Disease Containment

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Disease Containment

• An Introduction to the Community Containment for
  Disease Tool Box

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Disease Containment Primer

• Discussion of disease containment strategies
• Introduction to the Kansas Community Containment
  Isolation/Quarantine Tool Box
• Identification of steps necessary to prepare for
  an event involving multiple or community oriented
  strategies
• Opportunity to ask questions prior to the start
  of the exercise

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What is Disease Containment?
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Dictionary.com defines Containment

• the act or condition of containing.
• an act or policy of restricting the territorial
  growth or ideological influence of another, esp.
  a hostile nation.
• (in a nuclear power plant) an enclosure
  completely surrounding a nuclear reactor,
  designed to prevent the release of radioactive
  material in the event of an accident.

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Disease Containment Strategies

• Strategies implemented to stop or slow
  (contain...) the spread of a contagious disease
  in a community
• Websters alteration an act of restricting the
  growth of a hostile disease
• Can you name some examples?

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Disease Containment Strategies

• There are two general areas of containment
  strategies
• Measures targeted at individuals
• Measures targeted towards groups or the entire
  community

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Disease Containment Strategies

• Measures targeted at individuals include
• Isolation of symptomatic persons
• Quarantine of exposed persons
• Management of Contacts
• These measures are the most commonly used (small
  or limited outbreaks)

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Individual Containment Strategies
We usually think of

• Quarantine involves a situation where a group
  of persons is reasonably believed to have been
  exposed to a dangerous communicable disease and
  is kept apart from others to prevent disease
  transmission.
• Isolation is used when a person who is
  reasonably believed to have contracted a
  dangerous communicable disease is kept separate
  from others to prevent disease transmission.

p. 24 of 71
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Management of Contacts Challenge!
Household Contacts
Hospital
Incidental Contacts
Potential Contacts
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Individual Interventions

• Passive Monitoring
• Contact is asked to perform self-assessment
  periodically and to contact authorities
  immediately if symptoms occur.
• Active Monitoring without explicit activity
  restrictions
• A healthcare or public health worker evaluates
  the contact on a regular (at least daily) basis
  by phone and/or in person for signs and symptoms

p. 15 of 71
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Individual Interventions

• Active monitoring with Activity Restrictions
  (quarantine)
• The contact remains separated from others for a
  specified period, during which she is assessed on
  a regular basis (in person at least once daily)
  for signs and symptoms of disease. Persons with
  disease specific symptoms will require immediate
  evaluation by a trained healthcare provider.
  Restrictions may be voluntary or legally
  mandated confinement may be at home or in
  appropriate facility. - - No specific precautions
  are required for those sharing the household with
  a person in quarantine as long as the person
  remains asymptomatic.

p. 16 of 71
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Individual Interventions

• Working quarantine
• Employees are permitted to work but must observe
  activity restrictions while off duty. Monitoring
  for illness before reporting to work is usually
  required. This may change based on the clinical
  presentation of disease. Use of appropriate
  infection control procedures while at work is
  required.

p. 17 of 71
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Disease Containment Strategies

• Measures targeted at groups include
• Measures that affect groups of exposed or at-risk
  persons
• Measures that affect entire communities

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Group Interventions

• Community strategies
• Snow days and self-shielding (voluntary)
• Asking everyone to stay home
• May be instituted for periods that might
  encompass the incubation period of a particular
  disease (SARS Canada)
• Closure of office buildings, shopping malls, and
  public transportation
• May be feasible in some circumstances
• Consequences must be carefully considered

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Group Interventions

• When to implement measures that affect groups
• There is limited disease transmission in the area
• Most cases can be traced to contact with an
  earlier case or exposure to a known transmission
  setting (e.g. a school or workplace where a
  person has fallen ill)
• The intervention is likely to either
  significantly slow the spread of infection or to
  decrease the overall magnitude of an outbreak in
  the community

Page 12 of 71
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Groups that may be quarantined include

• Persons who might have been exposed
• Via family members
• At a public gathering
• On an airplane or cruise ship or other closed
  conveyance
• At their school or workplace
• Healthcare providers who work at a facility where
  disease cases receive care

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Measures that apply to specific sites or buildings

• Cancellation of public events
• Concerts
• Sports events
• Movies or Plays
• Closure of recreational facilities
• Community swimming pools
• Youth clubs
• Gymnasiums

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Individual vs. Community Quarantine Measures

• Key Considerations
• Do Public health and medical analysis warrant the
  imposition of a large-scale quarantine?
• Are implementation and maintenance feasible?
• Is there a plausible way to determine who should
  be quarantined?
• Are resources available to enforce confinement?
• Can the quarantined group be confined for the
  duration during which they could transmit
  disease?
• Do the potential benefits outweigh the possible
  adverse consequences?

p. 11 of 71
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Other Disease Containment Strategies

