Public Health and Preventive Medicine
Articles Information
Public Health and Preventive Medicine, Vol.3, No.4, Aug. 2017, Pub. Date: Oct. 30, 2017
Response to Outbreak at Densely Populated Settings, Identifying Fragilities and Closing Gaps
Pages: 22-26 Views: 892 Downloads: 197
[01] Hamid Y. Hussein, Health Affairs Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, UAE.
[02] Waleed Al Faisal, Health Affairs Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, UAE.
Scientific response to an infectious diseases outbreak is recognized as a key strategic element of successful containment of health threats. This study aims to identify key gaps in infectious disease outbreaks response, and to identify strategies to promote interactions between research and practitioner communities to begin to address these gaps. A major and long term chickenpox outbreak took place at one of the private primary school classes in Dubai for the period of 7th 2016 December to 1st of march 2017, a total number of 37 chickenpox cases where identified of different age, gender, national and immunization status background. The study revealed that the outbreak started at first with two cases of chickenpox. As outbreak origin appeared on seventh of December 2016, it was followed by other sporadic or multiple cases on different dates. The outbreak epidemic cure took the shape of propagated epidemic curve, which kept hick ting up and down but never declines to the zero index. Until 20 February, the investigation showed that 17 cases of the chickenpox outbreak occurred at age of 6 years, 13 cases at age of 7, and 5 cases at age of 8. This reflects the fact that the younger age group is more susceptible. The study results reflected that 70% of the outbreak population were male and 30% were females. As per nationalities, the outbreak distributed more among Arab nationalities from expatriates in Dubai (86.5%, followed by 8.1% non-Arab expatriates and only 5.4% among UAE Citizens). Despite routine and supplementary case investigation activities, Public Health team could not confirm any epidemiologic links between outbreak cases. The gaps in case detection and investigation revealed by this unusual outbreak can inform future outbreak response activities. Identifying and closing gaps in outbreak investigation and response is kept as an important opportunity to improve case outcomes and stopping further damages. The resources for any additional activities need to be weighed against what is already required to meet the current chickenpox outbreak investigation standards. There is a need to improve the ability and accurate description of the epidemiology of major and long term chickenpox outbreak among confirmed cases.
Outbreak, Gaps, Epidemiological Exercise
[01] Ministry of Health and Long-Term Care. Infectious diseases protocol. Appendix A: disease-specific chapters. Chapter: Measles. Toronto (ON): The Ministry [revised 2014 Aug]. oph_standards/docs/measles_chapter.pdf.
[02] Batagelj V, Mrvar A. Pajek - program for large network analysis. 2000.
[03] Public Health Agency of Canada. Elimination of measles, rubella and congenital rubella syndrome in Canada: documentation and verification report. Ottawa (ON): Public Health Agency of Canada [Last modified April 4, 2013].
[04] De Serres G, Boulianne N, Defay F, Brousseau N, Benoît M, Lacoursière S, et al. Higher risk of measles when the first dose of a 2-dose schedule of measles vaccine is given at 12-14 months versus 15 months of age. Clin Infect Dis 2012;55(3):394-402.
[05] Glass K, Grenfell BT. Waning immunity and subclinical measles infections in England. Vaccine 2004;22(29-30):4110- 6.
[06] Wilson SE, Fediurek J, Seo CY, Deeks SL, Lim GH. Immunization coverage report for school pupils: 2012-13 school year. Toronto (ON): Public Health Ontario; 2014. Immunization_coverage_report_2012-13.pdf.
[07] Gournis E, Shane A, Shane E, Arthur A, Berger L. Exploring gaps in surveillance of a small measles outbreak in Toronto, Canada, Gournis E, Shane A, Shane E, Arthur A, Berger L. Exploring gaps in surveillance of a small measles outbreak in Toronto, Canada. Can Comm Dis Rep 2016;42:146-8.
[08] Haley RW, Quade D, Freeman HE, Bennett JV. The SENIC Project. Study on the efficacy of nosocomial infection control (SENIC Project). Summary of study design. Am J Epidemiol 1980; 111(5): 472-485.
[09] O’Boyle C, Jackson M, Henly SJ. Staffing requirements for infection control programs in US health care facilities: Delphi project. Am J Infect Control 2002; 30(6): 321-333.
