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Released July 24, 2015 ISSN 0799-3927
NOTIFICATIONS-
All clinical
sites
INVESTIGATION
REPORTS- Detailed Follow
up for all Class One Events
HOSPITAL ACTIVE
SURVEILLANCE-30
sites*. Actively pursued
SENTINEL
REPORT- 79 sites*.
Automatic reporting
*Incidence/Prevalence cannot be calculated
1
Week ending July 11, 2015 Epidemiology Week 27
WEEKLY EPIDEMIOLOGY BULLETIN EPIDEMIOLOGY UNIT, MINISTRY OF HEALTH, JAMAICA
Weekly Spotlight Climate change and infectious diseases
(Contd.)
EPI WEEK 27
Predictive Modeling (continued) Statistical models require, first, the derivation of a statistical
(empirical) relationship between the current geographic distribution
of the disease and the current location-specific climatic conditions.
By then applying this statistical equation to future climate
scenarios, the actual distribution of the disease in future is
estimated, assuming unchanged levels of human intervention
within any particular climatic zone. These models have been
applied to climate change impacts on malaria, dengue fever and,
within the USA, encephalitis.
Process-based (mathematical) models use equations that express
the scientifically documented relationship between climatic
variables and biological parameters – e.g., vector breeding,
survival, and biting rates, and parasite incubation rates. In their
simplest form, such models express, via a set of equations, how a
given configuration of climate variables would affect vector and
parasite biology and, therefore, disease transmission.
This modeling method has been used particularly for malaria and
dengue fever (4). The malaria modeling shows that small
temperature increases can greatly affect transmission potential.
Globally, temperature increases of 2-3ºC would increase the
number of people who, in climatic terms, are at risk of malaria by
around 3- 5%, i.e. several hundred million. Further, the seasonal
duration of malaria would increase in many currently endemic
areas.
Since climate also acts by influencing habitats, landscape-based
modeling is also useful. This entails combining the climate-based
models described above with the rapidly-developing use of spatial
analytical methods, to study the effects of both climatic and other
environmental factors (e.g. different vegetation types…)
Conclusion Changes in infectious disease transmission patterns are a likely
major consequence of climate change. We need to learn more about
the underlying complex causal relationships, and apply this
information to the prediction of future impacts, using more
complete, better validated, integrated, models.
Adapted from:http://www.who.int/globalchange/climate/summary/en/index5.htm
SYNDROMES
PAGE 2
CLASS 1 DISEASES
PAGE 5
INFLUENZA
PAGE 7
DENGUE FEVER
PAGE 8
GASTROENTERITIS
PAGE 9
Released July 24, 2015 ISSN 0799-3927
NOTIFICATIONS-
All clinical
sites
INVESTIGATION
REPORTS- Detailed Follow
up for all Class One Events
HOSPITAL ACTIVE
SURVEILLANCE-30
sites*. Actively pursued
SENTINEL
REPORT- 79 sites*.
Automatic reporting
*Incidence/Prevalence cannot be calculated
2
REPORTS FOR SYNDROMIC SURVEILLANCE GASTROENTERITS
Three or more loose
stools within 24
hours.
FEVER
Temperature of
>380C /100.4
0F (or
recent history of
fever) with or without
an obvious diagnosis
or focus of infection.
0
200
400
600
800
1000
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53
Nu
mb
er
of
Cas
es
Epi weeks
GE ≥5 Weekly Threshold vs Cases 2015, EW 1-27
2015 Cases 5 years and older Epidemic Threshold
0
200
400
600
800
1000
1200
1400
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Nu
mb
er
of
Cas
es
Epi Weeks
GE <5 Weekly Threshold vs Cases 2015, EW 1-27
2015 Cases Epidemic Threshold
100
1000
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Nu
mb
er
of
Cas
es
Epidemiology Weeks
Fever in under 5y.o. and Total Population 2015 vs Epidemic Thresholds, EW 1-27
Total Fever (All Ages) Cases under 5 y.o.
<5y.o. Epidemic threshold Epidemic Threshold-Total Population
Released July 24, 2015 ISSN 0799-3927
NOTIFICATIONS-
All clinical
sites
INVESTIGATION
REPORTS- Detailed Follow
up for all Class One Events
HOSPITAL ACTIVE
SURVEILLANCE-30
sites*. Actively pursued
SENTINEL
REPORT- 79 sites*.
Automatic reporting
*Incidence/Prevalence cannot be calculated
3
REPORTS FOR SYNDROMIC SURVEILLANCE FEVER AND
RESPIRATORY
Temperature of
>380C /100.4
0F (or
recent history of
fever) in a previously
healthy person with
or without respiratory
distress presenting
with either cough or
sore throat.
