รวมเล่ม_PowerPoint_ว.ระบาดวิทยาฯ 2565 (Wanpen)

Epidemic or Outbreak 1. Common-Source Outbreak (Point Epidemic)...แหล่งร่วม... • Refers to an outbreak of acute disease with the same source of infection, with one patient having symptoms at the same time or during a similar period. (does not exceed the incubation period of the disease) 2. Propagated-Source Outbreak • Refers to an outbreak of a disease that occurs because the source of infection is most often from person to person, either directly or indirectly, the infection will be sick with that disease. • Patients will be higher and higher for a while and then gradually decrease. • The duration of this disease is often longer than Common-Source Outbreak.

Epidemiological Investigation Procedures Step 1 Outbreak Step 2 Step 3 verification Descriptive Study Formulation of of Epidemiology Hypotheses (ยนื ยนั วา่ มกี ารระบาดจรงิ ) (ตัง้ สมมตฐิ านของการระบาด) (ศกึ ษาวิทยาการระบาดเชิง ✓ Verify the diagnosis and confirm the outbreak พรรณนา) ✓ Time, Place, Person ✓ Define a case and conduct case finding ✓ Take immediate control measures ✓ 2x2 table Step 6 Step 5 Step 4 Management of an epidemic Investigation and Use of analytic epidemiology for and Reports of the analysis identification of the investigation cause of an epidemic (สอบสวนและวเิ คราะห์เพมิ่ เตมิ ) (บริหารจดั การเก่ียวกบั การควบคุม ป้องกันการ (พิสจู น์สมมตฐิ านโดยใชว้ ทิ ยาการ ระบาดและการรายงานผล การสอบสวนโรค) ระบาดเขิงวิเคราะห)์

Report After the investigation 1. Characteristics of disease outbreaks classified and control, the by person place and time operation prevented the spread of the disease. 2. Causes of outbreaks, pathogenic factors, sources A summary report of infection, and how to spread should be prepared and presented to relevant 3. Management of outbreaks and prevention and parties. control 4. Evaluate the implementation 5. Suggestions for preventing the next outbreak 6. Conclusion

แบบรายงานผู้ปว่ ยโรคตดิ เชอื้ ไวรัสโคโรนา 2019 ฉบับย่อ* Coronavirus Disease 2019 Patient Report Summary Form (Y 2022) (กรมควบคมุ โรค กระทรวงสาธารณสุข, 2564)

SRRT: Surveillance and Rapid Response Team (เครือข่ายทีมเฝ้าระวงั สอบสวนเคลื่อนท่ีเร็ว) Total in Thailand Central C-SRRT 1,030 teams Region R-SRRT Sub- District Province district D-SRRT P-SRRT Village Health Volunteers

SRRT: Surveillance and Rapid Response Team SRRT Investigate District news center Examine (Health center) community news source Notify unusual events in the community

ExampleExample: disease investigation analysis • A study on diarrhea at a party found that 40 out of 200 attendees were sick with diarrhea, 34 people out of 180 people ate papaya salad and 6 people who not ate, 5 people out of 150 people ate green curry, and 35 persons who not ate were diarrhea. • What kind of food must be the most likely cause of the disease? Diseased No diseased Exposed a b Non-exposed c d 18

Example • A study on diarrhea at a party found that 40 out of 200 attendees were sick with diarrhea, 34 people out of 180 people ate papaya salad and 6 people who not ate, 5 people out of 150 people ate green curry, and 35 persons who not ate were diarrhea. • What kind of food must bIlel (tปh่ วeย)most likWeelyll c(ไaม่ปu่ วsยe) ofTtohtealdisease? Exposed (contacted) 34 (a) 146 (b) 180 (a+b) Unexposed(uncontacted) 6 (c) 14 (d) 20 (c + d) Total 40 (a + c) 160 (b + d) 200 (N) For papaya salad : Odd of diarrhea among contacted = 34 ⁄ 180 = 0.18 = 18% Odd of diarrhea among uncontacted = 6 ⁄ 20 = 0.30 = 3% The odds ratio is simply the ratio of these two risks: Odds Ratio = 18 ⁄ 3 = 6.0 Thus, people who ate papaya salad were 6.0 times as likely to develop diarrhea as those who did not eat it.

Example • A study on diarrhea at a party found that 40 out of 200 attendees were sick with diarrhea, 34 people out of 180 people ate papaya salad and 6 people who not ate, 5 people out of 150 people ate green curry, and 35 persons who not ate were diarrhea. • What kind of food must bIlel (tปh่ วeย)most likWeelyll c(ไaม่ปu่ วsยe) ofTtohtealdisease? Exposed (contacted) 5 (a) 145 (b) 150 (a+b) Unexposed(uncontacted) 35 (c) 15 (d) 50 (c + d) Total 40 (a + c) 160 (b + d) 200 (N) For green curry : Odd of diarrhea among contacted = 5 ⁄ 150 = 0.03 = 3% Odd of diarrhea among uncontacted = 35 ⁄ 15 = 2.33 = 23.3% The odds ratio is simply the ratio of these two risks: Odds Ratio = 3 ⁄ 23.3 = 0.13 Thus, people who ate green curry were 0.13 times as likely to develop diarrhea as those who did not eat it.

