Released May 19, 2017 ISSN 0799-3927

NOTIFICATIONS-

All clinical

sites

INVESTIGATION

REPORTS- Detailed Follow

up for all Class One Events

HOSPITAL ACTIVE

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sites*. Actively pursued

SENTINEL

REPORT- 79 sites*.

Automatic reporting

*Incidence/Prevalence cannot be calculated

1

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Week ending May 6, 2017 Epidemiology Week 18

WEEKLY EPIDEMIOLOGY BULLETIN NATIONAL EPIDEMIOLOGY UNIT, MINISTRY OF HEALTH, JAMAICA

Weekly Spotlight

EPI WEEK 18

More than 3000

adolescents die

every day, totaling

1.2 million deaths a

year, from largely

preventable causes,

according to a new

report from WHO

and partners. In

2015, more than

two-thirds of these

deaths occurred in low- and middle-income countries in Africa and

South-East Asia. Road traffic injuries, lower respiratory infections, and

suicide are the biggest causes of death among adolescents.

Most of these deaths can be prevented with good health services,

education and social support. But in many cases, adolescents who suffer

from mental health disorders, substance use, or poor nutrition cannot

obtain critical prevention and care services – either because the

services do not exist, or because they do not know about them. In

addition, many behaviors that impact health later in life, such as

physical inactivity, poor diet, and risky sexual health behaviors, begin

in adolescence.

In 2015, road injuries were the leading cause of adolescent death among

10–19-year-olds, resulting in approximately 115 000 adolescent deaths.

Older adolescent boys aged 15–19 years experienced the greatest

burden. Most young people killed in road crashes are vulnerable road

users such as pedestrians, cyclists and motorcyclists.

The picture for girls differs greatly. The leading cause of death for

younger adolescent girls aged 10–14 years are lower respiratory

infections, such as pneumonia – often a result of indoor air pollution

from cooking with dirty fuels. Pregnancy complications, such as

hemorrhage, sepsis, obstructed labor, and complications from unsafe

abortions, are the top cause of death among 15–19-year-old girls.

Adolescent health needs intensify in humanitarian and fragile settings.

Young people often take on adult responsibilities, including caring for

siblings or working, and may be compelled to drop out of school, marry

early, or engage in transactional sex to meet their basic survival needs.

As a result, they suffer malnutrition, unintentional injuries, pregnancies,

diarrheal diseases, sexual violence, sexually-transmitted diseases, and

mental health issues.

Downloadedfrom:http://www.paho.org/hq/index.php?option=com_content&view=article

&id=13313%3Amore-than-12-million-adolescents-die-every-year-nearly-all-

preventable&catid=1443%3Aweb-bulletins&Itemid=135&lang=en

SYNDROMES

PAGE 2

CLASS 1 DISEASES

PAGE 4

INFLUENZA

PAGE 5

DENGUE FEVER

PAGE 6

GASTROENTERITIS

PAGE 7

RESEARCH PAPER

PAGE 8

Released May 19, 2017 ISSN 0799-3927

NOTIFICATIONS-

All clinical

sites

INVESTIGATION

REPORTS- Detailed Follow

up for all Class One Events

HOSPITAL ACTIVE

SURVEILLANCE-30

sites*. Actively pursued

SENTINEL

REPORT- 79 sites*.

Automatic reporting

*Incidence/Prevalence cannot be calculated

2

REPORTS FOR SYNDROMIC SURVEILLANCE FEVER Temperature of >380C /100.40F (or recent history of fever) with or without an obvious diagnosis or focus of infection.

KEY RED CURRENT WEEK

FEVER AND NEUROLOGICAL Temperature of >380C /100.40F (or recent history of fever) in a previously healthy person with or without headache and vomiting. The person must also have meningeal irritation, convulsions, altered consciousness, altered sensory manifestations or paralysis (except AFP).

FEVER AND HAEMORRHAGIC Temperature of >380C /100.40F (or recent history of fever) in a previously healthy person presenting with at least one haemorrhagic (bleeding) manifestation with or without jaundice.

50

500

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Nu

mb

er

of

Cas

es

Epidemiology Weeks

Fever in under 5y.o. and Total Population 2017 vs Epidemic Thresholds, Epidemiology Week 18

Total Fever (all ages) Cases under 5 y.o.

