STANDARD OPERATING PROCEDURES FOR ENHANCED ACTIVE CASE-BASED SURVEILLANCE
FOR EBOLA VIRUS DISEASE INSOUTH AFRICA, 2014
DIRECTORATE: EPIDEMIOLOGY AND SURVEILLANCE CLUSTER: HIMMENATIONAL DEPARTMENT OF HEALTH
ACRONYMS
CIF Case Investigation Form
DOH Department of Health
EVD Ebola Virus Disease
IHR International Health Regulations
NATHOC National Health Operations Centre
NDOH National Department of Health
NICD National Institute for Communicable Diseases
SOP Standard Operating Procedure
2 | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA
1. INTRODUCTIONIn light of the current EVD outbreak in West Africa, the National Department of Health has
instituted enhanced active case-based surveillance for clinically suspected and laboratory
confirmed Ebola Virus Disease (EVD) in South Africa.
2. PURPOSEThe aim of these Standard Operating Procedures (SOPs) is to guide health personnel at all
levels of the health care system (both in the public and private sector) in the implementation of
enhanced active case-based surveillance for the EVD in South Africa.
3. OBJECTIVETo 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 Objectivesa) To maintain zero reporting of EVD suspected 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 Daily National 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.
3 | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA
4 | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA
Case DefinitionsSuspected case
Any person* presenting with an acute onset of fever (≥38°C) with any of the following
additional symptoms: severe headache, muscle pain, vomiting, diarrhoea, abdominal
pain or unexplained haemorrhage who has:
Visited or been resident in Guinea, Liberia, Sierra Leone, Nigeria or another country
reporting imported cases with local transmission, in the 21 days prior to onset of illness
AND
Had direct contact or cared for suspected/confirmed EVD cases in the 21 days prior to
onset of illness, or been hospitalised in Guinea, Liberia, Sierra Leone, Nigeria or another
country reporting imported cases with local transmission
OR
Has unexplained multisystem illness that is malaria-negative
Confirmed CaseAny suspected case that has been laboratory confirmed.
ContactA person without any symptoms having had physical contact with an EVD case-patient,
or the blood/ body fluids of an EVD case-patient within the previous 21 days. The notion
of physical contact may be proven or highly suspected, such as having shared the same
room/bed, cared for an EVD case-patient, having had contact with an EVD case-patient’s
blood or body fluids, or closely participated in a burial of an EVD case-patient.
4 EVD DATA 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 completed by 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 EVD Testing: 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 an aggregated summary of suspected
and confirmed EVD cases, including zero reports;
e) EVD Line lists (Annexure 3): to be used by Provincial Communicable Disease Control
Focal Persons for a 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
interventions and publication of the National Situation Reports.
5 THE EVD OUTBREAK 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 will send zero (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 Person by 08:00 am. The list of Provincial Focal Persons
is indicated in Annexure 4.
5 | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA
B: SUSPECTED EVD CASESAny health care provider detecting and clinically diagnosing a patient who satisfies the case
definition for a suspected EVD case will immediately do the following:
STEP 1Perform risk assessment and complete a case investigation form (see annexure 1).
STEP 2
Immediately through telephone report the suspected EVD case to:
a. the Provincial Communicable and Disease Control Focal Person (see annexure 4);
b. the National Health Operating Centre (NATHOC) - 012 395 9636 or 012 395 9637 and;
c. the National Institute for Communicable Diseases (NICD) hotline - 082-883-9920.
STEP 3
Complete a written notification on the GW17/5 Notification Form immediately after the
suspected EVD case is identified. All notifications forms must immediately be sent to the
Provincial Communicable Disease Control Focal Person.
C: CONFIRMED EVD CASESAny suspected case will be laboratory confirmed by the NICD.
A health care provider will immediately after receiving laboratory confirmation, send a written
notification on the GW17/5 Notification Form to the Provincial Communicable Disease Control
Focal Person.
6 | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA
The legislative basis for disease notification in South Africa is the NATIONAL HEALTH ACT, 2003 (ACT NO. 61 of 2003).
5.2. Data Aggregation of EVD Cases at the Provincial Level
No EVD case detected (zero reporting)The Provincial Communicable Disease Control Focal Person will complete a Daily Situation
Report Form and indicate zero (0) if no EVD cases have been detected for that day. All zero
reports must be sent to the NATHOC by 09:00 am.
Suspected and confirmed EVD casesFor suspected and confirmed EVD cases, the Provincial Communicable Disease Control Focal
Person will do the following:
STEP 1Immediately through telephone report the suspected or confirmed EVD case to the NATHOC.
STEP 2Send copies of the GW17/5 Notification Form of the suspected or confirmed EVD cases to the
NATHOC.
STEP 2Summarize all individual notifications of the suspected and confirmed EVD cases into an
aggregated Daily Situation Report Form as well as a line list. All line lists and Situation Report
Forms must be sent to the NATHOC by 09:00 am each day.
5.3 EVD Laboratory TestingThe NICD will send laboratory test reports for all samples tested for EVD to (1) the health care
facility that requested the test, (2) the Provincial Communicable Disease Control Focal Person
and (3) the NATHOC as soon as the results become available.
7 | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA
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 and line lists of the suspected and confirmed cases of
EVD will 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 will assess 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 www.doh.gov.za as well
as on the viewing page of the NDOH Web-based Public Health Surveillance Notification
System www.nmc.gov.za.
6. CONTACT TRACINGContact 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 be
monitored 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.
