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Guidelines for the Investigation and Control of Disease Outbreaks

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Guidelines for the Investigation and Control of Disease Outbreaks Institute of Environmental Science & Research Limited Guidelines for the InvestigationGph-Yr Isol and Control of Disease Outbreaks 1200 1100 Pandemic (H1N1) 09 1000 Seasonal influenza 900 800 A (not sub-typed) 700 600 500 A(H1N1)pdm09 400 2010 300 No. of influenza viruses 200 100 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Week (by reported month) 2010 data only up to week 39¹ ¹Sentinel surveillance only Page 1 April 2012 www.esr.cri.nz Guidelines for the Investigation and Control of Disease Outbreaks Institute of Environmental Science and Research April 2012 Copyright Any part of this document may be quoted or reproduced and distributed (without addition or deletion), provided acknowledgement is given to the Institute of Environmental Science & Research Limited. Suggested citation Guidelines for the Investigation and Control of Disease Outbreaks. Porirua: Institute of Environmental Science & Research Limited; Updated 2011. FW12020 Published in April 2002. Updated April 2012 by the Institute of Environmental Science & Research Limited Kenepuru Science Centre PO Box 50-348 Porirua, New Zealand ISBN 978-1-877166-14-3 (Book) ISBN 978-1-877166-15-0 (Web) This document will be available on the ESR website www.esr.cri.nz Foreword This document is the latest revision of a series produced at different times over the past fifteen years. Over that time, there have been substantial changes to the environments in which outbreak investigators and responders operate. The 2002 Disease Outbreak Manual was partly based on the Guidelines for investigation of disease outbreaks in New Zealand produced by the Institute of Environmental Science & Research Limited (ESR) in 1996 and revised in 1997. At that time, substantial changes were made to the overall approach to outbreak investigation, and new sections were included on environmental investigation, the contribution of laboratory techniques to outbreak investigation, communication during outbreak investigations and outbreak control activities. The section on case-control studies was revised to include more detailed guidance on designing and managing studies. It is now a decade since the 2002 Manual was produced. While the District Health Board and Public Health Unit landscapes have remained relatively unchanged over that period, there have been many significant and relevant changes elsewhere: changes to food and biosecurity legislation; changes in the structure, name and function of government departments (especially in relation to food safety); consequential changes in the organisational relationships between the different groups responding to aspects of an outbreak; a number of multi-DHB outbreaks which have been managed co-operatively under the oversight and direction of the appropriate government agencies; and a number of major international sporting events or domestic exercises which have focussed attention on how we can best respond to major infectious disease events. The 2012 update has been re-named Guidelines for the Investigation and Control of Disease Outbreaks (the Guidelines) and, incorporated further changes - mainly in the areas of notifications systems, laboratory methods and incident response, including communications. It has also benefited from a previous review of best practice. The title of the updated document has been changed to indicate its role as a guide to good practice in outbreak investigation. While its main focus is on food and waterborne infections, it should be emphasised that the content of several chapters is equally useful in other infectious disease outbreaks. We invite you to continue to let us know where improvements can be made as you use these Guidelines. Virginia Hope Programme Leader Health Programme GUIDELINES FOR THE INVESTIGATION AND CONTROL OF DISEASE OUTBREAKS III Disclaimer The Institute of Environmental Science & Research (ESR) does not warrant or assume any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, or process contained within these guidelines or any consequences of their implementation in any given situation or scenario. ESR expressly disclaim all and any liability to any person, community or population in respect of anything done and of the consequences of anything done or omitted to be done by any person in reliance, whether in whole or in part, upon the whole or any part of the contents of this publication. In responding to specific situations, readers should not rely solely on the information contained within these guidelines. The information is not intended to be a substitute for advice from other authoritative and relevant sources. Any content in this publication that is either unclear or ambiguous should be referred to the ESR for clarification. Acknowledgements The first edition of this manual was prepared by Craig Thornley and Michael Baker in 2002. This update was edited by Don Bandaranayake. Thanks are due to the following organisations: Ministry of Health, Ministry for Primary Industries (formerly Ministry of Agriculture and Forestry) and the Public Health Units and specifically the following persons who contributed material for the updating of this document: Kerry Sexton, Shevaun Paine, Muriel Dufour, Ruth Pirie, Virginia Hope, Hilary Michie, Jenny Ralston, Jacqui Watson, Phil Shoemack, Greg Simmons, Craig Thornley, Darren Hunt, Trish Pearce, Helen Graham, Donald Campbell, Toby Regan, Christine Roseveare, Debbie Smith and Jackie Benschop. Your comments or suggestions for further improvements are welcome. Please send them to: The Co-ordinator Health Intelligence Team National Centre for Biosecurity & Infectious Disease Institute of Environmental Science & Research Limited PO Box 40-158 Upper Hutt 5140 New Zealand E-mail: [email protected] GUIDELINES FOR THE INVESTIGATION AND CONTROL OF DISEASE OUTBREAKS IV Executive summary The ability to plan and implement effective disease outbreak management is a key responsibility of the public health services (PHS) in New Zealand and elsewhere. The Guidelines for the Investigation and Control of Disease Outbreaks provides a step-by-step approach to the basics of disease outbreak management for those who are new to the area, and a reference guide to specific aspects of the outbreak management process for those who already have a working knowledge in the area. These guidelines also provide copies of outbreak reporting forms and other outbreak resources. Disease outbreaks are localised increases in cases of illness clearly in excess of that normally expected. The reasons for investigating and responding to outbreaks include the need to halt the outbreak and prevent further illness, to develop recommendations to prevent similar outbreaks occurring in the future, to address public concern, to improve understanding of new and emerging disease agents and transmission mechanisms, to satisfy local and international obligations and to use the opportunity to train staff. Comprehensive disease outbreak management involves several separate components. The relative emphasis placed on each component varies depending on the circumstances of the outbreak. These guidelines recognise that the components need not always occur in a rigid, linear sequence to meet the overall objectives of disease outbreak management. Agencies with responsibility for managing disease outbreaks need to prepare for outbreak contingencies. The keystone of preparation is development of an outbreak plan. The outbreak plan should identify the outbreak team, describe terms of reference for the team, provide outbreak investigation and response protocols, clarify the availability of materials and resources and define communication plans. Occasionally disease outbreaks can seriously endanger health (or have the potential for doing so) due to their intensity or severity of outcome(s). These situations may occur at a local level, but are mostly multi-regional with agencies additional to those responsible for health being involved. In these emergency situations an outbreak management system utilising the Coordinated Incident Management System (CIMS) may be implemented. CIMS however can also be useful in local situations in managing emerging public health events. The key components of this system include incident control, operations, communication, inter-agency liaison, planning and intelligence & logistics. The New Zealand Coordinated Incident Management System (CIMS) blue book can be purchased from Fire & Rescue Services ITO - www.frsito.org.nz. Optimal detection of disease outbreaks requires good disease information systems and regular and rigorous reviews of surveillance data. The information that is valuable for outbreak detection comprises reports of illness by the affected persons (self-reported illness) and surveillance of cases of notified disease reported by medical practitioners. Additional information is often required from these sources to enable outbreak detection. Steps should be taken to verify detected disease outbreaks, unless the existence of the outbreak is self-evident. Verification involves confirmation of the accuracy of diagnosis and reporting, confirmation that the increase in cases is genuine and not due to changes in diagnostic and testing thresholds, and confirmation that the increase in cases is greater than expected. Once the outbreak has been confirmed, an assessment should be made about further steps to be taken, based on the relative priorities of the investigation and the response. Outbreak description
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