Surveillance system

The recommendation is to establish the EWARN/Surveillance System, which focuses on communicable diseases of public health significance that are most likely in this setting. The reporting forms should be simple, with a standardized case definition. Data from laboratory resources need to be included. The system established should complement any existing surveillance structures. There needs to be the ability for real-time evaluations and prompt investigation of unusual events and rumors of outbreaks. This should be led by one agency that is identified as responsible for coordinating activities and linking all other agencies.

Health-care facilities should be used as appropriate sites for vaccinations. The following are considerations:

1. Vaccinations offered as part of national immunization programs should be made available to infants and other persons.

2. Measles immunization should be a high priority, along with supplementation with vitamin A. This should be provided for all children aged 6 months through 14 years, regardless of prior vaccination or disease history. The highest priority should be given to children aged 6 months to 4 years, and to those who are malnourished. It should also be noted that one case of suspected measles should prompt immediate implementation of measles control, and acceleration of the measles vaccination strategy.

3. Hepatitis A vaccine is not recommended for routine use, but may be used to control outbreaks.

4. Tetanus vaccination should be offered for persons who have open wounds, as routinely recommended.

5. Oral cholera vaccine should be given in the context of a cholera epidemic, but this must be accompanied by other strategies of disease prevention, including sanitation.

6. Typhoid vaccines are not recommended for routine use, but may be used to control typhoid outbreaks.

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