Problem Statement: In global companies with internationally mobile workforces and operations where people work and live together, infectious disease outbreaks can impact the health of workers and communities, disrupt operations and affect a company’s reputation. Emerging diseases such as coronaviruses and avian flu can be challenging in these settings. Adequate control of outbreaks in Company workplaces requires standardized measures that are globally communicated and applied consistently across worksites and countries. Objectives and Scope: Provide a standard and efficient approach to infectious disease outbreak prevention and control, including communication procedures and action plans with staged response for both known and emerging infectious diseases with outbreak potential. Method: Building on its global pandemic flu plans and site Infectious Disease Outbreak Management (IDOM) measures, the Company used a two-pronged communication approach to engage stakeholders and communicate with workers on latest emerging diseases: the Middle East Respiratory Syndrome coronavirus and avian influenza H7N9. This approach was developed within Company systems and interfaces at affiliate and headquarters levels, as well as with external experts to generate action plans aligned with scientific evidence progressively made available. Significant New Information: This outbreak management model represents an effective global and scalable approach to mitigate the impact of various communicable diseases in workplaces. Standardized outbreak management and communication approaches are potential innovations for oil and gas companies that could better protect the health of their workers and business. Conclusions: Infectious disease outbreak risk should be consistently integrated into safety, security, environmental and health programs of oil and gas sector companies, regardless of the geographic locations of their operation sites. Methodical application of evidence based outbreak prevention, preparedness and response measures, built on existing company systems, enables effective awareness, engagement and preparedness in Company sites.

This communication describes how the company established a corporate steering committee and programs built on operations systems to effectively protect its large globally mobile international workforces from vector borne diseases, outbreaks, and other communicable diseases. Application: Infectious diseases have potential for serious health consequences, operation disruption, loss of productivity, and impact on a company’s license to operate and reputation. Mitigation of such threats in the oil and gas sector requires corporate commitment, intricate partnership between Operations, Security, Safety, Health and Environmental (SSHE) organizations with consistent use of effective mitigation measures built on company processes. Observations: Global implementation of the Company malaria control program decreased reported cases from 230 in 2002 to less than 15 since 2005. Chemoprophylaxis compliance testing developed with corporate funds was instrumental in such success. Following the deployment of Infectious Disease Outbreak Management in 2010, average number of affected workers during outbreaks decreased from 23 in 2010 to 12, in 2012. The Steering Committee for Infectious Disease Control assembles Company executives, SSHE managers and Medical and Occupational Health (MOH) department representatives. The committee and attached unit periodically review program needs and performances while providing guidance and resources for program improvements. MOH and SSHE organizations work in partnership with Operations and providers for tool development and updates, program implementation, effectiveness reviews and reporting. The Company operations integrity management systems include also effectiveness reviews of infectious disease control program in operations sites. Significance: The visible engagement of Company Executives in workplace infectious disease control programs is critical. Embedding disease control program procedures in company mechanisms, and building internal partnerships between Operations, providers, MOH and SSHE organizations are essential for the effective protection of oil and gas workers exposed to emerging and re-emerging infectious diseases around the globe. It also prevents spread of outbreaks from the operation sites to surrounding communities.

No abstract

Objectives/Scope: –Illustrate tuberculosis risk identified in communities and ExxonMobil workplaces–Describe approach for program design and targeted global implementation rollout–Present accomplishments in preventing TB transmission in ExxonMobil workplaces Methods, Procedures, Process: Tuberculosis (TB) was evaluated in country populations using World Health Organization sources and in Exxon Mobil Corporation (ExxonMobil or Company) and its affiliates’ operation sites to target workplaces with the highest risk. In consultation with external experts, Company health and safety professionals and executives, the existing TB program became required for all offshore sites and camps in areas with ≥20 TB cases per 100,000. An implementation gap assessment and executive rollout communications were performed. For program sustainability, a contractor exhibit was established, and Company operations integrity management systems integrated TB aspects with site and headquarters reporting. Results, Observations, Conclusions: Tuberculosis is now a priority for infectious disease control in ExxonMobil workplaces. Executive Company committee periodically reviews program accomplishments with the intent to prevent workplace transmission, and minimize impact on workers’ health and productivity. TB Program elements include awareness, periodic screening with questionnaire and testing (blood or skin test or chest X-ray), and case management with active TB contact tracing. The gap assessment conducted in 2014 identified inconsistent implementation across eligible sites and among contractors and employees. Following management guidance roll out and support by health and safety teams, all eligible locations implemented the TB program by end 2016. TB exhibits are progressively being integrated in new global contract agreements. Between January and September 2017, 3886 TB screening tests were performed with 481 positive results. Latent TB prevails between 3 and 5% percent in the US and Europe, and about 30 percent in Africa and Papua New Guinea. Identification of latent TB is important for follow up and early detection of active stage and for baseline status of workers during contact tracing. Since 2010, 107 active TB cases have been identified with no workplace transmission, contributing to avert >1000 infections, considering that one case can infect 10 to 15 individuals. Novel/Additive Information: The oil and gas industry operates globally with international, mobile populations and congregate settings that increase TB transmission risk. Targeted TB programs for such sites and workers are pertinent to mitigate risk and consequences. Synergies between public and private institutions, including oil and gas companies, are critical for effective TB programs that can prevent workplace transmission, provide rapid diagnostic, treatment and care, protect Company business and contribute to end the global TB epidemic.

