presentedDATE to

GROUP NAME

The Great Lakes Border Health Initiative

What is GLBHI?

• A collaborative effort between jurisdictions in the U.S. & Canada to enable infectious disease surveillance and facilitate communication

Who is GLBHI?

History of GLBHI

• Before 2004

History of GLBHI

• Before 2004

History of GLBHI

• Now

History of GLBHI

• 2004– Early Warning Infectious Disease

Surveillance– Michigan and Ontario– Border Health Initiative

• 2005– New York, Wisconsin, Minnesota– Great Lakes Border Health Initiative

History of GLBHI

• 2006– MI-HAN enrollment: Ontario– Ohio

• 2007– Epi-X enrollment: Ontario– Pennsylvania & Indiana

History of GLBHI

• 2008– CIOSC enrollment: United States

Organization

About the Committees

• Members include:– State/Provincial representatives– Local public health representatives– Tribal/First Nations representatives– Federal representatives

• US/Canadian co-chairs• Scheduled to meet monthly to bi-

monthly

About the Steering Committee

• Members– Co-chairs of subcommittees– State/Provincial leads– Other key representatives

• Directs the actions of the subcommittees

• Tasks determined by grant agreement

• All participating organizations represented

About the Lab Subcommittee

• Routine surveillance sharing

• Lab capabilities• Sharing of protocols• Exploring import-export

permits from CDC & PHAC

About the Legal Subcommittee

• Data Sharing Agreement• Evaluates privacy laws and policies

of potential new partner states• Provides legal counsel for other

committees as issues/questions arise

About the Food Protection & Defense Subcommittee

• Newest subcommittee• Currently working to establish

relationships and communications channels between critical partners

About the PH Communication Subcommittee

• Communication links & tools– Communication Guideline– Communication System Matrix– Reportable Disease List

• Epi-X & CIOSC enrollment exchange

About the Ad hoc Subcommittees

• Education & Training • Emergency Response• Direct Care

Tools for Collaboration

• Face-to-face meetings• Communication pathways

– Federal– Local/Regional

• Data Sharing Agreement• Infectious Disease Emergency

Communications Guideline

Infectious Disease Emergency

Communications Guideline

IDECG Decision Tree

IDECG Decision TreeDecision Tree for Events Which Require Public Health Agency

Notification Between Ontario & Neighboring States1

PROCEED WITH PROPER NOTIFICATION: Situational alerts may be shared across borders via Health Alert Networks. 3 Communications which require sharing of

individually identifiable data should be shared via phone or internet in a secure manner.

Event involving single local health unit across the international border: Notify local health unit across the border and/or own provincial/state public health agencies.4

Event involving more than a single local health unit across the international border: Notify own state/provincial health agency and then cross-border state/provincial health agency.4

Please see: o Page 5 for Definitions/Examples o Page 6 for Epidemiological Data to Share Across State and International Borders o Appendices 1-7 for State/Provincial Communication Protocols

1 See Appendix 8 for listing of Immediately Notifiable Diseases in all GLBHI jurisdictions. See the GLBHI Reportable Disease Directory for a complete listing of all reportable diseases (available for printing at www.michigan.gov/borderhealth). 2 See Definitions/Examples, page 5. (Flow sheet adapted from 11/04 draft of the World Health Organization’s International Health Regulations. Current version, updated 05/05, found at: http://www.who.int/csr/ihr/IHRWHA58_3-en.pdf.) 3 Please see Appendix 9. 4 State & Provincial health units should consult the World Health Organization’s International Health Regulations Annex 2 Decision Tree for the Assessment and Notification of Events that May Constitute a Public Health Emergency of International Concern to determine duty to report to their Federal Health Agency. See http://www.who.int/csr/ihr/en/.

1. Might the event have a serious public health impact across the border?2

3. Might international travel or trade restrictions be necessary?2

If #1, #2 AND #3 = NO, no notification necessary at this time. Continue monitoring.

If #1 = NO, but #2 or #3 = YES, non-immediate notification as follows.

If #1 = YES, but NEITHER #2 nor #3 = YES, non-immediate notification as follows.

If #1 AND either #2 or #3 = YES, IMMEDIATE notification as follows.

2. Is there a significant risk of international spread?2

IDECG Decision Tree

1. Might the event have a serious public health impact across the border?

– Event due to unknown agent with unpredictable public health impact

– Event due to known agent with the following factors:• Unusual disease pattern• Previously eradicated agent• Known agent, but new for the geographical region• Potential to cause epidemic, even if no or few human

cases are being identified• Indication of treatment failure• Known potential to cause severe illness

– Accidental or intentional release of dangerous, banned or restricted chemical or radioactive agent

IDECG Decision TreeDecision Tree for Events Which Require Public Health Agency

Notification Between Ontario & Neighboring States1

PROCEED WITH PROPER NOTIFICATION: Situational alerts may be shared across borders via Health Alert Networks. 3 Communications which require sharing of

individually identifiable data should be shared via phone or internet in a secure manner.

