by Dominga C. Gomez, RN

1. DOMINGA C. GOMEZ, R.N.

2.  Surveillance and the work-up of epidemics
are the two inseparable responsibilities of
IPCN.
 Surveillance provides the baseline data to
define the presence or absence of an
epidemic or problem
 Epidemics of infection and diseases occur
when an agent and an adequate number of
susceptible individuals have sufficient contact
for continuing transmission

3.  An epidemic continues until the susceptible
hosts in the population falls below the
number at which the probability of contact,
transmission and infection becomes too low
for the process to continue

4.  Epidemic is defined as an excess of cases
over the expected or usual number of
occurrences
 “ The occurrence of more cases of disease
than expected in a given area or among the
specific group of people over a particular
period of time”- CDC

5.  Outbreak is a sudden occurrence of a disease
in a community, which has never experienced
the disease before or when cases of that
disease occurs in numbers greater than
expected in a given area.
 Outbreaks carries the same definition of
epidemic, but is often used for more limited
geographic area.

6. • Common source epidemics appear when
susceptible individual have mutual exposure
to the same agent. Example- exposure to
contaminated water with enteric organisms.
Sometimes infections and associated cases
may appear sequentially. If the exposure
happens as a single time and place, it is
called “ point source epidemic”

7.  Propagated epidemics take place when serial
direct or indirect transmission takes place
from susceptible host to susceptible host.
This may occur in the form of person to
person spread with a rapid sequence as in
airborne transmission with short incubation
period or slow pace in transmission with
agent with longer incubation period as in
hepatitis B

8.  1. Assure the presence of an epidemic.
Confirm the diagnosis or define the entity.
-know the endemic rate of occurrence
-Know the etiology or disease
-Verification of the diagnosis may come
from the laboratory or sometimes purely from
clinical grounds
- with identified agent or clinical features,
the approach is simplified with knowledge of
incubation periods, sources and routes of
transmission.

9.  Last April 20, 2017, the Office of the Hospital
Director forwarded to the ICC the report of
the Dept of Pediatric regarding the two cases
of varicella at the ER.
 TH- 8, year old was first seen April 16, 2017.
Vesicular lesion appeared April 18, 2017. He
was admitted to the Pediatric ward, placed in
the isolation room
 GB- 3 year old was seen April 18, 2017. He
was sent home

10.  2.Case definition- must be fulfilled for each
event that is counted as associated with
epidemic. This may include a medical sign or
symptoms or laboratory test or isolation of
etiologic agent. It may include classification
of the ill as a) definite case or confirmed
b)probable and c) suspected cases

11. • Varicella Zoster Virus (VZV)Agent
•Pre-school, young school-aged children
•Highly communicable
Epidemiology
• Fever
• Malaise
• Generalized vesicular rash
Symptoms

12. High Risk Patients
Newborns of
mothers with
Varicella
before
delivery
Infants 28
weeks
gestation,
less 1000
gms birth
weight
Immuno –
compromised
adults
Pregnant
women

13.  On April 25, another probable case of
varicella was reported. JO 8 year old was
admitted at the Pedia ward for hematologic
problem as primary diagnosis
 At about the same time, a Medical Intern
reported at the Employees Clinic as a
probable varicella. He said, he was the one on
duty when the two varicella cases were
managed at the ER.

14.  He said, he was with his Resident-trainor and
and Pedia IDS Fellow. They were not feeling
well but they continued their rounds at the
Pedia Neuro ward and Pedia ICU
 The following day, a physical therapist
reported to have clinical symptoms of
varicella
 On April 28, Baby RH, 35 year old, admitted
at the NICU was confirmed to have varicella

15. NEONATAL – ICU
Name
(+) exposure to
Varicella Zoster
(+) Vaccine
BASINAG FE A. (+)
BARBARAN, MA. MAGDALENA D. (+)
BALDAGO, BERNADETTE T. (+)
BERAYA, CHRISTOPHER R. ? ?
DE LEON, SHEEN ANN (-) (-)
DENOLAN, GWENDOLINE G. (-) (-)
DOCE, JOANNE (+) (-)
DURAN, APRILYN (-) (-)
FELICES, DARWIN O. (+) (+)
FELIPE, PATRICIA (+) (-)
GARCIA, MA. MACRINA MERICI S. (+) (-)
GUZMAN, ARLENE B (+) (-)
GUZMAN, ARLENE JOY M. (+) (-)
LABORDO, GENEVIEVE A. (+) (+)
LACUNA, RIZALYN A. - NIII (-) (-)
LANDICHO, GENAR T. – NIII (+) (-)
LIM, MABIN (+) (+)
MACABABBAD , KATHRINA BIANCA (+) (-)

16. Name (+) exposure to
Varicella Zoster
(+) Vaccine
BUHAT, NENITA A. (+) (-)
CANALEZA, ELISA MILBA A. (+) (-)
CLEOFE, AURELIA E. (+) (-)
CORPUZ, THELMA C.
DELOS SANTOS, ROSALINDA T. (-) (-)
EUSEBIO, CATHERINE E. (+) (+)
GAMENG, MYRNA V.
IBANEZ, LANIE A. NAI (+) (-)
ILAO, MA. CRISTINA (+) (-)
MANIO, LUCILA ? ?
METRAN, MARIA THERESA (+) (-)
NAVARRO, RACHELLEMAR (+) (+)
OPULENCIA, JULNETTE A. (+) (-)
NURSING ATTENDANTS

