Notes on Outbreak Management by Dr. Elijah Matovu

Introduction

• Dr. Elijah Matovu: Consultant microbiologist, infection control doctor, sepsis lead and educator at University Hospital of North Midlands, UK.
• Focus: Infection control and outbreak management.

Principles of Outbreak Management

• Steps in outbreak investigation can be done simultaneously, not strictly sequential.
• Key elements covered include:
  • Steps of outbreak investigation.
  • Relevant epidemiological methods.
  • Process involved in managing outbreaks.
  • Sources of outbreaks.
  • Key facts about outbreaks.

Initial Steps in Outbreak Investigation

1. Suspect an Outbreak

   • Information may come from lab, clinical teams, or environment.
   • Identify two or more cases above usual levels.

2. Call Key Stakeholders

   • Suggested team members:
     • Communicable disease consultant or PHE consultant.
     • Environmental officer.
     • Microbiologist or virologist.
     • Infection control nurse.
     • Regional epidemiologists.
     • Secretarial support.
     • Media or communication officer.
     • Food microbiologists or food standards authority, if relevant.
     • Veterinary services, if it involves animals.
   • Important to limit the number of stakeholders to avoid confusion.

3. Establish Case Definition

   • Characterize identified cases using clinical signs, symptoms, epidemiological information.
   • Identify the index case and related cases.
   • Create visual documentation (tables, color coding).

Managing the Outbreak

• Containment Measures:

  • Identify the source of the outbreak.
  • Implement infection control measures (e.g., isolation, quarantine, PPE).
  • Determine admission criteria for hospitals.
  • Notify testing labs and public health authorities.
  • Engage in contact tracing.

• Strategic Management Commands:

  • Establish a command structure for decision-making.
  • Coordination among different levels of management.

• Hypothesis Formulation and Testing:

  • Develop initial hypotheses about the outbreak.
  • Understand transmission modes and disease pathology.

Research and Surveillance

• Study Designs:

  • Cohort studies for exposed individuals.
  • Case-control studies for non-complete lists.
  • Consult statisticians for modeling outbreak progression.

• Long-term Control Measures:

  • Implement measures based on identified cause (e.g., closures, treatments).
  • Monitor emerging variants and outbreaks.
  • Document all actions taken and maintain surveillance.

Communication

• Importance of clear communication with public and stakeholders.
• Media strategy to manage misinformation.
• Publish an outbreak report and recommendations post-outbreak.
• Conduct an after-action review to assess performance.

Conclusion

• Importance of timely and accurate information dissemination.
• Preparedness for future outbreaks.
• References available on WHO website and Global Public Health Intelligence Network.