Management of outbreaks in health facilities

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

Shinichiro Morioka, M.D.

Scinario

A 32 y/o male presented with fever x 5 days, rash and lossof appetite x 1day, and was admitted on May 17, 2018.
Patient was diagnosed with measles on May 20.

Scinario

Your colleague told you on May 30;“There are some patients who recovered and are waiting fordischarge, but they developed fever and rash recently…”

Is this an outbreak?
What would you do?

(http://www.euro.who.int/__data/assets/pdf_file/0003/217164/OutbreakGuidelines-updated.pdf?ua=1)

Is this an outbreak?

(http://www.euro.who.int/__data/assets/pdf_file/0003/217164/OutbreakGuidelines-updated.pdf?ua=1)

9

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”

10

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”

Definition(http://www.euro.who.int/__data/assets/pdf_file/0003/217164/OutbreakGuidelines-updated.pdf?ua=1)

Case definition
Time:May 16-May 28, 2018

Personall inpatients and healthcare providers

who meet the clinical criteria

PlaceWard 〇〇 and 〇〇13

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

Age

GenderVaccine status〇〇〇〇May 16〇〇〇〇〇

MNo〇〇〇〇

May 24〇〇〇〇〇

MNo〇〇〇〇

May 24〇〇〇〇〇

FNo〇〇〇〇

May 25〇〇〇〇〇

M

Unknown・・・

PlaceTime17

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.euro.who.int/__data/assets/pdf_file/0003/217164/OutbreakGuidelines-updated.pdf?ua=1)

Infection control

STANDARDCONTACT
AIRBORNE

20

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”

Open discussions