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Syndrome of Fever

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					Syndrome of Fever
Diseases Under Surveillance : Malaria/ Typhoid / Measles / JE / Dengue Introduction – Why surveillance for fever? Fever is the most common symptom among patients presenting at the periphery. The common causes of fever are Upper respiratory infections, Malaria, etc. Of these, the disease conditions of public health interest are Malaria, Typhoid, Measles, JE and Dengue. While the latter two are not common, one needs to keep them under surveillance so that they are picked up early enough during an outbreak. To accommodate these 5 diseases, various subcategories of fever have also been developed; e.g. fever with rash (for suspected measles), fever with altered consciousness (for suspected JE) and fever with bleeding (suspected dengue or leptospirosis). Any fever of more than 7 days with none of the above symptoms may be considered as suspect typhoid. Syndrome definition

SYNDROME DEFINITION:
Clinical Description: A new patient with fever should be included under this definition. Further sub categories are as follows a).Fever less than 7 days with: Rash and coryza or conjunctivitis (suspected Measles) Altered sensorium (suspected JE or suspected Malaria) Convulsions (suspected JE) Bleeding from skin, mucus membrane, vomiting blood or passing fresh blood or black motion (suspected dengue) With none of the above (suspected malaria) b).Fever > 7 days (suspected typhoid)

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SUMMARY WEEKLY REPORTING FORMAT FOR SYNDROME OF FEVER For Health Worker Form-A Name ID No./unique identifier 1 Fever
Cases Cases of fever < 5 yr Fever < 7 days 1. 2. 3. 4. only fever With rash With bleeding With altered consciousness M > 5 yr To tal < 5 yr F > 5 yr To tal <5 yr Grand Total M > 5 yr Tot al <5 yr Deaths F >5 yr Tot al Grand Total

Name of the supervisor Date of reporting

Name of the reporting unit Reporting week

Specific Action action Taken (No. of taken slides collected)

Fever > 7 days

Not Done Done Remarks/ status

Specific Action Points
1. Fever with rash TRIGGER POINT A single case Active search for similar cases

2. Collect details of age/sex/location and immunization status of all cases
3. Ensure MO PHC verifies diagnosis of measles within next 48 hours. (either ensure referral or MO makes field visit) Active search for similar cases Collect details of age/sex/location and immunization status of all cases.

Fever with bleeding/ with altered sensorium TRIGGER POINT A single case

1. 2.

3. Ensure MO PHC examines the case/s within 48 hours and sends blood
sample to District Lab. with appropriate form No….. 1. Referral to the next level to rule out or confirm Typhoid.

Fever > 7 days

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When to initiate Local Response The trigger levels for syndrome of fever for initiating local response by the field staff are as follows:
1. At the Subcentre level two cases or more of Fever with Rash, Altered Consciousness or Bleeding should immediately inform the concerned MO regarding the disease occurrence. 2. Any increasing trend in fever (as compared to the previous weeks) should be informed to the MO. 3. Fever cases clustering together in a village should also be informed to the MO

Surveillance Action by ANM if threshold is crossed:
• • • • • Initiate Case Management – symptomatic treatment with Paracetamol. Refer Case to PHC/CHC if needed Search for more cases and do a line listing (as per form attached). Inform MO PHC /CHC Collection of lab samples - Smear should be taken to detect malarial parasite Prevention of further cases / deaths – as per the instructions of the MO

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1.

Preparation of Blood smear:

Confirming diagnosis of Malaria is by blood smear examination or by Rapid Diagnostic Test for Malaria (RDT. This is performed at each of the reporting centers. However quality control for smear examination is carried out by the District Public Health Laboratory where ever relevant.

Procedure:
Collection of Sample: Collect blood either during or 2-3 hours after the peak of temperature. Sample should be taken before administration of anti-malarial drugs. Preparation of blood smear: Both thick and thin films should be mae on the same slide Blood samples should be collected from the tip of the ring finger of the left hand.. However in small children, sample should be collected either from the heal or tip of the big toe of the foot taking all aseptic precautions using sterile needle or lancet. Apply gentle pressure to the finger and collect a single small drop of blood on to the middle of the slide.This is for the thin film. Apply further pressure to express more blood and collect 2 or 3 large drops of blood on the slide about 1 cms from the drop intended for thin film. Wipe the remaining blood away from the finger with a cotton wool. Thin Film: Using another clean slide as a spreader and with the slide with blood drops resting on a flat firm surface, touch the small drop with the spreader and allow the blood to run along its edge. Firmly push the spreader along with the slide way from the largest drop keeping the spreader at an angle of 45 degrees. Make sure the spreader is in even contact with the surface of the slide all the time the blood is being spread. Thick Film: Always handle slides by the edges or by a corner to make the thick film as follows: Using the corner of the preaer, quickly join the larger drops of blood and spread them to make an even thick film. The blood should not be excessively stirred but can be spread in a circular or rectangular form with 3-6 movements. Allow the thick film to dry in a flat level position protected from flies, dust and extreme heat. Label the dry film with a pen or marker pencil, by writing across the thick portion of the thin film the patients’ name , or number and the date. Do not use the ball pen to label the slide. Wrap the dry slide in clean paper and despatch with the patients record form to the laboratory as soon as possible. The slide used for spreading the blood films must be disinfected and should then be used for the next patient, another clean slide from the pack being used as a spreader.

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LINE LISTING OF CASES INVESTIGATING AT TRIGGER-1 RESPONSE BY CHC/PHC Form-D
District Code Number Unique identifier of Reporting unit No Date of onset of illness SYMPTOMS & SIGNS Exposure to risk factor Comments Date

Altered unconscious

Fever without signs

Treatment received

Fever > 7 days

Father’s name

Name of Village

Population of Village:

Number of affected People

< 5 Years

OUTCOME Dead / Alive

Bleeding

Address

Name

Rash

Age

Sex

>5 Years

Total

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Description: Syndrome of Fever