The Company framework of workplace infectious disease control used for our global preparedness and response to the Ebola outbreak in West Africa is presented. Results and lessons learned are described from a global perspective; including their contribution in mitigating the Ebola outbreak risk for workers and disruption to Company's global operations (not just those in Ebola affected countries). Using the existing Company emergency support approach and integrating workplace infectious disease control aspects, headquarters interfaces were established for Ebola support to locations in West Africa and globally. Company management coordinated the support to sites while working with representatives from the medical, safety, security, law, human resources, and public and government affairs departments. The World Health Organization road map for Ebola was adapted for support to affiliates and for periodic reviews with operations in West Africa. Global scalable guidance measures included awareness, travel recommendations, site screening, case management and collaboration with industry, governments, international experts and health care providers. Early in 2014, Company disease surveillance system recognized the Ebola outbreak in West Africa. The management was engaged and a global coordinated response initiated. As a result, periodic communications across Company organizations and sites were organized. Emergency Support Groups (ESG) at headquarters and locations in West Africa were convened to monitor the outbreak, prevent workplace case occurrence and prepare for the response. The implementation of recommended measures was periodically reviewed, indicating effective execution and management of identified gaps. Targeted relocation of dependents and staff was arranged. The business continuity plans (BCP) for Company sites outside West Africa were revisited. Global guidance for travelers coming from or going to affected countries was issued. Guidelines for marine terminals receiving ships were developed. External interfaces with other International Oil Companies, expert community representatives such as the US Centers for Disease Control and local health authorities were instrumental in tailoring the Company approach for Ebola, including appropriate investments to help address community needs. Engagement of Company senior management was critical, as well as working with the business community, health experts and governments. Integrating an infectious disease control program within Company systems and processes was essential for a sustained and effective response. Considering Ebola and other infectious disease risks, using standardized measures built into Company organizations and levels is essential. ESGs and management engagement are necessary for adequate internal and external coordination. Leveraging existing tools such as BCP and disease outbreak management plans facilitates readiness and response. Workforce communications are fundamental for adequate workplace preparedness which is best verified through drills. External expert engagement is critical for technical knowledge and effective interface with country health systems.

Objectives / scope A framework of Company's strategic and calculated preparedness and response to outbreaks with diminished adverse outcomes is presented. It is based on Nigeria Ebola Virus Disease (EVD) outbreak and its potential impact on country oil and gas operations. It describes the model of engaging stakeholders in all stages of an outbreak, culminating in lessons learned. Methods, procedures, process The EVD outbreak had potential for cataclysmic impact on workers, families and communities in Nigeria. The Company leveraged on a hybrid of outbreak management framework based on a pre-existing infectious disease outbreak management, pandemic planning and stakeholder engagement. A series of partnerships was established to provide an effective response towards protecting workers and their families; including working partnerships with Ebola Emergency Operations Center (EEOC), International SOS, the US Centers for Disease Control and Prevention, and Baylor College of Medicine. In-house capacity building was enhanced and included training Company healthcare staff in safeguarding their health and safety, while establishing ‘fever assessment’ centers. Results, observations, conclusions The strategic preparedness and response is described with the successful partnerships and enhanced alignment of key objectives, between in-country management, internal and external stakeholders. Communication and coordination with Company headquarters and external experts resulted in extensive training of health care providers and development of risk-based educational material for workers and dependents. In total about 1400 employees and healthcare providers were trained. The Company also achieved 100% worksite screening procedures which were implemented throughout the duration of outbreak resulting in no loss time recorded due to the outbreak. Provision of support to Nigerian government including efforts on contact tracing, led to the national recognition of Company for her community investments. Positive and proactive influence by partnering with the oil and gas industry and government to respond to the outbreak, ensuring robust business continuity planning and testing, showed the company's dedication to honoring commitment to our partners and stakeholders whilst protecting the workers and families. Paper benefits The experiences and lessons learned are important to share widely. They will assist others in the industry as preparations are made to attain readiness to deal with future public health challenges (not just EVD). An effective response requires the establishment of several partnerships across a wide range of stakeholders

