report ihr exercise crystal 2017

C
M
Y
CM
MY
CY
CMY
K
2
Acronyms
ACFS acute complex feline syndrome
APSED III Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies
EIS event information site
EOC emergency operations centre
IHR International Health Regulations
NDPH National Department of Public Health
NEMO National Emergency Management Office
NFP National IHR Focal Point
PHEIC public health emergency of international concern
RRT rapid response team
WHO World Health Organization
1.3 Objectives ................................................................................................................................... 5
2. Methodology .............................................................................................................................. 5
2.2 Exercise type ............................................................................................................................... 6
2.3 Exercise design ............................................................................................................................ 6
2.4 Exercise participants ................................................................................................................... 6
2.6 Exercise scenario ......................................................................................................................... 7
3. Observations and recommendations ........................................................................................... 8
3.1 Validate the accessibility of the National IHR Focal Points and WHO IHR Contact Point using
registered contact details ................................................................................................................. 9
3.2 Practise and test IHR NFPs’ assessment of public health events using the decision instrument
contained in Annex 2 of IHR (2005) ................................................................................................ 10
3.3 Practise and test IHR NFPs’ understanding and use of IHR (2005) principles and obligations . 11
3.4 Improve the understanding and familiarity of staff across Member States and WHO with the
IHR NFP system ............................................................................................................................... 12
3.5 Test the videoconferencing capability of the EOC in the WHO Regional Office for the Western
Pacific and National IHR Focal Points in some selected countries ................................................. 13
Annexes ....................................................................................................................................... 13
Annex 2 – Scenario .......................................................................................................................... 29
Annex 4 – Exercise schedule ........................................................................................................... 62
Annex 5 – Summary of participants feedback ................................................................................ 64
Annex 6 – Key statistics* ................................................................................................................. 66
Keywords
4
Summary The World Health Organization (WHO) works with and supports Member States to implement the International Health Regulations, or IHR (2005). A key component of IHR implementation is communication between National IHR Focal Points (NFPs) and the WHO IHR Contact Point. It includes public health event reporting, notification, verification, information-sharing and risk assessment. It may also involve official communications required for the determination of a public health emergency of international concern (PHEIC) and the associated emergency response under IHR (2005). Annually, the WHO Regional Office for the Western Pacific conducts a simulation exercise involving NFPs and the WHO IHR Contact Point. IHR Exercise Crystal 2017 was conducted on 5–6 December 2017. Participants from mainly Pacific island countries and areas took part in the exercise on 5 December, while those from mainly Asian countries participated on 6 December. The exercise was conducted over five hours, simulating the first 12 weeks of an outbreak. The exercise provided a functional test of emergency systems, and participants were required to undertake simulated emergency functions that reflected their role in a real-life developing situation. Relevant WHO country office staff supported participants as needed. Both Member States and areas were invited to participate in this recent exercise. The role of public health staff from areas differs from that of NFPs, but they also play an important role in IHR implementation. These participants were encouraged to follow already-established lines of communication for public health events. The simulation exercise is an important component of the global IHR (2005) Monitoring and Evaluation Framework, which has been embedded in the Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies (APSED III). Experience has shown that it is a useful way to test IHR capacities and to prepare countries to respond to real-life public health emergencies. The 2017 edition of IHR Exercise Crystal was the most successful to date, with a record-breaking 30 countries and areas testing their response to a fictional outbreak. Countries also demonstrated increased understanding of, and comfort with, IHR communication. In 2011, for example, only five countries and areas notified WHO of the simulated public health event within the expected time frame. That figure rose to 26 in 2017.
5
1. Introduction
1.1 IHR event communication The World Health Organization (WHO) works with Member States to implement the International Health Regulations, or IHR (2005). A key component of IHR implementation is communication between National IHR Focal Points (NFPs) and the WHO IHR Contact Point. It includes public health event reporting, notification, verification, information-sharing and risk assessment. It may also involve official communications required for the determination of a public health emergency of international concern (PHEIC) and the associated emergency response under IHR (2005).
1.2 IHR Exercise Crystal An IHR Exercise Crystal has been conducted almost every year since 2008 to maintain and strengthen the functions of NFPs across the Region and to improve communication between the NFPs and the WHO IHR Contact Point. The exception was in 2009, when resources were instead directed to a real- life event – pandemic influenza A(H1N1) 2009. The exercise in 2017 represents the latest iteration of this process and is aimed at furthering collaboration across the Region and familiarizing participants with their duties and obligations under IHR (2005).
1.3 Objectives The objectives of IHR Exercise Crystal in 2017 were:
1) to validate the accessibility of NFPs and the WHO IHR Contact Point using registered contact details;
2) to practise and test the NFPs’ assessment of public health events using the decision instrument contained in Annex 2 of IHR (2005);
3) to practise and test the NFPs’ understanding and use of IHR principles and obligations; 4) to improve the understanding and familiarity of staff across Member States and WHO with the
IHR NFP system and improve collaboration with other agencies, where possible; and 5) to test the videoconferencing capability of the Emergency Operations Centre (EOC) in the
WHO Regional Office for the Western Pacific and of NFPs in selected countries.
2. Methodology
2.1 Scope of the exercise
In 2017, IHR Exercise Crystal continued to focus on practising and testing participants’ understanding and use of IHR principles and assessment of public health events. The exercise continued the theme of past exercises by testing the accessibility of NFPs and participants from territories and areas to facilitate communication and collaboration during an emergency event.
6
2.2 Exercise type
IHR Exercise Crystal 2017, like previous years, was a modified functional exercise, requiring NFPs and
WHO exercise participants (players) to respond to incoming simulated event information and requests
in a timely manner. Participants received regular updates or “injects” by email, signalling a potential
public health event in the participants’ own country, including initial reports from a simulated local
public health unit, media reports on the event and situation updates from affected areas. WHO staff
played the role of the WHO IHR Contact Point, contacting NFPs with requests for more information
and other communication. The exercise required NFPs and players to simulate the actions they would
normally perform, given the type of information received during the exercise.
2.3 Exercise design The scenario for 2017 involved an unknown emerging illness and its potential consequences. The exercise encompassed many elements that have been identified as important aspects leading to the outbreak of a disease with pandemic potential. The initial scenario commences with an outbreak of an unidentified illness in mammals (in this case, domestic and wild cats). The virus then moves into the human population where it spreads rapidly from human to human. Cases are identified away from the site of the initial outbreak. The simulation continues to the point where cases are reported outside of the initial country and the WHO Director-General declares a PHEIC as defined by IHR (2005). The exercise used a simulated, artificial scenario that may not reflect a real-world situation, particularly with respect to the disease itself and its spread or impact. Elapsed time, place names and people were also artificial. The exercise was designed to raise issues for discussion. The aim of any simulation exercise is to help institutions learn by identifying strengths and shortcomings in a safe environment and thus help them to prepare for a real emergency situation. The exercise was designed to test decision-making during the simulated event and methods of communicating these decisions. Testing covered the use of appropriate communication systems as well as the use of the IHR event information site (EIS) online portal. The simulation consisted of a number of problem statements (injects) that participants addressed within their own country context. The exercise was conducted over five hours. The first group, mainly Pacific island countries and territories, participated on 5 December 2017. The second group, mainly Asian countries, participated on 6 December 2017.
2.4 Exercise participants In 2017, an all-time high of 30 countries and areas participated in the exercise. Both Member States
and areas were invited to participate in this exercise. The role of public health staff from areas differs
from that of NFPs, but these participants also have important contributions to make and were
instructed to follow already-established lines of communication for public health events.
NFPs were encouraged to work within their existing teams and to involve other staff members, as
appropriate. Most countries involved teams of three or more staff, with some countries involving up
to 20–30 staff in one location. Other in-country staff simulated their advisory and support roles and
demonstrated the utility of the NFP system, enabling countries to draw on a significant pool of experts
7
to support the NFP. WHO country office staff were encouraged to join their national counterparts
during the exercise.
2.5 Exercise management team An exercise management team was established within the WHO Regional Office to develop and
conduct the exercise. The team comprised an exercise director, a lead controller, an exercise designer,
several simulators, the WHO IHR Contact Point, an evaluator and administrative assistants. Relevant
WHO country office staff were encouraged to participate in the exercise as observers and/or
facilitators to support the exercise management team.
