Obligatory Statement of Diseases. Administrative division : 16 regions, 69 provinces (districts) Population : live births per year

Transcription

1 1 Dr DGHOUGHI Nouzha Dr LAKRANBI Mohammed Administrative division : 16 regions, 69 provinces (districts) Population : live births per year Epidemiological surveillance is an uninterrupted process of collection, compilation and analysis of data, as well as their broadcasting to the group of those who need to be informed. Obligatory Statement of Diseases

2 Obligatory Statement of Diseases The statement of diseases is a medical treatment which consists in signalling to health authorized authority appearance or presence of one or of several cases of certain diseases. She allows so to watch the health state of the population and to take the necessary measures. List of diseases with obligatory statement Diseases subjected to the international health regulations Diseases that can give rise to one pushed infectious Other diseases to obligatory statement. New diseases returned in obligatory statement Obligatory Statement of Diseases 1. Diseases subjected to the international health regulations Peste, yellow fever, cholera Obligatory Statement of Diseases 2. Diseases that can give rise to infectious increases: Diphtheria, lockjaw, poliomyelitis and PFA The measles, whooping cough and tuberculosis, Malaria, The bilharziose and leprosy, The AIDS and MST, syphilis firstly - secondary, infections méningococciques Typhoid fever and paratyphoids, TIAC, human rage, trachoma.

3 Obligatory Statement of Diseases 3. Other diseases with obligatory statement: Obligatory Statement of Diseases 4. New diseases returned in obligatory statement: High-pitched articular rheumatism, leishmanioses, human coal and brucellose, viral hepatitises, leptospirose, typhus exanthématique and recurrent fever, gonococcic conjunctivitis of the newborn baby. Illness of Creutzfeldt-Jakob and diseases related, The severe acute respiratory syndrome (SRAS), The haemorrhagic fever of Crimea-Congo, The fever of the Valley of the Rift valley, The fever of Nile Westerner, The hydatidose. Epidemiological surveillance - Morocco Epidemiological surveillance organization Morocco Based on disease reporting: Royal Decree: mandatory reporting, Ministerial note (Arrêtés ministériels) : list of diseases to be mandatory reported and procedures, Decentralized Surveillance : regional & provincial Units, Passive or active Surveillance according to the type of the disease Data aggregate and & case investigation,

4 System existing before 2000 Every program has its own system of surveillance; passive Surveillance in general; centralization of data: Delay in the catch of decision. Punctual epidemiological studies. From 2000 Restructuring of epidemiological surveillance in Morocco General Objective: DECENTRALIZATION Decentralize the activities of epidemiology and conflict against diseases at the level of all the regions at the end of plan Operational objectives: the training of the regional teams Define working norms Redeploy the personnel of DELM to reinforce regional structures Restructure DELM Objectives to Ameliorate the quality of the system of surveillance to Reinforce regional and peripheral competences in epidemiology to Implicate the liberal sector to Reinforce surveillance on borders. Create local databases Discern infectious phenomena, quick local reaction early and appropriate to epidemics. Institute the use of local data for the catch of DECISION and ACTION at LOCAL AND REGIONAL level

5 Actions Strategical axles Creation of the Regional Observatories of Epidémiologie (circular ORE / CPE) Restructuring and médicalisation of health services on borders General implementation of the computer tool at provincial and regional level Training of the personnel Systematic working of data and re-rendered at all levels Communication of data by electronic mail Development of systems of precocious alert and preparation in epidemics to Reinforce surveillance of environment to Reinforce surveillance sentry Private sector Other diseases: Influenza, trachoma to Institute a system of monitoring and valuation of the system of surveillance Promotion of the research applied in the field of the epidemiology and in the surveillance of diseases Promotion of the education of modules on epidemiological surveillance in faculties and institutes. Reins production of surveillance. Alert System Required to have simple and practical tools so that the set up system of surveillance is reactive System of epidemiological alert

