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EXERCISE BOOK

YELLOW FEVER DETECTION AND CONTROL WORKSHOP

CONTENTS

Workshop Exercises 1

Exercise 1 Case Definition of Yellow Fever 1

Exercise 2 Calculation of Case Fatality Rates 3

Exercise 3 Plan Vaccination Strategy (Calculate Age-Specific Attack Rates) 5

Exercise 4 Make a Graph 7

Exercise 5 Health Education 9

Exercise 6 Case Management 13

Self-Study Projects 15

Component 1 Ensure that the Surveillance SystemCan Detect Yellow Fever 15

Component 2 Ensure the Capability to Collect andTransport Specimens to a Laboratory 19

Component 3 Identify and Address Training Needs 25

Component 4 Maintain a Reserve Stock of EssentialEquipment and Supplies 33

Component 5 Organize an Epidemic Committee (District Level) 37

Component 6 Plan Logistics and Staff Needed for Control Measures 39

Component 7 Ensure Adequate Finances 41

Component 8 Organize Vaccination Teams 45

Component 9 Make an Emergency Response Plan 55

Component 10 Evaluate Epidemic Preparedness 57

Component 11 Plan for Prevention 63

ANNEXES 73

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Sample Immediate Notification Form 75

Article for Discussion: Yellow Fever in Nigeria 1986 - 1990 77

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WORKSHOP EXERCISES

EXERCISE 1

CASE DEFINITION OF YELLOW FEVER

Read about these patients and decide whether or not they meet the case definition forsuspected yellow fever. Yellow fever has not been reported in the district.

a. An 18-year old student developed a fever followed by jaundice. There is nobleeding in the mouth, no black vomitus, and he is still alive. The malaria smearwas negative.

Yes ______ No ______

b. A 7-year-old boy is seen at a rural clinic for high fever, followed five days laterby scleral icterus and bleeding in the mouth. A malaria smear is positive for P.falciparum.

Yes ______ No ______

c. A 5-year-old girl died at home after developing fever and yellow eyes.

Yes ______ No ______

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d. An 11-year-old boy arrived at the clinic with high fever, retrobulbar pain, chills,and myalgia. He was treated for malaria, but did not improve.

Yes ______ No ______

Now assume that you are on an investigation team. The epidemiologist has decided to usethe case definition suspect possible yellow fever during the investigation. Read about eachpatient again, and decide whether he or she meets the case definition for suspect possibleyellow fever. Circle the description of each patient that does.

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EXERCISE 2

CALCULATION OF CASE FATALITY RATES

There are suspected yellow fever outbreaks in District A and in District B.

In District A, there were 350 cases of yellow fever, and 10 deaths.

In District B, there were 400 cases of yellow fever and 150 deaths.

1. What is the case fatality rate in District A?

2. What is the case fatality rate in District B?

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3. What are possible reasons for a very low case fatality rate?

4. What are possible reasons for a very high case fatality rate?

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EXERCISE 3

PLAN VACCINATION STRATEGY

(CALCULATE AGE-SPECIFIC ATTACK RATES)

The Epidemic Committee in Canopy District is planning the strategy for the yellow fever massvaccination campaign. Because resources are limited, they need to vaccinate the people who aremost at risk.

1. Define “ attack rate” .

2. How should the committee decide which groups of people are most at risk?

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3. Calculate the age-specific attack rate, using these data collected by the investigation team.The population of Canopy district is 200,000 people. (Your facilitator may ask you to usethe population of your own district instead).

AGE GROUPS

(YEARS )% OF TOTAL

POPULATION

DISTRICT

POPULATION

NUMBER OF

CASES

ATTACK RATE

0-4 17 12

5-14 28 80

15-29 28 40

30-44 15 0

45 and older 12 0

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EXERCISE 4

MAKE A GRAPH

There is a yellow fever outbreak in Canopy District. The Epidemic Committee has asked you tomake a graph that shows the number of suspected yellow fever cases that occurred from July 15to July 21. These are the number of cases that were reported that week.

Number ofCases

8 7 9 10 12 17 22

Date July 15 July 16 July 17 July 18 July 19 July 20 July 21

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EXERCISE 5

CASE MANAGEMENT

CASE HISTORY # 1 - MARY

There is a yellow fever epidemic in your area. Twenty-four-year-old Mary comes to youcomplaining of a headache, muscle aches and vomiting. She became ill yesterday. Whenyou examine her, she appears ill and has a fever of 39.5.

