Philippine Integrated Disease Surveillance & Response (PIDSR) PDF

08/11/2024 DATA Philippine Integrated Disease Surveillance & Response (PIDSR) for...

08/11/2024 DATA Philippine Integrated Disease Surveillance & Response (PIDSR) for ACTION Disease Surveillance - refers to the ongoing, systematic Collection, analysis, interpretation, and Dissemination of outcome-specific data for use in the planning, implementation and evaluation of public health practice. Introduction  08/11/2024 Policies that support Disease Surveillance Policies that support Disease Surveillance GOAL (PIDSR) (PIDSR) AO 2007-0036 REPUBLIC ACT. 11223 To support the health sector in reduciing UNIVERSAL HEALTH CARE ACT morbidity and mortalli ty from diseases of Guidelines on the Philippine Integrated Disease CHAPTER IV: HEALTH SERVICES DELIVERY public health importance through an Surveillance and Response Framework. Section 17. Population-based Health Services. - The DOH shall endeavor to contract province-wide and city-wide health systems for the delivery of population-based health services. Province-wide and city-wide health systems shall have the following minimum institutionalized, functional, integrated components: disease surveillance and response system. (a) Primary care provider network with patient records accessible throughout the health system; (b) Accurate, sensitive, and timely epidemiologic surveillance systems; and (c) Proactive and effective health promotion programs or campaigns. Scope of PIDSR Policies that support Disease Surveillance Policies that support Disease Surveillance - Entire health sector, to include public and private, national (PIDSR) (PIDSR) agencies and local government units, external development AO 2021-0057 Republic Act. 11332 agencies, and the community involved in disease surveillance and response activities; Revised Guidelines on the Philippine Integrated Mandatory Reporting of Notifiable Diseases and Disease Surveillance and Response (PIDSR) Health Events of Public Health Concern Act - Routine surveillance of priority diseases and events identified by “PIDSR is hereby enhanced to integrate “ An act providing policies and prescribing the Department of Health Epidemic-prone Disease Case Surveillance (EDCS) and procedures on surveillance and response to notifiable Event-based Surveillance and Response (ESR) diseases, epidemics, and health events of public health - Routine surveillance complements the Event-based surveillance surveillance activities and response at all level of concern, and appropriate funds therefore, repealing for of priority diseases and events. Epidemiology and Surveillance Units (ESUs).” the purpose Act No. 3573.”  08/11/2024 CORE PRINCIPLES/ACTIVITIES Basic Features of PIDSR Disease Reporting Units (DRU) OF DISEASE SURVEILLANCE 1. Integrated in terms of the use of standard case I. DETECTION definitions, surveillance core activities II. REGISTRATION BHS (detection, registration, reporting, confirmation, III. REPORTING analysis, feedback) and resources. IV. LABORATORY TESTING & CONFIRMATION DRU V. DATA MANAGEMENT 2. Capacity for early detection of epidemics. VI. ANALYSIS & REPORT GENERATION VII.FEEDBACK 3. Integrated response to epidemics and other VIII.MONITORING & EVALUATION public health threats. GOV/ PRI. LABS HOSPITAL, CLINICS 4. Strengthens local capacity for surveillance and response. - An action identifying specific 5. Efficient and effective management of surveillance data notifiable disease/s based on (e.g., collection, analysis, interpretation and dissemination) and the signs and symptoms of use of information for decision-making, including monitoring patient. and evaluation of intervention programs at all levels. 6. Open lines of communication with established feedback loop Core Processes at all levels.  