2g Health Protection and communicable diseases Flashcards

Question

What specific surveillance systems do we use for Healthcare-associated infections?

Answer 1

PHE previously had a surveillance programs covering: Staphylococcus aureus (Methicillin resistant Staphylococcus aureus (MRSA) and Methicillin sensitive Staphylococcus aureus (MSSA)) Escherichia coli bacteraemia Clostridium difficile infection Enhanced surveillance of the first 4 infections is a mandatory requirement in regulated healthcare organisations in England and requires sign-off by the reporting organisation’s CEO. Utilises the HCAI Data Capture System (DCS) For MRSA bacteraemias, all positive cases must also have a Post Infection Review (PIR) completed, identifying how the case occurred and what actions could be taken to prevent a reoccurrence Also allows capture of voluntary information such as the source/primary focus of MRSA bacteremia Surgical Site Infection (SSI) Surveillance service also requires mandatory reporting of SSI in 4 categories of orthopaedics and voluntary surveillance in 13 categories of surgical procedures Patient Administration Systems (PAS) can also contribute data.

Answer 2

Genitourinary medicine clinical activity dataset (GUMCAD) – patient level data on diagnoses made and services provided from GUM and sexual health services Chlamydia Testing Activity Dataset (CTAD) – patient level data on testing and diagnoses HIV and AIDS new diagnosis database (HANDD) – new HIV diagnoses, AIDS and deaths Survey of prevalent HIV infections diagnosed (SOPHID) – people seen for HIV care HIV and AIDS Reporting system (HARS) – intended to replace HANDD and SOPHID CD4 Surveillance Scheme – Reports of CD4 cell count measures from microbiology laboratories National Survey of Sexual Attitudes and Lifestyles (NATSAL) sexual health behaviour survey Hepatitis B is a notifiable disease Antenatal screening for infectious diseases in pregnancy also provides data on HIV, hepatitis B, and syphilis (as well as Rubella susceptibility) Blood, tissue and organ donors screening – NHS Blood Transfusion/PHE surveillance scheme includes hepatitis B and HIV.

Answer 3

1. Describe the public health importance of the health event under surveillance; consider: * The total number of cases * Incidence and prevalence * Indices of severity (death rate, case fatality ratio) * Can it be prevented? 2. Describe the surveillance system to be evaluated. what are is objectives?: * Detecting and monitoring outbreaks * Detecting and monitoring trends * Setting priorities and allocating resources * Describe the health event under surveillance * State the case definition * State the population and choice of denominator * Draw a flow chart of the system * Describe the components and operation of the system * What information is collected? * Who collects the data? * Time to collect data? * Mode of data transfer and storage? * Who analyses data? * How is the data disseminated? * Who is it disseminated to? 3. Discuss validity and repeatability of case definitions in various types of surveillance data 4. Indicate the level of usefulness by describing the actions taken as a result of data collected by the surveillance system. (e.g. useful in prevention and control of adverse event): * What actions are taken because of the data? * Who uses data to initiate action? * List anticipated uses of data. 5. Describe cost / resources needed to run surveillance: * Indirect * Direct: data collection/analysis/interpretation and dissemination. 6. Evaluate the quality of the surveillance system by assessing its key attributes: * Simplicity * Flexibility * Acceptability: to public/data collectors * Sensitivity: ability to detect health events * Timeliness * Representativeness: does it accurately describe incidence of health events in population by time/place/person. 7. List conclusions and recommendations: * Is the system meeting its objectives? * Address the need to continue/modify surveillance

Answer 4

1. Describe the public health importance of the health event under surveillance; consider: * The total number of cases * Incidence and prevalence * Indices of severity (death rate, case fatality ratio) * Can it be prevented? 2. Describe the surveillance system to be evaluated. what are is objectives?: * Detecting and monitoring outbreaks * Detecting and monitoring trends * Setting priorities and allocating resources * Describe the health event under surveillance * State the case definition * State the population and choice of denominator * Draw a flow chart of the system * Describe the components and operation of the system * What information is collected? * Who collects the data? * Time to collect data? * Mode of data transfer and storage? * Who analyses data? * How is the data disseminated? * Who is it disseminated to? 3. Discuss validity and repeatability of case definitions in various types of surveillance data 4. Indicate the level of usefulness by describing the actions taken as a result of data collected by the surveillance system. (e.g. useful in prevention and control of adverse event): * What actions are taken because of the data? * Who uses data to initiate action? * List anticipated uses of data. 5. Describe cost / resources needed to run surveillance: * Indirect * Direct: data collection/analysis/interpretation and dissemination. 6. Evaluate the quality of the surveillance system by assessing its key attributes: * Simplicity * Flexibility * Acceptability: to public/data collectors * Sensitivity: ability to detect health events * Timeliness * Representativeness: does it accurately describe the incidence of health events in population by time/place/person. 7. List conclusions and recommendations: * Is the system meeting its objectives? * Address the need to continue/modify surveillance

