Key facts

A cluster of illness or deaths is a group of people or animals in the same area who become sick with the same symptoms at about the same time. The people or animals may get sick and recover or may die from the disease.

Unexplained means the cause of the illness or the deaths is not known.

Transmission: unknown

In the beginning, when it is unknown how the disease spreads, volunteers should assume it may be spread by any method (for example: person-to-person through the air, via animals, or through water or food)
It could also be kept as a possibility that the illness might be a deliberate event, and this is important especially in war or conflict-prone areas.

Most vulnerable

Vulnerable groups are usually unknown, especially at the beginning

It is important to identify what affected people have in common
- Are they near the same age (for example young children or the elderly)?
- Do they share a health or physical condition (for example, pregnant women)?
- Do they do the same type of work (for example, farmers)?
- Do they live or work in the same place (for example, school dormitory)?
- Do they share food or water sources?
- Are they located in war or conflict-prone areas?

Symptoms

Symptoms will depend on the type of disease affecting people. Make a note of the symptoms that sick people are reporting or that families report after a person has died.

What can you do to prevent and control an epidemic?

Monitoring the community and identifying sick people and animals

Detect sick people quickly for referral to health facilities
Monitor the community for clusters of sick or dead animals or dying plants
- Report any clusters or observations to your supervisor, animal health and welfare authorities, health authorities, or environmental health agencies.
- Encourage quarantining sick animals away from healthy ones
- Discourage community members from taking sick animals to markets or other places where they may encounter other animals or humans
- Encourage minimal contact between sick animals and humans
- Collect samples from food, plants, water, and soil to test at the laboratory for microorganism or other contaminants

Treatment and management

Rapidly refer suspected cases of illness to health services
Support safe and dignified funeral and burial practices is required
Provide psychosocial support to the sick person and their family members

Sanitation and waste management

Discourage open defecation
- Encourage use of toilets/latrines
Solid waste management
- Encourage the community to clear away rubbish and garbage

Food and water hygiene and safety

Encourage household water treatment for safe drinking water
- Store water in clean, covered water container
Promote thorough cleaning and cooking and secure storage of food
- Cover and store food safely (protected from insect/animal contamination)
- Use clean utensils and storage containers
Encourage exclusive breastfeeding for the first six months of life, and complementary breastfeeding until the age of two years (especially when a child is sick)

Hand hygiene

Promote good hand hygiene (handwashing with soap)
- BEFORE: preparing food; eating; feeding a child; treating wounds; or caring for sick people
- AFTER: using the toilet or cleaning a baby; touching garbage or waste; touching or feeding animals; blowing nose, coughing, or sneezing; treating wounds; or caring for sick people

Social mobilization and behaviour change

Find out the specific advice being given by health and other relevant authorities
If there are observations of illness affecting animals or environmental contamination, find out specific advice being given by the relevant professionals.
Model following this advice and inform community members of current health practice and advice
Offer support and encouragement to follow the advice
- Try to gain understanding about if and why health practice advice is not being followed
- With the guidance of your supervisor and health authorities, work with communities to overcome barriers to following health advice and recommended practices

Special considerations for volunteers during unknown illness

(** These recommendations are always sensible action, but in times of unknown illness they may also prevent you and others from becoming sick. **)

Inform health authorities that members of the community are falling sick or have died
Encourage sick people to go to health facilities as soon as possible
Encourage good personal hygiene
Encourage women to continue breastfeeding after six months, while giving children a wide variety of other foods
Listen carefully to the health authorities and community leaders when they share information
- Encourage others to listen to health authority and community leader messages

Mapping and community assessment

Make a map of the community.
Mark the following information on the map:
- How many people (differentiate women, men, girls and boys)/animals have fallen sick? Where?
- How many people/animals have died? Where? When?
- Who and where are the people/animals who are getting sick and dying?
- Are there any changes observed in plants, water or soil structure in the environment?
- Where are the local health/animal health facilities and services? (include traditional healers)
- Where do people obtain their drinking water?
Record the following information on the back of the map:
- When did people/animals start to fall sick with an unexplained illness?
- How many people/animals live in the affected community? How many are children under five years?
- Are children in the community generally well-nourished?
- Do people always have enough food?
- Is breastfeeding common?
- Is the water source safe?
- Do people know how to treat water? How do they do it?
- What sanitation facilities are available? (put communal toilets/latrines on map)
  - Do people use them?
- What handwashing facilities are available? (put communal handwashing stations on map)
  - Do they have soap?
- What are the community’s habits, practices and beliefs about caring for and feeding sick people? Consider any differences in roles and responsibilities between men and women.
  - When babies and infants are sick, do women continue to breastfeed them?
  - Who looks after sick people?
  - Do sick people isolate from healthy people?
  - What are people doing to protect themselves currently?
- Is a social mobilization or health promotion programme in place?
- What are the habits, practices and beliefs about hygiene, sanitation and water?
- Are there any anthropogenic activities such as mining, use of fertilizers and pesticides for agriculture, or waste disposal into water bodies?
- What are the roles, responsibilities, specific needs and priorities of women and girls, men and boys, and people with disabilities in handling, storing and treating water? (Make sure you think about cultural and social traditions and perceptions, household decision-making, livelihoods such as agriculture and livestock raising etc.)
  - What are the barriers people face in accessing water points and sanitation and hygiene facilities, of all gender identities, ages, disabilities and backgrounds?
- Which sources do people use/trust the most for information?
  - Are there rumours in the community about why people are becoming sick or dying? What are the rumours?

Volunteer actions

01. Community-based surveillance 02. Community mapping 03. Communicating with the community 04. Community referral to health facilities 05. Volunteer protection and safety 06. Personal protection equipment (PPE) for highly infectious diseases 19. Psychosocial support 20. Isolating sick people 26. Respiratory hygiene and coughing etiquette 28. Physical distancing 29. Hygiene promotion 30. Clean, safe household water 31. Good food hygiene 32. Sanitation 33. Encouraging the use and maintanace of latrines 34. Handwashing with soap 35. Handwashing in a highly infectious epidemic 36. Vector and reservoir control 38. Waste disposal and clean-up campaigns 41. Handling and slaughtering animals 43. Social mobilization and behaviour change

Other resources

WHO – World Health Organization; Biological Weapons; 2024