Principles of Epidemic Preparedness and
Response
Reported Cases of Encephalitis in Nepal, 1997-1998
0
50
100
150
200
250
300
350
1 5 9 13 17 21 25 29 33 37 41 45 49
Week No
Cas
es
1997
1998
Source: EWARS
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
0
10
20
30
40
50
60
70
80
90
Outbreak Detection and ResponseWithout Preparedness
Delayed Response
DAY
CASESOpportunity for control
Late Detection
First Case
0
10
20
30
40
50
60
70
80
90
Outbreak Detection and ResponseWith Preparedness
Rapid Response
DAY
CASES
Early Detection
Potential Cases Prevented
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 Risk Impact Control Resourcesprone disease measures
Cholera
Meningitis
Measles
JE
Malaria
Viral HF
High High
Low
Low
Low Low
High
High
Low
High
Low
Low
X
XX
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)
• What should be done ?
• Who should do it ?
• What resources or supplies will be required ?
Epidemic Preparedness and Response Plan - II
Surveillance - I
Health Care System Public Health Authority
Case
DetectionConfirm
DecisionControl
Measures
Investigation
Response
Report
OUTBREAK
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
Outbreakinvestigation
Laboratory
Support servicesand
logistics
MediaControl measures
Reports
PublicAuthorities
Environment
Epidemic response
committee
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 OUTBREAK CONTROL
Detect & Confirm
Investigate
Analyse
Respond
Evaluate
Predict & Prevent
Treat
Control
CommitteePriorities
PlanCo-ordination
ResponsibilitiesResourcesSuppliesTraining
SurveillanceRapid Response
Preparedness planning in different settings
• Hospital
• Local
• Disease-specific
• National
• International
Be
Prepared !