The document discusses epidemic preparedness and response. It describes how infectious diseases arise from various pathogens and spread between different species. Preparedness and response involves detection of public health threats, risk assessment, investigation and control. Epidemic intelligence aims to speed up detection of potential health threats and allow timely response. The document also outlines strategies for preventing and controlling vector-borne diseases like dengue, malaria and leptospirosis in the state. It provides clinical case definitions for malaria, leptospirosis and dengue and describes the evolution of the state and regional epidemic intelligence units.

1. Epidemic Preparedness & Response
Dr Sara Varghese
Professor & Coordinator
State PEID Cell
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2. Infectious Diseases
 Arise from many different pathogens: viruses,
bacteria, parasites
 Spread in many different species: humans, insects,
domestic and wild animals, aquatic animals and
sometimes breach barrier between animal and
humans (70% of emerging infections arise from
animal population)
 Take many different routes of transmission: direct
contact, vectors, food, environmental
 Affect all populations in all regions of the world
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3. Preparedness and response
Detection of public health threats
related to infectious disease, or of
unknown origin
Risk assessment, investigation and
control
Strengthening preparedness
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4. Epidemic Intelligence
 Definition
• The systematic collection and collation of
information from a variety of sources, usually in
real-time, which is then verified and analysed
and, if necessary, activates response
 Objective
• to speed up detection of potential health threats
and allow timely response
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5. Epidemic preparedness and Response
3-6-5 strategies for 365 days
3 Diseases - Leptospirosis, Dengue and Malaria
6 strategies - to prevent and control Vector borne
diseases
5 strategies - to avoid Leptospirosis deaths.
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6. 6 strategies for Vector borne diseases
 Total ,True & Timely Surveillance
(Clinical, Vector and Lab)
 Integrated vector management (IVM)
 IEC/BCC
 Intersectoral coordination
 Management (Medical & Non Medical)
 Monitoring & supervision
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7. Case Definition
 A set of clinical or laboratory criteria used
to decide whether or not an individual will
be considered as having the disease of
interest in an epidemiological study.
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8. Malaria
 Clinical Case Definition : Fever and any
two of the following
 Chills, sweating, jaundice, spleenomegaly
 Convulsions, coma, shock, pulmonary
edema and death in severe cases
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9. Leptospirosis
 Clinical description : Acute febrile illness with headeache, myalgia and
prostration associated with any of the following:
 Conjunctival suffusion
 Meningeal irritation
 Anuria/Oligiuria
 Jaundice
 Haemorrages
 Cardiac arrythmia or failure
 Skin rash & a history of exposure to infected animals
 Other common symptoms like nausea, vomiting, abdominal pain,
diarrhoea, arthralgia.
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10. Dengue
 Febrile illness with 2 or more of the
following:
 Headeache, retro-orbital pain, myalgia,
arthralgia, rash, Haemorrahagic
manifestations, leucopenia
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11. 5 strategies to prevent Lepto deaths
 Personal protection measures
 Chemoprophylaxis
 Fever- Avoid self treatment
 Prompt Treatment for Leptospirosis
 Environmental modification
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12. Evolution of State & RPEID Cells
 1982 – Constitution of State PEID Cell
G.O(Rt)No.2394/82/H &FW dt.7.10.82
 1989-Constitution of Regional PEID Cell
G.O(Rt)No.292/89/H&FW, dt.31.1.1989
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13. SDCMC
Constituted as per
G.O(Rt)No.4043/07/H&FWD
dt.30.11.2007
Funds provided to Regional PEID
Cells from NRHM through State
PEID Cell.
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14. SDCMC
Monitoring the fever situation in the state.
