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Home , Chikungunya, Monkeypox, Monkeypox virus

Week ending July 11, 2020 Epidemiological Week 28 WEEKLY BULLETIN NATIONAL EPIDEMIOLOGY UNIT, MINISTRY OF HEALTH & WELLNESS, JAMAICA

EPI WEEK 28 SYNDROMES

PAGE 2 Overview

Monkeypox is an that causes a disease with symptoms similar, but less severe, to . While smallpox was eradicated in 1980, monkeypox continues to occur in countries of CLASS 1 DISEASES Central and . Monkeypox is a : a disease that is transmitted from to . Cases are often found close to tropical rainforests where there are animals that carry the virus. Evidence of has been found in animals including squirrels, Gambian PAGE 4 poached rats, dormice, different species of monkeys and others. -to-human transmission is limited, with the longest documented chain of transmission being six generations, meaning that the last person to be infected in this chain was six links away from the original sick person. It can be transmitted through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets and contaminated objects. Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for monkeypox. The best diagnostic specimens are directly from the – skin, fluid or crusts, or biopsy where feasible. and detection methods may not be useful as they do not distinguish between . PAGE 5

Symptoms

Monkeypox presents with , an extensive characteristic rash and usually swollen lymph nodes. It is important to distinguish monkeypox from other illnesses such as , , bacterial skin , scabies, syphilis and medication-associated allergies. The of monkeypox is can range from 5 to 21 days. The febrile stage of illness usually lasts 1 to 3 days with symptoms including fever, intense , (swelling of the lymph nodes), back pain, (muscle ache), and an intense asthenia (lack of energy). The febrile stage is followed PAGE 6 by the skin eruption stage, lasting for 2 to 4 weeks. Lesions evolve from macules (lesions with a flat base) to papules (raised firm painful lesions) to vesicles (filled with clear fluid) to pustules (filled with pus), followed by scabs or crusts. The proportion of patients who die has varied between 0 and 11% in documented cases and has been higher among young children.

Treatment GASTROENTERITIS

Treatment of monkeypox patients is supportive dependent on the symptoms. Various compounds PAGE 7 that may be effective against monkeypox virus infection are being developed and tested. Prevention and control of human monkeypox rely on raising awareness in communities and educating health workers to prevent infection and stop transmission. Most human monkeypox infections result from a primary -to-human transmission. Unprotected contact with sick or dead animals should be avoided, and all foods containing animal meat or parts need to be properly cooked before eating. Close unprotected contact with infected people or contaminated materials should be avoided. Gloves and other personal protective clothing and equipment should be worn while taking care of the sick, whether in a health facility or in the home. Populations have become more susceptible to monkeypox as a result of the termination of routine smallpox , which offered some RESEARCH PAPER cross-protection in the past. Vaccination against smallpox with first generation -virus based smallpox was shown to be 85% effective in preventing monkeypox in the past. Family and PAGE 8 community members, health workers and laboratory personnel who were vaccinated against smallpox in childhood may have some remaining protection against monkeypox.

https://www.who.int/health-topics/monkeypox/#tab=tab_1

Released July 24, 2020 ISSN 0799-3927 SENTINEL SYNDROMIC SURVEILLANCE Sentinel Surveillance in A syndromic surveillance system is good for early detection of and response to Jamaica public health events.

Sentinel surveillance occurs when selected health facilities (sentinel sites) form a network that reports on certain health conditions on a regular basis, for example, weekly. Reporting is mandatory whether or not there are cases to report.

Jamaica’s sentinel surveillance system concentrates on visits to sentinel sites for health events and syndromes of national importance which are reported weekly (see pages 2 -4). There are seventy-eight (78) reporting sentinel sites (hospitals and health centres) across Jamaica.

Map representing the Timeliness of Weekly Sentinel Surveillance Parish Reports for the Four Most Recent Epidemiological Weeks – 25 to 28 of 2020

Parish health departments submit reports weekly by 3 p.m. on Tuesdays. Reports submitted after 3 p.m. are considered late.

