International Seminar onInternational Seminar on
Disease SurveillaDisease Surveilla1818 DecembDecemb
Disease SurveillaDisease Surveilla1818 DecembDecemb18 18 DecembDecemb18 18 DecembDecemb
Dr Nirmal Kandel , MBBS, MA
Preparedness, Surveil
Emergency and Humanit
Disease Surveillance an
WHO Ind
Preparedness, Surveillance and Response (PSR) – WHO Indo1 |
n 10 Year of Tsunami Acehn 10 Year of Tsunami Acehff
ance in Disasterance in Disasterberber 20142014
ance in Disasterance in Disasterberber 20142014ber ber 20142014ber ber 20142014
A (Anthropology), MPH, EMBA
llance and Response
tarian Action (EHA) &
d Epidemiology (DSE)
donesia
onesia
Outline of pOutline of ppp
Introduction
What is needed in an emergency What is needed in an emergency
Fundamental Principles of Contrpemergency and each of the princ
O tb k C t l Outbreak Control
Prevention and control of specifiPrevention and control of specifi
Preparedness, Surveillance and Response (PSR) – WHO Indo2 |
presentationpresentationpp
y?y?
rol of Communicable diseases in ciples
c communicable diseases.c communicable diseases.
onesia
IntroduIntrodu
Communicable Diseases are the min emergencies particularly so in co
Main causes of morbidity and mortadiseases acute respiratory infectiodiseases, acute respiratory infectioendemic malaria.
Malnutrition and trauma are additioamongst populations affected by em
Preparedness, Surveillance and Response (PSR) – WHO Indo3 |
uctionuction
major cause of morbidity and mortality omplex emergencies.
ality in emergencies are diarrheal ns measles and in areas where it isns, measles and in areas where it is
nal causes of illness and death mergencies.
onesia
What is needed durWhat is needed dur
Provision of shelter, water, sanitatiothe most effective means of protectthe most effective means of protectemergencies.
A systematic approach to control ofcomponent of humanitarian responthe health of the population.
Preparedness, Surveillance and Response (PSR) – WHO Indo4 |
ring an emergency?ring an emergency?g g yg g y
on, food and basic health care are ting health of those affected byting health of those affected by
f communicable diseases is a key nse and crucial for the protection of
onesia
FundamentaControl of Commu
FundamentaControl of CommuControl of CommuControl of Commu
Rapid Assessment Rapid Assessment
Prevention Prevention
S ill Surveillance
O tb k C t l Outbreak Control
Disease Management
Preparedness, Surveillance and Response (PSR) – WHO Indo5 |
al principles unicable Diseasesal principles unicable Diseasesunicable Diseases unicable Diseases
onesia
Rapid Health Rapid Health
The objectives should be :The objectives should be :
1. To assess the extent of the emergdiseases in the population
2 To define the type and size of inte2. To define the type and size of inte
3. To plan the implementation of the
4. To provide information to internatimedia to mobilize resources bothmedia to mobilize resources both
Preparedness, Surveillance and Response (PSR) – WHO Indo6 |
AssessmentAssessment
gency and the threat of communicable
erventions and priority activitieserventions and priority activities
se activities
onal community, donors and the human and financialhuman and financial.
onesia
PrevePreve
Communicable diseases can be prevCommunicable diseases can be prevmeasures which include:Good site planningGood site planningProvision of basic clinical servicProvision of appropriate shelterProvision of appropriate shelterClean water supplySanitationSanitationMass vaccination against specifRegular and sufficient food suppRegular and sufficient food suppControl of vectors
Preparedness, Surveillance and Response (PSR) – WHO Indo7 |
entionention
vented by appropriate preventivevented by appropriate preventive
ces
fic diseasesplyply
onesia
SurveiSurvei
Surveillance is the ongoing systeminterpretation of data in order to plainterpretation of data in order to plahealth intervention. Surveillance system should be simpy p
specific
Preparedness, Surveillance and Response (PSR) – WHO Indo8 |
illanceillance
matic collection, analysis and an, implement and evaluate publican, implement and evaluate public
ple, flexible, acceptable and situation p p
onesia
Objectives of a surveillancObjectives of a surveillanc
1 Identify public health priorities1. Identify public health priorities
2. Monitor the severity of an emergey gmortality and morbidity data
3 Detect outbreaks and monitor res3. Detect outbreaks and monitor res
4. Monitor trends in incidence and co to t e ds c de ce a d c
5. Provide information to ministry ofl i i l iprogram planning, implementatio
Preparedness, Surveillance and Response (PSR) – WHO Indo9 |
ce system in an emergencyce system in an emergency
ency by collecting and analyzing y y g y g
sponsesponse
case fatality from major diseasescase ata ty o ajo d seases
f health, donors to assist in health d bili ion and resource mobilization.
onesia
Task of Health Workers atTask of Health Workers at
Preparedness, Surveillance and Response (PSR) – WHO Indo11 |
t key steps of Surveillance t key steps of Surveillance
onesia
OutbreakOutbreak
An outbreak is occurrence of a n An outbreak is occurrence of a nthat is unusually large or unexpe
Outbreaks and epidemics refer
Outbreaks in emergency situatiorise to high morbidity and mortarise to high morbidity and morta
Aim should be to detect and con Aim should be to detect and conpossible.
