Ryan Van Meer, MD, MPH, is a resident, Public Health & Preventive Medicine Residency Program, McMaster University, Hamilton, Ontario, Canada. Karin Hohenadel, MSc, is Manager, Communicable Diseases; Alanna Fitzgerald-Husek, MD, MPH, is a Public Health Physician; Bryna Warshawsky, MDCM, MHSc, is Interim Medical Director; Doug Sider, MD, MSc, is a Public Health Physician; and Mark P. Nelder, PhD, is a Senior Program Specialist; all in Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario. Brian Schwartz, MD, MScCH, is Interim Vice-President, Science and Health Protection, Public Health Ontario, Toronto, Ontario.
Health Secur. 2017 May/Jun;15(3):230-237. doi: 10.1089/hs.2016.0127.
To determine the Ontario-specific risk of local and travel-related Zika virus transmission in the context of a public health emergency of international concern, Public Health Ontario (PHO) completed a rapid risk assessment (RRA) on January 29, 2016, using a newly developed RRA guidance tool. The RRA concluded that risk of local mosquito-borne transmission was low, with a high risk of imported cases through travel. The RRA was updated 3 times based on predetermined triggers. An independent evaluation assessed both the application of the RRA guidance tool (process evaluation) and the usefulness of the RRA (outcome evaluation). We conducted face-to-face, semi-structured interviews with 7 individuals who participated in the creation or review of the Zika virus RRA and 4 end-users at PHO and the Ministry of Health and Long-Term Care. An inductive thematic analysis of responses was undertaken, whereby themes were directly informed by the data. The process evaluation determined that most steps outlined in the RRA guidance tool were adhered to, including forming a cross-functional writing team, clarifying the scope and describing context, completing the RRA summary report, and updating the RRA based on predefined triggers. The outcome evaluation found that end-users judged the Zika virus RRA as evidence-informed, useful, consistent, and timely. The evaluation established that the locally tailored guidance tool, adapted from national and international approaches to RRAs, facilitated a systematic, evidence-informed, and timely formal RRA process at PHO for the Zika virus RRA, which met the needs of end-users. Based on the evaluation, PHO will modify future RRAs by incorporating some flexibility into the literature review process to support timeliness of the RRA, explicitly describing the limitations of studies used to inform the RRA, and refining risk algorithms to better suit emerging infectious disease threats. It is anticipated that these refinements will improve upon the timely assessment of novel or reemerging infectious diseases.
为了在国际关注的突发公共卫生事件背景下，确定安大略省与本地和旅行相关的寨卡病毒传播的特定风险，安大略省公共卫生局（PHO）于 2016 年 1 月 29 日使用新开发的快速风险评估（RRA）指导工具完成了快速风险评估（RRA）。RRA 的结论是，本地蚊媒传播的风险较低，通过旅行输入病例的风险很高。根据预定的触发因素，该 RRA 进行了 3 次更新。独立评估评估了 RRA 指导工具的应用（过程评估）和 RRA 的有用性（结果评估）。我们与参与寨卡病毒 RRA 创建或审查的 7 个人以及 PHO 和安大略省卫生部和长期护理部的 4 个最终用户进行了面对面的半结构化访谈。对答复进行了归纳主题分析，主题直接来自数据。过程评估确定，RRA 指导工具中概述的大多数步骤都得到了遵守，包括组建跨职能写作团队、澄清范围和描述背景、完成 RRA 总结报告以及根据预定义的触发因素更新 RRA。结果评估发现，最终用户认为寨卡病毒 RRA 具有循证依据、有用、一致和及时。评估结果表明，该工具通过采用国家和国际的 RRA 方法进行了本地化调整，为 PHO 寨卡病毒 RRA 提供了系统的、循证依据的、及时的正式 RRA 流程，满足了最终用户的需求。基于评估结果，PHO 将通过在文献综述过程中纳入一些灵活性来修改未来的 RRA，以支持 RRA 的及时性，明确描述用于告知 RRA 的研究的局限性，并改进风险算法以更好地适应新兴传染病威胁。预计这些改进将有助于及时评估新型或再现传染病。
