Epidemic Response

7/28/2019 Epidemic Response

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Epidemic

Response

Ofelia P. Tolentino, RNCity Epidemiology and Surveillance Unit


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Epidemic Detection

Case-based - routine collection of data, analyzed on a

periodic basis (NESSS)

Event-based - reports are received anytime from sourcesoutside the routine reporting system (Media Report)

Laboratory-based - reporting of laboratory results based oncriteria (influenza surveillance)


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Verification of Reported Epidemics

The DSC at the RHU and CHO shall promptly verify reports ofepidemics received from health facilities, laboratories or throughcommunity rumors. A feedback (verbal/written) to stakeholders(LCE, Province, CHD and NEC) should be provided within 24 hours.This is important to ensure that timely decisions are made and toprevent expending resources on investigating events that are nottrue epidemics.


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Flow of Investigation,Reporting and Response

to a Suspect Epidemic orReported Epidemic


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Suspector

reportedEpidemic

CHO verifies the report

CHO request for technicalassistance from PHO/CHD

EpidemicExits

CHOprepares and

submit thereport to

CHD

Is theepidemic of

nationalimportance

Could not be

determined No

YES

YES CHO notifies &consult CHD andNEC w/in 24 hrsand implement

controlmeasures

NOIs the CHOcapable ofconducting

fullepidemic

investigation

CHO conduct fullepidemiologic

investigation &implement

control measuresin close

coordination withCHD & NEC

YES

NO NO


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Verification of Reported Epidemics

Trigger for Epidemic Detection

Case-based surveillance - Alert and epidemicthreshold have been reached

Event-based surveillance - Reports of publichealth concern have been confirmed

Laboratory-based surveillance- detectedlaboratory results fulfills the criteriafor notification


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Role of Bureau of Quarantine in detecting epidemics

The Bureau of Quarantine shall immediately notifyNEC/CHD/Local health authorities of any suspect case ofnotifiable disease detected in airports and ports ofentries. Travel itinerary and other health-related

documents shall be submitted to NEC/CHD/Localauthorities


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Epidemics Investigation

Deciding to investigate an EpidemicThe decision to investigate an epidemic shall be based on the

following circumstances: The RHU/CHO receives a report of suspected epidemic An unusual increase threshold have been reached for specific priority

diseases Communities reports rumors of deaths or a large number of cases that are

not being seen in the health facility. A cluster or group of cases or deaths A report of cases or deaths for which the cause is not explained or is

unusual

The RHU/CHO recieves a report of a case with any of the following diseases: Acute Placcid Paralysis Adverse event following Immunization (AEFI) Anthrax Human Avian Influenza Measles Confirmed Meningococcal Disease Poliomyelitis Confirmed Severe Acute Respiratory Syndrome (SARS) Other emerging or re-emerging infection


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Roles of LGUs during epidemic investigation and response

Primary responsibility to manage epidemic investigation andresponse . However, the next higher level will continue to exerciseits technical oversight functions

The responsibilities of LGU during epidemic: Immediate release of funds Priority access to vehicles Provisional additional manpower Provision of resources for laboratory support

Provision of resources for treatment of patients and otherepidemic control measures

Provision of access to communication Local government unit should assess whether they have been

sufficient capacity to undertake the epidemic investigation and

response, and arrange for additional assistance if required.


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Composition and Core Responsibilities of and EpidemicInvestigation and Control Team

An Epidemic Investigation and Control Team (EICT) shall be organziedat the city level. The composition of the team may vary depending onthe disease suspected and the control measures required. The team

should include the Disease Surveillance Coordinator and other memberas determined by the city health officer. The members may include thefollowing: City Health Officer Health Program Coordinator

Clinician Laboratory technician Sanitation Engineer Vector control specialist Health Educator


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Composition and Core Responsibilities of and EpidemicInvestigation and Control Team

