Supplementary: Diarrheal Diseases: A true life example from Haiti, 20

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Health in Complex Humanitarian Emergencies

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Emory University

Health in Complex Humanitarian Emergencies

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The Center for Humanitarian Emergencies is a partnership between CDC's Emergency Response and Recovery Branch and the Rollins School of Public Health that drives global collaboration, research and evidence based training to improve the lives and well-being of populations impacted by humanitarian emergencies. - Center for Humanitarian Emergencies: http://www.che.emory.edu/ - CDC's Emergency Response and Recovery Branch: http://www.cdc.gov/globalhealth/healthprotection/errb/index.html This course covers the technical and management principles that are the basis of planning, implementing, and evaluating health programs for acutely displaced populations in developing countries. The emphasis is on refugees in camp situations. The course includes modules on assessment, nutrition, epidemiology of major health problems, surveillance, and program management in the context of an international relief operation. Course Objectives Upon completion of this course, learners will be able to: 1. Describe a complex humanitarian crisis in terms of magnitude, person, time and place. 2. Calculate basic epidemiology measures. 3. Evaluate the strengths and limitations of epidemiological data within the context of CHE. 4. Develop public health programs and strategies responsive to the diverse cultural values and traditions of the community being served. 5. Identify internal and external problems that may affect the delivery of essential public health services in a CHE. 6. Identify the different technical areas in a public health response in CHEs.

À partir de la leçon

Disease Control

Disease control, and communicable non-communicable diseases.

Diarrheal Diseases10:35

Vaccine Preventable Diseases / Measles10:54

Malaria Control8:49

Infectious Disease Emergency Response8:09

Communicable Diseases - Acute Respiratory Infections10:59

Non-Communicable Diseases8:28

Overview/Summary1:28

Supplementary: Diarrheal Diseases: A true life example from Haiti, 204:37

Rencontrer les enseignants

Dabney P. Evans, PhD, MPH
Assistant Professor
Hubert Department of Global Health. Rollins School of Public Health. Director, Center for Humanitarian Emergencies.
Cyrus Shahpar
Assistant Professor, Adjunct Assistant Professor
Department of Emergency Medicine, School of Medicine & Hubert Department of Global Health, Rollins School of Public Health

Hi, my name is Doctor Eric Mintz and I am an epidemiologist at the CDC,

the Centers for Disease Control and Prevention in Atlanta.

Today I'm going to talk about a real life example of how diarrheal

diseases surveillance was implemented in a complex humanitarian emergency.

On January 12th 2010, Haiti experienced a magnitude 7.0 earthquake.

The earthquake caused massive destruction of almost all infrastructure.

Within days over 200,000 persons had died and

over 1.4 million person were displaced.

The epicenter of the earthquake was near the capital Port-au-Prince.

The US embassy in Port-au-Prince where the CDC country office was located immediately

became the headquarters for all US government supported relief efforts.

And CDC work closely with the Ministry of Health and NGOs

to initiate disease surveillance and sent into health facilities around the country.

And in camps, for internally displaced persons in the Port-au-Prince area.

Our team was asked to help lead the surveillance effort for diarrhea and

other infectious diseases.

Before boarding the CDC jet to Port Au Prince,

we learned that rates of malnutrition and HIV were high.

Vaccine coverage was low and 11% of the population was under 5 years old.

We also learned that typhoid fever and shigella were endemic in Haiti, but

that cholera had never been reported.

Despite the fact that coverage with safe water and sanitation was very low.

Unfortunately, there was no information available on baseline disease rates.

However, we knew that oral rehydration solution was widely used for

diarrheal treatment.

Disease surveillance through sentinel health facility sites began on January

25th for all of the diseases listed here.

Each day, the sentinel sites reported the numbers of patients seen with

each of the 13 conditions shown here in white, including acute watery diarrhea and

acute bloody diarrhea.

Nationwide, all health providers were immediately

told to report any of the top six conditions in gray and

suspected outbreaks of any of the remaining of 13 conditions.

Sentinel surveillance was extended to the 21 major

IDP camps in Port-au-Prince on February 18th.

The disease surveillance form included information on age group and

on the number of deaths attributed to each disease.

Graphs like this one allowed us to follow trends in disease occurrence and maps

allowed us to visualize where reported diseases and deaths were most prevalent.

We even followed the number of newly constructed latrines and

showers in the camps for displaced persons.

To have a sense for whether diarrheal disease prevention efforts were on track.

As all this was getting started, we trained and

equipped the laboratory with everything they needed.

To perform rapid test for cholera ,typhoid fever and

shiga toxin-producing bacteria, such as Shigella dysenteriae.

And to isolate and identify these pathogens from stool culture and

to test the isolates for antimicrobial resistance.

And then the unthinkable occurred.

On October 20th, ten months after the earthquake surveillance was launched,

a cluster of adult patients with acute watery diarrhea and death was reported.

Stool samples from ten surviving patients were brought to the National Public Health

laboratory.

Rapid tests for cholera were performed and

eight of the ten tested positive for cholera.

By the next evening, the diagnosis of cholera was confirmed by stool culture.

The following day, antimicrobial susceptibility testing was initiated and

isolates were sent to CDC for further testing.

By October 23rd, we had returned to Haiti.

Despite the early detection of cholera,

we were too late to prevent the epidemic from spreading throughout the country.

And causing over 750,000 cases of whom over

400,000 were hospitalized and over 8,000 died.

The epidemic continues today and reminds us of the need to re-double

our efforts at prevention of diarrheal diseases.

Thank you and for

more information on diarrheal diseases, please visit the CDC website.

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