Example: disease investigation analysis • A study on diarrhea at a party found that 40 out of 200 attendees were sick with diarrhea, 34 people out of 180 people ate papaya salad and 6 people who not ate, 5 people out of 150 people ate green curry, and 35 persons who not ate were diarrhea. • What kind of food must be the most likely cause of the disease? 1. Papaya Salad ✓ Odds Ratio = 6 2. Green Curry Odds Ratio = 0.13 The Papaya Salad must be the most likely cause of the disease.

summary 1 2

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Chapter Contents 1 Disease Prevention 2 Disease Control

Definition of Prevention & Control • Prevention is defined as Control means reducing “actions aimed at eradicating, eliminating the number of new diseased or minimizing the or infections, the number of impact of disease and people currently diseased or disability. infected, and the number of people who become sick or die from a disease in local settings. Prevention Control

1 Disease Prevention

The Three Levels of Prevention and Tasks 1. Primary prevention refers to actions aimed at avoiding the manifestation of a disease Principle of primary prevention Primary prevention tasks Stage of susceptibility ➢ Promote health promotion behaviors 1. Susceptibility such as vaccination ➢ Promote a healthy environment & 2. Reduce the chance of those who have the disease (Susceptible individual) Sanitation 3. Eliminate or reduce the causes of ➢ Promote specific protection disease (mask, belt, helmet, vaccination, smoking cessation, quitting alcohol or limiting the amount, prophylaxis)

Herd immunity = Community Immunity Population Community Herd Immunity Immunity Immunity Herd immunity, also To prevent the It is necessary to known as 'population spread of disease by immunize the majority of immunity', is the the principle of herd people in the community indirect protection from immunity or group (about 80 percent or an infectious disease immunity. more) either naturally or that happens when a by vaccination or a population is immune combination of both. either through vaccination or immunity (Department of Mental Health developed through a Ministry of Public Health, 2021) previous infection.

The Three Levels of Prevention and Tasks 2. Secondary prevention prevention when the disease has already occurred Objectives - to find the disease in the early stages before the symptoms appear. - to reduce the severity of the disease and prevent the spread of the disease - to stop the progression of the disease (reducing the duration of illness and reducing disabilities as well as complications that will occur) - to prevent the disease from spreading faster to other people in the case of infectious disease

The Three Levels of Prevention and Tasks 2. Secondary prevention 2.1 Early detection of asymptomatic cases: screening of diseases such as - Blood pressure measurement in annual health check - Breast palpation and female mammogram to look for breast cancer - Blood glucose test to look for diabetes - Prostate-Specific Antigen (PSA) test to look for prostate cancer - Pap smear to look for uterine cancer 2.2 Early diagnosis of symptomatic cases and prompt treatment

The Three Levels of Prevention and Tasks 3. Tertiary prevention Tertiary prevention is the 3.1 3.2 stage of disability or Disability limitation Rehabilitation advanced disease prevention. • It is important to treat •The key goal is to provide patients with functional and patients with the ability to • To stop and controls structural disabilities, visual help themselves, and a disability and its effects. impairment, and hearing quality of life as close to • To reduce complications of disabilities such as normal as possible, giving the the disease. • Treatment of diabetic opportunity to use the •To reduce disability as well patients with cataracts handicapped part to the as the negative consequences • Putting a splint on a maximum benefit and able •To prevent the loss of that patient with a broken arm after to live in society without disease, such premature loss retracting much burden to society. of life.

2 Disease Control

Disease Control • The reduction of disease incidence, prevalence, morbidity, or mortality to a locally acceptable level as a result of deliberate efforts; continued intervention measures are required to maintain the reduction. Source: https://ddc.moph.go.th/uploads/publish/118922 0211018081043.pdf

Basic Principles of Control of Communicable Diseases ✓1) Must first consider where the germ is. (Reservoirs (รงั โรค) or Source (แหล่งโรค) ✓2) If a person has to be considered as a person who is sensitive or has low immunity. ✓3) Must have knowledge of methods of transmission (Mode of Transmission: contact transmission, droplet transmission, airborne transmission, other) ✓4) Must know portal of entry

Measures or Interventions to Prevent & Control Disease 1. Divided according to the level of the target group as follows: 1.1 Population approach: including law enforcement, awareness campaign encourages the importance of or encourages the masses to have healthy behaviors in a good way 1.2 High-risk approach: providing home isolation for those at risk for COVID-19, providing a smoking-cessation clinic for smokers, medication to lower blood pressure in people with high blood pressure, surveillance of COVID-19 in people in at-risk groups 2. Divided according to the nature of the measures as follows: 2.1 Fiscal measures include taxation of public service grants 2.2 Legal measures include the use of law enforcement such as helmets, seat belts, infectious disease reporting, etc. 2.3 Educational measures include educational campaigns such as radio and television health education spots. 2.4 Social measures include trying to involve society in various measures, for example, against non-cooperative people, keeping distance or being detained in their own homes, etc. 3. Divided according to the nature of enforcement as follows: • Voluntary measures (มาตรการท่เี ลือกได้) • Compulsory measures (มาตรการทีผ่ ้ใู ช้ไมส่ ามารถเลือกได้) such as legal measures or the design of a car with an automatic seat belt

From: Joann Elmore, Dorothea Wild, Heidi Nelson, David Katz. (2020). Jekel's Epidemiology, Biostatistics, Preventive Medicine, and Public Health. 5th Edition. Philadelphia: Saunders, p13.