08/11/2024 3-Tiered System: - Suspected case: indicative clinical picture without being a confirmed or probable case - Probable case: clear clinical picture, or linked epidemiologically to a confirmed case; Note: A "case with an Epidemiological Link" is a case that has either been exposed to a confirmed case, or has had the same exposure as a confirmed case (e.g. eaten the same food, stayed in the same hotel, etc). - Confirmed case: verified by laboratory analysis. Priority Diseases, Syndromes and Conditions Our partners in detecting and Use Standard Case Definitions for Surveillance Targeted For Surveillance reporting cases Vaccine Preventable Food and Waterborne Zoonotic Vector-borne Other Diseases Diseases (VPD) Diseases Diseases Diseases PRIORITY VPDs Acute Bloody Diarrhea Leptospirosis Chikungunya Acute Meningitis 1. Disease Reporting Advocates (DRA) - A standard case definition for surveillance is a set of criteria Acute Flaccid Paralysis Cholera Rabies Dengue Encephalitis Syndrome that is used to determine if a person has a particular disease, (AFP) Measles and Rubella Acute Viral Hepatitis (Hepatitis A Virus (AMES) Acute Encephalitis 2. Disease Surveillance Coordinators (DSC) syndrome or condition and if the case should be included Neonatal Tetanus [HAV]) Syndrome / in reporting and investigation. Rotavirus Japanese 3. Disease Surveillance Officers (DSO) OTHER VPDs Typhoid and Encephalitis Diphtheria Paratyphoid Fever Bacterial Meningitis Pertussis Influenza-like Illness (Whooping Cough) Severe Acute Respiratory Non-Neonatal Illness (SARI) Tetanus Meningococcal Diseases  08/11/2024 1. Disease Reporting Advocates (DRA) The roles of DSCs are the following: The roles of DSOs are the following: Disease Reporting Advocates are health workers and other Notify the next higher-level case/s of disease/syndrome/event classified as individuals who have attended orientation on the PIDSR and The DSO shall be responsible in the collection of PIDSR forms “immediate notification” within 24 hours of detection. committed to actively participate in reporting. They can be any Conduct preliminary investigation of suspect epidemics in their respective from the hospitals at their level. However, hospital DSC and of the following: areas. provincial DSO may agree on other means of submission or Community leaders – e.g. Barangay Captain, Tribal Leader Assist in epidemic investigation conducted by PESUs, RESUs or EB. collection of PIDSR appropriate to their local condition. Barangay Health Worker Record in the Weekly Notifiable Disease Report (WNDR) all cases of Faith Healer/Traditional Healer notifiable diseases. Encode data into the computer and maintain a file of the case Submit PIDSR report forms to the next higher level. Private Practitioners investigation forms. 2. Disease Surveillance Coordinators (DSC) 3. Disease Surveillance Officers (DSO) Consolidate data from the different DRUs for weekly submission to the next higher level. Disease Surveillance Officers are fulltime staff of the Disease Surveillance Coordinators are staff of government and Epidemiology and Surveillance Unit (ESU) of the CHOs (chartered Analyze and Interpret data to provide weekly and/or non-government health facilities (hospitals, private clinics, cities), PHOs and CHDs who has received training on basic epidemiology, public health surveillance and PIDSR; and, are monthly disease surveillance report to the next higher RHUs) officially designated as disease surveillance coordinator level. officially designated as Disease Surveillance Officer by the head of by the head of the facility and are trained on PIDSR. office. Provide technical assistance in outbreak investigations Ideally a DSO should either be a physician or a nurse. and response to their respective DRUs when necessary.  