Control of communicable diseases standard 4: outbreak preparedness
Measures are taken to prepare for and respond to outbreaks of infectious diseases.
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Key indicators (to be read in conjunction with the guidance notes)
An outbreak investigation and control plan is prepared (see guidance note 1).
Protocols for the investigation and control of common outbreaks are available and distributed to relevant staff.
Staff receive training in the principles of outbreak investigation and control, including relevant treatment protocols.
Reserve stocks of essential drugs, medical supplies, vaccines and basic protection material are available and can be procured rapidly (see guidance note 2).
Sources of vaccines for relevant outbreaks (e.g. measles, meningococcal meningitis, yellow fever) are identified for rapid procurement and use. Mechanisms for rapid procurement are established (see guidance note 2).
Sites for the isolation and treatment of infectious patients are identified in advance, e.g. cholera treatment centres.
A laboratory is identified, whether locally, regionally, nationally or in another country, that can provide confirmation of diagnoses (see guidance note 3).
Sampling materials and transport media for the infectious agents most likely to cause a sudden outbreak are available on-site, to permit transfer of specimens to an appropriate laboratory. In addition, several rapid tests may be stored on-site (see guidance note 4).
Guidance notes
1. Outbreak investigation and control plan: the following issues should be addressed in the plan:
a. the circumstances under which an outbreak control team is to be convened;
b. composition of the outbreak control team, including representatives from appropriate sectors, e.g. health, water and sanitation;
c. specific roles and responsibilities of organisations and positions on the team;
d. arrangements for consulting and informing authorities at local and national level;
e. the resources/facilities available to investigate and respond to outbreaks.
2. Reserve stocks: on-site reserves should include material to use in response to likely outbreaks. Such stocks might include oral rehydration salts, intravenous fluids, antibiotics, vaccines and consumable medical supplies. Single use/auto-destruct syringes and safe needle containers should be available, to prevent the spread of viral hepatitis and HIV. A pre-packaged cholera kit may be indicated in some circumstances. It may not be practical to keep some stocks on-site, such as meningococcal vaccine. For these items, the mechanisms for rapid procurement, shipment and storage should be determined in advance so that they can be rapidly available.
3. Reference laboratories: a reference laboratory should also be identified either regionally or internationally that can assist with more sophisticated testing, e.g. antibiotic sensitivity for Shigella, serological diagnosis of viral haemorrhagic fevers.
4. Transport media and rapid tests: sampling materials (e.g. rectal swabs) and transport media (e.g. Cary-Blair, Amies' or Stuarts' media for cholera, Shigella, E. Coli and Salmonella; Translocate for meningitis) should be available on-site, or readily accessible. In addition, several new rapid tests are available that can be useful in confirming diagnoses of communicable diseases in the field, including malaria and meningitis
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