OUTBREAK INVESTIGATION International Field Epidemiology Training Program Thailand

OUTBREAK INVESTIGATION International Field Epidemiology Training Program, Thailand

EXCESS OF NORMAL EXPECTANCY • More than • 5 -year median or • Average number + 2 sd of previous 5 yr or • Average number of previous few weeks or months • 2 cases with epidemiologic linkage • 1 case of an emerging or reemerging disease

http: //beid. ddc. moph. go. th/beid_2014/th/home

NUMBER OF MEASLES CASES IN PROVINCE A BY MONTH, THAILAND 2002 – 2006 AND 5 YEARS MEDIAN Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Data source: Bureau of Epidemiology, Ministry of Public Health, Thailand

LINKAGE More than 145 cases, who joined the school camp, were brought to a hospital because of food poisoning A cluster of cases which can be linked to the same exposure.

AN OUTBREAK OF EMERGING DISEASE A single case of disease that has never been occurred before. A 3 -year old boy, case of Avian Flu (H 5 N 1) in Hong Kong alerted the public health professionals around the world to start a full scale investigation.

TERMS • Endemic = A disease that normally occurs in an area case • Sporadic = A disease that sometime occurs in an area • Epidemic = Outbreak (Outbreak -> a sense of emergency Epidemic -> a sense of wide spreading) • Pandemic = The epidemic that spreads over many countries or regions of the world 22

No. of Cases of a Disease ENDEMIC VS. EPIDEMIC Endemic Time Epidemic

DETECTION OF AN OUTBREAK Sources of outbreak news: • Informal sources: • Health care providers or citizens who knows of “several cases. ” • Media: Newspaper, TV, Internet 24

“Usual” sequence of events Primary Case 1 st case at HC Report to DMO Samples taken Lab result No. Of Cases Response begins Opportunity for control ONSET DAY

“Ideal” sequence of events Primary Case Response begins No. Of Cases Potential cases prevented ONSET DAY

COMMON SOURCE OUTBREAK Food # case Common source Date of onset

PROPAGATED SOURCE OUTBREAK 1 IP # cases 1 IP Date of onset

STEPS OF OUTBREAK INVESTIGATION

(Passive cases) (Active cases) 42

การคนหาผปวยเพมเตม • • Passive strategies ตรวจสอบขอมลทมอยแลว • OPD, IPD log book in hospitals, Health center • Laboratory log book Active strategies • ตงจดคดกรองโรคในชมชน • Door to door

การวเคราะหขอมลเชงพรรณนา (DESCRIPTIVE DATA ANALYSIS) • Time: • Epidemic curve • Place: • • • spot map area map Attack rate by place • Person • Frequency • Specific attack rate

Measles case distribution by sector, Nupo camp, Tak, Jan – Mar 2007 1 13 10 8 5 6 Case in week 2 2 3 4 15 14 12 11 9 7 Case in week 6 Case in week 7 Case in week 8 Case in week 9 Case in week 10 Case in week 11 Burma Case in week 12 Case in week 13 Epidemic curve by week of onset) N = 27)

Person: Distribution, Specific AR DISTRIBUTION OF AVIAN INFLUENZA CASES, THAILAND 2004 Male : Female = 8 : 3 • Median age 7 (2 - 58 years old) • 8 died (CFR 72. 7%) : -Age <15 years CFR 85. 7% - Age >15 years CFR 50. 0%

VIBRIO CHOLERA INABA OUTBREAK IN KHONKAEN PROVINCE, JULY – SEPTEMBER 2010 Dr. Jamorn Makaroon 1, Dr. Potjaman Siriarayaporn 1 , Dr. Pimwilai Khlaichom 1, Dr. Ittapon Ieowongjaroen 1 , Dr. Manita Phanwadee 1, Dr. Supathida Pisek 1 , Dr. Kesorn Tawnonngin 2 , Sawarak Katamat 2 , Araya Jankhan 2 , Pankaew Rattanasin. Kanlachan 2 , Ratchanee Matphutorn 2 , Kamtad Termyanghuy 2 , Kitpong Subannarot 2 , Dr. Vitid Saritteechaigun 3 , Chumpon Rom. Tawee 3 , Wattana Nilbunpot 3 , Pipob Junmuan 3 1 Field Epidemiology Training Program 2 The Office of Prevention and Control 6 th Khonkean Province 3 Khonkaen Provincial Health Office

20 10 /5 /2 01 0 18 /5 /2 01 0 25 /5 /2 01 0 1/ 6/ 20 10 8/ 6/ 20 10 15 /6 /2 01 0 22 /6 /2 01 0 29 /6 /2 01 0 6/ 7/ 20 10 13 /7 /2 01 0 20 /7 /2 01 0 27 /7 /2 01 0 3/ 8/ 20 10 10 /8 /2 01 0 17 /8 /2 01 0 24 /8 /2 01 0 31 /8 /2 01 0 7/ 9/ 20 10 14 /9 /2 01 0 11 5/ 4/ NUMBER OF CHOLERA CASES IN KHONKAEN PROVINCE, MAY - SEPTEMBER IN 2010 Number of cases BOE investigation 7 6 5 4 Inaba Community 3 Inaba Hospital Ogawa Community 2 Ogawa Hospital 1 0 days

