Technical Guidelines for Integrated Disease Surveillance ... - PHRplus

Surveillance goal Detect outbreaks of fever with rash illness promptly. Immediately report (case-based reporting) suspected cases and deaths of fever withrash illness; confirm first five cases of measles in a health facility per week with alaboratory test (usually serum IgM).Case definitionSuspected case:Any person with fever and maculopapular (non-vesicular) generalised rash and cough,coryza or conjunctivitis (red eyes) or any person in whom a clinician suspects measles.Respond to an alertthresholdRespond to anepidemic thresholdAnalyse and interpretdataConfirmed case:A suspected case with laboratory confirmation (positive IgM antibody) or epidemiologicallink to confirmed cases in an outbreak.If an outbreak is suspected (more than 5 cases reported by a health facility perweek): Report suspected case to the next level. Collect blood samples for confirming the outbreak. Treat cases with oral rehydration, vitamin A, and antibiotics for prevention of bacterialsuperinfection. Use airborne isolation precautions where feasible.Investigate the case or outbreak to identify causes for outbreak.If an outbreak is confirmed: Improve routine vaccine coverage through the EPI, and lead supplemental vaccinationactivities in areas of low vaccine coverage.Mobilise the community early to enable rapid case detection and treatment.Time:Graph weekly cases and deaths. Construct epidemic curve for outbreakcases.Place:Person:Plot location of cases by communities.Count total cases and analyse by age group and immunization status.ReferenceUsing surveillance data and outbreak investigations to strengthen measles immunizationprogrammes, Geneva, World Health Organization. WHO/EPI/GEN/96.02MeningitisBackground Acute infection of the central nervous system usually caused by Neisserria meningitidis,Haemophilus influenzae, or Streptococcus pneumoniae, encapsulated bacteriatransmitted human-to-human via airborne droplet spread. Incubation period is 2 to 10 days. Attack rates are highest among children age less than 15 years. Case fatality rates areusually 10% to 20% among treated patients, and >70% among untreated cases. In Ghana, large outbreaks due to N. meningitidis (incidence greater than 1 case per1,000 population) may occur November through May in regions in the northern sector.Outside the meningitis belt, smaller outbreaks may occur year-round. Reported cases in 1998 and 2000 was an average of 1,000, in 1999 half that number ofcases were reported. The case fatality rate over the period has ranged between 21%and 25%. Antimicrobial resistance to chloramphenicol has not yet been detected in Africa.Resistance to sulfonamides is widespread. Viral or tuberculous meningitis and HIV-related opportunistic infections are among theconditions that may mimic this disease. Meningitis due to Haemophilus influenzaeoccurs principally in children less than 5 years of age.Surveillance goal Promptly detect meningitis outbreaks and confirm etiology of first 5 to 10 cases.Perform lumbar puncture and Gram stain of cerebral spinal fluid (CSF) on all cases ofsuspected meningitis where feasible to confirm etiology of meningitis for improvedsurveillance.100Technical Guidelines for Integrated Disease Surveillance and Response in Ghana