1. Does Mary have yellow fever?

2. Does she meet the case definition for suspected yellow fever?

3. What other clinical information would you like?

Physical Examination

Clinical Laboratory

History

4. Mary’s malaria smear is negative and you can find no other cause for her illness. Youthink that she may have yellow fever. She appears uncomfortable, but is alert and in nodistress. What do you tell Mary?

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CASE HISTORY # 2 - HENRY

There is a yellow fever epidemic in your area. Ten-year-old Henry is brought to you by hismother. She said that four days ago he had a high fever and was treated for malaria. Heimproved for a few hours, but she has brought him back because the fever returned, hiseyes have become yellow and his gums are bleeding. He has vomited frequently, andthere are black flecks in the vomit. Henry seems very ill, and moves about restlessly onthe bed. He says he is thirsty, but seems too weak to drink. His skin pinch goes back veryslowly. He weighs 30 kg.

1. Does Henry have yellow fever?

2. Does he meet the case definition for suspected yellow fever?

3. What other clinical information would you like?

Physical Examination

Clinical Laboratory

History

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4. Henry’s malaria smear shows falciparum malaria. Nonetheless, because there is ayellow fever epidemic in the area, you suspect that he also has yellow fever. How willyou treat him (what orders will you write?)?

5. After one day, Henry seems worse. He has been vomiting digested blood (blackvomitus) and although he is not urinating much, there is blood in his urine. How wouldyou decide if he needs a transfusion?

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EXERCISE 6

HEALTH EDUCATION

Use this space to write notes on the group discussion of Health Education Messages.

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SELF-STUDY PROJECTS

COMPONENT 1

ENSURE THAT THE SURVEILLANCE SYSTEM CAN

DETECT YELLOW FEVER

Project Objectives: To review case definitions,To describe the flow of surveillance information, andTo list information that should be reported.

Project: Answer these questions.

1. Turn back to the case definition exercise on page 1. Read about the patients again.

What information should the health facility keep on each of these cases? What additionalinformation about the patients should be recorded in the patient register?

2. Check a clinic register and see if there is room to record the information you listed in youranswer to Question #1. If there is not enough room, write how you will instruct healthworkers to record the information:

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3. During an epidemic, how often should health facilities send reports to the district level?

4. During an epidemic, how often should the district send a report to the next highest level?

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5. What information should be in the report?

Follow-up Project:

Ensure that health workers can recognize cases of yellow fever. Review the clinicalpresentation and the suspected case definition with health facility workers in your district.

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COMPONENT 2

ENSURE THE CAPABILITY TO GET LABORATORY CONFIRMATION

Project Objectives: To nominate members of the Investigation Team

To review information on laboratory confirmation

Projects:

1. The investigation team is responsible for arranging for laboratory confirmation of yellowfever. Collection of specimens may be done by personnel from the district or from acooperating reference laboratory. Draw up a list of individuals who could be part of yourdistrict’s yellow fever investigation team.

Find out whether each person being considered has been vaccinated against yellow fever(you must see a vaccination card to check “ Yes” ).

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ROLE NAME VACCINATED

AGAINST YELLOW

FEVER?

ALTERNATE VACCINATED

AGAINST

YELLOW FEVER ?

Yes No Yes No

Clinician AND/OR

Epidemiologist

Entomologist OR

Hygienist with mosquitotraining

Person trained incollection of yellow feverspecimens

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2. At the workshop, you will have learned which reference laboratories are available and whowill be responsible for collecting specimens. Answer the questions below with thatinformation in mind.

a. Why is it important to obtain laboratory confirmation of yellow fever?

b. What kinds of specimens are needed? When and from whom should they beobtained?

c. How should specimens be collected? What materials are needed?

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d. What precautions should health workers or laboratory workers observe whilecollecting specimens?

e. How should the specimens be packed for transport? What materials are needed?

f. What is the closest laboratory that can evaluate the specimens?

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g. What means of transportation is available to bring the specimens to thelaboratory? How long will it take for specimens to arrive?

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COMPONENT 3

IDENTIFY AND ADDRESS TRAINING NEEDS

Project Objectives: To draft a district training plan

To plan brief training sessions

Project: Make a training plan. Review Section 5.3 of the Guidelines and decidewhich health workers in the district need to be trained. In the table on thenext page, record the type of training needed by different types of healthworkers.1

1 During a large epidemic, it may be difficult for the regular health staff to do all that is needed. Consider how tobest use non-health staff — for example, nursing students, school teachers or community volunteers. They will alsoneed to be trained.