6 3,5 3 2,5 2 1,5 1 0,5 0 S1 S4 S7 Système d alerte de la méningite méningococcique, Maroc, années * * 2007 : situation à la semaine 24 S10 S13 S16 S19 S S25 S28 S31 S34 S37 S40 Semaines Date de mise à jour le 26/06/ S43 S46 S49 S52 S3 S6 S9 Ratio Limite supérieure Limite inférieure S12 S15 S18 S21 S24 ORE: Missions oto assure the epidemiological surveillance to the scale of the region oto coordinate the activities of epidemiology oto create regional data bases oto assure the systematic exploitation of the data, the diffusion / the rétroinformation oto assure the use of the results of the surveillance for the decision and the action to the local level Surveillance flow chart Distribution of the settings of the ORE/CPE in epidemiology, by regions. National level Epidemiological Surveillance Unit Regional level ORE Provincial level CPE Regional observatory of epidemiology Provincial unit of epidemiology Hospitals Laboratories Private Peripheral Primary health care units = Data collection = Feed back

7 Data collection & reporting Weekly cases reporting Software used: Excel Epi info Frequency of Reporting : Immediately notification & investigation: AFP, meningitis Weekly report: Measles, Pertussis, Diphteria Monthly report: others (Tetanus, Tuberculosis, Rotavirus ) Transmission by between provincial, regional and national levels. Flue and ARI cases reporting Monthly cases reporting

8 Identification du patient Nom/Prénom :... Sexe : M / / F / / Date de naissance : / / / / / / / / / / / Age en années :. Préfecture : Commune : Circonscription sanitaire :... N du dossier : / / / / / / / Milieu : Urbain / / Rural / / Données cliniques et épidémiologiques Data analysis Measles investigation form ère Date du début des symptômes : / / / / / / / / / / / Symptomatologie : Eruption maculopapuleuse généralisée : Oui / / Non / / Température 38,5 C : Oui / / Non / / Toux : Oui / / Non / / Coryza : Oui / / Non / / Conjonctivite : Oui / / Non / / Vaccination : L enfant est-il vacciné par la 1 ère dose Oui / / Non / / o Si oui, Date de la vaccination par dose / / / / / / la 1 / / / / / L enfant est-il vacciné par la 2 ème dose Oui / / Non / / o Si oui, Date de la vaccination par dose / / / / / / la 2 ème / / / / / Préciser la source de l information : 1 ère dose 2 ème dose o Carte vaccinale : / / / / o Registre : / / / / o Pas de document : / / / / Existe-t-il un (des) cas similaire(s) dans l entourage? : Oui / / Non / / Si oui : leur nombre / / / où? : Famille / / Ecole / / Voisins / / Autre :. Nombre de cas similaires investigués / / / Données du laboratoire Prélèvement : Non effectué / / Pourquoi?... Effectué / / Date / / / / / / / / / / / prélèvement : urinaire / / sanguin / / Rhino-pharyngé Type de / / Date d envoi au laboratoire : / / / / / / / / / / / Date de réception du résultat : / / / / / / / / / / / / / Négatif / / Résultat pour la rougeole : Positif Indéterminé / / Résultat pour la rubéole : Positif / / Négatif / / Indéterminé / / Evolution (Examen de contrôle 15 jours après la consultation initiale) Guéri / / Compliqué / / Décédé / / perdu de vue / / Responsable de l investigation Nom / Prénom :. Qualité :.. Date : / / / / / / / / / / / Signature :. Systematically done at all levels: Provincial, r (CPE), regional (ORE) and National surveillance Units Early warning system: based on the Epidemiological Ratio: Surveillance for Action Feed back Feed back Recommended at all levels (Monthly????): From the Province to all PHCU : printed reports From the Region to all provinces: by From National to all by: website: private web: Quarterly: Regional Epidemiological Bulletin National Epidemiological Bulletin info-rougeole (Measles) info-pfa (AFP) BULLETIN ROYAUME DU MAROC MINISTERE DE LA SANTE DIRECTION DE L EPIDEMIOLOGIE ET DE LUTTE CONTRE LES MALADIES Bulletin Epidémiologique Bilan année 2000 Avril 2001 ROYAUME DU MAROC - MINISTERE DE LA SANTE OBSERVATOIRE REGIONAL D EPIDEMIOLOGIE REGION SOUSS MASSA DRAA EPIDEMIOLOGIQUE REGIONAL ROYAUME DU MAROC MINISTERE DE LA SANTE Préfecture de fès Bulletin Epidémiologique Numéro spécial Avril 2000

