Investigation of Suspected Cases of Human Infection with Avian Influenza A (H5N1) Virus - PowerPoint PPT Presentation

1 / 97
About This Presentation
Title:

Investigation of Suspected Cases of Human Infection with Avian Influenza A (H5N1) Virus

Description:

Know when and how to prepare for the investigation of suspected human H5N1 cases ... Fourfold or greater rise in H5N1 neutralizing antibody titer from acute serum ... – PowerPoint PPT presentation

Number of Views:156
Avg rating:3.0/5.0
Slides: 98
Provided by: nels172
Category:

less

Transcript and Presenter's Notes

Title: Investigation of Suspected Cases of Human Infection with Avian Influenza A (H5N1) Virus


1
Investigation of Suspected Cases of Human
Infection with Avian Influenza A (H5N1) Virus

2
Learning Objectives
  • Know when and how to prepare for the
    investigation of suspected human H5N1 cases
  • Understand the objectives of outbreak
    investigation of suspected, probable, or
    confirmed H5N1 cases
  • Understand the mechanics of an outbreak
    investigation of suspected, probable, or
    confirmed H5N1 cases
  • Describe how to analyze and communicate findings
    from case investigations

3
Outline
  • Pre-Investigation and Response Planning
  • Gathering Initial Evidence
  • Case Finding and Clusters
  • Contract Tracing
  • Managing Data
  • Reporting and Evaluation

4
An important resource for H5N1 case
investigations
5
Investigating Cases to Protect Public Health
  • Confirm or exclude H5N1 virus infection
  • Reduce morbidity and mortality through rapid
    identification, isolation, treatment, clinical
    management of cases and follow-up of contacts
  • Reduce further spread of H5N1 virus infection
    through identification of exposure sources and
    implementation of control measures
  • Determine if cases or cluster of cases represent
    the beginning of a potential pandemic

6
Investigating Cases to Gather and Disseminate Data
  • Determine key epidemiological, clinical, and
    virologic characteristics of cases
  • Enhance surveillance
  • Ensure timely communication to facilitate
    informed decision-making

7
Phases of a Case Investigation
  • Pre-Investigation
  • Plan the Response
  • Investigation
  • Gather epidemiologic evidence Create case
    definitions, assess exposure and risk, collect
    clinical specimens
  • Conduct case/cluster finding, contract tracing
  • Manage and analyze data, study epidemic curves
    and patterns
  • Prevention and control activities
  • Post-Investigation
  • Write a summary report and evaluation of
    performance

8
Pre-Investigation and Response Planning
  • Phase 1

9
Triggers With Possible H5N1 Link
  • Any person that meets the WHO definition of
    suspect, probable or confirmed case of human H5N1
    infection
  • OR
  • SARI cases in workers in
  • poultry industry or among
  • those with other relevant
  • occupational exposures

Photo Tony Mounts, CDC
Photo Tony Mounts, CDC
10
Triggers Without Clear H5N1 Link
  • Severe, acute, respiratory cases in health care
    workers who care for patients with SARI or
    pneumonia
  • Clusters of 2 or more SARI cases in a 2 week
    period
  • 2 people in a family
  • Cases in a small geographic area
  • Cases with social or occupational connection
  • Increases in cases at a hospital compared
    to the same time in previous years
  • Change in the epidemiology of cases

11
Other Triggers for Investigation
  • Poultry events excessive deaths
  • Rumors from informal data sources
  • News media
  • Information hotlines

Photo Diane Gross, CDC
Photo Diane Gross, CDC
12
Preliminary Data Collection
  • How many suspected cases are there?
  • What are the signs and symptoms?
  • How serious is the condition of the case(s)?
  • What is the date of illness onset of the
    suspected H5N1 case(s)?
  • What is the geographic location of these cases?
  • Has this area had a recent bird or poultry H5N1
    epizootic?
  • Have the suspected cases had any relevant
    exposures, including poultry or other bird
    exposures?
  • Has any H5N1 testing been done?
  • ! Consider the security situation in the area !

