STANDARD OPERATING PROCEDURES FOR ENHANCED ACTIVE CASE-BASED SURVEILLANCE

FOR EBOLA VIRUS DISEASE INSOUTH AFRICA, 2014

DIRECTORATE: EPIDEMIOLOGY AND SURVEILLANCE CLUSTER: HIMMENATIONAL DEPARTMENT OF HEALTH

ACRONYMS

CIF Case Investigation Form

DOH Department of Health

EVD Ebola Virus Disease

IHR International Health Regulations

NATHOC National Health Operations Centre

NDOH National Department of Health

NICD National Institute for Communicable Diseases

SOP Standard Operating Procedure

2 | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA

1. INTRODUCTIONIn light of the current EVD outbreak in West Africa, the National Department of Health has

instituted enhanced active case-based surveillance for clinically suspected and laboratory

confirmed Ebola Virus Disease (EVD) in South Africa.

2. PURPOSEThe aim of these Standard Operating Procedures (SOPs) is to guide health personnel at all

levels of the health care system (both in the public and private sector) in the implementation of

enhanced active case-based surveillance for the EVD in South Africa.

3. OBJECTIVETo identify all suspected and laboratory confirmed cases, to detect the patterns of transmission,

and to estimate the potential for further spread of EVD to the general population of South Africa.

3.1Specific Objectivesa) To maintain zero reporting of EVD suspected and laboratory confirmed cases on a daily

basis;

b) To promptly detect suspected EVD cases from all health care facilities;

c) To link clinical surveillance of suspected EVD with cases tested for EVD at the Special

Viral Pathogens Laboratory at the National Institute for Communicable Diseases (NICD);

d) To liaise with the National Population Registry Unit of the Department of Home Affairs

with regards to suspected or confirmed EVD associated deaths;

e) To prepare Daily National Surveillance Reports with regards to the incidence,

prevalence, mortality and patterns of spread once a case of EVD has been detected;

f) To use this information for immediate public health control measures.

3 | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA

4 | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA

Case DefinitionsSuspected case

Any person* presenting with an acute onset of fever (≥38°C) with any of the following

additional symptoms: severe headache, muscle pain, vomiting, diarrhoea, abdominal

pain or unexplained haemorrhage who has:

Visited or been resident in Guinea, Liberia, Sierra Leone, Nigeria or another country

reporting imported cases with local transmission, in the 21 days prior to onset of illness

AND

Had direct contact or cared for suspected/confirmed EVD cases in the 21 days prior to

onset of illness, or been hospitalised in Guinea, Liberia, Sierra Leone, Nigeria or another

country reporting imported cases with local transmission

OR

Has unexplained multisystem illness that is malaria-negative

Confirmed CaseAny suspected case that has been laboratory confirmed.

ContactA person without any symptoms having had physical contact with an EVD case-patient,

or the blood/ body fluids of an EVD case-patient within the previous 21 days. The notion

of physical contact may be proven or highly suspected, such as having shared the same

room/bed, cared for an EVD case-patient, having had contact with an EVD case-patient’s

blood or body fluids, or closely participated in a burial of an EVD case-patient.

4 EVD DATA COLLECTION TOOLS REQUIRED FOR THIS SOP

a) Fixed telephone lines: to be used by all health care facilities (public and the private

sectors) for the immediate reporting of suspected and confirmed EVD cases, including

zero reports;

b) The legislated GW17/5 Notification Forms: to be completed by all health care providers

(public and the private sectors) for the immediate notification of suspected and confirmed

EVD case(s);

c) Case Investigation Form for EVD Testing: to be completed by all health care

providers (public and the private sector) for suspected EVD cases (Annexure 1):

d) Daily Situation Report Forms (Annexure 2): to be completed by the Provincial

Communicable Disease Control Focal Persons for an aggregated summary of suspected

and confirmed EVD cases, including zero reports;

e) EVD Line lists (Annexure 3): to be used by Provincial Communicable Disease Control

Focal Persons for a detailed summary of all suspected and confirmed EVD cases;

f) The NDOH Web-based Public Health Surveillance Notification System: to be used at

the NATHOC for:

- electronic capturing of all EVD cases

- sending SMS alerts to relevant authorities responsible for response and control

interventions and publication of the National Situation Reports.