DESCRIPTION OF VC INABA CASES cases Case -Confirm -Probable Carrier 44 5 5 District • Muang • Banpai • Banhad 50 3 1 Type of cases • Hospitalized - hypovolumic shock without ARF - hypovolumic shock with ARF • OPD • Community case 16 3 4 23 10 Male : female Median age (IQR) 1: 1. 45 36 (19 – 50) years

Map of VC Inaba cases in Khonkaen province, Jul-Sep 2010 Muang district Naimuang(municipal) subdistrict Banhad district Banpai district 25 -31 Jul 1 -7 Aug 8 -14 Aug 15 -21 Aug 22 -28 Aug 29 Aug-4 Sep 5 -11 Sep 12 -17 Sep

CLUSTER AND CASES AT THE BEGINNING PERIOD 59

CLUSTER AND CASES AT THE LATER PERIOD 60

Maping of Banlampu and Bobae market Market in the building Building street Bobae Building No chlorine Seafood Pork & Meat Steamed Mackerel Chicken Small shrimp Vegetable Toilet Banglamp u

WASTE WATER TREATMENT SYSTEM 63

65

MUCOUS BLOODY DIARRHEA OUTBREAK AND MANAGEMENT OF WATER SUPPLY SYSTEM BANLUANG SUBDISTRICT, CHOMTONG DISTRICT, CHIANGMAI, OCTOBER 2010 Jamorn Makaroon 1, Chuleeporn Jiraphongsa 1, Narong Henprasertthae 1, Hirunwut Praekunatham 1, Tan Sirisomboon 2 , Jorapot Aphichai 2, Natenong Chalearnsuk 3, Raweewan Aomaree 3, Sampan Gongnyeang 3, Raweewan Aomaree 3 1 Field Epidemiology Training Program 2 Chomtong health office 3 Chomtong hospital

EPIDEMIC CURVE OF DIARRHEA CASES (ICD 10 CODE: A 09) IN MOO 5 12 AND 23 FROM 26 AUG – 15 OCT 2010 n = 65 n = 12 67 n = 27

MAPPING OF MAE-YA RIVER AND LOCATION OF MOO 5 12 AND 23 COMPARE WITH EPIDEMIC CURVE OF DIARRHEA CASES (ICD 10 CODE: A 09) FROM 26 AUG – 15 OCT 2010 Flow of river + Map ����� 68

4/10/2010 5/10/2010 6/10/2010 7/10/2010 8/10/2010 9/10/2010 10/10/2010 11/10/2010 12/10/2010 13/10/2010 14/10/2010 15/10/2010 16/10/2010 17/10/2010 18/10/2010 19/10/2010 20/10/2010 21/10/2010 22/10/2010 23/10/2010 24/10/2010 EPIDEMIC CURVE OF MUCOUS BLOODY DIARRHEA CASES IN MOO 5 12 AND 23 FROM 1 ST – 22 ND OCTOBER 2010 Ceremony (������ ) Raw meat Cases 50 40 30 Series 3 Moo 23 (n=6) 20 Series 2 Moo 5 (n=3) 10 Series 1 Moo 12 (n=183) 0 Onset

Mapping of water filters, wells and attack rate in Moo 12 27 27/1 22 8 71 213 61 113 22 162 43 160 38 282 161 297 255 252 51/1 AR 43. 9% 63/1 13/1 215 21/1 15 21 20/2 259 256/1 15 233 3 Branch of river Stream House Water supply system Water filter well 72 40 56 19 80 139/1 20/3 285 116 65 24 54/1 229/1 235 215 8 (47. 4%) 39 55/1 251 173 242 34 159 30/2 32 36 36/1 45 10 4 (67. 7%) 147 257/1 9 5/1 62 41 5 4/1 234 181 30 57 3 (44. 3%) 1 2 2182 233 140 (17. 6%) 268 48 10 (0%) 257 52 117/1 51 183/1 146 53 139 13 (32. 8%) 151 46 47 177 6 (36. 7%) 298 12 7 55 139/2 139 158/1 26 59 49 4 158 20/1 5 292 (33. 3%) 292/1 139/3 215/1 14 14/2 28 34/1 AR 26. 4% 184 18 10/1 54/1 86/1 3 1/1 298 20 19 15 7 17 (43. 9%) 261 18/1 125 211/2 147/1 146 51/1 294 228 227 temple 47/1 210 101 15 258 247 227 N school 601 54 58 temple 127 Others (32. 0%)

ENVIRONMENTAL STUDY

RUBELLA OUTBREAK IN THE ROYAL PALACE, BANGKOK, DEC 2010 – JAN 2011 Dr. Jamorn Makaroon

Royal Page Cloth (AR 2. 3%) Palace (AR 0%) Food (AR 0%) Vehicle (AR 20. 8%) Administration Soldier Police (AR 0%) Maintenance (AR 0%) R O A D Map and attack rate of rubella cases in royal palace

ENVIRONMENTAL STUDY: BED ROOM 75

ENVIRONMENTAL STUDY: BED ROOM Bunk bed

Mass MMR vaccination by SRRT of Bo. E and Bangkok Health Center on January 20 th, 2011