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Japan’s Response to Ebola Outbreak in West AfricaA case of strengthening national implementation& lessons for cooperation and assistance

Tomoya Saito, MD, MPH, PhDChief Senior Researcher

Department of Health Crisis Management NATIONAL INSTITUTE OF PUBLIC HEATLH, MHLW

Visiting Associate ProfessorGraduate School of Science and Technology

TOKYO INSTITUTE OF TECHNOLOGY

BWC Expert Meeting 2015

Japan’s Ebola Response© T Saito/NIPH 2015

Introduction

n Ebola Virus Disease (EVD) outbreak in West Africa started in 2014 was the largest outbreak in history.q “Public Health Emergency of International Concern”q “constitutes a threat to international peace and security”

UN Security Council Resolution 2177 (2014)

n Although travelling between Japan and West Africa is very limited, Government of Japan reinforced the response capacity, taking a whole-‐of-‐government approach.

n Reinforcement of domestic capacity and international cooperation for EVD were reviewed to derive lessons for BWC context.


REINFORCING DOMESTIC CAPACITYFOR EVD IN JAPAN

A case of strengthening national implementation


n Legal Preparednessq Act on Infectious Disease Control

n Category 1 Infectious Diseases1)

q Hospitalization in Specified or Class 1 Infectious Disease Hospitals2)

q Restriction of activities, etc.

q Quarantine Actn Quarantine Diseases

q Isolation, Quarantine, etc.

n Medical Preparednessq 453) Infectious Disease hospitals for treatment2)

q Dx capacity at BSL-‐3 Laboratory in National Institute of Infectious Diseases

Preparedness for Viral Hemorrhagic Feversin Japan

1) Others include Smallpox and Plague2) With a negative pressured private ward with toilet and shower, dedicated ventilation and drainage, etc.3) 3 Specified* (designated by GOJ) and 44 Class 1* (designated by local gov.) as of Aug. 2014. * 2 are designated for both.


From August 2014: Reinforcement of border measures

n Raising awareness at Quarantineq Ensuring voluntary reporting of a travel

history to endemic countries to quarantine stationsn Postersn In-‐flight announcements

n Management for travelers from endemic countriesq Contact history (+), Symptom(+):

>>> Hospital isolationq Contact history (+), Symptom(-‐):

>>> Health monitoring


n Management for travelers from endemic countriesq Contact history (+), Symptom(+):

>>> Hospital isolationq Contact history (+), Symptom(-‐):

>>> Health monitoring

n Transmission in non-‐endemic countriesq Spainq U.S.

n Large increase of patients in endemic countries

n Hospital visit of a patient without declaration of the travel history to endemic countries (IASR 2014;35:274-‐275)

Travel history to endemic countries within 21 days = “contact history”

（from Oct. 24 2014)

Request high risk contacts to stay home (from Nov. 21 2014)

Additional Measures

From October 2014: Further reinforcement of measures


Whole-‐of-‐government response for EVD

Ministerial Meeting on the response to EVD

President: Prime Minister

Intergovernmental Coordination Meeting on EVD measures(Senior Official level)

Chairman: Deputy Chief Cabinet Secretary for Crisis Management

http://www.kantei.go.jp/jp/96_abe/actions/201410/28ebolakaigi.html

Established on October 28, 2014


Suspected cases screened for EVD in JapanYear Date Age Sex Residence Country Symptom Results Diagnosis2014 Oct27 40’s M ー Liberia Fever Negative ー

Nov7 60’s M Japan Liberia Fever Negative Tonsillitis

Nov7 20’s F Guinea Guinea Fever Negative Malaria

Dec29 30’s M Japan Sierra Leone Fever Negative Acute sinusitis

2015 Jan18 70’s F Sierra Leone Sierra Leone FeverCough

Negative Influenza

Mar15 40’s M Japan Liberia Fever, body aches, Chill

Negative Malaria

May18 40’s M Japan Guinea Head& back pain, fever

Negative Malaria

July1 40’s M Japan Guinea Fever Negative Malaria

July15 30’s M Guinea Guinea Fever Negative ー


n Capacity buildingq Expanded medical capacity

n Trainings in Infection Control (PPE, etc.)n 2 newly designated Class 1 Infectious Disease Hospital

q Convergence of limited expertisen Expert Committee for Therapeutics of Category 1 diseases at MHLW

q Operation of BSL4 Lab in NIIDn MoH reached an agreement with a local municipality in operating a BSL4 facility in NIIDn MoH designated NIID as a possessor of VHF pathogens on August 7, 2015.

