Epidemic Preparedness

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    Epidemic preparedness&

    Outbreak Investigation

    State Institute of Health & Family Welfare, Jaipur

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    Epidemic- Occurrence of diseases casesin community clearly in excess to thenormal expectation(measured asendemic level)

    Outbreak-Used interchangeably withEpidemic but applies to-

    Diseases with sudden onset

    Short incubation period

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    Why do Outbreaks Occur?

    Single lapse in infection control in hosp.Lapse in surveillanceA hidden pocket of infectionSmuggled animalsSingle volume of international air trafficRapid mutation & Adaptation in microbial

    worldEmergence of New risk groups

    Modes of transmission can changeDrug resistance effect on treatment and

    prophylaxis

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    Outbreak management.involves

    AnticipatingPreventing

    Preparing

    DetectingResponding

    Controlling disease outbreaks with thewhole purpose of preventing or

    minimizing health and economicimpacts of possible outbreaks

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    Why Preparedness in Advance?

    Emergencies caused by epidemics arefrequent

    Epidemics require urgent action and

    Epidemics may often lead to panic ifpreparedness is not adequate

    Response can be delayed, with possibility of

    fast spread, and avoidable loss to humanlives, and economy

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    Why Investigate?

    Control and prevention measures

    Knowledge of an agent

    Training

    Public concerns

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    Concepts in Outbreak Investigation

    Quantifying the epidemic(Descriptive epidemiology)

    Getting at the source (Analyticepidemiology)

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    Steps for Outbreak Investigation

    1. Preparation

    Health coordination meetings

    Use data from surveillance system

    Review local directives or plans foreach disease

    Assemble your team

    Epidemiologist

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    Identify and contact Keycommunity contacts

    Arrange supplies, equipment

    Sample questionnairesPlans for isolation wards

    Laboratory support

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    2. Detection

    a)Surveillance system with early warning

    system (EWS) for epidemic pronediseases.

    Clustering of cases ordeaths in time and/orspace

    Unusual increase in casesor deaths

    Acute haemorrhagic feverSevere dehydration

    following diarrhoea(usually with vomiting) in

    patients >5 years of age

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    Acute fever with renal involvement

    Acute flaccid paralysis in a childAcute fever with painful lymph nodes

    Acute febrile severe illness ofunknown aetiology

    Occurrence of two or moreepidemiologically linked cases ofmeningitis

    Even a single case of measles or anyother epidemic prone diseases

    from a tribal or other poorlyaccessible area

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    Unusual isolates

    Shifting in age distribution of

    casesHigh vector density

    Natural disasters

    b)Notify ministry of health and WHO in case of outbreaks of specific diseases c) Take appropriate specimens (stool,

    CSF or serum) for laboratory confirmation d) Include case in the weekly report

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    3. Response

    a) Confirm the outbreakDetermine if disease incidence is

    higher than backgroundlevel

    How do you determine backgroundlevel? -surveillance

    Reasons for Observed >Expected

    Change in case definitionChange in reporting procedures

    Increased awareness or interest

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    Improved diagnostics

    New clinicianChange in Population

    True increase

    Activate the outbreakcontrol team

    Investigate the outbreak

    Control the outbreak

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    b)Define and identify cases in terms of time,place and person distribution

    c)Establish Case Definition and classify as

    confirmed, probable, suspectd)Identify Population At Risk (that would

    serve as denominator to calculateattack rate)

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    4. Evaluation

    Assess appropriateness andeffectiveness of containmentmeasures

    Assess timeliness of outbreak

    detection and responseChange public health policy if indicated

    Write and disseminate outbreak report

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    Possible Control Measures for

    Different Communicable Diseases

    ARIEarly recognition and treatment

    All children with cough carefullyassessed

    Assess signs of malnutritionRefer severely malnourished to

    hospital

    Manage pneumonia with antibioticsFollow national treatment protocols

    Supportive measures

    Vaccination against measles,

    diphtheria and whooping cough

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    Thank You