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Pacific island countries and areas represent some of the most disaster-vulnerable locations in the world, facing a range of natural and infectious hazards along with incredibly challenging logistics and limited human resource pools. The World Health Organization supports the development of emergency medical teams across the Western Pacific Region. Since 2021, one aspect of this support has been supplying health emergency response equipment called cache kits for these unique island contexts. This report describes the process of designing and implementing standardized cache kits for these teams. Emergency medical team cache kits were designed and sourced using a semi-structured six-step approach: 1) problem identification and review of existing literature; 2) targeted key informant interviews and stakeholder consultations; 3) the alignment of cache with the goals and objectives of the teams' operations; 4) creation of the kits; 5) local and international procurement of selected items; and 6) monitoring of the delivery of cache to destination countries. The Organization procured specialized cache kits for 12 teams across the Pacific subregion. They comprise portable, durable, lightweight equipment that enables teams to deliver high-quality emergency medical care in remote and resource-limited island contexts. The Organization's centralized procurement of the cache kits in the Pacific aimed to facilitate nationally led health emergency responses, enhance team interoperability in the subregion, and ensure access to high-quality equipment in resource-constrained locations. The model established in the Pacific could serve as a blueprint for national emergency medical teams in low- and middle-income countries globally.
This regional analysis aims to provide a comprehensive review of emergency medical team development and action in health emergency response in the Western Pacific Region from 2010 to 2024. It details national, subregional and regional efforts to strengthen health emergency preparedness, response and resilience; it notes challenges faced by the teams in these efforts; and it provides examples that could be adopted or adapted to strengthen their development and action around the world. Emergency medical teams are critical components of national, regional and global health emergency workforces, enabling rapid, high-quality and self-sufficient responses to health emergencies domestically or internationally. They comprise clinical, mental health, public health, logistics and water/sanitation/hygiene personnel who collaborate in providing critical services to affected populations during health emergencies. By the end of 2024, emergency medical teams had been established in nearly every country in the Western Pacific Region, with 16 classified for international deployments, and many national teams developed to strengthen response to domestic emergencies. This analysis is based on published peer-reviewed literature on emergency medical team development and action in health emergencies in the Western Pacific Region, as well as publicly available data on team collaboration and deployment for health emergency response. This analysis considers the global evolution of the World Health Organization Emergency Medical Team Initiative and describes its development in the Western Pacific Region, including how the teams have contributed to emergency response efforts, and the key enabling factors and challenges faced as they develop and respond to emergencies. The analysis concludes by highlighting opportunities for future development, collaboration, research and insights that may be applicable to the global development of emergency medical teams.
Noncommunicable diseases impose a significant and growing burden in Pacific island countries and territories, prompting health authorities to implement media-driven communication campaigns as part of their broader strategies to address these diseases and promote health. This analysis was undertaken to assess the strengths and limitations of these campaigns and identify areas for improvement. A semi-structured online survey, conducted between August and October 2023, and a visual content analysis were used to examine noncommunicable disease-related communication in Pacific island countries and territories. Distributed through the Pacific Community's Public Health Division focal-point network, the survey was designed to gather qualitative insights on campaign development, evaluation, audience targeting, challenges and success factors. Public health posters from the Pacific Community's archives were analysed using a semiological approach to categorize their enunciative functions. Thirty-four survey responses from 12 Pacific island countries and territories were received. Tobacco was the top campaign issue, followed by nutrition, physical activity and cancer awareness; social media was the primary communication channel. Most respondents (80%) rated their campaigns as only moderately successful. Actions needed to enhance the impact of communications included better planning, more preliminary research, sustainable funding, skilled staff and greater cross-sector collaboration. Most noncommunicable disease-related posters (70%) served a representational function by portraying reality as designed by public health authorities. While most posters incorporated local cultural elements and vernacular languages, they were predominantly authoritative (46%) or neutral (44%) in tone. Furthermore, 73% were not tailored to specific target groups. Enhancing communication requires greater resourcing, transdisciplinary approaches and stronger audience engagement. More research-informed strategies that integrate behavioural science could improve interventions that promote healthier choices. Achieving this necessitates closer collaboration across disciplines, and stronger partnerships and engagement with communities.
