1 00:00:05,013 --> 00:00:09,004 In this session, we shall talk about epidemics. 2 00:00:09,004 --> 00:00:12,069 What do you understand by the term 'Epidemic' or 'Outbreak'? 3 00:00:12,069 --> 00:00:19,067 An epidemic (or outbreak) is the occurrence of a disease in excess of what is expected 4 00:00:19,067 --> 00:00:24,098 in a particular community, for a particular group of people, within a certain period of 5 00:00:24,098 --> 00:00:27,079 time. 6 00:00:27,079 --> 00:00:35,026 Other terms related to epidemics: endemic refers to the constant presence of a disease 7 00:00:35,026 --> 00:00:40,037 or infectious agent within a given geographic area or population group. 8 00:00:40,037 --> 00:00:46,094 It is the usual or expected frequency of disease within a population. 9 00:00:46,094 --> 00:00:54,011 Pandemic, on the other hand refers to an epidemic occurring simultaneously in multiple locations 10 00:00:54,011 --> 00:00:59,023 world-wide. 11 00:00:59,023 --> 00:01:04,096 As an example from your country, we see that epidemics are the commonest Public Health 12 00:01:04,096 --> 00:01:08,065 emergency in our districts across the East Africa region. 13 00:01:08,065 --> 00:01:15,077 In Uganda for example, 6 outbreaks occurred in 8 months in 2007. 14 00:01:15,077 --> 00:01:23,009 This included Cholera, Meningitis, Hepatitis E, Marburg, Plague and Ebola. 15 00:01:23,009 --> 00:01:31,929 Can you name 5 outbreaks that have occurred recently in your district? 16 00:01:31,929 --> 00:01:39,119 Common epidemic prone diseases include diarrhoeal diseases including watery diarrhoea, Cholera, 17 00:01:39,119 --> 00:01:41,719 dysentery and typhoid. 18 00:01:41,719 --> 00:01:46,999 These are likely to occur in many districts in the East Africa region. 19 00:01:46,999 --> 00:01:51,609 Outbreaks of immunisable diseases like measles. 20 00:01:51,609 --> 00:01:56,017 These are common because immunisation coverage is low. 21 00:01:56,017 --> 00:02:03,017 Malaria is endemic in most parts of Eastern Africa, especially in low land areas; however, 22 00:02:03,017 --> 00:02:08,075 outbreaks can occur in both low and highland areas. 23 00:02:08,075 --> 00:02:14,096 In areas where Malaria is endemic, outbreaks occur when the threshold far exceeds what 24 00:02:14,096 --> 00:02:20,064 is expected for that season. 25 00:02:20,064 --> 00:02:26,003 Other epidemic prone diseases include Sexually Transmitted Infections including HIV/AIDS, 26 00:02:26,003 --> 00:02:36,047 Syphilis, Gonorrhea, and others, Plague, Hepatitis E, a massive chemical poisoning, especially 27 00:02:36,047 --> 00:02:43,047 from illicit alcohol, which has become a common public health problem in Eastern 28 00:02:43,047 --> 00:02:45,036 Africa. 29 00:02:45,036 --> 00:02:50,006 Let us look at a case study 1. 30 00:02:50,006 --> 00:02:57,053 Refer to the word document on your CD. 31 00:02:57,053 --> 00:03:03,028 The questions: Is this a scenario that could occur in your district? And how did the district 32 00:03:03,028 --> 00:03:08,000 authorities establish that there is an outbreak? 33 00:03:08,000 --> 00:03:14,067 In detecting an outbreak, we have to obtain initial notification of the outbreak. 34 00:03:14,067 --> 00:03:20,029 We receive information about the likelihood of an outbreak from the community, and from 35 00:03:20,029 --> 00:03:23,099 cases coming to health units, and from local leaders. 36 00:03:23,099 --> 00:03:32,051 We therefore have to have an effective early warning system that is linked to the communities. 37 00:03:32,051 --> 00:03:40,004 The golden rule in detecting outbreaks is that every rumour must be investigated. 38 00:03:40,004 --> 00:03:46,007 In detecting an outbreak, we must have a case definition for the diseases and this should 39 00:03:46,007 --> 00:03:52,035 be known by the frontline health workers and then they must also be made for a community 40 00:03:52,035 --> 00:03:53,084 case definition. 41 00:03:53,084 --> 00:04:01,078 Secondly, there must be an un-expected rise in new cases of these diseases beyond the 42 00:04:01,078 --> 00:04:05,096 threshold. 43 00:04:05,096 --> 00:04:13,009 You look at the word document station activities and read the standard case definitions for 44 00:04:13,009 --> 00:04:16,039 some academic prone diseases. 45 00:04:16,039 --> 00:04:26,079 For instance, what is the standard case definition for polio, measles, cholera, bola, and bacterial 46 00:04:26,079 --> 00:04:28,075 meningitis? 47 00:04:28,075 --> 00:04:34,019 Case definitions may be changed according to the locality and the nature of the symptoms 48 00:04:34,019 --> 00:04:39,097 presenting in a particular outbreak situation. 49 00:04:39,097 --> 00:04:46,097 The District Rapid Reaction Team (RRT) can develop a working case definition where there is no standard case 50 00:04:46,097 --> 00:04:53,072 definition depending on common symptoms and risk factors related to the syndrome that 51 00:04:53,072 --> 00:04:56,002 has broken out. 52 00:04:56,002 --> 00:05:00,001 Can you suggest a case definition for the following? 