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Surveillance and Response Emergency and Humanitarian Action World Health Organization Update from FYR Macedonia: Surveillance in Kosovar refugee population.

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Presentation on theme: "Surveillance and Response Emergency and Humanitarian Action World Health Organization Update from FYR Macedonia: Surveillance in Kosovar refugee population."— Presentation transcript:

1 Surveillance and Response Emergency and Humanitarian Action World Health Organization Update from FYR Macedonia: Surveillance in Kosovar refugee population Dr Eric Noji, WHO E Noji/EHA

2 Purpose of mission 19 April - 1 may 1999 1. Establish health surveillance system 2. Ensure epidemic preparedness measures 3. Organise laboratory support for confirmation of suspected cases 4. Establish epidemic response mechanism E Noji/EHA

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5 What initial information would you want to know?

6 Kosovar refugee population 4 May 1999 Former Yugoslav Republic of Macedonia: 204,070 Albania:396,300 Montenegro: 61,900 Bosnia-Herzegovina 15,000 Total677,270 source: UNHCR E Noji/EHA

7 Refugees in FYR Macedonia 4 May1999 Camp population 99,850 source: UNHCR Host family population 93,370 source: Macedonian Red Cross Arrivals 3 May 11,600 Total 204,070 E Noji/EHA

8 Refugees in FYR Macedonia by camp 28 April1999 Stankovac I (Brazda)27,900 Stankovac II16,000 Blace reception centre 3,000 Bojane 4,000 Neprosteno 7,400 Senokos 2,400 Radusa 400 Cegraneunder construction E Noji/EHA

9 What would you like to know about the situation in the camps?

10 Shelter All camps at maximum capacity Security problems Implications on health Recommended minimum 30m2/person Brazda camp: built for 10,000 On 4 May had 31,000 refugees - 9m2 Radusa camp: 4.4m2 Neprosteno camp: 12.2m2 E Noji/EHA

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18 Water Brazda camp - water pumped from stream near camp 15L/person/day Cegrane camp - water transported in tanks from local town supply 20L/person/day Radusa - 28L/person/day E Noji/EHA

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20 Food Distribution by WFP Food items: Bread Canned beef/fish Pulses, sugar Cooked food/vegetables in smaller camps Cegrane camp - 30 April - WFP delivered 15,000 loaves of bread 6.2MT canned meat/fish 48,720 human daily rations E Noji/EHA

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23 Sanitation Recommended minimum standard - 20 persons per latrine in emergency phase Brazda camp - 37 persons per latrine Bojane camp - 68 persons per latrine Cegrane camp - opened 29 April to 8,000 new arrivals By 2 May - 14,000 refugees in camp On 4 May - 450 persons per latrine E Noji/EHA

24 Health services in camps Stankovac I (Brazda) MSF-H, MDM, Taiwan Hosp. German Red Cross Stankovac IIIMC, French Civil Service Blace MDM BojaneTurkish Red Cross NeprostenoDie Johanniter SenokosDOW-USA RadusaBulgarian Army, MSF-H CegraneMSF-H, German Army E Noji/EHA

25 What needs to be done to set up a health information system?

26 Health Information System WHO/MOH/UNHCR/NGOs Daily Health Report form agreedDaily Health Report form agreed Case definitionsCase definitions Reporting mechanisms agreedReporting mechanisms agreed Electronic database established at WHO Skopje officeElectronic database established at WHO Skopje office MOH Communicable disease form translated - 44 diseases require reportingMOH Communicable disease form translated - 44 diseases require reporting E Noji/EHA

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28 Data from Daily Health Reports Communicable diseases: 30% of all consultations Watery diarrhoea 10% URTI 15% TB - patients on Rx in Kosovo - 14 identified to date, referred to Institute for Lung Diseases and TB, Skopje Non-communicable diseases: 60-70% of all consultations Mental health problems - 20% NIDDM - prevalence 1-2% E Noji/EHA

29 How do these conditions differ from refugee crises in Sub- Saharan Africa?

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37 What “process” indicators would it be important to monitor?

38 Immunisation coverage rates - kosovo Measles1992: 67% 1997: 83% 1998: 72% Polio1996: 75% DPT1996: 76% BCG1996: 52% of newborns Source:UNICEF, WHO-Pristina, HINAP E Noji/EHA

39 Mass immunisation campaigns Implemented by UNICEF/MOH/IMC/WHO Target group - children<5 who cannot present a complete vaccination card Schedule Age group 0-2 monthsBCG 2-9 monthsOPV, DPT 9-47 monthsOPV, MMR E Noji/EHA

40 Mass immunisation campaigns Total target population: 8,915 Brazda: 26-28 April Stankovac II: 30 April - 2 May Other camps: 5-6 May Brazda camp: 2,381/5,447 children immunised but including children with vaccination cards - 85% coverage Neprosteno camp: 381/402 children immunised - 98%coverage E Noji/EHA

