epinato-2 weekly reporting feedback missing data 10 tur and 20 hun- no doc nid sheet: all mtfs: not...

NATO UNCLASSIFIED

1 of 11 NATO UNCLASSIFIED

NATO CENTRE OF EXCELLENCE FOR MILITARY MEDICINE

DEPLOYMENT HEALTH SURVEILLANCE CAPABILITY

MUNICH,80637, GERMANY Dachauer Strasse 128 Building 12

Phone: 00498912494003/4004, Fax: 00498912494015

Mail to: [email protected]

EPINATO-2 WEEKLY REPORTING FEEDBACK FOR KFOR

1. INTRODUCTION

Calendar Week 2017 / 11

Mission Kosovo Force

Summary of findings and recommendations

The overall health surveillance picture for KFOR is somewhat unsettled this week. Several events of interest for individual MTFs are detailed in section 4.

2. DATA COVERAGE

MTF coverage 12 / 14

Estimated coverage

98 %

Missing data 10 TUR and 20 HUN- no doc NID Sheet: all MTFs: not filled in

Interpretation Thank you for your support!

Notes MTF coverage indicates how many of the MTFs liable to submit an EpiNATO return have done so. MTFs with a liability to report are defined by the Medical Advisor and usually include, at least, all Role 1 MTFs that have an embedded physician. Estimated coverage indicates how representative the data is of the total population of the mission. It is only shown when the mission HQ reports the total strength of the deployed force. This is compared with the sum of PARs reported by MTFs. It is possible for coverage to exceed 100%; this could be due to changes in PAR during the reporting week, double affiliations or inaccuracy in determining the actual PAR

mailto:[email protected]

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3. TOTAL CONSULTATION RATE (TCR)

Findings

The overall TCR for KFOR is stable, but is higher than the historical baseline and was again very close to the upper expected this week.

KF

OR

Pec Vucitrn

Villagio Italia CMLT

01 AUT

07 ITA

11 USA

08 POL

19 NSPA

20 HUN

21 DEU

Rate 11.3 7.2 3.4 4.6 11.7 16.0 --- ---

Trend → ↘ → → → → --- ---

Table 1 – Total Consultation Rate for mission and individual MTFs (Part 1 of 2)

Pristina Urosevac Prizren

Film City KTM MSU Bondsteel Prizren Sultan Murat

02 CHE 04 ITA

09

POR/HUN 06 ITA

12 USA

05 DEU

10 TUR

Rate 44.2 8.2 --- 8.3 4.0 8.5 24.3 ---

Trend ↗ ↗ --- → → → → ---

Table 1 – Total Consultation Rate for mission and individual MTFs (Part 2 of 2)

Notes TCR includes all presentations at MTFs during the reporting period (new and follow-up).

Total Consultation Rate (TCR) is reported per 100 person-weeks.

TCR is deemed stable if it is within 3 standard deviations of the average TCR for the preceding 4 weeks.

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Figure 1 – u-Charts of TCR for mission

Notes The u-Chart is a method for monitoring rates over time. The TCR should be expected to vary week by week within certain limits. If the variation is outside expected limits, further investigation may be required.

Figure 2 – Funnel plot of TCR for mission by location of camps

Notes Funnel plots can help to visualize variation in rates between different locations. The expected limits of variation take account of the different sizes of PAR. Small populations have wider expected limits than large ones.

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4. NEW CONSULTATION RATE (NCR)

Findings and recommendations

We have noticed a rate of event A (gastro-intestinal illness) at CHE and ITA Pristina that exceeded the expected limits of the new consultation rate. We recommend reinforced hygiene measures and information to prevent further spread of illness. It would be good to know whether there exists a common cause for both of these findings in the same site and possibly coordinate control efforts.

A number of MTF’s reported somewhat higher levels of event B (upper respiratory tract infection), which may just reflect seasonal variation. DEU Prizren reported a new consultation rate for event F (hemorrhagic illness) that exceeded the expected limits. This is a rarely reported event and we would be interested to know whether there is a suspected cause for this.