[10] Scheckler WE, Brimhall D, Buck AS, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 1998; 19(2): 114-124. http://dx.doi. org/10.1086/647779
[11] Stricof RL, Schabses KA, Tserenpuntsag B. Infection control resources in New York State hospitals, 2007. Am J Infect Control 2008; 36(10): 702-705. ajic.2008.01.011
[12] Stone PW, Dick A, Pogorzelska M, Horan TC, Furuya EY, Larson E. Staffing and structure of infection prevention and control programs. Am J Infect Control 2009; 37(5): 351-357.
[13] Nguyen GT, Proctor SE, Sinkowitz-Cochran RL, Garrett DO, Jarvis WR. Status of infection surveillance and control programs in the United States, 1992-1996. Am J Infect Control 2000; 28(6): 392-400.
[14] Meyer PA, SewardJF, Jumaan. Varicella mortality: trends before vaccine licensure in the United States, 1970–1994, J Infect Dis, 2000, vol. 182 (pg. 383 -90)
[15] GalilK, Brown C, Lin F, Seward J. Hospitalizations for varicella in the United States, 1988 to 1999, Pediatr Infect Dis J, 2002, vol. 21 (pg. 931 -5)
[16] Davis MM, Patel MS, Gebremariam A. Decline in varicella-related hospitalizations and expenditures for children and adults after introduction of varicella vaccine in the United States Pediatrics, 2004, vol. 114 (pg. 786-92)
[17] Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality due to varicella after implementation of varicella vaccination in the United States, N Engl J Med, 2005, vol. 352 (pg. 450 -8)
[18] Centers for Disease Control and Prevention Evaluation of varicella reporting to the National Notifiable Disease Surveillance System—United States, 1972–1997, MMWR Morb Mortal Wkly Rep, 1999, vol. 48 (pg. 55 -8)
[19] Seward J, Watson B, Peterson C. Varicella disease after introduction of varicella vaccine in the United States, 1995–2000, JAMA, 2002, vol. 287 (pg. 606 -11 )
[20] Zhou F, Harpaz R, Jumaan AO, Winston CA, Shefer A. Impact of varicella vaccination on health care utilization, JAMA, 2005, vol. 294 (pg. 797 -802)
[21] Council of State and Territorial Epidemiologists (CSTE) Inclusion of varicella-related deaths in the National Public Health Surveillance System (NPHSS) [position statement 1998-ID-10], 1998 Atlanta CSTE Available at: Accessed 15 November 2006
[22] Centers for Disease Control and Prevention Notice to readers: changes in National Notifiable Diseases List and data presentation, MMWR Morb Mortal Wkly Rep, 2003, vol. 52 pg. 9 Available at:
[23] Council of State and Territorial Epidemiologists (CSTE) Varicella surveillance [position statement 02-ID-06], 2002 Atlanta CSTE Available at: Accessed 15 November 2006
[24] Parker AA, Reynolds MA, Leung J, et al.. Challenges to implementing second-dose varicella vaccination during an outbreak in the absence of a routine 2-dose vaccination requirement—Maine, 2006, J Infect Dis, 2008, vol. 197 Suppl 2 pg. S101 -7 ) (in this supplement) Google Scholar CrossRef Search ADS PubMed
[25] Civen R, Maupin T, Xiao H, Jumaan A, Mascola L. Trends in varicella outbreaks in active surveillance site: Antelope Valley, California 1995–2003 [abstract 997], Program and abstracts of the 42nd annual meeting of the Infectious Diseases Society of America (Boston), 2004 Arlington, VA Infectious Diseases Society of America pg. 222
[26] Marin M, Guris D, Chaves SS, Schmid S, Seward JF. Prevention of varicella: ecommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2007, vol. 56 (pg. 1-40) (RR-4)
[27] Centers for Disease Control and Prevention (CDC) National immunization survey (NIS), 2005 Atlanta CDC Available at: Accessed 27 November 2007
[28] Centers for Disease Control and Prevention Outbreak of varicella among vaccinated children—Michigan, 2003, MMWR Morb Mortal Wkly Rep, 2004, vol. 53 (pg. 389-92)
MA 02210, USA
AIS is an academia-oriented and non-commercial institute aiming at providing users with a way to quickly and easily get the academic and scientific information.
Copyright © 2014 - American Institute of Science except certain content provided by third parties.