PANDEMIC MODULE 3.1.pptx FOR MBBS 2019 M

pandemic module for UG MBBS #NMC #CBME #

1. responces at different levels isolation & Quaratine Contact tracing Pandemic module_3.1_Outbreak MX

2. Text responces to an outbreak ; general responce Till the specific source and route of transmission is identified. For example, if one is suspecting a droplet infection outbreak, start a campaign requesting people to follow social distancing, use of mask and hand.

3. Text responces to an outbreak; specific measures Depend on causative agent. BROAD STEPS ARE: Identification and nullification of the source of outbreak like chlorinating wells, Minimising transmission to prevent further exposure: vector control, Protection of the host- immunization / chemoprophylaxis, Controlling the reservoir include early diagnosis, notification, isolation, treatment, quarantine.

4. Text Broadly these are measures, pending results of epidemiologic/outbreak investigation. these activities routinely are now included in primary health care- it requires community participation, political support and intersectoral co-ordination.

5. Text 1. controlling the reservoir elimination of animal reservoir. ( eg. bovine tuberculosis, brucellosis) Elimination of human reservoir ?

6. 1. controlling the reservoir stamping out the ‘spark’ ; (a) early diagnosis the first step in the control of an outbreak is its Rapid identification. for treatment of patients; for epidemiological investigations for eg. the source of infection from index case (known) to the primary source (unknown) of infection. to study tpp —descriptive epidemiology

7. 1. controlling the reservoir (B) notification once detected or suspected - notifies to the local health authority. certain diseases are statutorily notifiable. physician, HOF, lay people, religious, political, administrative leaders, teachers can report even on suspicion.

8. 1. controlling the reservoir notification

9. 1. controlling the reservoir notification IHR - INTERNATIONAL HEALTH REGULATIONS To WHO Cholera, Plague, Yellow fever; Under surveillance: louse borne Typhus fever, Relapsing fever, Paralytic Polio, Malaria, viral Influenza-A, SARS, Small pox..

10. 1. controlling the reservoir (C) Epidemiological investigations Methodology (covered in last thursday lecture)

11. Text 10 steps:

12. (d) isolation Oldest ds control measure. “Separation, for the period of communicability of infected persons or animals from others in such places and under such conditions, as to prevent or limit the direct or indirect transmission of the infectious agent from those infected to those who are susceptible or who may spread the agent to others” 1. controlling the reservoir

13. (d) isolation PHYSICAL ISOLATION of CASE or CARRIER Treatment until free from infection 1. controlling the reservoir

14. (d) isolation PURPOSE: To protect the community by preventing transfer of infection from reservoir to the possible susceptible hosts. TYPES: varies Standard isolation, strict isolation, protective, high security, Hospital isolation >>>> Home isolation Difficult in rural areas. 1. controlling the reservoir

15. (d) isolation RING ISOLATION : Encircling the infected persons with a barrier of immune persons through whom the infection is unable to spread. Ring isolation in context of Small pox : a public health strategy where, upon identifying a smallpox case, the immediate close contacts of that person are isolated and vaccinated, creating a "ring" of protection around the infected individual to prevent further spread of the disease. 1. controlling the reservoir

16. (d) isolation RING ISOLATION : Encircling the infected persons with a barrier of immune persons through whom the infection is unable to spread. This method was applied worldwide in 1960s and 1970s eradicated smallpox. 1. controlling the reservoir

17. (d) isolation ; WHEN AND FOR WHAT ? For diseases like Diphtheria, Cholera, Streptococcal resp disease, pneumonic plague.. Isolation has distinctive value However Isolation becomes a futile excercise for ds where there is a large component of subclincal infection and carrier state like Polio, Hepatitis A, Typhoid fever.. Isolation has failed for TB, Leprosy and STDs 1. controlling the reservoir

18. (d) isolation ; WHEN AND FOR WHAT ? Isolation has FAILED in the control of ds like Leprosy, TB, STDs. here the Concept of Physical isolation has replaced by CHEMICAL Isolation. that is rapid treatment of cases in their homes and rendering them non-infectious as quickly as possible. in todays times, Isolation is recommended only when the risk of transmission if the infection is exceptionally serious. 1. controlling the reservoir

