Communicable disease outbreak - HAT Task 3
Analyze the selected communicable disease outbreak: SARS
Disease overview
Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV). According to the Centers for Disease Control and Prevention, the illness begins with a high fever (greater than 100.4 degrees F). The fever is sometimes associated with chills or other symptoms, including headache, general feeling of discomfort, and body aches. Some individuals experience mild respiratory symptoms at the outset. Diarrhea is seen in approximately 10 to 20 percent of patients. After 2 to 7 days, SARS patient may develop a dry, nonproductive cough that might be accompanied by hypoxia. In 10 to 20 percent of cases, patients require mechanical ventilation. Most patients develop pneumonia. The disease is spread by close person-to-person contact through direct contact with respiratory secretions and/or body fluids of an infected individual. The incubation period is typically 2 to 7 days, but there are reported cases of up to 14 days. An individual is considered infectious only when they have symptoms, and are considered most contagious during the second week of illness. (Centers for Disease Control and Prevention, 2005)
According to the World Health Organization (WHO), in November 2002 a SARS outbreak emerged in South China. An infected medical doctor who had treated infected patients in his hometown in South China traveled to a four-star hotel in Hong Kong, bringing the disease with him. Within days, guests, employees and visitors of the hotel were showing signs of the infection. The disease was simultaneously spreading around the world along international travel routes as guests of the hotel traveled home to Viet Nam, Singapore, Taiwan, Toronto, all of which became infection hot zones. The attached map provides a geographical graphic of the international pattern of the outbreak. The outbreak resulted in a total of 8,098 people with severe acute respiratory symptoms accompanied by either pneumonia or respiratory distress, of those with symptoms, 774 died. By late July 2003, no new cases were reported and the WHO declared the crises over. In the United States, only eight persons were confirmed as SARS cases, and none of these individuals died. All eight of these people had traveled to areas where SARS-CoV was occurring. (World Health Organization, 2003)
Transmission
The pattern of spread of SARS-CoV is primarily through droplets and close personal contact. The CDC has determined that infected persons do not transmit SARS-CoV “before the onset of symptoms and that most transmission occurs late in the course of illness when patients are likely to be hospitalized.”("SARS Core Document," 2005, Appendix 1)
Incubation Period
Many countries reported median incubation periods of four-five days, and a mean of four-six days, with China and Singapore reporting a maximum of fourteen days. The WHO has recommended the application of a maximum incubation period of ten days, based on the 2003 SARS outbreak. (Kutsar, 2004)
Period of communicability
Based on the 2003 SARS outbreak, specifically the cases in Singapore, severely ill patients present the highest communicability during the second week of disease and when isolated within five days of the disease onset rarely provided the opportunity for secondary cases occurring. The WHO guidelines state that there is no data of communicability or infectious agent transmission after 10 days following the resolution of fever. (Kutsar, 2004)
How would a SARS outbreak affect my community?
A SARs-type outbreak, similar to the 2003 SARS Global outbreak, has a high probability in my community due to its metropolitan nature and it’s location within sixty miles of both New York City and Philadelphia. New Jersey’s Department of Health requires health care providers within the State to report cases of communicable diseases to their local health departments once the diseases are confirmed or suspected. If a suspected case of SARS, or one of the other critical diseases is identified, a medical provider must contact their local Department of Health via telephone immediately. Depending on the severity of the symptoms, the health department would investigate the individual and where/how the disease was contracted, who that individual has been in contact with and determine whether the individual must be hospitalized and quarantined. My community participates in a rapid notify emergency notification system, where broadcast telephone, web and email broadcasts would be sent to provide emergency public information messages. Depending on the severity of the disease and the size of the outbreak, the local health department would work in cooperation with the State Department of Health, the Centers for Disease Control and Prevention, as well as the medical professionals and medical facilities in the area.
A SARS case has been identified, explain the appropriate protocol for reporting the possible outbreak.
