Outbreak simulation exercise of ICT

Disease Control and Prevention Center
National Center for Global Health and Medicine(WHO Collaboration Center)

Shinichiro Morioka, M.D.

Scenario

You are an infection control nurse at PMGH.
You got a report that there are some patientswith “unexplainable fever” on Nov 10, 2018.

PlacePlaceWhat would you do next?

Is this an outbreak?

a sudden rise in the incidence of a diseaseIncidence of influenza(year)

Number of reportedWeek8

Basic steps of outbreak investigation and response
1. Confirm the occurrence of outbreak

3. Monitor and survey the onsite and associated facilities
4. Understand characteristics of the cases: time, place, person
Line-listing → schematize
5. Establish hypotheses about the source of infection/transmission route and riskfactors

6. Verify the hypotheses
7. Attempt measures to prevent the spread of infection, propose future
preventative measures
8. Prepare investigation report(* Implement infection control measures as necessary)

Measures/communication

2. Define “case definition,” active surveillance using ”case definition”

(http://www.who.int/influenza/surveillance_monitoring/ili_sari_surveillance_case_definition/en/)Case definition
Time:Nov 1-Nov 10, 2018

Personall inpatients and all staff members

who meet ILI case definitionPlace

all inpatient wards in PMGH

11

Basic steps of outbreak investigation and response
1. Confirm the occurrence of outbreak

3. Monitor and survey the onsite and associated facilities
4. Understand characteristics of the cases: time, place, person
Line-listing → schematize
5. Establish hypotheses about the source of infection/transmission route and riskfactors

6. Verify the hypotheses
7. Attempt measures to prevent the spread of infection, propose future
preventative measures
8. Prepare investigation report(* Implement infection control measures as necessary)

Measures/communication

2. Define “case definition,” active surveillance using ”case definition”

Line listingID

Date of Onset

Location

AgeGender

Vaccine status〇〇〇〇Nov 3

East 4〇〇M

No〇〇〇〇

Nov 5

East 4〇〇M

No〇〇〇〇

Nov 5

East 4〇〇

FNo〇〇〇〇

Nov 6

West 4〇〇

M

Unknown・・・

Status of influenza incidence (all)All

Excluded

Analyzed

Confirmed

Suspected

Not infected

Staff35414340

36(11%)

13(4%)

291(86%)

Inpatients

268

4264

42(16%)

39(15%)

183(69%)

Total

622

18604

78(13%)

52(8%)

474(76%)

Unit: person* All:
Inpatients, residents, and staff of the facility between Dec 19, 2014 and Jan 19, 2015
* Excluded: Staff who were absent during the above period due to maternity/sick leave, etc., and those
who contracted the virus in the city

Epidemiological curve of influenza cases(n = 78)
Inpatients

Hospital staff

Other staff

18
16

Number of people

1412108
6
4
20
11/111/5

11/10

11/15
11/20
Date of diagnosis

11/25

11/30

16

Basic steps of outbreak investigation and response
1. Confirm the occurrence of outbreak

3. Monitor and survey the onsite and associated facilities
4. Understand characteristics of the cases: time, place, person
Line-listing → schematize
5. Establish hypotheses about the source of infection/transmission route and riskfactors

6. Verify the hypotheses
7. Attempt measures to prevent the spread of infection, propose future
preventative measures
8. Prepare investigation report(* Implement infection control measures as necessary)

Measures/communication

2. Define “case definition,” active surveillance using ”case definition”

Infection control

STANDARDCONTACTDROPLETWhat else would you do?

http://www.health.gov.au/internet/main/publishing.nsf/Content/27BE697A7FBF5AB5CA257BF0001D3AC8/$File/RCF_Guidelines.pdf

http://www.health.gov.au/internet/main/publishing.nsf/Content/27BE697A7FBF5AB5CA257BF0001D3AC8/$File/RCF_Guidelines.pdf

http://www.health.gov.au/internet/main/publishing.nsf/Content/27BE697A7FBF5AB5CA257BF0001D3AC8/$File/RCF_Guidelines.pdf

http://www.health.gov.au/internet/main/publishing.nsf/Content/27BE697A7FBF5AB5CA257BF0001D3AC8/$File/RCF_Guidelines.pdf

Examples of bad communication✓Mixed messages from multiple experts✓Information released late✓Paternalistic attitude✓Not countering rumors and myths in real-time✓Public power struggles and confusion

24

Basic steps of outbreak investigation and response
1. Confirm the occurrence of outbreak

3. Monitor and survey the onsite and associated facilities
4. Understand characteristics of the cases: time, place, person
Line-listing → schematize
5. Establish hypotheses about the source of infection/transmission route and riskfactors

6. Verify the hypotheses
7. Attempt measures to prevent the spread of infection, propose future
preventative measures
8. Prepare investigation report(* Implement infection control measures as necessary)

Measures/communication

2. Define “case definition,” active surveillance using ”case definition”

Epidemiological curve of confirmed influenza cases (by hospital ward)

West 3(n = 13)

105

staff
職員
inpatient
入院患者

010

West 4(n = 26)

staff
職員
5入院患者
inpatient

010

East 4(n = 18)

staff
職員
5入院患者
inpatient

010

East
5 (n=3)

inpatient
入院患者
50Open discussions