REPORTS FOR SYNDROMIC SURVEILLANCE

FEVER Weekly Visits to Sentinel Sites for Undifferentiated Fever All ages: Jamaica, Temperature of >380C Weekly Threshold vs Cases 2020 0 /100.4 F (or recent history of 1400 fever) with or without an 1200 obvious diagnosis or focus of infection. 1000 800 600 400 Numberofvisits 200 KEY 0 VARIATIONS OF BLUE 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 SHOW CURRENT WEEK Epidemiologic week

2020 <5 2020 ≥5 Epidemic Threshold <5 Epidemic Threshold >=5

2 NOTIFICATIONS- INVESTIGATION HOSPITAL SENTINEL All clinical REPORTS- Detailed Follow ACTIVE REPORT- 78 sites. sites up for all Class One Events SURVEILLANCE- Automatic reporting 30 sites. Actively pursued

Released July 24, 2020 ISSN 0799-3927 FEVER AND NEUROLOGICAL Weekly Visits to Sentinel Sites for Fever and Neurological Symptoms 2019 Temperature of >380C and 2020 vs. Weekly Threshold: Jamaica /100.40F (or recent history of fever) in a previously healthy 40 person with or without 35 headache and . The 30 person must also have 25 meningeal irritation, 20 convulsions, altered 15

consciousness, altered 10 Numberofvisits sensory manifestations or 5 paralysis (except AFP). 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Epidemiologic week

2019 2020 Alert Threshold Epidemic Threshold

FEVER AND Weekly visits to Sentinel Sites for Fever and Haemorrhagic 2019 and 2020 vs HAEMORRHAGIC Weekly Threshold; Jamaica Temperature of >380C /100.40F (or recent history of 8 fever) in a previously healthy 7 person presenting with at 6 least one haemorrhagic 5 (bleeding) manifestation with 4 3 or without jaundice. 2 Numberofvisits 1 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Epidemiologic week

2019 2020 Alert Threshold Epidemic Threshold

FEVER AND JAUNDICE Fever and Jaundice cases: Jamaica, Weekly Threshold vs Cases 2019 and Temperature of >380C /100.40F 2020 (or recent history of fever) in a 8 previously healthy person presenting with jaundice. 7 6 The epidemic threshold is used 5 to confirm the emergence of an epidemic in order to implement 4 control measures. It is calculated 3 using the mean reported cases Numberofvisits 2 per week plus 2 standard 1 deviations. 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Epidemiologic Week

2019 2020 Alert Threshold Epidemic Threshold

3 NOTIFICATIONS- INVESTIGATION HOSPITAL SENTINEL All clinical REPORTS- Detailed Follow ACTIVE REPORT- 78 sites. sites up for all Class One Events SURVEILLANCE- Automatic reporting 30 sites. Actively pursued

Released July 24, 2020 ISSN 0799-3927 ACCIDENTS Weekly visits to Sentinel Sites for Accidents by Age Group 2020 vs Weekly Any injury for which the Threshold; Jamaica cause is unintentional, e.g. motor vehicle, falls, burns, etc. KEY 500 VARIATIONS Of BLUE SHOW CURRENT WEEK

NumberofVisits

50 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Epidemiological weeks

≥5 Cases 2020 <5 Cases 2020 Epidemic Threshold<5 Epidemic Threshold≥5

VIOLENCE Weekly visits to Sentinel Sites for Violence by Age Group 2020 vs Weekly Any injury for which the Threshold; Jamaica cause is intentional, e.g. gunshot wounds, stab wounds, etc. 100

10 NumberofVisits

1 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Epidemiological week ≥5 y.o <5 y.o <5 Epidemic Threshold ≥5 Epidemic Threshold GASTROENTERITIS Weekly visits to Sentinel Sites for Gastroenteritis All ages 2020 vs Weekly Inflammation of the Threshold; Jamaica stomach and intestines, typically resulting from 1400 bacterial toxins or viral 1200 infection and causing 1000 vomiting and diarrhoea. 800

600

400 Numberofvisits 200 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Epidemiologic Week

2020 <5 2020 ≥5 Epidemic Threshold <5 Epidemic Threshold >5

4 NOTIFICATIONS- INVESTIGATION HOSPITAL SENTINEL All clinical REPORTS- Detailed Follow ACTIVE REPORT- 78 sites. sites up for all Class One Events SURVEILLANCE- Automatic reporting 30 sites. Actively pursued