Guidelines for Prevention and Control of Communicable Diseases Infectious and Environment Immunity & Health Contaminated Person Education • 8. Blocking of • 1. control source of transmission • 10. Health promotion infection • 8.1 Water-borne • 10.1 Physical activity diseases: Boil water & • 10.2 Nutrition • 2. Patient Isolation milk • 10.3 Stress reduction • 3. Contaminated person • 8.2 Air-born diseases: Mask & Distancing • 11. Specific protection quarantine • 8.3 Vector-borne • 11.1Vaccination • 4. Early diagnosis and diseases: • 11.2 Drug or Chemoprophylaxis prompt treatment • 9. Environmental control • 5. Disinfection (การทาลายเชื้อ) • 9.1 Vector control • 12. Health education • 6. Disease surveillance • 9.2 Sanitation • Mass communication • 7. Investigation and control (ประชาสมั พนั ธ์ทาง of epidemic ส่ือสารมวลชน) • Community participation (และกระตนุ้ ใหเ้ กิดความรว่ มมือ ของชมุ ชน

Natural Pre pathogenesis Pathogenesis Post of Period Period pathogenesis Diseases Susceptibility Preclinic Clinical Period Prevention Advance Prevention Diseased Prevention Post Clinical Post Diseased Prevention Primordial Primary Secondary Tertiary Prevention Prevention Prevention Prevention

Summary ✓ Disease prevention and control are a public health process undertaken to reduce the risk factors of disease. ✓ Disease prevention and control applied knowledge about the nature of disease as a guideline for the operation. ✓ The prevention and control of communicable diseases must be to control the source of infection, eliminate the chain of transmission, and prevent at-risk populations from contracting the disease.

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1 Epidemiological Information Technology 2 Ethics in the use of Epidemiological Information Technology

1 Epidemiological Information Technology

What is Epidemiological information technology? Epidemiological Technology information technology is a is machinery and equipment developed process and from the application of scientific system that help knowledge. to obtain the information Information (ขอ้ มลู ) applies to facts told, needed in read, or communicated that may be epidemiological. unorganized and even unrelated. Information technology (IT) is the use of computer systems or devices to access information.

Surveillance Procedure Procedure for operating epidemiological surveillance • Collection of Data • Consolidation and Analysis • Analysis and Interpretation • Presentation and Dissemination of Information The National Disease Surveillance (Report 506, รง.506)

Example of epidemiological information technology

Examples of epidemiological information technology

The diseases that needed investigation report Individual Case Investigation (การสอบสวนผู้ป่ วยเฉพาะราย ) Refers to the collection of detailed information about a patient or contact person. 1. Cholera 2. Diarrhea (Only for those who died aged 15 years and over) 3. Acute flaccid paralysis syndrome (AFP) 4. Diphtheria (คอตีบ) 5. Neonatal tetanus and tetanus 6. Pertussis (โรคไอกรน) 7. Measles (only inpatients and bedridden patients under 9 months of age) 8. Rabies

• JHCIS is a health center and primary care system program system. • JHCIS is an acronym for Java Health Center Information System. • The program was developed by the Center for Information and Communication Technology, Ministry of Public Health พ.ศ. 2540 HCIS (Health Center Information System) พ.ศ. 2550 JHCIS (Java Health Center Information System)

Example of epidemiological information technology Source: https://ddc.moph.go.th/ viralpneumonia/m_ddcc are.php

Example of epidemiological information technology

2 Ethics in the use of Epidemiological Information Technology

Ethics 1. Privacy (ความเป็นส่วนตวั ) 2. Accuracy (ความถูกตอ้ ง) 3. Property (ความเป็นเจา้ ของ) 4. Access (การเขา้ ถึงขอ้ มูล)

Ethics in Epidemiology Study Involving Human Participants . The four principles 1. Beneficence, 2. Nonmaleficence, 3. Justice, 4. Respect for autonomy

Ethics in Epidemiology Study Involving Human Participants In 1982, the World Health Organization (WHO) and the Council for International Organizations of Medical Sciences (CIOMS) published International Ethical Guidelines for Biomedical Research Involving Human Subjects This document built on Helsinki II and addressed issues of informed consent; standards for external review; and protections for vulnerable persons participating in medical research.

Summary ➢ Epidemiological information technology is an information management system Computers and networks help to obtain the information needed in epidemiology. ➢ Epidemiological information relating to people and illnesses requires privacy, accuracy, property (ownership), and access. ➢ Epidemiological operations are concerned with and related to people, especially epidemiological studies. Therefore, those involved in epidemiological studies must have four ethical principles of beneficence, nonmaleficence, justice, and respect for autonomy.