Once COVID-19 vaccines were rolled out, there was a need to monitor real-world vaccine effectiveness to accumulate evidence to inform policy and risk communication. This was especially true in Japan and the Philippines, given historical issues that affected vaccine confidence. Neither country had public health surveillance that could be enhanced to evaluate vaccine effectiveness or readily available national vaccination databases. Study groups were established in multiple health-care facilities in each country to assess vaccine effectiveness against both symptomatic infection and severe disease. In Japan, multiple study reports were published in Japanese on the web site of the National Institute of Infectious Diseases and presented at the national government's advisory board. Nationwide media coverage facilitated transparency and increased the confidence of the government and the public in the vaccination programme. In the Philippines, the launch of the study was delayed so as to align the research plan with the interests of various stakeholders and to obtain institutional review board approval. Ultimately, the studies were successfully initiated and completed. There were four main challenges in conducting our studies: finding health-care facilities for data collection; obtaining exposure (vaccination) data; identifying epidemiological biases and confounders; and informing policy and risk communication in a timely manner. Preparedness during inter-emergency/epidemic/pandemic periods to rapidly evaluate relevant interventions such as vaccination is critical and should include the following considerations: (1) the establishment and maintenance of prospective data collection platforms, ideally under public health surveillance (if not, clinical research networks or linked databases); (2) uniform and practical protocols considering biases and confounders; and (3) communication with stakeholders including institutional review boards.
Since its inception in April 2000, the Global Outbreak Alert and Response Network has played a pivotal role in coordinating the rapid deployment of technical experts to support countries, when requested, during public health emergencies. This paper presents a regional analysis of the Network's deployments within, to and from the World Health Organization Western Pacific Region over the past 24 years. The findings emphasize the critical importance of a well coordinated surge workforce and advocate for enhanced partner engagement with strategic utilization of regional and global expertise to strengthen future outbreak responses.
The International Health Regulations (2005; IHR) are a legally binding instrument for the 196 States Parties, including the 194 Member States of the World Health Organization (WHO), requiring them to build and maintain capacities across critical domains to prevent, detect and respond to public health threats. In an analysis of 15 IHR (2005) core capacity scores reported by States Parties in WHO's Western Pacific Region from 2021 to 2023, average regional scores increased from 68% in 2021 to 72% in 2022, then declined to 66% in 2023. Seven States Parties maintained consistently strong scores (≥ 85%), whereas nine exhibited fluctuations of at least 10 percentage points. Categorizing States Parties into three groups based on geographical and economic characteristics highlighted that core capacities such as financing, food safety and the control of zoonotic diseases were areas requiring additional capacity-building, particularly among Pacific Island States Parties. Low- and middle-income States Parties also reported notable gaps in financing and infection prevention and control. These findings underscore the need to strengthen national coordination and accountability mechanisms. The strategic establishment or designation of a National IHR Authority - a key amendment introduced in the 2024 revision of the IHR - has the potential to enhance implementation by ensuring institutional leadership, fostering multisectoral collaboration and facilitating resource mobilization. However, national efforts alone may not be sufficient. Regional coordination will enhance political commitment and promote coordinated action, thereby strengthening preparedness and response capacities across diverse contexts and supporting more effective implementation of the IHR (2005).
