Surveillance for AI in Human Bureau of Epidemiology Health - - PDF document
Surveillance for AI in Human Bureau of Epidemiology Health services Ministry of Public Health Central Department of disease control: Bureau of epidemiology Department of Medical science: NIH Regional disease control office Regional 12
Bureau of Epidemiology
Health services
Health center District health office District hospital Provincial health office 76 offices Provincial hospital 76 Regional disease control office 12 offices Village University hospital Private hospital Ministry of Public Health Department of disease control: Bureau of epidemiology Department of Medical science: NIH District level Province level Regional Central
Influenza Pneumonia
Diseases under notification
Annual cases report 1996-2002
Source: BOE, MOPH Confirmed case Suspect case Area of outbreak in poultry First round (Jan-Mar 2004) Second round (Aug-Oct 2004) Third round (Oct05-Nov05)
New reported 2 cases on 26 July, 5 Aug 2006 in Pichit, Uthai
Number of AI cases by date of onset, 2004
1 2 3 4 5 6 7 8 9 10
1-3 Jan 10-12 Jan 19-21 Jan 28-30 Jan 6-8 Feb 15-17 Feb 24-26 Feb 4-6 Mar 29-31 Aug 7-9 Sept 16-18 Sept 25-27 Sept 4-6 Oct
Suspect (22) Confirm (17) Probable (1)
Confirm AI in poultry and human Determine extent of problem Commitment of higher policy Construct structure and system Orientate the involving parties: physician,
lab, epidemiologist, logistic, risk communicator, policy maker,
Training the teams
up to 10 March 2004
Announcement of the first confirm 23 Jan 2004
Number of cases notified by week, Jan-Aug 2005
Third wave of human epidemic August-September 2005
Protection of high-risk groups
Case management and infection control
Migratory birds
Infected poultry
Risk communication for the public
Man
Disease Surveillance
surveillance
Prevent exposure
Outbreak control in poultry
Transparency in operation and information
virus in animals low risk for human
for human
no or only inefficient man-to-man Tx
man-to-man Tx, limited outbreak
in man-to-man Tx, extended outbreak
Detect the first generation of H-H
Identify risk groups and trace all
Limit the H-H transmission within 2
Health facility base reporting system Hotline for case notification Media check
Health volunteers & community leaders
Initiate and coordinate the network, emergency commander, monitoring and report
Medical care & Network:
Detect, Report, treat
SRRT:
rapid diagnosis, Investigation Control Warning
Medical care & network
Health services
SRRTs
Mr Bird Flu
Surveillance and Control: structure at province
Group1
Group 2
Group 3
Cluster of ILI (5case in the same community in 1 wk)
NP swab NP aspiration Tip of ET tube Pair serum
Prepare
PCR for influenza A or B PCR for Influenza A H1, H3, H5 Viral isolation Neutralization test
NP swab, T swab, NP aspirate
RT-PCR
Culture when NPA, or PCR + : Flu A
+
Flu B H1 RT-PCR H3 RT-PCR H5 Realtime-PCR H 1 or H 3 + H 5 + All neg Real time PCR RT-PCR + + => Report H5 +
Report
Flow of laboratory confirm
Hospitals Regional lab 12 labs PCR for Influenza A and B PCR for Influenza H1 H3 H5 National lab P 3 PCR for Influenza A and B PCR for Influenza H1 H3 H5 Viral isolation Negative Discard Positive for H5 Clinical screening for notification criteria Specimen collection
Screening: Dengue Leptospirosis Melioidosis Bacteria
Report to Hospital and NIH Confirm Positive for H5 Report to Higher policy BOE Hospital
Exposure
Direct contact without protection
+++
Living in areas
++
Contact to other pneumonia case
+
Clinical
Severe pneumonia
++++
Pneumonia
+++
ILI admitted
++
ILI not admitted
+
Case under surveillance Suspect case Probable case Confirm case Excluded case
Classification conduct when finish lab process, recover
Case definitions for surveillance Case definitions for surveillance (15 May 2006)
(15 May 2006)
Suspect: : An individual whose body temperature is more than 38o C and who has at least one of the following symptoms: muscle pain, cough, breathing difficulty, shortness of breath, or physician suspects pneumonia or influenza, and
who has a history of direct contact with sick or dead poultry in
the last 7 days or
there were reports of unusual poultry deaths in the village in the
last 14 days or
has been looking after another pneumonia patient in the last 10
days before illness onset, but
who does not have a specimen which complies with the
recommendation for laboratory testing for Influenza A/H5
Probable case: a suspect who developed signs and symptoms of, or died from, acute respiratory failure
Confirmed case: a suspect who has a final standard laboratory confirmation of Influenza A/H5 through at least
Single RT-PCR method using two primer/probe sets,
locations (such as throat swab and nasopharyngeal aspirate, etc.), or using at least two specimens collected from a patient at different period of illness),
Viral culture Neutralization test (four-fold antibody increase
between acute and convalescent serum
Case definitions for surveillance Case definitions for surveillance (15 May 2006)
(15 May 2006)
Daily lab result updated via e-mail report Daily situation report via e-mail Web base situation report for public:
www.dld.go.th http://epid.moph.go.th
Weekly case report with zero report check
Number of reported cases by week 2006
week number
Pitfall of case detection Surveillance is working with not only data
BUT PEOPLE
Lack of history taking Rely on laboratory
Time at collection Quality of collection process Quality of specimen transportation Media Quality of the test
Miss diagnosis to other diseases
Quick test result H1, H3, flu B
Sensitivity: 88%, PVP= 72% Specificity: 89% NPV=96%
PCR
Rapid test
positive negative Total Positive
265 100 365
Negative
36 882 918
Total
301 982 1283
Rapid test for 2 confirm H5, all are negative
Initiate and maintenance Centralize VS De-centralize data Warning VS threatening Simplicity and flexibility Trust and friendship
Surveillance and Response unit, BOE Epidemiologist at provincial health office, Thailand Regional office of diseases control 1-12 Department of Medical Science, NIH Department of Medical Service Department of Livestock, NIAH FETP