08/11/2024 1. Weekly Notifiable Disease Report Summary Page 3. Case Filling necessary information in Report Forms Case Investigation Form (CIF) or -line list type Case Report Form (CRF) or encoding information in PIDSR Software. PIDSR FORMS 2. Case Where will the patient’s information be recorded? Investigation - Notifying and PIDSR Case Investigation and Reporting Forms Forms submitting relevant Three (3) types of PIDSR Forms: forms to the next higher health facility through 1. Weekly Notifiable Disease Report Summary Page call/sms/e-mail. 2. Case Investigation Forms 3. Case Report Forms  08/11/2024 Hospital / BHS Flow of Reporting MESU/CESU Laboratory PESU - Confirmation of Notifiable Disease is done through Laboratory Examination of Confirmation and RESU a certain specimen, identifying the exact virus, bacteria or organism. Specimen Epidemiology Bureau Management - Proper specimen collection, storage, packaging, exact range of temperature Level 3 & DOH and transport is VITAL! Hospitals ZERO REPORTING Common Specimen Sent to RITM “Informing the next higher level that no cases were detected” NPS/OPS Indicators (are there really no cases in the area?): STOOL ✔ Lack of admission of cases that is notifiable ✔ Presence of missed cases CSF ✔ Absence of DSC who Is in charge of monitoring reports from Blood & Serum DRAs and admissions of notifiable disease BLOOD SERUM URINE  08/11/2024 Blood Specimen Collection 3. Disinfect the collection site by swabbing using 70% alcohol. Let Required for: SUPPLIES/EQUIPMENT NEEDED. the alcohol evaporate. 1. Measles Case Investigation Form (CIF) 4. Insert the needle with the bevel 2. Dengue Syringe with needle or vacutainer system facing up. 3. Chikungunya Yellow top or Red top tubes If using a syringe, collect at least 5mL of whole blood, or enough volume to fill up the desired specimen collection 4. Leptospirosis PPE (gloves, mask, goggles) tubes. 5. Acute Encephalitis Sy Refrigerator If using vacuum-evacuated tube, blood will enter directly into the collection tube. Pull 6. Zika Virus Centrifuge the tube out once the vacuum inside the tube is exhausted. Collection of Blood : Venipuncture Blood Specimen Collection Equipment: 5. Gently release the tourniquet then withdraw 5 ml vacuum blood-collecting tubes w/ 21/22 g needles 1. Determine site for venipuncture. the needle. 5-10 ml disposable syringes w/ 21/22 g needles The ideal area is the antecubital 6. Have a cotton ready and ask the patient to plastic screw cap vials space. press the puncture site until bleeding cease. Storage: Store heparinized blood, serum, or clot at 4º C 7. Label the collection tubes. 2. Place the tourniquet about 2 inches above the site of extraction and using fingers, palpate and locate vein.  08/11/2024 8. To collect serum, allow blood to clot SUPPLIES/EQUIPMENT NEEDED Required for: Case Investigation Form (CIF) then centrifuge. Virus Transport Media (VTM) If red top tube was used, aliquot the serum and Nasopharyngeal swab, Sterile Dacron/Rayon swab with pliable shaft transfer to a screw capped container. Label accordingly. 1. MERS CoV Oropharyngeal swab, Sterile Dacron/Rayon swab with plastic shaft Yellow top collection tubes have serum separator, BUT ideally, 2. Diphtheria Sterile tongue depressor samples should be shipped in cryovials to avoid breakage Test Tube rack and hemolysis. 3. Pertussis Resealable plastic bags (zip lock) 4. Measles Laboratory sealing film (parafilm) 9. Keep the serum refrigerated until transport. Masking tape 5. HFMD (Clustering of Cases) Permanent tube marker Maintain cold chain and submit specimens to the OPS Only Scissors Research Institute for Tropical Medicine PPE (gloves, mask, goggles) Refrigerator COLLECTION KIT Virus Transport Medium SPECIMEN COLLECTION OF Nasopharyngeal swab NASOPHARYNGEAL SWAB Oropharyngeal swab AND OROPHARYNGEAL SWAB Tongue Depressor (optional) SWABS  08/11/2024 AREA FOR NP SAMPLING THE ORAL CAVITY Sensitive to gag reflex GUIDELINES PRIOR TO TARGET SITE FOR SPECIMEN COLLECTION TARGET OPS SITE FOR NPS To gain access to the oral cavity, use a tongue depressor ACCESS TO THE NP AREA THE ORAL CAVITY SPECIMEN COLLECTION POLICIES Specimens shall be collected within 7days from onset of illness since it is the time when the virus is in high concentration. Do not collect beyond 7 days. Only qualified and trained staff shall perform the procedures Use only the approved kits for specimen collection. Do NOT use expired VTMs/kits. Do NOT use cotton swabs. Remove possible visual obstructions [e.g., loose hair]. Use a single kit for each individual patient Strictly follow infection control guidelines prior to each procedure [Protect yourself and the patient]  08/11/2024 INFECTION CONTROL GUIDELINES