Health and Diseases Managing the Spread of Infectious Diseases 1 Individuals Disease awareness Individuals can take action to help manage the spread of infectious diseases when they are aware of what these diseases are and the conditions which favour their spread. For example, when individuals are aware about Hand, Foot and Mouth Disease (HFMD) outbreaks in their community, they could be more mindful about their own hygiene and aware of the likely ways the disease can be transmitted. No local cases with severe complications due to HFMD were reported in 2012. In response to the HFMD outbreak, public education was enhanced and increased spot checks on preschool centres were carried out. To minimise prolonged transmission of the disease, In addition, the Ministry of Health (MOH) also implemented mandatory closure of pre- schools with significant numbers of HFMD cases. However, the number of hand, foot and mouth disease (HFMD) cases as of mid- June has exceeded 14,000 nearly 50% higher than during a similar period in 2014. Even though the cases were relatively mild strains of the virus, it still points to the ineffective control of the spread of the disease. Strategy #2 Exercising social responsibility Examples of these include being constantly aware of unsanitary conditions or conditions which make it conducive for diseases to spread. This allows individuals to take precautionary measures against infectious diseases. For example, a spray, protective clothing or insecticide- treated nets can be used to reduce contact with mosquitoes. Potential breeding sites could be identified and removed. Singapore saw the number of dengue cases fall from 891 in 2013 to about 240 in 2015. In 2013, Singapore saw 7 deaths due to dengue. Some of the victims lived in dengue cluster. This could have been the result of the lack of vigilance of residents in clearing stagnant water in their homes and the vicinity. Strategy #3 Refraining from participating in risk- taking behaviours These could make a person less likely to contract diseases. Other ways to reduce the risk of contracting diseases include obtaining up- to- date and timely vaccinations and following travel advisories. By doing so, a person is less likely to contract a disease at a new location or from another person. While travel to the affected areas is not restricted, the Ministry of Health urged Singaporeans to minimise travel to those areas. Those travelling there are advised to maintain vigilance and health precautions when overseas. They also encouraged to register with the Ministry of Foreign Affairs to facilitate contact in the event of an emergency. Singaporeans being vigilant and/or them minimising travel to affected countries has contributed to the lack of cases of MERs- CoV being detected in Singapore thus far. 263 Tanjong Katong Rd #01-07, Tel: 6702 0118 1
2 Communities Community- led strategies empower residents to develop their own solutions based on knowledge of local conditions. Residents undergoing treatment may also be able to get better support from their community. Sierra Leone: Community- Led Total Sanitation (CLTS) CLTS is one of the methods to rapidly increase sustainable sanitation coverage nationwide. It is a community- led approach to remove the practice of open defecation through awareness raising and affordable sanitation options. The community often organises itself to go from house to house digging toilets for each household that needs assistance. Implementation of CLTS gradually extended to the involvement of NGOs and district health management teams working together to help communities throughout the country. By June 2010 out of over 3000 communities triggered, over 1000 had been declared Open Defecation Free The incidences of diarrhoea due to improved sanitation had decreased. CLTS works best in rural areas where population density is low and has proved less successful in urban areas. This is due to ongoing migration and lack of space for toilets. In addition, continued engagement with triggered communities by community organizers was necessary to ensure that projects were completed. Triggering alone was not enough having dug their pits, the people may become confused about the next steps. They need technical support with toilet design and advice about construction and reminders to not continue their old habits. Strategy #2 Managua, Nicaragua: Community- based mosquito control The community residents conducted surveys to ascertain neighborhood residents' existing understanding of dengue and their mosquito- control practices. They also identified mosquito breeding sites and examined households for breeding sites. From 2004 through 2007, dengue infection in children declined by more than half. The pilot project began in 2004, and by 2007, households were 25% less likely to have breeding sites for mosquitoes. The community needs cooperation from the government to manage water and waste management issues. For example, sewers are potential breeding sites for mosquitoes which are not easily accessible to residents. The government could help to monitor these out- of- reach areas on behalf of the community. While the people have to change their habits, the governments should also be forced to provide more social services such as dependable water delivery and trash collection. Gateway 3 What can individuals and communities do to manage the spread of infectious diseases? 2
