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DISIAPKAN OLEH PROF. DR.DRH.PRATIWI, TS. MS DRH.ROSITAWATI, I. MP 02/05/2012 PTS-RST-PKH-5-6-2014 1.

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Presentation on theme: "DISIAPKAN OLEH PROF. DR.DRH.PRATIWI, TS. MS DRH.ROSITAWATI, I. MP 02/05/2012 PTS-RST-PKH-5-6-2014 1."— Presentation transcript:

1 DISIAPKAN OLEH PROF. DR.DRH.PRATIWI, TS. MS DRH.ROSITAWATI, I. MP 02/05/2012 PTS-RST-PKH

2 OUTBREAK INVESTIGATION PTS-RST-PKH /05/2012

3 PTS-RST-PKH Definition Outbreak investigation purposes The pattern of temporal, spatial and animals 10 steps outbreak investigation 02/05/2012

4 PTS-RST-PKH Definitions Occurrence of more cases of disease than expected : - in a given area - among a specific group of population - over a particular period of time What is an outbreak ? Outbreak Epidemiology - Study of a disease cluster or epidemic in order to control or prevent further spread of the disease in the population. 02/05/2012

5 PTS-RST-PKH DAERAH TERTULAR: daerah yang sudah dinyatakan ada kasus secara klinis, PA dan HP serta dikonfirmasi dgn hasil laboratorium DAERAH TERANCAM: daerah yang berbatasan langsung dengan daerah tertular atau tidak memiliki batasan alam dengan daerah tertular DAERAH BEBAS: daerah yang dinyatakan masih belum ada kasus secara klinis, PA dan HP atau memiliki batasan alam (propinsi, pulau)

6 SUBSISTEM KESIAGAAN DINI - PENGAMATAN DINI - PENANGGULANGAN DINI PTS-RST-PKH /05/2012

7 SUBSISTEM PERAMALAN WABAH - PREDIKSI KEJADIAN WABAH - TINDAKAN ANTISIPASI PTS-RST-PKH /05/2012

8 PTS-RST-PKH or more cases associated in time and place E. coli 0157:H7 (Northwest) Cryptosporidium (Milwaukee) Norwalk virus (Cruise ships) Vibrio cholerae (South America) Listeria (New York, New Jersey, CT) 02/05/2012

9 PTS-RST-PKH Epidemiology Deals with one population Risk case Identifies causes Infectious disease epidemiology Two or more populations A case is a risk factor The cause often known (www)www 02/05/2012

10 PTS-RST-PKH Clostridium botulinum, C. perfringens Staphylococci, Salmonella, Shigella Campylobacter jejuni, E. coli 0157:H7 Vibrio parahaemolyticus Hepatitis A, Norwalk virus, Rotavirus Calicivirus, Listeria monocytogenes Cryptosporidium, Giardia, Bacillus cereus Toxoplasma gondii, Cyclospora 02/05/2012

11 PTS-RST-PKH Infection long incubation period (days) diarrhea, nausea, vomiting, abdominal cramps. Fever often Salmonella, Hepatitis A Listeria, Giardia Vibrio, Campylobacter Norwalk virus Intoxication short incubation period (minutes - hours) Vomiting, nausea, double vision, weakness, numbness, disorientation C. botulinum Staph aureus certain fish/ shellfish 02/05/2012

12 PTS-RST-PKH Stomach acid pH 2 GI Tract immune system Normal intestinal flora Bile acids and digestive enzymes 02/05/2012

13 PTS-RST-PKH Gastrectomy acid blockers for ulcers antacids, excessive consumption of water buffering capacity of food- milk, fatty foods antibiotic therapy very young, old immunocompromised stress, poor hygiene, underdeveloped areas 02/05/2012

14 PTS-RST-PKH /05/2012

15 PTS-RST-PKH Retrospective investigation Often the outbreak exists since days, weeks,months Many cases already occurred Count on the memory of people Many data already collected; use them or start all over? Never too late, but more difficult 02/05/2012

16 1) Establish the existence of an outbreak 2) Confirm the diagnosis 3) Define a case and count cases 4) Perform descriptive epidemiology (person, place and time) 5) Determine who is at risk 6) Develop hypotheses explaining exposure & disease PTS-RST-PKH /05/2012

