Cholera Outbreak Guidelines: Preparedness, prevention and control | Cholera

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This practical field guide brings together lessons learned from Oxfam’s past interventions in the prevention and control of cholera, and other related guidance. The aim is to provide a quick, step-by-step guide to inform cholera outbreak interventions and ensure public health programmes that are rapid, community-based, well-tailored, and gender and diversity aware. They will enable both public health teams and programme managers to undertake necessary preparations to prevent cholera outbreaks from occurring and to respond effectively when they have occurred. They have been specifically designed to fit the cholera outbreak curve, depicting key activities in each critical phase before, during and after an outbreak. They can also be adapted to suit other water- and sanitation-related outbreaks, such as Typhoid, Hepatitis E, and dysentery, as well as other WASH-related diarrhoeal outbreaks. This is a pilot publication, and the team are looking for comments and suggestions on both the content and structure of the manual. Please send any feedback to policyandpractice@oxfam.org.uk, with Cholera guidelines in the subject line.
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  CHOLERA OUTBREAK GUIDELINES PREPAREDNESS, PREVENTION AND CONTROL Elizabeth Lamond and Jesee Kinyanjui June 2012  Table of Contents P REFACE  ......................................................................................................................... 4   A CKNOWLEDGEMENTS  ...................................................................................................... 4   A BBREVIATIONS  ............................................................................................................... 5   1.   I NTRODUCTION  .............................................................................................................. 6   1.1 Overview ............................................................................................................... 6   1.2 About cholera and its transmission routes ............................................................. 6   1.3 Risk factors ............................................................................................................ 7   2.   N ON - ENDEMIC COUNTRY ( NEW )  OUTBREAKS ................................................................. 10   2.1 Responding to non-endemic outbreaks ............................................................... 10   3.   P RE - OUTBREAK PHASE  ............................................................................................... 12   3.1 Cholera preparedness and action plans (endemic countries) .............................. 12   3.2 Key components of a good cholera preparedness plan ....................................... 12   4.   T RANSITION FROM PREPAREDNESS TO FOCUSED INTERVENTION  .................................... 18   4.1 Triggers to signal the start of a cholera outbreak ................................................. 18   4.2 Initial assessment and investigation of an outbreak ............................................. 19   4.3 Making quick sense out of initial data .................................................................. 20   5.   I NTERVENTION  ............................................................................................................ 22   5.1 Identifying high-risk areas .................................................................................... 22   5.2 Reducing the epidemic spread ............................................................................ 23   5.3 Improving water quantity and quality .................................................................... 24   5.4 Cholera-focused community hygiene education .................................................. 26   5.5 Sanitation ............................................................................................................ 29   5.6 Burial of the dead ................................................................................................ 30   5.7 Activities in marketplaces and other communal gathering places ........................ 30   6.   C OMMUNITY ENGAGEMENT  .......................................................................................... 32   6.1 Getting your message across .............................................................................. 32   7.   M ONITORING  ............................................................................................................... 34   7.1 Monitoring programme activities .......................................................................... 34   7.2 Monitoring framework .......................................................................................... 34   8.   C O - ORDINATION  .......................................................................................................... 36   8.1 National and field co-ordination committees ........................................................ 36   9.   P ROGRAMME EXIT  ....................................................................................................... 38   9.1 Linking cholera response with country programming ........................................... 38   9.2 Developing cholera preparedness plans for future cholera outbreaks .................. 38   9.3 Improving local capacity to manage public health activities ................................. 39   9.4 Encouraging line ministries to improve water and sanitation ................................ 39   10.   R ESOURCES  ............................................................................................................. 40   Resource 10.1: Sample cholera response team staffing ............................................ 40   Resource 10.2: Examples of job descriptions for cholera public health staff .............. 42   Resource 10.3: Example of cholera strategy  –  Haiti, December 2010 ....................... 46   Resource 10.4: Costing and quantities of blanket cholera prevention kits .................. 51   Resource 10.5: Map showing the world‟s cholera -endemic countries ........................ 