Principles of Epidemic
Preparedness and
Response
Reported Cases of Encephalitis in Nepal,
1997-1998
350
1997
300
Cases
250
1998
200
150
100
50
0
Source: EWARS
Week No
Objectives of Epidemic
Preparedness and Response
1. Anticipation/prediction
• so that epidemics be prevented
• e.g. meningitis, measles
2. Early detection
• to know when there is a problem
• e.g. EWARS
3. Rapid Response
• guidelines/trained staff/supplies
• in place before epidemic
4. Effective Response
• appropriate control methods
• adequate resources and logistics
Outbreak Detection and Response
Without Preparedness
First
Case
Delayed
Response
90
80
70
60
50
40
30
20
10
0
DAY
40
37
34
31
28
25
22
19
16
13
10
7
Opportunity
for control
4
1
CASES
Late
Detection
Outbreak Detection and Response
With Preparedness
Early
Rapid
Detection Response
DAY
40
37
34
31
28
25
22
19
16
13
10
7
Potential
Cases Prevented
4
1
CASES
90
80
70
60
50
40
30
20
10
0
FASTER
BETTER
Components of Epidemic Preparedness
1 Establish Epidemic Committee
2. Set priorities
3. Agree epidemic preparedness plan
4. Implement surveillance
5. Respond rapidly and effectively
Epidemic Preparedness
and Response Committee - I
• Who should be on the committee ?
• Technical
• Political
• Practical
• What are the tasks of the committee?
• Before the epidemic
• During the epidemic
• After the epidemic
Epidemic Preparedness
and Response Committee II
• Before the epidemic !
• Set priorities
• Write the epidemic preparedness and
response plan
• Define prevention and control strategies
(versatility, adaptability)
• Assign specific responsibilities for
surveillance, preparedness and response
• Identify and mobilise resources
Epidemic Preparedness
and Response Committee IIa
• Identify and mobilise resources
• HUMAN
• FINANCIAL
• PRACTICAL
Priority Setting - I
• What are the major epidemic prone diseases ?
• What is the risk of an epidemic ?
• time since last outbreak,
• frequency of previous outbreaks
• recent disease trends
• What would be the likely impact of an epidemic ?
• Potential number of cases
• Potential deaths
• Likelihood of spread
• Control measures ?
• Are effective and affordable measures available ?
• Resources ?
• Do we have adequate resources ?
Priority setting - II
Epidemic
prone disease
Cholera
Risk
Impact
High
High
Low
High
Measles
Low
Low
JE
High
Low
Malaria
Low
High
Viral HF
Low
Low
Meningitis
Control
measures
Resources
X
X
X
Epidemic Preparedness
and Response Plan - I
• List the priority diseases
• Define the surveillance, preparedness and
response measures to be implemented
• Identify responsibilities (who does what)
• Identify co-ordination mechanisms (leadership)
• Specify resources available for preparedness and
response (budget)
Epidemic Preparedness
and Response Plan - II
• What should be done ?
• Who should do it ?
• What resources or supplies
will be required ?
Surveillance - I
Health Care System
Case
Public Health Authority
Report
Confirm
Detection
OUTBREAK
Control
Investigation
Decision
Measures
Response
Surveillance - II
Support function
•
•
•
•
advocacy for training
supervision
resource
standards/guidelines
Epidemic Preparedness
and Response Committee - II
• During the epidemic !
•
•
•
•
Implement the plan
Rapid and coordinated response
Implement prevention and control strategies
Identify and mobilise resources
Rapid Response - I
• Early epidemic control team meeting
• Early assessment of the potential scale of
the outbreak
• Co-ordinated investigation and
implementation of control measures
• Public information
– Health education
– Media strategy
Authorities
Public
Support services
Outbreak
and
investigation
logistics
Epidemic
response
committee
Environment
Laboratory
Control measures
Media
Reports
Epidemic Preparedness
and Response Committee - III
• After the epidemic !
•
•
•
•
•
•
Evaluate the preparedness and the response
Review and update the plan
Modify prevention and control strategies
Identify and mobilise resources
Anticipate new outbreaks
Strengthen surveillance
PREPAREDNESS
Committee
Priorities
Plan
Co-ordination
Responsibilities
Resources
Supplies
Training
Surveillance
Rapid Response
OUTBREAK CONTROL
Investigate
Detect &
Confirm
Analyse
Respond
Treat
Control
Predict
& Prevent
Evaluate
Preparedness planning in
different settings
• Hospital
• Local
• Disease-specific
• National
• International
Be
Prepared !