FEVER AND
HAEMORRHAGIC
Temperature of
>380C /100.4
0F (or
recent history of
fever) in a previously
healthy person
presenting with at
least one
haemorrhagic
(bleeding)
manifestation with or
without jaundice.
FEVER AND
JAUNDICE
Temperature of
>380C /100.4
0F (or
recent history of
fever) in a previously
healthy person
presenting with
jaundice.
1
10
100
1000
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Nu
mb
er
of
Cas
es
Epi Weeks
Fever & Resp Weekly Threshold vs Cases 2015, EW 1-27
Epidemiological Weeks 2015 <5 Epidemiological Weeks 2015 ≥60
<5 year old's, Epidemic Threshold ≥60 year old's, Epidemic Threshold
0
5
10
15
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Nu
mb
er
of
Cas
es
Epidemiology weeks
Fever and Haem Weekly Threshold vs Cases 2015, EW 1-27
Cases 2015 Epidemic Threshold
0
2
4
6
8
10
12
14
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Nu
mb
er
of
Cas
es
Epi Weeks
Fever and Jaundice Weekly Threshold vs Cases 2015, EW 1-27
Cases 2015 Epidemic Threshold
Released July 24, 2015 ISSN 0799-3927
NOTIFICATIONS-
All clinical
sites
INVESTIGATION
REPORTS- Detailed Follow
up for all Class One Events
HOSPITAL ACTIVE
SURVEILLANCE-30
sites*. Actively pursued
SENTINEL
REPORT- 79 sites*.
Automatic reporting
*Incidence/Prevalence cannot be calculated
4
FEVER AND
NEUROLOGICAL
Temperature of >38
0C
/100.40F (or recent
history of fever) in a
previously healthy
person with or without
headache and vomiting.
The person must also
have meningeal
irritation, convulsions,
altered consciousness,
altered sensory
manifestations or
paralysis (except AFP).
ACCIDENTS
Any injury for which
the cause is
unintentional, e.g.
motor vehicle, falls,
burns, etc.
VIOLENCE
Any injury for which
the cause is
intentional, e.g.
gunshot wounds, stab
wounds, etc.
0
10
20
30
40
50
60
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Nu
mb
er
of
Cas
es
Epi Weeks
Fever and Neurological Symptoms Weekly Threshold vs Cases 2015, EW 1-27
2015 Epidemic Threshold
50
500
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Nu
mb
er
of
Cas
es
Epidemiology Weeks
Accidents Weekly Threshold vs Cases 2015, EW 1-27
≥5 Cases 2015 <5 Cases 2015 Epidemic Threshold<5 Epidemic Threshold≥5
1
10
100
1000
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Nu
mb
er
of
Cas
es
Epidemiology Week
Violence Weekly Threshold vs Cases 2015, EW 1-27
<5 y.o <5 Epidemic Threshold ≥5 Epidemic Threshold
Released July 24, 2015 ISSN 0799-3927
NOTIFICATIONS-
All clinical
sites
INVESTIGATION
REPORTS- Detailed Follow
up for all Class One Events
HOSPITAL ACTIVE
SURVEILLANCE-30
sites*. Actively pursued
SENTINEL
REPORT- 79 sites*.
Automatic reporting
*Incidence/Prevalence cannot be calculated
5
CLASS ONE NOTIFIABLE EVENTS and LEPTOSPIROSIS Comments
CONFIRMED YTD AFP Field Guides
from WHO indicate
that for an effective
surveillance system,
detection rates for
AFP should be
1/100,000 population
under 15 years old (6
to 7) cases annually.
___________
Pertussis-like
syndrome and Tetanus
are clinically
confirmed
classifications.
______________
The TB case detection
rate established by
PAHO for Jamaica is
at least 90% of their
calculated estimate of
cases in the island,
this is 180 (of 200)
cases per year.
*Data not available
**Leptospirosis is
awaiting classification
as class 1, 2 or 3
______________
1 Dengue Hemorrhagic
Fever data include Dengue
related deaths;
2 Maternal Deaths include
early and late deaths.