Answer 5

There tends to be a tiered organisation with primary responsibility for health protection, progressing from local to national level. These tiers may be within a single or separate organisation. In most countries, local health authorities conduct health protection activities at a local level such as receipt of case notifications, and investigation and control measures. National health authorities tend to be responsible for data collation, analysis, and dissemination for action (surveillance). They may also support outbreak investigation and control, particularly if investigations cross regional borders. There will also be a variety of organisations at each level that contribute to the efforts of the health protection team but whose primary function is not health protection, such as local government at a regional or sub-regional level, and food safety and veterinary health agencies at a national level.

Answer 6

There tends to be a tiered organisation with primary responsibility for health protection, progressing from local to national level. These tiers may be within a single or separate organisation. In most countries, local health authorities conduct health protection activities at a local level such as receipt of case notifications, and investigation and control measures. National health authorities tend to be responsible for data collation, analysis, and dissemination for action (surveillance). They may also support outbreak investigation and control, particularly if investigations cross regional borders. There will also be a variety of organisations at each level that contribute to the efforts of the health protection team but whose primary function is not health protection, such as local government at a regional or sub-regional level, and food safety and veterinary health agencies at a national level.

Answer 7

Hand Hygiene (for clinicians and the general public) Use of personal protective equipment (PPE) Handle and dispose of sharps safely Dispose of contaminated waste safely (Or hot wash) Managing blood and body fluids Decontaminating equipment Maintain a clean clinical environment Prevent occupational exposure to infection Manage sharps injuries and blood splash incidents Manage linen safely Suitable room/ward for patients with infections Disinfection (in hospitals, nurseries, schools and nursing homes) Tuberculosis screening services Changes to risk behaviour - This can be achieved through general or targeted education campaigns, e.g. avoid sharing personal items, safe sex, careful disposal of needles / clinical waste with blood borne pathogens.

Answer 8

Hand washing Safe clinical spaces (see the card on disease prevention in a clinical setting) Education on personal hygiene and hygienic preparation of food Children and adults in jobs likely to spread infection should stay away from school for 48 hours after any diarrhoea has stopped. Routine and selective immunisation Changes to risk behaviour

Answer 9

In hospital - Infection control team In Community - Health protection team

Answer 10

Healthcare-associated infections (HCAI) are infections that occur in patients or health care workers as a result of healthcare interventions.

Answer 11

Overall responsibility rests with the chief executive and the trust board and the Director of Infection, Prevention and Control (DIPC).

Answer 12

A hospital infection control team (ICT) comprises an Infection Control Doctor (usually a medical microbiologist), one or more infection control nurses and clerical support. They report to a multi-disciplinary Infection Control Committee who liaises with senior management. The hospital infection control team works with the Hospital Infection Control Committee. A Hospital Infection Control Committee consists of the ICT (see above), hospital chief executive or senior director, CCDC/CHP, Occupational Health Consultant and others as needed.

Answer 13

Maintain an effective programme for the prevention of hospital-acquired infection Containment of infections brought into the hospitals by patients, staff or visitors.

Answer 14

To ensure the management of infection control programmes is undertaken by competent, qualified Infection Control nurses Provision of ongoing education for all healthcare staff Develop infection control policies and ensure accessible to all staff Facilities and equipment are available to enable compliance with policies Ensure all clinical staff have received appropriate training Infection control audits Surveillance.

Answer 15

The local HPT takes a main role in community infection control. It works with all community organisations that provide care, healthcare or treatments outside hospital including nursing / residential homes, nurseries and schools. The HPT advises and helps maintain good infection control practices in these community settings. This is achieved through the direct input of health protection practitioners (who provide most of the HPT infection control advice) and the CCDCs/CHPs (who are the main link between CCG infection control teams and hospital ICTs). For example, a HPT may advise private nursing home staff about infection control principles, advise schools and nurseries on infection control principles in conjunction with the local authority, and review the infection control practices of tattoo parlours and beauticians.

