STANDARD OPERATING PROCEDURES
FOR ENHANCED ACTIVECASE-BASED SURVEILLANCE FOREBOLAVIRUS DISEASEIN
SOUTH AFRICA, 2014
Directorate: Epidemiology and Surveillance
CLUSTER: himme
NATIONAL DEPARTMENT OF HEALTH
ACRONYMS
CIFCase Investigation Form
DOHDepartment of Health
EVDEbola Virus Disease
IHRInternational Health Regulations
NATHOCNational Health Operations Centre
NDOHNational Department of Health
NICDNational Institute for Communicable Diseases
SOPStandard Operating Procedure
1.INTRODUCTION
In light of the current EVD outbreak in West Africa, the National Department of Health has instituted enhanced active case-based surveillancefor clinically suspected and laboratory confirmed Ebola Virus Disease (EVD) in South Africa.
2.PURPOSE
The aim of these Standard Operating Procedures (SOPs) is to guide health personnel atall levels of the health care system (both in the public and private sector) in the implementation of enhanced active case-based surveillance forthe EVD in South Africa.
3.OBJECTIVE
To identify all suspected and laboratory confirmed cases, to detect the patterns of transmission, and to estimate the potential for further spread of EVD to the general population of South Africa.
3.1Specific Objectives
a)To maintain zero reporting of EVDsuspected and laboratory confirmed cases on a daily basis;
b)To promptly detect suspected EVD cases from all health care facilities;
c)To link clinical surveillance of suspected EVD with cases tested for EVD at the Special Viral Pathogens Laboratory at the National Institute for Communicable Diseases (NICD);
d)To liaise with the National Population Registry Unit of the Department of Home Affairs with regards to suspected or confirmed EVD associated deaths;
e)To prepare DailyNational Surveillance Reports with regards to the incidence, prevalence, mortality and patterns of spread once a case of EVD has been detected;
f)To use this information for immediate public health control measures.
4EVDDATA COLLECTION TOOLS REQUIRED FOR THIS SOP
a)Fixed telephone lines:to be used by all health care facilities (public and the private sectors) for the immediate reporting of suspected and confirmed EVD cases, including zero reports;
b)The legislated GW17/5 Notification Forms: to be completedby all health care providers (public and the private sectors)for the immediate notification of suspected and confirmed EVD case(s);
c)Case Investigation Form for EVDTesting: to be completed by all health care providers (public and the private sector) for suspected EVD cases (Annexure 1):
d)Daily Situation Report Forms (Annexure 2): to be completed by the Provincial Communicable Disease Control Focal Persons for anaggregated summary of suspected and confirmed EVD cases, including zero reports;
e)EVDLine lists (Annexure 3): to be used by Provincial Communicable Disease Control Focal Persons fora detailed summary of all suspected and confirmed EVD cases;
f)The NDOH Web-based Public Health Surveillance Notification System: to be used at the NATHOC for:
-electronic capturing of all EVD cases
-sending SMS alerts to relevant authorities responsible for response and control interventionsand publication of the National Situation Reports.
5 THE EVDOUTBREAK DATA FLOW PROCESS AND REPORTING LINES
5.1.Reporting and Notification at the Point of Detection (Public and Private Health Care Facilities)
A: NO EVD CASE DETECTED (ZERO REPORTING)
All health care facilities willsendzero (0) reports if no EVD cases have been detected for that day. All zero reports must be sent to the relevant Provincial Department of Health,Communicable Disease Control Focal Personby 08:00 am.The list of Provincial Focal Persons is indicated in Annexure 4.
B: SUSPECTED EVDCASES
Any health care provider detecting and clinically diagnosing a patient who satisfies the case definition for a suspected EVD casewillimmediately do the following:
STEP 1
Perform risk assessment and complete a case investigation form (see annexure 1).
STEP 2
Immediatelythrough telephone report the suspected EVD caseto:
- the Provincial Communicable and Disease Control Focal Person (see annexure 4);
- the National Health Operating Centre (NATHOC)- 012395 9636or 012395 9637and;
- the National Institute for Communicable Diseases(NICD) hotline - 082-883-9920.
STEP 3
Complete a written notification on the GW17/5 NotificationForm immediately after the suspected EVD case is identified. All notifications forms must immediatelybe sent to the Provincial Communicable Disease Control Focal Person.
C: CONFIRMED EVDCASES
Any suspected case will be laboratory confirmed by the NICD.
A health care provider will immediatelyafter receiving laboratory confirmation,send a written notification on the GW17/5 Notification FormtotheProvincial Communicable Disease ControlFocal Person.