CLASS 1 EVENTS CURRENT
YEAR PREVIOUS
YEAR
NA
TIO
NA
L /
INT
ER
NA
TIO
NA
L
INT
ER
ES
T
Accidental Poisoning 320 333
Cholera 0 0
Dengue Hemorrhagic Fever1 0 0
Hansen’s Disease (Leprosy) 0 1
Hepatitis B 8 43
Hepatitis C 2 6
HIV/AIDS - See HIV/AIDS National Programme Report
Malaria (Imported) 2 1
Meningitis 183 388
EXOTIC/
UNUSUAL Plague 0 0
H I
GH
MO
RB
IDIT
/
MO
RT
AL
IY
Meningococcal Meningitis 0 0
Neonatal Tetanus 0 0
Typhoid Fever 3 0
Meningitis H/Flu 0 0
SP
EC
IAL
PR
OG
RA
MM
ES
AFP/Polio 0 0
Congenital Rubella Syndrome 0 0
Congenital Syphilis 0 0
Fever and
Rash
Measles 0 0
Rubella 0 0
Maternal Deaths2 22 21
Ophthalmia Neonatorum 114 168
Pertussis-like syndrome 0 0
Rheumatic Fever 2 6
Tetanus 1 0
Tuberculosis 23 39
Yellow Fever 0 0
UNCLASSED** Leptospirosis 12 9
Released July 24, 2015 ISSN 0799-3927
NOTIFICATIONS-
All clinical
sites
INVESTIGATION
REPORTS- Detailed Follow
up for all Class One Events
HOSPITAL ACTIVE
SURVEILLANCE-30
sites*. Actively pursued
SENTINEL
REPORT- 79 sites*.
Automatic reporting
*Incidence/Prevalence cannot be calculated
6
NATIONAL SURVEILLANCE UNIT INFLUENZA REPORT EW 27
July 5 – July 11, 2015 Epidemiology Week 27
June, 2015 Admitted Lower Respiratory Tract Infection and LRTI-related Deaths
Current year Previous year
Week 27
2015 YTD 2015
Week 27
2014
YTD
2014
Admitted Lower
Respiratory Tract
Infections 75 2228 102 1861
Pneumonia-related
Deaths 0 36 3 36
EW 27 YTD
SARI cases 4 504
Total Influenza
positive
Samples
0 37
Influenza A 0 31
H3N2 0 30
H1N1pdm09
0 0
Influenza B 6
Comments:
The current circulation of
influenza viruses is sporadic with
Influenza viruses detected
between epidemiological weeks 1
and 22 consisting of A/H3N2
(81%) and Influenza B,
Yamagata Lineage (16%). Both
viruses are components of the
2014 -2015 Influenza Vaccines
for the Northern Hemisphere.
INDICATORS
Burden
Year to date, respiratory
syndromes account for 3.7% of
visits to health facilities.
Incidence
Cannot be calculated, as data
sources do not collect all cases
of Respiratory illness.
Prevalence
Not applicable to acute
respiratory conditions.
*Additional data needed to calculate Epidemic Threshold
0
20
40
60
80
100
120
140
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Nu
mb
er
of
Cas
es
Epidemiology Week
2015 Cases of Admitted LRTI, SARI, Pneumonia related Deaths
Admitted LRTI 2015 No. of SARI cases for 2015
Pneumonia-related Deaths 2015 Mean of SARI cases 2010-2013*
Admitted LRTI 2014* 2013 Admitted LRTI seasonal trend
Released July 24, 2015 ISSN 0799-3927
NOTIFICATIONS-
All clinical
sites
INVESTIGATION
REPORTS- Detailed Follow
up for all Class One Events
HOSPITAL ACTIVE
SURVEILLANCE-30
sites*. Actively pursued
SENTINEL
REPORT- 79 sites*.
Automatic reporting
*Incidence/Prevalence cannot be calculated
7
69 77
47 35 33
46 36
70 78
201 196 173
0
50
100
150
200
250
Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec N
um
be
r o
f su
spe
cte
d C
ase
s
Months
2015 Cases vs. Epidemic Threshold
Total Dengue 2015 Epidemic Threshold
Dengue Bulletin July 5 – July 11, 2015 Epidemiology Week 27
DISTRIBUTION
Year-to-Date Suspected Dengue Fever
M F Total %
<1 3 2 5 17.2 1-4 1 0 1 3.4 5-14 3 3 6 20.7 15-24 1 1 2 6.9 25-44 6 5 11 37.9 45-64 2 1 3 10.3 ≥65 1 0 1 3.4
Unknown 0 0 0 0 TOTAL 17 12 29 100
Weekly Breakdown of suspected and
confirmed cases of DF,DHF,DSS,DRD
2015 2014YTD EW
27 YTD
Total Suspected
Dengue Cases 0 29 105
Lab Confirmed Dengue cases
0 3 0
CO
NFI
RM
ED DHF/DSS 0 0 2
Dengue Related Deaths
0 0 2
*Y-axis values presented in logarithmic scale, base 3.