2.6 Exercise scenario IHR Exercise Crystal 2017 was a scenario-based, modified functional exercise requiring participants to respond to simulated incoming event information and requests in a timely manner. This included making decisions on actions required, but not actually taking concrete action aside from preparing situation reports or summary paragraphs for the EIS. These actions were based on the type and nature of the information received during the exercise, information that could reasonably be expected in a real event. For the 2017 exercise, it was proposed that the evolving situation should be first identified in the participants’ own country. Previous exercises had the illness commencing in a third, usually artificial country, but to add urgency and realism, it was decided to examine how countries would react to an outbreak on their own land. The decision to identify the outbreak in the participants’ own country was agreed following an analysis of previous exercises and a desire to shift some of the exercise focus. By responding to an event in their own country, rather than in a fictitious neighbouring country, participants were able to discuss their own internal systems for early surveillance and reporting. To keep within this context, cats were used as the primary vector as they are common throughout all countries and areas in the Region. Another aspect introduced was more modern means of gathering information from communities. Alongside standard surveillance methods, it was decided that an element of public discourse through social media should be added. This is a reflection of modern, real-world surveillance in which public health authorities are beginning to make greater use of social media to augment traditional methods. This is being used for targeted events (for example, mass gatherings) as well as more general surveillance (for example, mapping influenza spread).1 Key elements of the simulation included the examination of internal systems related to IHR (2005), such as notification, restrictions on movement, travel and trade as well as transboundary arrangements. Consistent with past exercises, IHR Exercise Crystal 2017 involved partner agencies from outside the traditional public health sphere, such as:
1) veterinary and animal health departments; 2) national disaster management agencies and authorities; and
1 Fung I C-H, Tse ZTH, Fu K-W. The use of social media in public health surveillance. Western Pac Surveill Response J.
2015;6(2):3–6. doi:10.5365/wpsar.2015.6.1.019
8
3) other related bodies depending on the country’s own emergency management protocols (for example, the Prime Minister’s Office or, in the case of territories, their parent public health bodies).
The simulation concluded with the WHO Director-General declaring a PHEIC and inviting participants to join a hot-wash debriefing. This gave both the WHO Regional Office and participants the opportunity to test videoconferencing and audioconferencing capacity. For IHR Exercise Crystal 2017 new methods of video communications were used, including the Zoom Platform (San Jose, CA, USA). Overall, there was a high level of engagement in the exercise with most NFPs involving their wider teams. Some NFPs took the opportunity to engage staff and partners from the health sector at both the national and local levels. Some NFPs also involved departments outside the health sector and this was useful in testing some of the engagement issues that were part of the exercise design. These inclusions are encouraged as a mechanism for developing and sustaining an understanding of IHR (2005) and enhancing the capability of the NFP function. In the future, it would be useful to contact these agencies in advance and encourage their participation. This sentiment was echoed by some of the participants during the short debriefing after the event.
2.7 Limitations As anticipated, some of the more remote and smaller nations were not able to fully participate due to technical and logistical challenges. However, a system of one-to-one communication was established to communicate the exercise to these participants. Consistent with previous exercises, there was limited engagement directly between Member States with almost all interaction being between WHO and the NFP in country. This is a challenge for future exercises as this was raised as a limitation by some groups. It will require more thought and possibly the use of innovative technology and back-up options to ensure that the exercise is managed sufficiently.
2.8 Exercise feedback and evaluation For evaluation purposes, feedback from participants about their experience with the exercise was
obtained by means of:
a short debrief to capture impressions immediately after the exercise;
a debrief of the exercise team after both days of the exercise;
observations of the designated exercise evaluator; and
evaluation forms submitted by participants after the exercise (a summary of responses to
evaluation questions is in Annex 2).
3. Observations and recommendations
9
This section presents results of the exercise, based on observation during the exercise, and feedback
from observers and participating organizations through debriefing and the feedback forms. The
findings and recommendations are summarized according to the exercise objectives.
3.1 Validate the accessibility of the National IHR Focal Points and WHO IHR Contact Point using registered contact details
The primary aim of IHR Exercise Crystal is to improve communication and collaboration across the
Region in the event of a public health emergency as defined under IHR (2005). The first area tested
was the contact information of all IHR NFPs. This was a process that was largely carried out prior to the
exercise itself and required WHO Regional Office staff to contact each IHR NFP directly and to confirm
that they were still the designated person and that the contact details on hand were correct. By
undertaking IHR Exercise Crystal annually, it ensures that the database of NFP contact information is
regularly updated. This is a highly beneficial part of the process and ensures that the WHO Regional
Office for the Western Pacific has one of the most complete databases of NFPs globally. It is important
to note that even in the interval of 12 months there are significant changes to the NFP lists, and, as
such, a 12-month review should be considered the minimum interval within which to verify contact
details. A six-month review would be of greater utility; however, given time constraints (it typically
takes 1–2 weeks to verify the list), this may not be practical.
Recommendation: Maintain the current 12-month review interval for verifying NFP contact
details
In addition to verifying contact details, IHR Exercise Crystal in 2017 examined the performance of
various information and communication technologies to be used for the communication between the
NFPs and WHO IHR Contact Point.
Access to various information and communications technologies varied across the Region. In general,
participants in Pacific island countries and areas had limited access to more advanced technologies.
This ranged from a lack of high-speed Internet connections through to basics, such as reliable phone
lines and mobile services. Even with prior preparation for the simulation exercise, many Pacific island
countries struggled to effectively connect and there were frequent dropouts and service difficulties. As
part of the testing process, streaming services, particularly YouTube was used to distribute some
material elements. In some countries, such as Tokelau and Tuvalu, there was insufficient bandwidth to
stream even low definition video and it was difficult to move even moderate file size packages. Given
these problems, transferring large amounts of data in an emergency could prove challenging.
Traditional platforms, such as email provided a more consistent result, although file sizes needed to be
managed.
Another challenge faced by some countries was the issue of content filtering (that is, blocking access
to certain websites), which limited their ability to use platforms such as Skype for communication or
YouTube for streaming. This was partially mitigated by using applications generated by smaller
companies and using material hosted directly by WHO. For instance, Zoom provided excellent results
for video communications and the WHO website was used for interactive surveys rather than relying
10
on blocked services such as Survey Monkey. In a future response, it will be important for the WHO
Regional Office to properly scope what services can be used across all Member States to ensure that
interoperability is not compromised.
Comments from participants included:
“We faced a technical problem using the microphone because it was the first time to try the
videoconference for IHR Exercise Crystal.”
“Could not access some material [video] due to platform problems”
The in-country communications procedures appeared to require improvement in some countries.
While there is a consistent communication relationship between the WHO IHR duty officers and their
IHR NFP counterparts, some countries mentioned that they would need to improve communications
with animal health stakeholders and disaster management agencies. This indicates that further
improvement of multisectoral coordination and communication mechanisms for the implementation
of IHR(2005) appears critical in those countries.
Recommendations:
1. Provide more support and attention to Member States with limited access to information and
communications technologies, particularly those located in the Pacific. Examine innovative
ways of supporting communications during the emergencies.
2. Continue to explore innovative technologies that are low bandwidth and available to use
across the Region. It may be worth considering a standard set of communication and
collaboration tools.
3. Continue to encourage Member States to further enhance a multisectoral approach in
managing public health emergencies, including the communication procedures.
3.2 Practise and test IHR NFPs’ assessment of public health events using the decision instrument contained in Annex 2 of IHR (2005)
The exercise tested the use by the IHR NFPs of the decision instrument contained in Annex 2 of IHR
(2005) by requiring participants to assess the simulated situation and notify WHO when needed. These
requirements were generally well understood by participants, particularly by those that had
participated in previous Crystal exercises (demonstrating the utility of regular exercising). In 2017,
26 countries and areas notified WHO of the simulated public health event within the expected time
frame, up from just five countries and areas in 2011.