17 7) Evaluate hypotheses 8) As necessary, reconsider/refine hypotheses and execute additional studies – additional epidemiologic studies – other types of studies – laboratory, environmental 9) Communicate findings – written report – presentations 10) Implement control and prevention measures PTS-RST-PKH /05/2012

18 PTS-RST-PKH Definition of outbreak One case – for diseases of epidemic potential (e.g., measles, cholera) More than the expected number of cases – for endemic diseases Sometimes is quantitative threshold (e.g.meningococcal meningitis) Importance of a good surveillance system for early warning Confirm the Existence of an Outbreak 02/05/2012

19 Determine whether there is an outbreak – an excess number of cases from what would be expected Establish a case definition – Non-ambiguous – Clinical / diagnostic verification – Person / place / time descriptions Identify and count cases of illness PTS-RST-PKH /05/2012

20 Graph of the number of cases (y-axis) by their date or time of onset (x-axis) Interpreting an epidemic curve – Overall pattern: increase, peak, decrease Type of epidemic? Incubation period? – Outliers: Unrelated? Early or late exposure? Index case? Secondary cases? PTS-RST-PKH /05/2012

21 PTS-RST-PKH Endemic Epidemic No. of Cases of a Disease Time 02/05/2012

22 Starts slowly Time between the first case and the peak is comparable to the incubation period. Slow tail Vector-borne Disease PTS-RST-PKH /05/2012

23 This is the most common form of transmission in food- borne disease, in which a large population is exposed for a short period of time. Point Source Transmission PTS-RST-PKH /05/2012

24 In this case, there are several peaks, and the incubation period cannot be identified. Continuing Common Source or Intermittent Exposure PTS-RST-PKH /05/2012

25 TIME, PLACE, PERSON May be possible to answer: Who is at risk? What is source of infection? What is mode of transmission? PTS-RST-PKH /05/2012

26 Distribution of cases by date of onset X axis: timeY axis: number of cases Shows: – Time limits / duration of the outbreak – Peak / incubation period – Form of curve: evolution of outbreak – Formulate hypothesis regarding source PTS-RST-PKH /05/2012

27 Cycle of Foodborne Disease Control and Prevention Surveillance Epidemiologic Investigation Applied Research Prevention Measures PTS-RST-PKH /05/2012

28 Talk with health workers Examine cases yourself ! Laboratory testing (e.g., malaria, cholera, hemorrhagic fevers, etc.) PTS-RST-PKH /05/2012

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37 Control of present outbreak Prevention of future similar outbreaks PTS-RST-PKH /05/2012

38 Numerators Describe cases in terms of age, sex, other parameters : refugee / displaced / residents immunized, not immunized Denominators Distribution in the overall population (age, sex,...) Compare rates to identify high risk groups PTS-RST-PKH /05/2012

39 Map cases: identify geographic places at risk Determine where disease acquired: Home, work, travel, etc.. PTS-RST-PKH /05/2012

40 Personal information Age Sex Place of residence (address) Other relevant exposures – Refugees vs locals – Food source – Water source Ethnicity, religion, etc. PTS-RST-PKH /05/2012

41 Disease data Date of onset of symptoms Clinical symptoms and signs Immunized or not (measles, meningitis) Laboratory results (if any) Duration of disease, outcome (death, cured,..) Treatment received PTS-RST-PKH /05/2012

42 Often obvious from descriptive epidemiology Formulate idea about source of outbreak and mode of transmission PTS-RST-PKH /05/2012

43 Cross – sectional study? Cohort study Case – control study – Identify cases – Select control group Possibly matched on age or sex or location Community control, clinic control etc. – Compare exposures among cases and controls – Calculate odds for various exposures PTS-RST-PKH /05/2012

44 Clarifies your own ideas / synthesis Presents data and conclusions to anyone interested Often epidemiologist dont implement interventions Must communicate to those who will intervene Advocacy: MOH, UN, other NGOs, donors Basis for future reference PTS-RST-PKH /05/2012

45 Interventions include Prevention of further cases Control of transmission and source of infection Improve case management, lower case- fatality rate PTS-RST-PKH /05/2012

46 PTS-RST-PKH Terimakasih Selamat Belajar 02/05/2012


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