responding to a cholera outbreak in schools

RESPONDING TO A CHOLERA OUTBREAK IN SCHOOLS

Salome Williams Ph. D. Public Health StudentPUBH 8165

Professor: Dr. Howard RubinApril 2011

Responding to an Outbreak of Cholera in Schools

Schedule of the Seminar

• Overview of Cholera

• The history of Cholera in Jamaica West Indies

• The Global Burden of Cholera

• Planning for an Outbreak of Cholera

• Managing Cholera Cases

• Monitoring High Risk Groups

• Monitoring Water and Environmental Sanitation

• Providing Health Education

Owner


Objectives of the Presentation

This session aims to:

• provide an overview of cholera.

• discuss the measures for alleviating the impact of an outbreak of cholera in schools.


Background

• The ODPEM Jamaica includes schools in its disaster management plan.

• School personnel and youths are being trained in disaster management.

• The major stakeholders are UNICEF and the GOJ

ODPEM (2010). Disaster plan to be developed for child care facilities. Retrieved from: http://www.odpem.org.jm/ArticleDetails/tabid/226/Default.aspx?article=916


Background

Disaster response involves:

• Identifying vulnerable populations.

• Knowing the population’s current health status.

• Preparing the physical environment.

• Establishing standardized treatment protocols.

• Developing a good surveillance system.

Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore


Overview of Cholera

• Cholera is caused by the bacterium vibrio cholerae.

• Transmission is through consuming water or foods contaminated with feces.

• The reservoir is human.

• It has an abrupt onset.

• Seventy five (75%) of persons may not develop symptoms.

• Ten (10%) to 20 % of persons may develop severe diarrhea and vomiting.

Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. BaltimoreWHO. (2010). Cholera. Fact sheet N°107. Retrieved from: http://www.who.int/mediacentre/factsheets/fs107/en/WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from: http://www.unicef.org/wcaro/07-WHO_cholera_preparedness4.pdf


History of Cholera in Jamaica WI

• The first case was identified in Port Royal, in 1851.

• It accounted for 6000 deaths in Kingston.

• It spread rapidly throughout the island.

• Overall death toll was 40, 000.

Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. BaltimoreParkin, J. (1852). Statistical report of the epidemic of cholera in Jamaica. [Technical Report]. Cholera – epidemiology disease outbreak. Catalog no.101205146 . London : W. H. Allen. Retrieved from: http://resource.nlm.nih.gov/101205146 http://collections.nlm.nih.gov/pageturner/viewer.html?PID=nlm:nlmuid-101205146-bk


The Global Burden of Cholera

• Cholera is more prevalent in developing countries.

• In 1994, Congo reported 50,000 cases.

• In 2000 and 2001, Kwazulu-Natal South Africa reported 125, 000 cases.

• In 2006, 236, 896 cases and 6311 deaths were reported to the WHO.

• In 2010, Haiti had 121,518 cases and 2,591 deaths. CDC. (2010). “Cholera: Epidemiology and risk factors”. Retrieved from: http://www.cdc.gov/cholera/epi.htmlCDC. (2010). “Cholera in Haiti”. Retrieved from: http://www.cdc.gov/haiticholera/situation/ Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore.Morbidity and Mortality Weekly Report. (2010). Update on Cholera----Haiti, Dominican Republic and Florida. Weekly. 59 (50); 1637 1641. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5950a1.htm


Economic Loss Related to Life Expectancies for Cases of Cholera in Countries of the African Region

Years No. of Cases Cost at Age 40 Cost at Age 53 Cost at Age 73

2005 125018 US$ 39.0 million US$ 53.2 million US$ 64.2 million



Total 439,419 US$ 174.2 million US$ 241.3 million US$ 292.2 million

Kirigia, M.J., Sambo, L.G., Yokouide, A., Soumbey-Alley, E., Muthuri, L.K., Doris G Kirigia, D.G. (2009). “Economic burden of cholera in the WHO African region”BMC Int Health Hum Rights. 9: 8. doi: 10.1186/1472-698X-9-8.


Develop a Plan for the Control of Cholera

• Develop a committee or a task force.

• Prepare a budget.

• Determine the interventions to control the outbreak.

• Obtain critical supplies.

• Obtain updates on guidelines for managing cholera.

