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How Qatif responds to outbreaks

The Qatif Primary Health Care (PHC) Department is one of 12 districts that report notifiable diseases to the General Directorate for Primary Health Care in the Eastern Province. The Qatif district includes 26 primary health care centers, Qatif Central Hospital, Qatif General Hospital, one private hospital and 12 private dispensaries; all are required to report to the Qatif PHC Department. Patients may also seek treatment in nearby cities, such as Dammam or Khobar, or at Aramco. Qatif has a population of about 230,000 Saudis and 12,000 non-Saudis.
Each week the epidemiologist uses the computer to produce a graph of weekly incidence for each communicable disease (both suspect and confirmed cases) on the computer screen. These may be immediately compared with the pattern during previous years. When the epidemiologist notes any suspicious increase in incidence of any disease, he uses the computer to do a more detailed review by age, sex, nationality or residence. This weekly data review requires less than 30 minutes.
The speed of this system allows the epidemiologist to begin community-wide investigation without delay. Since both suspect and confirmed cases are entered, the epidemiologist is alerted to problems at a very early stage. For final reports to higher authorities it is a simple matter to restrict the data output to confirmed cases with complete investigations.
Several examples of outbreak investigations follow to illustrate prompt community-wide action in Qatif.
In late 1991, one Qatif PHC reported 35 measles cases among Mahri immigrants living in one house. The epidemiologic investigation identified 16 other houses with 700 Mahri in Qatif. None had previous measles vaccination and because of their previous isolation in remote areas of the Empty Quarter many had never been exposed to measles. The action was to vaccinate all Mahri in Qatif. No more measles occurred in the Mahri after the vaccination effort.
In early 1992 measles again appeared in Qatif (Chart 1). Prompt action identified a failure of vaccination policy in schools covered by a neighboring school district. We vaccinated all other children without written proof of vaccination in families with a case.
Later in 1992 an increase in typhoid fever was noted (Chart 2). The investigation revealed that typhoid was affecting Qatif residents who had visited Syria. It also eliminated the possibility that infection had been acquired in Qatif or during the travel to Syria or returning from Syria. However, a common source of typhoid in Syria was ruled out by the investigation. Waterborne typhoid remains the most likely, but unproven, cause. As action, PHC and hospital doctors were alerted to suspect typhoid fever in persons presenting with febrile illness after returning from Syria. Typhoid fever vaccine was recommended to Qatif residents going to Syria.

Editorial note:

Surveillance can be defined as information for action. Action for communicable diseases is often taken by the health inspector who visits patients and applies preventive measures to their contacts. However, many communicable diseases can have sources that are community-wide and do not involve contacts or person-to-person spread. This system illustrates how efficient handling of suspect cases using the computer can detect and trigger action directed to prevent community-wide spread of communicable disease.
The program for the Qatif surveillance system was developed on EpiInfo software. EpiInfo is available from the Field Epidemiology Training Program. Send two high-density diskettes or four double-density diskettes and your return address. The data entry format for the surveillance system will be provided.
Regions interested in developing computerized surveillance for rapid epidemiologic action and efficient management of surveillance data may contact the Field Epidemiology Training Program, Ministry of Health, for additional information and discussion.