technical scheme for emergency treatment of cholera epidemic situation
1 Preface
Cholera is an acute intestinal infectious disease caused by Vibrio cholerae O1 serogroup and O139 serogroup. It is a Class A infectious disease which is characterized by acute onset, rapid spread and wide spread, and can cause a pandemic, and it is also one of the international quarantine infectious diseases. The shortest incubation period of cholera is 3 ~ 6 hours, and the longest is several days, usually 1.2 ~ 72 hours. The main clinical manifestations are severe diarrhea (watery, yellow watery, rice swill-like or blood-like stool), accompanied by vomiting, rapid severe dehydration, circulatory failure and muscle spasm (especially gastrocnemius).
Jiangsu province is an old epidemic area of cholera, and the seventh world epidemic of cholera, which started in 1961, spread to our province in 1962. For more than 41 years, the epidemic situation has fluctuated from time to time. In the late 1971s and early 1981s, there was a high-intensity epidemic in which the incidence of Chinese New Year was over 1/111,111, and it has been repeated since 1991s. The epidemic type has also changed several times, with Ogawa 1a in the early 1961s, Ogawa 1b in the late 1971s, and rice leaf 1d in the early 1981s causing a high-intensity epidemic.
in recent years, the cholera epidemic situation in our city is still active, and the cholera epidemic situation in other surrounding areas may spread to our city, so there are potential factors causing the cholera epidemic in our county. In order to discover the cholera epidemic situation in our county in time, take effective control strategies and measures quickly, safeguard people's health and life safety, maintain social stability and promote economic development, this technical scheme is formulated according to the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases, the Emergency Regulations for Public Health Emergencies and the Emergency Plan for Public Health Emergencies in Jiangsu Province.
2 departmental responsibilities
the county government and the county health bureau have earnestly strengthened the organization and leadership of cholera prevention and control, and the relevant medical institutions, disease control institutions, health supervision institutions and other relevant departments have earnestly studied and deployed with a pragmatic work style, and strived to implement various prevention and control measures.
2.1 governments at all levels should organize relevant departments to provide necessary funds and materials for cholera emergency response, and urge health departments and relevant departments to implement various prevention and control measures.
2.2 county health bureau should organize and coordinate the investigation and treatment of epidemic situation and medical treatment, positively guide publicity and strengthen communication and cooperation with other departments.
2.3 disease prevention and control institutions should collect information for cholera epidemic monitoring; Carry out the verification, investigation and handling of epidemic situation of infectious diseases, and report the epidemic situation, and implement specific control measures; Carry out publicity and education related to cholera prevention and health promotion activities.
2.4 medical institutions are responsible for the medical rescue and on-site treatment of cholera patients or suspected patients and carriers, and carry out corresponding management as required, and assist disease prevention and control institutions to carry out epidemiological investigations and collect relevant specimens. Find the epidemic situation in time and report it in time; Carry out health education and popularize knowledge of health and disease prevention.
2.5 health supervision institutions should supervise and inspect the implementation of epidemic reports of infectious diseases, medical treatment and prevention and control measures of medical institutions and disease prevention and control institutions, and investigate and deal with illegal acts; To supervise and inspect drinking water and food hygiene within the jurisdiction according to law, and investigate and deal with illegal acts; Actively carry out publicity and education on health laws and regulations.
3 Related definitions and diagnostic basis
3.1 Terminology and definitions
(1) Diarrhea: refers to a clinical symptom of defecation for three or more times in 1 days and changes in fecal characteristics.
(2) Cholera refers to an acute intestinal infectious disease caused by infection with Vibrio cholerae O1 or/and O139, which causes diarrhea and other symptoms.
(3) Outbreak: Cholera outbreak refers to the sudden emergence of more cholera cases in a short period of time (generally referring to the longest incubation period of cholera) among a certain population in a certain area, and its incidence rate exceeds the average incidence level in general epidemic years.
3.2 Diagnostic criteria
3.2.1 Carrier: Vibrio cholerae O1 or/and O139 were isolated from feces, vomit or anal swab.
3.1.2 Suspected case: one of the following three items.
(1) Cases with typical clinical symptoms, such as severe diarrhea, watery stool (yellow water sample, clear water sample, rice swill sample or blood sample), accompanied by vomiting, rapid dehydration or severe dehydration, circulatory failure and muscle spasm (especially gastrocnemius muscle).
(112) People who had close contact with cholera patients or carriers during the cholera epidemic and had diarrhea and vomiting symptoms.
(3) Cases with painless diarrhea or vomiting, and positive for rapid auxiliary diagnostic test of Vibrio cholerae in feces or vomit.
3.1.3 clinically diagnosed cases: anyone with one of the following three items can be regarded as a clinically diagnosed case.
(1) Vibrio cholerae O1 and/or O139 were detected in the daily necessities or home environment of the suspected case;
(2) The samples of feces, vomit or anal swab of suspected cases were positive for Vibrio cholerae toxin gene PCR;
(3) Those who have a history of direct exposure and have painless diarrhea or vomiting symptoms in the same incubation period in a confirmed cholera outbreak.