13
Rapid Response Team (RRT)
  • Team leader
  • Epidemiologists
  • Medical officer
  • Veterinary officer
  • Laboratory scientist
  • Communications specialist
  • Logistician
  • Data Manager
  • Infection Control Nurse

Photo Tim Uyeki, CDC
14
Resources to Use
  • People
  • Physicians and nurses caring for case-patient
  • Agricultural and animal health workers,
    veterinarians, clinical and laboratory experts,
    support personnel
  • Local district, city, and provincial public
    health staff
  • Other
  • Security
  • Communication devices, money

15
Institutional Resources
  • Ministry of Health, and Ministry of Agriculture
  • Advice, guidance, additional personnel
  • Background information on organization of health
    care system
  • World Health Organization (WHO)
  • Request for assistance PPE, antiviral, personnel
  • WHO guidelines for investigation of human cases
    of avian influenza A (H5N1)
  • Other Non-governmental Organizations

16
Logistics and Documentation
  • Proof of employment
  • Information on cases already gathered
  • List of important contacts or resources
  • Manuals or Standard Operating Procedures (SOPs)
  • Case management, laboratory procedures
  • Local currency

17
Supplies
  • Epidemiological
  • Case definitions, reporting forms, questionnaires
  • Medical
  • Antiviral medications
  • Laboratory
  • Specimen collection materials, transportation
    containers, labels, viral transport media
  • Personal Protective Equipment (PPE)
  • Respirators, gloves, gown, goggles
  • Decontamination
  • Solution for homes or hospital rooms

18
Supplies, cont
  • Electronic equipment
  • Cell phone
  • Laptop (with epidemiologic software)
  • Educational materials
  • H5N1 information brochures and posters
  • Simple messages, culturally appropriate
  • Guidelines for contacts, family members, and
    healthcare workers
  • UNICEF communication materials

19
Stakeholders
  • Veterinary Health Authorities
  • Government Officials
  • Health Care personnel
  • Community
  • Non-governmental organizations
  • Laboratory

Centers for Disease Control and Prevention
20
Review Question 1
  • What are some of the logistic and planning
    documents you need to prepare as part of the
    pre-investigation?
  • Answer Many are possible. Examples include
  • Case reporting forms
  • WHO and national guidance documents
  • Standard protocols and procedures
  • Specimen collection forms

21
Collaborative Investigation
  • Public health investigators should work together
    with human, animal, and environmental health
    investigators
  • Plan joint visits to affected areas
  • Animal health investigators help assess
    appearance and health of animals and surrounding
    environment
  • Coordinate and share test results and
    surveillance data

22
Gathering Initial Evidence
  • Phase 2 Investigation

23
Evidence From a Suspect Case
  • Epidemiological findings
  • Exposures
  • Clinical evidence
  • Laboratory evidence

24
Key Questions to Address in H5N1 Case/Cluster
Investigations
  • What are the likely H5N1 virus exposure sources
    for the case(s)?
  • Has human-to-human transmission of H5N1 virus
    likely to have occurred?
  • Is there evidence of human-to-human H5N1 virus
    transmission beyond two generations?

25
H5N1 Avian Exposures
  • Unprotected exposure to H5N1 virus-infected
    poultry or wild birds (ill or dead)
  • Consumption of raw poultry products infected or
    contaminated with H5N1 virus
  • Visiting a live poultry market
  • Contact with healthy-looking ducks and geese
  • H5-vaccinated poultry
  • Unprotected contact with contaminated environment

26
Human H5N1 Exposures
  • Exposures to H5N1 virus-infected persons
  • Unprotected extended close contact (within 1
    meter) with a probable or confirmed case of H5N1
    from one day before to 14 days after the case
    patients illness onset
  • Speaking, touching, providing bedside care,
    sleeping with, sharing utensils, or other
    prolonged close contact

