Preventing disease Promoting and protecting health

CARPHA A New Caribbean Public Health Agency: Responding to public health emergencies Dr Babatunde Olowokure Director Surveillance, Disease Prevention & Control Division CARPHA CARIB RISK CLUSTER 4 June 2014 Martinique

OVERVIEW General description of CARPHA Responding to public health emergencies: Flooding - St Lucia Emerging disease - Chikungunya Vector control Take home messages

The Agency The Caribbean Public Health Agency (CARPHA) is the new single regional public health agency for the Caribbean. Legally established in July 2011 by an Inter-Governmental Agreement (IGA) signed by Caribbean Community (CARICOM) Member States and began operation in January 2013. CARPHA combines the functions of five previous Caribbean Regional Health Institutes (RHIs) into a single agency: Caribbean Environmental Health Institute (CEHI) Caribbean Epidemiology Centre (CAREC) Caribbean Food and Nutrition Institute (CFNI) Caribbean Health Research Council (CHRC) Caribbean Regional Drug Testing Laboratory (CRDTL) CARPHA is an institute of CARICOM and addresses public health issues requiring regional response and, where appropriate coordination.

Member Countries: 24 Anguilla Antigua & Barbuda Aruba Bahamas Barbados Belize Bermuda BES Islands (Bonaire, Saba & St Eustatius) British Virgin Islands Cayman Islands Curacao Dominica Grenada Haiti Guyana Jamaica Montserrat St. Kitts & Nevis St. Lucia St. Maarten St. Vincent & the Grenadines Suriname Trinidad & Tobago Turks & Caicos Islands

Our Mission To provide strategic direction in analysing, defining and responding to public health priorities of CARICOM, in order to prevent disease, promote health and respond to public health emergencies. To support solidarity in health, as one of the principal pillars of functional cooperation, in the Caribbean Community.

CARPHA: EMERGENCY PREPAREDNESS AND RESPONSE

Emergency response to flooding in St. Lucia and St Vincent & the Grenadines: On the 24th of December 2013, heavy rains from a lowpressure trough caused significant damage in the Eastern Caribbean Islands of St. Vincent, Dominica and St. Lucia Most of the damages caused were as a result of flooding especially in the low lying areas. Assistance was provided by CARPHA St Lucia in facilitating access to emergency water treatment solutions to these countries in the aftermath of the storm through contributions from Operation Blessing, the US Centers for Disease Control and Prevention and Procter and Gamble.

Emergency response to flooding in St. Lucia and St Vincent & the Grenadines: Operation Blessing dispatched an engineer to St. Lucia to reactivate a portable water treatment system for field deployment US CDC supplied a total of 28 residual chlorine field test kits (20 to St Lucia and 8 to St Vincent) and Procter and Gamble supplied 3 boxes (720) water disinfection sachets to St Vincent. The St Lucia team also participated in a field assessment along with a PAHO assessment team. A lessons learned meeting has been proposed by CARPHA to MOH St Lucia to include review of vector control measures

The emergence of CHIK in the Caribbean The Caribbean Public Health Agency (CARPHA) received reports of cases of chikungunya on the island of Saint Martin in early December 2013. This was the first time that locally transmitted chikungunya (CHIK) had been identified in the region. Additional cases have since been reported in other countries/territories in the Region As at 2 June 2014 there have been 5,252 confirmed/probable cases reported by 18 countries/territories in the region Experience elsewhere suggests long-term health impacts

CHIKINGUNYA CASES: 2 June 2014 Country/Territory # Confirmed/Probable Cases # Suspected Cases Anguilla 33 N/A Antigua & Barbuda 4 N/A Aruba 1 N/A British Virgin Islands 20 N/A Dominica 122 1,817 Dominican Republic 17 38,639 French Guiana 222 N/A Guadeloupe 1,328 (1) 23,100 Guyana 2 N/A Haiti 632 N/A Martinique 1,515 (9**) 29,200 Puerto Rico 1 N/A St. Barthelemy 135 520 St. Kitts and Nevis 22 N/A St. Lucia 5 N/A St. Vincent & the Grenadines 57 110 Sint Maarten 343 N/A St. Martin 793 (3***) 3,320 **Includes 2 death indirectly related to Chikungunya Preventing and disease, seven deaths promoting whose relation and protecting to Chikungunya health fever is being determined ***Includes one death indirectly related to Chikungunya due to co-morbidities and one death whose relation with Chikungunya fever could not be established (EW 09 2014)

