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Nurses' Roles in Disease Surveillance
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.
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