• Mass Prophylaxis is a containment strategy! (Also
  known as Pharmaceutical Interventions)
• Chemo-prophylaxis is providing antibiotics or
  antivirals as preventative treatment (ie.
  Anthrax, Plague or Influenza Exposure)
• Immuno-prophylaxis is providing an immunization
  to prevent disease transmission (smallpox, mumps,
  measles, influenza)

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Disease Containment Strategies

• Public Education
• Stressing the importance of hand washing
• Encouraging people to stay home when sick
• Encouraging people to avoid public gatherings
• Stressing the importance of good disease control
  measures
• Using tissues to contain respiratory secretions
  (cough etiquette)
• Disposing of tissues in the nearest waste
  receptacle after use
• Wash hands after contact with respiratory
  secretions and contaminated objects or materials
• Disinfecting inanimate surfaces

Page 13 of 71
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Suppression
Effect of Increasing Social Distance on Epidemic
Dynamics
Exponentiation
Ro 0.67, Progression 12432
Ro 2.0, Progression 124816
Source Shaw, UAlbany CPHP broadcast, 11/10/05
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Preparedness Checklist for Community Containment
Measures
General

• Establish and Incident Command Structure
• Establish a legal preparedness plan
• Establish relationships with partners, such as
  law enforcement, first responders, healthcare
  facilities, mental health professionals, local
  businesses, and the legal community

p. 21 of 71
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Preparedness Checklist for Community Containment
Measures

• Plan to monitor and assess factors that will
  determine the types and levels of response,
  including the epidemiological profile of the
  outbreak, available local resources, and level of
  public acceptance and participation
• Develop communication strategies for the public,
  government decision-makers, healthcare and
  emergency response workers, mental health
  professionals, and the law enforcement community.

p. 21 of 71
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Preparedness Checklist for Community Containment
Measures

• Invite key partners to participate in
  containment exercises and drills
• Utilize actual events as an opportunity to
  practice and improve processes
• Writing After Action Reports and improvement
  plans will document process improvements

p. 21 of 71
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Preparedness Checklist for Community Containment
Measures
Facilities

• Identify appropriate community-based facilities
  for isolation of patients who have no substantial
  healthcare requirements.
• Identify facilities for persons for whom home
  isolation is indicated but who do not have access
  to an appropriate home setting, such as travelers
  and homeless populations.
• Develop tools and mechanisms to prevent
  significant stigmatization and provide mental
  health services to persons in isolation or
  quarantine

p. 22 of 71
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Preparedness Checklist for Community Containment
Measures
Facilities

• Identify potential quarantine facilities and
  prepare contingency plans for staffing and
  equipping them.
• Identify potential sites for clinics and prepare
  for staffing and equipping them, including the
  ability to dispense antiviral drugs to identified
  cases in the priority groups.

p. 22 of 71
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Preparedness Checklist for Community Containment
Measures
Community Containment Measures

• Ensure that legal authorities and procedures are
  in place to implement the various levels of
  movement restrictions as necessary.
• Establish procedures for medical evaluation and
  isolation of quarantined persons who exhibit
  signs of illness
• Develop tools and mechanisms to prevent
  stigmatization and provide mental health services
  to persons in isolation and quarantine.

p. 22 of 71
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Preparedness Checklist for Community Containment
Measures
Community Containment Measures

• Identify key partners and personnel for the
  implementation of movement restrictions,
  including quarantine, and the provision of
  essential services and supplies
• Law enforcement
• First responders
• Other government service workers
• Utilities
• Transportation industry
• Local businesses
• Schools and school boards

p. 22 of 71
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Preparedness Checklist for Community Containment
Measures
Delivery of essentials to individuals in iso/quar

• Essentials include
• medical care
• food
• services
• Training for responders and health care workers,
  as necessary, in use of personal protective
  equipment
• Plans for the mobilization and deployment of
  public health and other community-service
  personnel

p. 22 of 71
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Tool Box Orientation

• What else is in the tool box?
• Decision Trees and Flowcharts (p. 5 8 of 71)
• Guidelines and recommendations (throughout)
• Sample Legal orders (p. 32 36 of 71)
• Forms for medical monitoring (p. 43 - 46 of 71)
• Copies of the applicable statutes and regulations
• KAC Guide for Implementing KSA 65-129 (p. 60 of
  71)

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Tool Box and SOG

• Today we will use a scenario to familiarize you
  with the contents of the tool box and our local
  Standard Operating Guide
• The SOG describes how we will use the tool box
  and how we will make decisions
• The tool box is the key attachment to the SOG
• Other attachments are notification flow charts
  and a description of our Incident Command
  Structure.

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Quarantine Pop Quiz True or False?

• 1) Requires 100 compliance to be effective

FALSE
2) Always means using a legal order to restrict
someones activity
FALSE
3) Must be mandatory to be effective
FALSE
4) Increases a persons risk for acquiring the
disease
FALSE

• 5) Not necessary if everyone who develops
  symptoms is rapidly placed in isolation

FALSE
6) Public will not accept it
FALSE
Source Shaw, UAlbany CPHP broadcast, 11/10/05
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Questions?
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X Minute Break!!