Event involving single local health unit across the international border: Notify local health unit across the border and/or own provincial/state public health agencies.4

Event involving more than a single local health unit across the international border: Notify own state/provincial health agency and then cross-border state/provincial health agency.4

Please see: o Page 5 for Definitions/Examples o Page 6 for Epidemiological Data to Share Across State and International Borders o Appendices 1-7 for State/Provincial Communication Protocols

1 See Appendix 8 for listing of Immediately Notifiable Diseases in all GLBHI jurisdictions. See the GLBHI Reportable Disease Directory for a complete listing of all reportable diseases (available for printing at www.michigan.gov/borderhealth). 2 See Definitions/Examples, page 5. (Flow sheet adapted from 11/04 draft of the World Health Organization’s International Health Regulations. Current version, updated 05/05, found at: http://www.who.int/csr/ihr/IHRWHA58_3-en.pdf.) 3 Please see Appendix 9. 4 State & Provincial health units should consult the World Health Organization’s International Health Regulations Annex 2 Decision Tree for the Assessment and Notification of Events that May Constitute a Public Health Emergency of International Concern to determine duty to report to their Federal Health Agency. See http://www.who.int/csr/ihr/en/.

2. Is there a significant risk of international spread?2

1. Might the event have a serious public health impact across the border?2

3. Might international travel or trade restrictions be necessary?2

If #1, #2 AND #3 = NO, no notification necessary at this time. Continue monitoring.

If #1 = NO, but #2 or #3 = YES, non-immediate notification as follows.

If #1 = YES, but NEITHER #2 nor #3 = YES, non-immediate notification as follows.

If #1 AND either #2 or #3 = YES, IMMEDIATE notification as follows.

IDECG Decision Tree

2. Is there significant risk of international spread?

– Evidence of epidemiological link to similar events in other countries

– Need to alert in regard to the potential for cross border movement of the agent, vehicle or host

– Cross border assistance is needed to detect, investigate, respond and control the current event, or prevent new cases.

– Inadequate human, financial, material or technical resources

IDECG Decision TreeDecision Tree for Events Which Require Public Health Agency

Notification Between Ontario & Neighboring States1

PROCEED WITH PROPER NOTIFICATION: Situational alerts may be shared across borders via Health Alert Networks. 3 Communications which require sharing of

individually identifiable data should be shared via phone or internet in a secure manner.

Event involving single local health unit across the international border: Notify local health unit across the border and/or own provincial/state public health agencies.4

Event involving more than a single local health unit across the international border: Notify own state/provincial health agency and then cross-border state/provincial health agency.4

Please see: o Page 5 for Definitions/Examples o Page 6 for Epidemiological Data to Share Across State and International Borders o Appendices 1-7 for State/Provincial Communication Protocols

1 See Appendix 8 for listing of Immediately Notifiable Diseases in all GLBHI jurisdictions. See the GLBHI Reportable Disease Directory for a complete listing of all reportable diseases (available for printing at www.michigan.gov/borderhealth). 2 See Definitions/Examples, page 5. (Flow sheet adapted from 11/04 draft of the World Health Organization’s International Health Regulations. Current version, updated 05/05, found at: http://www.who.int/csr/ihr/IHRWHA58_3-en.pdf.) 3 Please see Appendix 9. 4 State & Provincial health units should consult the World Health Organization’s International Health Regulations Annex 2 Decision Tree for the Assessment and Notification of Events that May Constitute a Public Health Emergency of International Concern to determine duty to report to their Federal Health Agency. See http://www.who.int/csr/ihr/en/.

2. Is there a significant risk of international spread?2

1. Might the event have a serious public health impact across the border?2

3. Might international travel or trade restrictions be necessary?2

If #1, #2 AND #3 = NO, no notification necessary at this time. Continue monitoring.

If #1 = NO, but #2 or #3 = YES, non-immediate notification as follows.

If #1 = YES, but NEITHER #2 nor #3 = YES, non-immediate notification as follows.

If #1 AND either #2 or #3 = YES, IMMEDIATE notification as follows.

IDECG Decision Tree

3. Might international travel or trade restriction be necessary?

– Similar events in the past have resulted in international restriction on trade and/or travel across the border

– The source is suspected or known to be a food product, water or any other goods that might be contaminated that has been exported/imported across the border

– The event might have occurred in association with an international gathering

– The event has caused requests for more information by cross border officials or media

Emergency Contacts

State Maps

Immediately Notifiable Diseases

• Epi-developed list• “Pick up the phone and call now”

diseases• Trumps the Decision Tree

Immediately Notifiable Diseases

Data Sharing Agreement

Data Sharing Agreement

• Ratified by all GLHBI partners• All states vetted by Legal

Subcommittee prior to Steering Committee approval– Privacy laws and policies

GLBHI Directory

• For non-emergency usage• State, local, federal and tribal

contacts• Available by request

GLBHI Website

• www.michigan.gov/borderhealth– Overview of GLHBI

• Explanation• Brochure• Poster

GLBHI Website

• www.michigan.gov/borderhealth– Tools for Border Health

• Important Documents, Best Practices & Helpful Resources

• Related Organizations• Local Travel Resources for Americans and

Canadians• International Travel Resources for

Americans and Canadians

GLBHI Website

• www.michigan.gov/borderhealth– News & Updates

• GLBHI Calendar• GLBHI annual conference presentations

available online • Other important reports and happenings• GLBHI News & Updates Archive

Recent & Future Efforts• Learning from the past:

– Historical mapping of regional influenza progression

• Functionally exercising an infectious disease emergency in the GLBHI region

• Pursuing northern border consistency• Continuing quality improvement of

tools/systems• Long-term strategizing

Questions??

Michigan GLBHI Contacts

Diane Krueger, Project Coordinatorkruegerd@michigan.gov

517-335-6533

Carol Somers, Support Staffsomersc@michigan.gov

517-373-4501