Source Josh Mott, CDC
27
Other H5N1 Exposures
  • Exposure to other H5N1 virus-infected animals
  • Touching or consuming an H5N1 virus infected
    animal (cat, dog, pig)
  • Laboratory exposure
  • Unprotected exposure while processing samples
    suspected of containing H5N1 virus
  • Other environmental exposure
  • Residence or visit to an area where H5N1 virus is
    suspected or confirmed

Centers for Disease Control and Prevention
28
Risk Stratification Based on Exposures
  • High risk exposure
  • Household or close family contacts
  • Moderate risk exposure
  • Other exposed persons who were not wearing
    appropriate PPE
  • Low risk exposure
  • Unexposed persons or those wearing appropriate
    PPE)
  • WHO Rapid Advice Guidelines on pharmacological
    management of humans infected with avian
    influenza A (H5N1) virus
  • http//www.who.int/csr/disease/avian_influenza/gu
    idelines/pharmamanagement/en/index.html

29
Why Use Risk Stratification?
  • Helps prioritize limited resources
  • A priori rationale for who will, and will not,
    receive resources
  • Is used in WHOs recommendations for guiding
    post-exposure antiviral chemoprophylaxis

30
Review Question 2
  • Which of these are possible exposure routes for
    H5N1 infection in humans?
  • Uncooked poultry meat
  • Close contact with a suspected case
  • Virus in home environment
  • Occupational exposure
  • Infected domestic pets
  • Cooked poultry meat
  • Answer first five!

31
Case Definitions
  • Standardizes the investigation
  • Clear criteria
  • Signs
  • Symptoms
  • Epidemiological data
  • Lab results
  • Unique for every outbreak
  • Objective measures
  • Person, place, and time

32
WHO Case Definitions for Human Infection with
Avian Influenza A (H5N1) Virus
  • Person under investigation
  • Suspected Case
  • Probable Case
  • Confirmed Case

WHO case definitions for human infections with
influenza A(H5N1) virus 29 August 2006
33
Person Under Investigation
  • Person whom public health authorities have
    decided to investigate for possible H5N1 virus
    infection

Photo Reuters / Amr Dalsh
34
Suspected Case
  • A person presenting with unexplained acute lower
    respiratory illness with fever (gt38C) and cough,
    shortness of breath, or difficulty breathing
  • AND
  • Potential exposure to H5N1 virus in the 7 days
    prior to symptom onset

35
WHO Suspected Case Exposures
  • Exposure to poultry or wild birds ,their remains,
    or areas contaminated by their feces in area with
    suspected/confirmed H5N1 in the last month
  • Consumption of raw or undercooked poultry
    products
  • Close contact (within 1 meter) with a person who
    is a suspected, probable, or confirmed H5N1 case
  • Close contact with a confirmed H5N1 infected
    animal other than poultry or wild birds
  • Handling samples (animal or human) suspected of
    containing H5N1 virus in a laboratory or other
    setting

36
Probable Case
  • Probable definition 1
  • A person meeting the criteria for a suspected
    case
  • AND
  • Exhibit infiltrates or evidence of an acute
    pneumonia on chest radiograph plus evidence of
    respiratory failure (hypoxemia, severe tachypnea)
  • OR
  • Have a positive laboratory confirmation of an
    influenza A infection but insufficient evidence
    for H5N1 virus infection
  • Probable definition 2
  • A person dying of an unexplained acute
    respiratory illness who is considered to be
    epidemiologically linked by time, place, and
    exposure to a probable or confirmed H5N1 case

37
Confirmed Case
  • A person meeting the criteria for a suspected or
    probable case
  • AND
  • A positive test result accepted as confirmatory
    by WHO, and was conducted in a national, regional
    or internationally accepted influenza laboratory

