Technical Guidelines for Integrated Disease Surveillance ... - PHRplus

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Case definitionGhana uses the Modified Bangui Classification for AIDS as follows:Adults At least two (2) major signs or symptoms plus at least one (1) minor sign orsymptom together with a POSITIVE HIV antibody testOR Three (3) major signs plus an additional requirement that these must be in theabsence of immuno-suppression and chronic malnutrition.ChildrenSame conditions as for adults plus the absence of immuno-suppression andchronic malnutrition{Major Signs: More than 10% weight loss; chronic diarrhoea for more than one month; andprolonged fever (intermittent or constant) for more than one month}{Minor Signs: Persistent cough for more than one month; generalised pruritic dermatitis;recurrent herpes zoster; oropharyngeal candidiasis; chronic progressive and disseminatedherpes virus infection and generalised lymphadenopathy}HIVA positive ELISA for confirming HIV and a rapid test for confirming the positive results aresufficient for an epidemiological case definition for HIV.Public health action Monitor local STI and opportunistic infections, including TB, as possible cofactor forHIV. Improve percentage of suspected HIV/AIDS cases confirmed via serology. Monitor use of condoms by commercial sex workers. Provide voluntary counseling and testing services at district and sub-district levels. Treatment of individual cases with antiretroviral therapy is not yet widely available inmost African countries. Rapid diagnosis and treatment of AIDS-related OI may prolonglife expectancy but this has not been widely evaluated in developing countries. Promote condom use, especially among high-risk individuals. Treat STIs, especially syphilis and chancroid diseases, as well as other ulcerativeprocesses. Mobilise non-paid blood donors and promote appropriate use of blood. Promote good infection control practices within health facilities in the district. Educate HIV/AIDS patients and their sexual partners to refrain from donating blood,tissues, semen or breast milk.Analyse and interpretdataTime:Place:Person:Count new AIDS cases and report monthly. Include trends for HIV serosurveillance.STI surveillance and results of any special studies (sociobehaviouralstudies drug sensitivity to anti-microbial agents, and so on).Plot data on map by place of residence.Analyse by number of cases confirmed with serology. At the end of theyear, calculate the total number of cases by age, sex and occupation.ReferenceGuidelines for Sexually Transmitted Infections Surveillance. Geneva. UNAIDS and WorldHealth Organization. WHO/CDS/CSR/EDC/99.3. UNAIDS/99.33E88Technical Guidelines for Integrated Disease Surveillance and Response in Ghana
Buruli UlcerBackground Buruli ulcer is an infectious disease involving the skin, caused by Mycobacteriumulcerans and characterized by a painless nodule, papule, plaque or oedema evolvinginto a painless ulcer with undermined edges, often leading to invalidating sequelae. Buruli ulcer is a disease that has terrible consequences if not promptly diagnosed andtreated. In terms of number of cases, Buruli ulcer is probably the third most commonmycobacterial disease in immunocompetent humans after tuberculosis and leprosy. It is endemic in at least 25 countries worldwide, mostly in tropical regions. However,due to lack of precise data, the burden of the disease at global and national levels is notentirely known. A survey done in one of the endemic districts (population106,500) in Ghana estimated the prevalence at 3.19 per 1000. In some communitiesin the country, Buruli ulcer has affected 16 – 22% of the population. Awareness of this disease is low and may lead to significant under-recognition andunder-reporting. There is little knowledge on the extent of the disease at national andinternational levels. The disease most commonly affects impoverished inhabitants in remote rural areaswith limited access to health care. It often occurs in close proximity to slow-flowing orstagnant bodies of water. All age groups, but particularly children under 15 years of age,are affected. No racial or socioeconomic group is exempt. Interestingly, HIV infection isnot a risk factor. As of today, the mode(s) of transmission is not entirely known. Theorganism probably enters the body through small breaks in the skin from contaminatedsoil, water or vegetation. Recent evidence suggests that in some cases insects may beinvolved in the transmission of the disease. There is no anecdotal evidence to supportperson-to-person transmission. A good surveillance system is needed to provide better data on the disease and to allowmonitoring for control.Surveillance goalCase definitionGenerally, the purpose for surveillance of Buruli ulcer is for early detection and response toleading causes of illness and disability.Suspected case:Two types active or inactive. The active types presents with different clinical forms.Active Papule: painless and raised skin lesion less than 1cm in diameter Nodule: painless palpable firm lesion, 1-2cm in diameter, situated in the subcutaneoustissue and usually attached to the skin Plaque: usually painless, well-demarcated, elevated, indurated lesion more than 2cm indiameter Oedema: diffuse, extensive, non-pitting, ill-defined margin, firm, and may be painfulwith or without colour change over the affected skin Ulcer: painless skin lesion characterised by a necrotic centre, undermined edges andoedematous skin. An early ulcerative lesion has a diameter of less than 2cm and a lateulcerative lesion has a diameter of more than 2cm.Inactive Healed lesion with characteristic depressed stellate (star-like) scar without sequelae. Asequelae of Buruli ulcer is defined as a complication resulting either directly from thedisease (contracture deformities, loss of organs such as breasts, eye and genitalia) oras result of treatment (amputation of limbs).Confirmed case:Suspected case that is laboratory confirmed by one or more of the following:Demonstrations of alcohol-acid-fast bacilli (AFB) in a smear from necrotic base ofulcersPositive culture of M. ulceransSection 9: Summary Guidelines for Specific Priority Diseases and Conditions89
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Technical Guidelines forIntegrated
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3.3.1 Review the updated charts, ta
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7.1.2 Monitor timeliness and comple
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List of TablesTable 1: Surveillance
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AcronymsAFROAFPAIDSCBSCBSWCDCDHMTE-
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An ill person presents to medical a
