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 observe ๓ . Analysis Normal VS abnormal ๔ . Propose action to authority

II. Surveillance and Rapid Response Team in Thailand Control action Central C-SRRT Intelligence Region R-SRRT Information province P-SRRT District D-SRRT หมูบาน ตําบล Village health volunteer ๗๐ , ๐๐๐

Epidemiological Surveillance network Epidemiological Surveillance network Hospital Veterinarian (SRRT) • 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 Laboratory member for 10 days • Antiviral prophylaxis for family member of confirm H5 cases Pathologists • Culling of affected poultry • Educated villagers to avoid risk

Early pandemic Alert phase 4 of new Influenza subtype A very narrow window of opportunity to contain pandemic at its origin Ro = 1.5 - 2

st . Patient 1 st . Patient “ “ The Mother The Mother” ” 1 • Female 26- year- old • Onset 10 th Sept. Died at 20 th . of September • Body was on religious rites at a temple. • History of visiting her daughter in Kampangphet • Her daughter died on 8 th . of September suspect of Dengue • Cluster of death need thorough investigation

Day 1 st : 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 on the following day.

Day 2 nd . Investigate the aunt 2 nd . Patient •32-year-old female • elder sister of the 1 st patient • Refer to provincial hospital • Isolation • Oseltamivir 75 mg x 2 for 10 days • Daily examination of all 5 family members •Survey the village

Index case “ The daughter ” • 11-year-old girl Household chicken ill and died (in Kamphaengpeth province) Last household chicken buried Onset of fever Index Admitedt to hospital with pneumonia Died case 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 October August September

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 5 th of investigation (26 September) • H5 confirmed in Aunt respiratory specimens by DMS Day 6 th of investigation (27 September) • Siriraj confirm H5 in Mother lung tissues • Expert committee conclude “Probable Human to Human”

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 HA •Confirmed H5 in poultry die-off in near by village Ck/HK/y385/97 HK/97/98 Gs/HK/w355/97 HK/486/97 • Confirmed H5 by PCR from lung of “The mother” Dk/HK/p46/97 Ck/HK/31.4/02 Ck/HK/409.1/02 Ck/HK/96.1/02 Ck/HK/YU56/01 • Demonstrated influenza A in lung tissue Sc/HK/SF189/01 Ck/HK/715.5/01 Ck/HK/FY150/01 Ck/HK/FY77/01 • Confirmed H5 from swab of “The aunt” Ck/HK/YU777/02 Ck/HK/61.9/02 Dk/CH/E319-2/03 Dk/HK/821/02 Gs/HK/739.2/02 • H5 Phylogenic tree of mother and aunt are closed G.H/HK/793.2/02 Eg/HK/757.3/02 HK/213/03 HK/212/03 • Unable to confirm H5 in daughter 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 0.1

Risk Communication Day 6 th . (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 7 th ( 28 September) • Press release

Policy Implication Day 8 th (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. Epidemic curve of confirm H5 human cases in Thailand from 2004 to present. (25 cases with 17 dead in 4 waves) cases จํานวน ( ราย ) 8 7 dead survive 6 cluster 5 4 3 2 1 0 Mar-04 May-04 July-04 Mar-05 May-05 July-05 Mar-06 May-06 July-06 Nov-03 Jan-04 Sep-04 Nov-04 Jan-05 Sep-05 Nov-05 Jan-06 Sep-06 Nov-06 Jan-07 2006 2004 2005 Remark : 3097 Notification and investigation in 2004 3244 Notification and investigation in 2005 5479 Notification and investigation up to 23 November 2006

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

Aunt buried ill chicken Provided bedside care for index case in hospital Attended funeral ritual Developed fever Admitted with pneumonia, received antiviral Recover Aunt 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 Mother Admitted to hospital with pneumonia Die 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 (in Kamphaengpeth province) Last household chicken buried Onset of fever Index Admitedt to hospital with pneumonia Died case 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 October August September Figure 2 Chronology of exposure and onset of the index case, her mother and aunt.