Released July 24, 2020 ISSN 0799-3927 CLASS ONE NOTIFIABLE EVENTS Comments

Confirmed YTD AFP Field Guides CURRENT PREVIOUS from WHO indicate CLASS 1 EVENTS YEAR 2020 YEAR 2019 that for an effective surveillance system, Accidental Poisoning 5 22 detection rates for AFP should be Cholera 0 0 1/100,000 Dengue Hemorrhagic Fever* NA NA population under 15

years old (6 to 7) Hansen’s Disease (Leprosy) 0 0 cases annually.

Hepatitis B 0 11 ______

INTEREST Hepatitis C 0 2 Pertussis-like syndrome and HIV/AIDS NA NA Tetanus are (Imported) 0 0 clinically confirmed classifications. NATIONAL /INTERNATIONAL /INTERNATIONAL NATIONAL Meningitis (Clinically confirmed) 1 11 ______

EXOTIC/ Plague 0 0 * Dengue UNUSUAL Hemorrhagic Fever Meningococcal Meningitis 0 0 data include Dengue

related deaths; Neonatal Tetanus 0 0

H IGH H IGH Typhoid Fever 0 0 ** Figures include

MORBIDIT/ MORBIDIT/ MORTALIY all deaths associated Meningitis H/Flu 0 0 with pregnancy AFP/Polio 0 0 reported for the period. * 2019 YTD Congenital Syndrome 0 0 figure was updated.

Congenital Syphilis 0 0 *** CHIKV IgM Fever and Measles 0 0 positive Rash cases Rubella 0 0 **** Zika ** Maternal Deaths 21 34 PCR positive cases Ophthalmia Neonatorum 23 105 Pertussis-like syndrome 0 0 Rheumatic Fever 0 0

SPECIAL PROGRAMMES Tetanus 0 0 Tuberculosis 6 27 0 0 *** 0 0

**** NA- Not Available 0 0

5 NOTIFICATIONS- INVESTIGATION HOSPITAL SENTINEL All clinical REPORTS- Detailed Follow ACTIVE REPORT- 78 sites. sites up for all Class One Events SURVEILLANCE- Automatic reporting 30 sites. Actively pursued

Released July 24, 2020 ISSN 0799-3927 NATIONAL SURVEILLANCE UNIT INFLUENZA REPORT EW 28 July 05, 2020-July 11, 2020 Epidemiological Week 28

Weekly visits to Sentinel Sites for Influenza-like Illness (ILI) All EW 28 YTD ages 2020 vs Weekly Threshold; Jamaica SARI cases 5 340 2500 Total 2000

Influenza visits 0 69 positive 1500 Samples 1000 Influenza A 0 45 Numberof 500 H3N2 0 4 H1N1pdm09 0 38 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Not subtyped 0 3 Epidemiologic week Influenza B 0 24 2020 2020 2020 Parainfluenza 0 0 Epidemic Threshold <5 Epidemic Threshold 5-59 Epidemic Threshold ≥60 Epi Week Summary Jamaica: Percentage of Hospital Admissions for Severe Respiratory Illness (SARI 2020) (compared with 2011-2019) During EW 28, 5 (five) SARI 6.0% admissions were reported. 5.0% 4.0%

3.0% 2.0%

1.0%

0.0%

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Percentage of hospitalizations forSARI hospitalizations of Percentage Epidemiological Week SARI 2020 Alert Threshold Average epidemic curve (2011-2019) Seasonal Threshold Epidemic Threshold Update EW 28 D istribution of Influenza and other

Respiratory in Surveillance by EW Caribbean: Influenza and other 15 110%

100% PERCENT POSITIVITY respiratory virus activity 90% remained low in the subregion. 80% 10 70% In Haiti and Suriname, detections 60% 50% of SARS-CoV-2 continue elevated 5 40% 30% and increasing.. 20% 10%