5 THE EVD OUTBREAK DATA FLOW PROCESS AND REPORTING LINES

5.1. Reporting and Notification at the Point of Detection (Public and Private Health Care Facilities)

A: NO EVD CASE DETECTED (ZERO REPORTING)All health care facilities will send zero (0) reports if no EVD cases have been detected for that

day. All zero reports must be sent to the relevant Provincial Department of Health,

Communicable Disease Control Focal Person by 08:00 am. The list of Provincial Focal Persons

is indicated in Annexure 4.

5 | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA

B: SUSPECTED EVD CASESAny health care provider detecting and clinically diagnosing a patient who satisfies the case

definition for a suspected EVD case will immediately do the following:

STEP 1Perform risk assessment and complete a case investigation form (see annexure 1).

STEP 2

Immediately through telephone report the suspected EVD case to:

a. the Provincial Communicable and Disease Control Focal Person (see annexure 4);

b. the National Health Operating Centre (NATHOC) - 012 395 9636 or 012 395 9637 and;

c. the National Institute for Communicable Diseases (NICD) hotline - 082-883-9920.

STEP 3

Complete a written notification on the GW17/5 Notification Form immediately after the

suspected EVD case is identified. All notifications forms must immediately be sent to the

Provincial Communicable Disease Control Focal Person.

C: CONFIRMED EVD CASESAny suspected case will be laboratory confirmed by the NICD.

A health care provider will immediately after receiving laboratory confirmation, send a written

notification on the GW17/5 Notification Form to the Provincial Communicable Disease Control

Focal Person.

6 | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA

The legislative basis for disease notification in South Africa is the NATIONAL HEALTH ACT, 2003 (ACT NO. 61 of 2003).

5.2. Data Aggregation of EVD Cases at the Provincial Level

No EVD case detected (zero reporting)The Provincial Communicable Disease Control Focal Person will complete a Daily Situation

Report Form and indicate zero (0) if no EVD cases have been detected for that day. All zero

reports must be sent to the NATHOC by 09:00 am.

Suspected and confirmed EVD casesFor suspected and confirmed EVD cases, the Provincial Communicable Disease Control Focal

Person will do the following:

STEP 1Immediately through telephone report the suspected or confirmed EVD case to the NATHOC.

STEP 2Send copies of the GW17/5 Notification Form of the suspected or confirmed EVD cases to the

NATHOC.

STEP 2Summarize all individual notifications of the suspected and confirmed EVD cases into an

aggregated Daily Situation Report Form as well as a line list. All line lists and Situation Report

Forms must be sent to the NATHOC by 09:00 am each day.

5.3 EVD Laboratory TestingThe NICD will send laboratory test reports for all samples tested for EVD to (1) the health care

facility that requested the test, (2) the Provincial Communicable Disease Control Focal Person

and (3) the NATHOC as soon as the results become available.

7 | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA

5.4: EVD, Data Verification, Validation, Collation, Analysis and Daily Reporting at the NATHOC

a) The NATHOC Surveillance Desk will verify, validate, collate, analyze and review all data

from the nine Provinces and immediately notify the IHR Focal person of any suspected

or laboratory confirmed EVD case;

b) All Daily Situation Report Forms and line lists of the suspected and confirmed cases of

EVD will be electronically captured into the NDOH Web-based Public Health

Surveillance Notification System at the NATHOC on a daily basis;

c) Daily surveillance reports will be compiled to be presented at the daily Public Health

Cluster (PHC) meetings;

d) The PHC will assess these reports, as well as reports from the laboratory, media and

international surveillance and compile a comprehensive risk assessment on the public

health threat of EVD to the South African public and prepare National Situation Reports;

e) These Situation Reports will be posted on the NDOH website www.doh.gov.za as well

as on the viewing page of the NDOH Web-based Public Health Surveillance Notification

System www.nmc.gov.za.

6. CONTACT TRACINGContact tracing to find everyone who has come in direct contact with a sick EVD patient will be

done by the local Outbreak Response Teams supported by the Field Epidemiology and

Laboratory Training Programme (FELTP) and coordinated by NATHOC. Contacts will be

monitored for signs of illness for 21 days from the last day they come in contact with the EVD

patient. If the contact develops a fever or other EVD symptoms, they will be immediately

isolated, tested, provided care. All of the new suspected EVD patient's contacts will also be

identified and monitored for 21 days.