Accepted by WHO
38
Confirmatory Test Results for H5N1 Virus
Infection
  • Isolation of an H5N1 virus
  • Positive H5 PCR results from tests using two
    different PCR targets
  • Fourfold or greater rise in H5N1 neutralizing
    antibody titer from acute serum specimen
    (collected 7 days or less after symptom onset)
    and a convalescent serum specimen (convalescent
    titer must be 180 or higher)
  • An H5N1 neutralizing antibody titer of 180 or
    greater in a single serum specimen collected at
    day 14 or later after symptom onset and a
    positive result using a different serological
    assay

39
Review Question 3
  • Is this case a suspect, probable, or confirmed
    case based on WHO definitions
  • A 8 year old boy dying of an unexplained acute
    respiratory illness who was a neighbor of a
    previously confirmed H5N1 case
  • Answer probable case

40
Specimen Collection
  • Confirm the Diagnosis

Centers for Disease Control and Prevention
41
Specimen Collection
  • Safe and correct collection
  • What samples to collect?
  • What to wear for protection?
  • How to transport specimens?
  • Procedures for diagnosis?
  • Who to collect from (trigger criteria)?

42
What to Collect
  • Collect multiple specimens from different sites
    on different days
  • Lower respiratory tract specimens (best)
  • Endotracheal aspirates
  • Bronchiolalveolar lavage (BAL)
  • Pleural fluid from chest tubes
  • BAL or pleural fluid should only be tested if
    they were collected for another purpose
  • Upper respiratory tract specimens
  • Throat swabs preferred
  • Nasal swabs (can help detect human influenza
    viruses)
  • Collect acute and convalescent serum

43
Investigation Step 2 Case Finding, Clusters,
Contract Tracing
44
Case Finding and Clusters
Photo Diane Gross, CDC
45
Importance of Case Finding
  • Identify all possible cases in a community
  • Treat affected persons, determine exposure
    sources, and prevent further transmission
  • May provide information about potential
    human-to-human transmission
  • Obtain information on cases related in time and
    location to other cases or clusters

46
What is Case Finding?
  • Attempt to identify additional cases
  • Persons who may have been exposed to the same
    H5N1 source as the case
  • Persons with bird/animal exposures or healthcare
    workers caring for H5N1 patients
  • Persons with unexplained acute lower respiratory
    infection with fever or persons who died of an
    unexplained acute respiratory illness
  • Close contacts of the case

47
Methods of Case Finding
  • Passive Suspect cases that are reported without
    efforts by public health staff
  • Routine surveillance
  • Rumor hotlines
  • Public information messages in the affected
    communities
  • Active Search effort by public health workers
    in an area where a case has occurred
  • House-to-house searches
  • Visits to health care facilities
  • Private practitioners
  • Traditional healers
  • Laboratories

Any cases meeting trigger criteria must be
referred for specimen testing and appropriate
medical care!
48
Whom to Interview
  • Suspected, probable, confirmed H5N1 cases, other
    persons meeting trigger criteria
  • Family members/Household contacts
  • Health care providers, health workers
  • Co-workers, if occupational exposures are
    suspected

49
Type of Information to Collect
  • Demographic data
  • Age, sex, household members
  • Epidemiology data
  • Occupational, home, avian or other environmental
    exposures (7 days before illness onset)
  • Contact with confirmed or suspect H5N1 cases (7
    days before illness onset)
  • Travel history
  • Clinical data
  • Signs symptoms, underlying conditions, physical
    exam, vitals,
  • Hospital admission, treatments, laboratory
    results, chest x-ray results, complications
  • Outcome

50
How to Interview
  • Generate list of potentially exposed contacts for
    each case
  • Collect as much information as reasonably
    possible
  • Structure and unstructured components to the
    interviews
  • Repeat critical questions for accuracy, validity,
    and additional details
  • Understand that family members may be grieving
    for deceased cases

51
Interview Tips
  • Be friendly, but professional
  • Identify yourself and your institution
  • Explain purpose of interview
  • Stress importance of information you will collect
  • Inform respondents that all information will be
    kept confidential
  • If appropriate, conduct the interview in private
    place

