Investigation disease outbreak and disease survelience.pdf

Institut Latihan Kementerian Kesihatan Malaysia (ILKKM)
Prog : Diploma in Medical And Health Science (DPMH)
Year 1 Sem I
MHBE 2013
BASIC EPIDEMIOLOGY ;
Investigating disease outbreak and
disease surveillances
(2 Hour)

Learning outcome (LO) ;
i. Describe the investigating
disease outbreak.
ii. Discuss disease survelliance
9/10/2020 2
ILKKM ; DPMH ; MHBE 2013 Basic Epidemiology

1. Disease outbreak.
2. Epidemic investigation and
objective.
3. Step taken in investigating
epidemic.
4. Disease surveillance, objective
and limitation.
9/10/2020 3
Content outline :

An epidemic or a disease outbreak is
the occurrence of the disease at an
unusual (unexpected) frequency.
(source; Ministry Of Health Malaysia)
An outbreak may occur in a restricted
geographical area, or may extend over
several countries.
It may last for a few days or weeks, or for
several years.
9/10/2020 4
Disease outbreak:

Example outbreak;
ILKKM ; DPMH ; MHBE 2013 Basic
Epidemiology
5

8 focus Malaysian
Strategy for
Emerging
Diseases (MySED)
Workplan (2012-
2015)
Epidemiology
6

8 focus
Malaysian
Strategy for
Emerging
Diseases
(MySED)
Workplan (2012-
2015)
1. Public Health Emergency
Preparedness.
2. Surveillance, Risk Assessment and
Response.
3. Laboratories.
4. Zoonosis.
5. Prevention through Healthcare.
6. Risk Communication.
7. Regional Preparedness, Alert and
Response.
8. Monitoring and Evaluation.
Epidemiology
7

1. Under the Prevention and Control of
Infectious Diseases Act (PCID) 1988,
the person authorised to declare an
outbreak is the Minister of Health.
2. Always refer guide line of Infectious
Diseases Outbreak Rapid Response Manual
by Ministry Of Health Malaysia.
9/10/2020 8
Disease outbreak:

1. 1996 -A major cholera outbreak occurred in Penang with subsequent
spread to the other Peninsular States resulting in a total of 1,182
reported cases and 231 detected carriers. Even though there were no
fatalities, the direct and indirect costs as a result of the outbreak had
adverse implications in several sectors.
2. 1997 - The Hand, Foot And Mouth Disease (HFMD) outbreak in
Sarawak, mainly during the months of June and July, generated a lot
of attention because of the 31 paediatric deaths.
3. 1999 - A Nipah Encephalitis outbreak which occurred in 3 defined
localities in Peninsular Malaysia resulted in 283 cases including 109
deaths. This was the first report of such infection in the world.
4. 2001 - An anthrax scare with a total of136 reported incidents occurred
nationwide following a bioterrorist attack in United States of America.
9/10/2020 9
History Disease outbreak:

1. Rapid response team (RRT) - RRTs should be
formed at district, state and national levels.
2. Laboratory preparedness- general and specific
need
3. Clinical resources – manpower, specialist,
hospital, clinic static and mobile.
4. Stockpiles of critical materials – reagent lab
etc.
9/10/2020 10
4 activities in outbreak preparedness:

1. Field Investigation (Epidemiological,
Environment & Laboratory).
2. Inventory of laboratory resources.
3. Regional reference laboratories.
4. National reference laboratories.
9/10/2020 11
Outbreak/Epidemic investigation;

Regional reference laboratories ;
Epidemiology
12

National reference laboratories ;
1. Institute for Medical Research, Kuala Lumpur
2. Hospital Universiti Kebangsaan Malaysia, (HUKM) Kuala
Lumpur
3. University Malaya Medical Centre, (UMMC) Kuala Lumpur
4. University Malaysia Sarawak, Kota Samarahan
5. National Public Health Laboratory, Sg. Buloh, Selangor
6. Veterinary Research Institute, Ipoh, Perak
Epidemiology
13

International Specialised laboratory
resources;
Epidemiology
14

1. To analyse and act on surveillance information concerning infectious diseases.
2. To plan control and response strategies for managing outbreaks.
3. To identify additional resources needed for rapid response.
4. To investigate and manage the outbreak including communication with the
general public and the media.
5. To collaborate and coordinate with other relevant agencies in managing the
outbreak.
6. To evaluate the effectiveness of the response and intervention measures
adopted during the outbreak.
7. To produce a detailed report on the outbreak investigation and control activities
including recommendations.
8. To predict and plan for the management of future outbreaks.
9/10/2020 15
Role Rapid response team (RRT) ;

Rapid response team (RRT) members at DISTRICT LEVEL ;
1. District Medical Officer of Health (MOH) / Epidemiologist – as team
leader.
2. Hospital Director / Physician / Medical and Health Officer Senior
Health Inspector
3. Health Inspectors (Disease Control / Vector Borne Disease Control).
4. Health Matron / Health Sister.
5. Health Education Officer / Health Education Co-ordinator.
6. Other co-opted members from relevant agencies as and when
needed.
Epidemiology
16

Rapid response team (RRT) members at STATE LEVEL ;
1. State Director of Health – as team
leader.
2. State Deputy Director of Health
(Public Health)
(Medical)
(Pharmacy)
(Administration)
6. State Epidemiology Officer
7. State Chief Health Inspector
8. State Health Matron
Epidemiology
17
9. State Medical Officer of Health
(Vector)
10. State Entomologist
11. State Health Education Officer
12. State Physician / Infectious
Disease Physician
13. State Paediatrician
14. State Pathologist
15. State Food Technologist
16. Other co-opted members from
relevant agencies as and when
needed.

