The failure mode and effect analysis (FMEA) methodology may facilitate physicians and public health officials instituting beneficial new controls for detection and assessment of dengue ahead of the 2020 summer Olympics and Paralympics in Tokyo, according to a study recently published in PLoS One Neglected Tropical Diseases.
Those who participate and attend international sporting games are at risk for acquiring both local and imported endemic infectious diseases. In 2014, an unexpected dengue outbreak occurred in Tokyo, which was the first time in 70 years that Japan experienced an autochthonous transmission. Dengue is a mosquito-borne disease that spreads emerging arboviruses. Symptoms typically develop between 4 to 7 days after the bite of an infected mosquito and last for 3 to 7 days. Although most patients recover without complications, roughly 5% of cases progress to severe dengue, which carries a high mortality rate when left untreated. Tokyo’s outbreak implies that the region possesses suitable climate and conditions for the existence of the Aedes mosquito, which is the common vector, and thus another potential dengue outbreak. Because infectious disease outbreaks can occur with little warning, host countries must be well prepared to address these challenges. Therefore, this study sought to identify strategies for early detection and prevention of dengue infection during the 2020 Summer Olympics and Paralympics in Tokyo.
The FMEA methodology was modified to examine the current controls for dengue detection and assessment specifically. Processes were divided into 3 components: detection of the disease focused on the role of travelers and community; assessment of the disease focused on the role of physicians, hospitals, and clinics; and patient communication. Other interventions for prevention or mitigating disease spread were not included, such as vector control strategies and community education.
Analyses showed 20 failure modes: 8 for detection of disease, 6 for assessment of disease, and 6 for patient communication. There were 5 failure modes that had risk priority numbers higher than 150 that fell into 3 main gaps, which included missed cases at vacation rentals, physicians failing to diagnose cases either at noninfectious disease-designated hospitals or clinics or at night, and communication failure at either vacation rentals or hospitals and clinics. These gaps could be reinforced in the following ways:
- Providing cyclic training or a certification program on tropical disease management for physicians, especially those working in noninfectious disease-designated hospitals or clinics
- Strengthening multilanguage communication methods in the health and hospitality sector
- Incorporating a formal tropical disease-training program for staff members of vacation/hospital accommodations and having a contingency plan for travelers suspected of having an infectious disease
Overall, the study authors concluded that, “[a]lthough FMEA analysis described has been applied to health‑preparedness plan for the potential outbreak of dengue at the 2020 summer Olympic and Paralympic Games in Tokyo, it certainly could be extended to other infectious diseases.”
Yanagisawa N, Wada K, Spengler JD, Sanchez-Pina R. Health preparedness plan for dengue detection during the 2020 summer Olympic and Paralympic games in Tokyo. PL0S Negl Trop Dis. 2018;12:e0006755.