Decision making - PDF Document

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  1. Decision making – what to consider – summary of criteria in an algorithm for decision making Training programme Evidence-based best practices on entry/exit screening for infectious diseases in humans 30th - 31st January 2019 Parc-Hotel Alvisse 120, route d’Echternach L-1453 LUXEMBOURG Prof. Christos Hadjichristodoulou, Laboratory of Hygiene and Epidemiology, University of Thessaly, Greece Dr. Barbara Mouchtouri SPECIFIC CONTRACT NUMBER No 2017 72 06 FWC Chafea/2015/Health/05-LOT3: Organisation of a training and production of training package on entry and exit screening Laboratory of Hygiene and Epidemiology, University of Thessaly, Greece 30th - 31st January 2019 Consumers, Health, Agriculture and Food Executive Agency

  2. Decision making algorithm Event Step 1 Disease Outbreak Step 2 Country Point of entry Step 3 Potential Balance Step 4 DECISION WHO temporary recommendations for screening YES NO Set main objectives & expected outcomes of screening Implementation of other alternative health measures with same or better effect Step 5 After decision/planning Consumers, Health, Agriculture and Food Executive Agency

  3. Step 1: Event • Event Step 2: Cross-border disease health threat? - Criteria included in Articles 2 and 9 of Decision 1082/2013/EU on serious cross-border threats to health • Disease/ outbreak Step 3: • Country/ point of entry Public health emergency of international concern (PHEIC)? - WHO declaration Step 4: • Potential/ balance Step 5: • After decision/ planning WHO temporary recommendations for entry/exit screening? Consumers, Health, Agriculture and Food Executive Agency

  4. Outbreak Disease Ste p 1: • Event Virulence? - Morbidity: hospitalization rate, complications - Mortality Transmissibility? - Before/after symptom onset Communicability? - Reproductive rate of infection (Rₒ) Mode of transmission? - Direct/indirect, respiratory, droplet, vector-borne, human fluids etc. Incubation period? - Infectivity period - Serial interval - Latent period Symptoms detectable? Proportion febrile? Proportion asymptomatic? Temporal and spatial extent? - When outbreak started? - Geographic distribution? - Dynamics? Step 2: • Disease/ outbreak Step 3: • Country/ point of entry Outbreak evolution and current state? - Increasing? - Stable? - Decreasing? Step 4: • Potential/ balance Have modeling studies been conducted for specific disease outbreaks? - Previous experience? Step 5: • After decision/ planning Consumers, Health, Agriculture and Food Executive Agency

  5. Country Point of entry Step 1: • Event Island country? Sharing of borders with affected areas? Traditional connections with affected areas? Distance from affected areas (especially for maritime sector)? Step 2: Direct connections with affected areas? Indirect connections with affected areas? Distance from affected areas (especially for maritime sector)? • Disease/ outbreak Step 3: • Country/ point of entry Disease epidemiology in country - Do indigenous cases exist? - Level of transmission? Public health priorities? Step 4: • Potential/ balance Volumes of travelers and conveyances from affected areas? Step 5: • After decision/ planning Level of core capacities at PoE? Level of core capacities in country? - Human resources and equipment, assessment and medical care - Human resources - Strong surveillance - Programme for vector control, trained staff for inspections, safe environment etc. - Response plans - Business continuity plans - Contingency planning Consumers, Health, Agriculture and Food Executive Agency

  6. Balance Potential Step 1: • Event What is the expected prevalence of disease among incoming/outbound travelers? - Previous experience could be used What are the expectations for detection rates? -Sensitivity - Positive predictive value (PPV) Are vaccines available? - If no, when are they expected to become available? Screening potential to identify cases? Step 2: • Disease/ outbreak Cost of intervention? Step 3: • Country/ point of entry Concomitant effects? What are potential infection control means in the community? - e.g. school closures, isolation of cases - Information to travellers Step 4: • Potential/ balance - Better contact tracing - Public and political pressure What is the potential to implement robust screening protocols? Laboratory diagnosis - Feeling of security for travelling public - Avoid travel restrictions’ adverse effects Step 5: • After decision/ planning Cost of implementing other effective measures? - Availability of rapid test - Accuracy of rapid test Effectiveness of alternative measures? - Time required to confirm test - Estimated cost of laboratory diagnosis Consumers, Health, Agriculture and Food Executive Agency

  7. Step 1 Event Step 2 Disease Outbreak Country Point of entry Step 3 Potential Balance Step 4 DECISION WHO temporary recommendations for screening YES NO Set main objectives & expected outcomes of screening (prior to planning stage) 1) Detect cases 2) Delay occurrence of outbreak 3) Inform passengers 4) Reassure the community? 5) Other After decision/ planning Implementation of other alternative health measures with same or better effect Step 5 Consumers, Health, Agriculture and Food Executive Agency

  8. After Step 1: decision/planning • Event Volumes of travelers from affected countries and which points of entry they arrive Case definition and contacts classification Step 2: • Disease/ outbreak Decisions on tools - e.g. thermal cameras, visual assessment, questionnaires, or combination of all three - Onboard conveyances or at ports/airports Tools and protocols - Exposure assessment - Symptoms assessment - Clinical diagnosis - Laboratory diagnosis *Keep in mind limitations of tools Step 3: • Country/ point of entry Step 4: • Potential/ balance Very important after-screening measures Step 5: - Diagnostic/laboratory facilities - Health care - Isolation - Transportation - Contact tracing - Logistics - Training (PPE, usage of tools etc.) • After decision/ planning How long and when to stop measures Consumers, Health, Agriculture and Food Executive Agency