8 | STANDARD OPERATING PROCEDURES FOR THE ENHANCED ACTIVE CASE-BASED SURVEILLANCE FOR THE EVD IN SOUTH AFRICA
Point of Detection - Detects a suspected case of EVD1.Do risk assessment and completes a case investigation form2.Immediately contacts:
a. the Provincial Communicable and Disease Control Focal Personb. NATHOC - 012 395 9636 or 012 395 9637c. NICD hotline - 082-883-9920.
2. If warranted collects and submits specimen for laboratory diagnosis (test to request VHF/EVD)
3. Completes GW17/5 Notification Form and send to the Provincial Communicable and Disease Control Focal Person
PROVINCE1. Immediately notifies NATHOC and sends copies of the GW 17/5 notification
forms2. Compile a Daily Situation Report Form and line list and send to NATHOC by
9am each day.
NATHOC1. Immediately verifies, validates, collates, analyzes and reviews all data from Provinces2. Immediately notifies the IHR Focal Point of any suspected or confirmed case3. Prepares daily surveillance reports
Public Health Cluster including the IHR Focal Point/Person1. Conduct risk assessment for all cases detected
2. Prepares National Situation Reports
NICD- Hotline provides guidance with regards to risk
assessment and meeting case definition- Conducts laboratory testing- Provides results/laboratory reports to NATHOC,
Provincial CDC and healthcare facility
National level
Province levelLocal level
Figure 1: Flow of information of for suspected and confirmed EVD cases
Annexure 1CASE INVESTIGATION FORM: REQUEST FOR EBOLA VIRUS DISEASE TESTING
PATIENT DETAILSSurname: Name/s: Date of birth: Age: Sex: Male FemaleContact telephone number/s: Occupation:Physical home address:
ATTENDING HEALTHCARE WORKER AND HEALTHCARE FACILITYDETAILSName 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
A. Date of onset of illness (dd/mm/yyyy):B. Clinical features(Tick appropriate box: yes, no, unknown)
Fever Yes □ No □ Unknown □ If yes, specify temperature ___°CHeadache 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, specifyDistribution 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:_____________________________________
C. Antimicrobial therapyHas the patient received any antibiotics therapy during this illness? Yes □ No □ Unknown □
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If yes complete the table belowAntibiotic 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 YD D M M Y Y Y Y D D M M Y Y Y YD 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 belowAntimalarial 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 YD D M M Y Y Y Y D D M M Y Y Y Y
D. Supportive management(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 INVESTIGATIONRESULTSFBCHaemoglobin:
RESULT g/dL
DATE……../……./……… Coagulation profile:
RESULT DATE……../……./………
Plateletcount: x 109/L ……../……./……… INR ……../……./………White cellcount: x 109/L ……../……./……… PTT ……../……./………Absolutelymphocytes x 109/L ……../……./……… D-dimers: ……../……./………Liver function testsTotal 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 ……../……./……… Other relevant tests and results (specify)
RISK FACTORS/ EXPOSURE HISTORY – during the 3 weeks prior to onset of symptoms
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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
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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 ConditionDetails/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: 012 395 9636 or 012 395 9637, Fax: 012 395 9722, E-mail: [email protected] or [email protected]
Annexure 3
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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: 012 395 9636 or 012 395 9637, Fax: 012 395 9722, E-mail: [email protected] or [email protected]
Annexure 4: List of EVD Contacts
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National Health Operations CentreNational Department of Health
Tel: 012 395 9637 or 012 395 9637
Fax: 012 395 9722,
E-mail: [email protected] or [email protected]
National Institute for Communicable DiseasesSpecial 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
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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 013 741 6278 072 511 0184
Gauteng Charlotte Maxeke Hospital Sister Felicity 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 018 406 4606 082 450 6116
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 043 709 2011 083 590 0499
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
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PROVINCE NAME TEL NUMBER FAX NUMBER EMAIL ADDRESS MOBILE No.
Eastern Cape Ms Lungelwa Quntana 040 608 0842/29 086 624 5696 or
043 642 1409
[email protected] 083 378 1771
Free State Ms Babsy Nyokong 051 408 1734 051 408 1074 [email protected] 083 452 8954
Northern Cape Mr Danie Stander 053 830 540/38 086 556 3960 [email protected] 083 449 4322
North West Ms Chriseldah Lebeko 018 391 4066 086 690 2756 [email protected] 079 521 5004
GautengMs Joy Mnyaluza 011 355 3867 011 355 3297 [email protected] 082 335 3134
Mr Rufus Makwela 011 355 3172 011 355 3297 [email protected] 071 365 8479
Limpopo
Mr. Eric Maimela
015 293 6059 015 293 6281 [email protected] or
084 686 5686
Ms. Freda Ngobeni 015 293 6062 015 293 6281 [email protected] or
079 491 1909
Mpumalanga
Mr Mandla Zwane 013 766 3078 013 766 3473 or
086 650 8656
[email protected] 082 229 8893 or
079 210 6549
Ms Riensie Vellema 013 766 3411 086 621 3058 [email protected] 083 289 6991
Western Cape
Mr Stephen Titus 021 483 3737 021 483 2682 [email protected] 083 488 0777
Ms Charlene Jacobs 021 483 9964 086 611 1092 or
021 483 2682
[email protected] 072 356 5146
KwaZulu-NatalMr Bruce Margot 033 846 7503 033 846 7272 [email protected] 083 457 1185
Ms Premi Govender 033 846 7461 033 846 7759 [email protected] 071 609 2505
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