Preventing disease Promoting and protecting health

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1 Preventing disease Promoting and protecting health

2 WHAT IS CARPHA? Integrated PH agency, manifestation of One Caribbean Combines the functions of five Caribbean Regional Health Institutes CEHI CAREC) CFNI CHRC CRDTL New single regional public health agency for the Caribbean Prevent disease, Promote health and Respond to public health emergencies Serves 24 Member states Mandate and vision for health and addressing the changing nature of public health

3 CARPHA and CTO PARTNER to address Tourism and HEALTH Recognizing that the Caribbean: most tourism-dependent region in the world and that the Industry is vulnerable to health, safety & environmental problems (HSE), particularly foodborne disease & traveler s diarrhea among visitors CARPHA in partnership with CTO agreed to establish Regional Tourism and Health Program in January 2014 Approved by CARPHA & CTO Board in Sept and Jan 2014 Goal : To Improve the health, safety, quality and sustainability of the Caribbean tourism industry and thereby contribute to the industry being more competitive, resilient and sustainable

4 Chikungunya Epidemic in the Caribbean CHI KUN GUN WHAT??? What is our response??

5 CONTENTS Globalization Chikungunya an overview CHIK by the numbers CARPHA response to the outbreak Preparedness and response Recommendations

6 Globalisation Caribbean - the most tourism dependent region in the world Health in the Caribbean affected by health of others Globalisation has highlighted the global interconnectedness of health Communicable diseases travel faster and further Media attention, political concern and public anxiety Regional health security important International Health Regulations identification, alert, preparedness and response

7 What is Chikungunya (CHIK) Viral disease spread by the bite of mosquitoes, most commonly Aedes aegypti and Aedes albopictus Causes sudden onset of fever, rash, arthritis and other joint pain and other accompanying symptoms Chikungunya often occurs in large outbreaks with a high attack rate no direct person-to-person transmission No specific antiviral drugs and no commercially available vaccine. Treatment is directed primarily at relieving the symptoms, particularly joint pain.

8 Symptoms Most people infected with chikungunya virus will develop some symptoms. Symptoms usually begin 3 7 days after being bitten by infected mosquito. The most common symptoms are fever and joint pain. Others headache, muscle pain, joint swelling, or rash. Chikungunya disease does not often result in death, but the symptoms can be severe and disabling. Most patients feel better within a week. In some people, the joint pain may persist for months. Once a person has been infected, likely to be protected from future infections. Diagnosis The symptoms of chikungunya are similar to those of dengue, See the doctor if you develop the symptoms described above. If you have recently traveled, tell your doctor. Your doctor may order blood tests to look for chikungunya or other similar diseases

9 Prevention No vaccine exists to prevent chikungunya Prevent chikungunya avoiding mosquito bites Mosquitoes that spread the chikungunya : bite mostly in daytime. Protect Yourself from Mosquito Bites Use AC or window/door screens to keep mosquitoes outside. sleep under a mosquito bed net. Help reduce the number of mosquitoes outside your home or hotel room by emptying standing water from containers such as flowerpots or buckets. When weather permits, wear long-sleeved shirts and long pants. Use insect repellents Repellents containing DEET, picaridin, IR3535, and oil of lemon eucalyptus and para-menthane-diol products If you use both sunscreen and insect repellent, apply the sunscreen first then the repellent. Do not spray repellent on the skin under your clothing. Treat clothing with permethrin or purchase permethrin-treated clothing. Always follow the label instructions when using insect repellent or sunscreen.

10 If you have chikungunya, follow these instructions: During the first week of infection, chikungunya virus can be found in the blood and passed from an infected person to another mosquito through mosquito bites. An infected mosquito can then transmit the virus to other people. To prevent further spread of the virus, it is important for people to avoid mosquito bites during the first week of illness. \ Treatment There is no medicine to treat chikungunya virus infection or disease. Decrease the symptoms: Get plenty of rest Drink fluids to prevent dehydration Take medicines, such as ibuprofen, naproxen, acetaminophen, or paracetamol, to relieve fever and pain.

