Name: GENEVIEVE B.

MUNDALA Date:  May 31, 2022

Course, Year, and Section: BSN 39th Batch Rating:

Unit III -Activity I

Developing Appreciation of the Nurses’ Roles in Disease Surveillance

INTRODUCTION
Nurses are among community health frontliners. They have a vital role in the
improvement of community’s health care. They are involved in planning,
implementation and evaluation of health care services. They are also decision makers in
matters relative to community health. As such in order to provide quality services
particularly on disease prevention, control and evaluation of its efficiency, they should
develop an appreciation in disease surveillance.

Objectives
By the end of the activity, the students will
1. Recognize the importance of disease surveillance in the prevention and control
of existing diseases in their locality.
2. Develop appreciation in their role as a nurse in the conduct of disease
surveillance.
Instructions
1. Read resource materials provided.
2. Make additional readings from Journals on disease surveillance.
3. Divide the class into four groups. (Groupings predetermined).
4. Discuss with members the concepts on Disease Surveillance. Each member
should actively participate in the discussion.
5. In a scale of 1 -5 rate, the degree of participation and contribution of ideas of
each groupmate.
6. In the discussion, be guided by the given questions.
7. Select a member who will summarize and submit the activity.

Guide Questions
1. What is your definition of disease surveillance?
Answer:
A close observation and continued watchfulness over the occurrence and
distribution of disease and events or conditions which increase the risk of
transmission.
2. Are there diseases in your community worthy of disease surveillance?
Answer:
Yes, dengue is one of those diseases that has to be put into under
surveillance.
3. Why is it important to conduct a disease surveillance of the disease occurring
in your locality?
Answer:
It is important to conduct disease surveillance in dengue for example to
detect epidemics quickly for early intervention. This will measure the burden
of disease and provide data for the assessment of the social and economic
impact of dengue on the affected community especially in our municipality.
Also, to monitor trends in the distribution and spread of dengue over time and
geographically. So that, we can evaluate the effectiveness of dengue
prevention and control programs and facilitate planning and resource
allocation on the basis of lessons learned from program evaluation.

4. What are the things that you are going to consider before you will conduct a
disease surveillance?
Answer:
a. Basis
 Consideration to be given in balancing the risk of an epidemic
occurring
 the value of early intervention in reducing the medical, social and
economic impact of the disease
 the finite resources available for investigation and control. 
 which diseases or conditions are reportable
 who are responsible for reporting what information is required for
each case of disease reported
 what information is required for each case of disease reported
 what manner of reporting is needed and to whom information is
reported
 Specific various protective measures to be taken in the event of
the occurrence of specified disease.
b. Preparation
 stablish objectives of disease surveillance system and determine
the data needed.
 Data Collect and review data Perform case investigation
 Organize the data
 Analyze and interpret the data
 Formulate Hypothesis concerning factors affecting disease
transmission and factors affecting disease transmission using the
above analysis and interpretation
 Test the hypothesis
 Recommend and or Implement control measures
 Prepare and distribute reports of data to all persons, agencies, etc.,
Disease control program includes; interpretations, projection of trends
and relevant recommendations for control.
  Assess the surveillance system
- Assess surveillance data: accuracy, completeness, timeliness
- Assess utilization and relevance of data
- Determine if surveillance objectives are being met.
- Develop and implement recommendations to improve the system
5. Identify at least 5 notifiable diseases considered by the Department of Health
with their standard case definition. (Each group should have different
notifiable diseases)
Answer:
1. Corona virus disease 2019- SARS-CoV
Clinical criteria
Any person with at least one of the following symptoms
- cough
- fever
- shortness of breath
- sudden onset of anosmia, ageusia or dysgeusia
Diagnostic imaging criteria
- Radiological evidence showing lesions compatible with COVID-19
Laboratory criteria
- Detection of SARS-CoV-2 nucleic acid or antigen in a clinical
specimen
Epidemiological criteria
At least one of the following two epidemiological links:
- close contact with a confirmed COVID-19 case in the 14 days
prior to onset of symptoms
- having been a resident or a staff member, in the 14 days prior to
onset of symptoms, in a residential institution for vulnerable
people where ongoing COVID-19 transmission has been confirmed
Case classification
A. Possible case: Any person meeting the clinical criteria
B. Probable case: Any person meeting the clinical criteria with an
epidemiological link or any person meeting the diagnostic imaging criteria
C. Confirmed case: Any person meeting the laboratory criterion.
2. Hand-foot and mouth disease
Suspected case of HFMD
- Any individual, regardless of age developed acute illness with
papulovesicular or maculopapular rash on palms and soles, with or
without vesicular lesion/ulcers in the mouth.
Probable Case of HFMD
- A suspected case that has not yet been confirmed by a laboratory
test, but is geographically and temporarily related to a laboratory-
confirmed case.
Case of Confirmed HFMD
- A suspected case with a positive laboratory result for human
Enteroviruses that cause HFMD
Case of Severe Enteroviral Disease
 - Any child less than 10 years of age: with fever plus severe signs
and symptoms referable to central nervous system involvement,
autonomic nervous system dysregulation and cardiopulmonary
failure.
- Or a suspect or probable HFMD case with complication
- Or who died <48hours after presenting with fever and CNS
involvement.
Confirmed Case of Severe Enteroviral Disease
- A suspected case of severe enteroviral disease that has positive
laboratory results for EV71