The Provincial Communicable Disease Control Focal Persons must send reports of all contacts

followed up to NATHOC by 09:00 am each day.

8 | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA

Point of Detection - Detects a suspected case of EVD1.Do risk assessment and completes a case investigation form2.Immediately contacts:

a. the Provincial Communicable and Disease Control Focal Personb. NATHOC - 012 395 9636 or 012 395 9637c. NICD hotline - 082-883-9920.

2. If warranted collects and submits specimen for laboratory diagnosis (test to request VHF/EVD)

3. Completes GW17/5 Notification Form and send to the Provincial Communicable and Disease Control Focal Person

PROVINCE1. Immediately notifies NATHOC and sends copies of the GW 17/5 notification

forms2. Compile a Daily Situation Report Form and line list and send to NATHOC by

9am each day.

NATHOC1. Immediately verifies, validates, collates, analyzes and reviews all data from Provinces2. Immediately notifies the IHR Focal Point of any suspected or confirmed case3. Prepares daily surveillance reports

Public Health Cluster including the IHR Focal Point/Person1. Conduct risk assessment for all cases detected

2. Prepares National Situation Reports

NICD- Hotline provides guidance with regards to risk

assessment and meeting case definition- Conducts laboratory testing- Provides results/laboratory reports to NATHOC,

Provincial CDC and healthcare facility

National level

Province levelLocal level

Figure 1: Flow of information of for suspected and confirmed EVD cases

Annexure 1CASE INVESTIGATION FORM: REQUEST FOR EBOLA VIRUS DISEASE TESTING

PATIENT DETAILSSurname: Name/s: Date of birth: Age: Sex: Male FemaleContact telephone number/s: Occupation:Physical home address:

ATTENDING HEALTHCARE WORKER AND HEALTHCARE FACILITYDETAILSName of clinician: Contact number/s of clinician:Healthcare facility name: Location of healthcare facility:Hospital number: Date of admission (dd/mm/yyyy): Ward:CLINICAL INFORMATION

A. Date of onset of illness (dd/mm/yyyy):B. Clinical features(Tick appropriate box: yes, no, unknown)

Fever Yes □ No □ Unknown □ If yes, specify temperature ___°CHeadache Yes □ No □ Unknown □Muscle pain Yes □ No □ Unknown □Joint pain Yes □ No □ Unknown □Abdominal pain Yes □ No □ Unknown □Sore throat Yes □ No □ Unknown □Nausea Yes □ No □ Unknown □Vomiting Yes □ No □ Unknown □Diarrhoea Yes □ No □ Unknown □Eschar Yes □ No □ Unknown □Jaundice Yes □ No □ Unknown □Bruising Yes □ No □ Unknown □Other, specify: ______________________________

Rash Yes □ No □ Unknown □If yes, specifyDistribution of rash:____________________________________Type of rash:Macular Yes □ No □ MaculopapularYes □ No □ VesicularYes □ No □ PetechialYes □ No □ VasculiticYes □ No □

Bleeding Yes □ No □ Unknown □If yes, specify EpistaxisYes □ No □ HaematuriaYes □ No □ EcchymosesYes □ No □ HaematemisisYes □ No □ MelaenaYes □ No □ Other: specify:_____________________________________

C. Antimicrobial therapyHas the patient received any antibiotics therapy during this illness? Yes □ No □ Unknown □

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If yes complete the table belowAntibiotic Route (po/IV /IM) Date started Date stopped Duration (days) of treatment

D D M M Y Y Y Y D D M M Y Y Y YD D M M Y Y Y Y D D M M Y Y Y YD D M M Y Y Y Y D D M M Y Y Y Y

Has thepatientreceivedanyantimalarialtherapyduringthisillness? Yes □ No □ Unknown □If yes complete the table belowAntimalarial Route (po/IV/ IM) Date started Date stopped Duration (days) of treatment

D D M M Y Y Y Y D M M Y Y Y YD D M M Y Y Y Y D D M M Y Y Y Y

D. Supportive management(Tick appropriate box: yes, no, unknown)PatientrequiringintensivecaresupportYes □ No □ Unknown □MechanicalventilationYes □ No □ Unknown □DialysisYes □ No □ Unknown □

Blood/blood product transfusion: Yes □ No □ Unknown □Other: specify ______________________________________

