GEIS Outbreak Investigations

Background

GEIS has been established to recognize and track disease occurrences in the Southeast Asian region. It is part of a global reporting network. There is some capacity to respond to certain types of outbreaks such as: Malaria, Gastrointestinal Diseases, Japanese Encephalitis, Dengue and DHF, Hepatitis A & E, Scrub Typhus.

How contact GEIS

Typically outbreak activities are forwarded to us for review through the WHO-SEARO or local health authorities. A request for GEIS evaluation can be directly initiated by this email contact. geis@afrims.org

Please provide a detailed description of the disease activity that you are concerned about and we will provide a response in the shortest time possible.

When Does GEIS investigate an Outbreak?

We investigate outbreaks in Southeast Asia. If an unusual infectious disease illness pattern or characteristic is found within our area of expertise (e.g., relatively high incidences of illnesses, unusual severity of illnesses or complications, a high number of persons reporting illnesses over a brief period of time, or suspicion of an uncommon etiologic agent), an investigation may take place. Other factors such as levels of local political and medical support as well as funding will help determine if investigations can occur.

Specialty Areas: Malaria, Gastrointestinal Diseases, Japanese Encephalitis, Dengue and DHF, Hepatitis A & E, Scrub Typhus.

What happens in an Outbreak Investigation?

Conducting an outbreak investigation is a cooperative effort that demands a rapid, organized, complete, and reliable responses by the local and national health authorities and GEIS team.

The objectives of an investigation are to:

• Determine the magnitude of illness.
• Identify the agent causing the illness.
• Identify risk factors associated with the illness.
• Formulate control measures to stop and prevent the spread of the illness.
• By determining the cause of an outbreak, the GEIS can help devise an effective intervention strategy to prevent a similar event from recurring

There are three concurrent phases of an investigation:
Epidemiological investigation. The patients who were or are ill are interviewed, and are asked to complete a standardized questionnaire. With the patient and local health authorities cooperation, a 100% return of completed questionnaires is expected. Additional information will be collected, including the community layout; customs and traditions; types of meals or activities, and other pertinent data.

Laboratory investigation. To confirm clinical suspicions of an agent or agents responsible for the outbreak, medical staff may collect blood, stool, and vomitus specimens as well as collection of potential vectors or disease reservoirs from patients or the affected community. Specimens may also be collected from non-ill individual for comparison.

Environmental health investigation. A comprehensive environmental health investigation is conducted and tailored to address the specific needs of the epidemiological investigation. For example, if preliminary data indicate water as a likely source, much more attention may be spent reviewing all aspects of the water system. In addition to a sanitary inspection, the potable water, ice, food, and other environmental samples may be collected for appropriate testing.

What Happens to information collected during an Outbreak Investigation?

Whenever possible, GEIS officials present a preliminary report of findings from the investigation to the health authorities in charge before leaving. They may also provide a preliminary impression of the outbreak and make recommendations. Consultation among appropriate environmental health and infectious diseases programs at AFRIMS are routine, and written recommendations are usually made jointly. This report remains preliminary until more extensive epidemiological and laboratory studies are completed.

On the basis of preliminary findings, GEIS may request additional materials from the health authorities and may undertake follow-up studies to address specific suspicions or concerns.

Upon completion of the investigation, a final report that describes details of the outbreak; results of epidemiological, laboratory, and environmental analyses; and summary recommendations for control and prevention will be forwarded to the health authorities for appropriate distribution.

How is information made available?

Upon completion of an investigation, a final report is prepared. Copies of the report may be found on this website or by writing:

USAMC-AFRIMS
GEIS section
315/6 Rajvithi Rd.
Bangkok, Thailand 10400

GEIS Outbreak Reports 2002
1. Scrub Typhus Thailand
2. Typhoid Fever Nepal
3. Influenza Maldives
4. Malaria Nepal
5. Scrub Typhus Maldives
6. Meningococcemia Thailand

Scrub Typhus Thailand
June 2002
Support the RTA investigation of an outbreak of scrub typhus in an RTA infantry battalion in June. Twelve cases were identified and the home post of the battalion was ruled out as the source while the training area commonly used was found to harbor Orientia tsutsugamushi rickettsia.

Typhoid Fever Nepal
July 2002
AFRIMS provided onsite epidemiologic and diagnostic evaluation in southern Nepal of Fevers of Unknown Origin which turned out to be probably the largest single source outbreak of multi-drug resistant typhoid fever ever reported in medical literature. Salmonella typhi affected over 6000 patients in a five week period and AFRIMS was able to accurately identify the causative agent, develop it resistant pattern, and identify through molecular typing that a single strain in the municipal water supply was the source. AFRIMS' provided key recommendations which were implemented by public health authorities. This cooperative relationship no doubt altered the destructive path of this epidemic.

Influenza Maldives
July 2002
In July, the Ministry of Health, Republic of Maldives, through the WHO, requested diagnostic assistance to determine the source of a respiratory febrile illness that was affecting over 4000 persons throughout the country. AFRIMS, through partnership with a Bangkok hospital, was able to quickly identify two isolates as influenza A and one as Influenza B (out of ten isolates provided under less than ideal conditions) while ruling out any flavivirus pathogens.

Malaria Nepal
July 2002
AFRIMS was able to supply the Royal Nepalese Army with malaria rapid diagnostic kits for to determine that many RNA troops returning from a United Nations mission in Sierra Leone were suffering from acute cases of falciparum malaria.

Scrub Typhus Maldives
September 2002
The Maldives Ministry of Health again called on AFRIMS GEIS program to verify an infectious disease outbreak and provide onsite consultation. Following four deaths of young persons and 36 cases on one island, public health officials were concerned that scrub typhus might be the culprit. AFRIMS was able to identify 14 of 28 samples as strongly positive for acute infection with Orientia tsutsugamushi and positively identify 2 of 4 samples by PCR. These represent the first documented cases of scrub typhus in the Maldives since the British recorded cases in World War II. AFRIMS was also able to provide onsite entomological and clinical consultation the following month for long term management of this disease.

Meningococcemia Thailand
Sangkhlaburi Thailand had a family cluster of hemorrhagic fever cases (1 death; 1 DIC with bipedal amputations) in a refugee camp. AFRIMS investigated and determined the cause to be meningococcemia. The origin was traced back to another refugee camp, which had transferred patients to the new camp recently. In coordination with staff from Medecins Sans Frontiers (MSF), chemoprophylaxis was initiated promptly and no secondary cases occurred in the camp.

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