Meningococcal meningitis if

WCC > 1000 cells mm3 (< 3 in normal CSF) with > 60 polymorphs. Protein concentration > 0.80 g l (< 0.60 g l in normal CSF). Gram stain Gram-negative diplococci (intra- or extracellular) in 80 of cases not previously treated. A lumbar puncture should be performed and the cerebrospinal fluid examined to differentiate viral from bacterial meningitis (see Annex 8 for guidelines on collection of CSF specimens). Thick and thin smears should be made to differentiate meningococcal meningitis...

Minimum data elements

Through appropriate data collection methods (see Section 3.4), the surveillance system must capture at least the following categories of health-related parameters - population figures and trends (demographic data), - programme activities (including vaccination). For each category, key indicators must be calculated to allow analysis of trends and comparison of the data. Ideally, mortality and morbidity data should be reported as the incidence for a given size of population, so demographic data...

Safety of injections

To ensure the safety of injections, WHO and UNICEF have issued a joint policy statement whereby the provision of sufficient quantities of auto-destruct syringes (designed to make reuse impossible) and safety boxes is automatically taken into account, together with high-quality vaccines, in the planning and implementation of all mass vaccination campaigns. Needles must not be recapped after use, but should be placed immediately into a designated (puncture-resistant) container and disposed of by...

Ministry of healthhead health agency

Data at this level should feed into the national surveillance system of the host country. The data can also be used for advocacy, fundraising, donor reports, programme reviews and overall evaluation of the effectiveness of health care interventions. The tasks of the various health workers at key steps in surveillance are summarized in Table 3.9. Table 3.9 Tasks of health workers at key steps in surveillance Table 3.9 Tasks of health workers at key steps in surveillance Ministry of Health Lead...

Diagnosis

The diagnosis of diarrhoeal diseases is usually based on clinical signs and symptoms. However, in outbreak situations stool samples must be collected from 10-20 cases to confirm the cause and to identify antimicrobial sensitivity. Once the outbreak has been confirmed, it is not necessary to obtain laboratory confirmation for every patient as this depletes laboratory supplies. IMPORTANT. Do not wait for laboratory results before starting treatment control activities. For assessment and case...

Volunteer collaboration

Volunteer collaboration within a community enables participatory mapping of priorities and needs, allows working with elders and leaders for advocacy and support, identifies volunteers who can help in organizing the community to address problems, and enables reporting information to the coordination body or local district. Success depends on whether volunteers' actions are measurable and make a difference. Important questions to ask include Are there volunteers in each community Are there...

Yellow fever vaccine

Vaccination is the primary means of preventing yellow fever. The yellow fever vaccine offers a high level of protection, with seroconversion rates of 95 or higher for both adults and children. The duration of immunity is at least 10 years and probably lifelong. The serological response to yellow fever vaccine is not inhibited by simultaneous administration of BCG, diphtheria, pertussis, tetanus, measles and poliomyelitis vaccines. Reactions to yellow fever vaccine are generally mild. It can be...

Site selection criteria

Settlements should avoid the major breeding sites of local vectors, as well as marshy areas and flat, low-lying ground at risk of flooding. Preference should be given to gently sloping, well drained sites on fertile soil with tree cover, sheltered from strong winds. Local expertise and knowledge of the biology of the vectors should be considered, such as avoiding forested hills in some Asian countries where vectors proliferate. If not already sufficiently documented by national and local health...

Location of family dwellings

The layout of dwellings relative to each other can have a significant impact on security and cultural activities, and is important for the building of a social structure. It also affects the use of latrines and water points. Although shelters arranged in straight lines on a close grid pattern might appear to ease some aspects of camp management, such a pattern is not normally conducive to social cohesion. The camp should be organized into small community units or villages each of approximately...