Strategy #3 Vellore, India: Geographic Information System (GIS) to monitor dengue outbreaks GIS is used to identify the location of infections and pinpoint the start of outbreaks of dengue fever. It is also used to locate potential mosquito breeding zones that may be targeted for control. Volunteers from the community helped to collect data for the mapping of dengue fever outbreaks. Since there is no vaccine available for dengue fever, identifying and reducing the breeding sites of mosquitoes is the most effective long- term prevention measure. By identifying the location of infections and pinpointing the start of outbreaks, GIS can be used to alert the public of an impending outbreak of dengue fever. By 2013, health utilization data, mortality and morbidity data linked over 150,000 people spatially. In some areas, street addresses are not available for mapping purposes. The relationship between pinpointing a disease and the potential environmental risk factor is difficult to prove. For example, working adults may spend much of their time outside their place of residence and be infected with the disease from elsewhere. Inaccurate data may thus be used in the mapping of the disease. 3 Governments Governments can manage the spread of diseases by carrying out precautionary measures that aim to prevent outbreaks of diseases. Governments also use mitigation measures to try to reduce the occurrence of an epidemic. A Implementing precautionary measures These are strategies used to reduce the occurrence of diseases Singapore: Providing vaccinations against H1N1 Vaccinations are a useful way to increase the body's immunity to certain diseases. In 2009, Singapore began providing vaccinations for its population against the H1N1 influenza virus before it emerged in the country. To ensure that Singaporeans had ready access to medical assessment and prompt treatment for mild cases of H1N1, more than 400 family clinics island- wide were stocked with H1N1 vaccines. Most cases in Singapore were mild, although up to 18 deaths were reported in 2009. Singapore is in the process of developing its own vaccine for H1N1. In 2013, Singapore's first H1N1 flu vaccine has reached the first phase of clinical trials. The first case of H1N1 in Singapore was confirmed in May 2009. By November, 1.3 million doses of the H1N1 vaccine were made available. By February 2010, more than 420,000 local residents had received the H1N1 vaccine injection. Vaccinations take up to two weeks to take effect. Individuals may choose not to receive vaccinations and risk being infected with influenza virus. The waiting period for imported vaccines would take up to 3 months. Gateway 3 What can individuals and communities do to manage the spread of infectious diseases? 3
Strategy #2 Thailand: Thermal fogging Thermal fogging involves the distribution of insecticides by using fog produced by heat. Under the malaria control programme in Thailand, thermal fogging is applied during malaria outbreaks and in uncontrolled transmission areas. In principle, it is applied once a week for 4 consecutive weeks. Thermal fogging kills adult mosquitoes found outdoors. Thermal fogging is expensive and must be carried out on a regular basis in order to be effective. Fogging, unless done at the right time, under suitable weather conditions with properly calibrated equipment, can be very inefficient. By the time severe outbreaks are known and fogging can be carried out, the mosquitoes responsible may no longer be present, Hence, such fogging could be wasted effort. The thick fog also causes reduced visibility and is a traffic hazard. B Implementing mitigation measures These are strategies used to reduce the impact of a disease or health problem after it has emerged in a country. Singapore: Control measures during the SARS outbreak in 2003 Tan Tock Seng Hospital was made a dedicated hospital for the detection and isolation of infected people. A private ambulance service was also used to transport people who were suspected to be infected. By monitoring the health of staff, restricting visitors and making their registration compulsory, the spread was prevented and controlled. Potential patients of the disease were subjected to home quarantine by law. Governmental intervention to control the spread of the diseases was prompt following the early detection of the disease. Singapore s handling of the outbreak and its prompt and open reporting of cases was commended by the WHO. Stringent measures taken by Singapore had contained the spread of the disease. Some patients displayed symptoms not commonly associated with SARS. Some patients who did not show any signs of SARS until much later. As a result, these patients infected people they came in contact with. This made the detection of the disease difficult and the disease harder to contain. Gateway 3 What can individuals and communities do to manage the spread of infectious diseases? 4
Strategy #2 Singapore s National Environment Agency (NEA) s approach to vector control The Do the Mozzie Wipeout campaign was launched by the NEA on 28 April 2013 to prevent an outbreak of dengue fever. The campaign includes community outreach to raise awareness on prevention methods. For example, the Colour Coded Alert System informs residents of the seriousness of the dengue situation in their neighbourhood through colour- coded banners. The colours indicate the corresponding preventive measures to take. The WHO cited Singapore as a good role model in preventing and managing dengue cases and encouraged other countries to learn from Singapore. The number of cases with more serious dengue fever has decreased in recent years since the 2005 dengue fever outbreak. Most people are unaware or complacent about Aedes mosquitoes breeding at their place of residence. This posed difficulties in preventing the breeding of the mosquitoes. Due to climate change, mosquitoes breed faster at higher temperatures. More people had been infected with Den- 1, a new dominant virus. The new virus can make a mosquito ready to spread and disease just three or four days after it bites an infected person, compared to the usual seven days. The majority of the population has no immunity against the new virus. Gateway 3 What can individuals and communities do to manage the spread of infectious diseases? 5