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TITLE KNOWLEDGE AND

SKILLS NEEDED

NUMBER

TO BE

TRAINED

TIME PERSON

RESPONSIBL

E

TRAINING

MATERIALS

Example:Nurses at ruralhealth posts

Surveillance foryellow fever,reportingprocedures

10 1 hour Matron Malta Copies of casedefinitions,report forms

Example:NursingAssistants

Disposal of usedneedles duringvaccinationcampaigns

45 ½ hour to1 hour

Nurse Ptori Needles andsyringes,container forused needles

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TITLE KNOWLEDGE AND

SKILLS NEEDED

NUMBER

TO BE

TRAINED

TIME PERSON

RESPONSIBL

E

TRAINING

MATERIALS

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Project: Plan Brief Training Sessions

Re-read Section 5.3 in the Guidelines and consult your training plan. Use the Guidelines and theExercise Book you used in the workshop as sources of information for your lessons.

Each lesson plan should include the following:

/ Topic of the lesson.

For example, how to recognize yellow fever.

/ Objectives for the lesson.

These are statements that explain exactly what you want the trainees tolearn or to be able to do after the lesson. For example, "Health post nurseswill be able to describe the clinical presentation of yellow fever and thesuspected case definition for yellow fever".

/ Methods you will use to teach the lesson.

Usually, in each lesson, trainees will learn some new information orpractice a new skill. Think of the best way to teach them.

To give trainees new information, you may tell them about it, or give themsomething to read. To review information that trainees have learnedbefore, or to up-date them on a topic, ask questions or lead a discussion.Then have them apply the information.

To teach or review a skill, explain and demonstrate each step in the skill.Then have trainees practice for themselves until they can do it properly.They should practice with the same materials or equipment that they willuse in their health facilities.

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/ Materials that will be used.

For example, materials for a lesson on surveillance and reporting mightinclude: "Immediate reporting forms, clinic register, list of casedefinitions, descriptions of patients in Exercise 1 of the Exercise Book".

/ Preparations that need to be done before the lesson.

/ Description of what you will do to teach the lesson.

There is an example of a lesson plan on the next page:

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LESSON PLAN

SAFE DISPOSAL OF NEEDLES FOR NURSING ASSISTANTS

WORKING IN VACCINATION CAMPAIGNS

Objective: After the lesson, nursing assistants will be able to:

. demonstrate how to dispose of used needles safely

Methods: Explanation of how to dispose of needles

Demonstration of how to handle and dispose of needles

Practice in handling and disposing of needles

Materials: Needles, syringes, empty vials, examples of types of needle containers

Preparations: ___ Get needles, syringes

___ Get examples of suitable containers that can be used for disposingof needles

Description of Lesson:

1. Ask trainees questions in order to review their knowledge on proper disposal ofneedles.

. What diseases can be transmitted by needles that have been contaminatedwith blood?

. Why do we use a new needle and a new syringe for each patient?

. What is the proper way to dispose of used needles?

. What is the danger of re-capping a needle?

. What kinds of containers can be used for needle disposal?

. What is the procedure for disposing of containers of needles after avaccination session?

Praise them for accurate answers and correct any errors or confusion.

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2. Using a needle, syringe and container, demonstrate how to properly dispose of a usedneedle. Show them examples of suitable containers that are locally available.

3. Have each trainee practice handling the syringe and needle and disposing of theneedle. Have each person practice until they can do it correctly.

4. Review and summarize the lesson. Answer any questions.

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COMPONENT 4

MAINTAIN A RESERVE STOCK OF ESSENTIAL

EQUIPMENT AND SUPPLIES

Project Objective: To do an inventory of treatment supplies needed for yellow fever.

Project: The workshop facilitators explained the Ministry of Health’s policy onwhat supplies should be stocked in advance of a yellow fever epidemic,and where they are held. At the moment that an epidemic of yellowfever is suspected, all health facilities will be asked to submit aninventory of the treatment supplies that they have on hand. For thisproject, do an inventory of treatment supplies that are on hand now. Fillin the items and the amounts on hand for the district stores, and theamounts on hand at two health facilities in the district.

