Friday, May 04, 2018

WHO Handbook: Managing Epidemics

Epidemics of the 21st Century Credit WHO


As the graphic above illustrates, the first two decades of the 21st century have been marred by a number of infectious disease epidemics, with 9 of 11 of them kicking off in the past 10 years.
  • SARS
  • H5N1
  • H1N1 Pandemic
  • Cholera in Haiti
  • MERS-CoV
  • H7N9 in China
  • Ebola In West Africa
  • Zika in the Americas
  • Yellow Fever in Central Africa/Brazil
  • Cholera In Yemen
  • Plague in Madagascar
And these were just the major events; to this list we could easily add Chikungunya in the Americas, Lassa Fever in West Africa, Monkeypox in Nigeria, EV-71 in China, and many, many others.

Add in the rise of old scourges, like measles, mumps, and diphtheria - along with  the staggering growth in antibiotic resistant organisms - and it appears that the predictions of anthropologist George Armelagos of Emory University more than 30 years ago, that we are an age of emerging and re-emerging infectious diseases, is on target (see The Third Epidemiological Transition).

In an attempt to help meet the challenge of an increasing number of infectious epidemic threats - and to prepare for the possibility of a pandemic - public health agencies and other entities around the world have been busy releasing or updating their guidance.

Some released over the past year include:
WHO List Of Blueprint Priority Diseases

ECDC: Guide To Revising The Influenza Pandemic Preparedenss Plan
The CDC/HHS 2017 Community Pandemic Mitigation Plan

World Bank: World Ill-Prepared For A Pandemic

Today we can add another; a 260 page handbook on the emerging disease threats of greatest concern - and how to respond to them - originally prepared for World Health Organization staff.
2 May 2018 – This resource provides concise and up-to-date knowledge on 15 infectious diseases that have the potential to become international threats, and tips on how to respond to each of them.

Originally created as a guidance for WHO staff, it is available to a wide audience, including communities, government officials, non-State actors and public health professionals, who need to respond rapidly and effectively during disease outbreaks and health emergencies.

At 260 pages, there's not much point in my trying to post excerpts, other than its mission statement (below). 
Despite its impressive length, this is not a highly technical manual, and is chock full of graphs, charts, maps, and other illustrations to make it's subject matter easier to digest.
You'll undoubtedly want to download (and keep) this publication as a reference guide.

About this handbook
Handbook purpose

Epidemics of infectious diseases are occurring more often, and spreading faster and further than ever, in many different regions of the world. The background factors of this threat are  biological, environmental and lifestyle changes, among others.
A potentially fatal combination of newly-discovered diseases, and the re-emergence of many long-established ones, demands urgent responses in all countries. Planning and preparation for epidemic prevention and control are essential.

The purpose of this “Managing epidemics” manual is to provide expert guidance on those responses. Although this publication is open to a wide readership, it is primarily intended to help the World Health Organization (WHO) country representatives (WRs) to respond effectively and rapidly atthe very start of an outbreak.

The manual provides concise and basic up-to-date knowledge with which WRs can advise Ministries of Health in all countries. Specifically, it examines and explains in detail a total of 15 different infectious diseases and the necessary responses to each and every one of them.

These diseases have been selected because they represent potential international threats for which immediate responses are critical. Nearly all of them are subject to WHO’s International Health Regulations (2005) monitoring, and are part of the Global Health Security Agenda.

Perhaps the greatest threat outlined in the manual is an influenza pandemic, which is both unpredictable and inevitable. In the worst-case scenario, there will be no protective vaccine for six months or longer after the virus is identified, and even there will be a global shortage of doses.

On this and other threats, the manual focuses on practical and indispensable things to know about infectious diseases that are most important for national political and operational decision-makers; it also links readers to more exhaustive WHO guidance. It has been developed in parallel with the creation of the WHO MOOCs (Massive Open Online Courses) on open WHO (

This year is both the 100th anniversary of the 1918 H1N1 pandemic, and the 50th anniversary of the 1968 H3N2 pandemic. While viruses don't read calendars, or care about anniversaries, every year that passes brings us closer to the next global health crisis.
Whether that comes from pandemic influenza (a leading contender), an emerging coronavirus (like SARS or MERS), or perhaps from something not yet on our radar - Virus X -  it will be important for everyone to have a plan, and to be prepared to implement it.
Some previous blogs on pandemic and disaster preparedness include:
Disaster Planning For Major Events

The Challenge Of Promoting Pandemic Preparedness

Pandemic Unpreparedness Revisited

Smithsonian Livestream: “The Next Pandemic: Are We Prepared?"

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