• For this Case Assignment you are to comment on the similarities and differences in pre-event preparation between an infectious disease event and other emergencies.
• Provide specific examples of issues that have become evident during the work you have done in this course.
• What are the particular challenges faced by resource poor countries in preparedness efforts for mitigation of infectious disease outbreaks following natural disasters?
For this Case Assignment you are to comment on the similarities and differences in pre-event preparation between an infectious disease event and other emergencies.
The initial pre-planning response to most natural disaster is similar, however; in many cases emergency responders are the first to detect an infectious disease outbreak occurring. For this reason it is important to properly pre-plan in advance for events that have potential in developing infectious disease outbreaks, which is common in developing countries following a natural disaster. The health impacts associated with the sudden crowding coupled with large numbers of survivors, often with insufficient access to safe water and sanitation facilities, will require planning for both medical and preventive interventions, such as rehydration, antibiotics and vaccination materials (World Health Organization, 2006). The sooner the incident and at-risk patients are identified, the higher the likelihood of decreasing morbidity, mortality, and cost associated with the event. The biggest difference between infectious disease disasters and other natural mass casualty’s events is that infectious disease disasters are more difficult to detect. With natural disasters, and even traditional or chemical terrorism, there is an obvious sign that something abnormal has happened or is going to happen. This can range from damaged buildings in an earthquake to flooding that will likely cause huge displacement and an influx of patients. Therefore, the immediate pre-planning response to saving lives and restoring infrastructures in a natural disaster will be similar, however, there needs to be an added Annex within all Emergency Operation Plans (EOPs) to cover the specific health need requirements for an infectious disease response. For instance, infectious disease disasters pose unique challenges to healthcare and public health agencies, response organizations, and businesses (Rebmann, 2013). It is critical for healthcare facilities to become better prepared for infectious disease disasters. Infectious disease disasters will result in a large number of patients requiring hospitalization for mechanical ventilation, isolation, or highly specialized treatment in intensive care beds. Rebmann, (2013) indicate that most healthcare facilities do not have adequate resources or the infrastructure required to manage all phases of patient care during an event that lasts long periods, which is necessary during a pandemic. Rebmann, (2013) also observed that some shortages in hospital preparedness for infectious disease disasters include: lack of ventilators, antibiotics or antiviral medications, respiratory protection (N95 respirators and masks), negative pressure. At the community level, it is vital that healthcare agencies become better prepared for infectious disease disasters. This is because hospital surges are expected during an infectious disease disaster outbreak, therefore, they will trickle down into community healthcare system and cause response challenges. Potentially contagious patients will likely be discharged to other alternate health facilities for long-term care, and/or home care during an infectious disease disaster, that will requiring the need for surge capacity and infection prevention strategies and training programs in these settings (Rebmann, 2013).
Provide specific examples of issues that have become evident during the work you have done in this course.
Besides the proper response, it has become evident that an Early Warning Active Surveillance System (EWAS) needs to be properly implemented immediately following all natural disaster events that are likely to cause communicable diseases in order to reduce mortality’s and illness’s. EWAS refers to surveillance activities implemented to detect bioterrorism incidents or other infectious disease disasters (Morse, 2015). However, emerging infectious diseases and most of the potential bioterrorism agents can cause uncommon illnesses, and therefore, not all facilities have the laboratory capability to test for all of these agents (Morse, 2015). This makes case finding and data collecting very difficult. An example of a productive and active surveillance program would be one in which the data collector would contact predetermined agencies, groups in the community, or access already approved and established electronic programs in order to collect information from hospitalized patients. Traditional active surveillance involves the collection of clinical information, usually in the form of laboratory tests, but can include other relevant clinical data such as chest radiograph results and patient symptoms and/or patient records (Morse, 2015).
However, most surveillance systems on the global scale tend to be passive and target only specific diseases. This means that there are numerous individual systems, which often lack the capability of information-sharing in which “new” or currently unknown diseases might be picked up only unsystematically or randomly (Morse, 2015). Thus, the global system is often used as a reactive system. Furthermore, to complicate matters, Morse, (2015) notes that each country has its own process as far as collecting and reflecting data within the organizations public health system. This can cause inaccurate ID of infectious disease when pre-planning for an international response. For example, in Aceh, Indonesia following the 2004 tsunami, a number of issues were found to hamper the surveillance and early warning systems. These included: multiple reporting of individual patients because of multiple sources of health services; incomplete or limited reporting which prevented adequate follow up of patients; inconsistent weekly reporting by agencies, especially as a result of their temporariness; lack of data allowing estimation of the population at risk, especially due to the high mobility of displaced personnel and the large number of dead and missing; physical difficulty of reaching the affected areas and lack of regular laboratory confirmation of suspected cases (Morse, 2015).