OBJECTIVES/SCOPE The development of an immunochromatographic test for quick detection of malaria preventive medicines (doxycycline, proguanil and mefloquine) in urine is described. The test integration and observed results in ExxonMobil (EM) workplace malaria program are also presented for potential adoption by organizations seeking to improve adherence to malaria prevention in workers operating in endemic locations. METHODS PROCEDURES, PROCESS In 2007, EM established a unique partnership with the French Army Biomedical Institute and two biomedical engineering manufacturers to develop a rapid detection test (RDT). Using specific drug antibodies, they created the tests detecting doxycycline, proguanil and mefloquine in urine. After the initial proof of concept in the laboratory setting, the RDTs were tested in malaria endemic locations using urine samples from workers on malaria preventive medicines and laboratory methods were used to confirm the results. Following such validation process and commercial production, the tests were integrated into ExxonMobil’s malaria program with implementation completed in all eligible sites located in endemic areas by 2013. RESULTS, OBSERVATIONS, CONCLUSIONS The first tests successfully developed were for proguanil and mefloquine, followed two years later by doxycycline. The RDT validity was tested against the standard laboratory techniques which use High-Performance Liquid Chromatography (HPLC). Using urine samples collected in Chad and Equatorial Guinea, 100% of the tests detecting the drugs were confirmed by the laboratory method. Reading and reporting issues were identified for the validation of proguanil and mefloquine and subsequently addressed by an improved test user guide. For doxycycline EM phase, two different RDTs were compared on 99 urine samples and verified with HPLC: 86.9% tested positive by both RDT’s and 91.9% by HPLC. This could be attributed to the detection level set for the RDT. Only 8 samples were truly negative. A further comparison of the strips showed that one had well-marked responses and more stable immunoglobulins for the test component. As a result of the test development and implementation, 65% of the 32,496 malaria drug prevention compliance tests performed between 2013 and 2016 were conducted by RDTs. They helped further reduce noncompliance rates, keep the number of cases as low as 15 per year and save approximately 1.6 million dollars during that period. Additional benefits are related to having immediate results and opportunity for timely counseling on malaria prevention. The use of this newly developed rapid test detecting malaria prevention medicines in urine is an additional incentive for malaria chemoprophylaxis compliance. It is affordable, practical and commercially available to help reduce malaria risk and consequences to companies and their non-immune workers going to malaria-endemic locations.

Global mobile workers risk serious disease and death from malaria while it is a curable and preventable disease. Organizations sending workers and their families into malarious areas are challenged by implementing efficient and consistent malaria control programs in the face of conflicting opinions, recommendations and perceptions regarding the necessity of malaria controls, especially regarding the use of chemoprophylaxis medications. Many of the issues related to malaria chemoprophylaxis have not been and are not likely to be studied in well-designed, randomized, double blinded clinical trials. In addition, country regulations differ and conflicting advice is provided by different health workers. To standardize advice and recommendations on malaria chemoprophylaxis, a list of issues was developed from questions frequently asked by managers, employees and contractors. During a two-day workshop, a world-renowned expert panel with extensive professional experience in infectious diseases, travel medicine, occupational medicine and health education, discussed the issues while reviewing the relevant literature and sharing their practical experience, to provide sound technical guidance. This paper provides scientific evidence-based malaria prevention guidance, balancing the precision of malaria protection with practical recommendations for chemoprophylaxis use, based on immune status and destination factors. The panel endorsed continued long-term use of chemoprophylaxis by individuals categorized as non-immune, traveling in high risk plasmodium falciparum areas. Specific guidelines were recommended for travelers to Mexico, Papua New Guinea and India. Guidance for travelers switching back and forth between various medications was provided to help individuals maintain protection and reduce the risk of adverse health affects from multiple drugs. Recommendations for offering medication breaks for offshore workers were not strongly endorsed due to unpredicted travel through high risk onshore locations and the difficulties in being able to effectively communicate and apply these guidelines.