n Interdepartmental collaborationq Whole-‐of-‐government responseq Collaboration of public health institute with Police/Fire Defense

n Documented protocol for transporting patients/lab samples

q Exercises in all 141 municipalities that owns public health centers

Public health legacies in Japanafter EVD outbreak in West Africa


CONTRIBUTION OF JAPAN FOR EVD OUTBREAK

Lessons for cooperation and assistance


Japan’s response to EVD outbreak in West African Total funding: USD 184 millionn Financial contribution (GOJ)n In-‐kind contribution (GOJ &JICA)

q Medical equipmentq Vehicles including ambulancesq Thermography camerasq Favipiravir (subject to a request)

n Personnel contribution (GOJ &JICA)q WHO GOARN

q UNMEER etc. http://www.mofa.go.jp/af/af1/page23e_000338.html


n Development of Ebola test kitq RT-‐LAMP assay system with a portable

LAMP device (Genie III) and specific primers developed in Nagasaki U

q High specificity and sensitivity shownby testing clinical samples in DonkaHospital in Guinea

n In-‐kind contributionq Provided to Guinea on request in April 2015

for use in the intensive campaign

Development and in-‐kind contribution of medical countermeasures (1)

Diagnosis kit was installed in a mobile lab and technical support was provided.

Genie III

By courtesy of Prof. Yasuda, Nagasaki University


n Development of anti-‐virals for EVDq Provided for an emergency use

in developed countries and a clinical trial (JIKI study) in Guinea by Toyama Chemical (in-‐kind)

q Pre-‐clinical studiesn Pharmacokinetics*n Safety studies in juvenile monkeys*n Challenge studies in animal model

q Development of intravenous injection form*

Development and in-‐kind contribution of medical countermeasures (2)

Favipiravir(Toyama Chemicals)

Licensed in Japan fornovel/re-‐emerging influenzaEfficacy for EVD in Mouse

*Project for Research and Development of Therapeutics and Diagnostics for EVD controlPI: Professor Tsutomu Takeuchi, St. Luke’s International University/funded by AMED


n Sharing protocols and reagentsq Taiwan, Thailand, Viet Nam, Philippine

from NIID Japan

n Training and lecturesq In 3 institutes in Viet Namq Accepted trainees from Thailand,

Viet Nam, Philippine, Indonesia, Laos, Malaysia, Zambia, Ghana in NIID Japan

Support and assistance for non-‐endemic countries and regions from Japan (1)

Training and lectures in NIHE in Viet Nam supported by JICA

Training and lectures in NIID, Japan supported by MHLW

By courtesy of Virology I, National Institute of Infectious Diseases


n Laboratoriesq Noguchi Memorial Institute of Medical Research in Ghana,

Kenya Medical Research Institute (KEMRI)q School of Veterinary Medicine in University of Zambia

n Points of Entryq Cote D’Ivoire, Ghana, Ethiopia, Kenya

n Health Facilitiesq Senegal, Ghana, Benin, Nigeria, Burkina Faso, Kenya

n Public awarenessq Ghana, Nigeria, Zambia, Senegal, Benin, Burkina Faso

n Knowledge sharingq Knowledge and experience sharing among francophone

countries (workshops in Cote D’Ivoire (in collaboration with DRC) and in Morocco)

Support and assistance for non-‐endemic countries and regions from Japan (2)

Presentation ceremony for Ebola Case Management Guideline toward health care workers and Mobile Surveillance System

(mSOS-‐Ebola) in Kenya

By courtesy of Japan International Cooperation Agency (JICA)


n Challenges in cooperation and assistanceq Personnel contribution was limited to 〜20 expertsn Lack of human resourcesn No deployable national team for an outbreak assistance n Safety and security

q Medvac capacity

Japan’s response to the Ebola outbreak in West Africa


Human resource development for global infectious disease control in Japann Development Program for Experts of Infectious Disease Crisis Management by MHLWq 2 year program

n OJT as a medical officer in MHLW, a trainee in FETP in NIID and an infectious disease physician in a hospital

n OJT in international agencies, etc.

q 5 MDs/yearq Registered as “Infectious Disease

Crisis Management Experts”to be dispatched in global emergency

Clinical expertise

International coordinationManagement


Summary (1)A case of strengthening national implementationn EVD outbreak from 2014 provided a crucial opportunity to reveal challenges and to improve preparedness in Japan for rare but high impact emerging diseases that are prone to be neglected. q Progress in interdepartmental collaboration was

remarkable through whole-‐of-‐government approach.q Efforts to sustain “legacies” may help contain future

emerging diseases including acts of bioterrorism and pandemic influenza.


n Continuous international support is required for developing IHR core capacity.

n Cooperation and assistance for surrounding non-‐endemic countries should not be neglected.

n Safety and security for dispatching experts to affected countries is a challenge even in a natural outbreak.q More efforts on capacity development concerning safety

and security of personnel is required for the assistance under Article VII.

Summary (2)Lessons for cooperation and assistance


Acknowledgment

n National Institute of Infectious Diseasesq Drs. Saijo, Shimojima, Fukushi (Dept. of Virology I)

n St.Lukes International Universityq Prof. Takeuchi, Ms. Maehira

n Nagasaki Universityq Prof. Yasuda

n National Institute for Defense Studiesq Dr. Tanaka

n Japan International Cooperation Agency (JICA)n Ministry of Foreign Affairs, Japann Research Fund from Japan Agency for Medical Research and Development

(15fk0108012h0201,15fk0108039h0002)and JSPS KAKENHI Grant Number 15KT0054

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