52
Review Question 4
  • What types of information do you need solicit
    during an interview?
  • Environmental exposures
  • Clinical symptoms
  • Travel information
  • Potential contacts
  • Poultry exposure during last month
  • Answer All of these EXCEPT poultry exposure in
    last month (should be in last 7 days before
    symptom onset)

53
Common Challenges to Case Finding
  • Even with active case finding, all cases may not
    be identified
  • Physicians may not suspect H5N1 virus infection
  • Some H5N1 virus-infected persons may not seek
    medical care
  • Secrecy about poultry outbreaks to avoid culling
    of poultry

54
Enhancing Surveillance
  • Location
  • Implement in areas where H5N1 cases live or where
    animal outbreaks are occurring
  • Active surveillance at healthcare facilities or
    healers, private laboratories
  • Active surveillance among health care workers,
    persons exposed to birds/animals
  • Duration
  • Minimum of 2 weeks after the last human H5N1 case
    is identified (2 incubation periods)
  • Maintain for longer periods if H5N1 poultry
    outbreaks are not controlled

55
Methods to Enhance Surveillance among Medical
Community
  • Conduct trainings at health care facilities in
    the area to recognize trigger events and
    reporting process
  • Ask health care facilities in the area to report
    all cases of SARI for the next 2-4 weeks
  • Notify pharmacists and dispensers to report
    increases in medications for respiratory
    illnesses

56
Methods to Enhance Surveillance among General
Community
  • Expand sensitization training to key community
    members
  • Ask village leaders, traditional healers, and
    religious leaders to report trigger events
  • Notify teachers and school administrators to
    report increases in student absenteeism
  • Pharmacists may also report any unusual increases
    in prescription practices

57
Clusters
PHOTO AP / Binsar Bakkara
58
A Cluster May Exist When
  • Two or more people with moderate or severe acute
    respiratory illness
  • Unexplained by other causes
  • May have died from the illness
  • Onset within two weeks of each other
  • AND
  • History strongly suggests exposure to H5N1 virus

59
Possible Human-to-Human H5N1 Virus Transmission
  • Documented exposure to a confirmed, probable, or
    suspected human H5N1 case, AND
  • The time interval between contact with a
    suspected, probable, or confirmed H5N1 case and
    illness onset is 7 days or less, AND
  • No other sources of H5N1 exposures (such as
    exposures to birds, other animals, feathers,
    droppings, fertilizers made of fresh bird
    droppings, live poultry markets, contaminated
    environments, or laboratory specimens)

60
Review Question 5
  • If you recognize a cluster of human H5N1 cases,
    what would cause you to suspect that
    human-to-human transmission of H5N1 virus has
    occurred?
  • Answer Criteria such as contact with a case,
    onset within one incubation period, and no other
    plausible source of infection should be of
    concern.

61
Contact Tracing
62
What is Contact Tracing?
  • The identification and diagnosis of persons who
    may have been in close contact with an infected
    individual during the infectious period

63
Purpose of Contact Tracing
  • Find new suspected human cases of H5N1
  • Provide interventions to decrease risk of illness
    and interrupt further transmission
  • Active surveillance for illness
  • Antiviral chemoprophylaxis of exposed
  • Early treatment of ill persons
  • Collection of specimens for H5N1 testing
  • Educational information to prevent transmission

64
How to Identify Contacts
  • Review the case patients activities for the 1
    day before onset of symptoms through 14 days
    after onset of illness
  • Based on their activities, identify all close
    contacts (within 1 meter) of the case
  • Identify additional individuals with exposure to
    birds and other animals suspected of being
    infected with H5N1 virus
  • Verify all information collected

65
Prioritize Contact Identification
  • If number of contacts is large, focus on
  • Contacts of probable and laboratory confirmed
    H5N1 cases
  • Contacts with prolonged close exposures to a
    suspected H5N1 case
  • Household contacts sharing the same sleeping and
    eating space, persons providing bedside care