Review of outpatient register

Health facility _ Type of facility _ Time period (collect data of a recent period, preferably of the week preceding the visit) Beginning date _Ending date _ Acute watery diarrhoea (including cholera) TB new cases (with without lab. confirmation) Total consultations during time period

Major arthropod vectors and associated diseases

Care should be taken to ensure that any insecticides, rodenticides, etc. that are used in control activities are registered for use in the relevant countries or that permission to use them is obtained from the appropriate government departments. Mosquitoes are the vectors of malaria, filariasis, dengue, Japanese encephalitis and yellow fever. Table 2.14 summarizes the associated morbidity and case fatality, and main treatment and prevention measures. Table 2.14 Diseases spread by mosquitoes and...

How to estimate the amount of supplies needed for a dysentery outbreak

(0.2 of the population expected to fall ill initially) The table below gives you an estimate of the amount of supplies you will need according to the number of people in your area. To find the amounts needed for each item, look in the column under the approximate population of your catchment area to the nearest 5000. You may add several columns (e.g. if your health facility serves 35 000 people, add the amounts in the 10 000 and 5000 columns to those in the 20 000 column). Write the amount...

Verification of an outbreak and laboratory confirmation

Reports and alerts of outbreaks are frequent in emergency situations and must always be followed up. It is important to aware that in some languages one word may be used for more than one disease (e.g. in Serbo-Croat and its variants the same word is used for typhus and typhoid). Diagnosis must be confirmed either on a clinical basis by senior clinical workers (e.g. for measles) or by laboratory tests, in which case specimens (e.g. blood, serum, faeces or cerebrospinal fluid) must be sent to a...

Pain

Pain (headache, joint pain, toothache) Paracetamol, tablet 100 mg, 1 2 tab x 3 Paracetamol, tablet 100 mg, 1 tab x 3 Aluminium hydroxide, 1 2 tab x 3 for 3 days Aluminium hydroxide, 1 tab x 3 for 3 days b For children under 12 years, paracetamol is preferred because of the risk of Reye syndrome. b For children under 12 years, paracetamol is preferred because of the risk of Reye syndrome.

Emergency feeding programme strategies

Nutrition interventions definitions In emergency situations, the aim should be to ensure that the food needs of the population are met through the provision of an adequate general ration. In certain situations, however, there may be a need to provide additional food for a period of time to specific groups who are already malnourished and or are at risk of becoming malnourished. It must be made very clear that selective feeding is not designed to compensate for the inadequacy of general food...

To confirm case

Positive parasitology - stained smears from bone marrow, spleen, liver, lymph node, blood - culture of the organism from a biopsy or aspirated material Positive serology (immunofluorescent assay, ELISA, Direct Agglutination Test) Person with clinical signs and parasitological confirmation of the diagnosis. Clinical signs Appearance of one or more skin lesions, typically on uncovered parts of the body. The face, neck, arms and legs are most common sites. A nodule may appear at the site of...

Providing a water supply

The affected population must be involved in this process from the start, as they will be relied on for repairs and maintenance in the future. All available sources of water should be considered a combination of sources may be used. the type of treatment needed, the method of extraction from the source, the most suitable distribution system. Water quality The key to disease prevention through water supply is ensuring that water is of a high quality when consumed, not only just after treatment or...

Skin conditions

Clean with clean water and soap or diluted chlorhexidine solution 3 gently apply gentian violet solution b once a day Immerse immediately in cold water, or use a cold wet cloth continue until pain eases, then treat as for wounds Severe bacterial infection (with fever) Clean with clean water and soap or diluted chlorhexidine solution Apply gentian violet solution twice a day If not improved after 10 days, refer Apply gentian violet solution once a day for 5 days Bacterial infection clean with...

Clinical features

In the early stages, a painful chancre (rare in T. b. gambiense infection), which originates as a papule and evolves into a nodule, may be found at the primary site of a tsetse fly bite. There may be fever, intense headache, insomnia, painless lymphadenopathy, anaemia, local oedema and rash. In the later stage there is cachexia, sleep disturbance and signs of central nervous system impairment. The disease may run a protracted course of several years in the case of T. b. gambiense. In the case...

