water-related disease surveillance and response roger aertgeerts program manager who regional office...
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Protocol Implementation Workshop Minsk 4-5 April 2011 Water-related disease surveillance and response 5 April 2011 Page 3 Agenda Water use –Target setting Access to water and sanitation –Target setting for water services Water-related diseases –Target setting for surveillance systemsTRANSCRIPT
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Water-related disease surveillance and response
Roger Aertgeerts
Program manager
WHO Regional Office for Europe
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 2
Targets are team work
• Manage resources• Provide water and
sanitation• Survey diligently• Detect outbreaks• Implement contingency
plans• Live and learn, and pass
it on…
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 3
Agenda
• Water use– Target setting
• Access to water and sanitation– Target setting for water services
• Water-related diseases– Target setting for surveillance systems
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 4
23%
10%
19%
12%
0%
5%
10%
15%
20%
25%
BLR MDA RUS UKR
Water withdrawal for domestic use (%)
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 5
278
540 523
764
0
100
200
300
400
500
600
700
800
BLR MDA RUS UKR
Water withdrawal for domestic use (m3/c)
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 6
Target setting
• Effective demand management can be an important contribution to climate change adaptation. Possible targets include– Reduction of unaccounted-for-water– Reduction of leaks– Introduction of metering systems
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 7
Agenda
• Water use– Target setting
• Access to water and sanitation– Target setting for water services
• Water-related diseases– Target setting for surveillance systems
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 8
94
6
94
6
76
24
76
24
89
11
89
11
0
10
20
30
40
50
60
70
80
90
100
Access No access Access No access Access No access
Urban Rural Total
Access to improved sanitation %
1990
2008
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 9
142,744133,797
9,1729,070
47,620
14,735
44,253
13,640
190,658
23,614
178,048
22,651
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
Access No access Access No access Access No access
Urban Rural Total
Access to improved sanitation (1,000 pop)
19902008
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 10
Target setting in sanitation
• Legal, institutional and administrative set-up• Issues of reliable information• Issues of infrastructure• Issues of economic capacity
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 11
Examples of target setting
• Finland– Universal centralized sewerage and
wastewater treatment• Czech Republic
– Compliance with EU 91/271/EEC – Construction of wastewater treatment
facilities in small settlements with less than 2,000 inhabitants, where sewerage exists
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 12
98
2
98
2
82
18
91
9
94
6
96
4
0
10
20
30
40
50
60
70
80
90
100
Access No access Access No access Access No access
Urban Rural Total
Access to safe water (%)
19902008
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 13
149,364
2,551
140,063
2,743
54,420
10,934
52,875
5,018
200,784
13,485
192,938
7,761
0
50,000
100,000
150,000
200,000
250,000
Access No access Access No access Access No access
Urban Rural Total
Access to safe water (1,000 pop)
1990
2008
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 14
Target setting in access to safe water
• Legal, institutional and administrative setup• Issues of reliable information• Issues of quality• Issues of economic capacity• Awareness-raising, education and training
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 15
Examples of targets to safe water
• Hungary– Nation-wide survey on population without access to
drinking water, and exploration of feasible solutions– Development of social subsidies
• Portugal– Affordability: 2% of family income as limit
• Czech Republic– Facilitation of connection of residences in suburbs
and small villages to public supply
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 16
Agenda
• Water use– Target setting
• Access to water and sanitation– Target setting for water services
• Water-related diseases– Target setting for surveillance systems
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
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“Water-related disease” means
Any significant adverse effects on human health such as death, disability, illness and disorders, caused directly or indirectly by the condition, or changes in the quantity or quality, of any waters;
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Water-related disease surveillance and response
5 April 2011 Page 18
Classes of water-related diseases
• Classic water-related diseases– Cholera– Typhus– Typhus
• Emerging water-related diseases– Cryptosporidiosis– Campylobacteriosis– Giardiasis– Legionellosis
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 19
Classic: Typhus - Viral hepatitis A
Viral hepatitis A
0
20
40
60
80
100
120
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Inci
denc
e ra
te (/
100.
000)
BLR
MDA
RUS
UKR
• Significant differences in incidence rate• Inconsistent reporting• Mostly decreasing trend
Typhus
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
0.16
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year
Inci
denc
e ra
te (1
,000
)
BLR
MDARUS
UKR
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 20
Emerging: Cryptosporidiosis Legionellosis
• Very uneven reporting system• Repeated cases of outbreaks
Legionellosis
0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Inci
denc
e ra
te (/
100,
000)
BLR
MDARUS
UKR
Cryptosporidiosis
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Inci
denc
e ra
te (/
100,
000)
BLR
MDA
RUS
UKR
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 21
Obligations under Art 6 par 2 (b)
Parties shall establish and publish national and/or local targets for the standards and levels of performance that need to be achieved to realize
The reduction of the scale of outbreaks and incidents of water-related disease;
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Water-related disease surveillance and response
5 April 2011 Page 22
Aspects in target setting
• Legal and administrative set-up• Availability and reliability of information on the
water quality• Issues of water-related disease surveillance• Economic sustainability
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Protocol Implementation Workshop Minsk 4-5 April 2011
Water-related disease surveillance and response
5 April 2011 Page 23
Obligations under Art 8
• Comprehensive national and/or local surveillance and early-warning systems established that– Identify outbreaks or incidents of wrd– Provide prompt and clear notification– Recommend preventive and remedial
action– Plan response to outbreaks
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Water-related disease surveillance and response
5 April 2011 Page 24
Target setting: focus and structure
• Priority diseases – is the activity a real priority for the country?
• Structure – is the structure of the national system effective and efficient?
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Water-related disease surveillance and response
5 April 2011 Page 25
Target setting: processes and capacity
• Detection (identifying cases and outbreaks)• Registration• Confirmation (epi and lab confirmation)• Reporting (early warning and routine)• Analysis and interpretation
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Water-related disease surveillance and response
5 April 2011 Page 26
Targets: response capacity
• Response– Control / response– Outbreak investigation– Programme adjustment– Changes in policy and planning
• Feedback• Evaluation and monitoring
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Water-related disease surveillance and response
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Surveillance targets: support functions
• Setting standards• Training• Supervision• Communication systems• Human resources• Material resources• Financial resources
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Water-related disease surveillance and response
5 April 2011 Page 28
Assessing, mapping and communication
• Laboratories– Availability, functionality and level of
sophistication– Accreditation– Electronic data management and reporting
• Health mapping– National capacity or at least database
preparation
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Water-related disease surveillance and response
5 April 2011 Page 29