7. Surveillance

8/2/2019 7. Surveillance

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Su r v e i l l ance f o r Hu m an Cases o fAv i an I n f lu e n za


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Manag in g Hum an Av ianI n f lu enza: St r a t eg ies a t a Glan ce

An im a l H ea lt h D ep t t .

Quarantine of bird

Culling of bird

Mopping-up

Disinfection & sanitisation

Vaccination of bird

Poultry surveillance

Other aspects

H um an Heal t h D ep t t .

Quarantine of human populations

Surveillance:

Active (0-3 km & 3-10 km)

Passive (0-10 km)

Health monitoring Chemoprophylaxis

Case management:

Isolation

Antivirals Ventilatory support

Lab investigation

Control room set-up

IEC

Logistics


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Ev en t Based Hu m an Su r v e i l l an ce

Outbreak

Outb reak

Ou t b reak

Outb reak

Outb reak

Outb reak

Outb reak

Outbreak


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Tr igg er Po in t f o r Cent r a l RRT

Report ofdetecting HPAI

from HSADLBhopal; NIV,Pune

Report of bird

death from District

Animal Husbandry

Officer/ChiefVeterinary Officer

Report of influenzalike illness with

travel history orcontact historysuggestive of avianinfluenza exposure

A V I A NI NFLUENZ

AMONI TORI

NGCELL,

NICD, Delhi

RapidResponse

Team

Media or otherreport


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W h at i s Su r v e i l l an ce?

Surveillance of disease is the continuing scrutiny of

all aspects of occurrence and spread of a disease

that are pertinent to effective control

Keeping a close watch


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Com po n en t s o f Su r v ei l l an ce

1. Collection of data

2. Compilation of data

3. Analysis of data

4. Interpretation

5. Action/Intervention

6. Feedback


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Dat a Co l lect ion Pr ocedu r es

1. Passive surveillance

2. Active surveillance

3. Sentinel surveillance

4. Outbreak investigation

5. Surveys


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Su r v e i l l ance f o r Hu m an Caseso f Av i an I n f l u en za Fever with ARI + history of contact

with dead/sick poultry

Passive: any in no. of cases in

OPDs of health facilities/privatepractitioners

Act i ve :

house to house

0-3 km & 3-10 km About 95% of targeted population

covered in 0-3 km daily up to 10days after last culling

3-10 km: one round completed in 3-4 days

500 popn=1HW; 4 HW=1 HS; 4 HS=1 MO


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Proforma: line list format

Name of affected area

No. of surveyed villages No. of houses: Total & visited

Population: Total & visited

No. of fever & ARI cases No. of fever & ARI cases, who handled dead birds

No. of houses having birds & observed death of

birds in last 10 days

Contact tracing

Act iv e Su r v e i l l ance


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Av i an I n f l u en za Ou t b r eak Dai l y Repor t i ng Fo r m at


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Av i an I n f l u e n za Ou t b r eak Da i l y Repor t i ng Fo r m at


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Act iv e Su r v e i l l an ce Lin e Lis t o f Cases


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Cas

eInv

estig

ation

She

et

N am e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Sex ___ ___

A ge i n Yea r s/ m o n t h s_ _ _ _ _ _

Cu r r e n t co n t a ct d e t a il s_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Fu l l ad d r e ss _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

T e l e p h o n e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

N at i o n al i t y _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

E t h n i c i t y _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Signs and sym p t om s :

Body t em pe r a tu r e h i ghe r t han 38 C Yes No Unkn ow n

Cough Yes No Unknow n

Sore th roa t Yes No Unknow n

Shor t ness o f b rea th Yes No Unknow n

Dat e of o nset o f i l ln ess ( d d / m m / y y yy ) _ _ _ _/ _ _ _ _/ _ _ __

History of travel.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hist or y o f o ccup at ion al ex po sur e.. . .. . . .. . . .. . . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .

Hist or y of ex posu re t o af f ected pou l t ry . . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .

His tor y o f exp osure t o w i ld / dom est ic an im als .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .

Hist or y of ex posu re t o possib l e h um an cases.. . .. .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. .