Furthermore, use of the EIS was also practised. The simulation required IHR NFPs to log into the
system and to report the situation. Most NFPs were able to successfully log in; however, a significant
number of NFPs could not access the system. The causes were:
1. lack of familiarity with the login system;
2. expired or forgotten passwords;
3. staff who were new to the role and has not activated an account; and
11
4. staff who were based in areas significantly geographically separated from their parent
countries (for example, Marshall Islands, American Samoa, New Caledonia) and, as they are
not the NFP, they rely on their headquarters to keep them informed.
These are issues that have been encountered in previous exercises and, in general, are easy to fix with
the adequate support. Item 4 may require improved coordination between the area and their parent
Member State and the procedures may require attention and strengthening.
Part of the exercise required the drafting of a mock EIS post, based on a risk assessment. This was
followed by an update to the risk assessment and feedback to the WHO IHR Contact Point. Comments
from the participants demonstrated that this was a useful exercise. Comments included:
“Yes, it was useful to try to draft EIS.”
“It provides the pathway towards information-sharing, the type of information to be shared
and the channel of communication involved.”
While relatively simple, this exercise is important as it verifies users’ ability to access and contribute to
the critical information-sharing system among IHR NFPs in a real incident.
In relation to the EIS posting, there were some issues with consistency, which could be addressed
through the use of a simple training tool and template.
Recommendations:
1. Examine whether it is possible to know who has access to EIS within the Region (examine the
login system). This will enable the WHO Regional Office to understand and update the list of
persons who have access to the system.
2. Provide further guidance as required in the form of an agreed template for EIS posting to
promote consistency of the posting.
3.3 Practise and test IHR NFPs’ understanding and use of IHR (2005) principles and obligations
Through participating in IHR Exercise Crystal, participants were reminded of the IHR (2005) principles
and obligations. The principles include: that its implementation be guided by the goal of applying full
protection of all people from the international spread of disease, and that States have the sovereign
right to legislate and to implement legislation, in support of the purpose of IHR (2005).
The participants were also reminded of the obligation to strengthen their core capacities to implement
IHR (2005), including those for surveillance, risk assessment and response. Under IHR (2005), State
Parties have to assess events by using the decision instrument in Annex 2, and should notify WHO by
the most efficient means of communication available by way of the IHR NFP, and within 24 hours of
assessment of public health information of all events which may constitute a PHEIC, and any health
measures implemented in response to those events.
The exercise helped to reinforce these key obligations. Regular refresher training using methods such
as IHR Exercise Crystal appears useful to deepen the understanding of IHR (2005) principles,
obligations and instruments. Some participants commented as follows:
12
“[We were able to] read and understand the use of IHR principles and obligations”
“[Used as an opportunity] to review the IHR (2005) Annex 2”
Recommendation:
Ensure that refresher material is provided at least annually. Exercise Crystal is the perfect opportunity
for this as it is directed specifically at IHR NFPs.
3.4 Improve the understanding and familiarity of staff across Member States and WHO with the IHR NFP system
Over the years, IHR Exercise Crystal has contributed to improving the understanding and familiarity of
staff across Member States and WHO with the IHR NFP system. Through exercises during peacetime,
staff deepen their understanding of how IHR NFPs function, and how communication should be
organized. Such understanding is expected to facilitate communication between IHR NFPs and the
WHO IHR Contact Point in real events.
Furthermore, the exercise in 2017 aimed to strengthen understanding of the role of NFPs to establish
in-country communication procedures and mechanisms with other in-country stakeholders. Similar to
the Crystal exercise in 2016, it involved information-sharing and decision-making in collaboration with
other agencies such as those in charge of animal health, and the National Disaster Management
Authority or Agency (NDMA) of the participating country. In this exercise, it was simulated, with the
only required information from the participants being the contact details of the relevant agencies (in
this case, ministries of agriculture and the NDMA, or equivalent). Several countries actually invited
members of the NDMA; in some other countries, animal health officials were also present. While this
was not required by the simulation, such cooperation between agencies should be encouraged.
Comments from participants included:
“Identified opportunity - that the exercise could have been improved if we had engaged a broader
section of the government agencies within [Country T], beyond the ministry of health, health
inspectors…”
Recommendation:
For future exercises, invitations should be sent well in advance and include invitations for other
agencies, such as the NDMA, agriculture, and other relevant sectors, as determined by the respective
participating country’s emergency management plan and legislation, and depending on the nature of
the exercise scenario.
13
3.5 Test the videoconferencing capability of the EOC in the WHO Regional Office for the Western Pacific and National IHR Focal Points in some selected countries
The videoconferencing tool used for the “hot wash” debrief at the end of the exercise exceeded
everyone’s expectations. In 2016, the facilitation team attempted to use in-house technology that
relied on the limited bandwidth of the WHO Regional Office for the Western Pacific in Manila.
For 2017, a cloud-based system (Zoom) was utilized, which was low bandwidth at the point of receipt
(connections are handled upstream). This resulted in the ability of a large number of participants to
participate in the hot wash. At one point, 18 simultaneous connections were established and the
debriefing was carried out with little interruption. The technology was simple to use, operating
through users’ own computers, negating the need to purchase expensive dedicated communications
equipment. Low bandwidth countries such as Solomon Islands and Tonga were also able to participate
effectively.
Recommendation:
Based on the excellent experience with videoconferencing gained this year, stakeholders should
continue to explore technology options that can improve IHR communications, particularly with
countries with limited information technology infrastructure.
Annexes
Introduction
The Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies (APSED
III) was developed as a common regional framework for action and provides a step-wise
approach for Member States to achieve the core capacities required under International
Health Regulations (IHR) (2005). Ensuring the functions of IHR (2005) National Focal
Points (NFPs) and the WHO IHR Contact Point, including IHR event communications, has
been an essential component of IHR (2005) implementation in the Western Pacific
Region. IHR event communications includes public health event reporting, notification,
verification, information-sharing and risk assessment. It may also involve official
communications required for the determination of a Public Health Emergency of
International Concern (PHEIC) and the associated emergency response under IHR
(2005).
Simulation exercises have been an important component of monitoring and evaluation
(M&E) of APSED III and IHR (2005). The guiding principles and mechanisms of M&E
developed for APSED III have contributed to the development of a global post-2016 IHR
Monitoring and Evaluation Framework comprising four components: annual reporting;
after-action review; simulation exercises; and joint external evaluation (JEE). Experience
has shown that such simulation exercises are a useful way to practice and test key IHR
capacities during peace time, before the actual public health events and emergencies to
occur.
To strengthen and maintain the functions of National IHR Focal Points, regular yearly
IHR communication exercises known as ‘IHR Exercise Crystal’ have been conducted
almost every year since 2008. The exception was in 2009, when resources were instead
directed to a real life event – H1N1. This event (and subsequent events, such as H7N9)
highlighted the key role of NFPs and the importance of IHR communication in
contributing to risk assessment and situation monitoring, regionally and globally.
In addition to the countries of our region, we are also inviting territories and areas to
participate in this exercise. Their role differs from that of the official NFPs, but these
participants are expected to follow the already established lines of communication for
public health events.
The "IHR Exercise Crystal 2017" will be conducted from 5 to 6
December 2017. It is an IHR communication and assessment
exercise involving NFPs and the WHO IHR Contact Point.
Relevant WHO country office staff will support participants as
appropriate. The exercise will last for 5 hours on one day for
each participating Member State, territory or area.
16
Objectives
The objectives of the IHR Exercise Crystal are:
1. to validate the accessibility of the National IHR Focal Points and WHO IHR
Contact Point using registered contact details;
2. to practise and test National IHR Focal Point's assessment of public health
events using the decision instrument contained in Annex 2 of IHR (2005);
3. to practise and test National IHR Focal Point's understanding and use of IHR
principles and obligations;
4. to improve the understanding and familiarity of staff across Member States and
WHO with the National IHR Focal Point system; and
5. to test the videoconferencing capability of the Emergency Operations Centre
(EOC) in the WHO Regional Office for the Western Pacific and National IHR
Focal Points in some selected countries.
Scope and type of exercise
For the 2017 exercise, we will continue to focus on practicing and testing participants’
awareness and use of IHR principles and assessment of public health events. The
exercise will continue the theme of past exercises by aiming to test the accessibility of
National IHR Focal Points and participants from territories and areas to facilitate
communication and collaboration during an emergency event.