3.1.4 Laboratory confirmed cases
(1) Anyone who has diarrhea symptoms and is positive for Vibrio cholerae O1 or/and O139 in stool, vomit or anal swab samples.
(2) In the search of epidemic focus, those who have diarrhea symptoms within 5 days before and after detection of Vibrio cholerae O1 or/and O139 in stool or anal swab samples
.
4 emergency preparedness
4.1 Formulate emergency technical scheme and relevant operating procedures
According to the general requirements of cholera prevention and control, combined with the local historical epidemic situation and laws, scientifically analyze the annual epidemic trend; Formulate technical plans for emergency response and relevant operating procedures.
4.2 professional training and emergency drills
before the high-incidence season and during the epidemic period, special training will be given to the managers, epidemic prevention personnel, inspection personnel and clinical medical staff of all medical and health units, so as to strengthen the awareness of early detection, early reporting and early isolation of cholera cases, carry out training in epidemiology, clinic, etiology and laboratory diagnosis techniques, and popularize new methods and technologies for effectively controlling the epidemic situation. Implement the technical preparations for epidemic control, and organize emergency drills according to the situation.
4.3 preparation of medical instruments
according to the actual needs of epidemic prediction and prevention, all localities should purchase sufficient investigation materials and disinfection drugs, and equip them with necessary rescue and treatment drugs, including drinking water disinfection drugs, sewage and excrement disinfection drugs, rapid fly and maggot killing drugs, necessary rescue and treatment drugs, instruments and beds.
(1) supplies for investigation and data analysis: cholera case questionnaire and other relevant forms and notebooks.
(2) Supplies for specimen collection and on-site detection: specimen collection record, swab for specimen collection (note that the swab for PCR detection specimen collection should use sterilized man-made fiber swab and plastic rod), straw, plastic tube with lid that can be sealed, self-sealing plastic bag, label paper, ink-resistant recording pen, sealed test tube with conveying medium, empty Petri dish and Petri dish with selective medium (including strong and weak).
(3) Drugs and instruments used for field disinfection: ① Common disinfectants: including bleaching powder, bleaching tablets, sodium hypochlorite, peracetic acid, iodophor, glutaraldehyde and ethylene oxide; (2) Equipment: including sprayer, graduated measuring cup, disinfection box for medicine, etc.
(4) On-site protective articles: protective articles for on-site work (epidemiological investigation, sample collection, disinfection and disinfestation), including disposable gloves, long rubber gloves, boots and work clothes.
(5) Preventive drugs: ciprofloxacin, norfloxacin, etc.
4.4 Management of Infectious Diseases Department (intestinal outpatient service)
All medical institutions should open intestinal outpatient service on time according to relevant requirements, and pay attention to the relative independence and reasonable setting of outpatient service to avoid cross-contamination; And equipped with trained and qualified professional (part-time) medical staff.
hospitals should work out relevant procedures for isolating or transferring cholera patients after they are found. Hospitals that can treat cholera patients in our hospital if conditions permit should work out working procedures on how to change the use of wards and establish isolation wards (wards) once cholera patients are found, and organize inspection and implementation before the cholera high-incidence season to make good preparations.
at the initial stage of the start-up of intestinal outpatient service every year, the self-examination of all units and the inspection and supervision of higher health administrative departments are carried out throughout the county to improve and perfect the start-up of intestinal outpatient service.
4.5 Health knowledge publicity
During the epidemic season of intestinal diseases, we regularly or irregularly publicize the prevention and treatment methods of intestinal diseases to the masses through media, posters and other means.
4.6 technical reserve
Strengthen personnel training and the establishment of relevant detection technologies, so as to make sufficient technical reserve for timely and effective response to cholera outbreaks.
5 emergency investigation and disposal
5.1 organization and leadership
According to the actual needs of emergency handling of epidemic situation and the level of events, the county health bureau proposed to the people's government at the same level the establishment of corresponding emergency command organization. The emergency command organization shall promptly organize the on-site investigation team to arrive at the scene. The on-site investigation team generally includes professionals in epidemiology, laboratory and clinical medicine, food hygiene, environmental hygiene, etc. The on-site investigation team should set up a person in charge to organize and coordinate the whole on-site investigation work, and the members of the investigation team should clarify their respective responsibilities.