The CHO shall automatically be the team leader , or may designate ateam leader in his behalf. Each member of team should be given a clearrole.The core responsibility of EICT are the following Conduct epidemiologic investigation of epidemics suspected or

confirmed Establish active surveillance in the active affected area Implement the epidemic response plan Identify and coordinate other sources of additional human, material

resources for managing epidemic

Ensure the use of standard treatment protocols for the disease andtrain health workers

Oversee the implementation of control measures Provide regular feedback to community (LGU,CHD,DOH and WHO) Request assistance when necessary

Perform other tasks as instructed by the head of office or agency


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What should the CHO do in instance when they do nothave the capacity in conducting epidemic

investigation?

The CHO should immediately request for assistance from the CHD/NEC. Theinvestigation will be conducted by PESU or RESU staff in close coordination

with the City EICT.

Assistance can be in three forms: Logistics Technical advise (verbal or written guidance)

Technical assistance (investigation team, experts or consultants who willgo to the field and assist in the investigation or with the control measures Laboratory back-up


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Instances shall the NEC and CHD-RESU provideimmediate on site technical assistance duringepidemic investigation

The DOH through the NEC in coordination with CHD-RESU shall provideimmediate on-site assistance to the LGU for further epidemic investigation in

the following conditions:

Epidemics of national importance The epidemic is continuing Similar epidemic have occurred before

The epidemic has attracted public, media or political interest Epidemic transmission route is new or unusual The causative agent is unknown Descriptive characteristic of the epidemic (time, place, person, or

organism subtype) suggest that a common source is highly likely


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Role of the National Epidemiology Center as theNational IHR Focal Point

The National Epidemiology Center is designated by the Department of Healthas the National IHR Focal Point (NFP). Among its crucial responsibilities as NFP

is to notify WHO of Immediate Notifiable Diseases and all events that mayconstitute a public health emergency of international concern within 24 hoursof assessment.

The National Epidemiology shall carry out all appropriate and expeditious

mean of obtaining information to assess all suspected epidemics incoordination with the CHD, local government units, government agencies andother parties directly or indirectly involved in the investigation and control ofepidemics


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Declaring an EPIDEMIC

Declaration of an epidemic should be reported by sufficientscientific evidence. This include:

Surveillance information Epidemiologic investigation (descriptive or analytic) Environmental investigation Laboratory investigation


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Basic requirement to declare an EPIDEMIC

Surveillance information Epidemiologic investigation (descriptive or

analytic) Environmental investigation

Laboratory investigation


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Basic requirement to declare an EPIDEMIC

Surveillance information Epidemiologic investigation (descriptive or

analytic) Environmental investigation Laboratory investigation


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Instances the DOH secretary have the sole authority indeclaring an epidemic

Local Government Code of 1991 (DOH RRILGC of 1991), Chapter 11, Section 44 c ,specifies that the Department of Health has the final decision regarding the presenceof epidemic, pestilence or other widespread public health danger in a particular areaor region.

Epidemic of National and International ConcernThe NEC shall take a lead in the investigation of epidemics of national andinternational importance, in coordination 2with CVH, local government unit, andother concerned agencies. The secretary of health shall have the authority todeclare epidemics of national and/or international concern. These include thefollowing :

a. Epidemic linked with nationally or internationally distributed productb. Cases of exotic disease acquired locallyc. Disease with high pathogenicityd. Disease with significant risks of international spreade. Epidemics in tourist facilities, among foreign travellers or at national/

international eventsf. Epidemics associated with health service failure


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Response

Investigation

Define cases- case definitions include location, time period and clinical symptoms

Identify all cases and contacts-Obtain a line list of cases from the hospitals, barangay health station

and other institution- Do contact tracing

Describe the case Time When did the case occur? Place- Where so the cases live? Where were they found? Draw a

spot map Person- What were the characteristic of those affected? Age, range,

median, age, sex distribution, symptoms, vaccination status & etc? Describe severity

