CASE DEFINITIONS OF EPIDEMIC PRONED DISEASES

CLINICIAN SENSITISATIONFEBRUARY 2016

Epidemic prone and diseases for eradication

• Cholera• Acute Flaccid Paralysis/Polio• Measles• Meningitis• Neonatal Tetanus• Yellow Fever• Guinea Worm

STANDARD CASE DEFINITION

Case Definition forAcute Flaccid Paralysis (AFP)

Surveillance• Any case of AFP in a child <15 years of

age

OR• Any case of paralytic illness (regardless

of age) in which clinician suspects polio

P O L I O 12

Acute Flaccid Paralysis• Acute:

Sudden onset — as opposed to chronic• Flaccid:

Loss of muscle tone, “floppy” (as opposed to spastic or rigid)

• Paralysis*:Weakness, loss of voluntary movement*

P O L I O 11

*May affect any muscle in the body, although primarily seen in those of the arms and/or legs

Partial Differential Diagnosis of AFP

P O L I O 16

Acute Flaccid Paralysis

Transverse Myelitis

TraumaticNeuritis

AFP Caused by

otherEnteroviruses(Including Coxsackie's Virus, Echovirus, etc.)

Poliomyelitisother

(toxins, metabolic, snake bite, drug-induced,

etc.)

Guillain-Barré Syndrome

Clues to the Presence of AFP

P O L I O 17

Acute Flaccid Paralysis

Paralysis:sudden onset

floppy limb weakness

cannot sit upcannot walk

cannot moveleg, arm

Measles Case Definitions• Suspected measles clinical case definition:

– Fever + Rash + either Cough or Coryza or Conjunctivitis

– Clinician suspects measles

• Lab confirmed:– Suspected measles case with blood sample [+] for

measles IgM antibody, not recently vaccinated (4–8 weeks ago)

• Confirmed by epidemiologic linkage:– Suspected measles case with no blood sample but

with history of contact* with a lab- or epi-confirmed case who had rash onset during the previous 30 days

*history of contact = lives in same or adjoining district with plausible transmissionM E A S L E S 15

Measles Case Definitionto Assist Communities inNotifying Health Facilities

M E A S L E S 16

ANY PERSONWITH

FEVER AND RASH

Rash +

Fever

M E A S L E S 20

MeaslesDengue Mononucleosis

Other Viral Exanthems

Kawasaki

MeningococcemiaToxoplasmosis

RoseolaInfantum

Scarlet Fever

Rubella

Meningitis Case Definitions

• Suspected meningitis case  : any person with sudden onset of fever (>38.5 C rectal or 38.0 C axillary) and one of the following signs: neck stiffness, altered consciousness or other meningeal signs .

• Confirmed meningitis case  : identification of the causal pathogen from the CSF of a suspected case

WHO recommanded Thresholds

• Alert threshold : – Populations between 30,000 and 100 000 inhabitants: an

attack rate of 5 cases per 100,000 inhabitants per week;– Populations < 30,000 inhabitants: an incidence of 2 cases in

one week or an increase in the number of cases compared to the previous non-epidemic years.

• Epidemic threshold : – Populations between 30 000 and 100 000 inhabitants: an

attack rate of 15 cases per 100 000 inhabitants per week. When the risk of epidemic outbreak is high, the recommended threshold is 10 cases per 100 000 inhabitants per week.

– Populations < 30 000 inhabitants: an incidence of 5 cases in 1 week or, the doubling of number of cases over a 3-week period.

Neonatal Tetanus—Surveillance

I M M U N I Z A T I O N 18

Any neonate with normal ability to suck and cry during the first 2 days

and Any child between 3 and 28 days of age who:cannot suck normally

and becomes stiff or has convulsions (jerking of

the muscles) or both(no laboratory confirmation needed)

NT cases reported by physicians are considered confirmed

CASE DEFINITIONConfirmed:

• Suspected: A case that is characterized by acute onset of fever followed by jaundice within two weeks of the onset of the first symptoms

• Confirmed:A suspected case that is laboratory-confirmed or epidemiologically linked to a laboratory-confirmed case or outbreak

I M M U N I Z A T I O N 22

Yellow Fever—SurveillanceCASE DEFINITION

Guinea Worm Disease

• Any person with a blister or boil and emergence of Guinea worm from the blister/boil.

• Every GWD rumour should be investigated. Investigation of GWD rumour is a public health emergency and should be acted upon immediately.

HEALTH FACILITY LEVEL• Immediately notify the LGA DSNO or state epidemiology

by the fastest means. Call the GWD Toll free hotline 0800100-1000.