Answer 16

The Public Health Act 1984 and subsequent Health Protection Regulations 2010 give UK local authorities powers to enable restrictions or requirements to be imposed on people and in respect of things and/or premises to protect human health, provided strict criteria are met. The powers are exercised either directly or indirectly through the 'Proper officer', an officer appointed by (or employed by PHE to whom the duty is delegated) the local authority for a specific purpose. The Proper Officer is usually the Consultant in Communicable Disease Control (CCDC)/ Consultant in Health Protection (CHP). These include: Local authority powers The 2A Orders Other powers - E.g. Powers of entry or inspection to carry out health protection functions.

Answer 17

Local authority powers provide a range of measures that can be to used to prevent, protect against, control or provide a health protection response to an incident or spread of infection or contamination that presents, or could prevent, significant harm to human health. They can be exercised without applying to a Justice of the Peace but specific criteria must be satisfied. The powers include: Require that a child is kept away from school Require a teacher to provide a list of contact details of pupils attending their school Disinfect/decontaminate articles on request Request (but not require) individuals or groups to cooperate for health protection purposes. Restrict contact with, or relocate, a dead body for health protection purposes.

Answer 18

Part 2A Orders are obtained by local authorities on application to a Justice of the Peace and impose restrictions or requirements on a person, thing, body or human remains, or premises. For example, for a person to be detained in a hospital; to restrict a person’s movements or contact with other people; or to require that a premises is closed or decontaminated. The power also includes a requirement for a person to give information about a ‘related party, person, or thing’, as relevant to the case.

Answer 19

A person, thing, dead body or premises is, or may be, infected or contaminated A risk assessment that the threat must present, or could present significant harm to human health There is a risk of spread of contamination/infection Use of the power is necessary to reduce that risk The action is proportionate to reduce that risk Use of the power is only to reduce that risk Use of a Part 2A Order is for a specified time period. *Note there are specific criteria for certain local authority powers and 2A orders and a 2A order cannot be used to impose medical treatment or vaccination on an individual.

Answer 20

The Environment Agency and Local Authority Environmental Health Departments: Have legal powers to control (by giving permits to operate under certain conditions or enforcement notices) aspects of the environment that could be a threat to human health. Whether the EA or local environmental health departments are the regulator depends on the nature and size of the facility/establishment. These often include: * Waste operations (including mining waste and waste incineration plants) * Radioactive substances activity * Water discharge and groundwater activities (including sewage disposal). The local authiority generally: Food Safety Act - Supplies and suppliers of food Private water supplies Statutory Nuisances and Clear Air section of the Environmental Protection Act 1990 - Pest control and other ‘nuisances’ e.g. fumes, smells, smoke, noise. The Health and Safety at Work Act - Occupational setting to compel premises occupiers to clean and disinfect

Answer 21

A framework for regulations that govern: Activity of food businesses Composition and labelling of foods Chemical safety Food hygiene Enforcement is the responsibility of local authority environmental health officers at a local level, and the Food Standards Agency nationally.

Answer 22

There are statutory duties for reporting notifiable diseases in the Public Health Act 1984 and the updated Health Protection (Notification) Regulations 2010. Registered medical practitioners in England and Wales have a statutory duty to notify the ‘proper officer’ of their local authority or local Health Protection Team of suspected cases of certain infectious diseases. In practice, this tends to be a CCDC/CHP within the local HPT. Practitioners are asked to notify of any suspected or confirmed cases within 3 days, or to report orally by telephone if urgent. Diagnostic laboratories in England can notify by electronic means. PHE collects these notifications and publishes analyses of local and national trends every week. The Health Protection Regulations 2010 extended the duty of practioners to a new ‘all hazards approach’, where any haxard that could pose a public health threat must be notified.

Answer 23

Acute encephalitis Acute infectious hepatitis Acute meningitis Acute poliomyelitis Anthrax Botulism Brucellosis Cholera Covid-19 Diphtheria Enteric fever (typhoid or paratyphoid fever) Food poisoning Haemolytic uraemic syndrome (HUS) Infectious bloody diarrhoea Invasive group A streptococcal disease Legionnaires’ disease Leprosy Malaria Measles Meningococcal septicaemia Mumps Plague Rabies Rubella Severe Acute Respiratory Syndrome (SARS) Scarlet fever Smallpox Tetanus Tuberculosis Typhus Viral haemorrhagic fever (VHF) Whooping cough Yellow fever Other diseases and contamination that may present significant risk to human health under the category ‘other significant disease’ e.g. Middle Eastern Respiratory Syndrome (MERS), radioactive agent release due to terrorism.