A strong global health surveillance system is needed for effective response for natural disasters. However, a recent development by the WHO seems promising. At the international level, the World Health Organization (WHO) is the coordinating body but is dependent on its international dispersed members for reporting. The WHO has a number of country and regional representatives intended to provide liaison and communication with national governments (Morse, 2015). The WHO International Health Regulations (IHR) provides the instructions for nations to report diseases found in incoming travelers. The IHR formerly required international reporting of only cholera, plague, yellow fever, and smallpox; however, the regulations have recently been revised to encompass a syndrome-oriented approach that would accommodate warnings of unknown infectious diseases. According to Morse, (2015), the broadened purpose and scope of the new IHR (2005) are to “prevent, protect against, control and provide a public health response to the international spread of disease and avoid unnecessary interference with international traffic and trade”(p.6). Although developing and gaining acceptance for the new IHR approach has taken time and there is strong progress being made. Implementing the new IHR (2005) effetely will ultimately require each nation to have a real-time event-monitoring system and strengthened surveillance capabilities that is compatible and able to communicate on a global scale. Additionally, it is required for each nation to fund the program from its own resources, and many will require financial help and other incentives (Morse, 2015).
National systems in many countries, including the United States, Canada, Thailand, China, and Vietnam to name just a few, have expanded. As already discussed, electronic networks have been developed, and in recent years, the WHO has begun both collecting and providing information in near real time (Morse, 2015). For example, in recent years, the WHO has developed the Global Outbreak and Response Network (GOARN), with information from a wide variety of sources; expanded its influenza surveillance; and revised the International Health Regulations to report a broader scope of infectious diseases, including the possibility of emerging infections. These are indications of real progress. Nevertheless, despite these improvements, it is equally obvious that more is needed (Morse, 2015). Improvements need to still be made in the coordination reporting systems worldwide, and ensure compatible standards for gathering and sharing data; educate policymakers on a global scale to consider disease surveillance a priority and further encourage clinicians and health officials to report by providing useful feedback, to provide rapid communications and, when needed, timely assistance in response (Morse, 2015).
What are the particular challenges faced by resource poor countries in preparedness efforts for mitigation of infectious disease outbreaks following natural disasters?
The risk of communicable disease outbreaks following natural disasters is higher in developing than in developed countries. For example, In Aceh Province, Indonesia, a rapid health assessment performed in the town of Calang two weeks after the December 2004 tsunami, found that 100 percent of the survivors drank from unprotected wells and that 85 percent of residents reported diarrhoea in the previous two weeks (World Health Organization, 2006). In Muzaffarabad, Pakistan, following the 2005 earthquake, an outbreak of acute watery diarrhoea occurred in an unplanned, poorly-equipped camp of 1800 persons. The outbreak involved over 750 cases, mostly adults, and was controlled following the provision of adequate water and sanitation facilities (World Health Organization, 2006). Hepatitis A and E are also transmitted by the faecal–oral route, in association with lack of access to safe water and sanitation. There are three primary challenges faced by resource poor countries in preparedness efforts for mitigation of infectious disease outbreaks following natural disasters. Among them are an uninterrupted supply of fresh drinking water, refugee evacuation planning, and access to proper health care facilities. Ensuring uninterrupted provision of safe drinking-water is the most important preventive measure to be implemented following a natural disaster (World Health Organization, 2006). However, it is noted by World Health Organization, (2006) that Chlorine is widely available, inexpensive, easily used and is very effective against nearly all waterborne pathogens. In accordance with international guidelines, refugee planning must provide for adequate access for safe drinking water and sanitation needs and meet the minimum space requirements per person. Access to primary care is critical for prevention, early diagnosis and treatment of a wide range of diseases, as well as providing further prolonged care (World Health Organization, 2006). Although there has been significant progress made by international policy and assistance from the CDC and WHO, there is still much work to be accomplished to ensure that infectious disease is properly mitigated and tracked and funded on a global scale to include resource poor countries.
References
Morse, S. S. (2015). Global Infectious Disease Surveillance And Health Intelligence. Health Affairs, 1069-1077. Retrieved from http://content.healthaffairs.org/content/26/4/1069.full
Rebmann, T. (2013). Infectious disease disasters: Bioterrorism, emerging infections, and pandemics. St. Louis: Saint Louis University. Retrieved from http://apic.org/Resource_/TinyMceFileManager/Topic-specific/47901_CH120_R1.pdf
World Health Organization. (2006). Communicable diseases following natural disasters: risk assessment and priority interventions. Geneva: WHO. Retrieved from http://www.who.int/diseasecontrol_emergencies/guidelines/CD_Disasters_26_06.pdf
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