WEBVTT 00:00:05.013 --> 00:00:09.004 In this session, we shall talk about epidemics. 00:00:09.004 --> 00:00:12.069 What do you understand by the term 'Epidemic' or 'Outbreak'? 00:00:12.069 --> 00:00:19.067 An epidemic (or outbreak) is the occurrence of a disease in excess of what is expected 00:00:19.067 --> 00:00:24.098 in a particular community, for a particular group of people, within a certain period of 00:00:24.098 --> 00:00:27.079 time. 00:00:27.079 --> 00:00:35.026 Other terms related to epidemics: endemic refers to the constant presence of a disease 00:00:35.026 --> 00:00:40.037 or infectious agent within a given geographic area or population group. 00:00:40.037 --> 00:00:46.094 It is the usual or expected frequency of disease within a population. 00:00:46.094 --> 00:00:54.011 Pandemic, on the other hand refers to an epidemic occurring simultaneously in multiple locations 00:00:54.011 --> 00:00:59.023 world-wide. 00:00:59.023 --> 00:01:04.096 As an example from your country, we see that epidemics are the commonest Public Health 00:01:04.096 --> 00:01:08.065 emergency in our districts across the East Africa region. 00:01:08.065 --> 00:01:15.077 In Uganda for example, 6 outbreaks occurred in 8 months in 2007. 00:01:15.077 --> 00:01:23.009 This included Cholera, Meningitis, Hepatitis E, Marburg, Plague and Ebola. 00:01:23.009 --> 00:01:31.929 Can you name 5 outbreaks that have occurred recently in your district? 00:01:31.929 --> 00:01:39.119 Common epidemic prone diseases include diarrhoeal diseases including watery diarrhoea, Cholera, 00:01:39.119 --> 00:01:41.719 dysentery and typhoid. 00:01:41.719 --> 00:01:46.999 These are likely to occur in many districts in the East Africa region. 00:01:46.999 --> 00:01:51.609 Outbreaks of immunisable diseases like measles. 00:01:51.609 --> 00:01:56.017 These are common because immunisation coverage is low. 00:01:56.017 --> 00:02:03.017 Malaria is endemic in most parts of Eastern Africa, especially in low land areas; however, 00:02:03.017 --> 00:02:08.075 outbreaks can occur in both low and highland areas. 00:02:08.075 --> 00:02:14.096 In areas where Malaria is endemic, outbreaks occur when the threshold far exceeds what 00:02:14.096 --> 00:02:20.064 is expected for that season. 00:02:20.064 --> 00:02:26.003 Other epidemic prone diseases include Sexually Transmitted Infections including HIV/AIDS, 00:02:26.003 --> 00:02:36.047 Syphilis, Gonorrhea, and others, Plague, Hepatitis E, a massive chemical poisoning, especially 00:02:36.047 --> 00:02:43.047 from illicit alcohol, which has become a common public health problem in Eastern 00:02:43.047 --> 00:02:45.036 Africa. 00:02:45.036 --> 00:02:50.006 Let us look at a case study 1. 00:02:50.006 --> 00:02:57.053 Refer to the word document on your CD. 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 00:03:03.028 --> 00:03:08.000 authorities establish that there is an outbreak? 00:03:08.000 --> 00:03:14.067 In detecting an outbreak, we have to obtain initial notification of the outbreak. 00:03:14.067 --> 00:03:20.029 We receive information about the likelihood of an outbreak from the community, and from 00:03:20.029 --> 00:03:23.099 cases coming to health units, and from local leaders. 00:03:23.099 --> 00:03:32.051 We therefore have to have an effective early warning system that is linked to the communities. 00:03:32.051 --> 00:03:40.004 The golden rule in detecting outbreaks is that every rumour must be investigated. 00:03:40.004 --> 00:03:46.007 In detecting an outbreak, we must have a case definition for the diseases and this should 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 00:03:52.035 --> 00:03:53.084 case definition. 00:03:53.084 --> 00:04:01.078 Secondly, there must be an un-expected rise in new cases of these diseases beyond the 00:04:01.078 --> 00:04:05.096 threshold. 00:04:05.096 --> 00:04:13.009 You look at the word document station activities and read the standard case definitions for 00:04:13.009 --> 00:04:16.039 some academic prone diseases. 00:04:16.039 --> 00:04:26.079 For instance, what is the standard case definition for polio, measles, cholera, bola, and bacterial 00:04:26.079 --> 00:04:28.075 meningitis? 00:04:28.075 --> 00:04:34.019 Case definitions may be changed according to the locality and the nature of the symptoms 00:04:34.019 --> 00:04:39.097 presenting in a particular outbreak situation. 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 00:04:46.097 --> 00:04:53.072 definition depending on common symptoms and risk factors related to the syndrome that 00:04:53.072 --> 00:04:56.002 has broken out. 00:04:56.002 --> 00:05:00.001 Can you suggest a case definition for the following? 