The exercise will be a functional test of emergency systems and participants will be
required to undertake simulated emergency functions that would reflect their role in a
real-life developing situation.
The scenario involves an unknown emerging illness and its potential consequences. The
exercise is designed to test decision-making during the simulated event and methods of
communicating these decisions. Testing will include the use of appropriate
communication systems as well as the use of the IHR event information site (EIS) online
portal. The simulation will consist of a number of problem statements (injects) that
participants will work through within their own country context.
Please recognise that this exercise will use a simulated, artificial scenario that may not
reflect a real-world situation, particularly with respect to elapsed time, place names and
people. Participants should accept these artificialities. Please do not be overly concerned
by complexities or details associated with the scenario itself. The objective is to work
17
[email protected]
with the scenario to facilitate your actions, rather than to challenge it or seek to resolve
every last possible detail.
Remember that this is a simulation exercise. There are no right or wrong answers and
no individual performance is being tested. The aim of any simulation exercise is to help
institutions learn by identifying strengths and shortcomings in a safe environment and
thus help to prepare for a real emergency situation.
Some specific instructions will be issued during the exercise. However, do not wait to be
prompted first in order to take action. As you receive each inject containing new
information, consider what you would do if this was a real-life event and who you would
contact, in line with IHR (2005) and your own national policies and procedures.
The exercise will be conducted over 5 hours. The first group, mainly Pacific Island
countries and territories, will take part on 5 December 2017 (Tuesday). A second group,
mainly Asian countries, will participate on 6 December 2017 (Wednesday). Please see
Annex D below for the local time at which the exercise will take place for each country
and territory.
How the exercise will be conducted
All participants will join the exercise from their normal office (no international travel
required). The primary means of communication will be email, with telephone used as a
means of checking communication and troubleshooting. Participants will be contacted
by email prior to the exercise to confirm contact details. In addition, the capability of
videoconference will also be tested with selected countries at the end of the exercise.
This year, some injects will contain short video clips. These videos are intended to add
some extra “colour” to the scenario. However, to ensure that those countries and areas
facing challenges with internet connectivity can fully participate, the emails themselves
will contain all of the necessary information to play in the exercise.
Participants are expected to act and communicate quickly, facilitating information flow
within the exercise time period, as they would do in a real world setting. Participants can
expect to have between 30 and 45 minutes to address each inject. However, timings
may vary based on the complexity of the situation or the expected response.
The exercise will be hosted by the Exercise Controller who will
regulate the pace of the exercise by managing the sequence
of events, including setting the scenario and injects and
monitoring the progress of the exercise. Assisting the
controller will be a facilitator who will assist communication
between NFPs and WHO and at least one evaluator who
will observe and evaluate the process and outcomes of the exercise. All of these people
are WHO staff and all information will be held in confidence. Detail contained in the final
report will be anonymized to ensure confidentiality. Country-, territory- or area-specific
feedback will only be communicated with the party concerned unless prior approval is
granted.
The exercise will take 5 hours in real time. This period will be used to simulate a time
scale of 12 weeks. Simulated times and dates will be communicated in the email injects
so please read these carefully.
Time for problem-solving and action-taking will be limited to the time allotted to each
inject. No extra time will be available and new injects may arrive before participants
have completed the previous task. Do not attempt to produce overly complicated
reports, as these are not expected within the time frame.
All participants are required to record their actions taken during the exercise. We
suggest participants to record all actions taken using your local log, and at the same
time record them at online action log sheet
(https://extranet.who.int/dataform/573774?lang=en), including actions taken to
communicate with other relevant departments/agencies/ individuals (if required based
on your communication protocol/procedures) and the results of any assessment made
using the IHR decision instrument. Online action log sheet will allow the Exercise
Management Team to monitor the responses of the participants. For those countries,
territories or areas facing difficulties with internet connectivity, please record your action
using the action log sheet (Annex B), and inform the controller ([email protected])
that the action has taken place. For those not using the online action log sheet, please
submit your completed action log sheet at the end of exercise to the controller
([email protected]).
At the end of the exercise, WHO will host a videoconference to review the exercise
(“hotwash”) using Zoom (https://wpro-who.zoom.us/j/6835035263) (see Annex E for a
guide on how to use Zoom). In case you face difficulties connecting via Zoom, as a
backup, the WHO Regional Office for the Western Pacific will telephone participants to
bridge them to the videoconference (audio only).
Who to contact during the exercise
For the purpose of the exercise, the public health unit (or equivalent) in your own
country will be simulated. As this is a simulation exercise, we do not expect each country
to contact its own public health department. The simulated public health unit will be
staffed by “Dr Sabine Manx”. Dr Manx can be contacted by email at
[email protected]. Likewise, the simulated Ministry of Agriculture and Animal
Health (or equivalent) of your country will be staffed by Dr Paul Leopard, who can be
participating, please pretend that
NFP ([email protected])
Management Authority of your country can also be reached at
[email protected] (see Annex A for the list of simulation contacts).
All communications with the WHO IHR Contact Point will use the
same email account that can be used during a real-life public
health event: [email protected]. However, please indicate
clearly that the communication is part of the exercise (i.e.
stating EXERCISE-EXERCISE-EXERCISE at the top of the
message). If a real incident occurs during the simulation,
ensure that all communications contain the subject line
ATTENTION-ATTENTION, THIS IS NOT A DRILL. This will
ensure that real messages to IHR are identified and given
priority.
Please note that there is no simulator arranged for other, non-participating or non-
playing agencies. DO NOT copy any person or agency outside the simulation as this can
lead to confusion or concern. If players want to communicate with another relevant
agency (e.g. their civil aviation authority, or NFPs in other countries) they should simply
record this pretended 'action' using the online action log sheet (or the paper version
included in Annex B) and notify the controller via email
([email protected]) that the action has taken
place. This should be done with NO real
involvement or communication with the agency.
Internal discussions within the office of the
NFPs are encouraged to facilitate exercise
play, but always remember to be clear that
the discussions pertain to an exercise, not a
real event.
For urgent problems experienced during the
exercise, contact Exercise Control via telephone
(+63 2 528 9049). Other issues can be sent via email
([email protected]). Please also record any
encountered problems using the online problem log sheet.
If a participant needs to withdraw from the simulation at any time, please immediately
send a message to [email protected].
1. Always start and end communication with "EXERCISE –
EXERCISE - EXERCISE" or “THIS IS AN EXERCISE MESSAGE"
2. Include your country name in the subject line of every email
communication to facilitate tracking of responses
3. Copy every email communication to [email protected]
4. Please do not fight the scenario
5. Record all of your activities using your local log, and at the
same time record them at online action log sheet
(https://extranet.who.int/dataform/573774?lang=en)
6. If online action log sheet is not accessible, please use the off-line action log
sheet (Annex B), and always notify the controller via email if you have taken an
action ([email protected]).
7. If you encounter any problems during the exercise, please record them on the
problem log sheet (Annex C)
8. Participate in a review “hot wash” via videoconference or teleconference to
debrief at the end of the exercise (https://wpro-who.zoom.us/j/6835035263)
9. Fill out and submit the evaluation form after the exercise online or using the
paper form (https://extranet.who.int/dataform/148757?lang=en)
10. Enjoy the exercise !
Participants will be asked to complete an online evaluation form
(https://extranet.who.int/dataform/148757?lang=en) to help the exercise management
team collect comments and suggestions. A paper copy of the evaluation form is also
available (Annex F), in case you run into any difficulties with the online form. A short
report will be developed by WHO and provided to participants. A short report will be
developed by WHO and provided to participants.
Annexes
Annex D Exercise schedule
Annex E Zoom participant guide
Annex F Exercise evaluation form
NOTE: If possible, participants should use the online versions of the action log and the
evaluation form. However, we have included offline versions as annexes in case you run
into technical difficulties and cannot use the online forms.
action! Send your
Controller
Every communication should always be copied to Exercise Controller at:
[email protected]
Health
[email protected]
[email protected]
[email protected]
NOTE: Do not use any email addresses other than those listed as communication to
other addresses will not be answered and may cause confusion or concern to outside
individuals.
https://extranet.who.int/dataform/573774?lang=en
https://extranet.who.int/dataform/148757?lang=en
Getting help:
(Annex C)
528 9045)
22
Annex B: Action log sheet – IHR Exercise Crystal 2017 NOTE: Please use the online action log form to submit actions. However, this form is a back-up option in case you run into technical difficulties.
