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In this session, we shall talk about epidemics.

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What do you understand by the term 'Epidemic'[br]or 'Outbreak'?

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An epidemic (or outbreak) is the occurrence[br]of a disease in excess of what is expected

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in a particular community, for a particular[br]group of people, within a certain period of

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time.

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Other terms related to epidemics: endemic[br]refers to the constant presence of a disease

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or infectious agent within a given geographic[br]area or population group.

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It is the usual or expected frequency of disease[br]within a population.

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Pandemic, on the other hand refers to an epidemic[br]occurring simultaneously in multiple locations

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world-wide.

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As an example from your country, we see that[br]epidemics are the commonest Public Health

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emergency in our districts across the East[br]Africa region.

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In Uganda for example, 6 outbreaks occurred[br]in 8 months in 2007.

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This included Cholera, Meningitis, Hepatitis[br]E, Marburg, Plague and Ebola.

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Can you name 5 outbreaks that have occurred[br]recently in your district?

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Common epidemic prone diseases include diarrhoeal[br]diseases including watery diarrhoea, Cholera,

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dysentery and typhoid.

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These are likely to occur in many districts[br]in the East Africa region.

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Outbreaks of immunisable diseases like measles.

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These are common because immunisation coverage[br]is low.

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Malaria is endemic in most parts of Eastern[br]Africa, especially in low land areas; however,

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outbreaks can occur in both low and highland[br]areas.

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In areas where Malaria is endemic, outbreaks[br]occur when the threshold far exceeds what

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is expected for that season.

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Other epidemic prone diseases include Sexually[br]Transmitted Infections including HIV/AIDS,

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Syphilis, Gonorrhea, and others, Plague, Hepatitis[br]E, a massive chemical poisoning, especially

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from illicit alcohol, which has become a common[br]public health problem in Eastern

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Africa.

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Let us look at a case study 1.

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Refer to the word document on your CD.

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The questions: Is this a scenario that could[br]occur in your district? And how did the district

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authorities establish that there is an outbreak?

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In detecting an outbreak, we have to obtain[br]initial notification of the outbreak.

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We receive information about the likelihood[br]of an outbreak from the community, and from

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cases coming to health units, and from local[br]leaders.

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We therefore have to have an effective early[br]warning system that is linked to the communities.

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The golden rule in detecting outbreaks is[br]that every rumour must be investigated.

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In detecting an outbreak, we must have a case[br]definition for the diseases and this should

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be known by the frontline health workers and[br]then they must also be made for a community

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case definition.

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Secondly, there must be an un-expected rise[br]in new cases of these diseases beyond the

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threshold.

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You look at the word document station activities[br]and read the standard case definitions for

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some academic prone diseases.

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For instance, what is the standard case definition[br]for polio, measles, cholera, bola, and bacterial

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meningitis?

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Case definitions may be changed according[br]to the locality and the nature of the symptoms

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presenting in a particular outbreak situation.

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The District Rapid Reaction Team (RRT) can develop a working case[br]definition where there is no standard case

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definition depending on common symptoms and[br]risk factors related to the syndrome that

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has broken out.

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Can you suggest a case definition for the[br]following?

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1. An outbreak of sudden alcohol related illness[br]and deaths in zone X

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2. An outbreak of dysentery in camp Y[br]3. An outbreak of sudden food-related illness

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and deaths in a village Z

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Some epidemic prone diseases exist in the[br]community even without an outbreak.

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An example is malaria, which is prevalent[br]in many parts of Eastern Africa.

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For an outbreak to be declared, there must[br]be a sharp rise in cases beyond the expected

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threshold for a particular season.

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Some epidemic prone diseases do not exist[br]normally in the community.

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The occurrence of just one confirmed case[br]is considered an outbreak.

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An example is cholera.

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Some epidemic prone diseases are rare and[br]highly deadly when they occur.

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We do not have to wait for confirmation of[br]a case.

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Just one suspected case is enough to consider[br]an outbreak.

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An example is ebola.

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Therefore, thresholds differ from disease[br]to disease.

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In cholera, just one confirmed case.

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In ebola, one suspected case.

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In measles, a cluster of 5 or more suspected[br]cases OR at least 3 confirmed positive cases

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in a catchment area of a health facility occurring[br]in one month.

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For malaria, because it is embedded in many[br]parts of Eastern Africa, an outbreak occurs

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when there is a sharp seasonal rise in cases[br]beyond the usual number of expected cases.

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Let us look at the second case study, which[br]is one of the documents on the CD.

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Let us read through this case study, and the[br]questions for general discussion are: How

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do you think the District and Ministry of[br]Health officials went about investigating

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this particular outbreak?

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What do you understand by the term 'early[br]response'?

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Steps in investigating an outbreak: Step 1.[br]Initial response and confirmation of outbreak.

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It is important to assemble a team and prepare[br]for an initial field visit as soon as possible.

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Two, it is important to choose a working case[br]definition and confirm cases.

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Three, find cases systematically.

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Four, confirm whether there is an outbreak[br]by comparing occurrence of cases with thresholds.

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And five, describe who is affected, when and[br]where?

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Step 2: Manage and identify cases.

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Establish a district task force and allocate[br]them their responsibilities.

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Use the working case definition to find cases[br]and set up a treatment centre.

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Step 3: Set up immediate control measures.

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Treat cases to interrupt transmission and[br]reduce deaths.

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Consider vaccination, disinfection and protective[br]wear.

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Provide health education to those at risk.

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Communicate clearly to reduce panic and prevent[br]spread of the disease.

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Step 4: Address the resource gaps.

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Ensure adequate medical supplies and logistics[br]to handle cases.

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Look for additional resources to address the[br]gaps and contact Ministry of Health and partner

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agencies in case the resources are inadequate.

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Step 5: Determine responsible factors for the [br]outbreak and make a report.

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Analyse available information to establish[br]the risk factors.

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Prepare a report and ensure that it is disseminated[br]to those who need to know and those who need

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to take action.

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On the report, you ought to recommend and[br]implement priority control measures.

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And Step 6: Be on your guard.

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Strengthen the existing surveillance system[br]to find cases actively and learn from this

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outbreak to respond better in future.

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Put in place measures to prevent similar outbreaks[br]in the future.

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Thank you for listening.