Which interventions are used in disease outbreak response?

Responding to outbreaks involves multidisciplinary teams with specific expertise in investigation, prevention and control of infectious diseases.

Clinicians
Epidemiologists
Microbiologists
Social Scientists
Infection Prevention & Control Specialists
Water, Sanitation & Hygiene (WASH) Specialists
Logistics and Security

Coordination of multidisciplinary teams is critical to ensure outbreak preparedness and response is: effective, coherent, comprehensive and efficient.

Clinicians

Clinicians work on the frontlines and are usually the first point of contact for patients in an outbreak.

They provide clinical care reducing the disease burden. Reporting cases in real-time is a key component of outbreak surveillance systems to inform the response.

Clinicians provide essential education and training for local healthcare workers and community members to build response capacity.

Ebola in the Democratic Republic of Congo

More than 111,000 people have been vaccinated in DRC Aug 2018 - May-2019

Ring vaccination is used to immunise people around each infected individual to prevent disease spread

Insecurity is a key challenge to controlling outbreaks - vaccination teams are geographically restricted

Epidemiologists

Epidemiologists use surveillance data to generate figures such as reproductive rates, attack rates and case fatality ratios of disease to estimate the severity of an outbreak.

Epidemiological data are used to map outbreaks using geographical information systems, enhance understanding of the outbreak using data visualisation techniques and build statistical models to understand and predict outbreaks, and the potential impact of different intervention responses. These data enable decision-makers to monitor the epidemic and respond in real-time.

Example data epidemiologists collect

WHO has declared 4 Public Health Emergency of International Concern (PHEICs) 2009 - 2019

2 PHEICs

were declared simultaneously
in 2014, with the resurgence
of polio and outbreak of Ebola
in West Africa

Guinea-worm is a parasitic disease on the verge of eradication

3,500,000

human cases in the 1980s

human cases in 2016

Microbiologists

Microbiologists provide laboratory-confirmation of clinically suspected cases. This involves coordination and receipt of all clinical samples in the field, logging and performing diagnostic tests.

Microbiologists ensure clinical samples are stored correctly and transferred to a national or regional reference laboratory for confirmatory testing.

Results from testing such as antibiotic susceptibility, serotyping and genotyping inform outbreak responses including case definitions, diagnostic testing requirements, clinical protocols and infection and prevention control measures.

Microbiology Interventions

Q&A

What do cholera, diphtheria, Ebola, polio, measles and yellow fever have in common?

Show

They are all vaccine-preventable diseases.

Social Scientists

Social scientists investigate social, political and economic factors that enable the spread of disease and limit the effectiveness of outbreak responses.

Social scientists explore context-specific issues including: social mobilisation; how behaviour is changing; how communities are engaging with the outbreak response; the acceptability of how patients are being treated; and what support is being provided to survivors.

Insights ensure outbreak responses are acceptable and relevant to communities and build on existing social and cultural resources. Social scientists can detect on-the-ground realities and unexpected events, and can use these to develop more effective responses.

Common goals of social scientists to control outbreaks

Helping affected communities to better understand the outbreak and response and to ensure people are included in the response

Migration patterns to predict the spread of disease

Risk assessments of social, political and economic factors near outbreak 'hotspots'

Infection Prevention
& Control Specialists

IPC specialists focus on disease prevention and control interventions to prevent, slow and halt transmission leading to new infections.

Standard and transmission-based precautions are key disease outbreak tools. Standard precautions include a set of evidence-based measures such as handwashing and glove use when handling body fluids. Standard precautions are applicable with all patients at all times.

Transmission-based precautions are applied in addition to standard precautions when alternative modes of transmission are known or suspected. These include contact, droplet and airborne/aerosol precautions.

Cholera is an acute diarrhoeal disease that can kill within hours if untreated

With treatment at least 99% survive

It is estimated each year there are up to

4,000,000

cholera cases

143,000

deaths

Water, Sanitation & Hygiene (WASH) Specialists

W A S H

WASH specialists focus on the prevention and control of water-borne and other infectious diseases.

Key WASH interventions during disease outbreaks include: distribution and training to use water chlorination kits; hand and equipment hygiene in treatment and quarantine zones; collaboration and training of local service providers to improve access to latrines and solid waste disposal practices; and identification of environmental contamination "hotspots".

Prioritising WASH interventions is based on epidemiological findings, assessment of risk factors, transmission routes, expected impact of each intervention and available resources.

WASH innovations with life saving implications

Children who had 'surprise soap' containing a visible toy, were 4 times more likely to wash their hands with soap at crucial moments

Logistics and Security

Logisticians acquire, manage and deliver life-saving supplies at the right time, in the right place during an outbreak.

To supply outbreak responses logisticians carry out market surveys, map stakeholders, pre-position stock and identify multiple supply routes. Maintaining a cold chain for medical supplies, such as vaccines, is a high priority where needed.

It is essential for logisticians to take into account and overcome known restrictions and potential bottlenecks such as physical inaccessibility, customs agencies and security threats.