Auditing the Management of Vaccine-Preventable Disease Outbreaks: The Need for a Tool

Abstract

Public health activities, especially infectious disease control, depend on effective teamwork. We present the results of a pilot audit questionnaire aimed at assessing the quality of public health services in the management of VPD outbreaks. Audit questionnaire with three main areas indicators (structure, process and results) was developed. Guidelines were set and each indicator was assessed by three auditors. Differences in indicator scores according to median size of outbreaks were determined by ANOVA (significance at p≤0.05). Of 154 outbreaks; eighteen indicators had a satisfactory mean score, indicator “updated guidelines” and “timely reporting” had a poor mean score (2.84±106 and 2.44±1.67, respectively). Statistically significant differences were found according to outbreak size, in the indicators “availability of guidelines/protocol updated less than 3 years ago” (p = 0.03) and “days needed for outbreak control” (p = 0.04). Improving availability of updated guidelines, enhancing timely reporting and adequate recording of control procedures taken is needed to allow for management assessment and improvement.

Selection of key recommendations for quality indicators describing good quality outbreak response

“…Two studies previously developed QIs applicable to some specific components of outbreak response [ 11 , 12 ]. One study focused on organizational aspects like vaccine availability, communication and reporting [ 11 ], while the other study focused on the correct and timely detection of the first cases and the initiation of prophylaxis, education and advice to healthcare workers [ 12 ]. Although there is some resemblance between the domains selected in these two studies and our study, our key recommendations are more detailed and specific, which is crucial for a valid and reliable assessment of quality but also for selecting targets for improvement.…”

“…In this manner, QIs provide a tool to systematically monitor response quality. Two studies developed QIs for infectious disease outbreak response describing the major domains of outbreak response [ 11 , 12 ]. Both studies lack transparency and reproducibility because they do not provide insight into among others; the selected literature, selected experts and the definition of consensus.…”

Factors Associated to Duration of Hepatitis A Outbreaks: Implications for Control

“…In summary, this study shows that timely intervention is the most important factor associated with outbreak duration. The link between surveillance units and laboratories has been shown to be positive in foodborne disease outbreaks allowing the implementation of public health interventions to prevent further cases [20] . Thus modifications of regulatory norms for reporting hepatitis A virus infection in clinical laboratories should be introduced to diminish outbreak duration.…”