DEU Prizren has reported an unusual high number of cases of event H (acute neurological disorders) that exceeded the expected limits. Even though this is a relative rarely reported event, there seems to be a slightly increasing trend since the end of last year. This may only reflect increased vigilance, rather than cause for concern. Unless local knowledge provides other clues, we will continue to monitor this.

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Notes Table 2 below summarizes the analysis of NCR. The analysis methods used include u-Charts and EWMA which are described further in the glossary. The NCR is reported per 100 person weeks. The analysis is performed by a specialist in public health/epidemiology using recognized methods. Where a NCR violates the defined threshold, it is highlighted in red. This suggests that the NCR this week is different from the expected based on previous experience. If further action is recommended, this will be noted in the “Findings” above. There are situations where the figures suggest something unusual but haven’t violated the defined threshold. In this case, the NCR is highlighted in Yellow. Again, if further action is recommended, this will be noted in the “Findings” above.

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Mission 4 week trend** and rate

Pec Vucitrn

Villagio Italia CMLT

01 AUT 07 ITA 11 USA 08 POL 19 NSPA 20 HUN 21 DEU

A- Gastro-intestinal infection (GII)

1.9 0.5 0.8

B - Upper respiratory tract infection

1.3 2.0 1.4 4.3 6.0

C - Reactive airway disease (RAD) / Asthma

<0,1

D - Influenza-like illness (ILI) and lower respiratory tract infection

0.7 0.3 2.0

E - Fever of unknown origin

F - Hemorrhagic illness

<0,1

G - Musculo – skeletal disorders (MSD)

1.1 0.7 1.0 6.0

H - Acute neurological disorders

<0,1

I - Psychiatric or mental disorders

0.2

J - Dermatological disorders

0.5 0.2 0.5 0.8 2.0

K - Sexual exposure

L - Dental disorders

1.5 0.4 1.0 1.2

M - Animal bites and stings

<0,1

N - Battle related injuries (BI)

O - Non-battle sport related injuries (NBI/Sp)

0.4 1.0 1.2 8.0

P - Non-battle non-sport related injuries (NBI/NSp)

0.4 0.8 2.0

Q - Climatic or environmental injuries

Table 2 – NCR for mission and individual MTFs by Event Code (Part 1 of 2)

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Pristina Urosevac Prizren

Film City KTM MSU Bondsteel Prizren Sultan Murat

02 CHE 04 ITA --- 09

POR-HUN 06 ITA 12 USA 05 DEU 10 TUR

A- Gastro-intestinal infection (GII) 10.8 5.6 0.6 1.1

B - Upper respiratory tract infection 1.5 0.9 1.1 2.8

C - Reactive airway disease (RAD) / Asthma 1.1

D - Influenza-like illness (ILI) and lower respiratory tract infection 1.9 0.7 0.4 3.2


F - Hemorrhagic illness 0.4

G - Musculo – skeletal disorders (MSD) 0.8 0.4 1.1 2.7 0.6 4.1

H - Acute neurological disorders 0.6

I - Psychiatric or mental disorders 0.9 0.2

J - Dermatological disorders 0.4 1.7 0.7 0.3 1.3

K - Sexual exposure

L - Dental disorders 0.8 0.2 1.1 8.8

M - Animal bites and stings 0.4


O - Non-battle sport related injuries (NBI/Sp) 0.4 0.5 0.6

P - Non-battle non-sport related injuries (NBI/NSp) 2.3 0.6 0.2


Table 2 – NCR for mission and individual MTFs by Event Code (Part 2 of 2)

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5. TOTAL ESTIMATED LOST WORKING DAYS (TELWD)

Findings Lost working is above expected limits this week. This is caused by the high number of cases for gastrointestinal illnesses.

