RESPONDING TO A CHOLERA OUTBREAK IN SCHOOLS Salome Williams Ph. D. Public Health Student PUBH 8165 Professor: Dr. Howard Rubin April 2011

Responding to an Outbreak of Cholera in Schools Schedule of the Seminar Overview of Cholera The history of Cholera in Jamaica West Indies The Global Burden of Cholera Planning for an Outbreak of Cholera Managing Cholera Cases Monitoring High Risk Groups Monitoring Water and Environmental Sanitation Providing Health Education

Responding to an Outbreak of Cholera in Schools Objectives of the Presentation This session aims to: provide an overview of cholera. discuss the measures for alleviating the impact of an outbreak of cholera in schools.

Responding to an Outbreak of Cholera in Schools Background The ODPEM Jamaica includes schools in its disaster management plan. School personnel and youths are being trained in disaster management. The major stakeholders are UNICEF and the GOJ ODPEM (2010). Disaster plan to be developed for child care facilities. Retrieved from:

Responding to an Outbreak of Cholera in Schools Background Disaster response involves: Identifying vulnerable populations. Knowing the population’s current health status. Preparing the physical environment. Establishing standardized treatment protocols. Developing a good surveillance system. Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore

Responding to an Outbreak of Cholera in Schools Overview of Cholera Cholera is caused by the bacterium vibrio cholerae. Transmission is through consuming water or foods contaminated with feces. The reservoir is human. It has an abrupt onset. Seventy five (75%) of persons may not develop symptoms. Ten (10%) to 20 % of persons may develop severe diarrhea and vomiting. Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore WHO. (2010). Cholera. Fact sheet N°107. Retrieved from: WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from:

Responding to an Outbreak of Cholera in Schools History of Cholera in Jamaica WI The first case was identified in Port Royal, in It accounted for 6000 deaths in Kingston. It spread rapidly throughout the island. Overall death toll was 40, 000. Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore Parkin, J. (1852). Statistical report of the epidemic of cholera in Jamaica. [Technical Report]. Cholera – epidemiology disease outbreak. Catalog no London : W. H. Allen. Retrieved from:

Responding to an Outbreak of Cholera in Schools The Global Burden of Cholera Cholera is more prevalent in developing countries. In 1994, Congo reported 50,000 cases. In 2000 and 2001, Kwazulu-Natal South Africa reported 125, 000 cases. In 2006, 236, 896 cases and 6311 deaths were reported to the WHO. In 2010, Haiti had 121,518 cases and 2,591 deaths. CDC. (2010). “Cholera: Epidemiology and risk factors”. Retrieved from: CDC. (2010). “Cholera in Haiti”. Retrieved from: Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore. Morbidity and Mortality Weekly Report. (2010). Update on Cholera----Haiti, Dominican Republic and Florida. Weekly. 59 (50); Retrieved from:

Responding to an Outbreak of Cholera in Schools Economic Loss Related to Life Expectancies for Cases of Cholera in Countries of the African Region YearsNo. of CasesCost at Age 40Cost at Age 53Cost at Age US$ 39.0 millionUS$ 53.2 millionUS$ 64.2 million US$ 91.9 millionUS$ millionUS$ million US$ 43.3 millionUS$ 60.0 millionUS$ 72.0 million Total 439,419 US$ millionUS$ millionUS$ million Kirigia, M.J., Sambo, L.G., Yokouide, A., Soumbey-Alley, E., Muthuri, L.K., Doris G Kirigia, D.G. (2009). “Economic burden of cholera in the WHO African region” BMC Int Health Hum Rights. 9: 8. doi: / X-9-8.

Responding to an Outbreak of Cholera in Schools Develop a Plan for the Control of Cholera Develop a committee or a task force. Prepare a budget. Determine the interventions to control the outbreak. Obtain critical supplies. Obtain updates on guidelines for managing cholera. Control infection Basics. (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore. WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness.World Health Organization Global task force on cholera control. Retrieved from:

Responding to an Outbreak of Cholera in Schools Manage the Cholera Cases Report promptly: severe dehydration. death from acute watery diarrhea. acute watery diarrhea, with or without vomiting. a case confirmed by laboratory testing. Basics. (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore. WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from:

Responding to an Outbreak of Cholera in Schools Manage the Cholera Cases An outbreak team will follow up with reports. Establish free flow of communication with health facilities. Health facilities should be adequately prepared. Basics. (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore. WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from:

Responding to an Outbreak of Cholera in Schools Manage the Cholera Cases Report possible sources of infection promptly to determine: - causes of the infection - the time of transmission - the place of transmission - the person transmitting the bacterium Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore.

