A 10-Step Hypothetical Outbreak Investigation and Response Model
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Managing Communicable Disease and Risk
After a suspected outbreak of a new strain of influenza virus among workers at the nation’s largest airport, a series of steps must be completed in order to confirm and manage the situation. Advice from the CDC in 2012 should be taken into consideration during this process; message mapping, priority communication, accuracy, credibility, empathy, providing action steps and, overall, a show of respect is vital to the process (CDC, 2012). Referring to the H1N1 pandemic response in 2009 that utilized an epidemiological triangle response, a 10-step protocol should be followed to address the pending outbreak (Mpolya et al., 2010). The following steps outline my recommendations for investigation.
Step 1 requires identifying the contagion, the source of the contagion and the population at risk in order to determine if an outbreak truly exists. In this case, the contagion in question has only been reported in persons exposed to a sick individual in tight quarters for more than 2 hours, such as an airplane. Reported symptoms are malaise, myalgia and upper respiratory symptoms, while the only clinical sign seems to be fever; the lack of clinical signs to verify the contagion until appropriate laboratory testing can be analyzed suggests that, at this point in time, the virus, and therefore an outbreak, cannot be confirmed.
The source of the contagion has not been identified. During this step the infected individuals should be tested using laboratory testing, if possible. However, the population at risk can be determined. Using the epidemiological triangle model, we can form a visual understanding of the interactions between the agent, the host and the environment. The contagion is the agent, which is influenced by the environment, the airport and airplanes; the contagion thrives in the close proximity of an airplane. The agent then influences the host, the person on the airplane. However, at this time, although humans can transmit the disease, it has been determined that it is not yet well adapted to humans. Evidence also shows that the contagion is quickly adapting.
In completing step 1, I would determine that there is no true outbreak at the current time; however, without proper management and regulation, in addition to the contagion’s capacity to adapt to the human population and increase transmission, the contagion could create the potential for an outbreak in the future. Therefore, skipping to the next step, the proposed management plan should be developed and communicated to the population at risk and the general public.
Step 9 includes communicating the results of the analysis to the community, while keeping in mind the six principles of crisis and emergency risk mentioned above (CDC, 2012). The plan suggested in this instance should focus on continual research, surveillance and international collaboration to garner additional information, monitor the contagion’s adaptability, and regulate the further spread of the disease. The population that has been infected should be provided the appropriate antiviral drugs when necessary and practice non-pharmaceutical measures, including social distancing when possible and behavioral changes to prevent the spread of the contagion further (Mpolya et al., 2010).
When communicating this information with the general public it is very important to provide the appropriate information to target groups, without leaving out key points; the discussion to provide the key points, without implying that information is being withheld. A successful method for delivering a clear, appropriate message is to develop a message map (Covello, 2016). This risk communication tool meets several goals, according to Vincent T. Covello, Ph.D., including identifying key stakeholders and developing a plan to anticipate questions, support the message with facts and promote cooperation between all individuals involved (2016).
Step 10 in this process includes monitoring, evaluating and refining the management and regulation plan. This allows for updates to the plan and the ability to identify future problems quickly, in order to deal with them efficiently and effectively.
My recommendations to the national authorities in this situation would be to disrupt the balance of the components of the epidemiological triangle model, including the following steps:
Implementation of personal hygiene and behavioral changes, including wearing masks in confined spaces such as on the airplane, frequent hand washing, sneeze and cough etiquette and limited contact with sick individuals.
Recommendation of social isolation for those individuals showing symptoms, if possible.
Individuals showing symptoms should report to their doctor for appropriate medication and non-pharmaceutical treatments.
High-risk populations, including the elderly and those with compromised immune systems, should limit their exposure to the contagion when possible.
Given the current circumstances within the nation, I believe the majority of the population will adhere to the steps mentioned above.
Public Health in Neighboring Countries (Second Post)
Assuming the position of the public health official in a neighboring country, my recommendations for the host country would include all of the suggestions posed above; it may also include a recommendation to restrict air travel in or out of the host country until the outbreak is contained. It would be impossible to prevent the spread of the new strain of flu into a neighboring country completely because of the ease of travel in today’s world. People can move freely between locations and, each time, they have the ability of carrying the contagion with them into a new region. Once the contagion has entered a new area that has an acceptable environment for transmission, the spread of the disease is inevitable.
Considering the social, political and economic realities of the host country, an example action plan for the border government to manage the risk of the new flu strain should include similar personal hygiene, behavioral changes and social isolation steps. Individuals that present clinical signs or symptoms should avoid traveling across the border until symptoms have resolved to avoid transmitting the disease further.
References
Atun, R. "Health Systems, Systems Thinking and Innovation." Health Policy and Planning 27.Suppl 4 (2012): Iv4-v8. Web.
Covello, Vincent. "Message Mapping." (2016): n. pag. Print.
Hill, A. B. "The Environment and Disease: Association or Causation?" Journal of the Royal Society of Medicine 108.1 (2015): 32-37. Web.
Mpolya, Emmanuel, Yuki Furuse, Nao Nukiwa, Akira Suzuki, Taro Kamigaki, and Hitoshi Oshitani. "Pandemic (H1N1) 2009 Virus Viewed from an Epidemiological Triangle Model." Journal of Disaster Research JDR 4.5 (2009): 356-64. Web.
Schoenbach, Victor J., and Wayne D. Rosamond. Understanding the Fundamentals of Epidemiology. Chapel Hill: U of North Carolina, 2000. Print.
