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VPD Surveillance and Outbreak Control – Measles Elimination Program in Thailand

VPD Surveillance and Outbreak Control – Measles Elimination Program in Thailand. Department of Disease Control Ministry of Public Health. National Disease Surveillance: passive surveillance. : Report 506. Surveillance and rapid response team 1,030 teams. Central - SRRT 4 teams.

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VPD Surveillance and Outbreak Control – Measles Elimination Program in Thailand

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  1. VPD Surveillance and Outbreak Control – Measles Elimination Program in Thailand Department of Disease Control Ministry of Public Health

  2. National Disease Surveillance: passive surveillance : Report 506

  3. Surveillance and rapid response team 1,030 teams Central - SRRT 4 teams Regional-SRRT 24 teams Provincial-SRRT 76 teams District-SRRT 926 teams Sub-district Village Health Volunteers

  4. Collect Analyse Interpret Capture Filter Verify Early Warning and Response System Surveillance: Case-based surveillance Event-based surveillance Data Reports Signal Response Assess Public health alert InvestigateControl Post-outbreak strengthening Evaluate

  5. Patient Patient Report 506/507 notify HCIS R506 computer-based program Flow of Report 506 Hospital ICD10 OPD Health Center SRRT Lab. IPD District Health Office Provincial Health Office

  6. 60 Diseases under506 surveillance 1. Food and Water borne diseases 2. Vaccine Preventable diseases 3. Vector-borne diseases 4. Zoonotic diseases 5. CNS Infectious diseases 6. Respiratory Infectious diseases 7. Other infectious diseases

  7. Vaccine PreventableDiseases • EPI program • Diphtheria • Tetanus • Pertussis • Hepatitis B • JE • Mumps • Measles • Rubella • Polio - AFP • Not EPI program • Chicken pox • Hepatitis A

  8. Objectives • To monitor trends of diseases • To detect outbreak • To describe epidemiological information • To identify high risk group of illness

  9. Example of VPD: Diphtheria Case definition

  10. Diphtheria Situation in Thailand DTP in Thailand

  11. Diphtheria outbreak in Loei, 2012 ร้อยละของอาการป่วยจากโรคคอตีบในอ.ด่านซ้าย 24 มิถุนายน –9 กันยายน 2555 (จำนวนผู้ป่วยรวม 32 ราย)

  12. Control measures • Close contacts including: • Household contacts • Classroom or workplace contacts • Any person who had history of contact to the patient during 2 weeks before to 4 weeks after onset of illness e.g. friend, relatives, neighbors, health care workers

  13. Control measures • All closed contacts must be prescribed Erythromycin 50mg/kg/day for 7 days (if throat swab positive, extend erythromycin to 10 days) and closely observe signs and symptoms of diphtheria

  14. Control measures • All close contacts must be checked for the history of vaccination • Complete 5 doses of DTP but more than 5 years ago: give dT 1 dose • Incomplete DTP: continue with the next doses according to routine immunization program • **Keep up vaccine coverage > 95% in the routine immunization

  15. Measles Elimination, Thailand Bureau of Epidemiology, DDC Bureau of General Communicable Diseases, DDC National Institute of Health, DMSc Bureau of Practical Development, DMS

  16. Measles elimination: WHO definition No endemic measles casefor at least 12 months Under an effective measles surveillance

  17. Effective measles surveillance • Suspected cases > 2:100000 pop at country level • Investigation with in 48 hr after case detection >80% • Measles IgM >80% of individual cases • Genotyping >80% of outbreak events

  18. Case definition • Suspected case • Fever > 38๐C AND cough AND maculo-papular rash with one of the following symptoms: • conjunctivitis (red eye) • runny nose • Koplik ‘s spot Each individual case needs to be reported and investigated according to measles elimination program

  19. Laboratory investigation • Individual case: single serum for Measles IgM • Outbreak: • 10 – 20 single serum specimens in an outbreak to confirm measles (Measles IgM) • 1 – 5 throat swab specimens (using influenza viral transport media) in an outbreak to identify measle virus genotype (viral isolation and PCR)

  20. ME Reporting system using online database

  21. Number of reported measles by month, Thailand, 2011 - 2012 2012 2011

  22. Number of reported measles by province, 2011 Measles outbreak จ.ลำปาง ก.ย. – ต.ค. Rubella outbreak น่าน พ.ค. Rubella outbreak ธ.ค. Measles outbreak Rubella outbreak สมุทรปราการ ก.พ Measles outbreak ก.ย. – ต.ค. Rubella outbreak ก.ย. – ต.ค. Number of cases Number of cases Measles outbreak ปัตตานี นราธิวาสต.ค. - ธ.ค. Rubella outbreak ปัตตานี ต.ค. R506 (75 prov) Measles elimination (41 Prov)

  23. Number of reported measles by province, 2012 Measles outbreak ม.ค. R/O Measles outbreak มิ.ย. Measles outbreak ก.พ. Measles outbreak ก.พ. Measles outbreak ก.ค. Number of cases Number of cases Measles cluster เม.ย. R506 (69 prov) Measles elimination (66 Prov)

  24. Confirmed Measles outbreak, 2012

  25. สรุปสถานการณ์โรคหัด • ประเทศไทยยังมีการเกิดโรคหัดภายในประเทศอย่างต่อเนื่อง และมีการระบาดเป็นกลุ่มใหญ่ประปราย • ยังมีกลุ่มอายุที่ไม่มีภูมิคุ้มกัน ได้แก่ 20 – 30 ปี โดยเฉพาะแรงงานต่างด้าว • ยังมีพื้นที่ที่ความครอบคลุมของวัคซีนต่ำ ทำให้เกิดการระบาดในเด็ก

  26. สรุปและข้อเสนอแนะต่อระบบเฝ้าระวังสรุปและข้อเสนอแนะต่อระบบเฝ้าระวัง • มีความพร้อมของการตรวจทางห้องปฏิบัติการที่ได้มาตรฐานทั้ง NIH และ ศูนย์วิทยาศาสตร์การแพทย์ • ควรมีการประเมินข้อมูลความครอบคลุมของวัคซีน • จังหวัดที่มีอัตราป่วยในเด็กสูง หรือ มีการระบาดในโรงเรียน

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