Papua New Guinea has hosted several mass gatherings in recent years. Yet, there is limited data on the involvement of emergency medical teams in these events, let alone in other low- and middle-income countries. Prior to Pope Francis's state visit in September 2024, the national emergency medical team (EMT) had not simulated its updated clinical patient flow systems. During Pope Francis's visit, an estimated 70 000 attendees gathered at the national stadium. Using Arbon's mass gathering model, the patient presentation rate was calculated to be 330 over 2 days, or 4.7 per 1000, posing a significant challenge to local health-care capacity. The National Department of Health mobilized its EMT to lead clinical operations in collaboration with the National St. John Ambulance service. Planning spanned 6 weeks and involved provincial partners. Over 2 days, 257 patients, or 3.7 per 1000, were managed using a hub-and-spoke model. First-aid stations operated by the St. John Ambulance service treated 200 patients for dehydration and headaches, while the Advanced Casualty Management Centre handled 57 cases of heat-related illnesses and chronic condition exacerbations. The deployment of the EMT showcased its capability and credibility, setting a national milestone and providing a feasible model for mass-gathering preparedness and response in low- and middle-income countries in the World Health Organization's Western Pacific Region. This report highlights not only the importance of multipartner collaboration in such preparedness, providing baseline data for low-resource settings, but also the scalability of rehabilitation services and the Interagency Integrated Triage Tool as frameworks for future deployments.
Many countries record high rates of fireworks-related injuries, especially during national celebrations. In the Philippines, increases in the number of injuries reported around the New Year period in recent years have highlighted the importance of continued strengthening of national fireworks-related injury surveillance. The Philippines' regional epidemiology and surveillance units play a significant role in surveillance by linking its key stakeholders, the sentinel hospitals and the Department of Health's Central Office. More specifically, these units promote compliance with reporting standards among sentinel hospitals and support case data validation. Approximately half of the sentinel hospitals that contribute data to the surveillance system are in the nation's capital, Metro Manila. This concentrated coverage prompted the Regional Epidemiology and Surveillance Unit staff in Metro Manila to implement low-cost, digital strategies to improve the quality and timeliness of fireworks-related injury reporting. During the 2023-2024 surveillance period (21 December to 5 January), the use of virtual coordination spaces and data dashboards contributed to reducing turnaround times for generating surveillance reports from 31 minutes to 8 minutes. Moreover, at least 80% of sentinel hospitals provided timely reports on 11 of the 16 days of the surveillance period. Staff commitment was a major contributing factor in overcoming the time and human resource constraints encountered during implementation of these strategies. However, it is important to recognize that beyond these digital innovations, policy reforms that increase funding are needed to enhance fireworks-related injury surveillance and secure its long-term sustainability and scalability in the Philippines.
The objectives of this study were to describe the characteristics of Thailand's first reported outbreak of herpes gladiatorum in Thai-boxing gyms and to provide recommendations for reducing the risk of transmission. Hospital reports of atypical rashes appearing among Thai-boxing trainees triggered investigations at three gyms in Phuket during May-August 2022. Semistructured questionnaires were used to collect data from gym owners, trainers and trainees. Skin and blood specimens were collected for reverse transcription-polymerase chain reaction testing for herpes simplex virus type 1 (HSV-1), antibodies to HSV-1 and other pathogens; genomic sequencing was performed on culturable samples. The environmental investigation included walk-through surveys, a review of each gym's web site, and testing of surfaces and water specimens. Nine cases of herpes gladiatorum were confirmed and one was suspected, all in non-Thai trainees. Attack rates in Gyms I, II and III were 21.4%, 11.5% and 2.6%, respectively. Risk behaviours included sparring with partners who had a rash, sharing equipment and neglecting to shower before training. HSV-1 was detected on gym equipment and surfaces, and cultures from skin lesions and blood samples revealed a genomic linkage between two cases in Gym II, identified as belonging to the East Asian Clade II strain. Disinfection of equipment reduced exposure to HSV-1. The first outbreak of herpes gladiatorum in Thailand was confirmed in 2022. Genomic sequencing suggested local transmission within Thailand, with the virus introduced independently into each gym. Skin-to-skin contact was likely the main mode of transmission; environmental findings indicated a lower risk of transmission via gym surfaces. Recommendations to prevent future outbreaks include stricter regulations for pre-fight screening and improved gym cleaning and hygiene among trainers and trainees.