TECHNICAL NOTES: NPS: STEP 1 CORRECT HANDLING OF SWAB Using the swab, visually measure* Personal protective equipment: wear from the base of the nostril towards a surgical mask and disposable the auditory pit. gloves. Swab held When completed, dispose of all PPE correctly Divide the length into half in order to and other contaminated materials in the know into what extent will be inserted appropriate trash bin. into the nostril (usually 5–6 cm in Wash hands thoroughly with soap and adults) to ensure that it reaches the Swab held water or alcohol‐based hand gel before posterior pharynx. incorrectly AND after the procedure. *Alternatively, you may use a ruler for more accurate measurements NPS: STEP 2 Incorrectly held SPECIMEN swab can injure With the patient seated, patient. tilt the head slightly COLLECTION PROPER backwards. NASOPHARYNGEAL Insert the swab into the nostril parallel to the Correctly held palate SWAB (NPS) swab can slide out of the way. What is wrong with this picture?  08/11/2024 NPS: STEP 3 OPS: STEP 1 Insert the swab into the nasal cavity until a slight Have the patient seated comfortably. resistance is met. Have the patient open his mouth. Rotate the swab and With gloved hands, hold down the apply a little force to take tongue with a sterile tongue depressor large quantities of mucosa Repeat in the other Have the patient say “AAH” to elevate nostril using same swab the uvula OPS: STEP 2 VESICULAR SWAB: FOR HAND FOOT AND MOUTH DISEASE SPECIMEN Use a sweeping motion to swab 1.Examine the body part and choose the posterior pharyngeal wall and the largest vesicle COLLECTION PROPER tonsillar pillars. 2.Clean area using 0.9% Normal OROPHARYNGEAL Avoid swabbing the soft palate. Saline Do not touch the tongue with 3.Rupture the vesicle with a SWAB (OPS) the swab tip. hypodermic needle 4.Swab the fluid from the area.  08/11/2024 POST-SWAB: STEP 1 POST-SWAB: STEP 3 SUPPLIES NEEDED Place the OPS immediately in the Case Investigation Form (CIF) Store inside the refrigerator (2-8C) VTM tube to avoid drying of the Gloves or thermobox with ice packs while DBS kit Ziplock bag swab. awaiting transport Cotton / Gauze Break/Cut the end of the shaft that Transport to RITM immediately or Blood Lancet sticks out of the tube (break point) Alcohol Swab should reach RITM within 72 and close the tube tightly. Humidity Indicator hours. (optional) Secure the cap with Parafilm to Desiccant Filter paper prevent leakage during *Supplies may vary depending on availability. Newborn screening kits can be used as alternative for Measles DBS kits. 7 8 POST-SWAB: STEP 2 PROCEDURE Wrap tubes with specimens in Disinfect using an alcohol swab and air dry the skin. tissue paper or any absorbent Puncture finger or heel with sterile lancet. material. Place upright in a separate 50 mL tube or any leak/puncture proof container. Place the container in a resealable Dried Blood Spot plastic bag (Ziplock)  08/11/2024 PROCEDURE PROCEDURE Wipe the first drop of the blood The DBS should be packed individually in a Hold the finger face down to card. Fill at least 3 circle resealable plastic bag with desiccant to completely with blood drop. prevent moisture. – A humidity indicator card (optional) is a card on which a ✔ moisture-sensitive chemical is impregnated such that it will change the color when the indicated relative humidity is exceeded. STOOL ✖ – A change in color from blue to pink at 30% mark indicates that the desiccant exceeded the recommended relative humidity inside the package and the desiccant is not working properly. PROCEDURE PROCEDURE SUPPLIES/EQUIPMENT NEEDED Place all the DBS samples and Case Investigation Case Investigation Form (CIF) Avoid milking Forms in an envelope and ship in an ambient Sterile stool container temperature. Plastic bag Resealable plastic bags (zip lock) Laboratory sealing film (parafilm) Label with the name of the patient AND date / time of Permanent tube marker collection. PPE (gloves, mask, goggles) Air dry blood spots completely for at least 1 hour Refrigerator before packaging with desiccant.  