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Infectious Disease Outbreaks

About Infectious Disease Outbreaks

Communicable diseases are caused by infectious agents affecting hosts in a given environment.

The reservoir for the agent is also important.

Communicable disease outbreaks require the cooperation of people from various areas of the health care system and beyond.

endemic - background disease rate
outbreak - increase in disease rate above normal
epidemic - an outbreak with iincreased size (time, number, geography)
pandemic - global epidemic

PHAC's Notifiable Diseases On-Line

Role of the Health Care Team

*** Most clinicians are not aware of the role of PH in infectious disease.

There is poor compliance with reportable disease, and there is much room to grow. They want info.

Labs need to be connected to primary care providers and public health.

Canadian Public Health Lab Network

Surveillance

Primary care providers need to report notifiable diseases and conditions, as well as collect appropriate specimens (find out from ID folks). Cases and contacts need to be found and managed, reinforcing Public Health's control measures. Primary care also has an important role in sharing information with the public.

Public Health's first task os recognition of outbreaks, requiring strong epidemiologic and lab surveillance.

ongoing, systematic, collection and collation, analusis and interor of daat reultiong in dissemination of info to people who need to know so that action xcan be takejn

in NS, every year there is a Notifiable Diseases Annual Report and Monthly Surveillance Report

there are legislative requirements for surveillance act and regulations

Nova Scotia Health Protection Act
- MDs, RNs, or medical
"Its the Law"
- more than 60 notifiable communicable diseases list
- also needs to report illness rates at higher than normal
- also covers school principals
confidentiality components
reporting requirements of HIV +ve people

Partners in communicable disease surveillance include:

provincial public health laboratory network through QEII and regional labs
Dept of Agriculture - food safety
NS Environment and Labour - environmental monitoring
long term care
schools and day cares
health care facilities
infectious diseases/infection control practitioners

Information can come from:

PHAC
other provinces or territories
CIOSC alerts
CBS
insurance comapnies
tissue banks

Laboratory Reporting

The lab reports 'confirmed cases' only, except in cases of outbreak or unusual circumstances, where clinical suspicion is enough to trigger action.

Outbreak Investigation

A case definition is required, being neither too stringent or lax, to try to get all you can.

Cases are confirmed and evaluated to see if an outbreak is occurring

PHCPs are contacted to ensure they report what's out there

Descriptinve epidemiology and environmental investigations help uncover the source(s)

Control measures and communication

There are some ethical considerations about contact tracing. People can be anonymously tested if they absolutely don't want to be reported, though there is usually no need to let contact tracing know who is the case.

A series of screening questions are used to establish risk

Disease Reports are received by PHS intake nurses, who open a case and begins its review
further information is gathered: date of onset, symptomology, activities to calculate the incubation and communicable period
numbers and locations of contacts are determined and traced,
with information, prophylaxis, and treatments as needed

Isolation is the separation of the person with communicable disease, while quarantine is the separation of contacts of people with the disease. Contacts are people who are not yet ill, and may not be; quarantine lasts during the incubation period.

PHAC online course on ID outbreaks

National online course is being prepared for all front line clinicians, including RNs, NPs, etc.

funded by PHAC, produced by MUN, in partnership with accrediting colleges and the Public Health Network Council.

Will help prepare for otbreak, improving reporting, and improve horizontal linkage between PH, primary care, and labs. Need vertical integration of local, provincial, federal, and international services.

Case-based formats based on day-to-day events

single case of a reportable disease (syphilis)
outbreak (mumps)
SRI (sporadic
pre-pandemic scenario

5 elements - infection control, history and screening, labs, public health connection, and patient education.

pre-test - challenges knowledge of people going in.

audio and video clips - interviews (1 min or so)

discussion boards for areas of debate

ask the expert

there is core content, but also more background information (levels 2-3) for people who might want it.

references

Provincial-territorial adaptation

- will be specific for each jurisdiction; basic reporting duties, list of notifiable diseases, and local contacts

Avenues of Communication

Naylor Report showed surveillance was an area of diffused responsibilty, with information coming from different areas and with variability.

Role of the Public

The public has some measure of responsibility to be educated and have a plan if/when outbreaks occur. Faith communities will likely be quite involved in caring for their people.

International Health Regulations

requires all countries to notify the WHO if an event of international concern arises