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On 27 June 2023, the Thailand Department of Disease Control was notified of an incident of carbon monoxide poisoning related to a Thai-style hotpot restaurant. An outbreak investigation was performed to describe the incident, confirm its cause and sources of exposure, and provide preventive measures. The restaurant owner, restaurant guests and waiting staff were interviewed, and the medical records of hospitalized cases were reviewed. In an environmental survey, air quality parameters were measured, including temperature, relative humidity, carbon dioxide and carbon monoxide. Additionally, a simulation of the incident was conducted, and data were reviewed from previous poisoning incidents in Thailand. There were 11 cases, all of whom were guests who dined in the same private dining room. The median age of cases was 28 years (range 2-62 years). Three cases were hospitalized and received hyperbaric oxygen therapy. The air changes in the dining rooms were below the recommended level. The incomplete combustion of charcoal in a poorly ventilated room led to carbon monoxide build-up, which caused the incident. The simulation experiment showed a high concentration of carbon monoxide (mean 183.16 ± 55.15 ppm), above the standard level. Ten similar poisoning incidents occurred between 2019 and June 2023, totalling 23 cases and 2 deaths; none occurred in a restaurant. Charcoal use in poorly ventilated areas poses a health risk, especially for children. The use of charcoal stoves for hotpot cooking indoors is prohibited. Public health policy should mandate regular restaurant inspections to ensure compliance with occupational and environmental health standards.
The COVID-19 pandemic disrupted disease surveillance systems globally, leading to reduced notifications of other infectious diseases. This study aims to estimate the impact of the COVID-19 pandemic on the infectious disease surveillance system in Klang district, Selangor state, Malaysia. Data on notifiable diseases from 2014 to 2022 were sourced from the Klang District Health Office. The 11 diseases with more than 100 notifications each were included in the study. For these 11 diseases, a negative binomial regression model was used to explore the effect of the pandemic on case notifications and registrations by year, and a quasi-Poisson regression model was used to explore the changes by week. The results showed a reduction in the number of notifications and registrations for all 11 diseases combined during the pandemic compared with previous years. Changes between expected and observed notifications by week were heterogeneous across the diseases. These findings suggest that restrictive public health and social measures in Klang district may have impacted the transmission of other infectious diseases during the COVID-19 pandemic. The differential impact of the pandemic on disease notifications and reporting highlights the large ancillary effects of restrictive public health and social measures and the importance of building resilience into infectious disease surveillance systems.
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In September 2024, an illegal toxic waste dumping incident along the Tebrau River in Johor State, Malaysia, raised widespread health concerns in Johor Bahru and Kulai districts. The pollution released a strong, unpleasant odour, resulting in acute symptoms among exposed individuals, including sore throat, dizziness and coughing. The Tebrau River is a vital waterway supporting urban populations in Johor. This was not the first chemical pollution event in the region, as previous incidents, including the Kim Kim River crisis in 2019, highlighted the region's vulnerability to such events. The involvement of multiple districts and agencies during the response presented challenges in coordination and data sharing. The Johor Bahru District Health Office promptly deployed a rapid assessment team to assess the affected areas and implement both active and passive case detection. Community engagement targeted vulnerable populations, such as schoolchildren, to minimize exposure risks. Additional dumping sites identified along the Tebrau River prompted expanded surveillance and a state-level response to coordinate efforts across districts and all health-care facilities. A total of 484 individuals were exposed to the pollution, 334 of whom developed symptoms related to chemical exposure. Timely public health actions consisted of actions to mitigate the impact. Health facilities were placed on high alert and community trust was maintained through proactive engagement. However, gaps in cross-district coordination and challenges accessing environmental data underscored areas for improvement. This incident highlighted the importance of rapid assessment, cross-sector collaboration, community engagement and integrated data systems. It also showed that effective public health action is possible despite environmental data limitations. The strengthening of communication, standardized protocols and real-time data sharing will be critical to improving future chemical pollution events.