0

10

20

30

40

50

60

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Nu

mb

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of

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es

Epidemilogy Weeks

Fever and Neurological Symptoms Weekly Threshold vs Cases 2017, Epidemiology Week 18

2017 Epi threshold

0

2

4

6

8

10

12

14

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Nu

mb

er

of

Cas

es

Epidemiology Weeks

Fever and Haem Weekly Threshold vs Cases 2017, Epidemiology Week 18

Cases 2017 Epi threshold

Released May 19, 2017 ISSN 0799-3927

NOTIFICATIONS-

All clinical

sites

INVESTIGATION

REPORTS- Detailed Follow

up for all Class One Events

HOSPITAL ACTIVE

SURVEILLANCE-30

sites*. Actively pursued

SENTINEL

REPORT- 79 sites*.

Automatic reporting

*Incidence/Prevalence cannot be calculated

3

FEVER AND JAUNDICE Temperature of >380C /100.40F (or recent history of fever) in a previously healthy person presenting with jaundice.

ACCIDENTS Any injury for which the cause is unintentional, e.g. motor vehicle, falls, burns, etc.

VIOLENCE Any injury for which the cause is intentional, e.g. gunshot wounds, stab wounds, etc.

The epidemic threshold is

used to confirm the

emergence of an epidemic

so as to step-up appropriate

control measures.

0

2

4

6

8

10

12

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Nu

mb

er

of

Cas

es

Epidemiology Weeks

Fever and Jaundice Weekly Threshold vs Cases 2017, Epidemiology Week 18

Cases 2017 Epi threshold

50

500

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Nu

mb

er

of

Cas

es

Epidemiology Weeks

Accidents Weekly Threshold vs Cases 2017

≥5 Cases 2016 <5 Cases 2016 Epidemic Threshold<5 Epidemic Threshold≥5

1

10

100

1000

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Nu

mb

er

of

Cas

es

Epidemiology Week

Violence Weekly Threshold vs Cases 2017

≥5 y.o <5 y.o <5 Epidemic Threshold ≥5 Epidemic Threshold

Released May 19, 2017 ISSN 0799-3927

NOTIFICATIONS-

All clinical

sites

INVESTIGATION

REPORTS- Detailed Follow

up for all Class One Events

HOSPITAL ACTIVE

SURVEILLANCE-30

sites*. Actively pursued

SENTINEL

REPORT- 79 sites*.

Automatic reporting

*Incidence/Prevalence cannot be calculated

4

CLASS ONE NOTIFIABLE EVENTS Comments

CONFIRMED YTD AFP Field Guides

from WHO

indicate that for an

effective

surveillance

system, detection

rates for AFP

should be

1/100,000

population under

15 years old (6 to

7) cases annually.

___________

Pertussis-like

syndrome and

Tetanus are

clinically

confirmed

classifications.

______________

The TB case

detection rate

established by

PAHO for Jamaica

is at least 70% of

their calculated

estimate of cases in

the island, this is

180 (of 200) cases

per year.

*Data not available

______________

1 Dengue Hemorrhagic

Fever data include

Dengue related deaths;

2 Maternal Deaths

include early and late

deaths.

CLASS 1 EVENTS CURRENT

YEAR PREVIOUS

YEAR

NA

TIO

NA

L /

INT

ER

NA

TIO

NA

L

INT

ER

ES

T

Accidental Poisoning 30 61

Cholera 0 0

Dengue Hemorrhagic Fever1 0 0

Hansen’s Disease (Leprosy) 0 0

Hepatitis B 5 11

Hepatitis C 1 2

HIV/AIDS - See HIV/AIDS National Programme Report

Malaria (Imported) 2 1

Meningitis ( Clinically confirmed) 8 22

EXOTIC/

UNUSUAL Plague 0 0

H I

GH

MO

RB

IDIT

/

MO

RT

AL

IY

Meningococcal Meningitis 0 0

Neonatal Tetanus 0 0

Typhoid Fever 0 0

Meningitis H/Flu 0 0

SP

EC

IAL

PR

OG

RA

MM

ES

AFP/Polio 0 0

Congenital Rubella Syndrome 0 0

Congenital Syphilis 0 0

Fever and

Rash

Measles 0 0

Rubella 0 0

Maternal Deaths2 13 23

Ophthalmia Neonatorum 78 177

Pertussis-like syndrome 0 0

Rheumatic Fever 1 3

Tetanus 1 0

Tuberculosis 0 11

Yellow Fever 0 0

Chikungunya 0 0

Zika Virus 0 17

Released May 19, 2017 ISSN 0799-3927

NOTIFICATIONS-

All clinical

sites

INVESTIGATION

REPORTS- Detailed Follow

up for all Class One Events

HOSPITAL ACTIVE

SURVEILLANCE-30

sites*. Actively pursued

SENTINEL

REPORT- 79 sites*.