53 00:05:00,001 --> 00:05:05,046 1. An outbreak of sudden alcohol related illness and deaths in zone X 54 00:05:05,046 --> 00:05:16,063 2. An outbreak of dysentery in camp Y 3. An outbreak of sudden food-related illness 55 00:05:16,063 --> 00:05:21,013 and deaths in a village Z 56 00:05:21,013 --> 00:05:27,002 Some epidemic prone diseases exist in the community even without an outbreak. 57 00:05:27,002 --> 00:05:33,007 An example is malaria, which is prevalent in many parts of Eastern Africa. 58 00:05:33,007 --> 00:05:39,081 For an outbreak to be declared, there must be a sharp rise in cases beyond the expected 59 00:05:39,081 --> 00:05:44,006 threshold for a particular season. 60 00:05:44,006 --> 00:05:50,002 Some epidemic prone diseases do not exist normally in the community. 61 00:05:50,002 --> 00:05:54,048 The occurrence of just one confirmed case is considered an outbreak. 62 00:05:54,048 --> 00:05:58,038 An example is cholera. 63 00:05:58,038 --> 00:06:01,009 Some epidemic prone diseases are rare and highly deadly when they occur. 64 00:06:01,009 --> 00:06:06,083 We do not have to wait for confirmation of a case. 65 00:06:06,083 --> 00:06:10,059 Just one suspected case is enough to consider an outbreak. 66 00:06:10,059 --> 00:06:13,081 An example is ebola. 67 00:06:13,081 --> 00:06:18,061 Therefore, thresholds differ from disease to disease. 68 00:06:18,061 --> 00:06:21,062 In cholera, just one confirmed case. 69 00:06:21,062 --> 00:06:24,019 In ebola, one suspected case. 70 00:06:24,019 --> 00:06:31,009 In measles, a cluster of 5 or more suspected cases OR at least 3 confirmed positive cases 71 00:06:31,009 --> 00:06:37,021 in a catchment area of a health facility occurring in one month. 72 00:06:37,021 --> 00:06:44,021 For malaria, because it is embedded in many parts of Eastern Africa, an outbreak occurs 73 00:06:44,021 --> 00:06:53,038 when there is a sharp seasonal rise in cases beyond the usual number of expected cases. 74 00:06:53,038 --> 00:07:04,056 Let us look at the second case study, which is one of the documents on the CD. 75 00:07:04,056 --> 00:07:11,056 Let us read through this case study, and the questions for general discussion are: How 76 00:07:11,056 --> 00:07:17,026 do you think the District and Ministry of Health officials went about investigating 77 00:07:17,026 --> 00:07:19,079 this particular outbreak? 78 00:07:19,079 --> 00:07:25,005 What do you understand by the term 'early response'? 79 00:07:25,005 --> 00:07:37,699 Steps in investigating an outbreak: Step 1. Initial response and confirmation of outbreak. 80 00:07:37,699 --> 00:07:45,037 It is important to assemble a team and prepare for an initial field visit as soon as possible. 81 00:07:45,037 --> 00:07:51,075 Two, it is important to choose a working case definition and confirm cases. 82 00:07:51,075 --> 00:07:54,083 Three, find cases systematically. 83 00:07:54,083 --> 00:08:01,003 Four, confirm whether there is an outbreak by comparing occurrence of cases with thresholds. 84 00:08:01,003 --> 00:08:07,084 And five, describe who is affected, when and where? 85 00:08:07,084 --> 00:08:14,084 Step 2: Manage and identify cases. 86 00:08:14,084 --> 00:08:22,016 Establish a district task force and allocate them their responsibilities. 87 00:08:22,016 --> 00:08:30,015 Use the working case definition to find cases and set up a treatment centre. 88 00:08:30,015 --> 00:08:34,579 Step 3: Set up immediate control measures. 89 00:08:34,579 --> 00:08:38,081 Treat cases to interrupt transmission and reduce deaths. 90 00:08:38,081 --> 00:08:45,022 Consider vaccination, disinfection and protective wear. 91 00:08:45,022 --> 00:08:48,056 Provide health education to those at risk. 92 00:08:48,056 --> 00:08:53,077 Communicate clearly to reduce panic and prevent spread of the disease. 93 00:08:53,077 --> 00:08:57,061 Step 4: Address the resource gaps. 94 00:08:57,061 --> 00:09:02,014 Ensure adequate medical supplies and logistics to handle cases. 95 00:09:02,014 --> 00:09:07,062 Look for additional resources to address the gaps and contact Ministry of Health and partner 96 00:09:07,062 --> 00:09:12,017 agencies in case the resources are inadequate. 97 00:09:12,017 --> 00:09:19,085 Step 5: Determine responsible factors for the outbreak and make a report. 98 00:09:19,085 --> 00:09:24,013 Analyse available information to establish the risk factors. 99 00:09:24,013 --> 00:09:29,062 Prepare a report and ensure that it is disseminated to those who need to know and those who need 100 00:09:29,062 --> 00:09:30,069 to take action. 101 00:09:30,069 --> 00:09:48,029 On the report, you ought to recommend and implement priority control measures. 102 00:09:48,029 --> 00:09:42,008 And Step 6: Be on your guard. 103 00:09:42,008 --> 00:09:49,019 Strengthen the existing surveillance system to find cases actively and learn from this 104 00:09:49,019 --> 00:09:52,069 outbreak to respond better in future. 105 00:09:52,069 --> 00:09:58,076 Put in place measures to prevent similar outbreaks in the future. 106 00:09:58,076 --> 99:59:59,999 Thank you for listening.