Outbreak preparedness and the NICD 24-hour hotline a review of calls made to the Hotline, and Outbreak Response Unit, July 2016-June 2017

Transcription

1 Outbreak preparedness and the NICD 24-hour hotline a review of calls made to the Hotline, and Outbreak Response Unit, July 2016-June 2017 FIDSSA 2017 Kerrigan McCarthy, Nevashan Govender, Vivien Essel, Genevie Ntshoe, Lucille Blumberg Outbreak Response Unit, National Institute of Communicable Diseases 11/21/2017 1

2 Why a 24-hour hotline at NICD? NICD is only RSA institution providing diagnostics for a number of conditions with significant public health implications, Rabies MERS-CoV Arbovirus infections (Rift Valley Fever) Viral haemorrhagic fevers NICD houses the public sector reference laboratories for NHLS, supports NHLS diagnostics for epidemic-prone diseases and conducts surveillance for diseases of public health significance NICD supports provincial and national DoH Communicable Diseases Clusters with technical advice 2

3 Why a 24-hour hotline at NICD? The international health regulations (IHR) 2005 require a 24-hour number for reporting outbreaks System for eventbased surveillance 3

4 Methods- where, when, how? NICD Pathologist/MO On call: Consultant support Expert referral Doctors answer enquiry, or refer on to ORU and NICD centers; obtain consultant/expert support where necessary On call for 7 days once every 12 weeks; Doctor record calls into excel spreadsheet Outbreak Response Unit ORU uploads spreadsheet into MS Access, adds metadata Conducts data cleaning, analytics NICD Centers For diagnostic testing, clinical and/or epidemiologic al advice NDoH, Provincial DoH For public health response, contact tracing, follow up 4

5 Trends in calls made to NICD hotline July 2016 June Number of calls made to NICD Hotline by month, July 2016-June 2017 (n=1295) Proportion of calls made by different categories of persons, July 16-June 17 (n=1295, %) Doctor 58 Laboratorian Member of the public Nurse Other health care w.. DoH official Proportion of calls made by pubic vs private sector, July 2016-June 2017 (n=1295, %) 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Private/for profit Public

6 EC GP LP NWP WCP unk Trends in calls made to NICD hotline July 2016 June 2017 Distribution of calls made to NICD Hotline by district of RSA July 2016-June 2017 (n=1295)

7 Type of calls made to NICD hotline July 2016 June 2017 Proportion of calls made to NICD Hotline by category, July 2016-June 2017 (n=1295) Rabies post-exposure prophylaxis Patient(s) investigation Lab-confirmed case for advice Other Food/Water-borne disease investigation Non-rabies post-exposure prophylaxis Administrative Animal/Environmental health Infection control Vaccination-related enquiry Pre-exposure prophylaxis Media/Journalist % 20 % 30 % 40 % 50 % 60% 7

8 Trends in calls made to NICD hotline July 2016 June 2017 Distribution of calls made to NICD Hotline by district of RSA, and proportion of calls related to rabies, by province July 2016-June 2017 (n=1295) LP MP NWP GP FSP KZN Non-rabies Rabies PEP NCP ECP WCP 8

9 Type of calls made to NICD hotline July 2016 June 2017 Suspected diseases for alerts requesting assistance with diagnosis of infectious disease (n=208) where Alert category was Patient investigation Suspected disease # % Anthrax Arbovirus Botulism (and Infant botulism) Brucellosis Chikungunya Cholera Crimean-Congo hemorrhagic fever (CCHF) Dengue fever Diphtheria Ebola hemorrhagic fever Enterovirus infection Filariasis Hepatitis B Influenza (flu) Lassa fever Leptospirosis Lyme disease (Lyme borreliosis) Malaria Measles Meningitis Meningococcal disease Middle East respiratory syndrome (MERS) Not applicable Other Pertussis (Whooping cough) Poliomyelitis Rabies Rickettsial infection Rift Valley fever (RVF) Strongyloidiasis Tetanus (Lockjaw) Tuberculosis Tularemia Typhoid Fever Unknown as yet Viral Haemorrhagic Fever Yellow fever Zika

10 Type of calls made to NICD hotline July 2016 June 2017 # cases involved in each alert to NICD hotline, by category Category # calls Single case 1, cases cases cases Not applicable 122 Total 1,320 Alert category for all alerts involving >1 case Alert category # calls Food/Water-borne disease investigation 39 Infection control 1 Lab-confirmed case for clinical/public health advice 28 Media/Journalist 1 Non-rabies post-exposure prophylaxis 7 Other 9 Patient(s) investigation 19 Pre-exposure prophylaxis 1 Rabies post-exposure prophylaxis 10 Related disease for all alerts pertaining to Lab-confirmed cases where alert involved >1 case Brucellosis 1 Clostridium difficile 1 Hepatitis A 13 Hepatitis B 1 Influenza (flu) 1 Leprosy 1 Leptospirosis 1 Listeriosis 1 Measles 1 Other 1 Schistosomiasis 1 Typhoid Fever 10 4

11 Severity of events reported 80 The proportion of all alerts falling into WHO severity grading scale Minimal (no deaths, minor disruptions) Minor (few illnesses, manageable by p.. Moderate (death or illness, public he.. Major (many deaths, disrupts public health service) Severe (substantial loss of life, widespread disruption) Amongst 1295 alerts, 22 pertained to a communicable disease where a death/s had occurred : Food/Water-borne disease investigation 4 Lab-confirmed case for clinical/public health support 6 Patient(s) investigation 12 11

12 Impact of NICD call phone Facilitated appropriate provision of rabies PEP Facilitated diagnosis, and ensured appropriate infection, prevention and control of highly transmissible/ significant communicable disease Facilitated early investigation and containment of diseases of concern Acts across private/public sector Sindbis, GP 2017 CCHF, FSP 2017 Diphtheria, WCP 2017 Measles, WCP 2017 H3N2 influenza,

13 Acknowledgements Farzana Ismail Sarona Mhlanga Vivien Essel Ranmini Kularatne 13