Name __________________________ Position _______________________ Location (country/territory/area) ____________________ Page __ of ___
Time/Date
Activity
Please send the completed sheet via e-mail to [email protected] immediately after the exercise (by 8 December 2017 latest)
Annex C: Problem log sheet – IHR Exercise Crystal 2017 Exercise Assignment: (circle) Participant, Controller, Simulator, Evaluator, Director, Observer
Time Message
no. (if
Please send the completed sheet via e-mail to [email protected] immediately after the
exercise (by 8 Dec, 2017 latest)
1 American Samoa (4 Dec) 12:00 – 17:00 07:00 – 12:00
2 Cook Islands (4 Dec) 13:00 – 18:00 07:00 – 12:00
3 Fiji 12:00 – 17:00 07:00 – 12:00
4 French Polynesia (4 Dec) 13:00 – 18:00 07:00 – 12:00
5 Guam 09:00 – 14:00 07:00 – 12:00
6 Kiribati 11:00 – 16:00 07:00 – 12:00
7 Marshall Islands 11:00 – 16:00 07:00 – 12:00
8 Micronesia, Federated States 10:00 – 15:00 07:00 – 12:00
9 Nauru 11:00 – 16:00 07:00 – 12:00
10 New Caledonia 10:00 – 15:00 07:00 – 12:00
11 New Zealand 12:00 – 17:00 07:00 – 12:00
12 Northern Mariana Islands 09:00 – 14:00 07:00 – 12:00
13 Niue (4 Dec) 12:00 – 17:00 07:00 – 12:00
14 Papua New Guinea 09:00 – 14:00 07:00 – 12:00
15 Palau 08:00 – 13:00 07:00 – 12:00
16 Samoa 13:00 – 18:00 07:00 – 12:00
17 Solomon Islands 10:00 – 15:00 07:00 – 12:00
18 Tokelau 12:00 – 17:00 07:00 – 12:00
19 Tonga 12:00 – 18:00 07:00 – 12:00
20 Tuvalu 11:00 – 16:00 07:00 – 12:00
21 Vanuatu 10:00 – 15:00 07:00 – 12:00
DAY 2: 6 December 2017 (Wednesday)
Participating Country/Territory/Area Local time Manila Time
1 Australia 12:00 – 17:00 09:00 – 14:00
2 Brunei Darussalam 09:00 – 14:00 09:00 – 14:00
3 Cambodia 08:00 – 13:00 09:00 – 14:00
4 China 09:00 – 14:00 09:00 – 14:00
5 Hong Kong SAR (China) 09:00 – 14:00 09:00 – 14:00
6 Japan 10:00 – 15:00 09:00 – 14:00
7 Lao People’s Democratic Republic 08:00 – 13:00 09:00 – 14:00
8 Macao SAR (China) 09:00 – 14:00 09:00 – 14:00
9 Malaysia 09:00 – 14:00 09:00 – 14:00
10 Mongolia 09:00 – 14:00 09:00 – 14:00
11 Philippines 09:00 – 14:00 09:00 – 14:00
12 Republic of Korea 10:00 – 15:00 09:00 – 14:00
13 Singapore 09:00 – 14:00 09:00 – 14:00
14 Viet Nam 08:00 – 13:00 09:00 – 14:00
25
What You Need To Get Started
An internet-connected computer, laptop, or device with camera function
How to Launch Zoom
Please click following Zoom link both for testing and for videoconference as part of
exercise: https://wpro-who.zoom.us/j/6835035263
After clicking the link, a dialog box may appear asking to launch Zoom and then to install
an application plugin. If prompted on-screen, please select “Run” to allow the installation of
a small, but necessary, plugin package.
For testing and videoconference
If needed, participants can connect anytime for their testing at above link. We suggest
installing the plugin before the exercise starts.
On the day of the exercise, at the end of IHR Crystal exercise, we will arrange a
videoconference for review (also called a “hot wash”), for which you will be able to
participate by using the link above.
In case you face difficulties in connecting with Zoom, as a backup, the WHO Regional Office
for the Western Pacific will telephone participants to bridge them to the videoconference
(audio only).
When you are not speaking, we suggest you to mute your microphone (please see below).
Audio Mute and Unmute
During a session you might be asked to mute your microphone until you have a
question or comment. This helps to minimize audio feedback. Mute your audio by
clicking on the microphone icon located in the lower left-hand corner of the menu bar.
Audio is not muted Audio is muted
27
Annex F: Evaluation Form – IHR Exercise Crystal 2017 NOTE: Please use the online evaluation form to submit your comments and
suggestions. However, this form is a back-up option in case you run into technical
difficulties.
______________________________________________________________________
Please take a few minutes to fill out this form. Your feedback and suggestions will help us
prepare and improve future exercises. Thank you for your cooperation!
Exercise Objectives:
Validate the accessibility of the National IHR Focal Points and WHO IHR Contact Point
using registered contact details
Practice and test National IHR Focal Point's assessment of public health events using the
decision instrument contained in Annex 2 of IHR (2005)
Practice and test National IHR Focal Point's understanding and use of IHR principles and
obligations
Improve the understanding and familiarity of staff across Member States and WHO with
the National IHR Focal Point system
Test the video teleconferencing capability of the Emergency Operations Centre (EOC) in
the WHO Regional Office for the Western Pacific and National IHR Focal Points in some
selected countries.
1. Did the exercise meet your expectations (i.e. did it do what you were led to believe in your
invitation)?
(1) Yes, fully (2) Yes, partially (3) No, not at all
If you answered (2) or (3), please briefly explain why: ________________________________
2. Did the exercise achieve the stated objectives?
(1) Yes, fully (2) Yes, partially (3) No, no at all
If you answered (2) or (3), please briefly explain why: ________________________________
3. What do you think about the scope of the exercise?
(1) Suitable (2) Too narrow (3) Too broad
If you answered (2) or (3), please briefly explain why:________________________________
4. Did you find the exercise helpful and/or useful in facilitating the event-related
communications?
If you answered (2), please briefly explain why:_____________________________________
5. What are two useful things that you have learned/observed from the exercise?
(1) ______________________________________________________________________
(2) ______________________________________________________________________
6. What are two priorities that you would suggest for improvement in the future?
(1) ______________________________________________________________________
(2) ______________________________________________________________________
Please send the completed form via e-mail to [email protected] immediately after
the exercise (by 8 December 2017 latest)
30
YC-1
VIA Email
FROM [email protected]
Responsible For Information
TO All Participants
COPY (info) [email protected]
SUBJECT Exercise Message: Initial Message – Outbreak of new disease in cats
Inject time Start of exercise
Expected
Actions
Respond to call from WPRO if required
Comments This incident is very unusual and the national veterinary service would like
to know more details. As the disease is infecting household pets as well as
wild cats there is concern that this could be spreading more widely
through the general feline population. There are anecdotal reports of people catching a form of influenza from
infected cats but these have not been confirmed.
31
YC-1
@paula23819
Poor Biggles the cat is not in a good way. Hope the vet can help #catflu #feelingpoorly
Social Media Post
@ataki9873
Feeling awful. Lying in bed with my cat who has tears on his face for me. Hope he is not sick also.
#catflu
@lia29875320
My cat died today. Took him to the vet after he started bleeding from his nose. Too late #catflu
THIS IS AN EXERCISE MESSAGE
Date: Day 0
Location: Your country
Social Media Posts
Meow Instant messaging
FELIX This how my cat looks this morning. He’s been poorly a couple of days but I’m taking him to the vet today as there is BLOOD on his nose and mouth. I don’t want to go out though cause I’m feeling sick myself, but poor puss.