 Reporting units in 14 districts (1200 RUs),
Reports of CDs from Govt . & Private
Medical Colleges, State & Reg. Public
health lab and NIV unit & Private hospitals
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15. Fever trend 2006 to 2010
0
500000
1000000
1500000
2000000
2500000
3000000
3500000
4000000
2006 2007 2008 2009 2010
Year
Cases
Series2
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16. Con. Dengue over 5 years
0
500
1000
1500
2000
2500
3000
2006 2007 2008 2009 2010
Year
Cases
Series2
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17. Malaria over 5 years - Kerala
0
500
1000
1500
2000
2500
2006 2007 2008 2009 2010
Year
Cases
Series1
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18. Con Lepto over 5 years in Kerala
0
500
1000
1500
2000
2006 2007 2008 2009 2010
Year
Cases
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19. Dengue ,Malaria & Lepto Kerala –
1st Jan – 26th Feb
District
New fever
cases DENGUE LEPTO MALARIA
OP Sus Con Sus Con
TVM 17844 34 83 12 35 12
KLM 6998 7 1 6 4 6
PTA 12254 4 0 10 1 14
ALP 12323 4 3 13 15 7
KTM 7906 28 0 35 2 3
IDK 10048 1 1 13 2 3
EKM 17861 3 4 0 5 8
TSR 29765 5 1 0 2 14
PLD 20594 9 0 15 3 4
MLP 23437 1 0 15 0 7
KKD 8866 5 3 51 5 10
WYD 12280 0 3 8 10 2
KNR 18189 18 0 9 0 9
KSD 16365 0 7 0 2 10
Total 214730 119 106 187 86 109
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20. OP Fever Jan - Feb 26th Kerala
0
5000
10000
15000
20000
25000
30000
35000 TVM
KLM
PTA
ALP
KTM
IDK
EKM
TSR
PLD
MLP
KKD
WYD
KNR
KSD
OP fever
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21. DENGUE Jan 1st - Feb 26th 2011
0
20
40
60
80
100
SUS
CON
SUS 34 7 4 4 28 1 3 5 9 1 5 0 18 0
CON 83 1 0 3 0 1 4 1 0 0 3 3 0 7
TV
M
KL
M
PT
A
AL
P
KT
M
IDK
EK
M
TS
R
PL
D
ML
P
KK
D
W
YD
KN
R
KS
D
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22. DENGUE Jan 1st - Feb 26th 2011
0
20
40
60
80
100
SUS
CON
SUS 34 7 4 4 28 1 3 5 9 1 5 0 18 0
CON 83 1 0 3 0 1 4 1 0 0 3 3 0 7
TV
M
KL
M
PT
A
AL
P
KT
M
IDK
EK
M
TS
R
PL
D
ML
P
KK
D
W
YD
KN
R
KS
D
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23. Malaria -Jan 1st - Feb 26th 2011
0
2
4
6
8
10
12
14
16
T
V
M
K
L
M
P
T
A
A
L
P
K
T
M
I
D
K
E
K
M
T
S
R
P
L
D
M
L
P
K
K
D
W
Y
D
K
N
R
K
S
D
Malaria
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24. Format for instantaneous reporting of Early Warning Signal / outbreaks as soon as it is detected
State :Kerala District: Date of reporting:
Is there any unusual increase in Cases/Deaths or unusual event in any area? Yes
Disease/ Syndrome(Provisional/Confirmed)
Area affected (Block, PHC, Sub-center, Village
No of cases
No of deaths
Date of start of the outbreak
Total population of affected area(Village)
Salient epidemiological observations
Lab results (type of sample, number of samples collected and
tested,What tests, where, results)
Control measures undertaken (Investigated by RRT or not)
Present status
Any other information
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25. DIRECTORATE OF HEALTH SERVICES
STATE SURVEILLANCE UNIT IDSP - Daily report -Form A
Name of District No. of Reporting units No. of reported units
Dat
e
N
o
Name of
RUs
TOTAL
OP
New
fever
cases
LEPT
O
CG
DENG
UE
AES
/JE
Malaria
H1
N1
C
.
p
o
x
A
D
D
C
h
o
l
e
r
a
T
y
p
h
o
i
d
Hepatiti
s
M
u
m
p
s
M
e
a
s
l
e
s
R
u
b
e
l
l
a
O
t
h
e
r
D
i
s
.
(
s
p
e
c
i
f
y
)
D
e
a
t
h
s
(s
p
e
ci
f
y
)
S
us
C
o
n
S
u
s
C
o
n
S
u
s
C
o
n
A
E
S
J
E
P
v
P
f
M
i
x
T
o
t
a
l
I
n
d
i
g
.
S
u
s
C
o
n
A B
C
/
E
OP
I
P
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26. DIRECTORATE OF HEALTH SERVICES
STATE SURVEILLANCE UNIT IDSP - Daily report of Death Cases- Form B
Name of District
No. of Reporting
units
No. of reported units
Dat
e
N
o
Name of
RUs
Lepto Dengue AES/JE
Mala
r
i
a
H1N1
C.pox
AD
D
Chole
r
a
Typho
i
d
Hepatitis
Measl
e
s
Rubel
l
a
Und
i
a
g
d
i
s
e
a
s
e
s
n
o
s
e
d
Pr
o
Co
n
Pr
o
Co
n
AE
S
J
E
Pr
o
Co
n
A B
C/
E
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27. DIRECTORATE OF HEALTH SERVICES
STATE SURVEILLANCE UNIT IDSP - Daily report for other diseases and
deaths Form C
Name of
District -
No. of Reporting
units
No. of reported
units
Da
ta Cases only
N
o
Name of
RUs
Diphtheria
W.
coug
h
Teta
nus
Dog
bite
Snak
e
bite
Food
pois
onin
g
TB
Pneum
onia
Menin
gitis
HIV
L
e
p
ro
sy
A
F
P
T
y
p
h
u
s
L
e
i
s
h
m
a
n
i
a
s
i
s
O
t
h
e
r
D
i
s
e
a
s
e
s
(
s
p
e
c
i
f
y
)
C D C D C D C D C D C D C D C D C D C D
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