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How are surveillance functions desc
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4.0 Investigate** 5.0 Respond 6.0 P
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National4.0 Investigate** 5.0 Respo
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In general, the health of Ghanaians
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How does Ghana’s MOH/GHS support
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1.0 Identify Cases of Priority Dise
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1.2 Improve district procedures for
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Section 2Report Priority Diseases a
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Name of diseaseRoutine summary repo
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Identify and train CBS volunteers o
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Clinicians, ward nurses or other re
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3.0 Analyse DataAnalysing trends of
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3. Label all the rows and columns,
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Figure 4: Meningitis cases from Bol
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The first step in analysing data by
Page 52 and 53: 3.2.3.3 Calculate case fatality rat
Page 54 and 55: Table 6: Alert and epidemic/action
Page 56 and 57: 3.4 Use the analysis results to imp
Page 58 and 59: 4.0 Investigate Reported Outbreaks
Page 60 and 61: 4.4 Prepare to conduct an investiga
Page 62 and 63: Review laboratory results with the
Page 64 and 65: Draw a histogram representing the c
Page 66 and 67: If the shape of the curve suddenly
Page 68 and 69: 5.0 Prepare and Respond to Outbreak
Page 70 and 71: Periodically review and update othe
Page 72 and 73: 3. Select appropriate communication
Page 74 and 75: Improve safe disposal of human wast
Page 76 and 77: Table 7: Daily water needs per pers
Page 78 and 79: Recommendations for improving epide
Page 80 and 81: 6.0 Provide FeedbackData are report
Page 82 and 83: The newsletter can be produced simp
Page 84 and 85: 7.0 Evaluate and Improve Surveillan
Page 86 and 87: Table 8 lists possible indicators t
Page 88 and 89: Priority diseases are recorded in t
Page 90 and 91: Indicators for measuring quality of
Page 93 and 94: Section 8Community-based Surveillan
Page 95 and 96: members to take action in the event
Page 97 and 98: Participate in information dissemin
Page 99 and 100: Section 9Summary Guidelines for Spe
Page 101: Analyse and interpretdataReferenceT
Page 105 and 106: Cholera may cause severe dehydratio
Page 107 and 108: Respond to epidemicthresholdIf a su
Page 109 and 110: In Ghana, the disease was endemic i
Page 111 and 112: ReferenceA guide to eliminating lep
Page 113 and 114: Promote environmental sanitation: c
Page 115 and 116: Surveillance goal Use a rapid late
Page 117 and 118: OnchocerciasisBackground Filarial
Page 119 and 120: Poliomyelitis (Acute flaccid paraly
Page 122 and 123: Public health action Conduct activ
Page 124 and 125: The global HIV pandemic has been a
Page 126 and 127: Respond toepidemicAnalyse and inter
Page 128 and 129: Public health action Case finding
Page 131 and 132: Annex 1Using Assessment Results to
Page 133: Tally, compile and report summary t
Page 136 and 137: Diseases of special public health f
Page 138 and 139: Pneumonia in childrenless than 5 ye
Page 140 and 141: Other diseases of public health imp
Page 143 and 144: Annex 5Laboratory Tests for Confirm
Page 145 and 146: Suspected disease orconditionCholer
Page 147 and 148: Suspected disease orconditionDiagno
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Annex 6List of Laboratories for Con
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Annex 8Case-based Surveillance Repo
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If laboratory specimen collectedFor
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16. When the investigation of the c
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(For reporting from health facility
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13. For vaccine-preventable disease
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Annex 11Total Number of Patients Se
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Annex 12Year ___________ Quarter __
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Analysis, interpretations, comments
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C. Location of Lesion(s)19. Upper l
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Annex 15Monthly Registration of Bur
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Classification a Location of Lesion
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Annex 17Managing Public Health Surv
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Annex 19Sample Tables for Person An
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Annex 20Log of Suspected Outbreaks
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Instructions for filling suspected
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INITIAL CLINICAL HISTORYPlease use
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SPECIMEN COLLECTIONDate Sent toDate
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186Technical Guidelines for Integra
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188Technical Guidelines for Integra
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Annex 25Treat Cases During an Outbr
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Also give home-based fluids as foll
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3. Give vitamin A to children with
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Annex 26Preparing Disinfectant Solu
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If the health facility does not kee
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Message:DO YOU PREPARE FOOD SAFELY?
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Reducing exposure to mosquitoesPERS
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Annex 30Estimating Vaccine Supplies
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Annex 31Recommended Immunization Pr
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Lab analysis and results:With text,
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District Epidemic Management Commit
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Annex 35Checklist for Supervising S
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Activity Supervisory Question Answe
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Annex 36Indicators for Monitoring t
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