66
Key Information for Contact Tracing
  • Who did the case come into close contact with?
  • What activities was case doing at the time?
  • Where did these activities take place?
  • When did case come into contact with this person?
  • Other key information
  • Contact information, health status

67
General Guidelines for Interviewing Contacts
  • Do not alarm contacts
  • Communicate preventive information
  • Refer symptomatic individuals to a designated
    healthcare facility
  • Consider if Personal Protective Equipment (PPE)
    is necessary

Centers for Disease Control and Prevention
68
Information from Contacts
  • Demographic and contact information
  • Name, Address
  • Occupation, age, gender, relationship to the case
  • Exposure History
  • Contact with case-patient
  • Poultry and wild bird exposure
  • Other high-risk exposures
  • Physical Exam and Clinical information
  • Health status
  • Temperature, other vital signs
  • Presence of signs or symptoms of acute
    respiratory infection (feverishness, fever, sore
    throat, coughing)

69
Monitoring and Managing Contacts
  • Actively (daily) monitor contacts for signs of
    illness for 7 days after exposure
  • Encourage self-health monitoring
  • Instruct to report onset of fever or respiratory
    symptoms
  • Visit or phone daily to monitor for illness
  • Refer contacts with fever or respiratory illness
    to medical care, isolation, treatment obtain
    respiratory specimens for H5N1 testing
  • MOH may request (voluntary) home quarantine of
    all contacts for 7 days post exposure
  • Consider antiviral chemoprophylaxis, if available

70
Investigation Step 3 Managing Data
71
Data Management
  • Line listing of cases, contacts
  • Record keeping
  • Validation and Cross-Checking

72
Line Listing
An organized way to view all cases in an
investigation
Case Age Sex Status Occupation Difficult breathing Date of Onset
1 5 M Probable Child Yes 7 July
2 55 F Suspect Caretaker of case 1 Yes 9 July
3 48 M Suspect Poultry Farmer No 7 July
  • Demographic, Epidemiological (exposures)
  • Clinical, Laboratory data

Information included
73
Record Keeping
  • Where will records be kept?
  • How will records be kept?
  • Who is assigned to record keeping?
  • Maintain confidentiality!!

74
Validation and Cross-Checking
  • Check line lists against medical charts and
    interviews
  • Validation
  • Ask same question in different ways
  • Ask same question at different times
  • Ensure answers are consistent
  • Double-entry of data

75
Creating an Epidemic Curve and Analyzing Data
76
What is an Epidemic Curve?
  • An epidemic curve (Epi curve) is a graph or
    histogram of the number of cases of illness by
    the date of illness onset

77
How Can an Epidemic Curve Help in an Outbreak?
  • Provides information on the characteristics of
    an outbreak
  • Pattern of spread or transmission pattern
  • Magnitude of epidemic
  • Outliers (case outside expected time frame)
  • Time trend
  • Disease incubation period, possible timing of
    exposure

78
Epidemic Curves and Transmission
  • Epidemic curves have different patterns depending
    on transmission
  • Infectious agent transmitted between people
  • Infectious agent transmitted from one source to
    multiple people
  • Can be used to assess whether human-to-human
    transmission is occurring
  • Patterns easier to identify with larger number of
    cases

79
Epi Curve for Human to Human Transmission
80
Epi Curve for Human Cases from Single Source
81
Key Analytic Questions
  • Do data suggest greater spread of H5N1 virus
    among humans?
  • Large increase in human H5N1 cases?
  • Increase in cluster frequency, duration of
    illness?
  • Cases in non-family member contacts?
  • Mild or moderately ill cases?
  • Absence of animal/bird exposures?
  • Change in age distribution?
  • Multiple generations of human-to-human
    transmission suspected?