Standardized objective approach ;
1. Public Health Objectives :
• Identify other cases and quickly detect any human -to-
human transmission.
• Reduce onward transmission, morbidity and mortality
through rapid identification, isolation, treatment and clinical
management of cases and follow up of contacts.
• Prevent future cases through identification of potential
human, animal, and/or environmental sources of exposure,
risk factors for infection, and implementation of appropriate
prevention and control measures.
Epidemiology
18

Standardized objective approach ;
2. Knowledge Objectives :
• Determine the size of geographic area where the pathogen is
transmitting.
• Determine key epidemiological, clinical, and virological
characteristics for cases including clinical presentation and
natural history, the mode(s) of transmission and disease
diagnosis, incubation period, period of transmissibility, and best
practices for treatment.
• Determine if the efficiency of human-to-human transmission of
the pathogen has changed or increased appropriate prevention
and control measures.
Epidemiology
19

Step taken in investigating epidemic ;
1. Basic information collected
2. Exposure Information and travel
history
3. Clinical Information
4. Develop a case definition
5. Serological investigation of
contact
6. Reporting Cases
Epidemiology
20

Disease surveillance ;
• Surveillance of disease is a continuous scrutiny of all
aspects of occurrence and spread of disease pertinent to
effective control of that disease.
• Public Health surveillance is a systematic ongoing
collection, analysis, interpretation and dissemination of
health data.
• Public health surveillance originally focused on
communicable diseases, but now includes the monitoring
of injuries, birth defects chronic disease and health
behaviours.
• Many surveillance systems employ secondary data,
including vital statistics.
Epidemiology
21

Epidemiology
22

6 mechanism of Disease surveillance in Malaysia ;
1. Mandatory notifiable diseases surveillance ; Notification of
presently 26 infectious diseases under the schedule 1 and 2 of the
Prevention and Control of Infectious Disease Act 1988 (PCID)
2. Laboratory based surveillance;
3. Clinical based surveillance;
4. Disease surveillance by other agencies;
5. Community based surveillance;
6. Surveillance activities at various levels ( district, state,
national); ILKKM ; DPMH ; MHBE 2013 Basic
Epidemiology
23

1. Mandatory notifiable diseases surveillance ; Notification of
presently 26 infectious diseases under the schedule 1 and 2 of the
Prevention and Control of Infectious Disease Act 1988 (PCID)
Epidemiology
24

Epidemiology
26

cont’…..Disease surveillance ;
Objective of surveillance ;
1. Give early warning of change of incidence any
disease.
2. Detect outbreak early.
3. Evaluate the effectiveness of interventions.
4. Identify at risk groups .
5. Helps set priorities for resource allocation .
Epidemiology
27

Surveillances report of infectious ;
1. Morbidity report.
2. Mortality report.
3. Report from selected sentinel centres.
4. Special field investigation of epidemics or individual
cases.
5. Laboratory monitoring of infectious disease.
6. Epidemiologic and clinical report.
7. Review of current literature on the disease.
Epidemiology
28

Limitations of surveillance systems ;
As with all information sources, there are four potential
short comings of surveillance systems :
1. Completeness
2. Accuracy
3. Relevant and representative
4. Timeliness
Epidemiology
29

Epidemiology
30

Epidemiology
31

Student reading/ priority references :
Book / Journal / Article
No References
1. Gordis Leon (2013) Epidemiology, 5th edition,Elsevier
Suander,USA.
2. William C. Cockerham (2016) Medical sociology 13th edition,
Routledge,USA
3. Schneider.M.J(2014),Introduction to public health (4th
Edition),Jones & Bartlett Learning,USA
9/10/2020 ILKKM ; DPMH ; MHBE 2013 Basic Epidemiology 32
Internet/ e book/ online
No References
1. http://www.moh.gov.my/
2. https://www.who.int/
3. https://books.google.com.my/books?id=AXZz6JIV9ikC&pri
ntsec=frontcover#v=onepage&q&f=false
4. https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section1
1.html
5. • infectious diseases outbreak rapid response manual.pdf
• (MYSED) II (2017–2021) National Strategic Work Plan.pdf

Epidemiology
33

Recommendation for student Independent Learning (IL) ;
Activities Source
1. Search and
download
• infectious diseases outbreak rapid response manual.pdf
• (MYSED) II (2017–2021) National Strategic Work Plan.pdf
2. Reading, making
short note on
related topic
As above and,
• https://www.who.int/csr/don/18-december-2019-mers-saudi-
arabia/en/
3. Discus • https://www.who.int/csr/don/20191218_mers_saudi_arabia.xls?ua=1
9/10/2020
Epidemiology
34

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