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Pre impact stage of warning (Early Detection):
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Early identification of an outbreak of disease of international public health importance shall require knowledge of early warning signals amongst all the echelons of health care providers. Some of the suggested early warning signals, which must command quick investigation by professionals, may include followings:
  • Sudden high mortality or morbidity following acute infection with short incubation period
  • Acute fever with haemorrhagic manifestations
  • Acute fever with altered sensorium and malaria and JE excluded in endemic areas
  • Even one case of suspected plague or anthrax
  • Occurrence of cases which are difficult to diagnose with available clinical and laboratory support non-responsive to conventional therapies
  • Clustering of cases/deaths in time and space with high case fatality rate
  • Unusual clinical or laboratory presentations
A comprehensive list of all the trigger events that shall attract immediate attention of local public health machinery need to be developed by a group of experts.
  • By suspicion:
    Management Plan should aim to identify crisis situation at a very early stage preferably confined to a limited area. This can be done only by suspecting danger of impending disaster by local health employees (at village by village health guide, at sub centre level by multi purpose worker and PHC level by doctors at PHC). Multipurpose workers at sub?centre level and doctors at Primary Health Centre level.
  • Alertness of institution dealing with emergency health, medical services/ Confirmation by identified laboratories
    If such a situation arises, after providing symptomatic treatment at PHC level, services of well established laboratory at district or medical college level may be requisitioned to identify the organism and also to seek guidance for specific treatment and management.
  • Constant surveillance, monitoring and community awareness and education on hygiene till there is no risk of any outbreak.
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