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Joined Up Thinking – Introduction

Professor Lightfoot has long been an expert in Emergency Response and Preparedness, and good collaboration between individuals, institutions, governments and nations has always been at the heart of his approach. In essence, his speciality is ‘joined up thinking’ – an ability to create and inspire effective communication in the face of public health crisis and CBRN threat.

Two recent projects have brought the need for joined up thinking centre stage, in relation to international Biosafety and Biosecurity. We will be describing these projects in our blog this week.

Do you need help to create joined up thinking in your organisation? How will you deal with the next global pandemic and it’s impact on your employees, customers and markets? NL Associates can help you know that you have done everything that you can to prepare for disaster and feel confident that if it happens you’ll be able to respond appropriately.

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Food Security

There is currently an outbreak of Salmonella Bareilly in the US. The number of people affected continues to rise and the geographic spread continues to widen. We have reported on the progress of this outbreak in our Daily Alerts and have provided more comprehensive coverage in our Weekly Food Safety Alert.

There are some important lessons to be learned from this outbreak. That a single food production facility in India can cause so much illness across the US indicates the weakness in developed countries’ food production systems which rely on mass production and global distribution. It is also worthy of note that such a vulnerability presents an opportunity for bioterrorists and others with malicious intent..

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Hand, Foot and Mouth Disease in Asia

We have recently been tracking reports of an increase in the number and severity of cases of Hand Foot and Mouth disease in Asia. It is not possible to get exact numbers but we have seen reports from China, Vietnam and Indonesia, with thousands of illnesses and tens of fatalities per outbreak.

The earliest reports that we have tracked are from Vietnam in August 2011 when the Ministry of Health declared a pandemic. At that point there had been 32,000 cases and 81 deaths in Vietnam so far in 2011. However, further research has shown that there has been a large and rapid spread of Hand Foot and Mouth disease in China since 2004.

In the UK and US Hand Foot and Mouth disease is most commonly caused by coxsackie virus A16. It causes mild symptoms and mostly affects children. The outbreaks we are seeing in Asia are caused by a range of enteroviruses but one that is commonly reported is human enterovirus 71 (HEV-71). The numbers of people affected, the severity of the symptoms and the incidence of fatality from this form of the disease are a cause for concern.

We have recently seen a report into the development of a vaccine against HEV-71. This work has been prompted by the rapid rise in cases of this more virulent form of the disease. it is interesting to note that human enteroviruses evolve in much the same way as influenza viruses do, which raises the spectre of more virulent and dangerous strains arising and makes combating the disease through vaccine development more difficult..

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Listeria

The very recent hospital outbreak of listeriosis in Northern Ireland resulting in six cases and one death is an unfortunate reminder of the dangers of this organism for the elderly, the immunocompromised and pregnant women.

The organism, Listeria is widespread in the environment and occasionally contaminates food such as soft cheeses, cold cuts of meat, pâtés and smoked fish.  It can also contaminate ready meals that have been pre-cooked and then chilled for some time before consumption. Listeria is an unusual organism in that it can grow at 5 degrees C, i.e. fridge temperatures and therefore care has to be taken with use-by dates and storage times.

In normal healthy adults the ingestion will only cause a mild infection that is flu-like and may be accompanied by diarhorea but in those with predisposing conditions may lead to serious infection.

Those with increased risk are advised to avoid these foods..

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The Kangaroo Group Workshop

In March, Professor Lightfoot travelled to Brussels to put on a workshop for the Kangaroo Group in the European Parliament. Attended by forty member state delegates from the European Council and MEPs, the workshop addressed the issue of Cross Border Health Threats and asked the question – Is The European Union prepared for a Bio-Terrorism Attack?

Professor Lightfoot gave the keynote presentation and directed his listeners’ attention to one key concept immediately ‘No one country can be expected to cope with a bioterrorist attack on its own…Member States will have to work together, coordination will be required and the international decision-making process will have to be researched, planned and then rehearsed’. His message was straightforward – ‘the essential requirement for rapid decisions in the first few hours is our mutual responsibility’.