Like – Comment - Share
Simulation – Simulation – Simulation
32
YC-1
Rue Mores – Staff reporter,
Mystery of the cat deaths in Nearby Province
Province City, Nearby Province: Local people are mystified by a disease sweeping through our feline
friends. Cats in a few villages in Nearby Province seem to be catching a nasty form of cat flu. Cat flu is
usually treatable and vaccine preventable but nothing seems to be helping the cats in this case.
Symptoms include streaming eyes and blood from the nose and mouth. The cats die shortly after
symptoms appear but some owners report that the cats seem unusually inactive for a few weeks
before any obvious signs.
Social media is alive with reports of sick cats with many owners in the area posting comments about
the health of their pets.
Our reporters have discovered that people have been finding dead cats around the towns for a few
weeks now and while most people put this down to cats being hit by traffic or otherwise meeting
accidental deaths, the numbers are unusual.
Our reporter investigating the incident found at least 5 dead cats and collected them to take to a local
vet for investigation and we await the results with interest. There have been rumours that a nearby
chemical plant has been the cause of the deaths, but the company has denied that there is a problem
and has pointed out that it appears that only cats are effected.
33
YC-1
Memo:
From: Chief Veterinary Officer, Ministry of Agriculture and Animal Health,
To: Your Country Ministry of Health, Public Health,
CC: IHR Focal Point
Subject: Routine event based surveillance through Social Media. Possible alert.
Routine event based surveillance through Social Media and local press has detected a number of
messages discussing an illness in cats. Users of social media are posting comments and messages
stating that their cats have become ill with a strange disease. Most of the pictures posted show what
appears to be a severe form of cat flu and owners are describing this as such.
Owners are reporting that the cats are not responding to treatment and in many cases, are reporting
that their cats have died or have been put down. There have also been occasional messages stating
that people have seen dead or dying cats in the area
Local veterinary practices in the area have requested advice on treatment and have confirmed that
regular treatments do not appear effective. They have stated that the illness falls outside a routine
cycle of illness in cats. Infected cats appear to bleed from the nose and mouth, exhibit watery eyes and
very quickly die from the disease, probably from organ failure. Fatality rate in cats is at least 80% of
cases.
All of the cases reported both by veterinary professionals and users of social media indicate that the
disease seems to be concentrated in one area of Nearby Province (the province 122 km from Your
Capital). The people posting appear to live in relatively close proximity to each other. This has been
verified by vet reports as well as GPS metadata on photographs and IP address spread.
One vet stated that after handling one of the infected cats he came down with a type of flu and felt
quite unwell for a few days. He also mentioned that his daughter also had a high fever but he was
unsure if it is the same thing. This was also reflected in social medial posts which also mentioned that
some of the owners of the cats are also feeling unwell with flu like symptoms. These have been
described by the owners as ‘mild’ with posts stating that the owners have caught ‘sympathy flu’ with
their cats. There may be a link and this should be investigated.
Actions
Please acknowledge the receipt of this memo
The WHO team may also reach out to check our communication via phone call.
34
YC-2.1
VIA Email
TO IHR NFP
Forward IHR DO
Inject time
Expected
Actions
Log in to IHR event information site (EIS) and confirm login Check the Global Early Warning System for health threats and
emerging risks at the human–animal–ecosystems interface (GLEWS+) and World Animal Health Information Database (WAHIS)
Provide contact details for animal health teams
Comments Confirm with participants that EIS is accessible
35
YC-2.1
Report from Veterinary Assessment Team - Memo
From: Dr Paul Leopard, Chief Veterinary Office, Ministry of Agriculture and Animal Health (or YOUR
COUNTRY equivalent)
Date: +2 weeks
Subject: URGENT, Unusual findings – Investigation into illness in cats in Nearby Province
Assessment team report:
This morning our team returned from Nearby Province after conducting an investigation into
unexplained death in cats reported in Nearby Province City. While this investigation was concentrating
on animal health, the team wished to emphasise the unusual nature of the illness and an illness in
humans that appears to be related.
Preliminary results of the animal health investigation:
1. This is an unknown novel illness in the feline population. The initial source appears to be the wild cat population and the disease has moved into domestic cats possibly through contact transmission. The actual method of transmission in cats is unknown and it appears highly contagious
2. The illness develops rapidly in cats with death most commonly occurring within a week. 3. Most cases appear to result in death through multiple organ failure. There appears to be a
haemorrhagic element to the disease that results in bleeding, most obviously through the nose and mouth
4. Deaths in cats occurs in almost all cases once the cat shows signs of bleeding 5. Specimens from infected animals have been taken for further investigation
During the investigation, the team cases of illness in those humans who kept infected cats as pets or
worked with infected cats (particularly veterinary workers). In many cases the owners of infected cats
stated that they had a ‘cold or flu’ when interviewed by the assessment team. In at least one case, an
elderly woman developed a very severe illness that doctors in the hospital in Nearby Province City are
attempting to treat.
Recommendation:
The Department of Agriculture and Animal Health would like to highlight what may be a connection
between the unexpected illness in cats and the subsequent development of symptoms in humans. We
are sharing this information should you wish to investigate this further. In some cases, people reporting
sick were relatives of cat owners but did not own cats themselves.
Dr Paul Leopard
36
YC-2.1
Memo
To: IHR National Focal Point
Subject: Joint assessment, animal health
Date: + 2 weeks
Refer to the attached statement from the veterinary officer at the Department of Agriculture
and Animal Health. His report is suggesting that there may be a link between the recent illness
in cats and reports of illness in people who have been in close contact with cats.
I am recommending the following:
1. A joint rapid response team (animal and human) be sent to Nearby Province to investigate due to the unusual nature of the illness if they have not already done so,
2. Specimens be taken from infected animals and suspected human cases for analysis. I would like the following to be undertaken:
1. Please supply the contact details for our assessment counterpart at the Ministry of Agriculture and Animal Health or the most appropriate department to join the assessment team. I require a name, address, contact number and email in order to provide the correct invitation for joining the team,
2. Please log in and search the event information site (EIS) and report if you find any events that may appear similar, or not. I need to know if this is a known illness or one that is emerging. Please also check the Joint FAO–OIE–WHO Global Early Warning System for health threats and emerging risks at the human–animal–ecosystems interface (GLEWS+) and World Animal Health Information Database (WAHIS). If you cannot login to EIS, please also inform me immediately.
Thank you,
37
YC-2.3
‘Cat Flu’ Spreads.
Today the Chief Veterinary Officer described the Cat Flu illness as ‘serious’ and recommended
that the government undertake a further investigation of the matter. He stated that the
illness was not confirmed but that further investigation was warranted.
She told News First that the disease appeared different to other forms of illness usually seen
in cats and that this should be investigated further. She stated, ‘It is important that the
relevant authorities have a better understanding of this new illness in cats. As a result, I am
recommending that the government explores the situation thoroughly. At this time, we are
not calling it ‘Cat Flu’ as it does not present in the same way as other illnesses in cats.’
In related news, several children at a primary school near to where the initial cat flu outbreak
occurred have become ill. It appears that the children had been feeding stray cats that come
to the school. Mr Nebelung, the Head teacher at the Selkirk Rex Primary school stated that he
was worried that the illness in the children may be related as he had heard reports of people
being able to contract the disease from cats. Local health authorities are more cautious,
stating that flu is common in children, particularly at this time of year, however the symptoms
of some of the children are more severe than the usual seasonal flu and that they are
monitoring the situation. The cases have been reported to the regional health authorities.
© 2017 News First.
38
YC-2.3
Keep your cat close.
Cats, our beloved feline friends face a new threat today. Veterinary professionals are baffled by a new
strain of what appears to be cat flu that has appeared near the capital. The new strain of flu is not
responding to regular treatment and the animals are dying at an alarming rate.
How do I know if my cat has the new disease?
Cats may initially be more sleepy or lethargic than usual. Once symptoms become obvious however,
the disease progresses very rapidly. Red watery eyes seem commonly be the first symptom. Within 24
hours owners notice the cat begins bleeding from the nose and mouth. Some owners describe this as a
sort of red foam. Death usually occurs within a couple of days of initial symptoms. Some cats have
been known to recover but this seems rare.
How can I protect my cat?
It appears that regular vaccination of cats with standard feline vaccines is ineffective in this case.
