OUTBREAK

MANAGEMENT
Nabila Swarna Puspa Hermana, S.Si., M.Si.
INTRODUCTION

In the course of human history, epidemics have been responsible for millions of
deaths.
During the plague epidemic in 541-542 AD, 100 million people died, half the human
population at that time.
In the plague epidemic between 1346 and 1350, Europe lost half its population.
The “Spanish flu” epidemic in 1918 killed more men than the First World War.
The “swine” flu in 2009 was responsible for 200,000 deaths,
more than 11,000 people died in an Ebola epidemic in 2014.
In 2017 alone, outbreaks of plague occurred in Madagascar and the Seychelles,
of Middle East respiratory syndrome in Saudia Arabia
INTRODUCTION

Epidemics occur worldwide.

Their magnitude and their consequences depend on the disease in question
(causative agent), the people or animals affected (host), and how the disease is
spread (mode of transmission).
Epidemics can be limited or can spread across continents (pandemics).
They tend to occur more frequently or to have more severe consequences in
populations that have experienced natural disasters, armed conflict, or
displacement, that have poor sanitation or lack a secure food and water supply,
or whose health system is underdeveloped or has been devastated.
INFECTION

An infection is is caused by a germ. An

infection may lead to a disease.
Different kinds of germ cause different
kinds of disease. A germ can be
transmitted in several different ways,
both between people and between
animals and people.
OUTBREAK OR EPIDEMIC

Outbreak or epidemic is an excess over the expected (usual) level of a disease

within a geographic area; however, one case of an unusual disease (e.g.,
postsurgical group A streptococcus infection) may constitute an epidemic.
Pandemic is an epidemic that spreads in several countries, usually affecting many
people
Endemic: The usual level of a disease within a geographic area (e.g., a hospital);
these ‘sporadic’ infect ions (also known as “baseline incidence”) represent most
preventable healthcare-associated infect ions
OUTBREAK OR EPIDEMIC
 WHY EPIDEMICS OCCUR?

1. When susceptible individuals travel into an area where the infectious diseasse is
endemic
2. When humans or animals travel from an endemic area into a susceptible human
population in whom the disease is not endemic, or when food, water, or other
vehicles become contaminated by an infectious agent not normally present.
3. When a pre-existing infection occurs in an area of low endemicity and reaches
susceptible persons as a result of new or unusual social, behavioural, sexual, or
cultural practices
4. When host susceptibility and response are modified by natural or drug-induced
immunosuppression (e.g., cancer treatment, malnutrition, or diseases such as
acquired immunodeficiency syndrome).
TRANSMISSION OF EPIDEMIC

Airborne: transmitted by air and droplets, for example, flu, measles, SARS, MERS
blood and/or body fluids borne: transmitted through contact, including blood
transfusion, mother to child in utero, and sexual activity, for example, Ebola virus,
HIV
waterborne: transmitted by water, for example, cholera
zoonotic: transmitted between animals and people, by direct and indirect contact,
for example, viruses, bacteria, parasites, and fungi;
vector-borne: transmitted by being bitten by mosquitos, fleas, ticks etc., for
example, malaria, dengue, plague; and
food-borne: transmitted by preparing and eating food, for example, salmonella,
listeria and hepatitis A.
TYPES OF OUTBREAK

Community-acquired: food-
borne infections, measles
Healthcare-associated: when
two or more cases of infection
appear to be
epidemiologically related or
infections occur above the
background rate or an
unusual microbe is
recognised
THE EPIDEMIC RESPONSE CYCLE

Epidemics tend to occur in cycles, not in sequence

When an epidemic occurs, the way it is handled and the actions that are
taken to respond to it will affect the behaviour of a future epidemic.
if we respond well to an epidemic now, we will limit the rate of sickness
and number of deaths this time and also reduce the impact of future
epidemics
 THE EPIDEMIC RESPONSE CYCLE

Four main phases of epidemic:

1. Prevention and preparedness: identify the risk
factors associated with epidemics and during the
period between epidemics prepare ourselves to
manage them
2. Alert: detect cases of disease that have the
potential to become epidemics and start to
mobilize the resources we will need to respond to
them
3. Response: take action to deal with the epidemic
4. Evaluation: review how we responded to the
epidemic after it is over
 UNDERSTANDING RISK

Epidemic risk is the likelihood or possibility that

a certain kind of epidemic will occur in a
community, taking into account the
vulnerability of the population, the diseases in
the community, and the surrounding
environment.
When the risk of an epidemic INCREASES,
it means that an epidemic is more likely to
occur.
When the risk of an epidemic DECREASES,
it means that an epidemic is less likely to
occur.
UNDERSTANDING RISK

Several factors influence or determine the likelihood of an epidemic (the level of risk).
For many diseases, the risk of an epidemic is influenced by the time of year and the
season.
Risk increases at certain times of the year and decreases at others.
It is important to know about risk because, if we can identify factors that increase risk in our
communities, we will be better able to prepare for and perhaps prevent epidemics. It is
always preferable to prevent epidemics rather than have to respond to them.
Yellow fever epidemic maps
Which country has the risk to
have a yelow fever outbreak?
 BEFORE AN EPIDEMIC

