Surveillance, risk assessment and response

seCTIon 3: foCUs aReas and aCTIons 17 IBS is the systemaic collecion and analysis of imely, reliable and appropriate data on priority diseases, syndromes and condiions. Data collecion follows a predeined format and includes speciic case or syndrome deiniions. Data reporing and analysis occur regularly, typically once a week, and alert or epidemic thresholds are oten used to idenify outbreaks. IBS aims at outbreak detecion, monitoring of disease trends and disease control programmes and programme planning. Use of appropriate informaion and communicaion technology ICT tools may aid in improving the quality of collecion and collaion of surveillance data at the naional and local levels. Risk assessment is a systemaic process for gathering, assessing and documening informaion to assign a level of risk for a potenial public health event. This enables objecive evidence-based decisions while giving consideraion to the uncertainies and limitaions of the informaion available at a paricular point in ime. It involves understanding the idenity and character of a hazard and evaluaing the risk of an adverse outcome in a populaion following exposure to that hazard. The process can also assess the risk associated with potenial intervenion measures. During an event, risk assessment is an ongoing process, not a one-ime acivity. Rapid response capacity in this context refers to the ability to mobilize a rouine and rapid invesigaion of and response to public health events at naional and local levels. This includes development and deployment of rapid response teams RRTs to any level in the public health sector. IBS and EBS are complementary and both are essenial components of naional surveillance systems. Surveillance informaion is used to help risk assessment, which in turn informs public health acions. Surveillance, risk assessment and response oten require efecive mulilevel, mulidisciplinary and mulisectoral coordinaion. APSED 2010 provides a framework for Member States to create a robust system of surveillance, risk assessment and response that includes the above interlinked components, as described in Figure 3.1. The surveillance and response system should be sensiive and broad enough to allow detecion of other public health events, including non-infecious disease events e.g. chemical and food safety-related events and lexible enough to be adapted to special situaions e.g. mass gatherings, natural disasters. The surveillance and response prioriies of each country should be informed through risk mapping so that any ideniied needs can be met. FET has proved invaluable in establishing naional capaciies for early detecion, prompt invesigaion and efecive response to public health events. FET focuses on learning by doing in a work seing and building competencies applicable to emerging disease outbreaks and other public health events.

3.1.2 Strategic actions

• Coninue to strengthen the exising EBS, IBS and rapid response components of naional surveillance and response systems. 18 STRATEGIC FRAMEWORK FOR WHO TECHNICAL AND COUNTRY WORK: GeTTInG THe RIGHT foCUs • Expand the scope of training of RRTs to support an all-hazards approach, with a speciic focus on the iniial assessment of events. • Strengthen risk assessment capacity at all levels. • Conduct naional risk and vulnerability mapping to idenify threats to public health, exposure factors, and the risk and protecive factors that increase or decrease the adverse impact of an outbreak or other acute public health event on the populaion at risk. • Build on exising mechanisms to promote and strengthen mulidisciplinary and interagency coordinaion for surveillance, risk assessment and response. • Consider the use of appropriate informaion and communicaion technology tools to support surveillance, risk assessment, and response aciviies. • Strengthen ield epidemiology training.

3.2 Laboratory

Eicient and reliable public health laboratory services are an essenial component of any public health system that aims to efecively respond to emerging diseases. Timely, accurate laboratory diagnosis in a safe environment is a cornerstone of any surveillance and response system for emerging diseases and other public health events. Strengthening naional and regional capacity for accurate laboratory diagnosis, laboratory-based surveillance and networking, and biosafety is therefore an essenial component of eforts to ensure regional health security. Public health laboratory capacity-building will coninue to focus on emerging diseases under APSED 2010, and these aciviies need to be coordinated with the WHO Asia Paciic Strategy for Strengthening Health Laboratory Services 2010–2015 and disinct regional strategies on the prevenion and containment of animicrobial resistance.

3.2.1 Key components

The key components of laboratory capacity-building to support emerging disease management are: • accurate laboratory diagnosis; • laboratory support for surveillance and response; • coordinaion and laboratory networking; • biosafety. Accurate and imely laboratory diagnosis is essenial for evidence-based clinical case management and also informs surveillance and risk assessment. Strong diagnosic capacity is therefore necessary to ensure implementaion of appropriate measures to seCTIon 3: foCUs aReas and aCTIons 19 reduce risk and miigate the impact of disease outbreaks. Laboratory capacity needs to be established in all countries for the diagnosis of potenial emerging diseases. This