He then went on to describe an imagined scenario of bio-terrorist attack – Anthrax – drawing his audience in to the drama and multiple streams of constantly developing information that they would be required to navigate and manage. He drew attention to the media and to the window of opportunity for effective response presented in the very earliest stages of attack; he raised the contamination issues of public transport, changes in weather and international travel and went on to consider the enormous challenge that will face the country in which the attack originally occurs. Will there be civil unrest? How will health care systems cope? How do we determine the areas of exposure rapidly? How do we protect emergency responders going into the contamination zone? How does that country begin recovery?

Professor Lightfoot emphasised that external help will be absolutely necessary.

A considerable amount of preparedness has been achieved since 9/11, but in the context of bio-terrorist attack a new paradigm of decision making will be required – decision-making within the first few hours. Critically, this speed response will not be achieved unless the response itself has been rehearsed. Professor Lightfoot concluded his keynote address by returning to the concept of mutual aid, ‘The proposed legislation on Cross Border Health Threats is an absolute requirement…it is easy to carry out an attack and yet very difficult to prevent’ – our defence is preparation, in a coordinated, united and codified way.

Throughout April, Nigel Lightfoot Associates’ blog posts have been united by the theme of prevention. We are an expert consultancy firm that helps clients to prepare for emergency situations. If you would like to find out more, please get in touch.

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Intelligence Gathering

In Atlanta in March, Professor Lightfoot met with two key players in the Intelligence Gathering sector – John Brownstein who runs Healthmap (http://www.healthmap.org/) and Larry Madoff who runs Promed (http://www.promedmail.org/). John and Larry are key contributors to the Global Health Security Initiative and form part of Professor Lightfoot’s Early Alerting Group.

Both Healthmap and Promed are making huge progress in the challenge of disease prevention. Their online systems use a wide range of open sources to track unusual incidences of infection and the result is a uniquely powerful mechanism of surveillance. By providing early warning of outbreaks, public health precautions can be taken quickly in order to prevent epidemic transmission and to save lives.

With so much information out there, the difficulty is how to focus on the important details and facilitate accurate risk assessments. It’s all about the lens that you use, which needs to be part machine and part human. Computer systems easily gather information, but it’s the human interface that is truly able to understand the problem and instinctively move towards hotspots.

The team at NL Associates depend upon intelligence gathering and have a number of systems in place to help track current public health events. We will profile the work of NL Intelligence Strategist Toby in May’s news update.

 

Next Up: The Kangaroo Group Workshop in Brussels

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CDC Atlanta

In early March Professor Lightfoot attended the International Conference on Emerging Infectious Diseases run by CDC Atlanta. CDC, founded in 1942, is the United States’ national public health institute and Atlanta it’s founding headquarters – due in part to the fact that malaria was once endemic in the Southern states.

The 2012 conference marked the eighth ICEID, organised in collaboration with public health partners including the American Society for Microbiology, the Council of State and Territorial Epidemiologists, the Association of Public Health Laboratories, and the World Health Organization. The conference brought together over two thousand public health professionals from around the world to foster knowledge exchange on global infectious disease issues.

It was a vast conference with a wide-ranging subject base – antimicrobial resistance, bioterrorism, respiratory infections, foodborne and waterborne illnesses, global health equity, influenza, international health regulations, vaccine preventable diseases, vector-borne and zoonotic diseases – presented through panel sessions with invited speakers, as well as oral and poster presentations on emerging infections.

Professor Lightfoot thoroughly enjoyed the experience and armed with a very weighty book of abstracts, focused in on his own areas of special interest – Salmonella, E Coli and Anthrax.

Christopher Lane of the UK Health Protection Agency presented on ‘Salmonella Enteritidis Epidemic in the UK Poultry Industry’, giving a description of the successful interventions that have been made to reduce high contamination rates in eggs and chickens since 1995. Interventions included improved poultry handling practices and vaccination strategy.

The most interesting part of these sessions is often the Q&A. Professor Lightfoot congratulated the HPA on their progress towards eradicating Salmonella, but mentioned the problem of Campylobacter, which 90% of chickens continue to be infected with. The speaker’s answer to his comment was an honest one, ‘that’s more difficult’.

