Technical Guidelines for Integrated Disease Surveillance ... - PHRplus

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Table A-3: Specimens for laboratory confirmation for priority diseases at the district levelSuspected disease orconditionDiagnostic test Specimen When to collect How to prepare, storeand transportAcute flaccid paralysis(polio)REFERENCE:WHO global action plan forlaboratory containment ofwild polio viruses. WHO/V&B/99.32, Geneva, 1999Manual for the virologicalinvestigation of polioWHO/EPI/GEN/97.01Geneva, 1997Isolation of polio virus fromstoolStoolNote: If no specimen iscollected, re-evaluatepatient after 60 days toconfirm clinical diagnosis ofpolio (AFP).Collect a sample from everysuspected AFP case.Collect the first specimenwhen the case is investigated.Collect a second specimenon the same patient 24hours later. Place stool in clean,leakproof container andlabel clearly. Immediately place inrefrigerator or cold boxnot used for storingvaccines or othermedicines. Transport specimens sothey will arrive atdesignated poliolaboratory within 72hours of collection. When there is a delay,and specimen will notbe shipped within 72hours, freeze specimenat -20°C or colder.Then transport frozenspecimen with dry iceor cold packs alsofrozen at -20°C orcolder.Buruli ulcer Isolation of MycobacteriumUlcerans from ulcer.Wound swabORTissue from the ulcerCollect the specimen for onecase if diagnosis uncertain.If sending directly to thelab, place swab ortissue in a dry cleantest tube and transportat room temperature.If sending to lab within 6hrs of collection, placeswab or tissue in about2 mls of saline in aclean test tube.When there will be adelay of about 2 ormore days, keep inthe refrigerator at 4-8°C.ResultsPreliminary test resultsare usually available 14-28 days after receipt ofspecimen by the laboratory.If wild polio virus isdetected, the nationalprogramme will planappropriate actions.Zeihl-Neelsen (ZN)staining and microscopyshould be completedwithin 24 hours of arrivalof specimen in thelaboratory.Culture and sensitivityresults should be ready in6-9 weeks of arrival at thelaboratory.130Technical Guidelines for Integrated Disease Surveillance and Response in Ghana
Suspected disease orconditionCholeraREFERENCE:“Laboratory Methods for theDiagnosis of EpidemicDysentery and Cholera”.CDC/WHO, 1999CDC, Atlanta, GA, USADiagnostic test Specimen When to collect How to prepare, storeand transportIsolate V. cholerae fromstool culture and determineO1 serotype using polyvalentantisera for V. choleraeO1.If desired, confirm identificationwith Inaba and Ogawaantisera.If specimen is notserotypable, consider, V.cholerae O139 (see note inResults columnLiquid stool or rectal swab Collect stool sample fromthe first suspected choleracase. If more than onesuspected case, collect untilspecimens have beencollected from 5 to 10cases. Collect stool frompatients fitting the casedefinition and: onset within last 5days, and before antibioticstreatment has started.Do not delay treatment ofdehydrated patients.Specimens may becollected after rehydration(ORS or IV therapy) hasbegun. Place specimen (stoolor rectal swab) in aclean, leakproofcontainer and transportto lab within 2 hours. If more than 2-hourdelay is expected,place stool-soakedswab into Cary-Blairtransport medium.If Cary-Blair transportmedium is not available andspecimen will not reach thelab within 2 hours: Store at 4°C to 8°C Do not allow specimento dry. Add smallamount of 0.85% NaClif necessary. To ship, transport in wellmarked, leakproofcontainer.Transport container incold box at 4°C to 8°C.Cary-Blair transport mediumis stable and usually good forat least one year after preparation.It does not require refrigerationif kept sterile andin properly sealed container.If color changes (mediumturns yellow) or shrinks (depressedmeniscus), do notuse the medium.ResultsCholera tests may not beroutinely performed in alllaboratories.Culture results usuallytake 2-4 days afterspecimen arrives at thelaboratory.The O139 serotype hasnot been reported inAfrica and only in a fewplaces in southwest Asia.Serological determinationof Ogawa or Inaba is notclinically required. It isalso not required ifpolyvalent antisera resultsare clearly positive.Annex 5: Laboratory Tests for Confirming Priority Diseases and Conditions 131
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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
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3.2.3.3 Calculate case fatality rat
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Table 6: Alert and epidemic/action
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3.4 Use the analysis results to imp
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4.0 Investigate Reported Outbreaks
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4.4 Prepare to conduct an investiga
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Review laboratory results with the
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Draw a histogram representing the c
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If the shape of the curve suddenly
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5.0 Prepare and Respond to Outbreak
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Periodically review and update othe
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3. Select appropriate communication
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Improve safe disposal of human wast
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Table 7: Daily water needs per pers
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Recommendations for improving epide
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6.0 Provide FeedbackData are report
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The newsletter can be produced simp
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7.0 Evaluate and Improve Surveillan
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Table 8 lists possible indicators t
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Priority diseases are recorded in t
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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 and 102: Analyse and interpretdataReferenceT
Page 103 and 104: Buruli UlcerBackground Buruli ulce
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: Annex 5Laboratory Tests for Confirm
Page 147 and 148: Suspected disease orconditionDiagno
Page 153: Annex 6List of Laboratories for Con
Page 157 and 158: Annex 8Case-based Surveillance Repo
Page 159 and 160: If laboratory specimen collectedFor
Page 161: 16. When the investigation of the c
Page 164 and 165: (For reporting from health facility
Page 166 and 167: 13. For vaccine-preventable disease
Page 169 and 170: Annex 11Total Number of Patients Se
Page 171: Annex 12Year ___________ Quarter __
Page 174 and 175: Analysis, interpretations, comments
Page 176 and 177: C. Location of Lesion(s)19. Upper l
Page 179 and 180: Annex 15Monthly Registration of Bur
Page 181: Classification a Location of Lesion
Page 185: Annex 17Managing Public Health Surv
Page 189 and 190: Annex 19Sample Tables for Person An
Page 191 and 192: Annex 20Log of Suspected Outbreaks
Page 193: 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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