PHEALTH Flashcards
Outline the public health response to a suspected case of meningococcal disease (5)
Every suspected case should prompt an urgent response to include:
Immediate telephonic notification to the local health authority by a healthcare worker in the facility, followed by written notification.
Rapid investigation of the case
Classification of the case as confirmed or probable
Provision of post exposure prophylaxis to close contacts
Identification of other cases in the same institution or community that may suggest a cluster.
The following Forest Plot shows the impact of corticosteroid use on mortality in patients with bacterial meningitis.
State how accurate the relative risk results is in the Wald and Girgis studies. Explain your answer (3)
Wald: The RR reported is not an accurate result (½) because the confidence interval (CI) is very wide (½). The CI also includes 1 therefore this risk is not a certainty (½). It is highly unlikely that the RR is 3 because of the variable/wide range of the CI.
Giris: The result is highly accurate (½) because the CI is very small (½) therefore it is more likely that the RR reported is approximately 0.53. Furthermore, the CI does not include 1 (½) and therefore it is significantly more likely that corticosteroid use is a protective factor in meningitis patients.
Based on the results of this meta-analysis, does corticosteroid use decrease the risk of dying in patients with meningitis? Yes/No (½) Please explain your answer (½)
No (½), because even though less people died in the intervention group, the results are not statistically significant (½)
Identify the individual studies in the forest plot which showed that corticosteroid use decreases the risk of mortality in patients with meningitis (1½)
De Gans 2002, Girgis, Mathur
The doctor read a journal article that highlighted the efficacy of vaccinations against meningitis. The study design was a community intervention trial. Explain the difference between a community intervention trial (CIT) and a randomized controlled trial (RCT) (3)
In a conventional RCT, individuals are randomly selected to a control and intervention group. In a CIT, groups of people, facilities or entire communities are randomly selected to a control and intervention group (2)
Outline the public health response to a suspected case of meningococcal disease (5)
Every suspected case should prompt an urgent response to include:
Immediate telephonic notification to the local health authority by a healthcare worker in the facility, followed by written notification.
Rapid investigation of the case
Classification of the case as confirmed or probable
Provision of post exposure prophylaxis to close contacts
Identification of other cases in the same institution or community that may suggest a cluster.
2 y/o males patient’s caregiver at the crèche notices he is irritable and feverish. Gives patient some paracetamol syrup. An hour later he is drowsy and not responding to his mom’s voice. Purplish spotty rash on his face and neck. Dr assesses him & immediately suspects meningococcal meningitis. Sends specimens to the lab and gives patient a stat dose of an antibiotic. He is admitted to an isolated high care ward where his condition is monitored carefully and further tests are performed. The superintendent is informed of the situation and immediately notifies the crèche and the authorities of the case before the diagnosis was confirmed by lab findings. Within the same week, 6 other patients from the area were admitted to hospital with meningococcal meningitis.
The superintendant telephoned the authorities. Is it still necessary for him/her to provide written notification to the authorities given that meningococcal meningitis is a category 1 notifiable disease? Explain your answer (1)
Yes (½) because category 1 notifiable diseases require immediate notification by telephone, fax or email and should be followed up with written notification within 7 days of diagnosis (½)
Should the superintendant have waited for the laboratory conformation before notifying the authorities (½) Explain your answer (½)
No, because category 1 notifiable diseases should be notified immediately without waiting for laboratory confirmation.
Outline how the notification process would differ if this was Haemophilus influenza type B, a category 2 notifiable disease (1)
Only written notification required (0.5) within 7 days of diagnosis (0.5).
Outline, with examples, what type of close contacts would require chemoprophylaxis (4)
Close contacts requiring prophylaxis include:
Those who have had prolonged close contact with respiratory secretions of the case in a household type setting during the seven days before onset of illness. Examples of such contacts would be those living and/or sleeping in the same household, those such as pupils, students, members of the military or police sleeping in the same dormitory or, sharing a kitchen where they prepare food together or sharing the same bathroom in a hostel, barracks or residence.
Those who have had transient close contact with a case require prophylaxis only if they have been directly exposed to large droplets or secretions from the respiratory tract within 10 days of a case becoming ill or admitted to hospital. This also applies to health care staff and ambulance or emergency personnel.
Outline, with examples, which close contacts of Mary Smith’s would require chemo prophylaxis (4)
Close contacts requiring prophylaxis include:
Those who have had prolonged close contact with respiratory secretions of the case in a household type setting during the seven days before onset of illness (1). Examples of such contacts would be those living and/or sleeping in the same household, such as parents, siblings, etc (1)
Those who have had transient close contact with a case require prophylaxis only if they have been directly exposed to large droplets or secretions from the respiratory tract within 10 days of a case becoming ill or admitted to hospital (1). This also applies to health care staff and ambulance or emergency personnel (1)
State whether this situation constitutes an outbreak of meningitis (½) Explain your answer (3½)
Yes (a), an outbreak is defined:
Two or more probable or confirmed cases during a 4-week interval in a group which makes sense epidemiologically (if cases are laboratory confirmed-serogrouping should be the same) (1) OR
Three cases of confirmed or probable meningococcal disease in ≤ 3 months (1) of the same serogrouping (if available) with a history of a common affiliation but no close contact (1)
The doctor read a journal article that highlighted the efficacy of vaccinations against meningitis. The study design was a community intervention trial. Explain the difference between a community intervention trial and a randomized controlled trial (RCT) (2)
In a conventional RCT, individuals are randomly selected to a control and intervention group. In a CIT, groups of people, facilities or entire communities are randomly selected to a control and intervention group (2)
Do you think viral meningitis is a major contributor to the Burden of Disease in South Africa? Briefly motivate your answer (3)
No. Burden of Disease is contributed by the number of life years lost, or by disability adjusted life years (DALYs) lost. Because viral meningitis is relatively uncommon, and it does not have a high mortality, it does not lead to a high burden of disease
You suspect that Ayesha is suffering from meningoccal meningitis, which is a notifiable disease.
What are the legal obligations with respect to notifying the health authorities? (Include in your answer the following subheadings: (6)
The relevant Health Act.
Timing of notification relevant to laboratory results.
People who can inform the Department of Health about a notifiable disease.
National Health Act, Act 61 of 2003
Notify when suspect the disease from clinical signs and symptoms (i.e. before you have lab confirmation)
Any health care worker who sees and diagnoses a notifiable case or death has a legal responsibility to notify the relevant Health Authority.
