Khaled Ali Abu Ali BSN. MPH. Ph.D. cand. Director of Epidemiology Department UCAS Lecturer -Nursing Khaled_abuali@yahoo.com
Communicable Disease Surveillance during Gaza War, 214.
Introduction Public Health Surveillance is an ongoing and systematic process of data collection, analysis and interpretation, it`s essential to the planning, implementation and evaluation of public health practice, closely integrated with the timely dissemination of these data to health officials. It consider as information for action. 43 communicable diseases are divided into three groups A, B and C according to its` epidemiological importance.
Communicable Disease is the major killers in complex emergencies. Death rates among refugees and displaced persons over 6 times the baseline rates have been recorded, with over three quarters of these deaths being due to communicable diseases.
On 8 July, Israeli military operation fights on Gaza Strip, in 51 days of attack more than 2.13 Palestinians have been killed, more than 11.22 people were injured and thousands of building completely or partially demolished. OCHA reported that about 485. populations had been displaced into UNRWA emergency shelters, government shelters and some of them displaced their families and friends. Populations affected by this war have experienced severe public health consequences:- -overcrowdings -inadequate shelters -poor sanitation -food scarcity -unsafe water -collapse of basic health services. These circumstances can increase the likelihood of communicable diseases transmission.
The goal To identify the impact of the communicable diseases surveillance on the mortality and morbidity of the communicable diseases in populations affected by the war.
Methodology MOH implemented the surveillance to monitor 14 communicable diseases -(Diarrheal diseases, Typhoid fever, Mumps, Scabies, Impetigo, Acute Respiratory Infection, AFP suspected cases, Aseptic Meningitis, Meningococcal disease, Other Bacterial Meningitis, Food poisoning, Measles, Infectious hepatitis and Cholera). 12 weeks of monitoring from 12 August to 31 October at daily basis. The data is being collected from the working health facilities Governmental, Nongovernmental and UNRWA and the shelters.
Diarrheal diseases Diarrhea is a common problem that generally lasts for few days. In Gaza strip, acute diarrhea is one of the most common childhood illnesses and the main cause of outpatient visits and hospitalizations. 3 The high incidence of diarrheal disease in some governorates often linked to contaminated food, poor water quantity and quality and bad sanitation and hygiene. The most effective control measures to prevent diarrhea are maximizing access to sanitation, safe water, safe food supplies, and improving personal hygiene practices. According to surveillance system classification, diarrhea is classified into diarrhea less than 3 years, diarrhea more than 3 years and bloody diarrhea.
Diarrheal diseases 384 3 2338 2949 2638 3323 3258 2982 3297 2811 1942 1698 w1 w2 w3 w4 w5 w6 w7 w8 w9 w1 w11 w12 Months 8-1/214 18.7/1, Daily mean 43 Months 8-1/213 13.8/1
Respiratory Tract Infection Acute respiratory infections (ARI) are the leading causes of illness in developing countries, particularly among children less than five years. About four million children die every year from pneumonia, most of them less than 2 months of age. Influenza is a viral infection mainly caused by influenza group A viruses which is endemic in Palestine. URTI is the commonest acute problem dealt within primary care settings caused by viruses or bacteria. It ranges from mild self-limited to life-threatening illnesses.
Acute Respiratory Infection 3427 3594 3542 3819 3684 3661 3374 28 2584 298 1541 894 w1 w2 w3 w4 w5 w6 w7 w8 w9 w1 w11 w12 Months 8-1/214 19.8/1, Daily mean 454 Months 8-1/213 17/1
Measles Measles is an acute infection of the measles virus, Morbillivirus of the family Paramyxoviridae. The disease is spread through close respiratory contact with contagious air droplets. Normal case fatality rates of measles range between 3-5%. However, among displaced populations, the case fatality rate ranges between 1-3%, but can be as high as 5%. Despite efforts of the global EPI, measles is still endemic in many developing countries, especially where conflict prevents routine immunization.
Measles w1 w2 w3 w4 w5 w6 w7 w8 w9 w1 w11 w12 No Measles cases reported
Acute Flaccid Paralysis Acute onset of a flaccid paralysis of one or more groups of muscles with decreased or absent tendon reflexes in the affected muscles, without other apparent cause, and without sensory or cognitive loss. All diagnosed cases must be investigated to exclude Poliomyelitis as one of WHO requirements for Poliomyelitis eradication goal.
AFP cases w1 w2 w3 w4 w5 w6 w7 w8 w9 w1 w11 w12 No AFP cases reported
Cholera Suspected case: acute watery diarrhea and/or vomiting with or without dehydration. Confirmed case: isolation of Vibrio Cholera from stools or vomitus in any patient with diarrhea. Transmission: Fecal-oral. Incubation period: Few hours to 5 days. One confirmed case means of an outbreak in the area.
