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International Seminar on International Seminar on Disease Surveilla Disease Surveilla 18 18 Decemb Decemb Disease Surveilla Disease Surveilla 18 18 Decemb Decemb 18 18 Decemb Decemb 18 18 Decemb Decemb Dr Nirmal Kandel , MBBS, MA Preparedness, Surveil Emergency and Humanit Disease Surveillance an WHO Ind Preparedness, Surveillance and Response (PSR) – WHO Indo 1 | n 10 Year of Tsunami Aceh n 10 Year of Tsunami Aceh ance in Disaster ance in Disaster ber ber 2014 2014 ance in Disaster ance in Disaster ber ber 2014 2014 ber ber 2014 2014 ber ber 2014 2014 A (Anthropology), MPH, EMBA llance and Response tarian Action (EHA) & d Epidemiology (DSE) donesia onesia

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International Seminar onInternational Seminar on

Disease SurveillaDisease Surveilla1818 DecembDecemb

Disease SurveillaDisease Surveilla1818 DecembDecemb18 18 DecembDecemb18 18 DecembDecemb

Dr Nirmal Kandel , MBBS, MA

Preparedness, Surveil

Emergency and Humanit

Disease Surveillance an

WHO Ind

Preparedness, Surveillance and Response (PSR) – WHO Indo1 |

n 10 Year of Tsunami Acehn 10 Year of Tsunami Acehff

ance in Disasterance in Disasterberber 20142014

ance in Disasterance in Disasterberber 20142014ber ber 20142014ber ber 20142014

A (Anthropology), MPH, EMBA

llance and Response

tarian Action (EHA) &

d Epidemiology (DSE)

donesia

onesia

Outline of pOutline of ppp

Introduction

What is needed in an emergency What is needed in an emergency

Fundamental Principles of Contrpemergency and each of the princ

O tb k C t l Outbreak Control

Prevention and control of specifiPrevention and control of specifi

Preparedness, Surveillance and Response (PSR) – WHO Indo2 |

presentationpresentationpp

y?y?

rol of Communicable diseases in ciples

c communicable diseases.c communicable diseases.

onesia

IntroduIntrodu

Communicable Diseases are the min emergencies particularly so in co

Main causes of morbidity and mortadiseases acute respiratory infectiodiseases, acute respiratory infectioendemic malaria.

Malnutrition and trauma are additioamongst populations affected by em

Preparedness, Surveillance and Response (PSR) – WHO Indo3 |

uctionuction

major cause of morbidity and mortality omplex emergencies.

ality in emergencies are diarrheal ns measles and in areas where it isns, measles and in areas where it is

nal causes of illness and death mergencies.

onesia

What is needed durWhat is needed dur

Provision of shelter, water, sanitatiothe most effective means of protectthe most effective means of protectemergencies.

A systematic approach to control ofcomponent of humanitarian responthe health of the population.

Preparedness, Surveillance and Response (PSR) – WHO Indo4 |

ring an emergency?ring an emergency?g g yg g y

on, food and basic health care are ting health of those affected byting health of those affected by

f communicable diseases is a key nse and crucial for the protection of

onesia

FundamentaControl of Commu

FundamentaControl of CommuControl of CommuControl of Commu

Rapid Assessment Rapid Assessment

Prevention Prevention

S ill Surveillance

O tb k C t l Outbreak Control

Disease Management

Preparedness, Surveillance and Response (PSR) – WHO Indo5 |

al principles unicable Diseasesal principles unicable Diseasesunicable Diseases unicable Diseases

onesia

Rapid Health Rapid Health

The objectives should be :The objectives should be :

1. To assess the extent of the emergdiseases in the population

2 To define the type and size of inte2. To define the type and size of inte

3. To plan the implementation of the

4. To provide information to internatimedia to mobilize resources bothmedia to mobilize resources both

Preparedness, Surveillance and Response (PSR) – WHO Indo6 |

AssessmentAssessment

gency and the threat of communicable

erventions and priority activitieserventions and priority activities

se activities

onal community, donors and the human and financialhuman and financial.

onesia

PrevePreve

Communicable diseases can be prevCommunicable diseases can be prevmeasures which include:Good site planningGood site planningProvision of basic clinical servicProvision of appropriate shelterProvision of appropriate shelterClean water supplySanitationSanitationMass vaccination against specifRegular and sufficient food suppRegular and sufficient food suppControl of vectors

Preparedness, Surveillance and Response (PSR) – WHO Indo7 |

entionention

vented by appropriate preventivevented by appropriate preventive

ces

fic diseasesplyply

onesia

SurveiSurvei

Surveillance is the ongoing systeminterpretation of data in order to plainterpretation of data in order to plahealth intervention. Surveillance system should be simpy p

specific

Preparedness, Surveillance and Response (PSR) – WHO Indo8 |

illanceillance

matic collection, analysis and an, implement and evaluate publican, implement and evaluate public

ple, flexible, acceptable and situation p p

onesia

Objectives of a surveillancObjectives of a surveillanc

1 Identify public health priorities1. Identify public health priorities

2. Monitor the severity of an emergey gmortality and morbidity data

3 Detect outbreaks and monitor res3. Detect outbreaks and monitor res

4. Monitor trends in incidence and co to t e ds c de ce a d c

5. Provide information to ministry ofl i i l iprogram planning, implementatio

Preparedness, Surveillance and Response (PSR) – WHO Indo9 |

ce system in an emergencyce system in an emergency

ency by collecting and analyzing y y g y g

sponsesponse

case fatality from major diseasescase ata ty o ajo d seases

f health, donors to assist in health d bili ion and resource mobilization.

onesia

Preparedness, Surveillance and Response (PSR) – WHO Indo10 | onesia

Task of Health Workers atTask of Health Workers at

Preparedness, Surveillance and Response (PSR) – WHO Indo11 |

t key steps of Surveillance t key steps of Surveillance

onesia

OutbreakOutbreak

An outbreak is occurrence of a n An outbreak is occurrence of a nthat is unusually large or unexpe

Outbreaks and epidemics refer

Outbreaks in emergency situatiorise to high morbidity and mortarise to high morbidity and morta

Aim should be to detect and con Aim should be to detect and conpossible.