3. Measles
Suspected Measles Case
- Any patient in whom a health care provider suspects the
possibility of measles.
Suspected Rubella Case
- Any patient in whom a health care provider suspects the
possibility of rubella. In suspected measles or rubella cases, a
serum sample should be collected from the patient upon initial
contact with the health provider.  This sample must be collected
within 30 days of rash onset to be considered adequate.
Laboratory-Confirmed Case
- A suspected measles or rubella case that after complete
investigation is:
o Confirmed as either measles or rubella using
commercially available enzyme immunoassays (EIA) for
measles or for rubella IgM antibodies, and/or
o Confirmed by isolation of measles or rubella virus and/or
o Epidemiologically linked to another laboratory-confirmed
case (the epidemiological link is established if any contact
between the suspected case and the laboratory-confirmed
case has occurred anytime during the month prior to rash
onset).
Clinically-Confirmed Case
- a suspected measles or rubella case that is not completely
investigated for any reason. This could include: patients that died
before the investigation was complete, patients lost to follow-up,
or patients without adequate specimens submitted for laboratory
analysis.
Discarded
- A suspected measles or rubella case that has
been completely investigated, including an adequate blood
specimen, which lacks serologic evidence of infection, has no virus
isolated, and does not have epidemiological link to a laboratory-
confirmed case. If laboratory
results indicate another viral infection compatible with the clinical
symptoms, such as dengue, the case should be discarded as well.
 Imported Measles Case
- A confirmed measles case in a person who traveled to another
country with documented measles circulation during the possible
exposure period (7-18 days prior to rash onset). The possibility of
local exposure must be ruled out through careful investigation.
4. Polio
Suspected Case
- Any case of acute-onset flaccid paralysis (AFP), including Guillain-
Barré syndrome, in a person under 15 years of age for any reason
other than severe trauma, or paralytic illness in a person of any
age in which polio is suspected. The classification "suspected
case" is temporary. It should be reclassified as "probable" or
"discarded" within 48 hours of notification.
Probable Case
- A case in which AFP is found, and no other cause for the paralysis
can be identified immediately. The classification of "probable
case" is also temporary; within 10 weeks of onset the case should
be reclassified as "confirmed", "compatible", "vaccine-associated"
or "discarded."
Confirmed Case
- case with acute paralytic illness, with or without residual paralysis,
and isolation of wild poliovirus from the stools of either the case
or its contacts.
Polio-compatible Case
- A case in which one adequate stool specimen was not collected
from a probable case within 2 weeks of the onset of paralysis, and
there is either an acute paralytic illness with polio-compatible
residual paralysis at 60 days, or death takes place within 60 days,
or the case is lost to follow-up.
Vaccine-associated Paralytic Poliomyelitis case
- A case with acute paralytic illness in which vaccine-like poliovirus
is isolated from stool samples, and the virus is believed to be the
cause of the disease. There are two possible types of vaccine-
associated paralytic poliomyelitis (VAPP): recipient and contact. A
case classified as a recipient is a person who has onset of AFP 4
to 40 days after receiving OPV and has neurologic sequelae
compatible with polio 60 days after the paralysis began. A case is
classified as a contact VAAP when a person who has residual
paralysis 60 days after the onset of AFP had contact 4 to 40 days
before the paralysis began with a person who received OPV
somewhere between 4 and 85 days before the contact's paralysis
began.

