EAHA DM 1.2a: Epidemics - Captions

This is a remix of 1.2a: Epidemics narrated by Roy William Mayega (Makerere University). This version includes English captions. The original video (without captions) can be found at http://www.youtube.com/watch?v=VHHGfll28RA. Video transcribed by Trisha Paul (University of Michigan). This video is part of a learning module from the East Africa HEALTH Alliance called Public Health Emergency Planning and Management for Districts. The full module and the video transcript can be accessed at http://openmi.ch/disaster-mgmt. Copyright 2009-2019 Roy Mayega (Makerere University). The video, transcript, and module are all shared under a Creative Commons Attribution (CC BY) 3.0 License: http://creativecommons.org/licenses/by/3.0/.

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.

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

And Step 6: Be on your guard.

outbreak to respond better in future.

Put in place measures to prevent similar outbreaks
in the future.

Thank you for listening.