• Give name and phone number of the informant and details of the rumour – name, sex, age,village, phone number

• Immediately make contact with the rumour to:• - Dress/bandage the wound• Discourage him from travelling out of the village until the

DSNO examines the patient.• Complete the case based form (IDSR001A)

LGA Level• Immediate investigation of case. Materials needed include

methylated spirit, IDSR case investigation form-guinea worm disease

• Verify case according to case definition• If suggestive of GWD, inform state and call GWD toll free hotline

0800100-1000• Preserve the worm specimen in spirit and label it properly.• Order daily visits and dressing by nearest HF• Discourage suspect from entering any water source or travelling out

of the village until investigated.

IDSR Form 002-Weekly (Dataflow/Deadlines)

LGA (IDSR 002)

STATE (IDSR 002)

NATIONAL (IDSR 002)

LGA report of previous week (Mon-Sun) should reach STATE by Tuesday of following week

State report of previous week (Mon-Sun) should reach National/Partners Office by Wednesday of following week

Note: Data is expected to be sent via electronic means

Feedback

Feedback should be sent between 3-7 days after receipt of data/report.

However, immediate response could be demanded sometimes where urgent.

Sometimes, where weekly newsletter/bulletins are published, which is rare, there may be a slight delay in feedback.

HFs (IDSR 002)HFs report of previous week (Mon-Sun) should reach LGA by Monday of following week

IDSR Form 003-Monthly (Dataflow/Deadlines)

HFs (IDSR 003)

LGA (IDSR 003)

NATIONAL (IDSR 003)

State (IDSR 003)

HFs report of previous month should reach the LGA by day 7 (1wk) after month-end

LGA report of previous month should reach State by day 14 (2 wks) after month-end

State report of previous month should reach National level latest by day 21 (3 wks ) after month-end

Note: Data is expected to be sent via electronic means

Feedback

Feedback should be sent between 1-2 wks after receipt of data/report.

However, immediate response could be demanded sometimes where urgent.

Sometimes, where monthly bulletins are published there may be a slight delay in feedback

If a case is Suspected,What Should a Health Provider

Do?• Manage case• Collect a blood specimen in the case of

measles and Yellow fever. In AFP and other cases sensitise for samples collection

• Fill out the immediate case reporting form

• Report case to Focal Person and/or District Health Office

M E A S L E S 13

IDSR Form 001A (Immediate case-based reporting form)Immediate/Case-based surveillance reporting form

REPORTING HEALTH FACILITY REPORTING LGA REPORTING STATE

IDENTIFICATION NUMBER IDSR 001A

Immediate/ Case-based Reporting Form From Health Facility/Health Worker to LGA health team

Cholera Dracunculiasis Neonatal

Tetanus Measles Meningitis Influenza

A/H5N1

Viral Hemorrhagic Fever e.g. Lassa fever

Yellow Fever

Diahrroea with Blood /shigella(Under5)

Others/specify* e.g. Dengue, SARS etc

Date form received at SMOH or the national level: / / (Date/Month/Year)

Name of Patient: Date of Birth (DOB):

/ / (Day/Month/Year)

Age (If DOB unknown):

Year Month (if

<12) Day (NNT only)

Sex: M=Male F=Female

Patient’s Address: Urban Rural

Settlement/Village

Ward LGA State:

Exact residential address:

If applicable or If the patient is neonate or child, please write full name of mother and father of the patient

Date Seen at Health Facility: / /

Date Health Facility notified LGA/:

/ / Date of Onset: / /

Number of vaccine doses received:

9=unknown For cases of Measles, NT (TT in mother), Yellow Fever, and Meningitis (For Measles, TT, YF- by card & for Meningitis, by history)

Date of last vaccination: / /

(Measles, Neonatal Tetanus (TT in mother), Yellow Fever, and Meningitis only) Close contact with infected poultry 1=Yes 2 =No

Close contact with suspected or confirmed case of Avian influenza

1= Yes 2 =No

Associated with an outbreak? 1=Yes 2=No

In/Out Patient 1=Inpatient 2=Outpatient

Outcome 1=Alive 2=Dead 9=Unknown

Final Classification of case 1=Confirmed 2=Probable 3=Discarded 4=Suspect

Final Classification for Measles 1= Laboratory Confirmed

2= Confirmed by Epidemiological linkage

3=Clinical Compatible

4=Discard 5=Suspect with lab pending

Person completing form Name:

Title: Address:

Signature:

Date form sent to LGA/: / / (Date/Month/Year) Date Form Received at LGA: / / / Signature

IDSR 001 A

Contact Telephone Numbers 1. H/F FOCAL POINT 08069092492

2. LGA DSNO 08167571975 3. ALIYU BUNZA state Epid.

08161700083 4. DR. BONOS 08034444349

5. DR. AUDU M. I. 08037005376

THANK YOU