6.4
4.0
2.7
1.8 1.1 0.8 0.5
0.2 0.0 0.0 0.0 0.0 0.0 0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
Inci
de
nce
(P
er
10
0,0
00
Po
pu
lati
on
)
Parish Incidence
1
3
9
27
81
243
729
2187
6561
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Nu
mb
er
of
Cas
es
Years
Dengue Cases by Year, 2004-2015, Jamaica
Total confirmed Total suspected
Released July 24, 2015 ISSN 0799-3927
NOTIFICATIONS-
All clinical
sites
INVESTIGATION
REPORTS- Detailed Follow
up for all Class One Events
HOSPITAL ACTIVE
SURVEILLANCE-30
sites*. Actively pursued
SENTINEL
REPORT- 79 sites*.
Automatic reporting
*Incidence/Prevalence cannot be calculated
8
Gastroenteritis Bulletin July 5 – July 11, 2015 Epidemiology Week 27
Year EW 27 YTD
<5 ≥5 Total <5 ≥5 Total
2015 150 157 307 6856 6933 13789
2014 322 246 568 6880 6679 13559
Figure 1: Total Gastroenteritis Cases Reported 2013-2015
0
200
400
600
800
1000
1200
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53
No
. o
f G
E C
as
es
Total GE - 2013
Total GE - 2014
Total GE - 2015
KSA STT POR STM STA TRE STJ HAN WES STE MAN CLA STC
GE cases < 5yrs old YTD 2372 201 170 367 495 261 505 378 361 257 575 472 442
GE cases ≥5yrs old YTD 1020 219 288 614 642 298 727 433 467 317 676 694 538
Total GE cases YTD 3392 420 458 981 1137 559 1232 811 828 574 1251 1166 980
0
500
1000
1500
2000
2500
3000
3500
4000
Nu
mb
er
of
case
s
Total number of GE cases Year To Date by Parish, 2015
Weekly Breakdown of Gastroenteritis cases In Epidemiology Week 27, 2015,
the total number of reported GE
cases showed a 46% decrease
compared to EW 27 of the
previous year.
The year to date figure showed a
2% increase in cases for the
period.
EW
27
Released July 24, 2015 ISSN 0799-3927
NOTIFICATIONS-
All clinical
sites
INVESTIGATION
REPORTS- Detailed Follow
up for all Class One Events
HOSPITAL ACTIVE
SURVEILLANCE-30
sites*. Actively pursued
SENTINEL
REPORT- 79 sites*.
Automatic reporting
*Incidence/Prevalence cannot be calculated
9
RESEARCH PAPER
Leadership hubs: Dynamic collaborations to engage nurses in strengthening the health care system for
HIV and AIDS care in Jamaica E Kahwa1, J. Aiken1, U Atkinson1, P Dawkins, 1 C Hepburn -Brown, 1 T Rae1, S Roelofs2, N Edwards2.
1The UWI School of Nursing, Mona, University of the West Indies, Kingston7, Jamaica
2University of Ottawa, School of Nursing, Ottawa, Canada
Objective: To examine the impact of leadership hubs on quality of nursing care in Jamaica for persons living
with HIV/AIDS.
Methods: Three leadership hubs consisting of frontline nurses, nurse managers, researchers, decision makers and
community representatives were established in purposively selected intervention parishes in Jamaica. Leadership
hubs were trained to use research and influence policy. Data were collected before and after the leadership hub
intervention in both intervention and control parishes using a survey questionnaire with randomly selected nurses
about clinical practice (including stigma), policies and procedures, quality assurance processes, and through an
institutional human resource management assessment tool for HIV and AIDS environments. Hubs assessed
changes in their own capacity to engage in evaluation research and influence policy.
Results: Hub members reported statistically significant increases in their evaluation of policy capacity (p<0.01).
While there were statistically significant improvements in pre versus post stigma scores for intervention parishes
(p<0.001) compared to control parishes, differences were not significant for other clinical practices, policies and
procedures of quality assurance processes. Intervention parishes had better post intervention outcomes than
control parishes for 50% of quality assurance indicators and 70% of policies and procedures. However, declines
were observed in clinical assessment and management outcomes for both intervention and control parishes for 5
of the 12 indicators.
Conclusions: The leadership hub intervention had limited impact on the quality of nursing care for HIV and
AIDS. Though leadership hubs are a promising, feasible model, longer intervention periods are required in order
to determine their true impact.
The Ministry of Health
24-26 Grenada Crescent
Kingston 5, Jamaica
Tele: (876) 633-7924
Email: [email protected]