MANAGEMENT OF EPIDEMICS Epidemiology= Epi among, Demos people, Logos study Epidemics= It is a sudden and unexpected increase in a disease or health related event in an unidentified area. Severity of increase and spread depends on the Geographic location, environmental condition and distribution of host population and socio- cultural behavior of people.
Management= management of epidemics involve step by step activities starting from forecasting to prevention for future occurrences.
EPIDEMICS The severity of the epidemic depends on--- Geographic environment condition. Characteristic of host population. Socio cultural behaviour. Types of Epidemics: Common source epidemic
Point or single exposure
Multiple exposure from viable source
Propagated epidemic Seasonal epidemic Cyclic epidemics Epidemic of non communicable diseases
1.FORECASTING EPIDEMIC Forecasting is an early warning system to get prepared to meet the challenge of impending epidemics. It is more appropriate in cyclic and seasonal epidemics where the pattern has been studied from the post data. By forecasting one may not totally prevent the epidemic, but definitely control its severity and spread to other areas.
1.FORECASTING EPIDEMIC 4.The various methods needed for forecasting are:
Study of incidence and prevalence rate
Disease specific morbidity rate
Age and sex wise morbidity and disease specific mortality
The various data are tabulated month wise/ year wise for last three years for comparison and study pattern
Then the collected data is plotted on graph for immediate detection and visual appreciation through trend analysis of the disease.
Plotting of data on the map of local area helps in immediate assessment, whether the cases are grouped or clustered.
Developing a surveillance system for continuous data reporting and observation.
2.CASE INVESTIGATION INVESTIGATION OBJECTIVES - To define the magnitude in terms of time, place and person.
To identity source and possible cause.
Factors contributing to spread.
To make recommendation to prevent.
In spite of accurate forecasting an epidemic may not be aborted. In an unfortunate occurrence of an expected epidemic, the case investigation must be started to confirm.
STEPS IN INVESTIGATION OF EPIDEMICS Verification of diagnosis Confirmation of existence of epidemics Defining the population at risk. Rapid search for all cases in the area. Analysis the data Formulation of hypothesis Testing of hypothesis Evaluation of ecological factor Expand the search in other areas Write a final report
EPIDEMIC INVESTIGATION By asking questions By making comparison By asking questions: What is the problem - what can be done to reduce the problem. Where is the problem – what action to be taken by different groups. When is the problem – how activities to be planned. What is the magnitude – what constraints may be faced. Who all are effected – To what extent these can be over come. Why did it happen – what action be taken to prevent in future. How did it started – what resources are required. B) By making comparison: Between two groups or two locations compare to find out the crucial difference between the host or environmental factors of effected area and not effected area.
CASE INVESTIGATION Define population at risk Confirm existence CASE INVESTIGATION Prepare for epidemic Start screening of area
CONFIRMATION OF CASES Confirmation of existence of epidemics is done through following process: Confirm diagnosis through clinical and lab tests. Define the gravity of situation by grouping/ clustering of cases on the local map. Age and sex wise people are suffering Type of disease/ health condition and risk factors Approximate number of cases suffering
START SCREENING THE AREA To apprise the total population at risk, screening of suspected cases starts. The screening depends on the geographic area and population group affected. Therefore the screening may be: Mass screening ,when all age and sex groups are involved. E.g. Dengue, swine flu, argemone oil poisoning(epidemic dropsy) Age specific screening for pediatric, geriatric disease categories. Women group screening for cervical cancer and breast cancer High risk group screening. Eg. HIV, Hypertension, Heart disease etc.
CRITERIA FOR SCREENING The various criteria used for assessment of screening test are: Validity: extent to which test measure the right cases it is supposed to measure Sensitivity: minimizes false negative, identify positive cases Specificity: identify negative cases. Repeatability: on repeated tests value do not change
DEFINE POPULATION AT RISK The population at risk can be found by: Population survey. Watch on migration of cases from other areas. Study of environmental conditions like air, water, sewarege pollution, food poisoning Mapping on local maps. Source of infection and family/ contact tracing.
PREPAREDNESS FOR EPIDEMICS Once the epidemic is suspected and cause identified, action should be taken to contain it by: Logistic planning, drugs, immunization, reagents. Manpower planning specially field staff, investigations, epidemiologists etc. Setting up of surveillance centers. Health education to public through media Training of medical and paramedical staff
SET UP SURVEILLANCE CENTERS Over and above the identified sentinel surveillance centers which provides data through out the year, there is need to start more surveillance cum cases reporting centers. Active surveillance by field investigators. Round the clock controlling room be established for receiving data and providing information. Surveillance guide lines be sent to the concerned identified center for case diagnosis and correct reporting.
SURVEILLANCE GUIDELINES Declare the disease as suspected epidemic Develop the standard case definition Develop the criteria to be used for diagnosis Develop the specific lab diagnostic tool Explain the objective of surveillance Develop data collection tools and frequency and reporting authority, information to be collected Decide the method of surveillance to be put in place i.e. only case reporting, or screening and reporting. Categorise the cases as suspected/ probable/ confirmed cases Guidelines for collection, transportation, storage of specimens for the lab test Data analysis, interpretation, and further action
CONTROL OF EPIDEMICS To control an epidemic one must have the information w.r.t Causative organism/ source Dynamic of disease transmission Mode of transmission… direct contact, indirect contact, vehicle of transmission
Root of transmission
3.CONTROL OF EPIDEMICS Three principles of dynamics of disease transmission is used to control the epidemic Removal of source of infection Prevent transmission Vector control measures
CONTROL OF EPIDEMICS Removal of Source of Infection: Treatment of infected cases Destruction of reservoir of infection Removal/ correction of source of infection
CONTROL OF EPIDEMICS 2. Prevent transmission: Isolation of infected cases Hand washing and personal protective measures Use of sterile supply Proper disposal of fomites Improve environmental sanitation Contact tracing, family, neighbor Screening of suspected cases Quarantine of migrated cases Health education Increase resistance of suspects through immunization, prophylactic drugs or immuno globulins.
CONTROL OF EPIDEMICS 3. Vector control measures: Prevent breeding of mosquitoes, flies and fleas Destruction of adult vectors through insecticide, pesticide Personal protection like prevent bite, use mosquito nets, use hot food, filtered water Increase personal hygiene improve environmental sanitation like open air, defecation, use of cut fruits, proper garbage disposal
4. PREVENTING MEASURES There is a saying ‘’ more you sweat during peace, less you bleed during wars.’’ Appropriate measures at right time, right place in right quantity can prevent the severity of any epidemic. Personal measures: Increase body resistance by immunization, nutritional diet Change in diet habits Regular yoga and exercises Pollution free atmosphere Giving away addiction
PREVENTING MEASURES 2. Environmental measures: Clean portable water supply Prevent open air defecation Proper disposal of garbage Adequate sewerage system Lighted and well-ventilated houses
3. Regular health education to public through mass media, group meetings, seminars, workshops.
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