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ITEM AMOUNT

(DISTRICT

STORE )

AMOUNT

(FACILITY 1)AMOUNT

(FACILITY 2)COMMENT

IV Fluids byType

Adult GivingSets

Child/InfantGiving Sets

Mosquito Bed-nets

Paracetamol

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Follow-up Projects:

1. For each item on the list that is not readily available in the district, find out how longit would take to get supplies from the sources.

2. Think about the situation in your district, and decide which items could be gottenquickly in the event of an epidemic, and which should be stockpiled. For each item,explain your reasons.

3. For each item you think should be held in reserve, estimate how much you shouldhave on hand to be ready for an outbreak of yellow fever.

4. For those items, make a plan for acquiring the items, and make a plan for rotatingthem with regular stores to avoid problems with expiry dates.

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COMPONENT 5

ORGANIZE AN EPIDEMIC COMMITTEE (DISTRICT LEVEL )

Project Objective: To identify the responsibilities and make-up of the epidemic committee.

Project: The district next to yours informs you that there is a possible outbreak ofyellow fever in their area. You wish to make preparations for controllingthe spread of the disease and for providing proper treatment in case yourdistrict is affected.

The first step is to convene a committee to plan and implement activities in your district.

1. What will the responsibilities of the committee be?

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2. Who should be part of this committee? Identify specific individuals and their positions.

Follow-up Project:

1. Contact each individual listed to get his/her agreement to be part of a yellow fevercommittee.

2. Convene a meeting, and bring members up to date on yellow fever surveillance,prevention and control. Review the duties of each member and discuss how theywould carry them out. Try to identify any problems and obstacles, and make a plan toovercome them.

3. At that meeting, or at another meeting, ask the group to review the evaluation of thedistrict’s state of preparedness (Component 10) and make a plan for a systematicevaluation.

If the evaluation has not been done, plan to do it.

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COMPONENT 6PLAN LOGISTICS AND STAFF NEEDED FOR CONTROL MEASURES

Project Objective: To select possible locations for fixed vaccination sites

To plan how vaccination sessions would be conducted

Project: Visit possible sites for yellow fever vaccination, in the event of anepidemic. Plan how to organize a vaccination session at one of thosesites (not a health facility). Make a drawing to show how you wouldorganize the vaccination site.

Include the following areas (each of which will need to be staffed):

a. waiting and health talk;

b. triage and age checking;

c. vaccine card table;

d. shot giving;

e. syringe loading;

f. card stamping and tallying of doses given; and

g. storage.

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Follow-up Projects:

Go to one location and practice setting up a temporary vaccination center.

Conduct a “mock” vaccination session to identify any problems.

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COMPONENT 7ENSURE ADEQUATE FINANCES

Project Objective: To identify possible funding sources

To seek support by writing a letter

Project: Planning and response activities have a cost. You should determine howmuch these activities will cost, and see whether they are covered in thedistrict’s budget. If they are not, you should ask for funding, from thedistrict or from another source. Agencies are more likely to give funds ifyou give them a plan and written estimate of costs. If more funding isnot available, think of ways to use the resources you already have (e.g.,re-assign personnel).

Use the table on the next page to list at least five activities you need to do to improve yourpreparedness level. In the second column, list the supplies and resources (e.g., personnel,technical support, money, equipment, etc.) you need that are not available in your district.In the third column, list possible sources of support.

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ACTIVITY RESOURCES NEEDED SOURCE OF SUPPORT

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2. After completing the table, draft a letter to one source asking for support. The letter shouldcontain the following:

a. a paragraph introducing yourself and your qualifications to write;

b. the reason for your request;

c. data which supports your request;

d. the items and amounts you need; and

e. an indication of when you would need them (for reserve against futureoutbreaks or immediately to respond).

Keep the letter brief (one page of text, and several pages of data).

Follow-up Project:

Follow up on the letter.

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COMPONENT 8ORGANIZE VACCINATION TEAMS

Project Objectives: To identify members of vaccination teams

To plan a mass vaccination campaign in rural and in urban areas

Projects:

1. The table on the next page lists possible members of a vaccination team. List people whowould be on vaccination teams in the district.

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TEAM MEMBER TEAM 1 TEAM 2

1. supervisor

2. vaccinator 1

3. vaccinator 2

4. record clerk 1

5. record clerk 2

6. record clerk 3

7. community representative 1

8. driver

9. syringe loaders

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2. Pick two places in your district — one remote village and one town — and imagine thatyellow fever has been confirmed in both of them. Plan how to conduct vaccination in eachplace.