5.2 epidemic situation report
According to the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases and the Administrative Measures on the Reporting of Public Health Emergencies and Infectious Disease Epidemic Situation Monitoring Information, the medical staff of each medical institution will report to the local CDC in the fastest way within 2 hours after finding the carrier, suspected, clinically diagnosed or confirmed cholera case, and make a direct report on the Internet; Those who do not have the conditions for direct network reporting should send (send) the "Infectious Disease Report Card of the People's Republic of China * * * and China" to the corresponding units by the fastest communication mode within 2 hours after diagnosis. The confirmed cases must be confirmed and reported by the Center for Disease Control and Prevention. When there are 1 or more confirmed cases of cholera, they should be reported according to the requirements of the relevant epidemic situation report and the "National Standards for the Management of Information Reporting on Public Health Emergencies (Trial)".
after receiving the cholera case report within its jurisdiction, the county CDC should immediately organize relevant personnel to investigate, verify and deal with it while reporting to the health administrative department at the same level and the disease prevention and control center at a higher level in the fastest way. After the case is confirmed, it should fill in the basic information within 6 hours and report it to the relevant departments in time by fax. At the same time, according to the changes of laboratory test results, epidemiological investigation results and epidemic dynamics, the cholera monitoring information reporting management system was filled in, updated and revised in time. The epidemiological case questionnaire of all cases shall be reported to the relevant departments within 5 days after the end of the epidemic.
5.3 Emergency Response
According to the Emergency Plan for Public Health Emergencies in Jiangsu Province, the National Regulations on Management of Information Reports on Public Health Emergencies (Trial) and other regulations, according to the development degree and danger of cholera epidemic, the cholera epidemic was classified with reference to the classification standard for public health emergencies. The people's governments at the county level, city (prefecture) level and provincial level and their relevant departments shall make corresponding emergency response according to the principle of graded response.
According to the objective law of the occurrence and development of cholera epidemic, combined with the actual situation and the needs of prevention and control work, the early warning and response levels should be adjusted in time to effectively control the incident and reduce the harm and impact.
5.4 field investigation
5.4.1 verification diagnosis
the purpose of verification diagnosis is to eliminate the misdiagnosis of medical staff and the errors in laboratory tests. The basic information of patients, including age, sex, address, occupation and onset date, as well as symptoms, signs, laboratory test data and risk factors such as suspicious water, food and contact history of patients with the same kind, are collected by reviewing cases, interviewing patients and people who can provide detailed information about patients' life before onset, and consulting experts. Analyze the accuracy of clinical sampling, and repeat sampling for testing if necessary. According to the clinical manifestations, laboratory examination and epidemiological data of the case, make a comprehensive analysis and make a judgment.
5.4.2 epidemiological investigation
objective of epidemiological investigation: to master the epidemic law of cholera outbreak, find out the source of infection, transmission route and epidemic scope, clarify the epidemic factors, and provide scientific basis for making the outbreak control plan in time.
Carry out case investigation to understand the causes of the patients and the current situation of the epidemic focus, and accumulate data as the basis of local epidemiological analysis. For epidemic spots and epidemic areas, pathogen retrieval (including contacts, water sources and suspicious food, etc.) should be carried out in a planned and purposeful manner in time. Carry out outbreak investigation in the whole area (unit) where the case occurred and related areas to determine the scale of the outbreak and find out the reasons. Quickly find out the time distribution, regional distribution and population distribution of the disease, and determine the possible sources of infection and transmission routes. When the existing clinical and epidemiological data are difficult to determine the source and route of infection, it is necessary to put forward assumptions and carry out special investigations; Through comprehensive methods such as case-control study and laboratory detection, the hypothesis was verified and the source, route and epidemic factors of infection were determined.
5.4.3 sample collection, transportation and laboratory testing
(1) sample collection
laboratory testing should be closely combined with epidemiological investigation, and patients, suspected patients and close contacts should be sampled at the same time as case investigation is carried out. The collected specimens include feces, vomit, anal swab, etc. In the case of working ability, samples should be collected from each case to isolate Vibrio cholerae. It is best to collect isolated specimens of pathogens before using antibiotics; When necessary, samples can also be collected from patients, suspected patients and close contacts after using antibiotics for testing.
For suspicious foods, water bodies, etc. that patients come into contact with, the samples should be collected in a standardized way for pathogen separation. For the outbreak caused by dinner, in addition to collecting suspicious food samples, food cleaning water sources should also be sampled and tested. If it is suspected or confirmed by pathogen isolation that the source of infection is commercially available food or raw materials, sampling and testing shall be conducted for the food related to the market.
when collecting specimens, the specimen inspection sheet should be filled in in detail. The specimen submission form of patients or suspected patients should include specimen number, name, address, onset time, clinical diagnosis, specimen type, sampling location (fill in the name of hospital and ward when hospitalized), sampling time, etc. The submission form of healthy specimens should include the specimen number, name, address, whether it is a close contact of the patient (if yes, the patient's name, onset date and hospital name should be recorded at the same time), whether there is a history of catering, specimen type, sampling place and sampling time, etc. The inspection list of food or environmental specimens shall include the specimen number, specimen name, sampling location, sampling time, etc. Specimen tube (box) appearance should be clearly marked, and the mark should be waterproof and not easy to erase.
(2) transportation of specimens
The collected specimens should be immediately treated and inoculated with culture medium for enrichment and/or culture. Specimens that cannot be detected immediately should be placed in a preservation medium (alkaline peptone