82
Investigation Step 4 Prevention and Control
Activities
Photo Reuters / Bobby Yip
83
Prevention and Control Activities
  • Animal health and control measures
  • Culling, disinfection, surveillance, vaccination
  • Infection control
  • Isolation of suspected and confirmed cases
  • PPE, infection control precautions
  • Treatment of ill patients
  • Contact tracing contact surveillance
  • Voluntary quarantine of well contacts
  • Antiviral chemoprophylaxis
  • Enhanced (active) surveillance and case finding

84
Reporting and Evaluation
  • Phase III Post Investigation

85
Multiple Levels of Reporting
  • Local Level Who is responsible for submitting
    H5N1 case reports? When should this be done?
  • National Level Who needs to be updated on the
    investigation and receive the final report on
    number of H5N1 cases? Who is responsible for
    assuring that this occurs?
  • International Level Probable, and confirmed H5N1
    cases should be reported immediately to WHO. The
    WHO IHR National Focal Point should be
    responsible for notifying WHO.

86
International Health Regulations (IHR)
  • Compulsory notification of highly-pathogenic
    strains of avian influenza
  • Under IHR (2005) all probable and confirmed H5N1
    cases in humans must be immediately reported to
    WHO
  • Compliance with these standards is required to
    strengthen early detection, reporting, and
    response

87
How and When to Report
  • Use standard reporting forms
  • Case/Lab specimen based forms, line-lists, weekly
    and monthly reporting forms, contacts follow-up
    forms
  • Immediate reporting of cases/clusters to next
    levels
  • Information flow
  • Information should be shared both vertically
    (reporting and feedback) and horizontally (among
    team/partners)

88
Writing a Summary Report
89
Why communicate the findings?
  • A document for action
  • Control and prevention measures
  • To share new insights
  • To obtain national and international resources
  • Documents the investigation
  • To assist other nations districts or countries
    with investigation
  • Inform the public
  • Help prevent future outbreaks

90
Content of a Summary Report
  • Summary
  • Introduction and Background
  • Outbreak Description
  • Methods and Results
  • Discussion
  • Lessons Learned
  • Recommendations
  • Acknowledgements
  • Supporting Documentation

91
Evaluate Performance
Detection
Onset
Response
92
Why Evaluate the Investigation
  • To summarize the events that occurred
  • To learn from experience
  • Make recommendations for future investigations
  • Take lessons from what worked well
  • Take lessons from mistakes

93
What to Evaluate
  • Timeliness of response
  • Completeness of the investigation
  • Accuracy of the data
  • Inter-agency coordination

94
Glossary
  • Trigger
  • A series of events or cases which initiate an
    epidemiologic investigation. Diseases have
    different and specific triggers. For example, a
    single suspect case of human H5N1 is a sufficient
    trigger for avian flu investigation. However,
    multiple cases of gastrointestinal disease would
    be required to trigger a salmonella
    investigation.
  • Rapid response team (RRT)
  • A multi-disciplinary group of investigators and
    medical scientists who are quickly mobilized in
    response to a disease outbreak or adverse health
    event. Teams can consist of epidemiologists,
    medical providers, veterinarians, laboratory and
    communication specialists, data managers,
    infection control nurses, etc.

95
Glossary
  • Stakeholder
  • A person or group who is affected by, or involved
    in the investigation and its outcomes
  • Risk Stratification
  • Grouping individuals according to specific risk
    attributes such as degree of exposure or severity
    of illness
  • Case finding
  • The concerted effort of public health
    professionals to search for and identify any
    potential cases of disease in order to treat or
    contain an illness

96
Glossary
  • Cluster
  • An unusual grouping, or excess number of disease
    cases in a geographical location or point in time
  • Case-patient
  • Index case, or patient who initiated the
    investigation
  • Line listing
  • A way to organize and present important
    information that is collected about each
    potential case or contact

97
References
  • WHO Guidelines for the Investigation of Human
    Cases of Avian Influenza A (H5N1), Jan 2007.
    Accessed from
  • http//www.who.int/csr/resources/publications/i
    nfluenza/WHO_CDS_EPR_GIP_2006_4r1.pdf
Write a Comment
User Comments (0)
About PowerShow.com