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Pengendalian dan pemberantasan penyakit 5-6/2014

Pengendalian dan pemberantasan penyakit 5-6/2014. DISIAPKAN OLEH PROF. DR.DRH.PRATIWI, TS. MS DRH.ROSITAWATI, I. MP. OUTBREAK INVESTIGATION. Definition Outbreak investigation purposes The pattern of temporal, spatial and animals 10 steps outbreak investigation. What is an outbreak ?.

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Pengendalian dan pemberantasan penyakit 5-6/2014

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  1. Pengendalian dan pemberantasan penyakit5-6/2014 DISIAPKAN OLEH PROF. DR.DRH.PRATIWI, TS. MS DRH.ROSITAWATI, I. MP PTS-RST-PKH-5-6-2014

  2. OUTBREAK INVESTIGATION PTS-RST-PKH-5-6-2014

  3. Definition • Outbreak investigation purposes • The pattern of temporal, spatial andanimals • 10 steps outbreak investigation PTS-RST-PKH-5-6-2014

  4. What is an outbreak ? Definitions • Occurrence of more cases of disease than expected : • - in a given area • among a specific group of population • over a particular period of time OutbreakEpidemiology - Study of a disease clusteror epidemic in order to control or prevent further spread of the disease in the population. PTS-RST-PKH-5-6-2014

  5. PENGENDALIAN BERDASARKAN PERWILAYAHAN (ZONING) PTS-RST-PKH-5-6-2014 • DAERAH TERTULAR: daerah yang sudahdinyatakanadakasussecaraklinis, PA dan HP sertadikonfirmasidgnhasillaboratorium • DAERAH TERANCAM: daerah yang berbatasanlangsungdengandaerahtertularatautidakmemilikibatasanalamdengandaerahtertular • DAERAH BEBAS: daerah yang dinyatakanmasihbelumadakasussecaraklinis, PA dan HP ataumemilikibatasanalam (propinsi, pulau)

  6. SISTEM KEWASPADAAN DINI(EARLY WARNING SYSTEM) • SUBSISTEM KESIAGAAN DINI - PENGAMATAN DINI - PENANGGULANGAN DINI PTS-RST-PKH-5-6-2014

  7. SISTEM KEWASPADAAN DINI(EARLY WARNING SYSTEM) • SUBSISTEM PERAMALAN WABAH - PREDIKSI KEJADIAN WABAH - TINDAKAN ANTISIPASI PTS-RST-PKH-5-6-2014

  8. Outbreaks PTS-RST-PKH-5-6-2014 2 or more cases associated in time and place E. coli 0157:H7 (Northwest) Cryptosporidium (Milwaukee) Norwalk virus (Cruise ships) Vibrio cholerae (South America) Listeria (New York, New Jersey, CT)

  9. What is infectious disease epidemiology? • Infectious disease epidemiology • Two or more populations • A case is a risk factor • The cause often known (www) PTS-RST-PKH-5-6-2014 Epidemiology Deals with one population Risk  case Identifies causes

  10. Agents PTS-RST-PKH-5-6-2014 Clostridium botulinum, C. perfringens Staphylococci, Salmonella, Shigella Campylobacter jejuni, E. coli 0157:H7 Vibrio parahaemolyticus Hepatitis A, Norwalk virus, Rotavirus Calicivirus, Listeria monocytogenes Cryptosporidium, Giardia, Bacillus cereus Toxoplasma gondii, Cyclospora

  11. Food borne Diseases • Infection • long incubation period (days) • diarrhea, nausea, vomiting, abdominal cramps. Fever often • Salmonella, • Hepatitis A • Listeria, Giardia • Vibrio, Campylobacter • Norwalk virus • Intoxication • short incubation period (minutes - hours) • Vomiting, nausea, double vision, weakness, numbness, disorientation • C. botulinum • Staph aureus • certain fish/ shellfish PTS-RST-PKH-5-6-2014

  12. Natural Barriers to Infection PTS-RST-PKH-5-6-2014 Stomach acid pH 2 GI Tract immune system Normal intestinal flora Bile acids and digestive enzymes

  13. Increased Susceptibility PTS-RST-PKH-5-6-2014 Gastrectomy acid blockers for ulcers antacids, excessive consumption of water buffering capacity of food- milk, fatty foods antibiotic therapy very young, old immunocompromised stress, poor hygiene, underdeveloped areas

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  15. Retrospective investigation • Often the outbreak exists since days, weeks,months • Many cases already occurred • Count on the memory of people • Many data already collected; use them or start all • over? • Never too late, but more difficult PTS-RST-PKH-5-6-2014

  16. Steps in Investigating an Outbreak • Establish the existence of an outbreak • Confirm the diagnosis • Define a case and count cases • Perform descriptive epidemiology (person, place and time) • Determine who is at risk • Develop hypotheses explaining exposure & disease PTS-RST-PKH-5-6-2014

