Week ending July 11, 2020 Epidemiological Week 28

WEEKLY EPIDEMIOLOGY BULLETIN NATIONAL EPIDEMIOLOGY UNIT, MINISTRY OF HEALTH & WELLNESS, JAMAICA

EPI WEEK 28

Monkeypox

Overview

Monkeypox virus is an orthopoxvirus that causes a disease with symptoms similar, but less severe, to smallpox. While smallpox was eradicated in 1980, monkeypox continues to occur in countries of Central and West Africa. Monkeypox is a zoonosis: a disease that is transmitted from animals to humans. Cases are often found close to tropical rainforests where there are animals that carry the virus. Evidence of monkeypox virus infection has been found in animals including squirrels, Gambian poached rats, dormice, different species of monkeys and others. Human-to-human transmission is limited, with the longest documented chain of transmission being six generations, meaning that the last person to be infected in this chain was six links away from the original sick person. It can be transmitted through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets and contaminated objects. Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for monkeypox. The best diagnostic specimens are directly from the rash – skin, fluid or crusts, or biopsy where feasible. Antigen and antibody detection methods may not be useful as they do not distinguish between orthopoxviruses.

Symptoms

Monkeypox presents with fever, an extensive characteristic rash and usually swollen lymph nodes. It is important to distinguish monkeypox from other illnesses such as chickenpox, measles, bacterial skin infections, scabies, syphilis and medication-associated allergies. The incubation period of monkeypox is can range from 5 to 21 days. The febrile stage of illness usually lasts 1 to 3 days with symptoms including fever, intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle ache), and an intense asthenia (lack of energy). The febrile stage is followed by the skin eruption stage, lasting for 2 to 4 weeks. Lesions evolve from macules (lesions with a flat base) to papules (raised firm painful lesions) to vesicles (filled with clear fluid) to pustules (filled with pus), followed by scabs or crusts. The proportion of patients who die has varied between 0 and 11% in documented cases and has been higher among young children.

Treatment

Treatment of monkeypox patients is supportive dependent on the symptoms. Various compounds that may be effective against monkeypox virus infection are being developed and tested. Prevention and control of human monkeypox rely on raising awareness in communities and educating health workers to prevent infection and stop transmission. Most human monkeypox infections result from a primary animal-to-human transmission. Unprotected contact with sick or dead animals should be avoided, and all foods containing animal meat or parts need to be properly cooked before eating. Close unprotected contact with infected people or contaminated materials should be avoided. Gloves and other personal protective clothing and equipment should be worn while taking care of the sick, whether in a health facility or in the home. Populations have become more susceptible to monkeypox as a result of the termination of routine smallpox vaccination, which offered some cross-protection in the past. Vaccination against smallpox with first generation vaccinia-virus based smallpox vaccine was shown to be 85% effective in preventing monkeypox in the past. Family and community members, health workers and laboratory personnel who were vaccinated against smallpox in childhood may have some remaining protection against monkeypox.

https://www.who.int/health-topics/monkeypox/#tab=tab_1

SYNDROMES PAGE 2

CLASS 1 DISEASES PAGE 4

INFLUENZA PAGE 5

DENGUE FEVER PAGE 6

GASTROENTERITIS PAGE 7

RESEARCH PAPER PAGE 8

Released July 24, 2020 ISSN 0799-3927

NOTIFICATIONS-

All clinical

sites

INVESTIGATION

REPORTS- Detailed Follow

up for all Class One Events

HOSPITAL

ACTIVE

SURVEILLANCE-30 sites. Actively pursued

SENTINEL

REPORT- 78 sites.

Automatic reporting

2

SENTINEL SYNDROMIC SURVEILLANCE Sentinel Surveillance in

Jamaica

Map representing the Timeliness of Weekly Sentinel Surveillance Parish Reports for the Four Most Recent Epidemiological Weeks – 25 to 28 of 2020 Parish health departments submit reports weekly by 3 p.m. on Tuesdays. Reports submitted after 3 p.m. are considered late.

FEVER Temperature of >380C /100.40F (or recent history of fever) with or without an obvious diagnosis or focus of infection.

KEY VARIATIONS OF BLUE SHOW CURRENT WEEK

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Epidemiologic week

Weekly Visits to Sentinel Sites for Undifferentiated Fever All ages: Jamaica, Weekly Threshold vs Cases 2020

2020 <5 2020 ≥5 Epidemic Threshold <5 Epidemic Threshold >=5

A syndromic surveillance system is good for early detection of and response to public health events. Sentinel surveillance occurs when selected health facilities (sentinel sites) form a network that reports on certain health conditions on a regular basis, for example, weekly. Reporting is mandatory whether or not there are cases to report. Jamaica’s sentinel surveillance system concentrates on visits to sentinel sites for health events and syndromes of national importance which are reported weekly (see pages 2 -4). There are seventy-eight (78) reporting sentinel sites (hospitals and health centres) across Jamaica.