Rodents and their control

Rodents are disease vectors, reservoir hosts and pests in emergency situations. The main problems associated with rodents are disease transmission, consumption and spoiling of food, damage to stored products, damage to electrical systems, destruction of vegetable gardens, and biting and disturbing people while they sleep (see Table 2.24). Table 2.24 Diseases spread by rodents and their treatment and prevention Table 2.24 Diseases spread by rodents and their treatment and prevention Morbidity...

Trypanosomiasis African African sleeping sickness6

African trypanosomiasis is found uniquely in sub-Saharan Africa. In epidemic situations, as in the Democratic Republic of the Congo, the prevalence of the disease can be as high as 70 in some areas. An important feature of African trypanosomiasis is its focal nature. It tends to occur in circumscribed zones. Observed prevalence ratios vary greatly from one geographical area to another, and even between one village and another within the same area. War and displacement are not directly involved...

Waste disposal solid waste

Solid waste, if not properly disposed of, acts as a breeding site for flies, cockroaches and rats. A system for the safe storage, collection and disposal of waste must be implemented in the earliest stages of an emergency. Consultation with the emergency-affected population is very important, as they may already be motivated to carry out some of the necessary tasks without outside intervention, and may also want to use their waste in a constructive way (e.g. in compost production). Table 2.11...

Public health importance

The most common bacterial pathogen causing epidemic meningitis in most countries is the meningococcus, Neisseria meningitidis. Meningococcal meningitis is characterized by sudden onset with fever, intense headache, stiff neck, occasional vomiting and irritability. A purpuric rash is a feature of meningococcaemia. Epidemic meningitis has been recognized as serious public health problem for almost 200 years. The main source of the infection is nasopharyngeal carriers. The infection is usually...

Waste disposal medical waste

Medical waste includes needles, scalpels, laboratory samples, disposable materials stained with body fluids, and body tissue. This waste requires special care in handling, since needles and scalpels can cut handlers and transmit diseases such as HIV AIDS, hepatitis B and C and viral haemorrhagic fevers. Medical waste should be burnt in an incinerator, preferably as close as possible to the source, e.g. within the clinic or hospital grounds, but also downwind of hospital buildings and dwellings....

Yellow fever

Adverse events following yellow fever vaccination. Weekly Epidemiological Record, 2001, 76 217-218. District guidelines for yellow fever surveillance. Geneva, World Health Organization, 1998 (document WHO EPI GEN 98.09). Robertson SE. The immunological basis for vaccination. Module 8 yellow fever. Geneva, World Health Organization, 1993 (document WHO EPI GEN 93.18). Robertson SE et al. Yellow fever a decade of re-emergence. Journal of the American Medical Association, 1996, 276 1157-1162. Silva...

Monitoring coverage

Once the campaign is complete, it is necessary to assess vaccine coverage among the population at risk. This means that every vaccination site and health facility will submit the number of people immunized to a central location. These numbers will be combined to give the total number immunized, and this number will then be divided by the population at risk and multiplied by 100 to provide the percentage of the population covered. These data will help determine if the vaccine campaign is...

Hepatitis viral

Acute hepatitis (typically presenting as acute jaundice) is generally caused by hepatitis A, B, C and E viruses, which belong to different virus families. These viruses also differ in their (a) modes of transmission, (b) geographical and epidemiological patterns, which explain various age-related incidence profiles, and (c) propensity to result or not in chronic infections. Hepatitis D (not detailed any further here) is a particular case, being caused by a defective virus that can replicate and...

Fact Sheets

Fact Sheet No. 264 October 2001 Fact Sheet No. 107 Revised March 2000 Dengue and dengue haemorrhagic fever Fact Sheet No. 117 Revised April 2002 Fact Sheet No. 89 Revised December 2000 Fact Sheet No. 237 revised January 2002 Fact Sheet No. 204 Revised October 2000 Fact Sheet No. 164 Revised October 2000 Fact Sheet No. 211 March 2003 Fact Sheet No. 231 Revised April 2002 Fact sheet N 286 March 2005 Fact Sheet No. 267 February 2005 Fact Sheet No. 114 Revised April 2003 Fact Sheet No. 99 Revised...

