Projects

Mekong Basin Disease Surveillance Network (MBDS)

Overview | Impact | Activities | Challenges | Supporters | Future Direction

Overview

NTI's Global Health and Security Initiative supports the an infectious disease surveillance network in Southeast Asia. In 1999, delegates from Ministries of Health in six Mekong counties agreed to collaborate in disease surveillance and outbreak management through the Mekong Basin Disease Surveillance (MBDS) Network.. The six countries include Cambodia, Yunnan and Guanxi Provinces of China, Laos, Myanmar, Thailand and Vietnam. A Memorandum of Understanding (MOU) signed by each country's Minister of Health formalized this collaboration in 2001. A new MOU was signed in May 2007, reinforc ing the MBDS partnership. MBDS facilitates new and stronger relationships to influence the way health officials in the region interact with each other.

Impact & Achievements

New relationships

MBDS helped establish a working relationship between WHO country offices in Asia. The MBDS Network demonstrates systems that facilitate compliance with the International Health Regulations through development and testing of guidelines and protocols with multiple sectors at border sites.

Tabletop exercises

With support from GHSI, MBDS conducted six national and one regional tabletop simulation exercises. In March 2007, senior government officials from all six MBDS countries completed a first-ever regional simulation exercise designed to test responses to a pandemic influenza emergency. Using techniques similar to those in modern war-gaming, the tabletop exercise was designed to foster cooperation among MBDS countries and also helped identify gaps and weaknesses in systems for detecting, monitoring, tracking and containing the deadly disease. Exercise participants responded to a plausible scenario involving a flu virus that threatens to spread into a pandemic.

Rapid Response Team to Myanmar for post-cyclone relief

In the aftermath of Cyclone Nargis, MBDS was able to deploy Rapid Response Teams to Myanmar with support from NTI. Representatives from MBDS were part of the 32 member medical team that assisted refugees in the Myuangmya region, approximately 46 miles from the hardest hit area of Laputta. The team was concerned about outbreaks of infectious respiratory diseases that without immediate assistance could spread to neighboring regions. Fears of cholera, as well as mosquito-borne diseases such as malaria and dengue fever, which are endemic to the area, were heightened, and the necessary aid was not being delivered due to the military leadership's initial refusal of outside support. MBDS helped facilitate this post-disaster relief effort which may not have mobilized without the existing relationships and collaborative procedures formed through this network.

MBDS and Red Cross representatives helped cyclone refugees in the flooded regions of Myanmar.

Activities

Regular cross-border information exchange

Data from routine surveillance on priority diseases in each site are exchanged through the national coordinators and the adjacent province's site coordinator. Reports of suspected outbreaks are also conveyed as appropriate. Information exchanges are carried our daily, weekly, monthly, or quarterly across border provinces.

Joint outbreak investigation and response

Cross-border teams made up of health, customs, immigration, and border officials established in 2006 facilitate the following activities:

• Dengue fever investigation between the Laos and Thai provincial sites, enabling officials to effectively stamp out the cross-border outbreak.
• Typhoid investigation between Laos and Vietnam provincial sites.
• Avian influenza investigation of cases in humans, triggered by the discovery of an infected Laos citizen in Thailand. Within less than 24 hours of the initial report from the MBDS coordinator in Thailand to his counterpart in Laos, a team was dispatched from Thailand to Laos to support the investigation.

Training of healthcare personnel

The joint Thai-U.S. CDC Field Epidemiology Training Program, Mahidol University, and the Southeast Asian Ministers of Education Organization -TropMed programs coordinate annual training for MBDS participants… As a result of these efforts, participants have enhanced their skills in research, outbreak investigation, and communication, and have established friendships and mutual trust with officers from adjacent provinces across borders.

Field epidemiology training

Members of MBDS are working to create and maintain existing field epidemiology capacity via a new Southeast Asia network - called The International Group for Epidemiology and Response (TIGER). The network produces graduates and tracks capacity building of field epidemiology training program (FETP), FE(lab)TP, FE(vet)TP, with particular attention to the increasing formal and informal scientific communication among MBDS countries and mentoring countries.

Distance learning

GHSI has partnered with the University of Edinburgh to provide online degrees to graduate students in Cambodia and Laos, for the advancement of veterinary and epidemiology professionals (link to press release). GHSI and the Fondation Merieux have provided ten scholarships for the entering 2008 cohort.

ProMED-MBDS

ProMED-MBDS is a special service of ProMED-mail for the MBDS countries and is a result of a collaboration between the International Society for Infectious Diseases' Program for Monitoring Emerging Diseases (ProMED-mail) and MBDS. ProMED-mail is an Internet-based reporting system. By providing early warning of outbreaks of emerging and re-emerging diseases, public health precautions at all levels can be taken in a timely manner to prevent epidemic transmission and to save lives. Communication between the lists of ProMED-mail and ProMED-MBDS will permit the reporting of important outbreaks that are occurring in the region and allowing for an early notification of outbreaks within the region.

Challenges

Language barriers

The MBDS Network operates across multiple languages in the region, including Thai, Lao, Vietnamese, Burmese and Mandarin. As a result, communication can be a challenge, not only between MBDS partner agencies but also among local communities.

Information security

Because public health information can be very sensitive, security concerns remain a barrier to effective data integration across borders. However, the trust and relationships that have developed through MBDS allow for much greater sharing of information.

Animal and human health

MBDS participants recognize a need for closer communication between programs within the health sector, and with other sectors such as veterinary public health. MBDS is working to integrate the animal and human health sectors in their core projects.

Infrastructure

MBDS participants continue to grapple with limitations in human resources and health systems. An additional hurdle includes unreliable communications technologies and systems, especially in rural areas.

Supporters

NTI's Global Health and Security Initiative provided targeted support for six national and one regional pandemic preparedness "tabletop" exercises, and is currently providing both technical and financial support for laboratory and human resource capacity building among the MBDS countries. The Rockefeller Foundation and the World Health Organization were initial supporters of the network. The Rockefeller Foundation continues to support MBDS along with Google.org and the U.S. Centers for Disease Control and Prevention.

Future Direction

GHSI is working with MBDS to strengthen human resource capacity in epidemiology enhancing laboratory capacity at the national and provincial levels.

Links

MBDS Action Plan