Automatic reporting

*Incidence/Prevalence cannot be calculated

5

NATIONAL SURVEILLANCE UNIT INFLUENZA REPORT EW 18

April 30- May 6, 2017 Epidemiology Week 18

April 2017

EW 18 YTD

SARI cases 5 210

Total Influenza

positive Samples

0 7

Influenza A 0 0

H3N2 0 0

H1N1pdm09 0 0

Not subtyped 0 0

Influenza B 0 7

Other 0 0

Comments:

During EW 18, SARI activity

slightly decreased and was below

the average epidemic curve. During EW 18, SARI cases were

most frequently reported among

children between 0-4 years of

age.

During EW 18, pneumonia case-

counts slightly decreased (150

cases in EW 18), and were

similar to the levels observed in

2015 and the prior season.

During EW 18, no influenza

detections were reported but only

one sample was tested. INDICATORS

Burden

Year to date, respiratory

syndromes account for 3.3% of

visits to health facilities.

Incidence

Cannot be calculated, as data

sources do not collect all cases

of Respiratory illness.

Prevalence

Not applicable to acute

respiratory conditions.

0

500

1000

1500

2000

2500

3000

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Nu

mb

er o

f C

ases

Epi Weeks

Fever and Respiratory 2017

<5 5-59

≥60 <5 years epidemic threshold

5 to 59 years epidemic threshold ≥60 years epidemic threshold

0%

20%

40%

60%

80%

100%

120%

0

1

2

3

4

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Pe

rce

nta

ge o

f p

osi

tive

s

Nu

mb

er

of

po

siti

ve s

amp

les

Distribution of Influenza and other respiratory viruses among SARI cases by EW surveillance

EW 18, 2017, NIC Jamaica

A(H1N1)pdm09 A not subtyped A no subtypable A(H1)

A(H3) Flu B Parainfluenza RSV

Adenovirus Methapneumovirus Rhinovirus Coronavirus

0%

1%

2%

3%

4%

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Per

cen

tage

of

SAR

I cas

es

Epidemiological Week

Jamaica: Percentage of Hospital Admissions for Severe Acute Respiratory Illness (SARI 2017) (compared with 2011-2016)

SARI 2017

Average epidemic curve (2011-2016)

Alert Threshold

Seasonal Trend

Released May 19, 2017 ISSN 0799-3927

NOTIFICATIONS-

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HOSPITAL ACTIVE

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sites*. Actively pursued

SENTINEL

REPORT- 79 sites*.

Automatic reporting

*Incidence/Prevalence cannot be calculated

6

Dengue Bulletin April 30- May 6, 2017 Epidemiology Week 18

DISTRIBUTION

Year-to-Date Suspected Dengue Fever

M F Un-

known Total %

<1 1 0 0 1 2.6

1-4 2 1 0 3 7.9

5-14 4 5 0 9 23.7

15-24 4 3 0 7 18.4

25-44 6 5 1 12 31.6

45-64 1 3 0 4 10.5

≥65 0 0 0 0 0 Unknown 1 1 0 2 5.3

TOTAL 19 18 1 38 100

Weekly Breakdown of suspected and

confirmed cases of DF,DHF,DSS,DRD

2017

2016 YTD EW

17 YTD

Total Suspected

Dengue Cases 2 31 663

Lab Confirmed Dengue cases

0 0 81

CO

NFI

RM

ED

DHF/DSS 0 0 3

Dengue Related Deaths

0 0 0

0

50

100

150

200

1 3 5 7 9 111315171921232527293133353739414345474951

No

. of

Cas

esEpidemeology Weeks

2013 2014 2015 2016 2017

0.0 0.0

0.5

0.0

1.0

0.0 0.1

0.50.9 0.9

0.30.0

2.2

0.0

0.5

1.0

1.5

2.0

2.5

Susp

ecte

d C

ases

(P

er

100,

000

Po

pu

lati

on

)

Suspected Dengue Fever Cases per 100,000 Parish Population

0

1000

2000

3000

4000

5000

6000

7000

Nu

mb

er

of

Cas

es

Years

Dengue Cases by Year: 2007-2017, Jamaica

Total confirmed Total suspected

Released May 19, 2017 ISSN 0799-3927

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up for all Class One Events

HOSPITAL ACTIVE

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SENTINEL

REPORT- 79 sites*.