Gerard Krause spoke about the 2011 German outbreak ‘STEC 0104-H4 Associated with Fenugreek seeds’, focusing in on investigation and epidemiological methods and concluding with lessons learned. NL Associates has recently produced an ebooklet on the E Coli infection, drawn from situation reports Professor Lightfoot issued at the time of outbreak, (to find out more click here) so this session was of special interest. Professor Lightfoot raised the question of how the fenugreek seeds became infected in the first place and the audience went on to address the key challenge for the future: how can we prevent the next large outbreak? This concept of first principles is, at its core, the bedrock of Emergency Preparedness.

As demonstrated by the German E Coli outbreak, the production of food is a whole series of steps from farm to plate. As soon as people begin to cut corners, be that through lack of training or investment, it is inevitable that something will go wrong. Professor Lightfoot has learnt from experience that outbreaks often occur due to a series of coincidences and that prevention is both simple and complex – a system must contain enough checks to ensure that errors are unable to stay undetected and mount up.

In the poster sessions Professor Lightfoot saw many interesting aspects of public health worldwide, but was drawn in particular to T.H. Whalen’s ‘Microbial Risk Assessment by Extrapolating Base Response Curve Lessons from Anthrax’ – a fascinating insight into the historic Anthrax outbreak of 1957 in a mill processing goat hair.

All in all, the CDC conference was a fantastic few days, from informal chats over coffee to high-level presentations drawing on cutting edge research. This is exactly the international network that Professor Lightfoot draws strength from in his work and gives clients unique access to in his consultancy work.  When you work with NL Associates, you’re working with the best in the field.

A conference such as CDC reports what has happened in the past and is a great chance to reflect, analyse and process. However, the next step must be to direct international energy towards early detection and prevention strategies.

Next Up: The importance of Intelligence Gathering

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The earlier you notice that something is beginning to happen, the more effective your intervention will be to reduce its impact

Professor Nigel Lightfoot, CBE

Over the last month Professor Lightfoot has travelled widely – to the US for CDC Atlanta’s International Conference on Emerging Infectious Diseases (http://www.cdc.gov/), to Brussels to give the keynote presentation for the Kangaroo Group in the European Parliament (http://www.kangaroogroup.eu/), to Geneva for the World Health Organisation (http://www.who.int/), to Berlin for the Robert Koch Institute (http://www.rki.de/) and most recently to London, in preparation for the Bio-Security event he will be running at Chatham House in May (www.chathamhouse.org/).

Professor Lightfoot’s approach to these different projects has been united by one theme – prevention; this first news update and three following posts will explore both the specifics of his recent consultancy work and the high-level concept of preparedness. It is of great value to understand what has happened in the past and work towards better investigation and detection strategies, but Professor Lightfoot is interested in one stage further – how governments, companies and individuals can work together to create processes and design intelligence gathering systems with enough resilience to prevent a problem from developing in the first place.

In other news: Professor Lightfoot has been invited by the European Food Safety Agency to speak about early alerting for food and feed safety issues and has a trip to the United States on the horizon. He and his team have also been following the recent HN51 controversy with interest and recommend a particular press report from the Guardian – http://www.guardian.co.uk/world/2012/mar/28/bird-flu-mutant-strains.

 

Next Up: Focus on CDC Atlanta

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Daily Alert, Tuesday 10th April 2012

Schmallenberg Virus England

DEFRA reports on new numbers

DEFRA has reported that 239 farms in England are infected with Schmallenberg virus. Infection with the virus has been reported at 214 sheep farms and 25 cattle farms.

DEFRA web site.

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Schmallenberg Virus Situation Report

The Schmallenberg Virus Outbreak is exactly the kind of public health threat that NL Associates specialises in – crossing borders and developing hour by hour.

We keep a constant watch on news and information sources and we are now offering a new On Demand Schmallenberg Situation Report to keep our clients informed and reassured.

This On Demand situation report delivers current outbreak status, scientific detail and expert opinion – saving you time searching online and allowing you to see the ongoing public health threat through the eyes of expert medical advisor Professor Lightfoot CBE and his team of analysts. It will be updated regularly as the outbreak progresses.

Governments and health providers consistently seek out our expertise – now you too can access our knowledge and advice with ease.

The Schmallenberg Situation Report is part of our new Information Services for 2012 – for details please click here.

To find out more or to subscribe, please get in contact..

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