Standard treatment cat diseases also appear to have limited success. The best course of action is to
keep your cat indoors and do not allow it out in case it comes into contact with other cats or strays. At
this stage, we do not know where the illness has originated.
Can I get sick from my cat?
At the moment, we don’t know. Some owners have reported getting fever, flu-like symptoms or
feeling generally unwell after their cats became sick. One elderly lady was admitted to hospital with
severe respiratory problems and one of her cats was later found dead in her home. This may or may
not be unrelated.
© 2017 News First.
39
YC-3.1
TO IHR
Inject time + 3-4 weeks
Expected Actions Complete an initial risk assessment and submit to the Director of public health unit
Comments 1 hour completion time
40
YC-3.1
Memo
To: National IHR Focal Point
Date: +3 weeks
Subject: Report of severe illness and possible human to human transmission
Severe illness leading to death
The Public Health Unit has been informed that a 28-year-old female was admitted to hospital with the
following symptoms:
1. High Fever, persistent and above 38°C 2. Conjunctivitis 3. Muscle Pain 4. Shortness of breath
As the disease progressed the following was also noticed:
1. Jaundice 2. Nausea and Vomiting 3. Petechial/purpuric rash
The patient continued to deteriorate. She was admitted to the intensive care unit and placed on
mechanical ventilation on day two after admission. On day four the patient died of suspected multi-
organ failure.
Since the admission of the primary case, 30 other cases have been referred with similar symptoms,
most typically persistent high fever and conjunctivitis, as well as in some cases vomiting and rash.
These symptoms are consistent with other cases of the recent illness in people associated with
infected cats.
Of concern in this case was that the victim had no recent contact with cats and had taken active steps
to keep away from the animals as she has had a severe allergy to cats. This victim was the
granddaughter of the 76-year-old female who was admitted with severe symptoms three weeks ago
and who remains in intensive care. The granddaughter was regularly visiting her grandmother and
frequently in close contact.
Possible cluster of cases associated with the Selkirk Rex Primary school.
Public health authorities are conducting further investigations into cases connected with the Selkirk
Rex Primary School. Since the initial seven cases there have been a further 12 cases of children at the
school with fever and conjunctivitis. In the past 24 hours two of these cases have been admitted to
hospital and are showing very severe symptoms, including;
41
YC-3.1
1. High fever 2. Jaundice 3. Purpuric rash
These further cases have emerged after the removal of cats from the school and are possibly the result
of human to human contact with other sick children.
Contact tracing has revealed that 6 of these children attended a multi school sports tournament.
Enquiries have revealed that a further 8 children from three other schools have taken time away from
school due to illness following the sports tournament.
The Ministry of Education should be able to provide details.
Actions to minimise spread should be taken
42
YC-3.2
TO IHR
Inject time + 3-4 weeks
Expected Actions Complete an initial risk assessment and submit to the Director of public health unit
Comments 1 hour completion time
43
YC-3.2
From: Dr Sabine Manx, Public Health Unit
Date: +4 weeks
Dear IHR National Focal Point,
I am attaching the report from the rapid response team (RRT). Please assess the public health risk
of this event, based on the attached report, and using multiple sources of information you may
have.
Please complete a risk assessment given the material received and forward this to me within
the next hour.
44
YC-3.2
Initial Report
Review of emergency department presentations:
Review of medical records indicates that 46 patients presenting with fever in the last month also had conjunctivitis
The number of gastro-intestinal illness presentations (vomiting and/or diarrhoea) were slightly above average this month (30 presentations versus average of 22 per month)
Influenza-like illness presentations are above average this month (24 presentations versus average of 10 per month) Review of hospital admissions:
Hospital admissions this month (N=120) are substantially higher than the average over the past 12 months (91 per month, range 70-105).
Admissions to critical care beds have also increased in the last month (N=25), compared with an average of 15 per month. Sixteen of the 25 critical care admissions this month were admitted with a febrile illness. Four of them died. Key findings:
Investigation of 3 cases of illness by the rapid response team (RRT):
Case # Details
Case 1 Age 5 years, female
Contact with pet cat which died 5 days prior to onset Developed fever and severe conjunctivitis 6 weeks ago. Condition deteriorated
and was admitted to the hospital on 1 November. On presentation was hypotensive, tachycardic and observed to have petechial rash on lower limbs. Supportive treatment provided and condition improved from day 6 of admission.
Case 2 Age 60 years, female
Contact with pet cat which died one week prior to case onset Presented to community health centre 4 weeks ago with fever, headache and
conjunctivitis. Given anti-pyretic and anti-microbial eye drops. Full recovery 1 week after onset.
Case 3 Age 34 years, male
Local veterinarian
Found unresponsive at home. Severe shock on arrival in emergency department on 2 weeks ago, unable to be resuscitated – deceased.
Relatives of the case noted that he was feeling unwell with fever, headache and sore eyes the day prior.
45
YC-3.2
The RRT discussed the situation with hospital staff, who commented on the unusually high number of
patients presenting with conjunctivitis as well as noting several young healthy patients who have
recently been admitted with haemorrhagic signs and shock on a background of pyrexia of unknown
origin.
The RRT was able to interview a sample of 10 patients who had presented to hospital with fever and
conjunctivitis during the past 6 weeks:
Of 10 interviewed cases: 6 males and 4 females. Age range 16 years – 65 years A range of other symptoms were reported by cases, including: headache, retro-orbital pain, arthralgia,
nausea and diarrhoea. Seven of the cases are cat owners, 2 of which had cats that had recently died. One case had contact
with a friend’s cat prior to onset. Two cases reported no contact with cats, one of which reported contact with a friend who had had
similar symptoms about a week prior. Of note, the other case with no cat contact was a nurse who was involved in the resuscitation of a veterinarian who had been brought to the hospital in cardiac arrest.
Specimens were obtained from seven of the ten cases interviewed and were sent to national reference laboratory.
The population appears to seek health care late as early symptoms are mild in most people.
Perception Issues:
There is an increasing level of interest in the press
There are reports that people are hiding sick cats for fear of them being put down if found to be unwell.
Strong comments on social media, often displaying incorrect or factually dangerous information
Recommended actions:
Elevate the level of emergency operations centre (or equivalent in your country), and activate incident management system
Establish case definition and interim guidance for clinical management Follow-up results of laboratory testing
Strengthen public health interventions, including risk communication, infection prevention and control, and contract tracing.
Ensure that the public receive accurate and objective information
END of REPORT
46
VIA Email
TO IHR
Inject time +6 weeks
Expected Actions Assess if the situation meet criteria for WHO notification as per
IHR(2005) Annex 2
Draft and send EIS posting
Comments +6 weeks
47
12 people dead, 5 of these children and over 50
critically ill as Cat Flu Spreads.
What started out as a mild case of flu in cat owners has become a health threat to the nation.
Today the Ministry of Health is racing to contain the outbreak of the disease known locally as
Cat Flu but described by health authorities as Acute Complex Feline Syndrome (ACFS). ACFS
has already claimed the lives of 12 people, almost half of these children and has now spread
to the nation’s capital.
As of today, there have been over 50 confirmed serious cases. There are undoubtedly more
cases in the general population, people staying at home with what they believe is the flu.
What do we know so far?
ACFS appears to be highly infectious but experts are still divided as to how the disease
spreads. Some believe that the transmission is similar to influenza and is spread by coughing
and sneezing while others believe it is through close physical contact with an infected person.
Regardless of how it is spread, health experts are recommending that anyone who suspects
that they have the illness should not go to health care facilities to prevent further
transmission, and instead make phone call to a local public health center.
Dr Sabine Manx of the Public Health Unit told News First that people should stay at home.
"We are very concerned about the continued spread of ACFS. It is clear that the disease
spreads easily between people but we are still unsure of the exact mechanism. Until we
understand more about the disease we strongly recommend that people stay at home unless
they become very ill. In most cases people will suffer mild symptoms, including fever and
conjunctivitis and these are best treated with rest and plenty of water. If people do become
very ill, they should call ahead to their local public health center, so that staff can arrange
appropriate medical assessment.. At present the ministry of health is establishing dedicated
wards at local health facilities to try to isolate victims of this illness. We are also actively
tracing the contacts and asking them to remain quarantined at home.”