Answer 24

1) What investigations (microbiological / environmental / epidemiological) are needed to identify the agent, the cause of the incident? 2) What is the Source of Infection? * Is it a continuing source that may need to be controlled? * If so, what generic control measures can be applied to limit morbidity whilst awaiting confirmation e.g. enhanced hand washing, environmental cleaning, etc? * Are there others exposed who may need advice / treatment? 3) What is the likelihood of transmission? * Advice / prophylaxis to close contacts, e.g. hepatitis B immunisation * Occupational transmission, e.g. exclusion of food handlers with gastrointestinal infection 4) Is public health action necessary, done through a risk assessment: * How infectious is the source * How close is the contact * How susceptible are those exposed * Is the index case at risk of a poor outcome? * Is the index case likely to pass the infection to others? * Is there likely to be an ongoing source that needs controlling? * Do contacts and others exposed to the same source need to be traced? * Do the public need information or reassurance? 5. Is immediate public health action needed? * Seriousness of disease * Transmissibility of infection * Length of incubation period * Vulnerability of people exposed * Public/ media / political reaction * What is good practice 6. Possible interventions * Improve outcome for cases, e.g. antibiotics, immunoglobulin * Trace others exposed to source or cases to provide advice, antibiotics or vaccines * Prevent others being exposed to cases / contacts by rendering them non-infectious by use of antibiotics and / or isolation * Provision of hygiene advice * Exclusion from work / school * Closure of premises associated with incident e.g. cooling towers, food premises * Identify possible source and implement and monitor control measures to contain this source 7. Communication * Cases / contacts / clinicians * Internal - specialist advice within HPT / microbiology * External - local authorities, press e.g. outbreak of meningococcal disease in a school

Answer 25

To provoke immunological memory to protect the individual against a particular disease.

Answer 26

Passive: Immediate protection with a temporary source of antibody, e.g. Immunoglobulin (Ig's) and antitoxins Active: Longer-term protection leading to the formation of antibodies

Answer 27

Live attenuated vaccine (weakened strains that replicate in the host): Examples include: MMR, oral polio, BCG, Yellow Fever, Live attenuated Influenza (LAIV) and Herpes Zoster vaccine. Inactivated vaccines (suspensions of whole intact killed organisms OR components of organism important in protection): Examples include: Diphtheria Tetanus Pertussis (DTP), typhoid, Hepatitis B, flu, rabies, meningitis (ACWY, B) Hib, HPV

Answer 28

Live attenuated: Single dose often sufficient to induce long-lasting immunity Long duration of immunity Less stable: may revert to a virulent strain Can cause disease in immuno-suppressed Inactivated vaccine: Stable Unable to cause the infection Need multiple doses and booster Shorter lasting immunity

Answer 29

A confirmed anaphylactic reaction to a previous dose of the vaccine or to a component of the vaccine Immuno-suppression (no live vaccines)

Answer 30

Primary: individual fails to make an adequate immune response to initial vaccination Secondary: Individual makes an initial adequate response, but then immunity wanes over time

Answer 31

Is there a need for the programme: Disease incidence Disease severity Mortality Disease complications Disease characteristics: Distribution of disease e.g. Age, sex Disease trends Vaccine delivery: Vaccine Efficacy and side effects Availability and validity of delivering Provision of trained primary care providers Vaccine type Other: Population / cultural attitudes Cost and benefit Political expenditure

Answer 32

To protect those at the highest risk (selective immunisation strategy) OR To eradicate, eliminate or contain disease (mass immunisation strategy)

Answer 33

Selective Vaccination: Given to those at increased risk, for example: For travel, e.g. Japanese B encephalitis Occupation, e.g. Hepatitis B High-risk groups e.g. Hepatitis B vaccine for neonates born to Hepatitis B positive mothers Chronic disease, e.g. Pneumococcal following Splenectomy During an outbreak, e.g. Hepatitis A Mass Vaccination: Given to everyone with the aim of: Eradication - Disease and its causal agent have been removed worldwide, e.g. smallpox Elimination - Disease has disappeared from one WHO region but remains elsewhere, e.g. polio Containment - The point at which the disease no longer constitutes a 'significant public health problem', e.g. Hib