REPORTS FOR SYNDROMIC SURVEILLANCE

Released July 24, 2020 ISSN 0799-3927

NOTIFICATIONS-

All clinical

sites

INVESTIGATION

REPORTS- Detailed Follow

up for all Class One Events

HOSPITAL

ACTIVE

SURVEILLANCE-30 sites. Actively pursued

SENTINEL

REPORT- 78 sites.

Automatic reporting

3

FEVER AND NEUROLOGICAL Temperature of >380C /100.40F (or recent history of fever) in a previously healthy person with or without headache and vomiting. The person must also have meningeal irritation, convulsions, altered consciousness, altered sensory manifestations or paralysis (except AFP).

FEVER AND HAEMORRHAGIC Temperature of >380C /100.40F (or recent history of fever) in a previously healthy person presenting with at least one haemorrhagic (bleeding) manifestation with or without jaundice.

FEVER AND JAUNDICE Temperature of >380C /100.40F (or recent history of fever) in a previously healthy person presenting with jaundice. The epidemic threshold is used to confirm the emergence of an epidemic in order to implement control measures. It is calculated using the mean reported cases per week plus 2 standard deviations.

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Weekly Visits to Sentinel Sites for Fever and Neurological Symptoms 2019 and 2020 vs. Weekly Threshold: Jamaica

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Weekly visits to Sentinel Sites for Fever and Haemorrhagic 2019 and 2020 vs Weekly Threshold; Jamaica

2019 2020 Alert Threshold Epidemic Threshold

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Fever and Jaundice cases: Jamaica, Weekly Threshold vs Cases 2019 and 2020

2019 2020 Alert Threshold Epidemic Threshold

Released July 24, 2020 ISSN 0799-3927

NOTIFICATIONS-

All clinical

sites

INVESTIGATION

REPORTS- Detailed Follow

up for all Class One Events

HOSPITAL

ACTIVE

SURVEILLANCE-30 sites. Actively pursued

SENTINEL

REPORT- 78 sites.

Automatic reporting

4

ACCIDENTS Any injury for which the cause is unintentional, e.g. motor vehicle, falls, burns, etc.

KEY VARIATIONS Of BLUE SHOW CURRENT WEEK

VIOLENCE Any injury for which the cause is intentional, e.g. gunshot wounds, stab wounds, etc.

GASTROENTERITIS Inflammation of the stomach and intestines, typically resulting from bacterial toxins or viral infection and causing vomiting and diarrhoea.

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Weekly visits to Sentinel Sites for Accidents by Age Group 2020 vs Weekly Threshold; Jamaica

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Weekly visits to Sentinel Sites for Violence by Age Group 2020 vs Weekly Threshold; Jamaica

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Weekly visits to Sentinel Sites for Gastroenteritis All ages 2020 vs Weekly Threshold; Jamaica

2020 <5 2020 ≥5 Epidemic Threshold <5 Epidemic Threshold >5

Released July 24, 2020 ISSN 0799-3927

NOTIFICATIONS-

All clinical

sites

INVESTIGATION

REPORTS- Detailed Follow

up for all Class One Events

HOSPITAL

ACTIVE

SURVEILLANCE-30 sites. Actively pursued

SENTINEL

REPORT- 78 sites.

Automatic reporting

5

CLASS ONE NOTIFIABLE EVENTS Comments

Confirmed YTD AFP Field Guides

from WHO indicate

that for an effective

surveillance system,

detection rates for

AFP should be

1/100,000

population under 15

years old (6 to 7)

cases annually.

___________

Pertussis-like

syndrome and

Tetanus are

clinically confirmed

classifications.

______________

* Dengue

Hemorrhagic Fever

data include Dengue

related deaths;

** Figures include

all deaths associated

with pregnancy

reported for the

period. * 2019 YTD

figure was updated.

*** CHIKV IgM

positive

cases

**** Zika

PCR positive cases

CLASS 1 EVENTS CURRENT

YEAR 2020 PREVIOUS

YEAR 2019

NA

TIO

NA

L /

INT

ER

NA

TIO

NA

L

INT

ER

ES

T

Accidental Poisoning 5 22

Cholera 0 0

Dengue Hemorrhagic Fever* NA NA

Hansen’s Disease (Leprosy) 0 0

Hepatitis B 0 11

Hepatitis C 0 2

HIV/AIDS NA NA

Malaria (Imported) 0 0

Meningitis (Clinically confirmed) 1 11

EXOTIC/

UNUSUAL Plague 0 0

H I

GH

MO

RB

IDIT

/

MO

RT

AL

IY

Meningococcal Meningitis 0 0

Neonatal Tetanus 0 0

Typhoid Fever 0 0

Meningitis H/Flu 0 0

SP

EC

IAL

PR

OG

RA

MM

ES

AFP/Polio 0 0

Congenital Rubella Syndrome 0 0

Congenital Syphilis 0 0

Fever and

Rash

Measles 0 0

Rubella 0 0

Maternal Deaths** 21 34

Ophthalmia Neonatorum 23 105

Pertussis-like syndrome 0 0

Rheumatic Fever 0 0

Tetanus 0 0

Tuberculosis 6 27

Yellow Fever 0 0

Chikungunya*** 0 0

Zika Virus**** 0 0 NA- Not Available

Released July 24, 2020 ISSN 0799-3927

NOTIFICATIONS-

All clinical

sites

INVESTIGATION

REPORTS- Detailed Follow

up for all Class One Events

HOSPITAL

ACTIVE

SURVEILLANCE-30 sites. Actively pursued

SENTINEL

REPORT- 78 sites.