Despite the widespread use of designated quarantine hotels to minimize the transmission of COVID-19 from imported cases, there is scant literature on the infrastructure and operational requirements of such facilities. Travellers to Hong Kong Special Administrative Region (SAR) (China) were required to undergo quarantine in designated hotels for up to 21 days. Prior to operation, all these hotels were modified and hotel staff received structured training in infection control practices. We conducted retrospective reviews of the procedures and operational protocols that were followed to convert and manage commercial hotels as quarantine hotels during the early part of the pandemic. We also reviewed the training provided and compliance monitoring. Finally, we reviewed intra-hotel outbreak investigations that were conducted between April 2021 and June 2022. Designated quarantine hotels received 842 510 quarantined travellers from December 2020 to October 2022. Ten outbreaks were reported, affecting 28 guests (0.003%) and two staff. Prompt epidemiological investigation and action stopped further transmission. In Hong Kong Special Administrative Region SAR (China), designated quarantine hotels successfully minimized COVID-19 transmission from imported cases to the community and should be considered as part of integrated response plans for future pandemics. Based on our COVID-19 pandemic experience, we recommend specifying requirements for quarantine centres and hotels to ensure adequate ventilation inside guest rooms and corridors, functioning drainage systems and the adoption of stringent infection control practices. We also recommend the installation of closed-circuit television cameras in all common areas to support compliance monitoring and outbreak investigation.
The aim of this study was to assess the effectiveness of safety regulations governing traditional Mongolian horse racing on the frequency and severity of injuries among child jockeys. Regulations introduced in 2019 mandate the wearing of helmets and protective clothing, prohibit the participation of jockeys aged < 7 years, and ban horse racing during the cold season (November-April). National injury surveillance data were used to compare the profile of injuries that occurred among children aged < 15 years in the 4-year periods before and after the introduction of the regulations (2015-2018 and 2019-2022) and to investigate whether injuries continued to occur among underage children and during the banned season. The proportion of head injuries among injured children was calculated before and after the regulations were introduced. During the study periods, 6309 animal-riding injuries were recorded among children aged 3-14 years; 2539 occurred before the regulations were introduced and 3770 occurred after. Following the introduction of the regulations, the proportion of injured children aged < 7 years decreased slightly. However, during 2019-2022, 294 animal-riding injuries were observed among underage children and 855 during the banned season. The proportion of head injuries among children with animal-riding injuries remained unchanged before and after the regulations were implemented (33.7% and 34.6%, respectively). The regulations have been ineffective. To reduce the burden of injuries among child jockeys, safety regulations need to be enforced throughout the year, and more stringent penalties for noncompliance should be imposed.
We explored the experiences of women in senior or leadership roles in navigating and leading during acute public health emergencies. Women leaders in the World Health Organization Western Pacific Region attending the Global Outbreak Alert and Response Network's Outbreak Response Leadership Training (11-18 September 2024) were invited to participate in this phenomenological study. Eleven interviews were conducted with training attendees and observational data were gathered. Inductive thematic analysis was conducted to identify key themes. Four themes associated with women-centric experiences in public health emergency response were identified: disproportionate expectations in the workplace; the use of authoritarian decision-making during planning and implementation; encompassing different perspectives and leadership styles compared to men; and requesting additional opportunities and equitable prospects for career growth. Four themes that reflect non-gender-exclusive challenges experienced during emergency responses were also detailed. Themes observed were related to: barriers to efficiency; consequences of working within this field; and needs and necessities during emergency response. This study highlights both gender-specific and systemic challenges experienced by women leaders in public health emergency responses, revealing how sociocultural norms and operational barriers intersect during times of crisis. We identified opportunities to assist women leaders through the recognition and promotion of different leadership styles, establishing a support network for women, and addressing systemic and organizational barriers that impact women.