• Control infection

Basics. (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: http://www.unicef.org.wcaro/07-Controlling_cholera_Basics.pdf.Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore.WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness.World Health Organization Global task force on cholera control. Retrieved from: http://www.unicef.org/wcaro/07-WHO_cholera_preparedness4.pdf


Manage the Cholera Cases

Report promptly:

• severe dehydration.

• death from acute watery diarrhea.

• acute watery diarrhea, with or without vomiting.

• a case confirmed by laboratory testing.

Basics. (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: http://www.unicef.org.wcaro/07-Controlling_cholera_Basics.pdf.Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore.WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from: http://www.unicef.org/wcaro/07-WHO_cholera_preparedness4.pdf



• An outbreak team will follow up with reports.

• Establish free flow of communication with health facilities.

• Health facilities should be adequately prepared.

Basics. (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: http://www.unicef.org.wcaro/07-Controlling_cholera_Basics.pdf.Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore. WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from: http://www.unicef.org/wcaro/07-WHO_cholera_preparedness4.pdf



• Report possible sources of infection promptly to determine:

- causes of the infection

- the time of transmission

- the place of transmission

- the person transmitting the bacterium Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore.



In a massive outbreak:

• Establish a cholera control unit.

• Offer specific services.

Treatment

Classification And

Assessment

SecurityWaste and

EnvironmentalManagement

Health Education

Preventionand Hygiene

Measures

Patient Care

Cholera Control

Unit

WHO. (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from: http://www.unicef.org/wcaro/07-WHO_cholera_preparedness4.pdf



• Triage the cases.

• Triaging is coordinated by the medical personnel and hospitals.

• Tag with specified colors and manage accordingly.

The Dead

Must be hospitalized.

Condition is critical

Require extensive resuscitative measures. May not survive.

Need hospitalization but the Condition is not critical

No hospitalization is required but treatment is needed

Auf der Heide, E. (2000). Disaster response online book. Chapter 8:Triage. Retrieved from: http://orgmail2.coe-dmha.org/dr/DisasterResponse.nsf/section/409583F8918DD44A0A25692A007C87F5/$file/p-182.jpg Basics. (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: http://www.unicef.org.wcaro/07-Controlling_cholera_Basics.pdf.



Triaging

• Classify and prioritize the cases.

• Use colors to indicate the priority for treatment.

2 BLUE Second Priority

3 YELLOW Third Priority

4 GREEN Treatment

is minor

5 BLACK Given

no priority

1 RED First Priority

Auf der Heide, E. (2000). Disaster response online book. Chapter 8:Triage. Retrieved from: http://orgmail2.coe-dmha.org/dr/DisasterResponse.nsf/section/409583F8918DD44A0A25692A007C87F5/$file/p-182.jpg


Flow of Cholera Cases in the CCU

Triage Staff

No Treatment The Morgue

ORS Treatment Room

Home

Observation Unit - TreatmentHospital - Treatment

Recovery Unit

Home

Auf der Heide, E. (2000). Disaster response online book. Chapter 8:Triage. Retrieved from: http://orgmail2.coedmha.org/dr/DisasterResponse.nsf/section/409583F8918DD44A0A25692A007C87F5/$file/p-182.jpg

WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from: http://www.unicef.org/wcaro/07-WHO_cholera_preparedness4.pdf

From the Schools


Monitor for the Continued Presence of the Disease

• Evaluate control measures.

• Provide ongoing reports on:

- all other cases identified

- all contacts of the cases

• Interview all contacts.

Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore



Monitor Water and Environmental Sanitation

• Monitor:

- all sources of food and water.

- food preparation in the school.

- solid waste and excreta disposal.

- hygiene practices of the school population.

Basics: (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: http://www.unicef.org.wcaro/07-Controlling_cholera_Basics.pdf.


Monitor Water and Environmental Sanitation

• Implement control measures

1. Provide adequate supplies of soap and water.

2. Provide adequate toilet facilities.

3. Treat water.

4. Dispose of all feces and stomach contents properly.

5. Careful preparation of meals for the school population is essential.

Basics: (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: http://www.unicef.org.wcaro/07-Controlling_cholera_Basics.pdf.Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore.WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from: http://www.unicef.org/wcaro/07-WHO_cholera_preparedness4.pdf


Provide Health Education

• Provide only critical messages.