Automatic reporting

6

NATIONAL SURVEILLANCE UNIT

INFLUENZA REPORT EW 28

July 05, 2020-July 11, 2020 Epidemiological Week 28

EW 28 YTD

SARI cases 5 340

Total

Influenza

positive Samples

0 69

Influenza A 0 45

H3N2 0 4

H1N1pdm09 0 38

Not subtyped 0 3

Influenza B 0 24

Parainfluenza 0 0

Epi Week Summary

During EW 28, 5 (five) SARI

admissions were reported.

Caribbean Update EW 28

Caribbean: Influenza and other respiratory virus activity remained low in the subregion. In Haiti and Suriname, detections of SARS-CoV-2 continue elevated and increasing..

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Weekly visits to Sentinel Sites for Influenza-like Illness (ILI) All ages 2020 vs Weekly Threshold; Jamaica

2020 2020 2020

Epidemic Threshold <5 Epidemic Threshold 5-59 Epidemic Threshold ≥60

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Epidemiological Week

Jamaica: Percentage of Hospital Admissions for Severe Acute Respiratory Illness (SARI 2020) (compared with 2011-2019)

SARI 2020 Alert ThresholdAverage epidemic curve (2011-2019) Seasonal ThresholdEpidemic Threshold

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A(H1N1)pdm09 A not subtyped A no subtypable A(H1)

A(H3) Parainfluenza RSV Adenovirus

Methapneumovirus Rhinovirus Coronavirus Bocavirus

Released July 24, 2020 ISSN 0799-3927

NOTIFICATIONS-

All clinical

sites

INVESTIGATION

REPORTS- Detailed Follow

up for all Class One Events

HOSPITAL

ACTIVE

SURVEILLANCE-30 sites. Actively pursued

SENTINEL

REPORT- 78 sites.

Automatic reporting

7

Dengue Bulletin July 05, 2020-July 11, 2020 Epidemiological Week 28 Epidemiological Week 28

Reported suspected and confirmed dengue

with symptom onset in week 28 of 2020

2020

EW 28

YTD

Total Suspected Dengue

Cases 0** 717**

Lab Confirmed Dengue cases

0** 1**

CONFIRMED Dengue Related Deaths

0** 1**

Points to note:

** figure as at July 14 , 2020

Only PCR positive dengue cases

are reported as confirmed.

IgM positive cases are classified

as presumed dengue.

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2020 Epidemic threshold

Released July 24, 2020 ISSN 0799-3927

NOTIFICATIONS-

All clinical

sites

INVESTIGATION

REPORTS- Detailed Follow

up for all Class One Events

HOSPITAL

ACTIVE

SURVEILLANCE-30 sites. Actively pursued

SENTINEL

REPORT- 78 sites.

Automatic reporting

8

RESEARCH PAPER ABSTRACT

Title A Description of Registered Nurses’ Documentation Practices and their Experiences with Documentation in a Jamaican Hospital C Blake-Mowatt, JLM Lindo, S Stanley, J Bennett

The UWI School of Nursing, Mona, The University of the West Indies, Mona, Kingston 7, Jamaica

Objective: To determine the level of documentation that exists among registered nurses employed at a Type

A Hospital in Western Jamaica.

Method: Using an audit tool developed at the University Hospital of the West Indies, 79 patient dockets from three medical wards were audited to determine the level of registered nurses’ documentation at the hospital. Data were analyzed using the SPSS® version 17 for Windows®. Qualitative data regarding the nurses’ experience with documentation at the institution were gathered from focus group discussions including 12 nurses assigned to the audited wards.

Results: Almost all the dockets audited (98%) revealed that nurses followed documentation guidelines for

admission, recording patients’ past complaints, medical history and assessment data. Most of the dockets

(96.7%) audited had authorized abbreviations only. Similarly, 98% of the nurses’ notes reflected clear

documentation for nursing actions taken after identification of a problem and a summary of the patients’

condition at the end of the shift. Only 25.6% of the dockets had nursing diagnosis which corresponded to the

current medical diagnosis and less than a half (48.3%) had documented evidence of discharge planning.

Most of the nurses’ notes (86.7%) had no evidence of patient teaching. The main reported factors affecting

documentation practices were workload and staff/patient ratios. Participants believed that nursing

documentation could be improved with better staffing, improved peer guidance and continuing education.

Conclusion: Generally, nurses followed the guidelines for documentation; however, elements were missing

which included patient teaching and discharge planning. This was attributed to high patient load and

nurse/patient ratio.

_____________________________________________________________________________________

The Ministry of Health and Wellness

24-26 Grenada Crescent

Kingston 5, Jamaica

Tele: (876) 633-7924

Email: surveillance@moh.gov.jm