CHIK CARPHA response Coordination CARPHA quickly established an incident management team to coordinate the response among member states, and with partners The response was multidisciplinary and multifaceted CARPHA - important role in catalyzing and coordinating the response. Partnership with PAHO/WHO CARPHA working closely with PAHO in response to the outbreak Joint outbreak response to St Maarten Coordinated supply of bednets to Dominica for use in hospitals Support reporting by CMS to PAHO/WHO IHR NFP Discussions on vector control, insecticide resistance and environmental sanitation Regular bimonthly teleconferences Ad hoc calls and conferences as required on technical issues as they arise

CHIK CARPHA response Field response CARPHA has deployed teams to the field to support CMS in: St Maarten (jointly with PAHO/WHO) and Dominica Laboratory response CARPHA provides diagnostic testing for member states A network of laboratories in the Caribbean, including those of CARPHA, US CDC, and Institut Pasteur in French Guiana are conducting appropriate diagnostic tests to confirm the presence of the chikungunya virus in suspected patients. Assesses insecticide resistance of vector

CHIK CARPHA response Communication CARPHA has a dedicated chikungunya page on its website including: Weekly updates to reflect changes in the number of reported cases. Media statements Vector control Regular and ad hoc teleconferences with Member States to: share information provide technical advice Regular teleconferences are held with: Representatives from: Institute Pasteur Cayenne; ECDC; Public Health England; US CDC; Public Health Agency of Canada (PHAC); PAHO and others.

Chikungunya vector control coming to a place near you soon are you prepared?

Preparedness and Response

Importance of Vector Control No vaccines or treatment available for vectorborne diseases such as dengue and chikungunya Most effective tool for prevention and control of these diseases is vector control through Integrated Vector Management (IVM)

CARPHA S Role in Vector Control Provide technical advice and assistance to countries in preparedness for and response to outbreaks of vector-borne diseases Provide assistance to countries in the development of IVM plans as part of the Integrated Management Strategy for Dengue (IMS-Dengue) prevention and control (partnership with PAHO) Build capacity in countries through training of Environmental Health and Vector Control Officers in: Basic microscopic identification of mosquitoes of public health importance Methods of vector control Vector surveillance

CARPHA S Role in Vector Control Conduct needs assessments and evaluations of vector control programmes, and make recommendations for improvements Provide guidance to countries in monitoring and evaluation of vector control programmes Provide assistance to countries in the development of research protocols and execution of research projects Conduct evaluations of new vector control tools Provide services such as: Microscopic identification of arthropods of public health importance Insecticide Resistance Testing (Aedes aegypti) use WHO Bioassay methods

Vector control measures - CHIK Preparedness Advice - combine dengue and CHIK prevention and control Vector control operations - surveillance Integrated Vector Management Environmental management = breeding sites Chemical control = spraying, bednets Communication Community engagement Educational materials Individual protection Household protection

Vector control - challenges Surveillance Monitoring vector populations and at-risk populations Communication with local epidemiology units, and others Vector Control Elimination of larval habitats Community engagement Fogging method Insecticide resistance Human resource capacity and capability Sustained commitment

Vector control - challenges Personal/Household protection Individual protection Storage drums Environmental sanitation Monitoring and evaluation Lack of M&E culture Multisectoral coordination and collaboration Requires strengthening Research Lack of evidence-base Development of sustainable vector control methods Burden of illness studies Effectiveness of vector control methods Resistance testing

Take home messages Recent events have demonstrated the value of CARPHA in responding to major regional public health events; CARPHA will coordinate and collaborate regional response to major public health events - CHIK response; Sustained commitment - substantial challenges ahead; Strengthen epidemiological and laboratory surveillance systems, and vector control response capability; Use a coordinated multisectoral approach; Provide timely and accurate information to help avoid confusion or miscommunication; Educate the public, and visitors on the importance of protecting themselves from being bitten by mosquitoes;

Take home messages Protect individuals, households, communities; Encourage individuals and communities to take responsibility; Leverage opportunity provided by chikungunya to strengthen health systems and prepare for long-term morbidity; Combine CHIK and dengue control efforts; Conduct - operational research, monitoring and evaluation; CARPHA will organize an Expert consultation on chikungunya in the Caribbean; CARPHA in partnership with CARICOM and PAHO to establish an annual Caribbean Mosquito Awareness Week.

Acknowledgements GC Martinique CARPHA Member States Institute Pasteur Cayenne PAHO/WHO US CDC; CARPHA CHIK IMT

THANK YOU http://carpha.org/