52   Resource 10.6: Cholera outbreak checklist for Programme Managers ...................... 53   Resource 10.7: Example of Oxfam GB cholera preparedness action plan ................. 55   Resource 10.8: Example materials for community education and engagement ......... 58   Resource 10.9: Oxfam GB WASH support kit for CTCs and ORPs ........................... 69   Resource 10.10: Guidelines for CTC hygiene, sanitation and isolation ...................... 71   Resource 10.11: Guidelines for setting up ORPs ....................................................... 76   Resource 10.12: Guidelines on bucket chlorination ................................................... 79   Resource 10.13: Treating high turbidity water............................................................ 81   Resource 10.14: Instructions for managing diarrhoea using ORS.............................. 82     3   Resource 10.15: Management of diarrhoea with homemade SSS ............................. 84   Resource 10.16: Example cholera prevention and control log frame  –  Somaliland .... 85   Resource 10.17: Field level cholera-specific monitoring forms .................................. 90   Resource 10.18: Surveys and ranking tables for water facility sanitary survey .......... 97   Resource 10.19: Example of data summarization and mapping .............................. 101   R EFERENCES  ............................................................................................................... 104   List of figures Figure 1: Example cholera curve depicting key programme focus ................................... 9   Figure 2: Example organogram from Cap Haitien, Haiti, 2010 ....................................... 40   Figure 3: A simple layout of a small health centre ......................................................... 75   Figure 4: Example weekly household chlorine levels for Sector 1B ............................. 102   Figure 5: Cholera cases by gender in International Rescue Committee refugee camp, Kiryandongo, Uganda .................................................................................................. 103   List of boxes Box 1: How cholera is transmitted through the faecal-oral route ...................................... 7   Box 2: Key points about cholera ...................................................................................... 8   Box 3: Cholera prevention kit contents .......................................................................... 14   Box 4: Definitions of cholera cases currently used in the field ....................................... 18   Box 5: Epidemic patterns............................................................................................... 21   Box 6: Importance of continued cholera prevention kit distribution  –  Haiti, 2010 ............ 23   Box 7: Hygiene messages about chlorination ................................................................ 25   Box 8: Example of community hygiene education in the Oromia region, Ethiopia .......... 26   Box 9: Four key hygiene messages for communities ..................................................... 28   Box 10: Two supplementary hygiene messages ............................................................ 29   Box 11: Preventing transmission at funerals .................................................................. 31   Box 12: Using schools to convey cholera messages in Oromia region, Ethiopia ........... 33   Box 13: Terms of reference  –  Cholera Response Team PHE/PHP Coordinator ............ 42   Box 14: Terms of reference  –  Cholera PHE Team Leader ............................................. 43   Box 15: Terms of Reference  –  Cholera PHP Team Leader ........................................... 44   Box 16: Oral rehydration points (ORPs) ........................................................................ 70   List of forms Form 1: Mini cholera survey for knowledge, attitude and practice baseline data ............ 90   Form 2: Monthly PHP household monitoring ................................................................. 92   Form 3: Post distribution of cholera prevention kits and water chlorination  –  household monitoring ..................................................................................................................... 94   Form 4: Latrine usage  –  Household level ...................................................................... 95   Form 5: Free residual chlorine monitoring form ............................................................. 96   Form 6: Sanitary survey form for open wells.................................................................. 97   Form 7: Sanitary survey form for boreholes with storage tank, pipe network and tap-stand ............................................................................................................................. 99      Preface These guidelines were srcinally developed by Oxfam GB as an internal resource. We are now sharing with external audiences as a pilot publication, and are inviting feedback from users to inform later drafts. Please send any comments, corrections, or suggestions on content, structure or style to: policyandpractice@oxfam.org.uk.  Acknowledgements These cholera guidelines would not have been possible without the support of the humanitarian department (HD). The authors are greatly indebted to Marion O'Reilly,  Andy Bastable and Foyeke Tolani for their support throughout this project. They also would like to acknowledge the valuable contributions from all the other public health advisors in HD, Prof. Sandy Cairncross from the London School of Hygiene and Tropical Medicine, and Sarah House. Thanks also to Suzanne Ferron and Abigail Laing for editing the text, and to Anna Coryndon, Tom Fuller, and Claire Harvey for managing production and publication.  All the examples used in the guidelines are borrowed from Oxfam‟s cholera response programmes in Ethiopia, Sudan, Somalia, Haiti, Zimbabwe and the Democratic Republic of Congo. The authors are indebted to all the teams that worked on these programmes for documenting their experiences and sharing them for use in these guidelines. Cover photo © Foyeke Tolani/Oxfam
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