Session 3.2. Actions in the epidemic alert phase

By the end of this session, you will be able to: 

• Discuss what actions need to be taken during the alert phase.
• Explain epidemic assessment. 
• Participate in community-based disease surveillance.

Part 3.2.1. Actions to be taken in the alert phase

The alert phase begins when there is talk or rumour of an epidemic but it has not been confirmed whether there is one or not. The talk and rumours may come from the community (who may complain, for example, that there are many cases of diarrhoea) or from outside (for example, after influenza spreads in a nearby region or country). The alert phase starts for certain diseases when the first case of the disease occurs, and starts for other diseases when cases of the disease begin to increase. It ends when health authorities confirm that there is an epidemic (or declare there is not).

Participate

Before going further, tell your facilitator what you think volunteers should do in the alert phase. Write in this box all the answers you and your colleagues suggest.

The alert phase begins when we notice or hear reports of unusual events or more cases than usual of a certain disease. More people fall sick, but the health authorities have not confirmed that there is an epidemic. At this stage, we merely suspect an epidemic.

In this phase, we need to take some actions to prepare ourselves for a possible epidemic. 

• Start doing an assessment in the community, to the extent possible and in coordination with health authorities. 
• Keep in touch with the community and with other volunteers, your Red Cross Red Crescent branch focal point, and with the health authorities. 
• Ask for, and participate in, a refresher course for volunteers working in the community. 
• Switch from passive to active surveillance and start looking for new cases of the disease. Refer these cases for medical support if required. (See 3.2.3.)
• Ask for the resources you will need to manage an epidemic if it occurs; have them ready and in place.
• Start working with the community to make sure that health messages about the suspected epidemic are culturally appropriate.

Part 3.2.2. Epidemic assessment

In Module 2, we defined an epidemic assessment. We explained how to do one and where to obtain information. To refresh your memory, look in the glossary for a definition or return to Module 2. Specific information to assist epidemic assessment is included in each disease tool.

Part 3.2.3. Surveillance

In natural disasters, an effective early warning system is particularly important because it saves many lives. When communities know that a flood, a typhoon or a tsunami is imminent, they have time to prepare or evacuate, reducing the threat to life. In epidemics, the same is true. Communities that understand the risk of diseases and how to prevent them are less likely to experience an epidemic. An early warning system that tells communities and health facilities that the level of illness is unusually high gives communities and health services time to prepare and respond while the number of cases is still small. This is why surveillance matters.

National and local public health authorities are responsible for routine public health surveillance. Surveillance establishes a baseline measure of the frequency of important infectious diseases in a country. An epidemic is suspected when the frequency of an infectious disease rises significantly above the baseline.

Surveillance systems are often based on disease reporting by healthcare providers or laboratories. Sometimes, however, the formal health surveillance system does not cover everybody or all areas, or all forms of illness. For example, some people fall outside the health service, or do not report illnesses they have; and in disasters (such as earthquakes) the surveillance system may be disrupted. In these cases, community-based surveillance (CBS) can help to detect increases in disease.

CBS uses community participation to detect, report, respond to and monitor health events in a community. It detects unusual events, uses simple case definitions to detect increases in the number of people falling sick, and establishes a communication link (via phone, SMS, paper or bicycle) with a medical professional who can investigate and confirm whether an outbreak is occurring.

CBS strengthens public health surveillance and response by linking communities with their local health facilities. It should always be undertaken in coordination with the Ministry of Health.

To do surveillance, you need to collect information by observing your community and surroundings. On the basis of this information, decide what needs to be done to prepare for an epidemic.

We use two kinds of surveillance for different situations:

1. The first occurs during the preparedness phase. While you are working in the community on your normal activities (CBHFA, water and sanitation programmes, etc.), you listen out for unusual illnesses or unusually high levels of illness. Take note of diseases that affect humans or animals. This passive surveillance makes it possible to detect diseases at an early stage and can provide warning that an epidemic may be on the way. 
2. The second occurs during an epidemic. With other volunteers, you actively search for new cases of illness as part of your work to promote health and manage the epidemic. You apply case definitions and report and refer sick people for examination and treatment in health facilities. This is called active surveillance.

Information on case definition and how to support surveillance is included in each of the disease tools. The most important thing to remember is that you should inform the focal point in your Red Cross Red Crescent branch and the nearest health facility immediately if you or people in the community see something unusual, for example an increase in the number of abortions in cows, or the sudden death of three members of the same family.