Risk Assessment

& Control Measures

Dr Wan Noraini Wan Mohamed Noor

Disease Control Division, MOH

Objectives
After completing this lesson, you will be able to
describe:
How risk matrix can be used to rank control
measures according to their effectiveness.
The application of STEEEP consequences in
implementing control measures.

The Risk
Management
Cycle
(Source: World Health Organization.
Rapid Risk Assessment of Acute Public Health
Events. 2012)

Introduction
The outcome of risk assessment should be used to direct
proportionate control measures that reflect the risk
The overall level of risk assigned to the event helps identify the
urgency and extent of the control measures needed
Control measures include measures that are aimed at:
Reducing the impact of the acute public health event: these
include immunization, prophylactic medicines and antitoxins, case
management, social mobilization and media communication
Preventing spread: these include infection control and health
staff protection, contact tracing and surveillance, environmental
control measures, mass prevention, social mobilization and media
communication

The Risk Matrix

The risk matrix can also be used to rank the likelihood that a
control measures will prevent further spread or dissemination of a
hazard and the consequences of applying each control measures
Consequences
Likelihood

Almost certain
(5)
Highly likely
(4)
Likely (3)
Unlikely (2)
Very unlikely
(1)

Severe
(5)

Major
(4)

Moderate
(3)

Minor
(2)

Minimal
(1)

10

8
7

7
6

6
5

5
4

4
3

The likelihood that a control

measure will prevent further
spread
Level

Definition

Almost certain

Is expected to prevent additional cases in most

circumstances

Highly likely

Will probably prevent additional cases in most

circumstances

Likely

Will prevent additional cases some of the time

Unlikely

Could prevent additional cases some of the time

Very unlikely

Could prevent additional cases under exceptional

circumstances

Consequences
of
implementing
each control
measure

STEEEP Consequences & Control Measures

Assessing the likely effectiveness and
consequences of control measures helps to ensure
that they are appropriate to the risk of harm
Upon which, the risk assessment team should also
consider all aspects of the STEEEP consequences
when giving options and recommendations of each
control measures
This type of assessment can help the team to
convince decision-makers of the most appropriate
set of control measures and to assist in deciding on
the level of acceptable risk

STEEEP

Social
Technical & Scientific
Economic
Environmental
Ethical
Policy & Political

Examples of STEEEP Consequences

Social

Effects of restricted contact e.g. for families visiting infected or seriously ill patients
Changes of important social or religious events e.g. social distancing policies
Impact on lifestyle e.g. changes to child care arrangement
Acceptability of the control measures by the affected community
Social stigma from being a case of an infectious disease

Technical & Specific

Morbidity, mortality and long-term disability

Effectiveness of control measures
Ability to implement control measures in timely manner
Side effects of treatment or prophylaxis

Economic

Direct financial costs for the preparedness and response agencies

Direct financial costs of the response activities for the affected individual/families
Indirect costs e.g.
Effect on individual and family ability to work
Effect on travel and trade
Effect on tourism

Examples of STEEEP Consequences (2)

Environmental

Negative effects of control measures on the environment (e.g.

contamination/residues)

Ethical

Individual liberty (e.g. restricted movement)

Unintended consequences (e.g. removal of primary food sources for families when
livestock is culled and no alternative can be provided)
Use of unlicensed or unregistered drugs and vaccines
Informed consent
Duty to provide care
Transparency
Unequal burden of risk (e.g. healthcare workers, other first responders)

Policy & Political

Views of senior management in a response or supporting organization

Diversion of resources from other programmes and projects to support the response
Views of the Ministers of Health and other Ministers
Views of Opposition parties
Imminent elections and other politically charged situations
Likely response of the media and key stakeholder groups

Technically & scientifically appropriate

but
The Event

The Recommendation

The Kingdom of Saudi Arabia

regularly reported sporadic
laboratory-confirmed cases of
MERS-CoV

Travellers should consider

postponing non-essential travel to
the KSA

An on-going and extensive

outbreak of Zika virus disease in
Brazil with the international
scientific consensus that Zika virus
is a cause of microcephaly and GBS

Postponing (or relocating) the

Olympic & Paralympic Events 2016

The longest, largest and most

widespread Ebola outbreak in
history and the first in West Africa

Quarantining humanitarian workers

or health care workers returning
from West Africa as part of the
efforts to contain Ebola virus
disease

Nevertheless .
At any stage, appropriate
control measures should
be carried out and
adapted according to new
information being
received. Control
measures should never
be delayed because
investigations are still
ongoing.

TERIMA KASIH