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