Event to report

Total estimated lost work days for mission

4 week trend Count

A - Gastro-intestinal infection (GII)

114

B - Upper respiratory tract infection (URTI)

15

C - Reactive airway disease (RAD) / Asthma

0

D - Influenza-like illness (ILI) and lower respiratory tract infection

11


0

F - Hemorragic illness

0

G - Musculo – skeletal disorders (MSD)

0

H - Acute neurological disorders

0

I - Psychiatric or mental disorders

0

J - Dermatological disorders

0

K - Sexual exposure

0

L - Dental disorders

0

M - Animal bites and stings

0


0

O - Non-battle sport related injuries (NBI/Sp)

1

P - Non-battle non-sport related injuries (NBI/NSp)

5


0

R - Unusual or exceptional events

0

Total

146

Table 3 – Total Estimated Lost Working Days for mission by Event Code

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Figure 3 – u-Charts of TELWD for mission

Notes u-Charts are a method for monitoring rates over time. The TCR should be expected to vary week by week within certain limits. If the variation is outside expected limits, further investigation may be required.

6. UNUSUAL OR EXCEPTIONAL EVENTS

Nothing to report.

7. NOTIFIABLE INFECTIOUS DISEASES

NID Sheet: not filled in.

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8. GLOSSARY MTF – Medical Treatment Facility = the smallest unit of reporting within this report. PAR – Personnel at Risk = the military personnel for whom MTFs have principal responsibility for providing Role 1 (primary) care. TCR – Total Consultation Rate = The sum of all consultation, both new and follow-up, seen during the reported week. This statistic is usually reported as per 100 person weeks. NCR – New Consultation Rate = The number of new consultation in each of the specific event categories. u-Chart – is a type of control chart that shows the rate during each reporting period along with the Centre Line and Upper and Lower Control Limits. This is at the core of our method to detect potential outbreaks using EpiNATO2 data. Funnel Plot – is a type of control chart that enables comparisons of PARs of different size alongside one another. The rate is plotted on the y axis and PAR on the x axis. The control limits for smaller PARs are wider than those for larger ones therefore the Upper and Lower control limits are curved and appear like a funnel that has been turned on its side hence the name funnel plot. CL – the Centre Line is a statistic shown on the control charts that estimates the expected average of the rate being monitored (ie. TCR, NCR, and TELWD). The CL is calculated based on 4 and 13 week periods. This statistic is usually reported as per 100 person weeks. LCL – the Lower Control Limit is a statistic shown on the control charts that estimates the minimum expected value of the rate being monitored (ie. TCR, NCR, and TELWD). The LCL is set 3 standard deviations below the CL. UCL – the Upper Control Limit is a statistic shown on the control charts that estimates the maximum expected value of the rate being monitored (ie. TCR, NCR, and TELWD). The UCL is set 3 standard deviations above the CL. EWMA – is a different type of control chart that takes into account historical data to determine whether the rate is within expected limits. It is better suited to monitoring rarer events or common events in smaller PARs. We use this as an add-on to u-Charts in certain situations. Interpreting control charts – When the rate being monitored lies between the LCL and UCL, it is usually considered to be “within expected limits”. Some variation in the rate is to be expected week to week and is considered normal or due to “common cause variation”; however, there are a number of situations when the variation is considered abnormal or due to “special cause variation”. There are a number of

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reasons which might explain an abnormal variation including: poor data quality, case-mix, or something is going on. Using this feedback. The feedback is intended to provide information about the health of the deployed force and early warning of emerging threats to their health. It is similar to a smoke detector in this respect by being sensitive to changes in the occurrence of illness. Unfortunately, it cannot explain why there has been a change and so further assessment and confirmation of the facts is necessary. This includes making use of local knowledge of the PAR, the operating environment, and anything else that could explain the real cause of the change. It is reliant on accurate and consistent reporting by MTFs as poor quality and missing data can cause false alarms.

epinato-2 weekly reporting feedback missing data 10 tur and 20 hun- no doc nid sheet: all mtfs: not...

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