National Institute of Health (NIH), Islamabad, Pakistan; Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan.
National Institute of Health (NIH), Islamabad, Pakistan.
Acta Trop. 2021 Jul;219:105910. doi: 10.1016/j.actatropica.2021.105910. Epub 2021 Apr 5.
Public Health Emergency Operations Center (PH-EOC) and Incident Management System (IMS) provides a platform for inter-sectoral coordination, and collaboration to enhance efficiency of response activities and help in effective control of disease outbreaks. Dengue fever (DF) is an emerging serious public health threat with a potential to transform into a public health emergency. Pakistan faced a heavy outbreak of Dengue fever (DF) from August to December 2019. National Institute of Health (NIH), Islamabad activated its Public Health Emergency Operations Center (PH-EOC) with an objective to implement principles and practices of IMS for control of the outbreak. The challenges during inter-sectoral collaboration for response activities were also identified. PH-EOC was activated on 16th September 2019, and remained operational for next 81 days till 05th December 2019. Incident management structure, incident action plan (IAP), and risk communication plan was developed and executed during this phase. Daily morning and evening meetings were held during all operational days. Federal and provincial health departments, district health offices (DHO), and government/private hospitals were coordinated for collection of the data pertaining to Dengue confirmed cases and deaths. As of 05th December 2019, a total of 52,877 confirmed Dengue cases were reported from all across Pakistan with maximum cases reported from Rawalpindi and Islamabad collectively i.e. 20,988 (40%), followed by Karachi 14,768 (28%), and Peshawar 2,699 (5%), while AJK reported 1,690 (3%). A total of 92 deaths happened all across Pakistan, out of which 43 (47%) happened in Karachi, 23 (25%) in Rawalpindi, and 22 (24%) in Islamabad. The response was coordinated through NIH based PH-EOC, but was carried out by relevant federal and provincial district health offices, vector surveillance programs, dengue control programs and sanitation departments respectively. As a part of response plan, vector surveillance, larva source management, and insecticidal spraying i.e. both fogging and indoor residual spraying activities were carried out in hotspots or the areas where confirmed cases were reported. Sanitation departments daily reported the removal of additional 80-100 ton of solid waste from hotspot areas. Hospitals were coordinated for reporting of isolation of DF patients and provision of quality clinical management for admitted patients. The International Federation for Red Cross/Crescent conducted community awareness, and covered 28,800 households in affected areas of Islamabad. Conversely, the DF outbreak was controlled 02-03 weeks ahead of previous years trends. All the coordinated activities were incorporated in a daily situation report (SitRep) and this was widely distributed among all the stakeholders through emails. Additionally, the data was displayed on the dashboard in PH-EOC. The data dashboard at PH-EOC served as an information management hub that visually mapped, tracked, analyzed, and displayed clusters of DF cases and hotspots. Accordingly, SitRep substantiated as the main reporting tool to monitor response activities initiated by rapid response teams at the national and subnational level. The inter-sectoral coordinating efforts made among concerned line departments resulted in a timely response leading to effective handling of a national public health threat. The information distilled from this experience was that the early and judicious activation of PH-EOC with adaptation of IMS under decision making leadership resulted in a well-managed and prompt response executed by different departments/stakeholders, and effective control of the outbreak before its transformation into a public health event/emergency of national or international concern.
公共卫生应急行动中心（PH-EOC）和事件管理系统（IMS）为部门间协调和合作提供了一个平台，以提高应对活动的效率，并有助于有效控制疾病爆发。登革热（DF）是一种新出现的严重公共卫生威胁，有可能演变成公共卫生事件。巴基斯坦在 2019 年 8 月至 12 月期间遭遇了登革热（DF）的严重爆发。伊斯兰堡的国家卫生研究所（NIH）启动了其公共卫生应急行动中心（PH-EOC），旨在实施 IMS 的原则和实践，以控制疫情爆发。在应对活动的部门间合作中也确定了挑战。PH-EOC 于 2019 年 9 月 16 日启动，并在接下来的 81 天内一直运行至 2019 年 12 月 5 日。在此期间制定并执行了事件管理结构、事件行动计划（IAP）和风险沟通计划。在所有运营日举行了每日早晚会议。联邦和省级卫生部门、地区卫生办公室（DHO）和政府/私立医院协调收集有关登革热确诊病例和死亡的信息。截至 2019 年 12 月 5 日，巴基斯坦各地共报告了 52877 例确诊登革热病例，其中报告病例最多的是拉瓦尔品第和伊斯兰堡，共计 20988 例（40%），其次是卡拉奇 14768 例（28%），白沙瓦 2699 例（5%），而 AJK 报告了 1690 例（3%）。巴基斯坦各地共发生 92 例死亡，其中 43 例（47%）发生在卡拉奇，23 例（25%）发生在拉瓦尔品第，22 例（24%）发生在伊斯兰堡。该反应是通过 NIH 基于 PH-EOC 进行协调的，但由相关联邦和省级地区卫生办公室、病媒监测计划、登革热控制计划和卫生部门分别开展。作为应对计划的一部分，在热点地区或报告确诊病例的地区进行了病媒监测、幼虫源管理和杀虫喷雾，即喷雾和室内滞留喷雾活动。卫生部门每天报告从热点地区清除 80-100 吨额外的固体废物。协调医院报告隔离 DF 患者并为住院患者提供优质临床管理。国际红十字/红新月会开展了社区宣传活动，覆盖了伊斯兰堡受影响地区的 28800 户家庭。相反，DF 疫情在比前几年趋势提前 02-03 周得到控制。所有协调活动都纳入了每日情况报告（SitRep），并通过电子邮件在所有利益相关者中广泛分发。此外，数据显示在 PH-EOC 的仪表板上。PH-EOC 的数据仪表板充当信息管理中心，可直观地映射、跟踪、分析和显示 DF 病例和热点集群。因此，SitRep 成为监测国家和国家以下各级快速反应小组发起的应对活动的主要报告工具。相关职能部门之间的部门间协调努力导致了及时的反应，有效地处理了国家公共卫生威胁。从这次经历中得出的信息是，在决策领导层的领导下，及早和明智地启动 PH-EOC，并采用 IMS，有助于不同部门/利益相关者进行管理良好和迅速的反应，并在疫情演变成国家或国际关注的公共卫生事件/紧急情况之前有效控制疫情。