Maternal health antenatal care

Since crisis, has there been anybody pregnant or become pregnant Yes No If Yes, complete table - If No, cross out table Guess how many months since day conceived 3. Household member other than the one pregnant antenatal care (Write zero if never gone) Anti-tetanus vaccination given + HB + urine check Asked to attend more than one check per month (Yes No) If Yes, was is it possible to complete the treatment (Yes No)

Data collection methods

There are three main methods for collecting data in emergency situations routine reporting (including epidemic-prone diseases requiring immediate notification), surveys and outbreak investigations (see Table 3.1). Weekly (emergency phase), then monthly Alert system epidemic (early warning) Delays in setting up routine surveillance, or Household-based data (e.g. nutrition, basic needs, vaccination) Depends on specific needs or questions addressed In routine reporting, clinical workers collect...

Laboratory Premises

Laboratories should provide an adequate level of secondary (environmental) containment to allow safe working within and to protect those using the area around the laboratory from microbiological risk. In acute emergencies, almost any accommodation that can provide cover from the sun and rain has at one time or another been used for laboratory work. While a tent or plastic sheeting can be so used, the ability of the staff to do useful work is likely to be rapidly degraded by poor working...

Data sources for routine surveillance

The six categories of data are collected from the sources given in Table 3.5. Table 3.5 Categories and sources of data Table 3.5 Categories and sources of data Health facilities, home visitors, grave-watchers, numbers of shrouds issued, community leaders Local health and administrative services, other agencies Agencies involved in water sanitation, food distribution Nutritional surveys, food distribution agencies Programme activities, including vaccination The main sources of data for routine...

Disposal of the dead

The risks posed by the dead are of two types risks to those handling the cadaver, and risks to the population in general. In the majority of cases dead bodies do not pose a serious health risk. The diseased living are a far greater hazard than the deceased, because most pathogens do not long survive the chemical and temperature changes that occur after the death of their host. Even if they do survive, the conditions suitable for multiplication of the organisms are rarely met. In the living,...

Food and nutrition

Food shortages and malnutrition are common features of emergency situations. Ensuring that the food and nutritional needs of an emergency-affected population are met is often the principal component of the humanitarian response to an emergency. When the nutritional needs of a population are not met, this may result in protein-energy malnutrition and micronutrient deficiencies such as iron-deficiency anaemia, pellagra, scurvy and vitamin A deficiency. There is also a marked increase in the...

Monitoring and evaluation of water and sanitation programmes

The major components of the water and sanitation programmes must be monitored and evaluated at regular intervals in order to assess their effectiveness and suitability. Problems identified can be addressed by means of changes in design, location or improved education methods. Monitoring is essential in ensuring that all sectors of the population receive an adequate water supply. Water shortages may result from an underestimation of population size, the more powerful groups in the community...

Site layout and design

It is important to prepare a master plan of the camp. The site plan should be sufficiently flexible to allow for a greater than expected influx of people. A 3-4 per year population growth rate must also be planned for. Overdevelopment of some areas of the site must be avoided as it can cause health problems, especially for people who come from sparsely populated environments. Tribal, ethnic or religious differences may exist within the camp population or between this population and the local...

WHO reference values for emergencies

Table A1.1 Cut-off values for emergency warning Table A1.1 Cut-off values for emergency warning not more than 150 metres from housing Ideally 1 per family Minimum 1 seat per 20 people 30 metres from housing including shelter, sanitation, services, warehousing, access with one economic stove per family, the needs may be Acute respiratory infections, < 5 years Diarrhoeal diseases, < 5 years Expected attack rate in emergency situations 10 per month in cold weather 50 per month Essential...

Classification of malnutrition

The impact of food shortages on the health of a population generally becomes apparent through signs of protein-energy malnutrition (PEM), but it should be kept in mind that micronutrient deficiencies are often present as well. In some emergencies, micronutrient deficiencies owing to the poor quality of accessible food items can reach epidemic proportions (e.g. the scurvy epidemic among isolated populations in Afghanistan). The most reliable indication of acute malnutrition is wasting (low...