New Jersey has developed an electronic, web-enabled system where public health partners statewide an instantly report and track incidences of communicable diseases. The Communicable Disease Reporting and Surveillance System (CDRSS) is available 24 hours a day, 7 days a week and weekly transmissions to the Centers for Disease Control and Prevention (CDC) support national as well as statewide surveillance. ("CDRSS," 2012) Individuals who are employed in a public health occupation have access to the system. If a disease has been identified as an “immediate reportable” (such as SARS), then the medical professional must contact the New Jersey Department of Health immediately via telephone. All healthcare providers are required by New Jersey Administrative Code, Title 8, Chapter 57 to report specific communicable diseases. ("CDRSS," 2012) Once the Department of Health has been notified, isolation and quarantine procedures would be initiated if necessary. The Department of Health will contact the infected individuals immediately and begin an investigation, triage, treatment, containment, public communication, etc.
Poor air quality index is poor, as the community health nurse how would you modify the plan of care for those with asthma and other respiratory diseases
When meeting with patients who suffer from asthma it is important to educate and provide planning initiatives to help them lessen the chances of a potential asthma crisis. All asthmatics should have an asthma action plan that has been reviewed with their doctors in preparation for managing any respiratory crisis. “Poor air quality caused by a combination of ground-level ozone and air pollution can worsen asthma symptoms, triggering wheezing, coughing, trouble breathing, and even leading to hospitalization in serious cases. Newspapers, websites, and TV news broadcasts often warn of so-called "ozone-advisory," "ozone-alert," or "ozone-action" days, when sensitive groups—those with asthma and other respiratory conditions—should stay indoors because potentially dangerous smog conditions are likely.”("4 ways to stay safe," 2010, para. 1)
The first strategy that asthmatics should initiate on those ozone-alert days is to try to stay indoors, keep windows closed at home or in the car, restrict outdoor activities to times of the day when air quality is better (usually in the morning and evening hours) and check air quality forecasts by monitoring their local weather and air quality forecasts online. If asthmatics also suffer from allergies, such as tree pollen, etc., that may be trigger an asthma crisis, they should consider wearing an allergy facemask when they must venture outside. They should also change their clothing immediately upon entering their homes after being outside and washing or containing that clothing immediately so that those allergens are not shed inside. Asthmatics should always have their asthma medications nearby, especially their rescue inhaler. It is important to take all of their preventative medications, such as Advair or Flovent, as prescribed. All medications should be checked for expiration dates to ensure effectiveness. Finally, they should stay hydrated and breathe properly. Lungs like the right temperature and right amount of hydration. Breathing should be through the nose, not through the mouth. The nose must filter the air and bring it to the correct temperature and humidity prior to the delivery to the lungs. When breathing through the mouth this process does not occur, causing the lungs additional stress on the lungs. ("4 ways to stay safe," 2010) References
Air pollution and asthma: 4 ways to stay safe on ’ozone-alert’ days. (2010, June 11). U. S. News and World Report. Retrieved from http://health.usnews.com/health-news/family-health/respiratory-disorders/articles/2010/06/11/air-pollution-and-asthma-4-ways-to-stay-safe-on-ozone-alert-days
Centers for Disease Control and Prevention. (2005). http://www.cdc.gov/sars/about/faq.html
Communicable Disease Service Guide. (2012). Retrieved August 23, 2012, from http://www.state.nj.us/health/cd/cdrss.shtml
Kutsar, K. (2004). The global epidemiology of SARS. Retrieved from http://www.epinorth.org/eway/default.aspx?pid=230&trg=Area_5268&MainArea_5260=5263:0:15,2946:1:0:0:::0:0&Area_5263=5268:44984::1:5264:1:::0:0&Area_5268=5273:44424::1:5266:3:::0:0
Public health guidance for community-level preparedness and response to Severe Acute Respiratory Syndrome (SARS). (2005). Retrieved from http://www.cdc.gov/sars/guidance/core/app1.html
World Health Organization. (2003). Severe acute respiratory syndrome (SARS): Status of the outbreak and lessons for the immediate future. Retrieved from http://www.who.int/csr/media/sars_wha.pdf