Preparedness, Surveillance and Response (PSR) – WHO Indo12 |
k Controlk Control
number of cases of a diseasenumber of cases of a disease ected for a given place and time.
to the one and same thing.
ons can spread rapidly giving ality ratesality rates.
ntrol the outbreak as early asntrol the outbreak as early as
onesia
Sequence of Events in OutbrSequence of Events in Outbr
Alert
708090
506070
ases
203040
01020
1 4 7 10 13 16 19
Day
Preparedness, Surveillance and Response (PSR) – WHO Indo13 |
y
reak Detection and Confirmationreak Detection and Confirmation
t Response
OpportunityOpportunity
for control22 25 28 31 34 37 40
y
onesia
y
Sequence of Events in OutbSequence of Events in Outb
90
Early Alert Rapid Response
708090
405060
203040ases
01020
1 4 7 10 13 16 19
Days
Preparedness, Surveillance and Response (PSR) – WHO Indo14 |
reak Detection and Confirmationreak Detection and Confirmation
PotentialPotential
Cases Prevented
22 25 28 31 34 37 40
s
onesia
Detection oDetection o
Preparedness, Surveillance and Response (PSR) – WHO Indo15 |
of Outbreakof Outbreak
onesia
ConfConf
Preparedness, Surveillance and Response (PSR) – WHO Indo16 |
firmation & Evaluation of Outbreak
firmation & Evaluation of Outbreakof Outbreakof Outbreak
onesia
Major diseases with epidemic pMajor diseases with epidemic p
Cholera Cholera
Measles
Shigellosis
Acute Respiratory Infection
Meningococcal disease
In certain areas the following dis In certain areas the following dismalaria, leishmaniasis, viral hemhepatitis A and E.
Preparedness, Surveillance and Response (PSR) – WHO Indo17 |
hepatitis A and E.
potential in emergency situatiopotential in emergency situatio
seases have to be included:seases have to be included: morrhagic fever, typhoid and
onesia
Steps in the ma communicable
Steps in the ma communicablea communicable a communicable
1 P ti1. Preparation
2 D t ti2. Detection
3. Response
4. Evaluation
Preparedness, Surveillance and Response (PSR) – WHO Indo18 |
management of disease outbreak
management of disease outbreakdisease outbreakdisease outbreak
onesia
Preparation foPreparation fopp
Health coordination meetings Health coordination meetings
Strong surveillance systemg y
Outbreak response plan for each
Stocks of iv fluids, antibiotics and
Plans for isolation wards
L b t t Laboratory support
Preparedness, Surveillance and Response (PSR) – WHO Indo19 |
or the outbreakor the outbreak
h disease
d vaccines
onesia
Detection oDetection o
Surveillance system with early wdiseases.
Inform ministry of health and WHdiseases.diseases.
Take appropriate specimens (stoconfirmation.
Include case in the weekly repor Include case in the weekly repor
Preparedness, Surveillance and Response (PSR) – WHO Indo20 |
of outbreakof outbreak
warning system for epidemic prone
HO in case of outbreaks of specific
ool, CSF or serum) for laboratory
rtrt.
onesia
Response to Response to pp
C fi th tb kConfirm the outbreak
Activate the outbreak co
Investigate the outbreak
Control the outbreak
Preparedness, Surveillance and Response (PSR) – WHO Indo21 |
the outbreakthe outbreak
ontrol team
k
onesia
EvaluEvalu
Assess appropriateness aAssess appropriateness acontainment measures.
Assess timeliness of outbresponseresponse.
Change public health poliChange public health poli
Write and disseminate ouWrite and disseminate ou
Preparedness, Surveillance and Response (PSR) – WHO Indo22 |
uation uation
and effectiveness ofand effectiveness of
break detection and
icy if indicatedicy if indicated.
utbreak reportutbreak report.
onesia
Prevention and Ci b
Prevention and Ci bcommunicabcommunicab
Acute Respiratory Infections
Cholera
Other diarrheal diseases
Conjunctivitis
Dengue
Diphtheria Diphtheria
Hepatitis
HIV/AIDS
Japanese Encephalitis
Leishmaniasis
Malaria
Measles
Preparedness, Surveillance and Response (PSR) – WHO Indo23 |
Control of specific bl di
Control of specific bl dible diseasesble diseases Meningococcal Meningitise gococca e g t s
Relapsing Fever(louse borne)
S bi Scabies
Sexually Transmitted Infections
Trypanosomiasis
Tuberculosis
Typhoid
Typhus (Epidemic louse borne) Typhus (Epidemic louse borne)
Viral Hemorrhagic fever
onesia
References used for trecommended
References used for trecommendedrecommended recommended
Communicable disease control in Communicable disease control inWHO
Control of Communicable DiseaseChin
Reingold AL Outbreak InvestigatioInfectious Diseases, 1998, 4(1):2
Preparedness, Surveillance and Response (PSR) – WHO Indo24 |
this presentation and further readingthis presentation and further readingfurther readingfurther reading
emergencies (Field manual) emergencies (Field manual)-
es Manual APHA Editor James
ons- a perspective Emerging 1-27
onesia