08/11/2024 FOR CHILDREN USING TOILETS Rectal Swabs OR CHAMBER POTS Equipment: 3.Close the container tightly. – Cary and Blair transport media – sterile cotton swabs 1. Before the child defecates, place a clean ordinary plastic bag on top of 4.Using a ballpen, write the the toilet bowl or chamber pot. Procedure: name of the child and the – Adults: The plastic bag will help catch the stool subjects bend forward and holding their buttocks to show anal opening specimen. date the stool was collected dip cotton swab into the Cary and Blair bottle Make sure the plastic bag is taped on the sticker of the container. insert swab into the anus, rotate and remove, making sure securely to the sides of the toilet bowl fecal materials stain the swab or chamber pot. place in bottle, break the stick to fit in, and cover immediately label properly FOR CHILDREN USING DIAPERS 5. Place the container inside the resealable Procedure: plastic bag provided and put inside the – Young children: 1.Remove the diaper immediately after refrigerator. 1. ask the mother or guardian to carry the child and the child defecates. 6. After at least 24 hours, collect stool again expose the anal opening 2. dip cotton swab into the Cary-Blair bottle 2.Using the spoon under the cap of the from the same child. Follow the 3. gently insert the swab into the anus, rotate and specimen container provided, carefully instructions 1 to 5 above. (FOR AFP 4. remove, making sure fecal materials stain the swab scoop the stool and place it inside the CASES) 5. place in bottle, break the stick to fit in, and cover immediately container. Fill up to half of the container 7. Pack the styrobox appropriately and ship 6. label properly with the child’s stool. to the Research Institute for Tropical Medicine  08/11/2024 Sample Collection Supplies Triple Packaging System In every collection, storage and transport, a Triple Packaging System should be Stool Collection Kit Vacuum evacuated tubes observed. This will prevent leaking and possible contamination of your specimen. Virus Transport Media (VTM) Universal Transport Media (UTM) Dried Blood Spot Card Cold Chain Cold Chain is a network of refrigerators, cold stores, freezers This includes data processing and cold boxes organized and maintained so that samples are and quality assurance: kept at the right temperature to remain viable during transportation, storage and distribution from the DRU to the Checking for data referral laboratory. – Reverse cold chain- from the DRU to the NRL completeness and – Forward cold chain- from the NRL to the DRU. A good example is the transport of vaccine to the end user. inconsistencies Deduplication process Data reconciliation Data archiving  08/11/2024 Analysis Types Disease Surveillance Reports Time – Chronological Analysis - Surveillance Data Analysis is a ⮚ Analysis over a period of time (daily, weekly, careful, systematic exercise that monthly, annual, etc.) requires focus to generate information useful for decision- Place – Geographical Analysis making and appropriate ⮚ Analysis based on location response. Person – Demographic Analysis ⮚ Analysis pertaining to Population (Age, Sex, Ethnic Group, Etc.) 1 2 Linelist of Reported Diarrheal Cases in City XYZ Name Age Sex Barangay Number of Reported Diarrheal Cases by Barangay in City XYZ Barangay Male Female Total Clustering - The transmission of evaluative TKA 30 F Poblacion Poblacion 1 2 3 JTC 27 M Barangay 1 Barangay 1 1 3 4 Vaccine Preventable Non-VPD or corrective information and WYG 39 M Barangay 3 Barangay 2 0 1 1 Diseases (VPD) analysis about notifiable JPN 26 M Poblacion Barangay 3 1 1 2 KSAY 40 F Barangay 1 Total 3 7 10 diseases or health events. JST 26 F Barangay 2 2 or more cases in 4 3 or more cases in 4 IL 46 F Barangay 1 GL 37 F Poblacion consecutive weeks consecutive weeks GR 64 F Barangay 1 MAB 39 F Barangay 3  08/11/2024 TYPES OF FEEDBACK HOW CAN SURVEILLANCE INFORMATION TYPE OF FEEDBACK EXAMPLES Verbal feedback Telephone calls BE USED Monitoring refers to the routine and continuous tracking of the implementation of planned surveillance activities and of the Supervisory visits Policy