Mr Manx stated that the ministry was doing all it to understand the disease better in order to
limit its spread.
© 2017 News First.
48
YOUR COUNTRY REFERENCE LABORATORY
49
50
From: Dr Sabine Manx, Public Health Unit
Date: +6 weeks
Subject: Case Management and Investigation
Dear IHR National Focal Point,
Please take note of the information received from our ongoing investigation into cases of Acute
Complex Feline Syndrome (ACFS).
Please undertake the following appropriate action:
1. Please assess the current situation against Annex 2 of the International Health Regulations (IHR)(2005) and advise if the current situation warrants notification to WHO, and please let me ([email protected]) know your judgement.
2. Should this situation warrant notifying to WHO, please brief me ([email protected]) on the national procedure to obtain approval for notifying WHO.
3. Please also prepare a posting for the event information site (EIS) and email it to the WHO IHR contact point for uploading into the system.
(FOR THE PURPOSES OF THE EXERCISE DO NOT UPLOAD ANY INFORMATION DIRECTLY TO THE EIS
SYSTEM).
51
YC-5.1
VIA Email
TO IHR NFP WHO IHR DO
Inject time (Manila) + 8 weeks
Expected Actions Provide contact point for national disaster management structure
52
YC-5.1
Death toll in YOUR COUNTRY rises as the disease arrives in the nation's capital
122 people dead, and at least 550 critically ill as ACFS takes hold.
Acute Complex Feline Syndrome (CFS) is now spreading across the country. For the first time ACFS has
been detected in the capital of YOUR COUNTRY alarming health authorities who have been struggling
to contain the outbreak.
A spokesperson for the Ministry of Health stated, “We are concerned about the spread of ACFS as it
now seems to have established itself in the human population and appears to be spreading easily.
People who develop only mild symptoms of the illness can still pass the infection on to others. We ask
that any person who feels unwell with fever and conjunctivitis to stay at home unless they are in real
need of medical attention.
The majority of cases recover without treatment. However, approximately 10% of cases develop a
serious form of the disease. This outbreak is impacting health facilities and it is therefore important
that people take measures to prevent the further spread of infection.”
© 2017 News First.
53
YC-5.1
THIS IS AN EXERCISE MESSAGE
From: National Disaster Management Authority or Agency (NDMA) of YOUR COUNTRY
Date: +8 Weeks
Dear National IHR Focal Point
The National Disaster Management Authority or Agency (NDMA) has been monitoring the
situation and is on standby in case support services are required. The NDMA can provide the
following:
1. Tankered water services, 2. Food supplies and emergency food kitchens 3. Tented accommodation to support staff on site and/or patient overspill 4. Emergency transportation 5. Blankets and camp bedding 6. General logistics support
The NDMA has the immediate capacity to deal with approximately 1000 people but this can
be increased if required over time.
NDMA
54
YC-5.2
From: Dr Sabine Schmitz, Public Health Unit
Date: +8 weeks
Subject: Case numbers
Executive Summary:
1. Number of Cases continues to rise with 728 suspected cases, and 550 critically ill 2. Number of new cases reported since yesterday 156 3. Fatalities 122 4. National Disaster Management Agency is on standby. 5. ACFS is known to spread through direct person to person contact and through contact with
contaminated objects. 6. The virus remains active on surfaces for up to 8 hours. Contaminated surfaces should be cleaned with
bleach or exposed to UV radiation (sunlight). General cleaning with soap is not completely effective but appears to shorten the virus’s persistence in the wild.
7. Handwashing with soap and water is recommended to prevent spread. 8. Ambulance services are reduced due to the time required for disinfection following transport of
suspected cases.
Actions
1. Please send me the contact details for our counterparts at the National Disaster Management Authority or Agency (NDMA) who could assist with logistics and support
Dr. Sabine Manx
55
YC-6
VIA Email
Responsible IHR National Focal Points, IHR contact points, NFP’s
TO IHR NFP WHO IHR DO
Inject time + 12 weeks
Expected Actions Provide response to the question on border closure. Provide response to the question on the point of entry.
56
YC-6
OTHER COUNTRIES REACT
Acute Complex Feline Syndrome (ACFS) is now spreading across the globe. For the first time ACFS has
been detected in two countries outside YOUR COUNTRY alarming health authorities around the globe.
A spokesperson for the World Health Organization stated,
“We are closely monitoring the spread of ACFS as it now seems to have established itself in the human
population and appears to be spreading easily. In the early stages the disease appears difficult to detect
and some people who are asymptomatic seem to be able to pass on the virus. WHO is not
recommending any travel or trade restrictions as we feel that imposing such restrictions will have little
impact. We recommend that all Member States share what they know about the virus and take
appropriate steps to limit the spread of the illness”
The Republic of GlobalLand closes its borders
The nearby country of GlobalLand has announced that it will close its borders to try to prevent the
entry of the disease into the country. A government spokesperson stated;
“This is a very serious situation and we must do everything possible to prevent the arrival of this
disease into GlobalLand. Unfortunately, GlobalLand does not have the resources to enable screening at
its borders or contact tracing for individuals suspected of being infected. As a result, we will be closing
our borders to all travellers.”
Human rights advocates have expressed concern at the move and they are worried that GlobalLand is
rounding up recent arrivals, particularly arrivals from YOUR COUNTRY and placing them in forced
quarantine. The WHO has also expressed concern and has reminded GlobalLand of goals and their
obligation under IHR.
Cases in other countries
So far there have been 40 cases of suspected ACFS reported in two NEIGHBOURING COUNTRIES to
YOUR COUNTRY
They have stated that they are working closely with health officials from YOUR COUNTRY to benefit
from your experience with the illness.
© 2017 News First.
57
YC-6
National Disaster Management Authority or Agency (NDMA)
[YOUR COUNTRY]
To: Public Health Unit
Date: +12 Weeks
Summary of Activities
1. Assisting with the deployment of 5 tented medical facilities in locations across the main city to augment existing hospital capacity
2. Coordinating with the military on the deployment of field hospitals. Locations are being determined in collaboration with the Health Department.
3. Activating first response capacity with the NDMA to assist with triage 4. Providing clean water and sanitation to tented operations 5. Staffing field kitchens 6. Providing emergency patient transfer and vehicle disinfection 7. Liaising with the police to improve security at health facilities 8. Providing emergency power and lighting kits to provide backup power to site 9. Assist with public health messaging and community engagement
Please also note that following a review of our capacity we are also available to help with screening at
points of entry and can provide emergency assistance to assist with the clearing of emergency goods
imported for this crisis
The NDMA stands ready to assist when it can and would welcome further collaboration.
Joseph Ocicat
Operations, NDMA
TASK
1. GlobalLand closed the border to restrict movement of people and goods. What action would you consider in such situation?
2. Given this scenario, what measures would you consider at your point of entry?
58
YC-6
Final Note to Participants EXERCISE-EXERCISE-EXERCISE Dear Exercise Crystal participants, The Director-General of the World Health Organization has declared the outbreak in YOUR COUNTRY a Public Health Emergency of International Concern: “Based on the recommendations of the Emergency Committee, I am declaring this outbreak a Public Health Emergency of International Concern. We are seeing the spread of the epidemic beyond international borders and there is a need for an international response. The recommended control measures such as strict hygiene practices, identification and isolation of infectious cases and adequate use of personal protective equipment must be enforced. At this point, the Emergency Committee is not recommending any travel or trade restrictions.” – WHO Director-General Watch the video of the DG’s press conference. This is the end of the exercise. Please be on standby to participate in a “hot wash” debriefing. Those who are joining via videoconference, can join here. Our team will call those who are connecting via teleconference shortly to facilitate your connection. Regards, Exercise Control
Objectives
1. To validate the functional accessibility of the NFPs and the WHO IHR Contact Point using registered
contact details;
2. to practice and test NFPs’ assessment of public health events using the decision-making instrument
contained in Annex 2 of IHR (2005);
and its notification process including IHR event information site (EIS) posting;
3. to pr

report ihr exercise crystal 2017

Documents