Assume you will vaccinate everyone under the age of thirty years. Assume a vaccinationteam can administer 1,000 doses of vaccine a day. Answering the questions below will helpyou plan how to organize the vaccination campaign. Estimate the amount of suppliesneeded on a daily basis. Add other items you think of to the blank rows at the bottom of thetable.

Overall Planning for Vaccination Campaign

a. Should you vaccinate the town and the village at the same time, or one after theother? If one after the other, explain how you would pick the one to do first.

b. How many vaccination teams will be needed?

c. When will they be trained?

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d. Who will train them?

e. How is vaccine requested?

Planning the Vaccination Campaign in the Remote Village:

a. What is the population of the village?__________________________________

b. How many people are there under the age of 30? _________________________

c. How many doses of vaccine and syringes and needles are needed?___________

d. How many vaccine carriers are needed? ________________________________

e. How long will it take to travel to the village? ____________________________

f. How many people from your headquarters will travel there?________________

g. How many vehicles are needed? ______________________________________

h. What is the best way to communicate with the village leaders?______________

How can you communicate with health workers there, or nearby?

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How will you communicate with the vaccination team?

i. What messages will you send to the leaders and the health workers before youarrive? What should they prepare?

j. How long will it take to vaccinate everyone under the age of 30 years?

k. Are public education messages available in the language spoken there?

What are the best ways to communicate with the people of the village?

l. Will you attempt to collect specimens while there? If so, add materials neededto the table.

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Planning the Vaccination Campaign in the Town

a. What is the population of the town? ___________________________________

b. How many people are there under the age of 30? _________________________

c. How many doses of vaccine and syringes and needles are needed?___________

d. How many vaccine carriers are needed? ________________________________

e. How long will it take to travel to the town? _____________________________

f. How many people from your headquarters will travel there?________________

g. How many vehicles are needed? ______________________________________

h. What is the best way to communicate with the town’s leaders? _____________

How will you communicate with the local health workers?

i. What information do you want the townspeople and the local health workers tohave before you begin the campaign?

j. How long will it take to vaccinate everyone under the age of 30 years?

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k. Are public education messages available in the language(s) spoken there?

What are the best ways to communicate with the people?

l. Will you attempt to collect specimens while there? If so, add materials neededto the table.

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SUPPLIES /PERSONNEL AMOUNT

VILLAGE

AMOUNT TOWN SOURCE OF

SUPPLIES

vehicles

fuel

vaccine doses

needles

syringes

vaccine carriers

cold packs/ice

disinfectant for cleaningskin

vaccinators

drivers

other staff

helpers

allowance for staff

health educationmaterials

vaccine cards

immunization tally sheets

IV solutions and givingsets

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Follow-up Projects:

1. Interview everyone listed as possible vaccination team members, and find out whohas been vaccinated against yellow fever. Write your findings in the space below:

2. Arrange for yellow fever vaccination for all personnel who might be involved inyellow fever control efforts (do not forget drivers, cleaners and others who may notbe trained health workers). In the space below, describe your efforts, and give thedate when all have been vaccinated.

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COMPONENT 9

MAKE AN EMERGENCY RESPONSE PLAN

Project Objective: To think through activities that need to be done during an emergencyresponse.

Project: Planning Matrix for Emergency Response

Pretend that a yellow fever epidemic is about to begin. Completing the following matrix willhelp you think through activities that need to be undertaken during an epidemic. For eachactivity, identify a person responsible, an alternate, time frame, materials/resources needed andtheir possible sources, and monetary costs to the district.

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ACTIVITY PERSON

RESPONSIBLE /ALTERNATE

TIME

FRAME

MATERIALS

/RESOURCES

NEEDED

SOURCE COST

1. convene epidemiccommittee

2. identify staffresponsibilitieswhen epidemicstarts

3. organize and fieldmobile controlteams

4. inform healthfacilities

5. obtain healthfacility reports

6. inform otherdistricts

7. inform provincialofficer

8. arrange forlaboratoryconfirmation

9. mobilizeinvestigation team

10. plan vaccinationstrategy

11. inventory treatmentand vaccinationsupplies

12. obtain vaccine andtreatment supplies

13. monitor andevaluate controlmeasures

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COMPONENT 10

EVALUATE EPIDEMIC PREPAREDNESS

Project Objective: To assess the district’s epidemic preparedness.