development overall performance of surveillance and response systems. Meetings Health Education Activities Strategic planning Program Implementation Review (PIR) Decision making Routine monitoring serves to: Exit conference Notification, investigation and intervention of epidemics Track progress of implementation of planned activities; Press conference Ensure that planned targets are achieved in a timely manner; Written feedback Disease surveillance report Program management Track progress of improvements in targeted indicators of the Outbreak response report Impact monitoring quality and attributes of the system, such as timeliness of Fact sheets Newsletter Problem identification reporting, completeness of reporting, etc; Social mobilization Identify the problems in the system in order to institute Others Health education materials corrective measures in a timely manner. Radio programs FEEDBACK ACTIVITIES CORE PRINCIPLES/ACTIVITIES Evaluation is the periodic assessment of the relevance, effectiveness OF DISEASE SURVEILLANCE and impact of activities in the light of the objectives of the Dissemination of surveillance reports (written feedback) surveillance and response systems. I. DETECTION - Assesses the sensitivity of the DRU Dissemination of data requests (written feedback) Evaluation of surveillance systems serves to: Dissemination of surveillance data via training/orientation II. REGISTRATION - Ensures details of cases are recorded Ensure that the surveillance system meets the objectives for (verbal feedback) III. REPORTING - Ensures immediate notification and proper channels of information are met which it was formulated; Document the status of, and any change in the performance of Conduct of management review/meetings IV. LABORATORY TESTING & CONFIRMATION - Actualizes the disease the system after each evaluation period; (weekly/monthly) V. DATA MANAGEMENT - Ensures information is accurate, precise and readily available Identify gaps and/ or enablers in the surveillance system; Provide recommendations for improving the system; VI. ANALYSIS & REPORT GENERATION - Ensures data is more understandable Ensure that the quality of surveillance adheres to a high standard VII. FEEDBACK - Supports and enables appropriate action to be taken of implementation with respect to the attributes of the system.  08/11/2024 SILENT DRU DRU STATUS A health facility that has not submitted PIDSR, TRACKER including failure to maintain zero reporting for two or more weeks SAMPLE CATEGORY 1 When a silent DRU is identified, the DSO should conduct IMMEDIATE NOTIFIABLE DISEASE active surveillance in that health facility to determine reason for “silence” Scrutiny of Hospital Records and Logbooks DRU STATUS SAMPLE Retrospective records review Find out the reasons why they failed to submit the PIDSR Persuade the hospital management to participate in the surveillance activities  08/11/2024 CATEGORY 2 WEEKLY NOTIFIABLE DISEASE Mosquito-borne Diseases  08/11/2024 Dengue: Case Definition SPECIMEN MANAGEMENT Leptospirosis: Standard Case Definition: Probable Case: Probable Case: DISEASE TEST APPROPRIATE TIME OF QUANTITY CONTAINER/ STORAGE TRANSPORT/ A suspected case and with a positive Dengue NS1, SPECIMEN COLLECTION TRANSPORT PRIOR TO TIME A suspected case in an ongoing epidemic or epidemiological linked to MEDIA TRANSPORT CONDITION antigen test or dengue IgM antibody test Dengue PCR SERUM W/in 5 days 1-2 ml Red top tube Freeze prior 1-2 ice packs a confirmed case OR a clinically tested positive by Rapid Test Kits from onset to transport Transported of fever within 24- Confirmed Case: 48hrs after collection A suspect case that is Laboratory Confirmed. Confirmed Case: Chikungunya SEROLOGY SERUM After 5-14 1-2 ml Red top tube Freeze prior 1-2 ice packs Specimen for Confirmation: Fever days from to transport Transported Blood Serum A suspected case with positive results for: onset of fever within 24- 48hrs after Urine - Viral culture isolation, and/or Polymerase Chain collection CSF Reaction (PCR) CHIKUNGUNYA: Case Definition Rabies: Case Classification: Suspect Case: Suspected