9 Cas Cas Attendus Ratio % Specimens %Fiches Préfectures / Provinces Année 2006 Année 2006 Année 2006 Adéquats Hebdomadaires reçues Oued Ed-Dahab- Laguira Oued Ed-Dahab Aousserd Laâyoune-Boujdour-Sakia El Hamra Laâyoune Boujdour Guelmim- Es-Smara Guelmim Tata Assa-Zag Es-Smara Tan-Tan Souss- Massa- Draâ Agadir-Ida-ou-Tanane Inezgane-Aït Melloul Chtouka-Aït Baha Ouarzazate Taroudant Tiznit Zagora Gharb- Chrarda- Beni Hssen Kénitra Sidi Kacem Chaouia- Ouardigha Settat Khouribga Benslimane Marrakech- Tensift- Al Haouz Marrakech Chichaoua Al Haouz El Kelaâ des Sraghna Essaouira Région de l'oriental Oujda- Angad Jerada Berkane Taourirt Figuig Nador Grand- Casablanca Casablanca- Anfa Al Fida- Mers-Sultan Aïn Sebaâ- Hay Mohammadi Hay-Hassani Ain-Chok Sidi Bernoussi Ben- M'Sick Moulay Rachid Mohammedia Nouacer Médiouna Rabat- Salé- Zemmour- Zaër Rabat Salé Skhirate- Témara Khemisset Doukala- Abda Safi El Jadida Tadla- Azilal Béni Mellal Azilal Meknès- Tafilalet Meknès El Hajeb Ifrane Khénifra Errachidia Fès- Boulemane Fès Moulay Yacoub Sefrou Boulemane Taza- Al Hoceïma- Taounate Al Hoceïma Taza Taounate Tanger- Tétouan Tanger- Assilah Fahs -Anjra Tétouan M'diq-Fnidaq Larache Chefchaouen Ministère de la santé / DELM / SSE Info-PFA, année 2006 T O T A L ORE / CPE realizations o Analysis systematic data HIMSELF. o Development of an alert system. o Detection of the epidemics. o Regional data bases. o Investigating of epidemics. o Interventions. o Framing of the formations (local, regional, national and international). o Feed Back Regional Epidemiological bulletin. Provincial Epidemiological bulletin. Obstacles and Pressures -Instability of the medical personnel. Administrative -cutting up is sometimes an obstacle to the activities of surveillance. -not membership of certain trainings in the system of surveillance: TEACHING HOSPITAL, BMH, military hospitals. -Weak participation of the private. -Lack of training of person -Role restricted by laboratories.

10 Epidemiological surveillance at the migrants Epidemiological surveillance to the population migrant follows the same principles of epidemiological surveillance put comes back as part of the health control on borders (HCB): HCB : The epidemiological surveillance of the passengers. The epidemiological surveillance of the airships and ships; Information and education of the passengers, the crews and the staff of the ports and airports. Introduction of new work tools (infrared camera for the detection of the fever, scanner for the radioactivity) Taken measurements 1: o Taken measurements: Strengthening of the measurements of health control on borders: research of infectious diseases (yellow fever, paludism, brain fever). o Health control at the level of all provinces: In the presence of illness at an immigrant, the patient will be summary judgment towards the hospital for a catch in appropriate load. In that case besides infectious diseases known named, other diseases can be disseminated by the underground immigrants (tuberculosis, bilharziose, IST ). if a case of these diseases is discerned: take all necessary measures (inquiry, screening, treatment and appropriate prophylactic measurements). Not ill persons from a country infected by an infectious illness requiring a surveillance on borders: strict monitoring (periodical visits of the aliens in their place of residence) hang an identical period on the period of incubation of illness being discussed. In that case the isolation at home or in a hospital service is recommended if the risk of transmission is well brought up. 2 examples o Statement of cases of diseases: CPE, ORE, delm. o Intersectoral coordination (police, authorities, other ministerial departments, ONG )

11 I. Poliomyelitis Further to the happening of an epidemic of poliomyelitis in Mauritania in 2001: o Catch of the necessary dispositions to reinforce surveillance on borders: o Immediate Statement of case in DELM o discerned case à the hospital for diagnosis, isolation and catch in charge. o Measurements of hygiene: disinfection of the vats of toilet of the means of transport borrowed by the sick man and all objects having been in contact with this one. II. MALARIA o Any subject which introduces evocative signs of paludism must make the object of a sample (thick drop or smear) and taken care immediate. o The most part of cases belong to Plasmodium Falciparum: yes + taken care immediate at the level of the province (coartem). o If strict case hospitalization and treatment by: Quinimax IV + quinine. o Other kinds: nivaquine + primaquine. Statement of cases (CPE, ORE, DELM). THANK YOU VERY MUCH