Answer 34

Aim of programme Cost of programme Population accessibility Cultural attitudes and practices Facilities available for delivery

Answer 35

Pre-license: Phase 1 studies = Safety studies - In healthy adults Phase 2 studies = Immunogenicity (how effective is it at developing immunity) - In target population (n=100-120) Phase 3 studies = Protective efficacy - In target population (large). Also cost-benefit analysis studies Post-license: Phase 4 studies = Surveillance - To detect adverse events

Answer 36

Recommendations for use of a vaccine/vaccine policy are based upon The Joint Committee of Vaccination and Immunisation (JCVI) expert opinion after reviewing all the available evidence. The JCVI is an independent expert advisory committee whose role is to advise UK public health departments on matters relating to communicable diseases, preventable and potentially preventable through immunisation. They are involved in: Choice of policy - mass or selective Publishing recommendations on ‘Immunisation against infectious disease’ (the green book) License vaccine and batch release Procurement of vaccine

Answer 37

Socio-demographic variables Deprivation Urban living Mobile families Birth order Large families Children with chronic illnesses Ethnicity Personal variables Parents Professionals Health service variables: Poor coordination (private and public sectors) Unclear responses Access to guidelines and policies

Answer 38

1986: District immunisation coordinator appointed 1987: Rapid monitoring and feedback of coverage data - COVER statistics 1988: National guidelines on immunisation 1990: Accelerated immunity schedule 1990: GP contracts - financial incentives 1992: Parent-held records/Personal Child Health Record often referred to as the Red book Others: National vaccination campaigns - intermittent (e.g. MMR/Hib) Opportunistic delivery Specific immunisation clinics Targeted information campaigns Child Health Information Services (CHIS) computer generates automatic letters inviting children for vaccination, and ensures GP call and recall for immunisation

Answer 39

In the UK since 1988 computerised child health records contain vaccination details of all children resident in the area. These are completed each time a vaccine is given by a healthcare professional and allow rapid monitoring and feedback of vaccine coverage data. This information is collected every 3 months from local Child Health Computer Systems detailing the number of children who have completed the vaccination schedule at 1, 2 and 5 years of age.

Answer 40

Detect change rapidly and monitor trends in uptake Look for pockets of poor coverage Estimate vaccine efficacy Measure impact and success of a vaccination campaign Evaluation of Vaccine Programmes Disease incidence Susceptibility Vaccine Coverage Adverse events and vaccine safety

Answer 41

The Committee on Safety of Medicines (CSM) advises the Medicines and Healthcare Products Regulatory Agency (MHRA) on the safety, quality and efficacy of vaccines MHRA is responsible for the Yellow Card Adverse Drug Reaction reporting system Yellow Card reports can signal the possibility that a product may be associated with certain risks. These can then be investigated further to decide whether a side effect is truly from a vaccine or not.

Answer 42

1) Confirmation of Outbreak 2) Verify the Diagnosis 3) Case Definition 4) Case Finding 5) Descriptive Epidemiology 6) Generate a Hypothesis 7) Analytical Epidemiology 8) Evaluate Control Measures 9) Surveillance

Answer 43

If an outbreak is suspected an Outbreak Control Team (OCT) should be convened to conduct the investigation with the following represented in the membership: Essential: * Consultant in Communicable Disease Control (CCDC)/Consultant in Health Protection (CHP) * Environmental Health Officer (EHO) * Consultant Microbiologist or Virologist * Secretarial/Administrative support Optional: * Regional epidemiologist * Media/press officer * Infection control nurse * State veterinary service * Food chemist/microbiologist/Food Standards Authority * Toxicologist * Director of Public Health * Water company

Answer 44

Is there an increase in the number of cases expected in the population/time/place? Confirm numbers; interview cases, review laboratory findings Is further investigation needed? The extent and urgency of the investigation should be considered.

Answer 45

Obtain medical records and laboratory reports Repeat tests if necessary Further clinical testing if needed

Answer 46

Component of case definition (Example) Hepatitis A Outbreak Person Detail needed - Type of illness (e.g. “a person with…”) Example - A person with an acute illness Place Detail needed - Location of suspected exposure Example - Which occurred after staying at Hotel X Time Detail needed - Based on incubation (if known) Example - Between Sep-Nov 2015 Clinical symptoms/Lab results Example - with jaundice or elevated liver function tests Define population at risk Example - Of all residents and diners during this period.’