If you live in a region or community where epidemics occur regularly, or a place where you
are afraid they will occur, you will want to try to prevent and prepare for them.
Preparation takes place before, so that you can respond competently and effectively when
an epidemic happens. If you know what to do and how to do it, your actions will help to reduce
the harm the epidemic causes.
Prevention and preparedness take place at several levels, starting at your National
Society’s headquarters and going all the way down to your local branch and community
 BEFORE AN EPIDEMIC

To be ready for action when the epidemic comes, you need three things in place:
A plan. What will volunteers do when an epidemic happens?
People. Volunteers and others need to be available and trained to do the right things
when an epidemic occurs.
Resources. Equipment and materials need to be in place.
ACTION IN THE EPIDEMIC ALERT PHASE

The alert phase begins when there is talk or rumour of an epidemic but it has not
been confirmed whether there is one or not.
The talk and rumours may come from the community (who may complain, for
example, that there are many cases of diarrhoea) or from outside (for example, after
influenza spreads in a nearby region or country).
The alert phase starts for certain diseases when the first case of the disease
occurs, and starts for other diseases when cases of the disease begin to increase. It
ends when health authorities confirm that there is an epidemic (or declare there is
not).
ACTION IN THE EPIDEMIC ALERT PHASE

Surveillance is a system created to detect new cases of diseases in the community and refer
them to health facilities.
It involves the organized collection, analysis and interpretation of data, making it possible to
detect outbreaks promptly and monitor factors related to disease occurrence
Two kind of surveillance:
Passive surveillance: collection of data from those voluntarily reporting it, such as
hospitals, health care providers, parents or health departments
Active surveillance : involves actively looking for cases either with a reporting system or
using a systematic protocol, such as calling every health department in a region during a
disease outbreak
ACTION DURING AN EPIDEMIC
ACTION DURING AN EPIDEMIC

Behavioural change in epidemics

ACTION AFTER AN EPIDEMIC

Only your health authorities can tell you when an epidemic is over. It is very important
to continue working and helping others (using what you learnt from your facilitator,
your toolkit and here) until you are told by the health authorities that the epidemic has
ended and it is safe to stop
After the authorities have declared that an epidemic is over, it is useful to evaluate
the work that you did.
ACTION AFTER AN EPIDEMIC

There are many things you can do after an epidemic. They include:
Health promotion. You can continue to deliver health messages in your community so that
people will protect themselves from epidemics in the future.
Following up. It is important to follow up cases, make sure no people are falling sick, and tell
people how to keep safe. Check on those who are recovering from illness. Make sure they
are not stigmatized and have access to the services they need.
Evaluating your actions during the epidemic.
Drawing lessons. Tell others what you have learned or write your experience down so you
remember. Share your conclusions and recommendations.
Planning for the next time. Speak with the health authorities and ask them what could be
done differently to make your response quicker and better when an epidemic of the same
kind recurs. Check your community epidemic plan and make adjustments.
ACTION IN THE EPIDEMIC ALERT PHASE
 OUTBREAK MANAGEMENT COMMITTEE

An outbreak management committee must be formed at the national, regional and district levels. This
committee is charged with “managing” the outbreak, that is, ensuring that resources are appropriate to
needs.
The major strategic directions are generally decided at the national level. The other levels (regional and
district) are involved in the warning system and in implementing the response. Subcommittees can be
charged with specific technical aspects such as laboratory, vaccination, information and communication,
logistics, etc.
At each level, the committee is composed of representatives from:
the Ministry of Health (including representatives from the national immunisation programme);
the laboratories;
the hospitals;
the administrative authorities;
the support agencies (WHO, UNICEF, bilateral cooperation) and non-governmental agencies involved.
OUTBREAK MANAGEMENT COMMITTEE

Outbreak response requires close coordination with other sectors, which participate in the
committees according to the needs. These sectors are:
information (radio, newspapers and television): the media disseminates information on the
existence of an outbreak, the symptoms of the disease, treatment locations, free care, and
vaccination dates/locations;
education: schools can host vaccination sites; teachers can help make up vaccination
cards and keep a tally of those vaccinated ;
customs: it can facilitate the importation of drugs, medical supplies and vaccines ;
public safety: the police can help maintain order during mass vaccination campaigns.
OUTBREAK MANAGEMENT COMMITTEE

The committee defines the

surveillance, patient
management, vaccination and
public information strategies. It
implements activities by
mobilising the necessary
resources and coordinating and
informing the partners.
OUTBREAK MANAGEMENT COMMITTEE

The committee defines the

surveillance, patient
management, vaccination and
public information strategies. It
implements activities by
mobilising the necessary
resources and coordinating and
informing the partners.
INDONESIAN REGULATION IN OUTBREAK MANAGEMENT
THANK YOU