Case Scenario IV

Outbreak investigations in Al-Hayat

District
1. What type(s) of surveillance are
currently in place in Al-Hayat District?

A. Event-based surveillance : as the information

includes events related to the occurrence of disease
in humans, such as rumours of unexplained details.
B. Passive surveillance : as the hospital is reporting
an increase in diarrhea cases as part of routine data
collection without request by the health authorities

Question 2:
Event-based surveillance (EBS) can complement
the current situation in AI-Hayat District by:
1. Detecting Early Signals: EBS monitors informal
sources (e.g., social media, community rumors,
NGO reports) to identify potential outbreaks faster
than traditional systems, which may rely on formal
healthcare reporting delays.
2. Filling Gaps in Formal Reporting: Since local
clinics have not submitted formal reports, EBS can
capture unreported cases through community
health workers, schools, or local leaders.
3. Enhancing Situational Awareness: By tracking
rumors (e.g., contaminated water) and correlating
them with hospital data, EBS can help verify risks
and guide targeted investigations.
4. Enabling Rapid Response: Early detection via EBS
allows quicker mobilization of resources (e.g.,
testing water sources, deploying oral rehydration
kits) before the outbreak escalates.
Example:
The NGO’s notification and social media rumors
about water contamination could trigger immediate
environmental testing, even before lab-confirmed
cases are documented.
Limitation:
EBS data may lack specificity (e.g., unverified
symptoms), so it should be paired with case
confirmation through active or passive surveillance.

Question 3: What data sources would

be most useful to confirm and
investigate the outbreak?

To confirm and investigate the outbreak, the

following data sources would be most useful:

1. Hospital and Clinic Records:

 - Number of cases presenting with symptoms such
as acute watery diarrhea, vomiting, and fever.
- Age distribution of affected individuals,
especially children under 10.
- Dates of symptom onset and any signs of
geographic clustering.

2. Routine Health Surveillance Data:

- Reports of communicable diseases from local
health facilities.
- Comparison with baseline data from previous
months or years to detect any unusual increase.

3. Reports from Community Health Workers and

NGOs:
- Field observations of affected households or
neighborhoods with multiple cases.
4. Laboratory Testing of Patient Samples:
- To identify the specific pathogen (e.g., bacteria,
virus, or parasite) causing the symptoms.

5. Water Quality Testing:

- Collect and analyze samples from potentially
contaminated drinking water sources.

6. Social Media and Informal Community Reports: -

Monitor public concerns, rumors, or local posts to
detect unreported clusters or high-risk areas.

Q4.In the case scenario from the Al-

Hayat District, collecting data from both
formal and informal channels during a
disease outbreak poses several
challenges:
---
1. Data Validity and Reliability:
Formal channels (e.g., hospitals, clinics): May
underreport due to overwhelmed staff or limited
surveillance systems.
Informal channels (e.g., social media, community
rumors): Often unverified, may spread
misinformation or exaggeration.
---

2. Incomplete or Inconsistent Data

Community-level symptoms might not be medically
documented.
Informal sources often lack key epidemiological
details (e.g., onset date, exposure history,
outcomes).
---
3. Lack of Standardized Reporting
Health workers might use different criteria or
terminology for symptoms.
Informal reports do not follow a consistent format,
making analysis difficult
---
4. Accessibility and Coverage Gaps
Not all affected individuals may have access to
healthcare facilities (formal channel).
Vulnerable or rural populations may be missed by
both channels.
---

5. Privacy and Ethical Concerns

Collecting personal health information from social
media or informal networks raises ethical and legal
issues.
Ensuring informed consent and data confidentiality
is challenging.
---
6. Communication Barriers
Language, literacy levels, or cultural beliefs may
hinder accurate reporting from informal sources.
Fear of stigma or repercussions might prevent
honest disclosure.
---
7. Verification Challenges
Cross-checking informal reports with formal data
can be time-consuming.
Rumors (e.g., about water contamination) need
scientific verification before action is taken.
---

8. Limited Resources
Public health teams may lack the manpower or
tools to track and analyze informal data effectively
during a fast-moving outbreak.
---