17. • 2 days before onset of rash until
lesions have crusted.
Period of
Communicability
•10-21 days after exposure
• Post Exposure VZIG: 28 days
Incubation Period
• Contact with vesicles
• 3-6 feet close proximity in a room
for >/ 1 hour
Exposure
Definition

18. Hospital Acquired
Sharing of
2-4 bed
hospital
room
Prolonged
direct face
to face
contact

19. IMMUNE
 Varicella by history
Serologic immunity
(97-99%)
 Negative or Uncertain
Serologic immunity
(71-93%)
NON - IMMUNE
 No reliable history of
Varicella -
Seronegative

20.  4.Formulate a working hypothesis-based on
the preliminary analysis, a hypothesis is
prepared. One may attempt to identify the
risk population and find the level of exposure
and to contrast the exposed and not
exposed.
 With additional findings , analysis all cases
will be done and prepare an interpretation of
the event. If the hypothesis is supported, it is
confirmed in the report.

21.  5. Test the hypothesis
 6. Add data on all additional cases
 7. As soon as etiology is established. Any
pertinent control measures should now be
activated

22. VARICELLA (CHICKEN POX) AND VARICELLA ZOSTER (SHINGLES)
Source Case
VZV Infection (Chicken Pox)
Exclude from work until lesions have crusted
Exclude from work: 10-28 days post-exposure
Post exposure Prophylaxis
1. ACYCLOVIR: 20-40 mg/kg q day x 7 days
2. VARICELLA VACCINE: (0.5 mL 5Q x 2 doses, last dose after
4 weeks
No Further Intervention
No Further Intervention
Patient
HCW
Confirm Diagnosis History and PE
Immunity
Status
1. Early Discharge
2. Source Isolation
Airborne and Contact
Precautions
3. Immune Personnel
Immune
Negative
Non-Immune
Prior History of Chicken Pox
PositiveSerologic
Test

23. Immunization
99%
seropositive
after 2nd dose
Routine testing not
necessary
Serologic Test:
ELISA IgG

24. VARICELLA (CHICKEN POX) AND VARICELLA ZOSTER (SHINGLES)
Source Case
VZV Infection (Chicken Pox)
Exclude from work until lesions have crusted
Exclude from work: 10-28 days post-exposure
Post exposure Prophylaxis
1. ACYCLOVIR: 20-40 mg/kg q day x 7 days
2. VARICELLA VACCINE: (0.5 mL 5Q x 2 doses, last dose after
4 weeks
No Further Intervention
No Further Intervention
Patient
HCW
Confirm Diagnosis History and PE
Immunity
Status
1. Early Discharge
2. Source Isolation
Airborne and Contact
Precautions
3. Immune Personnel
Immune
Negative
Non-Immune
Prior History of Chicken Pox
PositiveSerologic
Test

25. Source Isolation
Airborne precautions
Contact precautions

26. Vaccination
Two 0.5 ml doses SQ
4-8 weeks apart
Within 3-5 days of exposure

27. Work Restrictions
Post Exposure:
exclude from
duty
a. 10-21 days
after exposure
b. 10-28 days
of VZIG given
Vaccinated
Exposed: serotest
for antibody
If negative;
exclude form duty
or monitor for
symptoms
Infected
Exclude unti lesions
have crusted

28. VARICELLA (CHICKEN POX) AND VARICELLA ZOSTER (SHINGLES)
Source Case
VZV Infection (Chicken Pox)
Exclude from work until lesions have crusted
Exclude from work: 10-28 days post-exposure
Post exposure Prophylaxis
1. ACYCLOVIR: 20-40 mg/kg q day x 7 days
2. VARICELLA VACCINE: (0.5 mL 5Q x 2 doses, last dose after
4 weeks
No Further Intervention
No Further Intervention
Patient
HCW
Confirm Diagnosis History and PE
Immunity
Status
1. Early Discharge
2. Source Isolation
Airborne and Contact
Precautions
3. Immune Personnel
Immune
Negative
Non-Immune
Prior History of Chicken Pox
PositiveSerologic
Test

29.  8. Recommend control programs- directed at
three links in the chain of infection.
◦ * modifying the environmental reservoirs- active
surveillance can be done for proper management
and work restriction. Inanimate environment can be
altered by following IPC protocols
◦ *Interrupting transmission-should include
behavioral changes… hand hygiene, personal
hygiene, use of PPE
◦ * Protecting the host-active immunization
◦ * Antibiotic Prophylaxis

30. * Other action taken- contact tracing of all who
are possibly exposed , other patients and
watchers, and possibly the community
9.Announce result and prepare written report
10. Continue surveillance and documentation

31.  Investigation of an epidemic requires a
prioritized and systematic approach to
gathering and analysis of data with careful
attention to detail at each step of the way
 It must be recognized that “cook book”
approach is not always to all epidemics
 Investigative steps may be carried out
concurrently instead of sequence.
 Epidemic investigation is being conducted
with the ultimate aim of solving the problem

32.  Thank you