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DISEASE CONTROL
HVD 21103
Case Investigation & Contact
Tracing
By:Khairul Nizam Mohd Isa
MCHSc (Environmental Health)
UniKL MESTECH
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Goals
At the end of this lecture, student should be able
To identify the most suitable approaches to conduct
investigation for specific disease.
Conduct an investigation in accordance to the job specification
and guidelines set on the regulation and ACT.
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Introduction
Objectives:
To prevent, control and contain infectious diseases
To reduce morbidity and mortality due to infectious diseases
To develop good repo with patient
To identify the sources of infection
To determine contact
To explain the importance of follow up treatment and
contact examination
To counsel and educate
To strengthen public health infectious diseases surveillance
Provide general guidelines and develop a mechanism for
effective implementation of outbreak management
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Technique
Interview
Individual
Phone call
Analysis review
Patients health records
Laboratory analysis/ test results
Chronology
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Important Aspect
Verify the cases- to check the basic data and result
Investigation to be carried out with patient / family member
Patient particulars (verify)
Patient movement Social activities of patient
Living condition (environment)
Risk factors
Contacts if known (eg. Patients, friends)
Referral if necessary for treatment
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Legislation
Destruction ofDisease-Bearing Insects Act 1975
Section 10A- Power to require information and examine
persons
Prevention and Control ofInfectious Diseases Act 1988
Section 7-Entry into and examination of vehicles and the
measures thereafter
Section 15- Observation or surveillance of contacts
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Complaint/Report
CaseVerification
Data Analysis
Response
Control measure
Communication
DocumentationDescription
Full investigation
Analytic
Lab analysis
Investigation
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Verification
The purpose of verification is to confirm the occurrence of the
case.
A multidisplinary approach is required and will include one or
a combination of the following:
Review of the epidemiological data and trend
Clinical examination of cases
Review of medical records
Review the laboratory results
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Evaluation of severity of the cases
Upon verification of the case, assessment of severity will take
into account the following:
Increase mortality and morbidity
High case-fatality rate
High rate of severe presentation of disease
High rate of anti-microbial resistance
Involvement of vulnerable and other high risk group
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Case Definition
For each case, there should be a case definition
For known disease: Refer to Disease Control Division,MOH Case Definition forInfection Disease in Malaysia
For unknown diseases, considerer epidemiological linkage
(time, place, person, clinical presentation) The case definition should contain the following:
The name of the disease (or as ...like until more precisedata is available)
The most frequently occurring signs and symptoms
Epidemiological circumstances
Confirmatory laboratory tests, if any
Criteria of the data level of certainty: confirmed,probably and suspected
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Proxy Indicators
Proxy Disease/Problem
Acute gastroenteritis Food and water borne diseases
Acute Flaccid paralysis Poliomelitis
Acute respiratory infection Pneumonia, influenza virus
The defined syndromes under
the syndromic notification
system
Emerging of unknown infections
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Final Report
A final report must be produced for every case.
The person who responsible for writing the report as follows:
PPKP
PKA
Dissemination of report
State Director
Director of CDC, MOH
Relevant district authorities
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Final Report
Publication
The report may ne published in local or international
journal/ bulletins, ect with the permission ofDirector
general of Health
Communicate to the public with permission
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Case Study 1
19-01-2009
Mr Hamid who stay in Taman Edaran,KL
been warded with positive Malaria
01-01-2008 03-01-2009He went to kelantan. Shopped at Pasar
04-01-2009
Went back to rawang. Stop for dinner at
Gua Musang on 1930 Hrs
05-01-2009-09-01-2009
Stayed home with family
10-01-2009
Went back to in-law family
12-01-2009 16-01-2009
Committee for Kem Remaja Sekolah at
kampungOrang Asli Slim River
High Fever
Took paracetamol
Suspected been coursed by ghost
17-01-2009
Went back to night market in KL
Went to private clinic and received
injection
18-01-2009
Went back to Wedding fiest at Kampung
Melayu, Sg Buloh
High fever
Joint paint
Investigation
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Case study 1
Malaria case in Kuala Lipis
Location: Sungai Ular
Date started: 01-01-2008 first case of onset of symptoms
Date ended: 08-01-2008
Chronology
First case in Slim River
Location: Kampung Orang Asli Slim River
Case started on: 20-01-2008 - first case of onset of symptoms
Date ended: 21-01-2008
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Report
Malaria case was started on 01-01-2008 in Kuala Lipis and
ended on 21-01-2008 in Slim River. The agent was P.vivax and
involving 50 cases.
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Case study 2
Case Food
& water
borne
Illness
Movement WHERE
WHEN
WHO
Food history
-meal at home
-meal outside
Contact
-Fly contacts
-Work contact
-Social contacts
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Case study 3
Case TB
Movement
ofpatients
WHERE
WHEN
WHO
Patientsoccupation
-types of works
-duration of exposure
Contact
-Family
-Work contact
-HostelSocial
Historyofcontact with other patients
Lifestyle
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THANK YOU
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References
Heymann,D.L. 2004. Control of communicable disease
manual. Ed. 18th. Washington: American Public health
Association.
Mulvihill, M.L., Zelman, M., Holdaway, P., Tompary, E. &
Turchany, J. 2005. Human disease: Asystemic approach. Ed.
5. Prentice Hall.