Project: Evaluate District Epidemic Preparedness

Chapter 5.0 of the Technical Guidelines on the Detection and Control of Epidemic Yellow Feverdiscusses eleven components of preparedness. Re-read the information in that chapter, andanswer the questions about preparedness which are in the boxes. When you can answer “ yes” toall the questions, your district is ready to respond to an epidemic of yellow fever.

You will find these questions in the table on the next page. Use the columns at the right of thetable to record what the district has accomplished.

For this Project, review each of the questions, and decide whether or not your district is ready.This is a good Project to do with a group of co-workers, ideally with members of the EpidemicControl Committee.

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DISTRICT PREPAREDNESS CHECKLIST

Yes No Comment

Ensure That the Surveillance System Can Detect Yellow Fever

Routine Reporting and Emergency Notification

Can health workers recognize cases of yellow fever?

Do health workers know the surveillance case definitionsfor yellow fever?

Do health workers know how to report suspected cases bythe most rapid and reliable means?

Do health workers know what to report?

Investigation Team

Have members of an Investigation Team been identified?

Have members been trained or briefed on their duties?

Has funding for an investigation been provided for?

Have supplies and resources been provided for?

Ensure the Capability to Get Laboratory Confirmation

Has a reference laboratory been identified?

Are supplies needed for collection and transport ofspecimens available?

Have funds for laboratory costs been allocated?

If district personnel will collect and transport specimens:Has a person been trained to collect specimens from yellowfever patients?

Training

What percentage of the district's health workers are up-to-date on yellow fever? _____ %

Have the responsibilities of health staff been determined?

Is there a plan to train health workers in advance of anepidemic?

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Is there a plan to quickly train health workers at the time ofan epidemic?

Are health workers being trained according to the plan(s)?

Maintain a reserve stock of equipment and supplies

Is there a reserve stock of vaccine?

If there is a reserve stock, where is it located?

How many doses are there?

Has funding been found for the reserve supplies?

Do district officials know how to request vaccine?

Is there a stock of materials needed for laboratoryconfirmation?

Has funding been found for the reserve supplies?

Organize an Epidemic Committee

Is there a yellow fever epidemic committee (or asubcommittee of another committee)?

If so, do the members meet regularly?

If so, are members working to prepare the district for apossible epidemic?

Plan staff and logistics needed for control measures

Have responsibilities for health facility and districtpersonnel been decided upon?

Is there a plan for re-assigning staff during an epidemic?

Is there a plan to recruit additional persons (such asnursing students) to help with vaccination campaigns?

Is there a plan to train non-health personnel to help in massvaccination campaigns?

Has funding been identified for extra staff costs during anepidemic?

Have logistics needs during an epidemic been identified?

Have potential sites for vaccination been identified?

Has funding for extra costs related to logistics beenidentified?

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Financial support for preparation and response

Have costs related to preparation for an epidemic beenidentified?

Have costs related to investigation of a suspected epidemicbeen identified?

Have costs related to the response to an epidemic beenidentified?

Has a source of funding or support been found for eachexpense?

Organize Vaccination Teams

Have potential members of vaccination teams beenidentified?

If so, have they been trained?

Has a source of supplies (other than vaccine itself) beenidentified?

Is the cold-chain prepared?

Has transport been identified?

Have possible vaccination sites been identified?

Has funding for mass vaccination (other than for vaccineitself) been identified?

Make an Emergency Response Plan

Is there a written Emergency Response Plan forresponding to an epidemic of yellow fever?

Are members of the epidemic committee, and otherpersons who are involved, aware of the plan?

Evaluate Epidemic Preparedness

Has the preparedness of the district been evaluated?

If so, have recommendations of the evaluation been actedon?

Are regular, periodic evaluations scheduled?

If Yellow Fever is in EPI

Is yellow fever vaccine being regularly given in the districtas part of the Expanded Programme on Immunization?

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If Yellow Fever vaccine is not being routinely andregularly given, is there a determined effort to:

a. obtain enough vaccine?

b. provide it to all eligible children?

Reduction of Peri-Domestic Mosquitoes

It is known whether the common peri-domesticmosquitoes in the district are possible vectors of yellowfever?

Do people know how to store household water safely?

Do people know how to reduce mosquito breeding sites?

If not, have health education materials been prepared,and has health education been scheduled?

