3.6 The investigation in practice

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    3.6.1 Preparing for the investigation

    Rigorous preparation makes the teams’ work in the field easier. This includes:

    • Studying the responses to previous outbreaks (reports, surveillance data) and anticipated responses to future outbreaks (annual response strategy)
    • Identifying the locations to be investigated, according to the alert from the surveillance system or information reported by the population
    • Notifying the local authorities and obtaining pre-authorisation from the relevant central authorities
    • Organising the logistical resources
    • Preparing the supplies and the information and data collection forms
    • Preparing the supplies for collecting and transporting samples
    • Preparing health education tools and community measles surveillance
    • Preparing “uncomplicated case” and “complicated case” treatment kits, to be distributed, if necessary, to the health posts and hospitals visited (Appendix 10)
    • Drawing up the budget and making it available


    3.6.2 Composition of the investigation team

    The team should include an epidemiologist (or experienced person), a medical person, and a logistics officer. A team member with experience in health promotion and community engagement is recommended. Each person’s role should be clearly defined to ensure that all activities are covered without any duplication.


    Recruit a driver who knows the region and, if possible, the local language. 
     

    3.6.3 Supplies and documents

    Logistics and communications

    • A terrain-appropriate vehicle in good working order
    • Maps of the region
    • Functional, appropriate means of communication
    • Computer, GPS


    Laboratory

    • Specimen collection and shipment supplies (e.g., syringes, needles, tubes, gloves, compresses, adhesive tape, filter paper, triple packaging bags)
    • Information cards for samples
    • Cold chain for samples, if necessary (vaccine carrier, ice packs and thermometer)


    Data collection

    • Population census
    • List of health care facilities, personnel (health system) and contacts
    • Inventory sheets for drugs, medical supplies and the cold chain
    • Reference documents (case definition, data collection sheets)
    • Paper register, line list


    Medical supplies

    • Treatment protocols
    • Treatment kits
    • First aid kit


    3.6.4 Investigation report

    When the investigation is over, write an accurate, concise report. It should contain the following elements:


    1 - Summary


    2 - Introduction

    • Quick description of the overall, health and epidemiological context:   
      • Geographic, administrative, and logistical (access, distances, etc.) information,
      • Population data
      • Security, population movements, social events, etc.
      • Health system
      • Epidemiological situation in previous years: cases, deaths, vaccination coverage (EPI and campaigns, specify the target population), dates of most recent outbreaks, and risk factors
      • Succinct description of the surveillance system: case definition, reporting system, data transmission and analysis


    3 - Objectives of the investigation and methods

    • How was the alert given?
    • General and specific objectives
    • Team composition, resources and sequence of events
    • People met with


    4 - Results

    • Laboratory confirmation: date, type of specimens, number and results
    • Epidemiological description (time, place and person): 
      • Date of the alert and first cases
      • Number of cases and deaths, case fatality rate, percent vaccinated
      • Epidemic curve
      • Attack rate by location
      • Attack rate by age group
      • Common complications and comorbidities (malnutrition, malaria, etc.)

    Describe the situation, from the general to the specific (e.g. regions and districts, IDP camps and sectors, city and neighbourhoods). Specify the data source. 


    5 - Analysis of results and discussion

    • Is the outbreak confirmed, and according to which definition?
    • Is there laboratory confirmation?
    • Which are the hardest hit places and populations? Where are the main foci currently?
    • Which control measures have been implemented?
    • What are the current response capabilities? Are they appropriate and sufficient?
      • Surveillance and laboratory
      • Patient management (treatment protocol, availability of drugs and supplies, human resources, etc.)
      • Vaccination
      • Health promotion and community engagement
    • Available resources: staff, laboratory, medical and non-medical supplies, etc.


    6 - Conclusion(s)


    7 - Recommendations/proposed interventions

    • Surveillance and laboratory
    • Patient management
    • Vaccination
    • Informing the population
    • Community participation


    Specify the protocols, target populations, strategies and means.


    8 - Appendices

    • Tables
    • Graphs
    • Maps


    To speed up or improve the response, technical support may be needed for:

    • Surveillance (mapping, setting up an epidemiological monitoring dashboard)
    • Case management: organisation, supervision and procurement
    • The vaccination campaign: logistics and medical support for planning, organisation, supervision and assessment; health promotion and community engagement support for mobilisation
    • Assessing the intervention: functioning, results, impact, cost
    • Emergency preparedness: technical support and training


    Evaluate the need for technical support as soon as the outbreak begins. Draw up the terms of reference or collaboration.

     

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