  17. Steps in Investigating an Outbreak • Evaluate hypotheses • As necessary, reconsider/refine hypotheses and execute additional studies • additional epidemiologic studies • other types of studies – laboratory, environmental • Communicate findings • written report • presentations • Implement control and prevention measures PTS-RST-PKH-5-6-2014

  18. Confirm the Existence of an Outbreak Definition of outbreak • One case – for diseases of epidemic potential • (e.g., measles, cholera) • More than the expected number of cases – for • endemic diseases • Sometimes is quantitative threshold • (e.g.meningococcal meningitis) Importance of a good surveillance system for early warning PTS-RST-PKH-5-6-2014

  19. Verify the outbreak • Determine whether there is an outbreak – an excess number of cases from what would be expected • Establish a case definition • Non-ambiguous • Clinical / diagnostic verification • Person / place / time descriptions • Identify and count cases of illness PTS-RST-PKH-5-6-2014

  20. Plot an Epidemic Curve • Graph of the number of cases (y-axis) by their date or time of onset (x-axis) • Interpreting an epidemic curve • Overall pattern: increase, peak, decrease • Type of epidemic? • Incubation period? • Outliers: • Unrelated? • Early or late exposure? • Index case? Secondary cases? PTS-RST-PKH-5-6-2014

  21. Endemic vs. Epidemic No. of Cases of a Disease Epidemic Endemic Time PTS-RST-PKH-5-6-2014

  22. Vector-borne Disease • Starts slowly • Time between the first case and the peak is comparable to the incubation period. • Slow tail PTS-RST-PKH-5-6-2014

  23. Point Source Transmission • This is the most common form of transmission in food-borne disease, in which a large population is exposed for a short period of time. PTS-RST-PKH-5-6-2014

  24. Continuing Common Source or Intermittent Exposure • In this case, there are several peaks, and the incubation period cannot be identified. PTS-RST-PKH-5-6-2014

  25. Descriptive Epidemiology • TIME, PLACE, PERSON • May be possible to answer: • Who is at risk? • What is source of infection? • What is mode of transmission? PTS-RST-PKH-5-6-2014

  26. Descriptive Epidemiology - Time • Distribution of cases by date of onset • X axis: time Y axis: number of cases • Shows: • Time limits / duration of the outbreak • Peak / incubation period • Form of curve: evolution of outbreak • Formulate hypothesis regarding source PTS-RST-PKH-5-6-2014

  27. Cycle of Foodborne Disease Control and Prevention Surveillance Prevention Measures Epidemiologic Investigation Applied Research PTS-RST-PKH-5-6-2014

  28. Confirm the Diagnosis • Talk with health workers • Examine cases yourself ! • Laboratory testing (e.g., malaria, cholera, hemorrhagic fevers, etc.) PTS-RST-PKH-5-6-2014

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  32. Epidemiologic Curve

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  37. Recommend control measures • Control of present outbreak • Prevention of future similar outbreaks PTS-RST-PKH-5-6-2014

  38. Descriptive Epidemiology - Person • Numerators • Describe cases in terms of • age, sex, • other parameters : refugee / displaced / residents • immunized , not immunized • Denominators • Distribution in the overall population (age, sex,...) • Compare rates to identify high risk groups PTS-RST-PKH-5-6-2014

  39. Descriptive Epidemiology - Place • Map cases: identify geographic places at risk • Determine where disease acquired: Home, work, travel, etc.. PTS-RST-PKH-5-6-2014

  40. Information to Collect on Cases Personal information • Age • Sex • Place of residence (address) • Other relevant “exposures” • Refugees vs locals • Food source • Water source • Ethnicity, religion, etc. PTS-RST-PKH-5-6-2014

  41. Information to Collect on Cases Disease data • Date of onset of symptoms • Clinical symptoms and signs • Immunized or not (measles, meningitis) • Laboratory results (if any) • Duration of disease, outcome (death, cured,..) • Treatment received PTS-RST-PKH-5-6-2014

  42. Develop Hypotheses • Often obvious from descriptive epidemiology • Formulate idea about source of outbreak and mode of transmission PTS-RST-PKH-5-6-2014

  43. Test Hypotheses • Cross – sectional study? • Cohort study • Case – control study • Identify cases • Select control group • Possibly matched on age or sex or location • Community control, clinic control etc. • Compare exposures among cases and controls • Calculate odds for various exposures PTS-RST-PKH-5-6-2014

  44. Write a Report • Clarifies your own ideas / synthesis • Presents data and conclusions to anyone interested • Often epidemiologist don’t implement interventions • Must communicate to those who will intervene • Advocacy: MOH, UN, other NGOs, donors • Basis for future reference PTS-RST-PKH-5-6-2014

  45. Implement - Take ACTION Interventions include • Prevention of further cases • Control of transmission and source of infection • Improve case management, lower case-fatality rate PTS-RST-PKH-5-6-2014

  46. Terimakasih Selamat Belajar PTS-RST-PKH-5-6-2014

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