5.2. Data Aggregation of EVD Cases at the Provincial Level
No EVD case detected (zero reporting)
The Provincial Communicable Disease ControlFocal Person will complete a Daily Situation Report Form and indicate zero (0)if noEVD cases have been detected for that day. All zero reports must be sent to the NATHOC by 09:00am.
Suspected and confirmed EVD cases
For suspected and confirmed EVD cases, the Provincial Communicable Disease ControlFocal Person will do the following:
STEP 1
Immediatelythrough telephone report the suspected or confirmed EVD case to the NATHOC.
STEP 2
Send copies of theGW17/5 Notification Formof the suspected or confirmed EVDcases to the NATHOC.
STEP 2
Summarize allindividual notifications of the suspected and confirmed EVD cases into an aggregated Daily Situation Report Form as well asalinelist. All linelists and Situation Report Formsmustbe sent to the NATHOC by 09:00am each day.
5.3EVD Laboratory Testing
The NICD will send laboratory test reports for all samples tested for EVDto (1) the health care facility that requested the test, (2) the Provincial Communicable Disease ControlFocal Person and (3) theNATHOC as soon as the results become available.
5.4: EVD, Data Verification, Validation, Collation, Analysis and Daily Reporting at the NATHOC
a)The NATHOC Surveillance Desk will verify, validate,collate, analyze and review all data from the nine Provinces and immediately notify the IHR Focal person of any suspected or laboratory confirmed EVD case;
b)All Daily Situation Report Forms andlinelists of the suspected and confirmed casesof EVDwill be electronically captured into the NDOH Web-based Public Health Surveillance Notification System at the NATHOC on a daily basis;
c)Daily surveillance reports will be compiled to be presented at the daily Public Health Cluster (PHC) meetings;
d)The PHC willassess these reports, as well as reports from the laboratory, media and international surveillance and compile a comprehensive risk assessment on the public health threat of EVD to the South African public and prepare National Situation Reports;
e)These Situation Reports will be posted on the NDOH website well as on the viewing page of theNDOH Web-based Public Health Surveillance Notification System
6.CONTACT TRACING
Contact tracing to find everyone who has come in direct contact with a sick EVD patient will be done by the local Outbreak Response Teams supported by the Field Epidemiology and Laboratory Training Programme (FELTP) and coordinated by NATHOC. Contacts will bemonitored for signs of illness for 21 days from the last day they come in contact with the EVD patient. If the contact develops a fever or other EVD symptoms, they will be immediately isolated, tested, provided care. All of the new suspected EVD patient's contacts will also be identified and monitored for 21 days.
The Provincial Communicable Disease Control Focal Persons must send reports of all contacts followed up to NATHOC by 09:00 am each day.
1 / | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA1 / | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA
Annexure 1
CASE INVESTIGATION FORM: REQUEST FOR EBOLA VIRUS DISEASETESTINGPATIENT DETAILS
Surname: Name/s:
Date of birth: / Age: / Sex: Male Female
Contact telephone number/s: / Occupation:
Physical home address:
ATTENDING HEALTHCARE WORKER AND HEALTHCARE FACILITYDETAILS
Name of clinician: / Contact number/s of clinician:
Healthcare facility name: / Location of healthcare facility:
Hospital number: / Date of admission (dd/mm/yyyy): / Ward:
CLINICAL INFORMATION
- Date of onset of illness (dd/mm/yyyy):
- Clinical features(Tick appropriate box: yes, no, unknown)
Fever Yes □ No □ Unknown □
If yes, specify temperature___°C
Headache Yes □ No □ Unknown □
Muscle pain Yes □ No □ Unknown □
Joint pain Yes □ No □ Unknown □
Abdominal pain Yes □ No □ Unknown □
Sore throat Yes □ No □ Unknown □
Nausea Yes □ No □ Unknown □
Vomiting Yes □ No □ Unknown □
Diarrhoea Yes □ No □ Unknown □
Eschar Yes □ No □ Unknown □
Jaundice Yes □ No □ Unknown □
Bruising Yes □ No □ Unknown □
Other, specify: ______/ Rash Yes □ No □ Unknown □
If yes, specify
Distribution of rash:______
Type of rash:
Macular Yes □ No □
MaculopapularYes □ No □
VesicularYes □ No □
PetechialYes □ No □
VasculiticYes □ No □
Bleeding Yes □ No □ Unknown □
If yes, specify
EpistaxisYes □ No □
HaematuriaYes □ No □
EcchymosesYes □ No □
HaematemisisYes □ No □
MelaenaYes □ No □
Other: specify:______
- Antimicrobial therapy
If yes complete the table below