Have all health facilities been inspected to be sure that:

a: all water is stored safely, and

b: there are no potential mosquito breeding sites nearby

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Follow-up Project:

1. Make a plan to turn all the “ no” answers into “ yes” answers. The plan shouldinclude:

/ what should be done

/ who should do it

/ when it should be done (starting and ending dates)

/ resources or materials that are needed to do it

/ a method of evaluation (how will you know that it was done well?)

2. If you think that some parts of the preparedness components can not, or should not bedone at your level, then explain your reasons to your supervisor. Work together withyour supervisor to arrange for some one else to be responsible for that activity.

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COMPONENT 11

PLAN FOR PREVENTION

Project Objectives: To inspect three health facilities for mosquito breeding sites,

To identify ways to support yellow fever vaccination in the E.P.I.programme (if it is included), and

To identify district-level activities that would help reduce mosquitopopulations.

Project: Inspect Three Health Facilities for Mosquito Breeding Sites and TeachStaff How to Eliminate Any That Are Found

Choose three (or more) health facilities. If possible choose:

a. a referral hospital or large health facility where yellow fever patients might bereferred,

b. an urban health facility, and

c. a rural health facility.

Go to the health facility and teach the staff about the dangers of letting mosquitoes breed nearby.

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Inspect the health facility and inspect how water is stored there. Inspect the building and all thegrounds to look for possible mosquito breeding places.

The inspecting group should include:

/ a senior person (the chief if possible), and a deputy who can followup on the project

/ persons responsible for the grounds (e.g., groundskeeper, gardener,helpers, guards)

/ health educators and appropriate personnel

/ environmental technicians, hygienists

The group should include people who will be able to repeat the inspection in the future at thisand other health facilities.

Take sacks or barrows on the inspection tour so that small items can be removed. If things orplaces in which mosquitoes breed cannot be removed, think of ways to prevent mosquitoes frombreeding. During the inspection, explain clearly to gardeners and groundskeepers why certainthings are dangerous and must be eliminated.

If possible, return in 3-6 months to look for improvement.

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Write A Report Of Your Findings Here:

Health Facility # 1 (Hospital)

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Health Facility # 2 (Urban Health Facility)

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Health Facility # 3 (Rural Health Facility)

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Follow-up Projects:

In the long term, routinely vaccinating all children against yellow fever is probably thesimplest and most effective way to prevent epidemic yellow fever. If yellow fever vaccineis given as part of the E.P.I. programme in your country, then support the effort howeveryou can.

1. Think of ways that you, and your department, can support routine immunization ofchildren with yellow fever vaccine. Try to think of things that are not already beingdone by the E.P.I. programme. Discuss your ideas with co-workers and put them intoaction. Discuss the results at the next meeting of the Yellow Fever Epidemic ControlCommittee. Find ways to work with E.P.I..

Ideas on How to Support Yellow Fever Vaccination in my District

a.

b.

c.

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Results of Putting Those Ideas into Action

a.

b.

c.

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2. The only sure way to prevent yellow fever from occurring is to vaccinate the non-immune population. However, during an epidemic, it is possible to prevent the spreadof yellow fever by eliminating the mosquitoes that transmit the disease.

Since yellow fever can be transmitted by a number of mosquitoes, and thosemosquitoes differ in their habits, it is best to get the advice of an expert at the time ofan epidemic. Even if the activities in this exercise do not eliminate the mosquitoesresponsible for a particular yellow fever outbreak, the activities are valuable since theelimination of mosquitoes may reduce other mosquito-borne diseases, and since theprotection of water supplies will prevent diarrhoea (collaborate with the Control ofDiarrhoeal Diseases Programme on promoting safe water containers).

Read the table, and beside each measure list activities that you can do in your district.Be very specific, e.g., instead of writing "public education," write "go house-to-houseto deliver the following messages (followed by the messages themselves)." Also listresources that you will need to do the activity, as well as possible sources of support.

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MEASURES DISTRICT ACTIVITIES IF UNAVAILABLE ,POSSIBLE SOURCES

1. reducemosquitopopulation byprotecting watercontainers

2. reducemosquitopopulation byeliminatingbreeding sites

3. reduce mosquitobites by usingmosquito bednets

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ANNEXES

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SAMPLE IMMEDIATE NOTIFICATION FORM

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Article for Discussion : Yellow Fever in Nigeria 1986-1990

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