The prevalence of chronic hepatitis B in Vanuatu is high, at approximately 9%. While immunization has been available for infants since 1989, subsets of the adult population remain susceptible, including health-care workers. Prior to a planned roll-out of hepatitis B vaccination for health-care workers, we conducted a knowledge, attitudes and practices survey to inform education programmes aimed at promoting vaccine uptake. Clinical and non-clinical health-care professionals at risk of occupational exposure to hepatitis B were invited to complete an online survey from April to June 2024. The survey sought information on hepatitis B knowledge
(10 questions), attitudes (6 questions) and clinical practices (3 questions), as well as participant demographics. Participant knowledge scores were calculated and potential associations with demographic factors explored using Fisher's exact test. Most of the 50 respondents were female (73%) and worked in either hospitals or the Ministry of Health (82%). Knowledge was high, with a median score of 9 (range: 3-10); 21 participants scored 100%. The proportion of incorrect responses was highest for questions related to treatment availability and transmission risks. We found no evidence of associations between demographic factors and knowledge scores. Most participants believed that hepatitis B vaccines were useful (88%) and prevention and control measures would protect them from infection (96%). Our survey revealed high levels of knowledge and generally positive attitudes towards people with hepatitis B and infection control practices. While our respondents are unlikely to be representative of all health-care workers in Vanuatu, findings offer useful insights into specific knowledge gaps that could be addressed in planned health-care worker education sessions ahead of the vaccination roll-out.
In 2023, Republic of Korea's Korea Disease Control and Prevention Agency (KDCA) enhanced its event-based surveillance practices by using the World Health Organization's (WHO) Epidemic Intelligence from Open Sources (EIOS) to actively screen and share information about potential public health threats to the country. This report describes the preliminary assessment of the results of implementing these enhanced event-based surveillance activities from June to October 2023. During this period, 425 (0.4%) events were detected globally by the KDCA from 99 945 media articles, with the highest frequency reported in Asia (185, 43.5%) and North America (81, 19.1%). The most frequently reported diseases or conditions were dengue fever (111, 26.1%) and mpox (32, 7.5%). Eight events were detected early by the KDCA using EIOS before being officially listed on WHO's Event Information Site (EIS) or in Disease Outbreak News (DON), with an average interval of 20 days (range: 5-41) between the detection date and posting on EIS or DON. Thus, EIOS is efficient in aiding early detection of potential public health threats at the national level. This finding highlights the importance of sustaining international cooperation and support to enhance surveillance capabilities in resource-limited settings and expanding the scope of EIOS, including by incorporating additional sources and sources in additional languages, reducing noise. However, as the current report is based on a descriptive analysis, in the future a systematic evaluation of event-based surveillance using EIOS to identify relevant attributes will need to be conducted.
Antimicrobial resistance (AMR) is a global concern. However, in Cambodia, as in other countries in the World Health Organization's Western Pacific Region, the magnitude of the problem is largely unknown. Thus, this study aimed to determine the prevalence of AMR in common pathogens, namely Escherichia coli and Staphylococcus aureus, isolated from blood cultures at one provincial hospital, a national sentinel site for AMR surveillance, during a 3-year period. Sample processing and analysis were conducted at the hospital's on-site microbiology laboratory. Blood cultures were processed manually, and conventional methods were used for bacterial identification. Antibiotic susceptibility testing (AST) was performed by disk diffusion and Etest minimum inhibitory concentration measurement, in accordance with current Clinical and Laboratory Standards Institute guidelines. Blood culture data from 1 January 2020 to 31 December 2022 were extracted from the hospital's microbiology database and, for the AST analysis, deduplicated to include results only for the first isolate per patient per year. Of 6102 blood cultures collected, 529 (9%) were positive. The most common blood culture pathogens found were E. coli (150, 28% of positive isolates) and S. aureus (65, 12% of positive isolates). For E. coli, resistance to ceftriaxone was detected in 110/148 (74%) isolates and resistance to imipenem in 3/147 (2%). For S. aureus, 18/56 (32%) isolates were methicillin-resistant, but vancomycin resistance was not detected. These rates of resistance to first-line treatments are of concern and have the potential to negatively impact patient outcomes.