• Establish a communication coordinating committee.

• Prepare health messages with health personnel.

• Focus health messages on food and water safety and prompt treatment.

Basics: (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: http://www.unicef.org.wcaro/07-Controlling_cholera_Basics.pdf.WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from: http://www.unicef.org/wcaro/07-WHO_cholera_preparedness4.pdf


Conclusion

• Cholera is one of the oldest communicable diseases.

• It remains a public health problem in some countries.

• A country should be prepared for an outbreak.

• Adequate resources is necessary to respond to an outbreak.

• Response requires a well coordinated approach.

• Basic measures can mitigate the impact.

Basics. (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: http://www.unicef.org.wcaro/07-Controlling_cholera_Basics.pdf.

ODPEM (2010). Disaster plan to be developed for child care facilities. Retrieved from: http://www.odpem.org.jm/ArticleDetails/tabid/226/Default.aspx?article=916 Parkin, John, 1801-1886. ): Cholera -- epidemiology ; Disease Outbreaks ; Jamaica ; Technical Report . Statistical report of the epidemic cholera in Jamaica. London : W. H. Allen, 1852 Text; iv, 61 p. Catalog record: 101205146 Retrieved from: http://resource.nlm.nih.gov/101205146 http://collections.nlm.nih.gov/pageturner/viewer.html?PID=nlm:nlmuid-101205146-bk (Digital archived document).


http://www.unicef.org.wcaro/07-Controlling_cholera_Basics.pdf


References

• Auf der Heide, E. (2000). Disaster response online book. Chapter 8:Triage. Retrieved from: http://orgmail2.coedmha.org/dr/DisasterResponse.nsf/section/409583F8918DD44A0A25692A007C87F5/$file/p-182.jpg

• Basics: (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: http://www.unicef.org.wcaro/07-Controlling_cholera_Basics.pdf.

• CDC. (2010). “Cholera: Epidemiology and risk factors”. Retrieved from: http://www.cdc.gov/cholera/epi.html

• CDC. (2010). “Cholera in Haiti”. Retrieved from: http://www.cdc.gov/haiticholera/situation/

• Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore.

• Kirigia, M.J., Sambo, L.G., Yokouide, A., Soumbey-Alley, E., Muthuri, L.K., Doris G Kirigia, D.G. (2009). “Economic burden of cholera in the WHO African region”

• BMC Int Health Hum Rights. 9: 8. doi: 10.1186/1472-698X-9-8.

• Morbidity and Mortality Weekly Report. (2010). Update on Cholera----Haiti, Dominican Republic and Florida. Weekly. 59 (50); 1637 1641. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5950a1.htm

• ODPEM (2010). Disaster plan to be developed for child care facilities. Retrieved from: http://www.odpem.org.jm/ArticleDetails/tabid/226/Default.aspx?article=916

• Parkin, John, 1801-1886. ): Cholera -- epidemiology ; Disease Outbreaks ; Jamaica ; Technical Report . Statistical report of the epidemic cholera in Jamaica. London : W. H. Allen, 1852Text; iv, 61 p. Catalog record: 101205146 Retrieved from: http://resource.nlm.nih.gov/101205146 http://collections.nlm.nih.gov/pageturner/viewer.html?PID=nlm:nlmuid-101205146-bk (Digital archived document).

• Stone, M. (2010). Precautions against cholera from CDC. Retrieved from: http://www.suite101.com/content/precautions-against-cholera-from-the-cdc-a323374

• WHO. (2010). Cholera. Fact sheet N°107. Retrieved from: http://www.who.int/mediacentre/factsheets/fs107/en/

• WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from: http://www.unicef.org/wcaro/07-WHO_cholera_preparedness4.pdf


Further Readings

• Auf der Heide, E. (2000). Disaster response online book. Chapter 8:Triage. Retrieved from: http://orgmail2.coedmha.org/dr/DisasterResponse.nsf/section/409583F8918DD44A0A25692A007C87F5/$file/p-182.jpg

• Basics: (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: http://www.unicef.org.wcaro/07-Controlling_cholera_Basics.pdf.

• Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore

responding to a cholera outbreak in schools

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