Infectious Disease Outbreaks in confined spaces

Transcription

1 Infectious Disease Outbreaks in confined spaces Dr Andrew Ebringer Senior Medical Director, Medical Services - Australia International SOS AEA International Holdings Pte. Ltd. All rights reserved. Unauthorized copy or distribution is prohibited.

2 Introduction to Norovirus Norovirus outbreaks common : cruise ship virus Caribbean Cruise Jan 2014 : 20% of 3000 passengers were infected Rapid spread : Vessel or Rig explosive outbreak - inoperative Case history - rig with 98 POB.

3 Why, What and How? Infectious outbreaks - significant risk Rig running costs + staffing - $1MIL/d Health Incident Plan vital Gastroenteritis is a common infection of the intestines : diarrhoea +/- vomiting Causes: Viruses Norovirus, rotavirus (children) Bacteria E. coli (common cause of Travellers Diarrhoea), salmonella, campylobacter Serious infection e.g. typhoid, cholera Parasites Cryptosporidia, giardia

4 Norovirus : pattern of Illness Incubation period 24-48h Symptoms: sudden onset of vomiting watery non-bloody diarrhoea with abdominal cramps Nausea occasionally low-grade fever chills, headache, muscle aches, and fatigue. Symptoms usually last 24-60h Asymptomatic 30% Shedding of Norovirus by infected individuals usually. begins when symptoms first occur and may occur for up to two weeks after recovery.

5 Norovirus : how it spreads contaminated food or water direct contact with infectious droplets - caring for or sharing food / drink with an infected person indirect contact touching a contaminated object and then inadvertently transferring the virus to the mouth The virus is highly infectious and as few as viral particles may be sufficient to cause infection.

6 Norovirus : outbreak importance Rapid spread Hardy survives: low levels of chlorine wide temperature range (0-60C) hard surfaces for 12h carpet for 12d

7 Norovirus : the incident Date: 28 Mar 2014 Location : Semi Submersible Rig Rig Population: 98 Pax Distance to Evacuate: 120 miles Situation: 6 workers presenting with acute diarrhoea & vomiting over 3d 2 cases settled spontaneously over a 24h Health Incident Plan implemented: general preventive measures on personnel and food hygiene. Public Health Unit notified Date: 31 Mar 2014 Situation: 15 cases. Three still remain unwell, others have recovered and are symptom free. The last two cases were cooks who have been stood down from their roles in the galley. Date: 4 Apr subjects unwell but improving

8 Outbreak Plan : Considerations procedures to follow when an incident occurs disease dependent norovirus vs. Ebola vs. meningococcal meningitis infection control non-pharmaceutical preventive measures health risk mitigation processes to reduce the likelihood of these events occurring living document : reviewed periodically, updated to reflect current policy, organisational structure, and procedures Health Incident Plans should sit within the greater framework of business continuity plans

9 Outbreak Plan : Procedures Screening and PPE Isolation / Quarantine 3. Cleaning Food handling 5. Health authorities are notified 6. Prevention 9

10 Norovirus - Diagnosis and Treatment Diagnosis suspected on clinical symptoms in an outbreak Confirmation : lab test using stool specimens taken within 48 to 72 hours of onset Treatment no specific treatment replacing fluid losses and correcting electrolyte disturbances through oral and intravenous solution therapy Norovirus infections are prevented through hygiene. Hand washing is the most important action to prevent spread of Norovirus.

11 Prevention of Norovirus 1. Good personal hygiene 2. Safe water 3. Safe food

12 Good Personal Hygiene Washing your hands frequently and properly is one of the best ways to stay healthy Before preparing food or eating After toilet use After attending to infected people After changing nappies After participating in clean-up activities If you have a limited supply of clean water use an alcohol-based sanitiser to wash your hands Washing your hands will help prevent germs from spreading.

13 Washing hands Use soap: Using water alone does not remove soil and grease which can trap unseen germs and viruses. Wash your hands for at least seconds using the following steps. Total duration of the entire procedure is seconds.

14 The correct way to use hand sanitiser Rub hands for hand hygiene! Wash hands when visible dirty. Duration of the entire process is: seconds Apply palmful of product in a cupped hand covering all surfaces Rub hands palm to palm Right palm over back of left hand with interlaced fingers and vice versa Palm to palm with fingers interlaced Backs of fingers to opposing palms with fingers interlocked Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa 7. Once dry, your hands are safe

15 Safe Food and Water Effective food hygiene: Wash hands before preparing food Cook food thoroughly Eat food while still hot Prevent cooked foods from being contaminated by raw foods, water, ice, contaminated surfaces Boil it, cook it, peel it, or forget it Bottled water Boiled water Treated water

16 EBOLA WHAT IS IT? Ebola is caused by a virus. Causes a severe illness, with bleeding ( Ebola haemorrhagic fever ) Approximately 25 to 90% of all infected people die No vaccine, and no specific treatment are available Once someone is infected, if proper precautions aren t taken, an epidemic can spread quickly FACT With the proper precautions in place, Ebola will not spread to other people. 16

17 EBOLA Outbreak in West Africa 2014 Began in Guinea December Initial cases in southern forested area of Guinea thought to be bat hunters First time the disease had been found in West Africa Diagnosis not made until March 2014, by which time clusters of infection in several areas. Spread to Liberia and Sierra Leone. Imported case into Nigeria which infected others there. SPREAD is entirely human to human (from one person to another). It is not spreading from animals or bushmeat to people in this outbreak 17

18 EBOLA Outbreak in West Africa 2014 Now the largest and most challenging outbreak that has ever occurred. WHO declared it a Public Health Event of International Concern in early August. Case numbers are thought to greatly underestimate the extent of the outbreak Experts expect it will take at least 6 months to come under control The most heavily affected areas of Guinea, Liberia and Sierra Leone are under cordon sanitaire quarantine. Movement in or out of these areas is heavily restricted by authorities. Measures are enforced by security / military 18

19 EBOLA WEBSITE Latest News Travel Advice About Ebola Transmission Symptoms Prevention Country specific updates FAQs French page Education Materials Useful Links 19

20 Questions?