Antibiotic / Route (po/IV /IM) / Date started / Date stopped / Duration (days) of treatment
D / D / M / M / Y / Y / Y / Y
/ D / D / M / M / Y / Y / Y / Y
D / D / M / M / Y / Y / Y / Y
/ D / D / M / M / Y / Y / Y / Y
D / D / M / M / Y / Y / Y / Y
/ D / D / M / M / Y / Y / Y / Y
Has thepatientreceivedanyantimalarialtherapyduringthisillness? Yes □ No □ Unknown □
If yes complete the table below
Antimalarial / Route (po/IV/ IM) / Date started / Date stopped / Duration (days) of treatment
D / D / M / M / Y / Y / Y / Y
/ D / M / M / Y / Y / Y / Y
D / D / M / M / Y / Y / Y / Y
/ D / D / M / M / Y / Y / Y / Y
- Supportivemanagement(Tick appropriate box: yes, no, unknown)
PatientrequiringintensivecaresupportYes □ No □ Unknown □
MechanicalventilationYes □ No □ Unknown □
DialysisYes □ No □ Unknown □ / Blood/blood product transfusion: Yes □ No □ Unknown □
Other: specify ______
LABORATORY INVESTIGATIONRESULTS
FBC
Haemoglobin: / RESULT
g/dL / DATE
……../……./……… / Coagulationprofile: / RESULT / DATE
……../……./………
Plateletcount: / x 109/L / ……../……./……… / INR / ……../……./………
White cellcount: / x 109/L / ……../……./……… / PTT / ……../……./………
Absolutelymphocytes / x 109/L / ……../……./……… / D-dimers: / ……../……./………
Liverfunctiontests
Total bilirubin: / mmol/L / ……../……./……… / FDP / ……../……./………
Malaria tests:Date: ______/______/______
Malaria smear: Pos □Neg□
Directbilirubin: / mmol/L / ……../……./………
AST / IU/L / ……../……./………
ALT / IU/L / ……../……./……… / Malaria antigen: Pos □Neg□
ALP / IU/L / ……../……./………
GGT / IU/L / ……../……./……… / Blood culture: Date collected: _____/______/______
Status:
U & E:
Urea: / mmol/L / ……../……./………
Creatinine: / µmol/L / ……../……./……… / Otherrelevanttests and results (specify)
RISK FACTORS/ EXPOSURE HISTORY – during the 3 weeks prior to onset of symptoms
Travelled to a country where EVD cases have occurred during the current outbreak Yes □ No □ Unknown □
(West African countries affected by outbreak and countries reporting imported cases with local transmission)
History of contact with blood/body fluids of a patient withsuspected/confirmed EVD Yes □ No □ Unknown □
History of contact with the immediate environment of a patient with suspected/confirmed EVD Yes □ No □ Unknown □
Handled or slaughtered bats or bush-meat animals in Guinea, Liberia or Sierra Leone Yes □ No □ Unknown □
Handled clinical/laboratory specimens from a patient withsuspected/confirmed EVD Yes □ No □ Unknown □
Involved in the funeral preparations of a patient with suspected/confirmed EVD Yes □ No □ Unknown □
Had sex in the last 3 months with a patient with suspected/confirmed EVD Yes □ No □ Unknown □
PASTMEDICAL AND TRAVEL HISTORY
Underlying illness : Yes □ No □ Unknown □
If yes, give details:
Travel outside of South Africa in the four weeks prior to onset of illness? Yes □ No □ Unknown □
If yes, details:
Country visited / Location/s visited within country: / Date of arrival (dd/mm/yyyy): / Date of departure (dd/mm/yyyy):
………../………./……… / …..…../………./………
………../………./……… / ….…../………./………
………../………./……… / ….…../………./………
Reason for travel (e.g. business, tourist, visiting friends/family), specify: ______
Activities (e.g. hiking, walking, hunting), specify: ______
Yellow fever vaccine received: Yes □ No □ Unknown □
Antimalarial chemoprophylaxis taken : Yes □ No □ Unknown □
DIFFERENTIAL DIAGNOSES
List current differential diagnoses considered:
______
Annexure 2
The EVD Daily Situation Reporting Form(To be completed by Provincial Communicable and Disease Control Focal Persons) / SITUATION REPORT NUMBER:
Report for period: / / 2014 to / 2014
Due daily by 09:00 am
Surveillance Point
SITUATION SUMMARY
Summary of the suspected or confirmed EVD case(s):
Medical Condition / Details/Potential source (If available please include potential source, any risk assessment under general comments)
No. confirmed cases / No. suspected cases / No. of deaths / General comments
EVD Virus Disease
4. REPORT DETAILS
Prepared by: / Telephone number:
Approved by: / Telephone number:
Date: / Next situation report to be sent at: / Date: Time:
Send this form together with the line list to the NATHOC: Tel: 012395 9636 or 012395 9637, Fax: 012395 9722, E-mail: or
Annexure 3
ENHANCED EVD SURVEILLANCE
LINE LIST TOOL
To be completed by Provincial Communicable and Disease Control Focal Persons
Surname / Name / ID/Passport No. / Age / Sex / Residential Address / Country of origin / Notification date / Possible place of infection / Date of onset / Lab investigation result / Confirmed/Suspected case / Outcome (Alive/Dead) / Health Facility / Notified by / Tel. no.