19. (d) isolation ; duration 1. controlling the reservoir

20. (d) isolation ; duration 1. controlling the reservoir

21. Text

22. (E) Treatment; complete, early. The limitation of freedom of movement of such well persons or domestic animals exposed to communicable disease for a period of time not longer than the longest usuasl incubation period of the disease, in such manner as to prevent effective contact with those not so exposed. To a ship, an aircraft, a train, 1. controlling the reservoir (F) Quarantine

23. ABSOLUTE QUARANTINE: MODIFIED QUARATINE: A selective partial limitaion of freedom of movement such as exclusion of children from school. SEGRAGATION; With better techniques of early diagnosis and Rx, quaratine as a method of disease control has become outdated. It has been replaced by Active Surveillance. 1. controlling the reservoir (F) Quarantine

24. method of conducting surveillace. allows scientist to gather data about infections and how they spread. Once a person tests positive for a disease, they will be asked to list the people they have been in contact with andthe places they visited during the period in which they were contagious. 1. controlling the reservoir (G) CONTACT TRACING:

25. When systematically applied, this will break the chain of transmission of an infectious disease and is an effective tool in public health. 1. controlling the reservoir (F) Contact tracing

26. Text next lecture Case scenarios preparation of EPIDEMIC CURVE Preparation of SPOT MAP Calculation of ATTACK RATE from a given data.

27. thank you

28. case scenarios activities of inter-sectoral co-ordination, formation & meeting of rrt.

29. Text recap IN THE PREVIOUS LECTURE PRINCIPLES OF PRIMARY HEALTH CARE. OUTBREAK CONTROL TEAM MEMBERS

30. Text OUTBREAK TEAM MEMBERS AN EPIDEMIOLOGIST CLINICIAN MICROBIOLOGIST ENVIRONMENTAL HEALTH OFFICER COMMUNICATION SPECIALIST DATA MANAGER ADMINISTRATIVE SUPPORT STAFF

31. Text Rrt In the event of a suspected outbreak, the Rapid Response Teams (RRT) - a multidisciplinary team that looks into various aspects of an outbreak is alerted. RRT will be to investigate and confirm outbreak. The members of RRT are regularly doing their work but, in the event of an outbreak, come together to undertake a special function.

32. Text Rrt They should work in coordination with the Government health staff. They will help and support health staff in management and control of outbreak but the responsibility of implementing control measures mainly rests with local health staff. RRT should be formed at all levels of administrative system (district, block, Panchayat). The name, address and mobile phone number of RRT members should be available at respective levels so that they can be alerted as soon as possible.

33. Text CASE SCENARIO 1 Mr. X, Medical Officer of a primary health centre noticed increased number of cases with symptoms of fever, sore throat and cough during third week of March. While taking detailed history one patient had a history of international travel 2 weeks back from a place where some of his friends also had similar illness. In the next week, one of the tertiary care hospitals in the city reported increased number of severe acute respiratory illness among admitted patients and two of them died due to this. As a Medical Officer or a member of a district health care team, how do you investigate this and manage the situation?

34. Text Case scenario 2 Dr. X was appointed as Medical Officer of the Primary Health Centre. One of his field staff reported three cases of watery diarrhoea and dehydration (two mild and one severe) in his field area and he referred them for admission to the hospital. As a health professional what do you think about this episode and how do we proceed to investigate and control the situation.

35. Text Case scenario 3 Dr. X was on casualty duty that day. Mr. Y, 49 years old, presented to Medicine casualty with high grade fever (3 days), retro-orbital pain, myalgia and rash. While eliciting detailed history from the patient, he revealed that there was history of fever and bodyache for his brother and brother’s wife one week back for which they took treatment in a private hospital. Mr. Y and his four brothers lived in nearby houses in the same compound (within 300 metres). He took paracetamol on the first two days of fever thinking that he was feverish as he walked in the rain the previous day. As a health professional what do you think about this episode and how do we proceed to investigate and manage the situation.

