysis of the stool samples reveals the presence of E. coli O157 in two crew members but not in the passengers. Potable water analysis of the water on board indicates that the water was positive for total coliforms according to WHO guidelines for drinking-water quality. From a review of the records, inspectors found that the ship’s water tank had been cleaned but not disinfected on 28 October. One of the crew members who cleaned the water tank developed symptoms of diarrhoea the same day. This crew member joined the ship one day before he developed the symptoms of diarrhoea. Question: In light of this information, what actions should have been taken (that were not taken): by the master of the ship, and by Saint Luis Eugenio Port health authorities,
Considering: communication and reporting events, preventive and control measures on board, documentation and issuance of ship sanitation certificates, and public health emergency preparedness planning?
References: IHR (2005), Articles 22, 24, 27, 28 and Annex 4 WHO Handbook for Inspection of Ships and Issuance of Ship Sanitation Certificates
STEP 5 - Timeline: 5 November 2007 A focused inspection is conducted. The Port Health Authority orders that the tank be drained, cleaned and disinfected, and, after refilling the tank, a sample is collected for water quality control. A review of the water safety management plan on board is carried out. The Port Health Authority recommends that the crew be trained on reporting of symptoms of gastroenteritism and that crew members with symptoms of gastroenteritis not handle any part of the potable water system or food handling and be excluded from such duties until symptom free for 48 hours. Using laboratory analysis, a food sample collected on 2 November tests negative for E. coli O157. Crew members and passengers are informed of the E. coli risk and are educated on proper control measures. They are advised to notify the ship's master immediately in the event of a new case. Question: How can the inspector of Saint Luis Eugenio Port take note of the control measures on the certificate, knowing that the current certificate issued by Porto Carina is full? Reference: WHO Handbook for Inspection of Ships and Issuance of Ship Sanitation Certificates
STEP 6 - Timeline: 5 November 2007 Control measures are reported on an Evidence Report Form (refer to Annex 7 of WHO Handbook for Inspection of Ships and Issuance of Ship Sanitation Certificates) that is attached to the certificate issued by Porto Carina. Because of the incubation period for E. coli, and because new patients cannot be excluded, further surveillance is required. Timeline: 6 November 2007 The ship leaves the Port of Saint Luis Eugenio and continues to the next port, Cimennu City. Questions: To whom and how should this event be communicated so that needed measures can be taken for the future port? References: IHR (2005), Articles 6, 9.2, 27
ANNEX 10
Day 3: Breakout Session 2 Case Study Group 2: Event management in air travel Scenario: A(H1N1)
1. Overview This scenario-based exercise is largely inspired from the early stages of the A(H1N1) 2009 influenza epidemic and from data published in an article written by Baker MG et al. (Transmission of pandemic A/H1N1 2009 influenza on passenger aircraft: retrospective cohort study. BMJ, 2010, 340:c2424). Nevertheless, the story was changed for instructional purposes; it does not reflect what actually happened. The names of the countries have been modified as well as some of the timeline. This scenario-based exercise is designed to elicit constructive discussion as participants examine and resolve problems based on the training received in the IHR course. Learning objectives Upon completion of the exercise, participants will be able to: (1) identify the responsibilities of the competent authority at an airport; (2) identify the capacities needed at an airport; (3) identify the need for a contingency plan at an airport in case of an event that may constitute a public health emergency of international concern as described in IHR (2005), Annex 1B; (4) identify the specific requirements for procedures, communication and collaboration needed by the competent authority at an airport for routine surveillance and response to events; (5) identify the responsibilities of air crew on international flights; and (6) explain the specific requirements for communication and collaboration needed among the competent authority at the point of entry, the national surveillance systems and the National IHR Focal Point. Prerequisites Participants are expected to have knowledge from all the sessions taught during the distance-learning component of the IHR course. Duration 3 hours
References IHR (2005), Articles 23, 24, 25, 27, 28, 30. 38 and Annex 9 Assessment tool for core capacity requirements at designated airports, ports and ground crossings. Geneva, WHO, 2009. WHO technical advice for case management of Influenza A(H1N1) in air transport. Geneva, WHO, 2009. Baker MG et al. Transmission of pandemic A/H1N1 2009 influenza on passenger aircraft: retrospective cohort study. BMJ, 2010, 340:c2424 2. Instructions to participants Participants will be split into 5 groups. All groups will work in the plenary room. This scenario-based exercise is divided into five steps. In each group and for each step: o you identify a rapporteur; o you receive the scenario and a set of questions; o you discuss and provide answers to the questions (15 minutes); and o the rapporteur reports the work of the group (10 minutes) or complements the reports of other groups (5 minutes maximum). Each step will be debriefed with the facilitators before moving to the following step of the exercise.