Answer 47

Interview known cases Locate others exposed to probable risk factor Review routine surveillance data, notifications and laboratory results Contact other CCDC’s/CHPs, EHO’s, health workers

Answer 48

Using data collected by the outbreak control team and arranging it into a set of descriptive data (e.g. person/place/time). This can also be used to form an Epidemic Curve or Line list.

Answer 49

A graph of occurrences of cases over time, this can help determine the nature of the outbreak: Point (common) source Propagated (continuing) source Point source and person-to-person spread

Answer 50

A table summarising the information about persons associated with the outbreak. Each row represents a single individual and each column represents a specific characteristic: Identifying information Demographics Dates of illness/results Pertinent risk factors Exposures Clinical details/lab results

Answer 51

Causes may have already been suspected, however, a formal hypothesis is helpful to establish after reflecting on the data interpreted in the descriptive epidemiology. It is useful for determining the most likely exposure that has caused the outbreak.

Answer 52

Epidemiologic analytical studies can be used to test your generated hypothesis. If controls are chosen appropriately this will reduce the bias in the studies performed. This is often done through a cohort or case-control study: Cohort Study Everyone potentially exposed Only use if a comprehensive list is available Can assess relative risk and attack rate (the proportion of an at-risk population that contracts the disease during a specified time interval.) Case-Control Study Comparison of exposure amongst cases and controls. Useful study if the complete list is unavailable or is too large Can assess the odds ratio

Answer 53

Monitor the incidence of cases once control measures are enforced. Laboratory results useful for continued definitive identification of infectious agent in cases and if appropriate monitoring response to treatment/control measures.

Answer 54

Control source (Animal/Human/Environmental) Consider closing outlet Isolate and/or treat cases Destroy/treat food EHO to take samples if necessary Protect persons at risk Consider prophylaxis (e.g. antibiotics) Improve hygiene / personal protective equipment if applicable Interrupting transmission Depends on the mode of spread (e.g. bottled water if contaminated water supply with Cryptosporidium).

Answer 55

During outbreak Agree media strategy at initial OCT meeting and review at every meeting After outbreak Outbreak report published and disseminated Recommendations made Media Strategy Ensure accurate and timely information relayed Consider which type of media and for which groups; social media/secure comms/sensitive information/anonymity of cases. Media attention may be necessary if public action is required.

Answer 56

Point source - explosive (primary cases will cluster within the range of the incubation period) e.g. Salmonella outbreak at wedding reception Continuing source - e.g cases of S. agona PT15 by week of onset in England and Wales Point source and person-to-person spread - e.g. E.Coli 0157 in a residential home

Answer 57

Point source

Answer 58

Continuing source

Answer 59

Point source and person-to-person spread

Answer 60

General: Involve Environmental Health Officer in the investigation to find the source. Collect stool specimens if possible from all sporadic cases; as many as possible in the outbreak Prevention: Hand washing and no towel sharing Disposal of soiled material Disinfect toilet area and taps daily Education of personal hygiene and hygiene in the preparation of food Exclusions: All cases must be excluded from work or school until free from diarrhoea and vomiting for 48 hours as a minimum. In the case of an 'at risk' group, exclude for longer and consider the need for microbiological clearance before returning to work in: * Food handlers * Health care facilities * Children under five years * People with learning disabilities Screening and follow up: In the case of 'non-risk' groups, there is no microbiology follow up Most food poisoning - no screening of contacts necessary, except in the case of Typhoid and E.coli OI57

Answer 61

Check: Occupational exposure Recreational exposure Domestic exposure Consumption of water, vegetables, fish (in areas of infected water)

Answer 62

Formal reports are received from Ministries of health, WHO Regional and Country offices, national public health organisations, military and civilian laboratories, academic institutions, WHO collaborating centres and non-governmental organisations (NGO’s). Informal sources such as social media and online news reports are monitored by the Global Public Health Intelligence Network (GPHIN) to identify information about outbreaks of disease or public health events of international concern. This was used in covid-19 and ebola outbreaks.