Cholera w1 w2 w3 w4 w5 w6 w7 w8 w9 w1 w11 w12 No Cholera cases reported
Food Poisoning An incident in which two or more cases experience a similar illness after ingestion of a common food and epidemiological analyses implicates the food as the source of illness. Transmission: Fecal-oral. Incubation period: Few hours to 3 days
Food Poisoning 7 Underreporting w1 w2 w3 w4 w5 w6 w7 w8 w9 w1 w11 w12
Meningococcal Disease Meningococcal disease Neisseria meningitides, H. Influenza B or clinical. It manifests most commonly as meningitis and/or meningococcemia that may progress rapidly to purpura fulminant, shock, and death. Other manifestations could be fever, headache, vomiting, neck stiffness, consciousness, convulsion, petechial rash and bulging fontanel in small babies and infants. Transmission: droplet spread by direct or indirect contact with cases Incubation period: 2 to 4 days
Meningococcal Disease 1 1 1 w1 w2 w3 w4 w5 w6 w7 w8 w9 w1 w11 w12
Other Bacterial Meningitis Case definition: Suspected: a case of high fever, headache, vomiting and neck stiffness with/ or altered consciousness or convulsion and bulging fontanel in small babies and infants. Probable: a case with turbid CSF or a positive antigen test in CSF. Confirmed: A suspected or probable case with laboratory confirmation by isolation of causative agent from CSF. Transmission: Airborne or droplet. Incubation period: 3 to 4 days.
Bacterial meningitis 13 9 w1 w2 5 w3 w4 w5 4 w6 6 w7 3 w8 w9 1 w1 w11 1 w12 2 Months 8-1/214 2.4/1, Months 8-1/213 5.3/1,
Aseptic Meningitis Suspected: A case of high fever and neck stiffness with/ or altered consciousness or convulsion and bulging fontanel in small babies and infant. Probable: A suspected case with one or more of the following: - normal CSF glucose and normal or mild increase in CSF protein, moderate increase CSF cells (<5) and lymphocyte predominance (>5%) Confirmed: A suspected or probable case with laboratory confirmation or negative culture from CSF.
Aseptic Meningitis 48 28 318 266 218 152 111 59 31 42 7 56 w1 w2 w3 w4 w5 w6 w7 w8 w9 w1 w11 w12 Months 8-1/214 11.5/1, Daily mean 26 Months 8-1/213 3.1/1,
Case Definition: Hepatitis "A" Suspected case: every case complaining of fever, general weakness, loss of appetite, abdominal pain, nausea, vomiting and jaundice. Confirmed case: HAV IgM positive & highly elevated liver enzymes. Transmission: Faecal-oral. Incubation period: 15 to 5 days.
Infectious Hepatitis 14 11 8 7 5 3 4 4 1 1 1 1 w1 w2 w3 w4 w5 w6 w7 w8 w9 w1 w11 w12 Months 8-1/214 Months 8-1/213 17.7/1, 3.3/1, Underreporting
Case Definition: Mumps Suspected case: an illness with acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting greater than or equal to 2 days, and without other apparent cause. Confirmed case: a case that meets the clinical case definition and is laboratory-confirmed, (positive IgM antibody). Transmission: Airborne or droplet; direct contact with saliva from an infected person. Incubation period: 16 to 18 days.
Mumps 58 67 57 62 56 25 27 34 3 1 1 1 w1 w2 w3 w4 w5 w6 w7 w8 w9 w1 w11 w12 Months 8-1/214 24/1, Months 8-1/213 23/1,
Typhoid Fever An illness caused by Salmonella typhi or Paratyphi that is often characterized by fever, headache, malaise, anorexia and constipation or diarrhea. Transmission: Fecal-oral. Incubation period: 7-14 days.
Typhoid fever 5 5 1 1 1 1 1 w1 w2 w3 w4 w5 w6 w7 w8 w9 w1 w11 w12 Months 8-1/214 8/1, Months 8-1/213 11/1,
Scabies Scabies is an itchy, highly contagious skin disease caused by an infestation of mite Sarcoptes scabiei. Scabies is classified by the WHO as a waterrelated disease. Scabies is more often seen in crowded areas with unhygienic living conditions.
Scabies 911 85 812 48 639 628 57 52 484 42 44 176 w1 w2 w3 w4 w5 w6 w7 w8 w9 w1 w11 w12 Months 8-1/214 4.7/1, Daily mean 85
Impetigo Impetigo is one of the most common skin infections among kids, usually produces blisters or sores on the face, neck, hands, and diaper area. It caused by Staphylococcus aureus or group A streptococcus. It could be prevented by hand and face washing.
Impetigo 1283 168 96 464 762 722 495 692 636 699 528 242 w1 w2 w3 w4 w5 w6 w7 w8 w9 w1 w11 w12 Months 8-1/214 47/1, Daily mean 18
Conclusion No outbreak occurred during the war. Communicable diseases are common in displaced populations that have poor access to basic needs. No mortalities occurred. Surveillance in the affected areas is fundamental to understand the impact of the war on the communicable disease morbidity and mortality. Obtaining relevant surveillance information in these situations is frequently challenging.
Recommendation Disease surveillance and early warning system. Rapid detection of cases of epidemic-prone diseases is essential to ensure rapid control. Primary health-care services access to primary care is critical to prevention, early diagnosis and treatment of a wide range of diseases. Availability of safe water and sanitation. Site planning with adequate shelters spacing. Immunization. Health education nutrition, personal hygiene.
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