Automatic reporting

*Incidence/Prevalence cannot be calculated

7

Gastroenteritis Bulletin April 30- May 6, 2017 Epidemiology Week 18

Year EW 17 YTD

<5 ≥5 Total <5 ≥5 Total

2017 160 205 365 4,368 4,581 8,949

2016 96 195 291 2,648 3,893 6,541

Figure 1: Total Gastroenteritis Cases Reported 2016-2017

0

200

400

600

800

1000

1200

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Nu

mb

er o

f C

ases

Epidemiology Weeks

Gastroenteritis Epidemic Threshold vs Cases 2017

<5 Cases ≥5 Cases Epi threshold <5 Epi threshold ≥5

0.0

50.0

100.0

150.0

200.0

250.0

300.0

KSA STT POR STM STA TRE STJ HAN WES STE MAN CLA STC

Suspected GE Cases < 5 yrs/ 100 000 pop 198.7 162.1 111.1 164.9 168.1 203.6 116.3 169.5 123.3 57.2 148.7 93.2 54.1

Suspected GE cases ≥5yrs/ 100 000 pop 112.5 162.1 178.2 237.0 241.3 235.2 148.4 201.3 190.3 105.2 186.7 148.3 54.6

Highest number of cases < 5 /100,000 pop 0

Highest number of cases ≥ 5/100,000 pop 0

Susp

ecte

d C

ases

(P

er 1

00

,00

0 P

op

ula

tio

n) Suspected Gastroenteritis Cases per 100,000 Parish Population

Saint Ann reportedthe highest number ofGE cases per 100,000in their 5 years oldand over population

Trelawny reported thehighest number of GEcases per 100,000 intheir under 5 yearsold population

EW

18 Weekly Breakdown of Gastroenteritis cases Gastroenteritis:

In Epidemiology Week 18, 2017, the

total number of reported GE cases

showed an 8.5% increase compared to

EW 18 of the previous year.

The year to date figure showed a 7.2%

increase in cases for the period.

Released May 19, 2017 ISSN 0799-3927

NOTIFICATIONS-

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INVESTIGATION

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HOSPITAL ACTIVE

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SENTINEL

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Automatic reporting

*Incidence/Prevalence cannot be calculated

8

RESEARCH PAPER

A Description of Registered Nurses’ Documentation Practices and their Experiences

with Documentation in a Jamaican Hospital

C Blake-Mowatt, JLM Lindo, S Stanley, J Bennett

The UWI School of Nursing, Mona, The University of the West Indies, Mona, Kingston 7, Jamaica

Objective: To determine the level of documentation that exists among registered nurses employed at a Type

A Hospital in Western Jamaica.

Method: Using an audit tool developed at the University Hospital of the West Indies, 79 patient dockets

from three medical wards were audited to determine the level of registered nurses’ documentation at the

hospital. Data were analyzed using the SPSS® version 17 for Windows®. Qualitative data regarding the

nurses’ experience with documentation at the institution were gathered from focus group discussions

including 12 nurses assigned to the audited wards.

Results: Almost all the dockets audited (98%) revealed that nurses followed documentation guidelines for

admission, recording patients’ past complaints, medical history and assessment data. Most of the dockets

(96.7%) audited had authorized abbreviations only. Similarly, 98% of the nurses’ notes reflected clear

documentation for nursing actions taken after identification of a problem and a summary of the patients’

condition at the end of the shift. Only 25.6% of the dockets had nursing diagnosis which corresponded to the

current medical diagnosis and less than a half (48.3%) had documented evidence of discharge planning. Most

of the nurses’ notes (86.7%) had no evidence of patient teaching. The main reported factors affecting

documentation practices were workload and staff/patient ratios. Participants believed that nursing

documentation could be improved with better staffing, improved peer guidance and continuing education.

Conclusion: Generally, nurses followed the guidelines for documentation; however, elements were missing

which included patient teaching and discharge planning. This was attributed to high patient load and

nurse/patient ratio.

The Ministry of Health

24-26 Grenada Crescent

Kingston 5, Jamaica

Tele: (876) 633-7924

Email: surveillance@moh.gov.jm