 In this session, we shall talk about epidemics. What do you understand by the term epidemic or outbreak? An epidemic or outbreak is the occurrence of a disease in excess of what is expected in a particular community for a particular group of people within a certain period of time. Our terms related to epidemics. An epidemic refers to the constant presence of a disease or infectious agent within a given geographic area or population group. It is the usual or expected frequency of disease in a population. Pandemic, on the other hand, refers to an epidemic occurring simultaneously in multiple locations worldwide. As an example from your country. We see that epidemics are the commonest publicate emergency in our districts across the East African region. In Uganda, for example, 6 outbreaks occurred in 8 months in 2007 and this included cholera, meningitis, hepatitis E, mabak, plague and Ebola. Can you name 5 outbreaks that have occurred recently in your district? Common epidemics from diseases include diarrhea diseases like water diarrhea, cholera, dysentery and typhoid. These are likely to occur in many districts in the East African region. Outbreaks of immunizable diseases can occur like measles and these are common because immunization coverage is low. Malaria is endemic in most parts of Eastern Africa, especially in the low land areas. However, outbreaks can occur in both low and high land areas. In areas where malaria is endemic, outbreaks occur when the threshold far exceeds what is expected for that season. Other epidemic prone diseases include sexually transmitted infections including HIV AIDS, syphilis, gonorrhea and others, plague, hepatitis E and massive chemical poisoning especially from illicit alcohol which is becoming a common publicate problem in Eastern Africa. Let us look at the case today. One, refer to the word document on your CD. The question is this a scenario that could occur in your district and how did the district authorities establish that there is an outbreak? In detecting an outbreak, we have to obtain initial notification of the outbreak. We receive information about the likelihood of an outbreak from the community and from cases coming to health units and from local leaders. We therefore have to have an effective alewani system that is linked to the communities. The golden rule in detecting outbreaks is that every woman must be investigated. In detecting an outbreak, we must have a case definition for the diseases and this should be known by the frontline health workers and there may also be need for a community case definition. Secondly, there must be an unexpected rise in new cases of the disease beyond the threshold. You look at the word document in your extension activities and read the standard case definition for some epidemic prone diseases. For instance, what is the standard case definition for polio, measles, cholera, Ebola and bacterial meningitis? Case definitions may be changed according to the locality and the nature of the symptoms presenting in a particular outbreak situation. The district rapid reaction team can develop a working case definition where there is no standard case definition depending on common symptoms and risk factors related to the syndrome that has broken out. Can you suggest a case definition for the following? One, an outbreak of sudden alcohol related illness and deaths in zone X. Two, an outbreak of dysentery in camp Y. Three, an outbreak of sudden food related illness and deaths in village Z. Some epidemic prone diseases exist in the community even without an outbreak. An example is malaria which is prevalent in many parts of East Africa. For an outbreak to be declared there must be a sharp rise in cases beyond the expected threshold for a particular season. Some epidemic prone diseases do not exist normally in the community. The occurrence of just one confirmed case is considered an outbreak. An example is cholera. Some epidemic prone diseases are rare and highly deadly when they occur. We do not have to wait for confirmation of a case. Just one suspected case is enough to consider an outbreak. An example is Ebola. Therefore thresholds differ from disease to disease. In cholera just one confirmed case. In Ebola one suspected case. For measles a cluster of five or more suspected cases or at least three confirmed positive cases in a catchment area of a health facility occurring in one month. For malaria because it is endemic in many parts of East Africa an outbreak occurs when there is a sharp seasonal rise in cases beyond the usual number of expected cases. Let us look at the second case study which is one of your documents on the CD. Let us read through this case study and the questions for general discussion are how do you think the district and minister of health officials went about investigating this particular outbreak and what do you understand by the term early response? Steps in investigating an outbreak. Step one initial notification response and confirmation of the outbreak. It is important to assemble a team and prepare for an initial field visit as soon as possible. Two it is important to choose a working case definition and confirm cases. Three find cases systematically. Four confirm whether there is an outbreak by comparing occurrence of cases with the thresholds. And five describe who is affected when and where. Step two manage and identify cases. Establish a disc-tricked task force and allocate them their responsibilities. Use the working case definition to find cases and set up a treatment center. Step three set up immediate control measures. Treat cases to interrupt transmission and reduce deaths. Consider vaccination, disinfection and protective wear. Provide health education to those at risk. Communicate clearly to reduce panic and prevent spread of the disease. Step four address the resource gaps. Ensure adequate medical supplies and logistics to handle cases. Look for additional resources to address the gaps and contact the Minister of Health and Partner Agencies in case the resources are inadequate. Step five determine responsible factors for the outbreak and make a report. Analyze available information to establish the risk factors. Prepare a report and ensure that it is disseminated to those who need to know and those who need to take action. But in the report you ought to recommend and implement priority control measures. And step six be on your guide. Strengthen the existing surveillance system to be able to find cases actively and learn from this outbreak to respond better in the future. Put in place measures to prevent other similar outbreaks in the future. Thank you for listening.