Responding to an Outbreak of Cholera in Schools Manage the Cholera Cases In a massive outbreak: Establish a cholera control unit. Offer specific services. WHO. (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from:

Responding to an Outbreak of Cholera in Schools Manage the Cholera Cases Triage the cases. Triaging is coordinated by the medical personnel and hospitals. Tag with specified colors and manage accordingly. Auf der Heide, E. (2000). Disaster response online book. Chapter 8:Triage. Retrieved from: dmha.org/dr/DisasterResponse.nsf/section/409583F8918DD44A0A25692A007C87F5/$file/p-182.jpg Basics. (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from:

Responding to an Outbreak of Cholera in Schools Manage the Cholera Cases Triaging Classify and prioritize the cases. Use colors to indicate the priority for treatment. Auf der Heide, E. (2000). Disaster response online book. Chapter 8:Triage. Retrieved from: dmha.org/dr/DisasterResponse.nsf/section/409583F8918DD44A0A25692A007C87F5/$file/p-182.jpg

Responding to an Outbreak of Cholera in Schools Flow of Cholera Cases in the CCU Triage Staff No TreatmentThe Morgue ORS Treatment Room Home Observation Unit - Treatment Hospital - Treatment Recovery Unit Home Auf der Heide, E. (2000). Disaster response online book. Chapter 8:Triage. Retrieved from: 0A25692A007C87F5/$file/p-182.jpg WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from: From the Schools

Responding to an Outbreak of Cholera in Schools Monitor for the Continued Presence of the Disease Evaluate control measures. Provide ongoing reports on: - all other cases identified - all contacts of the cases Interview all contacts. Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from:

Responding to an Outbreak of Cholera in Schools Monitor Water and Environmental Sanitation Monitor: - all sources of food and water. - food preparation in the school. - solid waste and excreta disposal. - hygiene practices of the school population. Basics: (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: Controlling_cholera_Basics.pdf.

Responding to an Outbreak of Cholera in Schools Monitor Water and Environmental Sanitation Implement control measures 1.Provide adequate supplies of soap and water. 2.Provide adequate toilet facilities. 3.Treat water. 4.Dispose of all feces and stomach contents properly. 5.Careful preparation of meals for the school population is essential. Basics: (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore. WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from:

Responding to an Outbreak of Cholera in Schools Provide Health Education Provide only critical messages. Establish a communication coordinating committee. Prepare health messages with health personnel. Focus health messages on food and water safety and prompt treatment. Basics: (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from:

Responding to an Outbreak of Cholera in Schools Conclusion Cholera is one of the oldest communicable diseases. It remains a public health problem in some countries. A country should be prepared for an outbreak. Adequate resources is necessary to respond to an outbreak. Response requires a well coordinated approach. Basic measures can mitigate the impact. Basics. (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: ODPEM (2010). Disaster plan to be developed for child care facilities. Retrieved from: Parkin, John, ): Cholera -- epidemiology ; Disease Outbreaks ; Jamaica ; Technical Report. Statistical report of the epidemic cholera in Jamaica. London : W. H. Allen, 1852Text; iv, 61 p. Catalog record: Retrieved from: (Digital archived document). WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from:

Responding to an Outbreak of Cholera in Schools References Auf der Heide, E. (2000). Disaster response online book. Chapter 8:Triage. Retrieved from: Basics: (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: CDC. (2010). “Cholera: Epidemiology and risk factors”. Retrieved from: CDC. (2010). “Cholera in Haiti”. Retrieved from: Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore. Kirigia, M.J., Sambo, L.G., Yokouide, A., Soumbey-Alley, E., Muthuri, L.K., Doris G Kirigia, D.G. (2009). “Economic burden of cholera in the WHO African region” BMC Int Health Hum Rights. 9: 8. doi: / X-9-8. Morbidity and Mortality Weekly Report. (2010). Update on Cholera----Haiti, Dominican Republic and Florida. Weekly. 59 (50); Retrieved from: ODPEM (2010). Disaster plan to be developed for child care facilities. Retrieved from: Parkin, John, ): Cholera -- epidemiology ; Disease Outbreaks ; Jamaica ; Technical Report. Statistical report of the epidemic cholera in Jamaica. London : W. H. Allen, 1852Text; iv, 61 p. Catalog record: Retrieved from: (Digital archived document). Stone, M. (2010). Precautions against cholera from CDC. Retrieved from: a WHO. (2010). Cholera. Fact sheet N°107. Retrieved from: WHO (2004). Cholera outbreak: assessing the outbreak response and improving preparedness. World Health Organization Global task force on cholera control. Retrieved from:

Responding to an Outbreak of Cholera in Schools Further Readings Auf der Heide, E. (2000). Disaster response online book. Chapter 8:Triage. Retrieved from: Basics: (1996). Controlling cholera, a checklist for planners. USAID funded project. Retrieved from: Heyman, D.L. (2008). Cholera and other vibrioses. Control of communicable diseases manual. Washington D.C: United Book Press Inc. Baltimore