Lecture 13 - Case Investigation & Contact Tracing

8/3/2019 Lecture 13 - Case Investigation & Contact Tracing

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DISEASE CONTROL

HVD 21103

Case Investigation & Contact

Tracing

By:Khairul Nizam Mohd Isa

MCHSc (Environmental Health)

UniKL MESTECH


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Goals

At the end of this lecture, student should be able

To identify the most suitable approaches to conduct

investigation for specific disease.

Conduct an investigation in accordance to the job specification

and guidelines set on the regulation and ACT.


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Introduction

Objectives:

To prevent, control and contain infectious diseases

To reduce morbidity and mortality due to infectious diseases

To develop good repo with patient

To identify the sources of infection

To determine contact

To explain the importance of follow up treatment and

contact examination

To counsel and educate

To strengthen public health infectious diseases surveillance

Provide general guidelines and develop a mechanism for

effective implementation of outbreak management


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Technique

Interview

Individual

Phone call

Analysis review

Patients health records

Laboratory analysis/ test results

Chronology


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Important Aspect

Verify the cases- to check the basic data and result

Investigation to be carried out with patient / family member

Patient particulars (verify)

Patient movement Social activities of patient

Living condition (environment)

Risk factors

Contacts if known (eg. Patients, friends)

Referral if necessary for treatment


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Legislation

Destruction ofDisease-Bearing Insects Act 1975

Section 10A- Power to require information and examine

persons

Prevention and Control ofInfectious Diseases Act 1988

Section 7-Entry into and examination of vehicles and the

measures thereafter

Section 15- Observation or surveillance of contacts


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Complaint/Report

CaseVerification

Data Analysis

Response

Control measure

Communication

DocumentationDescription

Full investigation

Analytic

Lab analysis

Investigation


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Verification

The purpose of verification is to confirm the occurrence of the

case.

A multidisplinary approach is required and will include one or

a combination of the following:

Review of the epidemiological data and trend

Clinical examination of cases

Review of medical records

Review the laboratory results


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Evaluation of severity of the cases

Upon verification of the case, assessment of severity will take

into account the following:

Increase mortality and morbidity

High case-fatality rate

High rate of severe presentation of disease

High rate of anti-microbial resistance

Involvement of vulnerable and other high risk group


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Case Definition

For each case, there should be a case definition

For known disease: Refer to Disease Control Division,MOH Case Definition forInfection Disease in Malaysia

For unknown diseases, considerer epidemiological linkage

(time, place, person, clinical presentation) The case definition should contain the following:

The name of the disease (or as ...like until more precisedata is available)

The most frequently occurring signs and symptoms

Epidemiological circumstances

Confirmatory laboratory tests, if any

Criteria of the data level of certainty: confirmed,probably and suspected


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Proxy Indicators

Proxy Disease/Problem

Acute gastroenteritis Food and water borne diseases

Acute Flaccid paralysis Poliomelitis

Acute respiratory infection Pneumonia, influenza virus

The defined syndromes under

the syndromic notification

system

Emerging of unknown infections


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Final Report

A final report must be produced for every case.

The person who responsible for writing the report as follows:

PPKP

PKA

Dissemination of report

State Director

Director of CDC, MOH

Relevant district authorities


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Final Report

Publication

The report may ne published in local or international

journal/ bulletins, ect with the permission ofDirector

general of Health

Communicate to the public with permission


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Case Study 1

19-01-2009

Mr Hamid who stay in Taman Edaran,KL

been warded with positive Malaria

01-01-2008 03-01-2009He went to kelantan. Shopped at Pasar

04-01-2009

Went back to rawang. Stop for dinner at

Gua Musang on 1930 Hrs

05-01-2009-09-01-2009

Stayed home with family

10-01-2009

Went back to in-law family

12-01-2009 16-01-2009

Committee for Kem Remaja Sekolah at

kampungOrang Asli Slim River

High Fever

Took paracetamol

Suspected been coursed by ghost

17-01-2009

Went back to night market in KL

Went to private clinic and received

injection

18-01-2009

Went back to Wedding fiest at Kampung

Melayu, Sg Buloh

High fever

Joint paint

Investigation


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Case study 1

Malaria case in Kuala Lipis

Location: Sungai Ular

Date started: 01-01-2008 first case of onset of symptoms

Date ended: 08-01-2008

Chronology

First case in Slim River

Location: Kampung Orang Asli Slim River

Case started on: 20-01-2008 - first case of onset of symptoms

Date ended: 21-01-2008


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Report

Malaria case was started on 01-01-2008 in Kuala Lipis and

ended on 21-01-2008 in Slim River. The agent was P.vivax and

involving 50 cases.


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Case study 2

Case Food

& water

borne

Illness

Movement WHERE

WHEN

WHO

Food history

-meal at home

-meal outside

Contact

-Fly contacts

-Work contact

-Social contacts


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Case study 3

Case TB

Movement

ofpatients

WHERE

WHEN

WHO

Patientsoccupation

-types of works

-duration of exposure

Contact

-Family

-Work contact

-HostelSocial

Historyofcontact with other patients

Lifestyle


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THANK YOU


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References

Heymann,D.L. 2004. Control of communicable disease

manual. Ed. 18th. Washington: American Public health

Association.

Mulvihill, M.L., Zelman, M., Holdaway, P., Tompary, E. &

Turchany, J. 2005. Human disease: Asystemic approach. Ed.

5. Prentice Hall.

Lecture 13 - Case Investigation & Contact Tracing

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