11 Chikungunya in the Caribbean (CHIK) First reported case to the Caribbean Public Health Agency (CARPHA): December 2013:St Marteen Now in 18 Caribbean countries June ,252 confirmed/probable casesn Introduction and Spread is Travel Related Caribbean is at risk. New virus to the Region :Not seen before Majority of population susceptible Same vector (mosquito) transmits Dengue Frequent intra regional and international Travel : increases the risk

12 Update June

13 CHIKINGUNYA CASES: 2 JUNE 2014 Country/Territory # Confirmed/Probable Cases # Suspected Cases Anguilla 33 N/A Antigua and 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 St. Kitts and Nevis 22 N/A St. Lucia 5 N/A St. Vincent and the Grenadines Sint Maarten 343 N/A St. Martin 793 (3***) 3,320 **Includes 2 death indirectly related to Chikungunya Preventing and seven disease, deaths whose promoting relation to and Chikungunya protecting fever health 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 )

14 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 reponse. Partnership with PAHO/WHO CARPHA worked closely with PAHO in response to the outbreak Field response CARPHA has deployed teams to the field to provide support in: St Maarten (jointly with PAHO/WHO) and Dominica

15 CHIK CARPHA response Laboratory response CARPHA provides diagnostic testing for member states Assessed laboratory capacity for chikungunya in the region 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.

16 Spend 10 mins a we and use this chart to inspect your yard an get rid of or cover ALL breeding place for mosquitos!

17 CHIK CARPHA response Communication CARPHA has a dedicated chikungunya page on its website including weekly updates to reflect changes in the number of recently reported cases. Teleconferences held with Member States to share information and provide technical advice for preparedness and response activities Regular teleconferences are held with international agenices

18 Preparedness and Response

19 Preparedness and Response

20 Recommendations Sustained commitment - substantial challenges ahead; Strengthen systems in countries to respond rapidly to outbreaks; Use a coordinated multisectoral approach - include education, tourism, media, local government and other sectors and capabilities, including private enterprise; Provide timely and accurate information to help avoid confusion or miscommunication; Affected and as-yet-unaffected countries urged to educate the public, and visitors on the importance of protecting themselves from being bitten by mosquitoes;

21 Need for clear protocols on alerts, responses, and comms in crises: Example of Chikungunya State the facts : As of June 20 2 : over 5000 confirmed & probable cases reported to CARPHA from 18 Member States Caribbean populations completely susceptible, vector mosquitos abundant, high levels of travel/movement Communication will play a key role in managing situation in months ahead

Impact of Chikungunya on Tourism in the French Island, La Réunion, 2005-06 Widespread ChikV

close for a period Many employees dismissed But Mauritius had big epidemic in same period,

22 Impact of Chikungunya on Tourism in the French Island, La Réunion, Widespread ChikV epidemic Number of tourists down 30% All hotels had difficulties 17/28 main hotels had to close for a period Many employees dismissed But Mauritius had big epidemic in same period, with little impact on tourism Media amplification in La Reunion contributed to increase in scare

Media amplification in La Réunion Health authorities communication Unexpected size of the epidemic late and poorly organised communication strategy.

23 Media amplification in La Réunion Health authorities communication Unexpected size of the epidemic late and poorly organised communication strategy. Healthcare providers received little information and felt lost started speaking publicly with a message different to the one of the health authorities Lack of communication appears as a lack of transparency to population. Campaign (in particular vector control) gave the impression that all attention focussed on mosquitoes Feeling that France started acting only when south of Europe may be threatened Media coverage Tension between health authorities messages and population perception create a good subject for the Media. Lack of public messages allow for more alarmist titles. Population feels that they don t receive enough attention Population perception Population was asked to rank their feeling about Chik : How would you rank Chik on a severity scale ranking 0-10? It was ranked as 8, when in fact this is not a severe disease. But the perception of the disease was seen as very severe, when they felt that health authorities were not prepared enough.

24 Informing the public(s) Prepare comms plan, incl risk comms; collaboration health, tourism and other relevant sectors Don t lie: Yes, a large quantity of the population may get sick over 12 mos (could be 30-40%!) But this is a short term illness; nearly everyone recovers quickly; You could protect yourself better from mosquitos; You can get Chik only once Chik is far less lethal than Dengue But more people will get Chik than Dengue, as everyone susceptible to ChikV; joint pain can be painful and could last long Inform health practitioners how to recognize, report and manage cases Provide more info to people re symptoms, what to do if ill, need to work on reducing mosquito population Discuss with Media, informing them on the virus to avoid alarmist headlines Tourist-oriented businesses can prepare comms re vector control (e.g., hotel providing free anti-mosquito repellent, vector control in gardens ) Market to more tourists from the Caribbean region: they are likely less afraid of Chik

27 THANK YOU

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Preventing disease Promoting and protecting health

Preventing disease Promoting and protecting health CHIKV IN THE CARIBBEAN: PROJECTIONS OVER THE NEXT YEAR ENDEMICITY, PAIN AND MISERY.. Dr. C. James Hospedales Executive Director CARPHA Preventing disease,