Q 5: Which type of surveillance (active,

passive, sentinel, syndromic, or event-
based) would be most appropriate for:
1-Ongoing monitoring?
Syndromic surveillance would be most appropriate
for ongoing monitoring in this scenario. This
method focuses on tracking symptoms (e.g., acute
watery diarrhea, fever, vomiting) before confirmed
diagnoses are available, allowing for early detection
of trends.
2-Immediate outbreak response?
Active surveillance would be most suitable for an
immediate outbreak response. This involves health
authorities proactively seeking cases by contacting
healthcare facilities, households, and community
sources to identify all potential cases, confirm the
outbreak's scope, and implement control measures
(e.g., investigating water contamination). Active
surveillance ensures rapid data collection and
intervention.
Rationale:
- Syndromic surveillance is ideal for early detection
during ongoing monitoring because it captures
symptom-based data quickly.
- Active surveillance is necessary for outbreak
response to ensure no cases are missed and to
address the urgency of severe dehydration and
hospitalization risks.
Other types considered:
-*Event-based surveillance could complement both
tasks by monitoring rumors/social media, but it
lacks the systematic approach needed for
confirmation.
- Passive or sentinel surveillance may be too slow or
limited for this acute situation.

Q6: Based on what you know about

good surveillance systems, assess the
current response efforts. Are they:

1- Timely: Partially timely

⦁ Passive reports from hospitals and local clinics
incur delays in recognizing the full scope before
aggregation.
⦁ Social media rumors and NGO alerts provided
faster signals, but require verification before action.

2- Representative: Not fully representative

‐Hospital data over‐represent severe cases (e.g.
hospitalized children) and miss mild community
cases.
⦁ Formal data largely capture those with access to
care; remote or underserved neighborhoods may
be under-represented.

3- Sensitive: Moderately sensitive

⦁ Severe cases (high fever, severe dehydration) are
making it into the system, but milder or self-treated
cases likely go unreported.
⦁ Community rumors suggest many families haven’t
sought formal care.
⦁ Without a lab confirmation strategy or
standardized case definition rollout to all providers,
early or suspected cases may slip.
4- Acceptable to the community: Variable
acceptability

⦁ Engagement so far has been mainly NGO-driven

rather than community-led.
⦁ Unchecked rumors on social media risk mistrust
or panic, potentially discouraging formal reporting.
⦁ Local health workers and NGO involvement
increase trust in some areas.

Q7: What ethical issues should you

consider when collecting information
from families and healthcare providers?

1. Privacy and confidentiality:

Patient information must be kept private and
shared only with permission.
2. Informed consent:
People should understand why data is being
collected and agree to it freely.

3. Respect:
Families and healthcare providers should be treated
with care, especially during stressful times.

4. Avoiding harm or discrimination:

Data should never be used in ways that cause blame
or stigma.

5. Building trust:
Being honest and clear helps the community feel
safe and willing to cooperate.
6. Voluntary participation:
No one should be forced to give information, it
should be their choice.

7. Data security:
All collected data must be stored safely to prevent
misuse

Q8. How can you ensure that

community rumors are addressed while
avoiding misinformation

Effectively addressing community rumors while

minimizing misinformation requires a rapid and
appropriate response approach:

1. Utilize event-based surveillance:

 Rumors and informal reports from media, NGOs,
and health workers, although these sources may
lack verification, they should be rapidly assessed
and responded to appropriately.

2. Coordinate with indicator-based surveillance:

Integrating event-based and indicator-based
surveillance forms what is termed the
"Epidemic intelligence", offering a comprehensive
understanding of the situation. As both systems are
essential components of national surveillance
system.

3. Ensure clarity and transparency

Communicate accurate, up-to-date information
through trusted sources
Use clear, simple language that the public can easily
understand.
4. Engage community leaders and media:
to rapidly counteract false claims and promote
behaviors of the community to health care

5. Verify all claims with reliable data:

Avoid responding based on speculation. All
community concerns. consistent surveillance data
and proper epidemiological analysis for the issue

6. Help ease the panic of the community

7. Team up with other organizations and

community leaders
to effectively distribute valid information