Preparedness, Surveillance and Response (PSR) – WHO Indo12 |

k Controlk Control

number of cases of a diseasenumber of cases of a disease ected for a given place and time.

to the one and same thing.

ons can spread rapidly giving ality ratesality rates.

ntrol the outbreak as early asntrol the outbreak as early as

onesia

Sequence of Events in OutbrSequence of Events in Outbr

Alert

708090

506070

ases

203040

01020

1 4 7 10 13 16 19

Day

Preparedness, Surveillance and Response (PSR) – WHO Indo13 |

y

reak Detection and Confirmationreak Detection and Confirmation

t Response

OpportunityOpportunity

for control22 25 28 31 34 37 40

y

onesia

y

Sequence of Events in OutbSequence of Events in Outb

90

Early Alert Rapid Response

708090

405060

203040ases

01020

1 4 7 10 13 16 19

Days

Preparedness, Surveillance and Response (PSR) – WHO Indo14 |

reak Detection and Confirmationreak Detection and Confirmation

PotentialPotential

Cases Prevented

22 25 28 31 34 37 40

s

onesia

Detection oDetection o

Preparedness, Surveillance and Response (PSR) – WHO Indo15 |

of Outbreakof Outbreak

onesia

ConfConf

Preparedness, Surveillance and Response (PSR) – WHO Indo16 |

firmation & Evaluation of Outbreak

firmation & Evaluation of Outbreakof Outbreakof Outbreak

onesia

Major diseases with epidemic pMajor diseases with epidemic p

Cholera Cholera

Measles

Shigellosis

Acute Respiratory Infection

Meningococcal disease

In certain areas the following dis In certain areas the following dismalaria, leishmaniasis, viral hemhepatitis A and E.

Preparedness, Surveillance and Response (PSR) – WHO Indo17 |

hepatitis A and E.

potential in emergency situatiopotential in emergency situatio

seases have to be included:seases have to be included: morrhagic fever, typhoid and

onesia

Steps in the ma communicable

Steps in the ma communicablea communicable a communicable

1 P ti1. Preparation

2 D t ti2. Detection

3. Response

4. Evaluation

Preparedness, Surveillance and Response (PSR) – WHO Indo18 |

management of disease outbreak

management of disease outbreakdisease outbreakdisease outbreak

onesia

Preparation foPreparation fopp

Health coordination meetings Health coordination meetings

Strong surveillance systemg y

Outbreak response plan for each

Stocks of iv fluids, antibiotics and

Plans for isolation wards

L b t t Laboratory support

Preparedness, Surveillance and Response (PSR) – WHO Indo19 |

or the outbreakor the outbreak

h disease

d vaccines

onesia

Detection oDetection o

Surveillance system with early wdiseases.

Inform ministry of health and WHdiseases.diseases.

Take appropriate specimens (stoconfirmation.

Include case in the weekly repor Include case in the weekly repor

Preparedness, Surveillance and Response (PSR) – WHO Indo20 |

of outbreakof outbreak

warning system for epidemic prone

HO in case of outbreaks of specific

ool, CSF or serum) for laboratory

rtrt.

onesia

Response to Response to pp

C fi th tb kConfirm the outbreak

Activate the outbreak co

Investigate the outbreak

Control the outbreak

Preparedness, Surveillance and Response (PSR) – WHO Indo21 |

the outbreakthe outbreak

ontrol team

k

onesia

EvaluEvalu

Assess appropriateness aAssess appropriateness acontainment measures.

Assess timeliness of outbresponseresponse.

Change public health poliChange public health poli

Write and disseminate ouWrite and disseminate ou

Preparedness, Surveillance and Response (PSR) – WHO Indo22 |

uation uation

and effectiveness ofand effectiveness of

break detection and

icy if indicatedicy if indicated.

utbreak reportutbreak report.

onesia

Prevention and Ci b

Prevention and Ci bcommunicabcommunicab

Acute Respiratory Infections

Cholera

Other diarrheal diseases

Conjunctivitis

Dengue

Diphtheria Diphtheria

Hepatitis

HIV/AIDS

Japanese Encephalitis

Leishmaniasis

Malaria

Measles

Preparedness, Surveillance and Response (PSR) – WHO Indo23 |

Control of specific bl di

Control of specific bl dible diseasesble diseases Meningococcal Meningitise gococca e g t s

Relapsing Fever(louse borne)

S bi Scabies

Sexually Transmitted Infections

Trypanosomiasis

Tuberculosis

Typhoid

Typhus (Epidemic louse borne) Typhus (Epidemic louse borne)

Viral Hemorrhagic fever

onesia

References used for trecommended

References used for trecommendedrecommended recommended

Communicable disease control in Communicable disease control inWHO

Control of Communicable DiseaseChin

Reingold AL Outbreak InvestigatioInfectious Diseases, 1998, 4(1):2

Preparedness, Surveillance and Response (PSR) – WHO Indo24 |

this presentation and further readingthis presentation and further readingfurther readingfurther reading

emergencies (Field manual) emergencies (Field manual)-

es Manual APHA Editor James

ons- a perspective Emerging 1-27

onesia

Preparedness, Surveillance and Response (PSR) – WHO Indo25 | onesia

ThankThank

Preparedness, Surveillance and Response (PSR) – WHO Indo26 |

k Youk You

onesia