00:05:00.001 --> 00:05:05.046 1. An outbreak of sudden alcohol related illness and deaths in zone X 00:05:05.046 --> 00:05:16.063 2. An outbreak of dysentery in camp Y 3. An outbreak of sudden food-related illness 00:05:16.063 --> 00:05:21.013 and deaths in a village Z 00:05:21.013 --> 00:05:27.002 Some epidemic prone diseases exist in the community even without an outbreak. 00:05:27.002 --> 00:05:33.007 An example is malaria, which is prevalent in many parts of Eastern Africa. 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 00:05:39.081 --> 00:05:44.006 threshold for a particular season. 00:05:44.006 --> 00:05:50.002 Some epidemic prone diseases do not exist normally in the community. 00:05:50.002 --> 00:05:54.048 The occurrence of just one confirmed case is considered an outbreak. 00:05:54.048 --> 00:05:58.038 An example is cholera. 00:05:58.038 --> 00:06:01.009 Some epidemic prone diseases are rare and highly deadly when they occur. 00:06:01.009 --> 00:06:06.083 We do not have to wait for confirmation of a case. 00:06:06.083 --> 00:06:10.059 Just one suspected case is enough to consider an outbreak. 00:06:10.059 --> 00:06:13.081 An example is ebola. 00:06:13.081 --> 00:06:18.061 Therefore, thresholds differ from disease to disease. 00:06:18.061 --> 00:06:21.062 In cholera, just one confirmed case. 00:06:21.062 --> 00:06:24.019 In ebola, one suspected case. 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 00:06:31.009 --> 00:06:37.021 in a catchment area of a health facility occurring in one month. 00:06:37.021 --> 00:06:44.021 For malaria, because it is embedded in many parts of Eastern Africa, an outbreak occurs 00:06:44.021 --> 00:06:53.038 when there is a sharp seasonal rise in cases beyond the usual number of expected cases. 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. 00:07:04.056 --> 00:07:11.056 Let us read through this case study, and the questions for general discussion are: How 00:07:11.056 --> 00:07:17.026 do you think the District and Ministry of Health officials went about investigating 00:07:17.026 --> 00:07:19.079 this particular outbreak? 00:07:19.079 --> 00:07:25.005 What do you understand by the term 'early response'? 00:07:25.005 --> 00:07:37.699 Steps in investigating an outbreak: Step 1. Initial response and confirmation of outbreak. 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. 00:07:45.037 --> 00:07:51.075 Two, it is important to choose a working case definition and confirm cases. 00:07:51.075 --> 00:07:54.083 Three, find cases systematically. 00:07:54.083 --> 00:08:01.003 Four, confirm whether there is an outbreak by comparing occurrence of cases with thresholds. 00:08:01.003 --> 00:08:07.084 And five, describe who is affected, when and where? 00:08:07.084 --> 00:08:14.084 Step 2: Manage and identify cases. 00:08:14.084 --> 00:08:22.016 Establish a district task force and allocate them their responsibilities. 00:08:22.016 --> 00:08:30.015 Use the working case definition to find cases and set up a treatment centre. 00:08:30.015 --> 00:08:34.579 Step 3: Set up immediate control measures. 00:08:34.579 --> 00:08:38.081 Treat cases to interrupt transmission and reduce deaths. 00:08:38.081 --> 00:08:45.022 Consider vaccination, disinfection and protective wear. 00:08:45.022 --> 00:08:48.056 Provide health education to those at risk. 00:08:48.056 --> 00:08:53.077 Communicate clearly to reduce panic and prevent spread of the disease. 00:08:53.077 --> 00:08:57.061 Step 4: Address the resource gaps. 00:08:57.061 --> 00:09:02.014 Ensure adequate medical supplies and logistics to handle cases. 00:09:02.014 --> 00:09:07.062 Look for additional resources to address the gaps and contact Ministry of Health and partner 00:09:07.062 --> 00:09:12.017 agencies in case the resources are inadequate. 00:09:12.017 --> 00:09:19.085 Step 5: Determine responsible factors for the outbreak and make a report. 00:09:19.085 --> 00:09:24.013 Analyse available information to establish the risk factors. 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 00:09:29.062 --> 00:09:30.069 to take action. 00:09:30.069 --> 00:09:48.029 On the report, you ought to recommend and implement priority control measures. 00:09:48.029 --> 00:09:42.008 And Step 6: Be on your guard. 00:09:42.008 --> 00:09:49.019 Strengthen the existing surveillance system to find cases actively and learn from this 00:09:49.019 --> 00:09:52.069 outbreak to respond better in future. 00:09:52.069 --> 00:09:58.076 Put in place measures to prevent similar outbreaks in the future. 00:09:58.076 --> 99:59:59.999 Thank you for listening.