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902208

1622879

2525087

852563

1304284

2156847

0.41%

0.08%

0.21%

0

500000

1000000

1500000

2000000

2500000

3000000

0-3 Km 3-10 km Total

Area

To

talPopulation&Surveyed

0.00%

0.05%

0.10%

0.15%

0.20%

0.25%

0.30%

0.35%

0.40%

0.45%

%F

ever-ARIcase

s

Total Popn SUV Popn % Fever-ARI cases

Act i ve Su r v e i l l an ce : Popu la t ionSu r veyed & I n cidence Ra t es o f

Fever-ARI Cases, Av ian I n f lu enzaOu t b r eak , Ja rg on , 2 0 0 6

94.5%

80.4%

85.42%


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Con t act Tr acin g

Information about close contacts can be obtained from:

interviews of patient, family members, workplace

or school associates, or

others with knowledge about the patients recent

activities and travels

If no. of contacts requiring investigation is large or

personnel resources are limited - focus on contacts withthe highest risk of infection or exposure


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Con t act Tr acin g

Priority groups should be based on:

Heightened probability of infection, such as contact

with a laboratory confirmed case

Duration, spatial proximity and intensity of exposure

to the case patient (e.g. HCW, household contacts

sharing same sleeping/eating space, persons

providing bedside care)

Exposure in settings that could accelerate spread to

large numbers of contacts, e.g. when a confirmed

case worked in a school or attended a large

gathering

Likelihood that human-to-human transmission hasresulted from contact with the case patient


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Con t act Tr acin g

Whenever possible, cases should be isolated in health

facilities for strict infection control

Contacts should be advised to remain at home

(voluntary home quarantine) for at least 7 to 10 daysafter the last contact with a person under investigation

Should evidence of spread beyond the initial

containment zone emerge: containment areas designated for antiviral

prophylaxis should be re-defined

decision to be made in collaboration with local &national authorities and WHO


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Con t act Tr acin g

For symptomatic persons:

refer persons with fever & respiratory illness for:

collection and laboratory testing of specimens and

appropriate medical care including antiviral

therapy

depending on the severity of illness and availability of

hospital beds, contacts that are ill may be isolated at a

healthcare facility or at home while awaiting test

results


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Con t act Tr acin g

For asymptomatic contacts:

initiate active monitoring (e.g. daily visits or

telephone calls) for the development of fever or

respiratory symptoms for 7 days after the last

exposure to the case patient

self-health monitoring with daily supervision may

be advised

administration of antiviral chemoprophylaxis

should be guided by an exposure risk assessment


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I m p or t an t Ter m s

I so la t i on : Separation (for the period ofcommunicability) of infected persons from others in such

places and under such conditions so as to prevent or limit

the direct or indirect transmission of the infectious agent

from infected to non-infected persons or who may spreadthe agent to others

Quaran t i ne : Restriction of the activities of apparently

healthy persons who have been exposed to a case ofcommunicable disease during its period of

communicability to prevent disease transmission during

the incubation period if infection should occur

Soc ial d is t anc ing : public health practice of encouraging

people to keep physical distance from each other during

disease outbreaks in order to slow the spread of infection


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Sel f Heal t h Mon i t o r i ng Pr o fo r m a


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Clu st e r Repor t in g For m at


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Tr a in in g o f St a f f

W h o

Medical officers

Health supervisors Health workers

On W ha t

Case definition

Active surveillance Proforma

Chemoprophylaxis

IEC


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Deputation of health teams (MO, HS, HW)

Preliminary strategic meeting - briefing

Chemoprophylaxis & Health monitoring of staff IEC & risk communication

Logistics & supplies

Reporting, supervision, monitoring & coordination Control room

Ot h e r I m p o r t an t I ssu e s in Su r v e i l lan ce


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Chem opr ophy lax i s & Heal t h Mon i t o r i ng

To Whom:

Cullers

Helpers

Poultry farm workers

Household contacts

Surveillance teams

Others at risk

Oseltamivir, 75 mg OD

On DOTS pattern

Daily monitoring:

temperature & any flu like

symptoms

Any side effects


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Ch em opr oph y lax i s

Risk Gr ou p s

Antiviral chemoprophylaxis be considered according to

risk stratification:

High risk exposure groups

Moderate risk exposure groups

Low risk exposure groups


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High Risk Ex p osu r e Gr ou p s

Household or close family contacts of a strongly

suspected/ confirmed H5N1 patient:

Potential exposure to a common environmental orpoultry source

Exposure to the index case


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Moder a t e Risk Ex p osu r eGroups

Personnel involved in handling sick animals,

decontaminating affected environments (including

animal disposal), if PPE not used properly

Individuals with unprotected & very close direct

exposure to sick/dead H5N1 infected animals/birds

Healthcare personnel in close contact with strongly

suspected/confirmed H5N1 patient

Laboratory personnel might have unprotected exposure

to virus containing samples


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Low Risk Ex po su r e Gr ou ps

HWs not in close contact with a strongly suspected/

confirmed H5N1 patient

HWs who used appropriate PPEs during exposure toH5N1 patients

Personnel involved in culling (likely) non-infected animal

populations Personnel involved in handling sick animals or

decontaminating affected environments (including

animal disposal) who used proper PPEs


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Th an k You

7. Surveillance

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