Send this form to the NATHOC: Tel: 012395 9636 or 012395 9637, Fax: 012395 9722, E-mail: or
Annexure 4: List of EVD Contacts
National Health Operations Centre
National Department of Health
Tel: 012395 9637 or 012395 9637
Fax: 012395 9722,
E-mail: or
National Institute for Communicable Diseases
Special Pathogens Unit,
NICD1 Modderfontein road,
Sandringham,
Johannesburg
Requests for testing (with a detailed clinical, travel and exposure history) should be directed to the NICD Hotline at 082 883 9920 (a 24‐hour service, for healthcare professionals only).
DESIGNATED EVD OUTBREAK HEALTH FACILITIES AND FOCAL PERSONS
PROVINCE / HOSPITAL / FOCAL POINT / TELEPHONE NO. / MOBILE NO.Limpopo / Polokwane Hospital / Ms. Mavis Madaba / 015 287 5000/ 5803/ 5713 / 082 691 0823
Mpumalanga / Rob Ferreira Hospital / Sister Francina Henning / 0137416278 / 0725110184
Gauteng / Charlotte Maxeke Hospital / SisterFelicity Brown / 011 488 4419 / 488 3388 / 072 254 5769
Steve Biko Academic Hospital / Prof. Stoltz / 012 354 4961 / 082 214 1811
KwaZulu-Natal / Addington Hospital / Sister Carol Gumede / 031 327 2993 / 083 709 3225
North West / Klerksdorp Hospital / Sister Mojaki Mosiatlhaga / 0184064606 / 0824506116
Free State / Pelonomi Hospital / Dr. D Steyn / 051 436 9310 / 083 249 6682
Northern Cape / Kimberly Hospital / Mr. Danie Stander / 053 802 2360 / 083 449 4322
Eastern Cape / Frere Hospital / Mrs. N Tyalisi / 0437092011 / 0835900499
Livingston Hospital / Dr. J. Black / 041 405 2617 / 083 378 0911
Western Cape / Tygerberg Hospital / Dr. Jantie Taaljaard / 021 938 5229 / 083 419 1452
PROVINCIAL CDC FOCAL PERSONS FOR THE ENHANCED SURVEILLANCE OF EVD
PROVINCE / NAME / TEL NUMBER / FAX NUMBER / EMAIL ADDRESS / MOBILE No.Eastern Cape / Ms Lungelwa Quntana / 040 608 0842/29 / 086 624 5696 or 043642 1409 / / 083378 1771
Free State / Ms Babsy Nyokong / 051 4081734 / 051 408 1074 / / 083452 8954
Northern Cape / Mr Danie Stander / 053 830 540/38 / 086 556 3960 / / 083 449 4322
North West / Ms Chriseldah Lebeko / 018 391 4066 / 086 690 2756 / / 079 521 5004
Gauteng / Ms Joy Mnyaluza / 011 355 3867 / 011 355 3297 / / 082 335 3134
Mr Rufus Makwela / 011 355 3172 / 011 355 3297 / / 071 365 8479
Limpopo / Mr. Eric Maimela / 015 293 6059 / 015 293 6281 / or / 084686 5686
Ms. Freda Ngobeni / 015 293 6062 / 015 293 6281 / or / 079491 1909
Mpumalanga / Mr Mandla Zwane / 013 766 3078 / 013 766 3473 or
0866508656 / / 082229 8893 or 079210 6549
Ms Riensie Vellema / 013 766 3411 / 086 621 3058 / / 083 289 6991
Western Cape / Mr Stephen Titus / 021 483 3737 / 021 483 2682 / / 083488 0777
Ms Charlene Jacobs / 021 483 9964 / 086 611 1092 or
021 483 2682 / / 072 356 5146
KwaZulu-Natal / Mr Bruce Margot / 033846 7503 / 033 846 7272 / / 083457 1185
Ms Premi Govender / 033 846 7461 / 033 846 7759 / / 071609 2505
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