Number of fatalities, case fatality rate Number who were hospitalized Number who had complication


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Response

Investigation

Define cases- case definitions include location, time period and clinical symptoms

Identify all cases and contacts-Obtain a line list of cases from the hospitals, barangay health station

and other institution- Do contact tracing

Describe the case Time When did the case occur? Place- Where so the cases live? Where were they found? Draw a

spot map Person- What were the characteristic of those affected? Age, range,

median, age, sex distribution, symptoms, vaccination status & etc? Describe severity

Number of fatalities, case fatality rate Number who were hospitalized Number who had complication


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Response

Confirm the diagnosis Obtain and analyse specimen from cases Obtain and analyse specimen from environment (water, air, soil

food) Identify possible sources of the epidemic Identify possible causes of transmission The results of the epidemic investigation should be communicated to all

stakeholder s in two forms

a. Oral Briefingb. Written report


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Response

Oral Briefing Should be attended by local authorities and persons responsible for

control and prevention measures Findings must be presented in clear and convincing fashion with

appropriate and justifiable recommendations for action. Thispresentation is an opportunity to describe what the investigation andcontrol team did, what they found and what they think should be doneabout it. The findings should be presented in scientifically objective

fashion and should be able to defend the conclusions andrecommendations.


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Response

Written Report A written report of epidemic investigations should be provided to all

levels of the reporting systems. This include PHO, CHD, NEC WHO By formally presenting recommendations, the report provides a blueprint

for action. It also serves as a record of performance and a document forpotential legal issues

It serves as a reference if the health department encounters a similarsituation in the future

A written epidemic investigation report should follow the IMRAD formatwhich includes:

a. Introduction

b. Methodsc. Resultsd. Analysise. Discussionf. Conclusiong. Actions Takenh. Recommendation


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Response

Treatment of Cases Hospitals should be alerted and should activate

response plans. There should be adequateantimicrobials and supplies for treatment . Needsmust be immediately identified and a request forlogistic assistance should be made.

Referral hospitals should be alerted about theepidemic


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Establish Epidemic Disease Surveillance

The Location of the epidemic disease surveillanceand the extent of its catchment area will depend onthe location of the epidemic and its severity

Information to be gathered should include: Name Age

Sex Address (sitio, Bgy, City) Date of onset of illness Other patient information depending on disease

Frequency of reporting will depend on the epidemic


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Implementation of Public Health Measures

The data gathered in the course of investigations will be usedto define the measures needed to control the epidemic and

prevent similar situation in the future In any epidemic, the plan of action measures should fall in

any of the following: Prevention and control of exposure Prevention and control of infection/ disease

Prevention of spread Prevention of death

The selection of control measure should consider feasibility(technical/operation), availability, acceptability, safety and

cost


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Risk Communication

Coordinated communication is essential during epidemic response Activate the communication plan for the following areas

Within the epidemic investigation and control team With the epidemic management committee, the ESUs at differentlevels and the NEC

Directly with the affected community-public and local officials With the general public through media With other agencies involved (hospitals, laboratories, industries and

other govt. agencies) Determine which level (city/provincial) will be responsible for

communication to each area mentioned ) Identify persons who will take charge of communicating to each

other

Schedule regular meeting for each area


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Evaluation

After an epidemic, the following should be thoroughly assessed : Preparedness

Surveillance Response

Investigation Treatment of cases Public health measures Risk communication Epidemic management


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Evaluation

Each component should be assessed according to: Timeliness

Efficiency and effectiveness Cost Lost opportunities Policy gaps and


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Evaluation

The team leader of the epidemic management committee willbe the one to organize the evaluation. All members of the

management committee, the investigation team and controlteam and other person involved in the epidemic surveillanceand response should be present during the evaluation.

A post-epidemic assessment report should be documentedand used as a reference for improving epidemic preparednessand response


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Epidemic Response

Documents

Transcript of Epidemic Response