LABORATORY INVESTIGATIONRESULTSFBCHaemoglobin:

RESULT g/dL

DATE……../……./……… Coagulation profile:

RESULT DATE……../……./………

Plateletcount: x 109/L ……../……./……… INR ……../……./………White cellcount: x 109/L ……../……./……… PTT ……../……./………Absolutelymphocytes x 109/L ……../……./……… D-dimers: ……../……./………Liver function testsTotal bilirubin: mmol/L ……../……./………

FDP ……../……./………

Malaria tests:Date: ______/______/______Malaria smear: Pos □Neg□

Directbilirubin: mmol/L ……../……./………AST IU/L ……../……./………ALT IU/L ……../……./……… Malaria antigen: Pos □Neg□ALP IU/L ……../……./………GGT IU/L ……../……./……… Blood culture: Date collected: _____/______/________

Status:U & E:Urea: mmol/L ……../……./………Creatinine: µmol/L ……../……./……… Other relevant tests and results (specify)

RISK FACTORS/ EXPOSURE HISTORY – during the 3 weeks prior to onset of symptoms

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Travelled to a country where EVD cases have occurred during the current outbreak Yes □ No □ Unknown □(West African countries affected by outbreak and countries reporting imported cases with local transmission)History of contact with blood/body fluids of a patient withsuspected/confirmed EVD Yes □ No □ Unknown □History of contact with the immediate environment of a patient with suspected/confirmed EVD Yes □ No □ Unknown □Handled or slaughtered bats or bush-meat animals in Guinea, Liberia or Sierra Leone Yes □ No □ Unknown □Handled clinical/laboratory specimens from a patient withsuspected/confirmed EVD Yes □ No □ Unknown □Involved in the funeral preparations of a patient with suspected/confirmed EVD Yes □ No □ Unknown □Had sex in the last 3 months with a patient with suspected/confirmed EVD Yes □ No □ Unknown □

PASTMEDICAL AND TRAVEL HISTORY Underlying illness : Yes □ No □ Unknown □ If yes, give details:

Travel outside of South Africa in the four weeks prior to onset of illness? Yes □ No □ Unknown □ If yes, details:

Country visited Location/s visited within country: Date of arrival (dd/mm/yyyy): Date of departure (dd/mm/yyyy):………../………./……… …..…../………./………………../………./……… ….…../………./………………../………./……… ….…../………./………

Reason for travel (e.g. business, tourist, visiting friends/family), specify: ___________________________________________________Activities (e.g. hiking, walking, hunting), specify: _____________________________________________________________Yellow fever vaccine received: Yes □ No □ Unknown □Antimalarial chemoprophylaxis taken : Yes □ No □ Unknown □DIFFERENTIAL DIAGNOSES List current differential diagnoses considered:______________________________________________________________________________________________________________________________________________________________________________________

Annexure 2

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The EVD Daily Situation Reporting Form (To be completed by Provincial Communicable and Disease Control Focal Persons)

SITUATION REPORT NUMBER:

Report for period: / / 2014 to / / 2014

Due daily by 09:00 am

Surveillance Point

SITUATION SUMMARY

Summary of the suspected or confirmed EVD case(s):

Medical ConditionDetails/Potential source (If available please include potential source, any risk assessment under general comments)

No. confirmed cases

No. suspected cases

No. of deaths

General comments

EVD Virus Disease

4. REPORT DETAILS

Prepared by: Telephone number:

Approved by: Telephone number:

Date: Next situation report to be sent at: Date: Time:

Send this form together with the line list to the NATHOC: Tel: 012 395 9636 or 012 395 9637, Fax: 012 395 9722, E-mail: Nathoc1@health.gov.za or Nathoc2@health.gov.za

Annexure 3

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ENHANCED EVD SURVEILLANCE LINE LIST TOOL

To be completed by Provincial Communicable and Disease Control Focal Persons

Surname Name ID/Passport No.

Age Sex Residential Address

Country of origin

Notification date

Possible place of infection

Date of onset

Lab investigation result

Confirmed/Suspected case

Outcome (Alive/Dead)

Health Facility

Notified by

Tel. no.

