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เฝ้าระวังโรคตามกลุ่มอาการ

เฝ้าระวังโรคตามกลุ่มอาการ. Kriangsak_v@yahoo.com. What is Syndromic Surveillance ?. The ongoing, systematic collection, analysis, interpretation, and application of real-time indicators for disease that allow for detection before public health authorities would otherwise identify them.

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เฝ้าระวังโรคตามกลุ่มอาการ

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  1. เฝ้าระวังโรคตามกลุ่มอาการเฝ้าระวังโรคตามกลุ่มอาการ Kriangsak_v@yahoo.com

  2. What is Syndromic Surveillance ? • The ongoing, systematic collection, analysis, interpretation, and application of real-time indicators for disease thatallow for detection before public health authorities would otherwise identify them. Source: Dan Wartenberg PhD. Robert Wood Johnson Medical School, USA

  3. ธรรมชาติของการเกิดโรคธรรมชาติของการเกิดโรค Symptom Disease No Disease Asymptomatic W D Exposed Death Test Dx S/S Behavior Bio-marker Diseases Syndrome

  4. What are indicators of Diseases ? Example: Fever + Runny nose + Sore throat + Cough + Fatigue = Influenza-like illness “ Indicators” are clinical symptoms & signs that we can categorize into syndromes, but “ NOT a specific diagnosis ! ”

  5. Why do Syndromic Surveillance ? • Early detection of clusters in naturally occurring outbreaks or a BT event – Minimizes mortality & morbidity • Characterize outbreak – Magnitude, rate of spread, effectiveness of control measures • Quick investigation • Detection of unexplained deaths

  6. สำนักงานระบาดวิทยา • Hemorrhagic Fever Syndrome • Respiratory Syndrome • Gastrointestinal Syndrome • Neurological Syndrome • Skin Syndrome • Undefined Reportable Syndrome

  7. Hemorrhagic Fever Syndrome DHF DSS Hantavirus Ebola • มีไข้สูง นอนซึม มีผื่นหรือจุดแดงที่ผิวหน้ง • มีไข้สูง มีเลือดออก อาเจียน ถ่ายอุจจาระเป็นสีดำ • มีไข้สูง มีจุดแดงที่ผิวหนัง ถ่ายปัสสาวะไม่ออก • มีไข้สูงเฉียบพลัน อาเจียน ถ่ายอุจจาระเป็นเลือด มีอาการเลือดออกอย่างรุนแรง ความดันต่ำรุนแรง • มีไข้สูง มีเลือดออก ซึม ตัวเหลือง ตาเหลือง ตามองไม่เห็น Rift Valley Fever

  8. Respiratory Syndrome Flu Pneumonia Legionnaire, Melioidosis Hanta virus TB Diphtheria Pertussis Plague • มีไข้ ปวดศีรษะ ปวดเมื่อยตามตัว • มีไข้ ไอเจ็บหน้าอก หายใจหอบเหนื่อย • มีไข้ ไอเป็นเลือด • มีไข้ เจ็บคอ มีแผ่นฝ้าขาวในลำคอ • มีไข้ ไอติดต่อกันอย่างรุนแรง • มีไข้ ต่อมน้ำเหลืองโต ไอ หอบรุนแรง

  9. Gastrointestinal Syndrome Food poisoning Cholera Salmonellosis, Enteric fever E.Coli O157, Shigellosis Hepatitis Leptospirorsis Yellow fever • อุจจาระร่วง และมีอาเจียนร่วมด้วย • อุจจาระร่วง(คล้ายน้ำซาวข้าว) อาเจียน • อุจจาระร่วง มีไข้ • อุจจาระร่วง มีมูก มีเลือด • อุจจาระร่วง มีไข้ ตาเหลือง ตัวเหลือง

  10. เครือข่ายและการไหลเวียนรายงานเครือข่ายและการไหลเวียนรายงาน สอ. SR, SRE0, SRE1, SRDR, SRE2, SRE3 ส่ง SR ภายใน 3 วัน สสอ. ส่ง SR ภายใน 3 วัน SRE0, SRE1, SRDR, SRE2, SRE3 รพช. คปสอ. ส่ง SR ภายใน 4 วัน ส่ง SR ภายใน 3 วัน SRE0, SRE1, SRDR, SRE2, SRE3 SRE0, SRE1, SRE2, SRE3 ของจังหวัด รพท./รพศ. สสจ. ส่ง SRE2, SRE3 ภายใน 5 วัน ส่ง SR ภายใน 5 วัน ระบาดภาค SRE2, SRE3 ระดับภาร/เขต ส่ง SRE2, SRE3 ภายใน 14 วัน คปสข. สคต. กองระบาดฯ

  11. World Health Organization • Acute hemorrhagic fever syndrome • Acute lower respiratory tract infections • Acute (watery) diarrhea • Acute (bloody) diarrhea • Antimicrobial resistance • Anti-tuberculosis drug resistance • Food borne diseases • Sexually transmitted diseases/syndrome