case: a patient with acute onset of fever, rash (over limbs or acute neurological syndrome (encephalitis) trunk) and severe arthralgia or arthritis not explained by other medical Hydrophobia conditions. Photophobia Anemophobia Confirmed Case: hyperactivity (furious rabies) or - a suspect case with any of the following CHIK specific tests: Zoonotic paralytic syndromes (dumb rabies) progresses to coma and death, usually by respiratory failure, within 7 to 10 Diseases Detection of viral RNA by RT-PCR. days after the first symptom if no intensive care is instituted Detection of IgM in a single serum sample (collected during Probable Case: suspected case + history of contact with suspected rabid animal. Surveillance acute or convalescent phase). Four-fold increase in CHIKV-specific antibody titers (samples Confirmed Case: laboratory confirmation (of either human or animal) collected at least two to three weeks apart). Note: Bites or scratches from a suspected animal can usually be traced back in the patient’s medical Viral isolation. history. The incubation period may vary from days to years but usually falls between 30 and 90 days.  08/11/2024 SPECIMEN MANAGEMENT Acute Bloody Diarrhea: Standard Case Definition Cholera: Case Definition DISEASE TEST APPROPRIATE TIME OF QUANTITY CONTAINER/ STORAGE TRANSPORT/ Suspect SPECIMEN COLLECTION TRANSPORT PRIOR TO TIME Probable Case: Not applicable MEDIA TRANSPORT CONDITION ▪ A person with acute diarrhea with visible blood in the stool. Leptospirosis RT - PCR SERUM Within 10 days ≥1 ml Red top Freeze prior - 6-8 ice from the onset tube, yellow to transport packs Confirmed Case: A suspected case that is laboratory-confirmed. of illness top - Transported Cryotube within 24- Probable 48hrs after CSF 0.5-2ml Sterile collection ▪ N/A container URINE 2nd week up to 5-10 ml Sterile 20 days after container onset of Confirmed symptoms Rabies TEST ARE AVAILABLE FOR RESEARCH PURPOSES ONLY ▪ N/A Cholera: Case Definition Acute Viral Hepatitis: Case Definition Probable : Suspected Case: Not applicable Food and - Disease unknown in the area: A person aged 5 years or more with severe dehydration or who died from acute watery diarrhea, OR Confirmed Case: Waterborne - Disease endemic in the area: A person aged 5 years or more with A suspected case that is laboratory confirmed. Disease acute watery diarrhea with or without vomiting, OR Surveillance - In an area where there is a cholera epidemic: A person with acute watery diarrhea, with or without vomiting  08/11/2024 Typhoid & Paratyphoid: Case Definition SPECIMEN MANAGEMENT Probable Case: DISEASE TEST APPROPRIATE TIME OF QUANTITY CONTAINER/ STORAGE TRANSPORT/ A suspected case that is epidemiologically linked to a SPECIMEN COLLECTION TRANSPORT MEDIA PRIOR TO TRANSPORT TIME CONDITION Priority Vaccine Acute Bloody Culture Rectal Swab ASAP; 1-2 swabs Cary Blair Room temp 1-2 ice packs confirmed case in an outbreak. Diarrhea preferably Transport (20-22°C) Transported during active medium within 24- A suspected case that is positive for rapid antigen test Preventable diarrhea 48hrs after collection for typhoid fever Cholera Culture Rectal Swab ASAP; 1-2 swabs Cary Blair Room temp 1-2 ice packs Disease preferably Transport (20-22°C) Transported during active medium within 24- diarrhea 48hrs after Surveillance Confirmed Case: collection Acute Viral Serology Serum After 5- At least 1-2 Red top, Refrigerated 6-8 ice packs A suspected or probable case that is laboratory hepatitis 14days from ml yellow top, (2-8 °C) Transported onset of cryotube ASAP after confirmed. fever collection Rotavirus: Standard Case Definition Acute Flaccid Paralysis : Case Definition SPECIMEN MANAGEMENT Suspected Case: Child less than 15 years old (14 years old and DISEASE TEST APPROPRIATE TIME OF QUANTITY CONTAINER/ STORAGE TRANSPORT/ A child 100 cells/ mm3) or, and/or Note: The onset of fever should be within three days of leukocytosis (10-100 cells/ mm3) AND either an elevated protein (>100 Other Notifiable presentation and fever should be measured at the time of presentation. mg/dl) or decreased glucose (