Answer 63

An incident is an event requiring a response from the emergency services. An emergency is an event or situation that threatens serious damage to human welfare or the environment or war or an act of terrorism that threatens serious damage to security. A major incident is an event or situation requiring a response under one or more of the emergency services’ major incident plans. A disaster is a serious disruption of the functioning of a community or a society involving widespread human, material, economic or environmental losses and impacts, which exceed the ability of the affected community or society to cope using its own resources.

Answer 64

Source: ‘Man-made’ e.g. transport-related, terrorism Natural e.g. flooding, earthquake Speed: ‘Big bang’ - sudden events such as bombings or earthquakes Rising tide’ gradual events such as famine, and infectious disease pandemics.

Answer 65

The aspect of emergency management concerned with developing and maintaining procedures to prevent emergencies and to mitigate the impact when they occur. It is a systematic and ongoing/cyclical process which should evolve as lessons are learnt and circumstances change.

Answer 66

The step beyond emergency planning, where a plan is in place, and has been tested: organisations and individuals are clear about their roles and responsibilities.

Answer 67

The level of exposure to a hazard The conditions of vulnerability that are present The capacity or measures to reduce or cope with the potential negative consequences Level of community resilience

Answer 68

Category 1: Core to civil protection Emergency services, local government, acute hospitals and emergency departments, health service managers, public health agency, the environment agency, maritime and coastguard agency, port health authority Category 2: Play a supporting role Utility companies, highway authorities, railway, harbour and airport operators, health and safety executive, primary care organisations The military are not categorised here because the Act governs responses to civil emergencies

Answer 69

Category 1 responders have to put in place emergency plans, business continuity arrangements, arrangements to keep the public informed during emergencies, and to provide advice and assistance to local business and voluntary agencies about business continuity. Category 1 & 2 responders have a duty to cooperate and share information for the purpose of civil protection.

Answer 70

Build resilience: Set up/improve surveillance and forecasting systems Advocacy for political commitment Business continuity management plans (which appraise potential organisational risks, threats and vulnerabilities and proactively plans to mitigate their effects) Plan an effective response: Develop a risk profile to determine which potential emergencies you should prioritise Plan how to minimise the impact of the emergency: * What immediate actions can be taken, e.g. how will you know an event is an emergency (different services have usually defined situations that constitute an emergency or major incident), and how will you be alerted? * What remedial actions can then be taken to reduce the effects? * What is the recovery plan following these actions? Prioritise 3 groups in the plans: the vulnerable, the victims and the responders. Define roles and responsibilities of partners in an emergency. Train responders Maintain plans – they must be kept up to date. Establish lines of communication to other agencies and the public Multi-agency planning exercises and drills to test protocols

Answer 71

The management of an emergency will involve one or more of 3 levels of coordination, command and control for emergency incidents: * Bronze (operational): on-scene responders * Silver (tactical): near to scene directing response and allocating resources * Gold (strategic): off-site e.g. at headquarters coordinating multi-agency response. Attended by senior representatives from responding agencies; they must be able to commit to decisions and expenditure. * The Cabinet Office Briefing Rooms (COBR): For when there are more than one emergency response over several regions, offers a level of strategic oversight in the UK. A ‘bottom up’ approach (bronze upwards) is taken, as not all emergencies will require multi-agency strategic or on scene tactical coordination. The Gold command is supported by a team providing health advice - Scientific and Technical Advisory Cell (STAC) in the UK. It is chaired by a senior public health consultant, e.g. Director of Public Health, or Consultant in Communicable Disease Control/Consultant in Health Protection. There should be multi-agency representation from the health services/commissioners. Decisions should be taken at the lowest appropriate level, with co-ordination at the highest necessary level, i.e. response should be as local as possible, with higher level of response only if necessary for resources or coordination

Answer 72

Play a role when there is more than one emergency response over several regions, offers a level of strategic oversight in the UK. They take the strategic lead and is a forum of Ministers and senior officials from relevant Departments and agencies, brought together to make decisions on an emergency response. External representatives and experts are invited to attend COBR meetings as appropriate; discussions are confidential. COBR should facilitate rapid coordination of the Central Government response and effective decision-making. In an emergency where a central response is required, a Lead Government Department (LGD) is appointed. The LGD is responsible for ensuring that appropriate plans exist to manage the emergency, for ensuring that adequate resources are available and for leading on public and parliamentary handling. LGDs are also responsible for ensuring they have effective arrangements to access scientific and technical advice in a timely fashion in an emergency. This may involve establishing a Science Advisory Group for Emergencies (SAGE).