  12. Acute hemorrhagic fever syndrome Recommended Case Definition: Clinical case description: Acute onset of fever of less than 3 weeks duration in a severely ill patient and any 2 of the following • Hemorrhagic or purpuric rash • Epistaxis • Hematemesis • Hemoptysis • Blood in stools • Other hemorrhagic syndrome and no known predisposing host factors for hemorrhagic manifestation

  13. Acute hemorrhagic fever syndrome • Dengue hemorrhagic fever • Ebola-Marburg viral diseases • Lassa fever • Yellow fever • Rift Valley • Hatavirus infection • Crimean-Congo hemorrhagic fever • Other viral, bacterial or rickettsial diseases

  14. Acute hemorrhagic fever syndrome Recommended Type of Surveillance : Immediate case-based reportingof acute hemorrhagic fever syndrome whether occurring singly or in cluster, from peripheral to intermediate and central level, in order to ensure rapid investigation and laboratory confirmation. All cases must be investigated, with contact tracing. Blood samples and appropriate clinical specimens must be collected to confirm a diagnosis as rapidly as possible.

  15. Acute (watery) diarrhea Clinical case definition: Acute watery diarrhea (passage of 3 or more loose or watery stools in the past 24 hours) with or without dehydration Laboratory criteria for diagnosis: Laboratory culture of stools may be used to confirm possible outbreak of specific agents, but is not necessary for case definition. Case classification: Not applicable.

  16. Acute (watery) diarrhea Recommended Type of Surveillance: Routine monthly/ weekly reporting of aggregated datafrom peripheral level to intermediate and central level. Community surveys/sentinel surveillance to complement routine data and for the evaluation of control program activities. Note:If laboratory examination are undertaken at the start of an outbreak in order to identify the causative agent, this need not be continued once the causative agent has been identified (unnecessary burden on laboratory facilities).

  17. Information Flow Peripheral Intermediate National Epidemiological bulletin; Electronic media MOPH Central Regional / International WHO Weekly Epidemiological Record; Regional Bulletin; Electronic media

  18. WHO Sample Format ICD code Disease name Rationale for surveillance Recommended case definition Recommended type of surveillance Recommended minimal data elements Recommended data analysis, presentation, reports Principal uses of datafor decision-making Special aspects Contact information

  19. CDC Syndrome Definitions for Diseases Associated with Critical Bioterrorism-associated Agents • Botulism like • Hemorrhagic illness • Lymphadenitis illness • Localized cutaneous lesion • Gastrointestinal • Respiratory • Neurological • Rash • Specific infection • Fever • Severe Illness or Death potentially due to infectious disease

  20. Botulism like Syndrome Syndrome Definitions for Diseases Associated with Critical Bioterrorism-associated Agents Definition: • ACUTE condition that may represent exposure to botulinum toxin • ACUTE paralytic conditions consistent with botulism: cranial nerve VI (lateral rectus) palsy, ptosis, dilated pupils, decreased gag reflex, media rectus palsy. • ACUTE descending motor paralysis (including muscles of respiration) • ACUTE symptoms consistent with botulism: diplopia, dry mouth, dysphagia, difficulty focusing to a near point.

  21. Rash Syndrome Syndrome Definitions for Diseases Associated with Critical Bioterrorism-associated Agents Definition: • ACUTE condition that may present as consistent with smallpox (macules, papules, vesicles predominantly of face/arms/legs) • SPECIFIC diagnosis of acute rash such as chicken pox in person > XX years of age (base age cut-off on data interpretation) or smallpox • ACUTE non-specific diagnosis of rash compatible with infectious disease, such as viral exanthem • EXCLUDES allergic or inflammatory skin conditions such as contact or seborrheaic dermatitis, rosacea • EXCLUDES rash NOS, rash due to poison ivy, sunburn, and eczema

  22. Severe Illness or Death potentially due to infectious disease Definition: • ACUTE onset of shock or coma from potentially infectious causes • EXCLUDES shock from trauma • INCLUDES SUDDEN death, death in emergency room, intrauterine deaths, fetal death, spontaneous abortion, and still births • EXCLUDES induced fetal abortions, deaths of unknown cause, and unattended deaths

  23. Severe Illness-Death due to ID ICD-9-CM Code List

  24. Process mode for early outbreak detection Output Process stage Data collection and processing Real time data forearly outbreak detection Automate statistical Analysis Signal:Somethingunusual noted Epidemiological analysis and interpretation Low probabilityof outbreak High probabilityoutbreak Error True increasein disease Natural variationin diseaseno outbreak Reportinganomaly DataProcessingerror Investigation Epidemiologic Forensic Naturaloutbreak Deliberateoutbreak

  25. Surveillance Data Flow Chart Human view of automated decisions-verification and response Automate data capturing analysis and alerting system Patient encounter dataMultiple sources Historicaldata Action Syndrome Classification Createmodel Syndrome>expected Monitoringclosely Signal Syndrome<expected Periodicsum Analysisalgorithm No action No action False negative

  26. Syndromic Surveillance for EnvOcc. • ICD code, Disease name ? • Rationale for surveillance ? • Case definition ? • Minimal data elements ? • Principal uses of data for decision-making ?

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