In this session, we shall talk about epidemics.
What do you understand by the term 'Epidemic' or 'Outbreak'?
An epidemic (or outbreak) is the occurrence of a disease in excess of what is expected
in a particular community, for a particular group of people, within a certain period of
time.
Other terms related to epidemics: endemic refers to the constant presence of a disease
or infectious agent within a given geographic area or population group.
It is the usual or expected frequency of disease within a population.
Pandemic, on the other hand refers to an epidemic occurring simultaneously in multiple locations
world-wide.
As an example from your country, we see that epidemics are the commonest Public Health
emergency in our districts across the East Africa region.
In Uganda for example, 6 outbreaks occurred in 8 months in 2007.
This included Cholera, Meningitis, Hepatitis E, Marburg, Plague and Ebola.
Can you name 5 outbreaks that have occurred recently in your district?
Common epidemic prone diseases include diarrhoeal diseases including watery diarrhoea, Cholera,
dysentery and typhoid.
These are likely to occur in many districts in the East Africa region.
Outbreaks of immunisable diseases like measles.
These are common because immunisation coverage is low.
Malaria is endemic in most parts of Eastern Africa, especially in low land areas; however,
outbreaks can occur in both low and highland areas.
In areas where Malaria is endemic, outbreaks occur when the threshold far exceeds what
is expected for that season.
Other epidemic prone diseases include Sexually Transmitted Infections including HIV/AIDS,
Syphilis, Gonorrhea, and others, Plague, Hepatitis E, a massive chemical poisoning, especially
from illicit alcohol, which has become a common public health problem in Eastern
Africa.
Let us look at a case study 1.
Refer to the word document on your CD.
The questions: Is this a scenario that could occur in your district? And how did the district
authorities establish that there is an outbreak?
In detecting an outbreak, we have to obtain initial notification of the outbreak.
We receive information about the likelihood of an outbreak from the community, and from
cases coming to health units, and from local leaders.
We therefore have to have an effective early warning system that is linked to the communities.
The golden rule in detecting outbreaks is that every rumour must be investigated.
In detecting an outbreak, we must have a case definition for the diseases and this should
be known by the frontline health workers and then they must also be made for a community
case definition.
Secondly, there must be an un-expected rise in new cases of these diseases beyond the
threshold.
You look at the word document station activities and read the standard case definitions for
some academic prone diseases.
For instance, what is the standard case definition for polio, measles, cholera, bola, and bacterial
meningitis?
Case definitions may be changed according to the locality and the nature of the symptoms
presenting in a particular outbreak situation.
The District Rapid Reaction Team (RRT) can develop a working case definition where there is no standard case
definition depending on common symptoms and risk factors related to the syndrome that
has broken out.
Can you suggest a case definition for the following?
1. An outbreak of sudden alcohol related illness and deaths in zone X
2. An outbreak of dysentery in camp Y 3. An outbreak of sudden food-related illness
and deaths in a village Z
Some epidemic prone diseases exist in the community even without an outbreak.
An example is malaria, which is prevalent in many parts of Eastern Africa.
For an outbreak to be declared, there must be a sharp rise in cases beyond the expected
threshold for a particular season.
Some epidemic prone diseases do not exist normally in the community.
The occurrence of just one confirmed case is considered an outbreak.
An example is cholera.
Some epidemic prone diseases are rare and highly deadly when they occur.
We do not have to wait for confirmation of a case.
Just one suspected case is enough to consider an outbreak.
An example is ebola.
Therefore, thresholds differ from disease to disease.
In cholera, just one confirmed case.
In ebola, one suspected case.
In measles, a cluster of 5 or more suspected cases OR at least 3 confirmed positive cases
in a catchment area of a health facility occurring in one month.
For malaria, because it is embedded in many parts of Eastern Africa, an outbreak occurs
when there is a sharp seasonal rise in cases beyond the usual number of expected cases.
Let us look at the second case study, which is one of the documents on the CD.
Let us read through this case study, and the questions for general discussion are: How
do you think the District and Ministry of Health officials went about investigating
this particular outbreak?
What do you understand by the term 'early response'?
Steps in investigating an outbreak: Step 1. Initial response and confirmation of outbreak.
It is important to assemble a team and prepare for an initial field visit as soon as possible.
Two, it is important to choose a working case definition and confirm cases.
Three, find cases systematically.
Four, confirm whether there is an outbreak by comparing occurrence of cases with thresholds.
And five, describe who is affected, when and where?
Step 2: Manage and identify cases.
Establish a district task force and allocate them their responsibilities.
Use the working case definition to find cases and set up a treatment centre.
Step 3: Set up immediate control measures.
Treat cases to interrupt transmission and reduce deaths.
Consider vaccination, disinfection and protective wear.
Provide health education to those at risk.
Communicate clearly to reduce panic and prevent spread of the disease.
Step 4: Address the resource gaps.
Ensure adequate medical supplies and logistics to handle cases.
Look for additional resources to address the gaps and contact Ministry of Health and partner
agencies in case the resources are inadequate.
Step 5: Determine responsible factors for the outbreak and make a report.
Analyse available information to establish the risk factors.
Prepare a report and ensure that it is disseminated to those who need to know and those who need
to take action.
On the report, you ought to recommend and implement priority control measures.
And Step 6: Be on your guard.
Strengthen the existing surveillance system to find cases actively and learn from this
outbreak to respond better in future.
Put in place measures to prevent similar outbreaks in the future.
Thank you for listening.