The 1918 Spanish flu, the 1957 Asian flu and the 1968 Hong Kong flu, present influenza pandemics that have caused tremendous deaths over the last century. Initial cases of influenza virus A (H1N1) were reported in Mexico and America on April 2009 (Baker et al. 2011, p.1608). The following are the H1N1 outbreak investigation steps.
- Step 1: Initiate planning and resource mobilization such as identifying investigation team (Epi staff) and contact persons, means of communication (telephone, online social media and fax lines), clinician guidelines and H1N1 screening procedures. Others resources include specimen collection guidelines, specimen transportation guidelines, storage facilities, lab testing equipments and kits, fill-in forms for population and demographic characteristics as well as data analysis designs and instruments. Begin tracking H1N1 trends through surveillance for seasonal flu.
- Step 2: Initiate contact with lead authorities (such as the Department of Health) on the ground, where suspected cases were reported. Put in place measures for social distancing. Identify isolation and quarantine areas within suspect sites (Ministry of Health and Long-Term Care, 2004).
- Step 3: Using the clinician guidelines gather data through lab specimens from suspected cases (population and demographic characteristics).
- Step 4: Using transportation guidelines and proper equipment (lab coolers) to transport specimen. Maintain contact with authorities to monitor for any new cases reports. If no new cases are registered, close the groundwork investigation after one week. Store the specimen.
- Step 5: Perform lab tests to confirm influenza cases. It may take 3-5 days to process a single specimen. For confirmed cases, data are stored within the electronic reporting system. To prevent further influenza spread, send recommendation letters and CDC guidelines for facilities and authorities (Federal Bureau of Prisons, 2009).
- Step 6: Quality control for each case through verification to ensure correct data entry.
- Step 7: Initiate communication cycle to the patient through the health care provider.
- Step 8: Warehouse file case forms.
- Step 9: Analyze data and communicate findings. Initiate programs to educate on transmission, prevention and control measures for H1N1.
- Step 10: Undertake mock exercises to establish level of preparedness, response and recovery from H1N1 (Federal Bureau of Prisons, 2009, p.9)
There are three prevention levels for disease outbreaks, that is, primary, secondary and tertiary. At primary level, H1N1 can be prevented through good health habits (hand hygiene, respiratory etiquette and avoid touching one’s eyes, nose and mouth) as well as antiviral chemoprophylaxis (pre-exposure or post-exposure) (Vermont Department of Health, 2009).
At the secondary level, H1N1 can be prevented through viral culture and real-time or reverse RT-PCR. At tertiary level, H1N1 can be prevented through separating sick from the well (sick stay back at home) and limit gatherings (group meals, close schools) as well as use face masks and respirators (Federal Bureau of Prisons, 2009, p. 2).
Mobilize competent investigation team, responsible for disease surveillance and infection prevention. Use appropriate media to disseminate primary level preventive measures to target populace. Initiate primary level preventive measures. Mobilize resources for H1N1 screening. Identify and initiate local and state contacts (such as public health authorities) for suspect outbreak sites. Establish local or state requirements for reporting H1N1 (such as specified forms and guidelines).
Identify criteria for scrutinizing desirable labs. Identify and initiate contact with laboratories capable of processing H1N1 cultures. Set in place equipments, specimen collection frames, cultures and reporting forms in readiness for screening during surveillance.
Use these parameters to evaluate: level of preparedness (working policy guidelines and action plan); number of identified suspected sites for screening; the time taken during the screening cycle per site; number of successfully screened suspected cases and trend of prevention rates (through isolation, quarantine or for wide transmission through border points) (Health Protection Agency, 2010).
Other parameters are number of identified certified lab facilities for screening; time taken for communication during response and recovery; number of successfully closed investigation cases; number of credible reports released and the level of public goodwill (New Jersey Department of Health and Senior Services, 2006).
Baker, P. R.A., Sun, J., Morris, J. and Dines, A. (2011). Epidemiologic Modeling with FluSurge for Pandemic (H1N1) 2009 Outbreak, Queensland, Australia. Emerging Infectious Diseases, 17(9), 1608-1619.
Federal Bureau of Prisons (2009). Pandemic Influenza Plan. Web.
Health Protection Agency (2010). Assessment Report on the EU-wide Response to Pandemic (H1N1) 2009. Web.
Ministry of Health and Long-Term Care (2004). A Guide to the Control of Respiratory Infection Outbreaks in Long-Term Care Homes. Web.
New Jersey Department of Health and Senior Services (2006). Surveillance and Testing for Influenza A (H5N1) in Humans Pandemic Alert Period. Web.
Vermont Department of Health (2009). Swine Influenza (H1N1): Investigation and Interim Recommendations. Web.