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WEST MIDLANDS HEALTH PROTECTION TEAM Basics in Public Health Michele Lawrence Objectives • Overview of Health protection in the West Midlands • What is health protection • Purpose of outbreak management • Outbreak management communications • Outbreak management control measures • Outbreak control team 2 Basics in Public Health November 2016 INTRODUCTION We have one Health Protection Team across the West Midlands based in three locations in Birmingham, Stafford and Kidderminster serving a combined population of 5.7 million. 3 Basics in Public Health November 2016 What is Health Protection? The primary role of the health protection team is to provide specialist health protection advice, epidemiological and microbiological support. To ensure there are effective arrangements in place locally for preparing, planning and responding to health protection concerns and emergencies, including the future impact of climate change. We have a legal requirement to respond to incidents/emergencies and outbreaks as a Category 1 responder. (i.e. emergency services, local authorities, NHS). The Regulations of the Public Health Act include legal powers, available to enforce actions to protect public health: Part 2A Orders. 4 Basics in Public Health November 2016 Key Partners in the West Midlands • 22 x CCGs • 14 x Local Authorities • 23 x Hospitals • 12 x Universities • 2,200 Other educational settings including primary schools, secondary schools and further education establishments. • 2 x Airports • 12 x Prisons • 1,800 x Care Homes (with and without nursing) 5 Basics in Public Health November 2016 Acute Desk We have an acute response service that covers the West Midlands operating from three locations. • The Acute Desk is staffed from 9am – 5pm from the office (also an out of hours service operates between the hours of 5pm and 9am 365 days a year and is covered by the clinical team. • We respond to incoming enquiries, cases, outbreaks and incidents 6 • Giving advice (clinical team) • Following up with other partners on current incidents/situations • Sending information and advice (letters, e-mails, faxes) • Collecting information for statutory reporting obligations • Collecting information relevant to cases and incidents (immunisation status, lab test results) Basics in Public Health November 2016 HPZone • National web-based case management system • Rolled out nationally in 2009 • Records all enquiries, cases and incidents • Geographical “contexts” allows cases to be linked nationally • Provides each HPT with a local ‘dashboard’ summarising all current activity • Helps improve continuity in incident management • Enables users to view, query and extract timely and comprehensive information on incidents and outbreaks • HP Zone Dashboard allows users to query data nationally 7 Basics in Public Health November 2016 What is an Outbreak? 8 Basics in Public Health November 2016 What is an Outbreak? •Two or more linked cases of an illness •A single case of an unusual or rare infection. •A greater than expected rate of infection compared with the usual background rate that is expected in that population for that place or time. •A suspected, anticipated or actual event involving microbial contamination of food or water 9 Basics in Public Health November 2016 Purpose of Outbreak Management 10 Basics in Public Health November 2016 Outbreak Management Framework Case definition •Confirm diagnosis in known cases •Determine background incidence of disease •Case-finding •Data collection •Descriptive epidemiology •Microbiological investigation •Environmental investigation •Hypothesis generation •Analytic epidemiology •Communications •Control measures 11 Basics in Public Health November 2016 Outbreak Management: Communications Robust communication systems are required for: •Investigation – active case finding (e.g. from GPs, microbiologists) •Control – disseminating advice to the public, health professionals and other agencies •Liaison – with public, media, and health & non-health agencies 12 Basics in Public Health November 2016 Outbreak Management: Control Measures Basic principles: •Removing source of infection Isolate cases Product recall •Interrupting transmission Personal hygiene e.g. hand washing •Protecting persons at risk Prophylaxis Vaccination •Preventing recurrence Guidelines Recommendations 13 Basics in Public Health November 2016 Outbreak Management: Control Measures TASK What control measures could be put into place for the following: •Food poisoning outbreak •Pandemic flu Basic Principles • Remove source of infection • Interrupting transmission • Protecting persons at risk • Preventing recurrence 14 Basics in Public Health November 2016 Outbreak Control Team: Membership Chair (usually a CCDC) •Environmental Health •Public Health Laboratory representative •Consultant Microbiologist •Administrative and secretarial support •Director of Public Health (or nominated deputy) •Consultant Epidemiologist •Communications Officer •Health Protection Nurse/Practitioner •Community Infection Prevention & Control •Hospital Infection Prevention & Control • 15 37 Basics in Public Health November 2016 Outbreak Control Team: Membership Clinical Virologist •Toxicologist •CCG Representative •NHS England Area Team Representative •Representatives from affected NHS Trust •Health & Safety Executive representative •Food Standards Agency representative •Environment Agency representative •Department for Environment, Food & Rural Affairs representative •State Veterinary Service representative •Water Company representative •Legal Officer 16 Basics in Public Health November 2016 Challenges for Health Protection in the West Midlands Varied population health challenges including: • High rate and complex nature of acute reactive work • Tuberculosis • Hepatitis • Emergency Planning • Health Care Acquired Infections • High number of prisons in WM area • Environmental Issues 17 Basics in Public Health November 2016 major incidents Buncefield Explosion 2005 Poisoning of Alexander Litvinenko 2006 Pandemic flu 2009 Zika 2016 Ebola 2014 18 Basics in Public Health November 2016 Any Questions…………………. 19 Basics in Public Health November 2016