Answer 73

Gather information (METHANE): M – Major Incident Declared? E – Exact Location T – Type of Incident H – Hazards present or suspected A – Access – routes that are safe to use N – Number, type and severity of casualties E – Emergency services present, and those required Assess risk to health: * Review health effects and exposure pathways (obtain expert clinical/toxicological advice, weather modelling of plume) * Define affected population * Consider sampling persons, animals, environment * Establish register of exposed/symptomatic persons. Response: * Biological, chemical, or radiation release hazard: hazard containment, decontamination then primary treatment of victims, countermeasures, follow up * Infectious epidemic: containment by case detection and isolation and contact tracing, control measures, prophylaxis for exposed, arrange definitive treatment of cases, follow up. Communications: * Advise partner agencies and professionals via a STAC * Media (statement/press release/briefings) * Public (telephone helpline) Post acute-phase response – Activate recovery plans: * Site clean up * Clinical follow up of those affected * Initiate epidemiological study

Answer 74

Long-term follow up/surveillance of cases/exposed and analytic study Lessons learnt: * Written report * Audit of response * Review and revision of plans

Answer 75

Provide understandable scientific and technical advice during the response to the emergency Advise on impact on health of the population, and health impact of containment or evacuation policies Agree all media statements and advice to the public related to health with the Gold command chair Liaise with national departments of (public) health, other national and local agencies Formulate advice to health professionals, e.g. ambulance service, primary care Formulates advice on strategic management of the health service response.

Answer 76

Port Health Authorities are Local Authority environmental health departments and have powers to control the public health aspects of port activity involving ships, international trains and aircraft. Each Port Health Authority appoints port health officers and port medical officers.

Answer 77

1. Prevent the importation of disease, e.g. visit and inspect aircraft 2. Rodent control, e.g. ships must be inspected every 96 months for rats 3. Imported food, e.g. inspection and clearance of Products of Animal origin into the EU 4. Fish and shellfish, e.g. FSA monitor quality of local shellfish 5. Food premises inspections, e.g. monitors standards in shore-based premises and in-flight catering 6. Animal health, e.g. assist with enforcement of rabies controls.

Answer 78

May act as a Port Medical Inspector (PMI) providing advice to Immigration and Nationality service. Also involved in medical clearance (including Chest X-ray) in any person intending to remain in the UK for 6 months or more or those who are unwell.

Answer 79

Port Medical Inspector (PMI) gives medical clearance (including Chest X-ray) to any person intending to remain in the UK for 6 months or more or those who are unwell. Medical clearance may take place in the country of origin Persons with infectious diseases that are likely to endanger the health of others in the UK may be refused entry Unless entry is refused, details of any immigrant and results of any examination are passed to CCDC in the proposed area of residence Subsequent action can vary but include invitations to attend for further medical assessment

Answer 80

The International Health Regulations (IHR) are an agreement between 196 countries to work together for global health security. All countries are required to report events of international public health importance to the WHO with an aim to prevent, protect against, control and respond to the international spread of disease while avoiding unnecessary interference with international traffic and trade. The IHR were enforced in 2007 outlining that all countries must have the capacity to do the following; DETECT: Ensure surveillance systems and laboratories can identify potential threats. ASSESS: Work alongside other countries in making decisions for public health emergencies. REPORT: Report specific diseases and PHEICs (public health emergencies of international concern) RESPOND: Respond to public health occurrences.

Answer 81

Public health emergencies of international concern A PHEIC should be declared to the WHO if 2 of 4 following criteria are met: 1. Is the public health impact of the event serious? 2. Is the event unusual or unexpected? 3. Is there a significant risk of international spread? 4. Is there a significant risk of international travel or trade restrictions? Three PHEIC have been declared in recent years - H1N1 Influenza (2009), Polio (2014), Ebola (2014).

Answer 82

Always notifiable: Smallpox; Poliomyelitis due to wild-type poliovirus; SARS; Human influenza caused by a new subtype. Potentially notifiable: Cholera Plague Yellow Fever Viral haemorrhagic fever West Nile Fever Others included

Answer 83

A localised epidemic of two or more cases of disease related in time and or place in excess of normal expectancy.

Answer 84

a. Identify source and mode of spread b. Interrupt further transmission c. Prevent secondary spread d. Educate e. Introduce future preventative measures f. (prosecute)

2g Health Protection and communicable diseases Flashcards

(112 cards)