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TAF Prev Med Bull. 2010; 9(4): 303-308


The Development of case based Early Warning and Response System (EWRS) for communicable diseases with diarrhea (2008, Turkey)

Mehmet Ümit Topçu, Ali Göktepe, Mehmet Yılmaz, Sinan Kazaz, Sema Şevken, Belgin Ünal.

Abstract
AIM: Routine surveys do not detect early waterborn and foodborn infections which are mostly observed during the summer. This is a pilot project that is being implemented in Kocaeli, Malatya and Trabzon cities to detect and control diarrhoeal illnesses in the early stages. The aim of the project is to develop an applicable Early Warning System (EWRS) that can be implemented throughout the country.
METHOD: This research is a partial report of the diarrhoeal illnesses that were indicated in between 01/08/2008 – 01/10/2008. The weekly cases were calculated by moving averages of three week time in the same period of time in 2007. Then the results were converted to daily counts after adding 10% (threshold value) of the average of weekly observed counts. The daily expected case counts were collected from public hospitals and public village clinics in the same period of time by using the diagnosis which was defined as ICD10 code in advance. Having analysised the data in SPSS 15.0 programme, descriptive and pearson’s correlative statistics were done.
RESULTS: The findings fromKocaeli andr Trabzon were analysed by the pearson’s correlation and there was not a meaningful relationship between getting over the threshold and the precaution components. In Malatya, 206 warnings were recorded. The rate of the incidence was 0.2 – 23.2 per 1000 population in per week. The rate of the invasive E.coli outbreak which was experienced in Battalgazi was 22.1 per 1000 population. With the help of the EWRS, the risk of epidemi was determined 18 days in advance, then retrospectively EARS_X programme has statisticly confirmed the case as an “epidemi”. It was also confirmed that there was an intermediate level, a positive and statistical significant relationship between the weekly measured amount of chlorine residue and the threshold with pearson’s correlation.(r = 0,45; p< 0,001). The correlation between number of bacterial samples and thresholds were also similar.
CONCLUSION: The findings from a single region (Malatya) were determined as epidemic attack. The regional monitoring and supervision team was informed about the situation on time. In Battalgazi (which is very close to Malatya ) the case counts were limited with 1269. This prevented spread of highly communicable Enteroinvasive E. coli outbreak. Since manual data collection is difficult, EWRS should be integrated into an automated system.

Key words: Early Warning System, EARS-X, Outbreak control, surveillance



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