NUMBER OF POSITIVE SAMPLES POSITIVE OF NUMBER 0 0% 1 3 5 7 9 11131517192123252729313335373941434547495153 EPIDEMIOLOGIC WEEK A(H1N1)pdm09 A not subtyped A no subtypable A(H1) A(H3) Parainfluenza RSV Adenovirus Methapneumovirus Rhinovirus Coronavirus Bocavirus

6 NOTIFICATIONS- INVESTIGATION HOSPITAL SENTINEL All clinical REPORTS- Detailed Follow ACTIVE REPORT- 78 sites. sites up for all Class One Events SURVEILLANCE- Automatic reporting 30 sites. Actively pursued

Released July 24, 2020 ISSN 0799-3927 Dengue Bulletin July 05, 2020-July 11, 2020 Epidemiological Week 28 Epidemiological Week 28 Dengue Cases by Year: 2004-2020, Jamaica 12000 10000 8000 6000 4000

Numberofcases 2000

0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Year Total Suspected Confirmed DF Reported suspected and confirmed dengue with symptom onset in week 28 of 2020

2020

EW YTD 28

Total Suspected Dengue 0** 717** Cases Lab Confirmed Dengue 0** 1** cases CONFIRMED 0** 1** Dengue Related Deaths

Suspected Dengue Cases for 2018, 2019 and 2020 vs. Monthly Mean, Alert, and Epidemic Thresholds 2500

Points to note: 2000

 ** figure as at July 14 , 2020 1500  Only PCR positive dengue cases

are reported as confirmed. NumberofCases 1000

 IgM positive cases are classified as presumed dengue. 500

0 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Month of onset

2018 suspected dengue 2019 Suspected Dengue 2020 Epidemic threshold 7 NOTIFICATIONS- INVESTIGATION HOSPITAL SENTINEL All clinical REPORTS- Detailed Follow ACTIVE REPORT- 78 sites. sites up for all Class One Events SURVEILLANCE- Automatic reporting 30 sites. Actively pursued

Released July 24, 2020 ISSN 0799-3927

RESEARCH PAPER ABSTRACT Title A Description of Registered Nurses’ Documentation Practices and their Experiences with Documentation in a Jamaican Hospital

C Blake-Mowatt, JLM Lindo, S Stanley, J Bennett The UWI School of Nursing, Mona, The University of the West Indies, Mona, Kingston 7, Jamaica

Objective: To determine the level of documentation that exists among registered nurses employed at a Type A Hospital in Western Jamaica.

Method: Using an audit tool developed at the University Hospital of the West Indies, 79 patient dockets from three medical wards were audited to determine the level of registered nurses’ documentation at the hospital. Data were analyzed using the SPSS® version 17 for Windows®. Qualitative data regarding the nurses’ experience with documentation at the institution were gathered from focus group discussions including 12 nurses assigned to the audited wards.

Results: Almost all the dockets audited (98%) revealed that nurses followed documentation guidelines for admission, recording patients’ past complaints, medical history and assessment data. Most of the dockets (96.7%) audited had authorized abbreviations only. Similarly, 98% of the nurses’ notes reflected clear documentation for nursing actions taken after identification of a problem and a summary of the patients’ condition at the end of the shift. Only 25.6% of the dockets had nursing diagnosis which corresponded to the current and less than a half (48.3%) had documented evidence of discharge planning. Most of the nurses’ notes (86.7%) had no evidence of patient teaching. The main reported factors affecting documentation practices were workload and staff/patient ratios. Participants believed that nursing documentation could be improved with better staffing, improved peer guidance and continuing education.

Conclusion: Generally, nurses followed the guidelines for documentation; however, elements were missing which included patient teaching and discharge planning. This was attributed to high patient load and nurse/patient ratio.

______The Ministry of Health and Wellness 24-26 Grenada Crescent Kingston 5, Jamaica Tele: (876) 633-7924 Email: [email protected]

8 NOTIFICATIONS- INVESTIGATION HOSPITAL SENTINEL All clinical REPORTS- Detailed Follow ACTIVE REPORT- 78 sites. sites up for all Class One Events SURVEILLANCE- Automatic reporting 30 sites. Actively pursued