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close this bookCommunicable Disease Control in Emergencies - A Field Manual (WHO - OMS, 2003, 223 p.)
View the document(introduction...)
View the documentACKNOWLEDGEMENTS
View the documentINTRODUCTION
Open this folder and view contentsCHAPTER 1: RAPID ASSESSMENT
Open this folder and view contentsCHAPTER 2: PREVENTION
Open this folder and view contentsCHAPTER 3: SURVEILLANCE
Open this folder and view contentsCHAPTER 4: OUTBREAK CONTROL
Open this folder and view contentsCHAPTER 5: DISEASE PREVENTION AND CONTROL
View the documentANNEX 1: WHO REFERENCE VALUES FOR EMERGENCIES
View the documentANNEX 2: SAMPLE HEALTH SURVEY FORMS
View the documentANNEX 3: NCHS/WHO NORMALIZED REFERENCE VALUES FOR WEIGHT FOR HEIGHT BY SEX
View the documentANNEX 4: SAMPLE WEEKLY SURVEILLANCE FORMS
View the documentANNEX 5: RECOMMENDED CASE DEFINITIONS
View the documentANNEX 6: OUTBREAK INVESTIGATION FORMS
View the documentANNEX 7: ORGANIZATION OF AN ISOLATION CENTRE
View the documentANNEX 8: BASIC LABORATORY SERVICES
View the documentANNEX 9: LABORATORY INVESTIGATION KIT
View the documentANNEX 10: TREATMENT GUIDELINES
View the documentANNEX 11: MANAGEMENT OF THE CHILD WITH COUGH OR DIFFICULTY IN BREATHING6
View the documentANNEX 12: ASSESSMENT AND TREATMENT OF DIARRHOEA
View the documentANNEX 13: FLOW CHARTS FOR SYNDROMIC MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS
View the documentANNEX 14: SAMPLE HEALTH CARD
View the documentANNEX 15: LIST OF WHO GUIDELINES ON COMMUNICABLE DISEASES
View the documentANNEX 16: LIST OF PUBLISHERS
View the documentANNEX 17: GENERAL REFERENCES

INTRODUCTION

This manual is intended to help health professionals and public health co-ordinators working in emergency situations prevent, detect and control the major communicable diseases encountered by affected populations. Emergencies include complex emergencies and natural disasters (e.g. floods and earthquakes). The term "complex emergencies" has been coined to describe "situations of war or civil strife affecting large civilian populations with food shortages and population displacement, resulting in excess mortality and morbidity".

In this manual, the generic term "emergencies" will be used to encompass all situations in which large populations are in need of urgent humanitarian relief. There has been a marked increase in the number of complex emergencies in recent years with large civilian populations affected by conflict. Following an emergency, the affected population is often displaced and temporarily resettled. They may be placed in camps or become dispersed among the local population (either in towns or in rural communities). People who are displaced across national borders are termed refugees whereas those who have been displaced within their country are called "internally displaced persons" (IDPs). Resettlement in camps may entail high population densities, inadequate shelter, poor water supplies and sanitation, and a lack of even basic health care. Increases in numbers in established host communities, or the return of displaced populations to their territories of origin may cause similar problems. In these situations, there is an increased threat of communicable disease and a high risk of epidemics.

Communicable diseases are a major cause of mortality and morbidity in emergencies, and particularly in complex emergencies, where collapsing health services and disease control programmes, poor access to health care, malnutrition, interrupted supplies and logistics, and poor co-ordination among the various agencies providing health care often coexist. The main causes of morbidity and mortality in emergencies are diarrhoeal diseases, acute respiratory infections, measles and, in areas where it is endemic, malaria. Other communicable diseases, such as epidemic meningococcal disease, tuberculosis, relapsing fever and typhus, have also caused large epidemics among emergency-affected populations. Malnutrition and trauma are the two main additional causes of illness and death.

Ensuring adequate shelter, water, sanitation and food and providing basic health care are the most effective means of protecting the health of those affected by emergencies. A systematic approach to the control of communicable diseases is a key component of humanitarian response, and is crucial to protect the health of emergency affected population. This requires co-operation among agencies working at local, national and international levels, and collaboration among all sectors involved in the emergency response - health, food and nutrition, shelter, water and sanitation.

This field manual is the result of collaboration among a number of WHO departments and several external partner agencies in reviewing existing guidelines on communicable disease control and adapting them to emergency situations. This manual deals with the fundamental principles of communicable disease control in emergencies, which are:

· RAPID ASSESSMENT: identify the communicable disease threats faced by the emergency-affected population, including those with epidemic potential, and define the health status of the population, by conducting a rapid assessment;

· PREVENTION: prevent communicable disease by maintaining a healthy physical environment and good general living conditions;

· SURVEILLANCE: set up or strengthen disease surveillance system with an early warning mechanism to ensure the early reporting of cases, to monitor disease trends, and to facilitate prompt detection and response to outbreaks;

· OUTBREAK CONTROL: ensure outbreaks are rapidly detected and controlled through adequate preparedness (i.e. stockpiles, standard treatment protocols and staff training) and rapid response (i.e. confirmation, investigation and implementation of control measures); and

· DISEASE MANAGEMENT: diagnose and treat cases promptly with trained staff using effective treatment and standard protocols at all health facilities.

It is hoped that this manual, by setting standards for communicable disease control in emergencies, will promote effective, co-ordinated action towards the prevention and control of communicable diseases in emergencies. Where appropriate, the manual provides suggestions for further reading, with references to relevant background material, guidelines and reviews.

Steps in ensuring communicable disease control in emergencies

Conduct rapid health assessment

· Identify main disease threats, including potential epidemic diseases

· Obtain data on the host country, on the country of origin of displaced persons and on the areas through which they may have passed

· Identify priority public health interventions

· Identify the lead health agency

· Establish health coordination mechanisms

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Prevent communicable diseases

· Select and plan sites
· Ensure adequate water and sanitation facilities
· Ensure availability of food
· Control vectors
· Implement immunization campaigns (e.g. measles)
· Provide essential clinical services
· Provide basic laboratory facilities

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Set up surveillance/early warning system

· Detect outbreaks early
· Report diseases of epidemic potential immediately
· Monitor disease trends

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Control outbreaks


Preparation

- outbreak response team
- stockpiles
- laboratory support
- standard treatment protocols

Detection

- surveillance system, early warning system

Confirmation


Response

- investigation
- control measures

Evaluation