Outbreak Investigation

Module Overview

Since the beginning of this century, the world has been confronted with numerous threats posed by epidemic and epizootic outbreaks of emerging and re-emerging diseases that, in most cases, result from interaction between humans/animals and the environment. Emerging diseases such as the Highly Pathogenic Avian Influenza, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), Ebola hemorrhagic fever and Nipah virus infection, as well as other endemic diseases such as rabies, human and animal tuberculosis, Rift Valley Fever, brucellosis and cysticercosis, represent serious threats to human and animal life and sound environmental management.

Several initiatives are being launched in the face of these threats, including the One Health strategy, which encourages cross-sector and multidisciplinary collaboration, adherence to the International Health Regulations (IHR, 2005) and the Global Health Security Agenda (GHSA).

One Health is defined as the collaborative effort of multiple disciplines working locally, nationally and globally to attain optimal health for people, animals and our environment. The One Health paradigm emerged from the recognition that the wellbeing of humans, animals and ecosystems are interrelated and interdependent, and there is need for more systematic and cross-sectoral approaches to identifying and responding to global public health emergencies and other health threats arising at the human-animal ecosystem interface. The One Health concept is, therefore, a worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans, animals and the environment. The synergism achieved will advance health care for the 21st Century and beyond by accelerating biomedical research discoveries, enhancing public health efficacy, expeditiously expanding the scientific knowledge base, and improving medical education and clinical care. When properly implemented, it will help protect and save untold millions of human and animal lives in the present and future generations.

One Health Central and Eastern Africa (OHCEA) is a network of universities in Central and Eastern Africa which are collaborating to build One Health capacity and academic partnerships between the member institutions in the region and with governments. The overall goal of this collaboration is to enhance One Health policy formation and implementation in order to contribute to improved capacity of countries to respond to any emerging pandemics in the region.

The OHCEA network’s vision is to be a global leader in One Health, promoting sustainable health for the prosperity of communities, productive animals and balanced ecosystems. OHCEA seeks to expand the human resource base needed to detect and respond to potential pandemic disease outbreaks, and increase integration of animal, wildlife and human disease surveillance and outbreak response systems.

The academic institutions in the OHCEA that are responsible for training personnel in the health care and related sectors must continue to train and re-train both future officials and current service providers to ensure they comply more effectively with the principles of prevention, early detection and control of the potentially epidemic diseases and the resistance to antimicrobials and pesticides that are gripping the country. In these circumstances, a disciplined, capable, prudently trained and re-trained staff will strive to apply the principles for preventing and controlling emerging and re-emerging diseases.

This Facilitator Guide addresses several shortcomings of service providers regarding the prevention, early detection and response to epidemics and epizootics. It can also serve as the resource for a number of health sciences courses taught at the secondary and university levels, and for on-the-job training of health care professionals, by adapting it as necessary to identified instructional needs.

This Guide consists of six sections subdivided into units. The sectons address the One Health approach to prevention, early detection and response to emerging infectious diseases and antimicrobial resistance phenomena. The Gender Analysis section recognizes the need for gender sensitive disease surveillance, control and response processes. It is a practical method to incorporate a gender perspective into emerging disease programs through gender analysis tools that recognize and reveal how sex and gender affect infectious disease transmission, prevention and outcomes.

The Guide also includes a practical module for use in the field, which places the participants in actual professional environments.

The module is designed to provide both future and currently active health care professionals with the necessary skills to work as part of a multidisciplinary team in preventing epidemics caused by emerging diseases and in implementing strategies for monitoring and responding to outbreaks as well as participants and faculty.

By the end of this training, participants should be able to make an effective contribution in preventing, detecting and responding to nosocomial infections, emerging and re-emerging diseases (Ebola and other zoonotic diseases) and resistance to antimicrobials and pesticides, using the One Health approach.

Target Audience

The module can be used by undergraduate and post-graduate learners, middle cadre trainees and in-service personnel from multiple disciplines and sectors (private, public, NGOs, civil society). This module can also be adopted for continuous professional development by health professional organizations such as medical associations, pharmacy associations and veterinary associations as well as nursing, public health, environmental scientists and biotechnologists. It is intended for use in training participants in the beginners and advanced stage in medicine and health sciences as well as officials in the health care system and related sectors.

Goals of the Training

The training is designed to:

i) equip participants with knowledge and skills required for outbreak investigations and response while utilizing the One Health approach.
ii) help participants acquire the skills they will need to collaborate more closely with colleagues in other disciplines and sectors in order to prevent, detect and respond effectively to epidemics, epizootics and antimicrobial and pesticide resistance.
iii) help participants become transformative agents by promoting gender equality and equity in all aspects of their work and sharing this information with others.

One Health Approach

The goal of this module is to help participants acquire the skills they will need to collaborate more closely with colleagues in other disciplines and sectors in order to prevent, detect and respond effectively to epidemics, epizootics and antimicrobial and pesticide resistance. Several instructional methods are used in this module, including presentations, case studies, role-plays, active information seeking, group discussions and plenary sessions. In addition, the presence of participants from multiple disciplines will help them learn more about each other and acknowledge and respect the contributions made by fellow professionals who are working to improve, maintain and promote health care.

Module Competencies

i) Initiating a shared vision: creating, inspiring and motivating personnel from multiple sectors; managing service activities as part of the One Health Approach.
ii) Acquiring, synthesizing and exchanging information across sectors and disciplines and among various stakeholders, in order to promote and reinforce an enhanced, mutual understanding of the actions taken as part of the One Health Approach.
iii) A comprehensive approach that acknowledges and assesses how the dynamics and interdependence of various systems and entities can affect a complex process (e.g. epidemic, resistance to antimicrobials and pesticides).
iv) Demonstrating integrity, transparency, fairness, honesty, responsibility, trust and adaptability

Learning Objectives of the Course

By the end of this module, the learner should be able to:

i) illustrate the One Health concept as it relates to outbreak investigation and response:
- Describe One Health concept.
- Apply One Health core competencies in multiple disciplines.
ii) evaluate disease outbreak investigation and response principles and approaches.

• Describe disease outbreak patterns and approaches to investigations utilizing One Health concept.

iii) explain a multi-sectoral approach to disease investigation and response:
- Demonstrate leadership roles in disease investigations and response.
- Apply communication principles in designing disease outbreak investigation and response.
iv) illustrate the role of socio-cultural beliefs and gender in disease investigation and response:
- Identify gender and socio-cultural gaps in disease investigation and response.
- Explain specific gender analysis tools used for outbreak investigation and response.
- Create and implement a gender sensitive emergency response plan