Surveillance and Rapid Response Kumnuan Ungchusak Bureau of - - PowerPoint PPT Presentation

Surveillance and Rapid Response

Kumnuan Ungchusak Bureau of Epidemiology Department of Disease Control

Outlines

• Surveillance
• Surveillance and rapid response team
• Epidemiology in action

• I. Surveillance

Hakone’s Check point

How Surveillance work? How Surveillance work?

๑. Observe and record

๒. Describe the

• bserve

๓. Analysis

Normal VS abnormal

๔. Propose action to

authority

ตําบล province

District

Central D-SRRT P-SRRT R-SRRT C-SRRT Region

• II. Surveillance and Rapid Response Team in Thailand

Village health volunteer ๗๐,๐๐๐ หมูบาน

Intelligence Control action

Information

Epidemiological Surveillance network Epidemiological Surveillance network

• Screening of history of exposure
• Confirm clinical finding
• Testing of respiratory specimens
• Survey of village and identify exposure
• Active case finding and

Surveillance of all household member for 10 days

• Antiviral prophylaxis for family member
• f confirm H5 cases
• Culling of affected poultry
• Educated villagers to avoid risk

(SRRT)

Hospital

Laboratory

Veterinarian

Pathologists

Early pandemic Alert phase 4 of new Influenza subtype

Ro = 1.5 - 2

A very narrow window

• f opportunity to

contain pandemic at its origin

• Female 26- year- old
• Onset 10th Sept. Died at 20th. of September
• Body was on religious rites at a temple.
• History of visiting her daughter in Kampangphet
• Her daughter died on 8th. of September suspect of Dengue
• Cluster of death need thorough investigation

1 1st

• st. Patient

. Patient “ “ The Mother The Mother” ”

Day 1st : Investigate the mother

• Her sister also ill and could not joined the religious rites
• Lung aspiration fail to detect PCR of Influenza
• Ask for last minute Autopsy of the mother at 21.00 pm
• n the following day.

Day 2nd. Investigate the aunt

• Refer to provincial hospital
• Isolation
• Oseltamivir 75 mg x 2 for

10 days

• Daily examination of all 5

family members

• Survey the village
• 2nd. Patient
• 32-year-old female
• elder sister of

the 1st patient

27 29 31 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 2 4 6 8

Household chicken ill and died (inKamphaengpeth province) Last household chicken buried Onset of fever Admitedt to hospital with pneumonia Died Funeral ritual in different unaffected village

Index case

August September

October

• 11-year-old girl

Index case “ The daughter ”

Laboratory investigation Laboratory investigation Day 4 of investigation (25 September)

• Specimen of the mother was tested simultaneously at
• Department of medical science (DMS)
• Siriraj Medical School
• US CDC at Atlanta

Day 5th of investigation (26 September)

• H5 confirmed in Aunt respiratory specimens by DMS

Day 6th of investigation (27 September)

• Siriraj confirm H5 in Mother lung tissues
• Expert committee conclude “Probable Human to Human”

0.1 Qa/NC/12-340/00 H1N1 A/teal/China/2978.1/02 Ph/HK/675.14/02 Env/HK/437-10/99 Gs/GD/1/96 HK/156/97 Ck/HK/258/97 Ck/HK/786/97 Ck/HK/y385/97 HK/97/98 Gs/HK/w355/97 HK/486/97 Dk/HK/p46/97 Ck/HK/31.4/02 Ck/HK/409.1/02 Ck/HK/96.1/02 Ck/HK/YU56/01 Sc/HK/SF189/01 Ck/HK/715.5/01 Ck/HK/FY150/01 Ck/HK/FY77/01 Ck/HK/YU777/02 Ck/HK/61.9/02 Dk/CH/E319-2/03 Dk/HK/821/02 Gs/HK/739.2/02 G.H/HK/793.2/02 Eg/HK/757.3/02 HK/213/03 HK/212/03 Thailand/LFPN-2004/2004 Aunt Mother Dk/Kamphaephet/04 Ck/Kamphaephet/04 TH/5(KK-494)/04 TH/2 (SP-33)/04 TH/1(KAN-1)/04 TH/3 (SP-83)/04 Ck/TH/CH-2/04 Ck/Nakornsawan-02/04 Hanoi/03/04 TH/4(SP-528)/04 VietNam/1203/04 Ck/TX/167280-4/02 H5N3 Ck/TW/1209/03 H5N2 Dk/NY/191255-99/02 H5N8 Ml/OH/556/87 H5N9

HA

• Confirmed H5 in poultry die-off in near by village
• Confirmed H5 by PCR from lung of “The mother”
• Demonstrated influenza A in lung tissue
• Confirmed H5 from swab of “The aunt”
• H5 Phylogenic tree of mother and aunt are closed
• Unable to confirm H5 in daughter

Day 6th. (27 September)

• Expert committee conclude “probable person-to-

person”

• Briefing the Minister of Health at 4.00 pm
• Brief the Priminister at 9.00 pm
• Get permission to release information

Day 7th ( 28 September)

• Press release

Risk Communication

Policy Implication

Day 8th (29 September)

• Priminister meet with all governors ,provincial veterinarian

and chief medical officer

• Take Avian Influenza as national agenda

“Declare war on Avian Flu”

• Integrated and joint operation between Human and

Animal Health under governor

• Mobilize village health volunteer to

“X-ray all household” of dead poultry Educate villagers and bring suspect case to health unit

4 months after

• National strategic plan to control avian

influenza and Influenza pandemic preparedness (105 million US dollars)

Influenza A (H1) Samutsakorn ๒๐๐๖

• Total Factory worker 1700
• Influenza like symptom 180
• Stop work
• Isolation
• Daily temperature monitoring

2006 Massive outbreak of Botulism from home canned bamboo shoot.

• 209 cases
• 134 hospitalized
• 43 on ventilation,
• 93 doses of antitoxin were

mobilized from US, UK, Japan through WHO and US CDC

• No dead

Conclusion

1 2 3 4 5 6 7 8

Nov-03 Jan-04 Mar-04 May-04 July-04 Sep-04 Nov-04 Jan-05 Mar-05 May-05 July-05 Sep-05 Nov-05 Jan-06 Mar-06 May-06 July-06 Sep-06 Nov-06 Jan-07

dead survive

2004

2005

จํานวน (ราย)

Remark: 3097 Notification and investigation in 2004

3244 Notification and investigation in 2005 5479 Notification and investigation up to 23 November 2006

cases

• 1. Epidemic curve of confirm H5 human cases in Thailand

from 2004 to present. (25 cases with 17 dead in 4 waves)

2006

cluster

Conclusion

• Complacency causes repeated outbreaks
• Institute lay report at village level and national AI surveillance
• Intensive investigate human case especially clusterings
• Inefficient human-to-human sustainable human-to-human
• Initiate pre-emptive measures
• International joint effort for containment

27 29 31 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 2 4 6 8

Household chicken ill and died (inKamphaengpeth province) Last household chicken buried Onset of fever Admitedt to hospital with pneumonia Died Funeral ritual in different unaffected village

27 29 31 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 2 4 6 8 27 29 31 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 2 4 6 8

Mother live and work in another province (Nonthaburi) Arrived at hospital and provided bedside care Attended funeral ritual for 3 nights in different unaffected village Developed fever Stayed one night in index case village Returned to Nonthaburi Admitted to hospital with pneumonia Die Aunt buried ill chicken Provided bedside care for index case in hospital Attended funeral ritual Developed fever Admitted with pneumonia, received antiviral Recover

Aunt Mother Index case

August September

October Figure 2 Chronology of exposure and onset of the index case, her mother and aunt.