Discarded (Not Poliomyelitis) Case

- A case with acute paralytic illness for which one adequate stool
specimen was obtained within 2 weeks after onset of paralysis
and was negative for poliovirus.
5. Dengue Fever
Clinical Description
- An acute febrile illness of 2-7 days duration with 2 or more of the
following: headache, retro-orbital pain, myalgia, arthralgia, rash,
hemorrhagic manifestations, leucopenia.
Laboratory Criteria for Diagnosis: One or more of the following:
- Isolation of the dengue virus from serum, plasma, leukocytes, or
autopsy samples,
- Demonstration of a fourfold or greater change in reciprocal IgG or
IgM antibody titers to one or more dengue virus antigens in
paired serum samples,
- Demonstration of dengue virus antigen in autopsy tissue by
immunohistochemistry or immunofluorescence or in serum
samples by EIA,
- Detection of viral genomic sequences in autopsy tissue, serum or
CSF samples by polymerase chain reaction (PCR).
Case classification
Suspected
- A case compatible with the clinical description.
Probable
- A case compatible with the clinical description with one or more
of the following:
o supportive serology (reciprocal hemagglutination-
inhibition antibody titre greater than 1280
o comparable IgG EIA titre or positive IgM antibody test
in late acute or convalescent-phase serum specimen)
occurrence at same location and time as other
confirmed cases of dengue fever.
Confirmed
- A case compatible with the clinical description, laboratory-
confirmed.
Criteria for Dengue Hemorrhagic Fever/Dengue Shock Syndrome
Dengue Hemorrhagic Fever
- A probable or confirmed case of Dengue and Hemorrhagic
tendencies evidenced by one or more of the following:
o Positive tourniquet test
o Petechiae, ecchymoses or purpura
o Bleeding: mucosa, gastrointestinal tract, injection sites
or other
o Hematemesis or melena
and thrombocytopenia (100 000 cells or less per mm3)
and evidence of plasma leakage due to increased
vascular permeability, manifested by one or more of
the following:
 more than 20% rise in average
hematocrit for age and sex
  more than 20% drop in hematocrit
following volume replacement treatment
compared to baseline
 signs of plasma leakage (pleural
effusion, ascites, hypoproteinemia)
Dengue Shock Syndrome
- All the above criteria, plus evidence of circulatory failure
manifested by rapid and weak pulse, and narrow pulse pressure
(less than 20 mm Hg) or hypotension for age, cold, clammy skin
and altered mental status.

6. Why is it important to have a standard case definition for each disease under
surveillance?
Answer:
Case definitions have been recognized to be important elements of public
health surveillance systems. They are to assure comparability and consistency
of surveillance data and have crucial impact on the sensitivity and the positive
predictive value of a surveillance system. The reliability of case definitions has
rarely been investigated systematically.

7. What important information are you going to include in your case finding?
Answer:
 Name of patient, Sex, Occupation, Address, Immunization status,
Place or source of infection, date of onset, etc.
 When?
- Regular reporting as prescribed – weekly, monthly
- Immediate reporting for potential epidemic: Within 24 hrs.
- Information may be through telephone, telegram, fax, any
form of social media.
- Full information follows later in regular reporting
 How? Use prescribed forms
- Use of special forms
- Use of telecommunication
- Follow procedures prescribed by the Health Department for
National, Regional, District morbidity reporting and
surveillance of diseases.
 To Whom?
- Local Epidemiologist (sentinel)
- Those in charge of the disease control program
 Who are responsible for reporting?
- Health practitioners
- Administrators of health facilities
 - Individuals knowing of suspecting the existence of
reportable disease
 Consolidation of Data
 Analysis and Interpretation

8. How will you describe the results of your disease surveillance?

What important information are you going to give emphasis in the discussion
of results.
Answer:
Results of disease surveillance which have a direct bearing on and must
be considered in the analysis and interpretation of collected data.
- Accuracy – the quality or state of being correct/ precise.
o Is sensitivity + specificity
Represents the proportion of true positive
results (both true positive and true negative) in a
population.
- Sensitivity – the ability to test to correctly identify those with
the disease. (true positive)
- Specificity – the ability of the test to correctly identify those
without the disease. (true negative)
- The degree to which the accuracy and sensitivity of the data
remain the same over extended periods of time or are
similar in different places, determines the comparability of
the surveillance data from one place over time or from
different places over the same period of time.
- The comparability of surveillance data must be maintained if
the important epidemiologic indices and trends are to be
identified and used.
9. As a nurse how will you help the physician (MHO) in the conduct of disease
surveillance? What are your roles?
Answer:
As nurses work on the front lines, they stand in an excellent position to
rapidly identify communicable diseases and spot infectious pathogens
early. Prevention is the ideal response to a potential disease outbreak. The
key to prevention is early recognition.  Nurses in community or public health
who have regular and ongoing connections to community members are
positioned to recognize symptoms of new or reemerging infectious diseases.
Further, nurses help tracks symptoms. They can also refer patients and
educate them about disease transmission and how to protect themselves and
others.
Additionally, nurse can work to develop early reporting networks that
keep public health officials and public health organizations, such as local
 health departments, informed so they can take early preventive measures and
communicate with the public.

10. How did you feel about the activity?

Answer:
This activity feels like you have figured it all out in taking care not just
for an individual’s health, but you’re going to deal with family’s health and the
community at large. The vital role of nurses is undeniable. It is the adaption in
the community that is the tricky part, but once the daunting new environment
is ‘old news’, the experience really starts to becomes challenging yet
enjoyable. This is a new set of challenge. The way you do so may change in
efforts to limit disease spread and to protect their health and the health of
your patients. It has introduced you to a new dynamic of nursing profession in
the field of community health.

Thank you God Bless and Keep Safe Always!