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3. Background March Health officials in Ficusland, a Central American country, have reported several dozen cases of influenza-like illness. 1 April A group of 22 high school students and two teachers from Pongaland (an island in Oceania) arrive in Ficusland for a three-week study tour in the capital city and throughout the countryside. 23 April Peachland, a North American country, announces it has identified new cases of the influenza A(H1N1) virus. The H1N1 virus is spread from person to person, similar to seasonal influenza viruses. It is transmitted as easily as the normal seasonal flu and can be passed to other people by exposure to infected droplets expelled by coughing or sneezing that can be inhaled, or that can contaminate hands or surfaces. The estimated incubation period could range from one to seven days. Persons with H1N1 flu virus infection are considered potentially contagious (able to spread disease) for up to seven days after illness onset. Signs of the pandemic influenza are flu-like, including malaise, fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting and diarrhoea.
4. Case scenario steps STEP 1 - 25 April Consistent with the IHR Emergency Committee recommendations, the WHO Director-General determines that the ongoing public health event in Ficusland and Peachland constitutes a public health emergency of international concern, and issues temporary recommendations as well. No H1N1 case has been reported by Pongaland. The group of Pongaland students starts their return home from the capital city airport in Ficusland at 8:00. The group transits through an airport in Western Peachland (12:00). Since early morning, a student has not been feeling well: he has fever and is coughing. Questions: In this situation, what measures could be put in place at the airports in Ficusland’s capital and Western Peachland to prevent or reduce the risk of spread of the disease internationally? How does the international information (for example, public health recommendations) reach points of entry? What mechanisms should be in place in the country?
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References: IHR (2005), Articles 22, 23, 24, 25, 27, 28 and Annexes 1 and 4 Assessment tool for IHR core capacity requirements at designated airports, ports and ground crossings.
STEP 2 - 25 April At Ficusland airport, travellers are provided with written advice, in the form of posters and flyers, advising them not to travel if they were experiencing influenza-like illness symptoms. In addition, exit temperature screening is applied. The sick student is detected and advised not to travel. Nevertheless, the student explains that family reasons oblige him to go back home as soon as possible. He therefore boards the plane to Peachland Western airport. In transit in Peachland Western airport, the only measure taken is the distribution of informational flyers. The whole group, including the sick student, boards the plane for the 12-hour flight to Pongaland. Question: In this situation, what measures could be taken, regarding: communication between the airport authorities and airline operators; and international communication with WHO and other countries?
References: IHR (2005), Articles 27, 28, 30 Assessment tool for IHR core capacity requirements at designated airports, ports and ground crossings. WHO technical advice for case management of Influenza A(H1N1) in air transport.
STEP 3 - 25 April 25 (13:00) The students are located in the rear section of the aircraft, a Boeing 747. Of the 128 seats in this section of the plane, 126 are occupied by passengers. No specific control measure is taken on board for the sick student. During the flight, 11 other students from the Pongaland group start to feel sick with symptoms of cough and/or fever. Additional passengers from the rear section start to cough and feel sick as well, including several passengers who will transit through Pongaland to Eucalyptland, a nearby Oceanian country. Question: What actions should be taken by the captain and crew of the flight to Pongaland regarding: communication of the event; and control measures on board the plane for: o the patient, o the crew, and o other passengers? References: IHR (2005), Articles 24 and 38 and Annex 4 and 9 WHO technical advice for case management of Influenza A(H1N1) in air transport.
STEP 4 - 26 April The aircraft from Western Peachland lands in Pongaland with the group of students. No specific actions are taken at the airport upon arrival. Questions: What kinds of actions could have been taken by the airport? What capacity should be in place to deal with this kind of situation?
References: IHR (2005), Articles, 22 27, 28 and Annexes 1B, 4, 9
Assessment tool for IHR core capacity requirements at designated airports, ports and ground crossings WHO technical advice for case management of Influenza A(H1N1) in air transport.
STEP 5 - 26 April The passengers arriving from Western Peachland separate into two groups: (1) travellers who have arrived at their destination leave the airport and disperse to different places around Pongaland using various transportation means, including trains and coaches/buses; and (2) travellers in transit take their four-hour flight to Eucalyptland. Later in the day, three sick members from the Pongaland group of students, having heard in the media about the situation, consult their general practitioner. Questions: Considering that influenza-like illness is not a notifiable disease in Pongaland, what should be put in place to deal with a public health emergency of international concern involving influenza-like illness? How does international information (for example, public health recommendations) reach the level of the general practitioners? What mechanisms should be in place in the country? How does information from the general practitioner reach the national surveillance system? Regarding the travellers in transit to Eucalyptland, what procedures should be in place regarding international communication, and who is responsible?
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References: IHR (2005), Article 27 and Annexes 1A and 1B Assessment tool for IHR core capacity requirements at designated airports, ports and ground crossings 5. Epilogue On 27 April, two countries in addition to Ficusland and Peachland will report H1N1 cases. On 28 April, Pongaland will notify its first cases of H1N1 to WHO, together with three other countries. One month later, 48 countries will have reported officially to WHO a total of 13 398 cases.
6. Key messages Staff at points of entry and crew need to be trained in order to be able to make decisions. The more information for travellers, the better it is. Good preparations (for example, case definitions) and clearly defined responsibilities and communication channels are crucial. Surveillance systems need to be related to points of entry. Health care workers at points of entry need to be involved in national planning processes.