36. Text Case scenario 4 Mr. A,17 years old, was brought to Medicine casualty with history of headache, myalgia and vomiting in the past 2 days. He reached home only 4 days back after a tour along with 13 friends. The day after he came home, he had mild fever and body ache. He thought it might be due to tedious travel and took rest at home. But last night his friend phoned him and said that one of their friends was taken to hospital following fever, vomiting and loss of consciousness. As a health professional what do you think about this episode and how do we proceed to investigate and manage the situation.

37. Text Case scenario 1 This scenario suggests a possible outbreak of a contagious respiratory illness, potentially of pandemic concern. As a Medical Officer or a member of the district healthcare team, the approach to investigation and management should follow systematic outbreak investigation steps while ensuring inter-sectoral coordination as per the principles of primary health care..

38. Text Step 1: Formation of a rapid response team by district health authority 1) Medical Officer (PHC)- Leads local investigation and response. 2) Epidemiologist- Analyses data, confirms outbreaks, and tracks spread. 3) Microbiologist/Laboratory Personnel - Collects and tests samples. 4) Public Health Nurse/Health Inspector - Conducts community surveys and ensures preventive measures. 5) District Surveillance Officer (DSO)- Coordinates reporting and response with state/national authorities. 6) Administrative Officer (from Local Government) - Facilitates inter-sectoral coordination with municipal authorities, police, and transport officials.

39. Text Step 2: case definition & case finding 1) Establish a working case definition (e.g., fever + sore throat + cough + recent travel/contact history). 2) Conduct active case search in hospitals, community health centers, and primary care clinics. 3) Contact tertiary care hospitals for retrospective case review. 4) Enhance Integrated Disease Surveillance Programme (IDSP) reporting for real-time data collection.

40. Text STEP 3: CONFORM THE DIAGNOSIS 1) Collect throat/nasal swabs from suspected cases and send them for RT-PCR or other diagnostic tests. 2) Confirm the causative agent (e.g., Influenza, SARS-CoV-2, or another novel respiratory virus).

41. Text STEP 4: EPIDEMIOLOGICAL INVESTIGATION 1) Descriptive Epidemiology: Collect data on person, place, and time to identify clusters. 2) Hypothesis Generation: Determine source (travel-related introduction, community transmission). 2) Analytical Study (if needed): Compare cases vs. non-cases to identify risk factors.

42. Text STEP 5: IMPLEMENT CONTROL MEASURES MEDICAL MEASURES: 1) Isolate confirmed cases in dedicated hospital wards. 2) Treat based on severity (mild cases managed at home or isolation centers, severe cases in hospitals). 3) Provide chemoprophylaxis/vaccination if applicable. disinfection, and public awareness.

43. Text STEP 5: IMPLEMENT CONTROL MEASURES Community-Based Measures 1) Quarantine contacts of cases (home/institutional). 2) Implement non-pharmaceutical interventions (mask use, hand hygiene, social distancing). 3) Conduct risk communication through community leaders and social media.

44. Text STEP 5: IMPLEMENT CONTROL MEASURES INTERSECTORAL COORDINATION: 1) Collaborate with municipal authorities for sanitation, disinfection, and public awareness. 2) Work with transport authorities for surveillance at airports, railway stations, and bus terminals. 3) Involve police and administration for quarantine enforcement if needed. 4) Coordinate with schools and workplaces for temporary closures if necessary.

45. Text STEP 6: MONITOR & EVALUATE 1) Conduct daily surveillance to track new cases and assess the impact of interventions. 2) Modify strategies based on evolving epidemiological trends. 3)Prepare for possible scaling up of healthcare facilities if the outbreak worsens.

46. Text STEP 7: REPORT AND COMMUNICATE FINDINGS 1) Report cases to state/national health authorities (IDSP, ICMR, MoHFW). 2) Conduct post-outbreak analysis to document lessons learned and improve future response plans.

47. THANK YOU