41 What are elements in a good epidemic preparedness plan?

42 Epidemic preparedness Laboratory - Republic Institute for Health Protection agreed to conduct lab testsLaboratory - Republic Institute for Health Protection agreed to conduct lab tests WHO Guidelines for management of major epidemic-prone diseases in Macedonia developed and distributed to NGOsWHO Guidelines for management of major epidemic-prone diseases in Macedonia developed and distributed to NGOs WHO Guidelines for collection of laboratory specimens distributed to NGOsWHO Guidelines for collection of laboratory specimens distributed to NGOs Steps for management of outbreaks agreed with MOH, UNHCR and NGOs - WHO as lead investigatorSteps for management of outbreaks agreed with MOH, UNHCR and NGOs - WHO as lead investigator E Noji/EHA

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44 Main epidemic threats to refugee population in Macedonia Bacillary dysenteryBacillary dysentery CholeraCholera MeaslesMeasles Meningococcal meningitisMeningococcal meningitis Hepatitis AHepatitis A ScabiesScabies Haemorrhagic fever with renal syndromeHaemorrhagic fever with renal syndrome E Noji/EHA

45 Bacillary dysentery (Shigellosis) Major outbreak of Shigella sonnei in 1995-Major outbreak of Shigella sonnei in 1995- 5,500 cases in 1995 in city of Stip with population 70,000 Of stool samples examined in Institute of Microbiology, Skopje 1995 - 1997 60% - Shigella sonnei60% - Shigella sonnei 40% - Shigella flexneri40% - Shigella flexneri E Noji/EHA

46 Shigella- antibiotic sensitivity Stool samples tested at Medical Faculty, Institute of Microbiology, Skopje 1995- 1997 19/225 (8.4%) samples were sensitive to TMP/SMX19/225 (8.4%) samples were sensitive to TMP/SMX 203/218 (93.1%) samples were sensitive to ciprofloxacin203/218 (93.1%) samples were sensitive to ciprofloxacin E Noji/EHA

47 Cholera Last reported case in Macedonia 1989, imported case from Saudi ArabiaLast reported case in Macedonia 1989, imported case from Saudi Arabia Endemic status unclearEndemic status unclear Outbreaks in South east Albania in 1994 (V cholera O1 El Tor, serotype OgawaOutbreaks in South east Albania in 1994 (V cholera O1 El Tor, serotype Ogawa outbreak due to heavy faecal contamination of drinking wateroutbreak due to heavy faecal contamination of drinking water all strains (>60) isolated were resistant to TMP/SMX and tetracyclinesall strains (>60) isolated were resistant to TMP/SMX and tetracyclines E Noji/EHA

48 How would you define an “epidemic”?

49 Epidemic thresholds Cholera Bacillary dysentery Bacillary dysentery Measles Measles Meningococcal meningitis Meningococcal meningitis !! One (suspected) case = potential outbreak = potential outbreak = immediate reporting = immediate reporting = immediate follow up = immediate follow up E Noji/EHA

50 Suspected cases of epidemic- prone diseases reported to WHO Bloody diarrhoea - 12 cases reported from Brazda, no lab confirmationBloody diarrhoea - 12 cases reported from Brazda, no lab confirmation Measles- 2 suspected cases reported from Stankovec IIMeasles- 2 suspected cases reported from Stankovec II Meningococcal meningitis - 3 cases, one N. meningitidis B in 9 month old babyMeningococcal meningitis - 3 cases, one N. meningitidis B in 9 month old baby Scabies - 28 cases reportedScabies - 28 cases reported Varicella (chicken pox) - 6 cases in one campVaricella (chicken pox) - 6 cases in one camp Acute jaundice - 3 cases - suspected Hepatitis A- lab confirmation pendingAcute jaundice - 3 cases - suspected Hepatitis A- lab confirmation pending E Noji/EHA

51 How does one “usually” diagnose measles in a refugee camp setting?

52 Investigation by WHO of suspected case of measles 28 April - 2pm WHO informed by UNHCR of two suspected cases of measles in Stankovac II camp28 April - 2pm WHO informed by UNHCR of two suspected cases of measles in Stankovac II camp 28 April - 3.30pm - WHO/UNHCR team visit camp28 April - 3.30pm - WHO/UNHCR team visit camp Suspected cases - AD, 8 months and MM, 6 months, different families but in same tent MM - maculo-papular rash, but no fever Blood sample taken 29 April - blood sample sent to lab by WHO29 April - blood sample sent to lab by WHO 30 April - sample IgM and IgG negative30 April - sample IgM and IgG negative E Noji/EHA

53 Is there anything else that needs to be done once the epidemic investigation has been completed?

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55 Issues on Communicable disease control in refugee population High and increasing risk of outbreaksHigh and increasing risk of outbreaks Rapid response capacity for deploying field epidemiologists in the event of an outbreak must be availableRapid response capacity for deploying field epidemiologists in the event of an outbreak must be available Epi has important role in analysis and dissemination of surveillance dataEpi has important role in analysis and dissemination of surveillance data Epi has crucial role in co-ordination between MOH, other UN agencies and NGOsEpi has crucial role in co-ordination between MOH, other UN agencies and NGOs E Noji/EHA

56 U.S. Department of Health and Human Services Eric K. Noji, M.D., M.P.H. Special Assistant to the US Surgeon General for Disaster Medicine, US Public Health Service Phone: 202-690-5707 Fax: 202-690-6985 Email: Enoji@cdc.gov For Questions Contact:


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