Send this form to the NATHOC: Tel: 012 395 9636 or 012 395 9637, Fax: 012 395 9722, E-mail: Nathoc1@health.gov.za or Nathoc2@health.gov.za

Annexure 4: List of EVD Contacts

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National Health Operations CentreNational Department of Health

Tel: 012 395 9637 or 012 395 9637

Fax: 012 395 9722,

E-mail: Nathoc1@health.gov.za or Nathoc2@health.gov.za

National Institute for Communicable DiseasesSpecial Pathogens Unit,

NICD1 Modderfontein road,

Sandringham,

Johannesburg

Requests for testing (with a detailed clinical, travel and exposure history) should be directed to the NICD Hotline at 082 883 9920 (a 24‐hour

service, for healthcare professionals only).

DESIGNATED EVD OUTBREAK HEALTH FACILITIES AND FOCAL PERSONS

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PROVINCE HOSPITAL FOCAL POINT TELEPHONE NO. MOBILE NO.

Limpopo Polokwane Hospital Ms. Mavis Madaba 015 287 5000/ 5803/ 5713 082 691 0823

Mpumalanga Rob Ferreira Hospital Sister Francina Henning 013 741 6278 072 511 0184

Gauteng Charlotte Maxeke Hospital Sister Felicity Brown 011 488 4419 / 488 3388 072 254 5769

Steve Biko Academic Hospital Prof. Stoltz 012 354 4961 082 214 1811

KwaZulu-Natal Addington Hospital Sister Carol Gumede 031 327 2993 083 709 3225

North West Klerksdorp Hospital Sister Mojaki Mosiatlhaga 018 406 4606 082 450 6116

Free State Pelonomi Hospital Dr. D Steyn 051 436 9310 083 249 6682

Northern Cape Kimberly Hospital Mr. Danie Stander 053 802 2360 083 449 4322

Eastern Cape Frere Hospital Mrs. N Tyalisi 043 709 2011 083 590 0499

Livingston Hospital Dr. J. Black 041 405 2617 083 378 0911

Western Cape Tygerberg Hospital Dr. Jantie Taaljaard 021 938 5229 083 419 1452

PROVINCIAL CDC FOCAL PERSONS FOR THE ENHANCED SURVEILLANCE OF EVD

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PROVINCE NAME TEL NUMBER FAX NUMBER EMAIL ADDRESS MOBILE No.

Eastern Cape Ms Lungelwa Quntana 040 608 0842/29 086 624 5696 or

043 642 1409

lungelwa.quntana@impilo.ecprov.gov.za 083 378 1771

Free State Ms Babsy Nyokong 051 408 1734 051 408 1074 NyokongB@fshealth.gov.za 083 452 8954

Northern Cape Mr Danie Stander 053 830 540/38 086 556 3960 dstander@ncpg.gov.za 083 449 4322

North West Ms Chriseldah Lebeko 018 391 4066 086 690 2756 clebeko@nwpg.gov.za 079 521 5004

GautengMs Joy Mnyaluza 011 355 3867 011 355 3297 Joy.Mnyaluza@gauteng.gov.za 082 335 3134

Mr Rufus Makwela 011 355 3172 011 355 3297 Mashaole.Makwela@gauteng.gov.za 071 365 8479

Limpopo

Mr. Eric Maimela

015 293 6059 015 293 6281 Eric.Maimela@dhsd.limpopo.gov.za or

ericmaimela@yahoo.com

084 686 5686

Ms. Freda Ngobeni 015 293 6062 015 293 6281 Marlene.Ngobeni@dhsd.limpopo.gov.za or

fredangobeni@yahoo.com

079 491 1909

Mpumalanga

Mr Mandla Zwane 013 766 3078 013 766 3473 or

086 650 8656

MandlaZW@mpuhealth.gov.za 082 229 8893 or

079 210 6549

Ms Riensie Vellema 013 766 3411 086 621 3058 RiensieV@mpuhealth.gov.za 083 289 6991

Western Cape

Mr Stephen Titus 021 483 3737 021 483 2682 Stephen.Titus@westerncape.gov.za 083 488 0777

Ms Charlene Jacobs 021 483 9964 086 611 1092 or

021 483 2682

CharleneA.Jacobs@westerncape.gov.za 072 356 5146

KwaZulu-NatalMr Bruce Margot 033 846 7503 033 846 7272 Bruce.Margot@kznhealth.gov.za 083 457 1185

Ms Premi Govender 033 846 7461 033 846 7759 Premi.Govender@kznhealth.gov.za 071 609 2505

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