11/21/2017 1

Outbreak preparedness and the NICD

24-hour hotline –a review of calls made to the Hotline, and Outbreak

Response Unit, July 2016-June 2017

Kerrigan McCarthy, Nevashan Govender, Vivien Essel, Genevie Ntshoe, Lucille Blumberg

Outbreak Response Unit,

National Institute of Communicable Diseases

FIDSSA 2017

2

Why a 24-hour hotline at NICD?

• NICD is only RSA institution providing diagnostics for a number of conditions with significant public health implications,

– Rabies– MERS-CoV– Arbovirus infections (Rift Valley Fever)– Viral haemorrhagic fevers

• NICD houses the public sector reference laboratories for NHLS, supports NHLS diagnostics for epidemic-prone diseases and conducts surveillance for diseases of public health significance

• NICD supports provincial and national DoHCommunicable Diseases Clusters with technical advice

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Why a 24-hour hotline at NICD?

The international health

regulations (IHR) 2005

require a

• 24-hour number for

reporting outbreaks

• System for event-

based surveillance

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Methods- where, when, how?

On call for 7 days once every 12 weeks; Doctor record calls into excel spreadsheet

NICD Pathologist/MO On call: 082-883-9920 Consultant support Expert referral

ORU uploads spreadsheet into MS Access, adds metadata

Conducts data cleaning, analytics

Outbreak Response Unit NICD Centers

Doctors answer enquiry, or refer on to ORU and NICD centers; obtain

consultant/expert support where necessary

For diagnostic testing, clinical and/or epidemiological advice

For public health response, contact tracing, follow up

NDoH, Provincial DoH

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Trends in calls made to NICD hotline

July 2016 – June 2017

74

92

127134

122

164

126

9399

91

106

91

0

20

40

60

80

100

120

140

160

180

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

2016 2017

58

7

7

15

58 Doctor

Laboratorian

Member of thepublic

Nurse

Other health carew..

DoH official

38

62

0 20 40 60 80

Public

Private/for profit

Proportion of calls made by pubic vs private sector, July 2016-June 2017 (n=1295, %)

Proportion of calls made by different categories of persons, July ‘16-June ‘17 (n=1295, %)

Number of calls made to NICD Hotline by month, July 2016-June 2017 (n=1295)

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Trends in calls made to NICD hotline

July 2016 – June 2017

0

100

200

300

400

500

600

EC GP LP

NW

P

WC

P

un

k

Distribution of calls made to NICD Hotline by district of RSAJuly 2016-June 2017 (n=1295)

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Type of calls made to NICD hotline

July 2016 – June 2017

0

1

1

1

1

1

4

4

5

9

16

57

0 10 20 30 40 50 60

Media/Journalist

Pre-exposure prophylaxis

Vaccination-related enquiry

Infection control

Animal/Environmental health

Administrative

Non-rabies post-exposure prophylaxis

Food/Water-borne disease investigation

Other

Lab-confirmed case for advice

Patient(s) investigation

Rabies post-exposure prophylaxis

Proportion of calls made to NICD Hotline by category, July 2016-June 2017 (n=1295)

%%%%%%

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Trends in calls made to NICD hotline

July 2016 – June 2017

Distribution of calls made to NICD Hotline by district of RSA, and proportion of calls related to rabies, by province

July 2016-June 2017 (n=1295)

Rabies PEP

Non-rabies

ECP

FSP

GP

KZN

LP

MP

NWP

NCP

WCP

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Type of calls made to NICD hotline

July 2016 – June 2017

Suspected diseases for alerts requesting assistance with diagnosis of infectious disease (n=208) where ‘Alert category’ was ‘Patient investigation’

Suspected disease # %Anthrax 2 0.96Arbovirus 1 0.48Botulism (and Infant botulism) 3 1.44Brucellosis 5 2.4Chikungunya 2 0.96Cholera 3 1.44Crimean-Congo hemorrhagic fever (CCHF) 16 7.69Dengue fever 16 7.69Diphtheria 4 1.92

Ebola hemorrhagic fever 1 0.48Enterovirus infection 2 0.96Filariasis 1 0.48Hepatitis B 2 0.96Influenza (flu) 9 4.33Lassa fever 1 0.48Leptospirosis 3 1.44Lyme disease (Lyme borreliosis) 1 0.48Malaria 6 2.88Measles 10 4.81Meningitis 1 0.48Meningococcal disease 4 1.92Middle East respiratory syndrome (MERS) 4 1.92Not applicable 1 0.48Other 3 1.44Pertussis (Whooping cough) 1 0.48Poliomyelitis 4 1.92Rabies 24 11.54Rickettsial infection 1 0.48Rift Valley fever (RVF) 1 0.48Strongyloidiasis 1 0.48Tetanus (Lockjaw) 2 0.96Tuberculosis 1 0.48Tularemia 1 0.48Typhoid Fever 3 1.44Unknown as yet 34 16.35Viral Haemorrhagic Fever 10 4.81Yellow fever 8 3.85Zika 15 7.21

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Type of calls made to NICD hotline

July 2016 – June 2017

Category # calls

Single case 1,083

2-5 cases 64

6-10 cases 23

11-20 cases 13

21-200 11

101-1000 4

Not applicable 122

Total 1,320

Alert category # callsFood/Water-borne disease investigation 39Infection control 1Lab-confirmed case for clinical/public health advice 28Media/Journalist 1Non-rabies post-exposure prophylaxis 7Other 9Patient(s) investigation 19Pre-exposure prophylaxis 1Rabies post-exposure prophylaxis 10

Brucellosis 1

Clostridium difficile 1

Hepatitis A 13

Hepatitis B 1

Influenza (flu) 1

Leprosy 1

Leptospirosis 1

Listeriosis 1

Measles 1

Other 1

Schistosomiasis 1

Typhoid Fever 4

# cases involved in each alert to NICD hotline, by category Alert category for all alerts involving >1 case

Related disease for all alerts pertaining to ‘Lab-confirmed cases’ where alert involved >1 case

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Severity of events reported

0

10

20

30

40

50

60

70

80

Minimal (no deaths, minordisruptions)

Minor (few illnesses,manageable by p..

Moderate (death orillness, public he..

Major (many deaths,disrupts public health

service)

Severe (substantial loss oflife, widespread

disruption)

The proportion of all alerts falling into WHO severity grading scale

Food/Water-borne disease investigation 4

Lab-confirmed case for clinical/public health support 6

Patient(s) investigation 12

Amongst 1295 alerts, 22 pertained to a communicable disease where a death/s had occurred :

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Impact of NICD call phone

• Facilitated appropriate provision of rabies PEP

• Facilitated diagnosis, and ensured appropriate infection, prevention and control of highly transmissible/ significant communicable disease

• Facilitated early investigation and containment of diseases of concern

• Acts across private/public sector

Diphtheria, WCP 2017

Sindbis, GP 2017

Measles, WCP 2017CCHF, FSP 2017

H3N2 influenza, 2017

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Acknowledgements

Vivien Essel

Farzana Ismail

Ranmini Kularatne

Sarona Mhlanga