Outbreak response and management Interview with Koert Ritmeijer

DR KOERT RITMEIJER: In terms of outbreak response, the WHO has developed guidelines for outbreak response, which clearly identifies the different steps that are required in the response process. Those guidelines are quite general. And there are several countries that have contextualised those guidelines in very specific guidelines and procedures in response to outbreaks in their country. The different steps in response to an outbreak is first the confirmation of an outbreak, which requires laboratory support in terms of confirming the disease, but also trying to get information on what is the species, also trying to get information on the vector to get a picture of the transmission dynamics that contributed to the outbreak.

And then the next step is, of course, in the first place– is to provide access to early diagnostic and treatment services for patients. That is the first priority, and then, in the meantime, specific control interventions can be started, like factor control, active case detection in a community.

There are different ways in which outbreaks can be detected. The most traditional one is that a health worker in the field observes an unusual increase in number of cases that he sees in a clinic and then reports that to the higher authorities, who will pick it up and start an outbreak investigation. In reality, you see that often there is a very big delay before the health worker notices– is aware that something is happening, and then a delay in the reporting, a delay before it is noticed at higher levels that something unusual is happening and then a delay in generating the whole response process.

And that’s why it’s so important to have a good emergency preparedness planning– that the whole process is already described and everybody that plays a role exactly knows what to do and what triggers a response. But there are also other ways in which an outbreak can be detected and nowadays– you see the role of the media is increasing– that they hear, local journalists– they hear something and they report it in the media. Of course, that is something that needs to be verified because very often you see rumours that are not based on reality.

But there’s also occurrences of, especially in extremely resource limited context where district health authorities– they try to attract resources, in terms of drugs and medical supplies, by claiming that an outbreak is occurring and hoping that then there will be a response with a supply of what they need. And then there is, of course– if it’s in an area where health NGOs work, then very often they are the first ones that pick up that an unusual occurrence of cases is taking place and very often they themselves might have the capacity to do outbreak investigations, and to involve the national authorities and even also international agencies like the WHO to assist in outbreak investigations and response.

The delay in the different response steps can be shortened or minimised if there is already a good preparedness plan in place, so that the health worker in the field knows what he has to look for, that he does regular analysis of the medical data in the clinic, that he knows that if there is an increase of cases - a doubling of cases, that he reports that immediately to the higher authorities who then will know that they have to trigger the next response step.

So if all the people that are involved in the different response steps are well trained, and prepared and know what they have to do, then all those delays can be minimised– that an effective response can be generated much earlier in the epidemic peak and, therefore, have a much bigger impact in bringing down the epidemic curve and preventing further spread of the outbreak.