To be used in conjunction with
Pan American Health Organization
Scientific Publication No. 420

PAN AMERICAN HEALTH ORGANIZATION
Pan American Sanitary Bureau, Regional Office of the
WORLD HEALTH ORGANIZATION
525 Twenty-third Street, N.W.
Washington, D.C. 20037, U.S.A.

Disaster
Management Center
UNIVERSITY OF WISCONSIN-EXTENSION
Engineering and Applied Science
432 North Lake Street
Madison, Wisconsin 53706

608-262-2061 Telex No: 265452

Final examination

Multiple Choice

Circle the correct answer:

1. Probably the greatest risk leading to an epidemic after a natural disaster is:

a. poor sanitation
b. new diseases brought in by relief workers
c. diversion of scarce resources from normal public health activities
d. movement of large numbers of people from rural to urban areas
e. movement of large numbers of people from urban to rural areas

2. Weekly reporting from all units is best carried out by:

a. messenger
b. telephone, telegraph or shortwave radio
c. mail
d. word of mouth
e. none of the above

3. The most efficient way of handling rumors of any origin during and after disasters Is by:

a. explaining the situation to the media
b. visiting the area for an inspection
c. providing factual surveillance data
d. all of the above
e. b and c

4. Interruption of basic public health services:

a. may increase the probability of disease transmission after disaster in a developing country
b. is often overlooked and may increase disease transmission
c. may be the cause of an outbreak of communicable disease months after the disaster
d. ail of the above
e. b and c

5. Examples of communicable diseases which may cause primary disasters in developing countries are:

a. measles
b. poliomyelitis
c. malaria
d. all of the above
e. a and c

True/False

Indicate T or F:

____6. In most countries epidemiology units have the authority and resources to carry out necessary control measures.

____7. Improvised emergency vaccination of the general population against typhoid fever, tetanus, and cholera are necessary control measures following disasters.

____8. New diseases introduced into an area following a disaster have been historically a much bigger problem than diseases which occurred in the area before the disaster.

____9. With the exception of epidemics or unusual cases, field reports in long-term refugee camps need only be done once per week.

____10. There is no need to use standardized case definitions or symptom complexes during the relief effort, since all cases with generally similar descriptions are combined in the reports.

____11. Previous exposure and the development of immunity to disease frequently mean that rural populations without sanitary facilities are at a lower risk of acquiring communicable diseases than are urban dwellers and relief workers.

____12. A form of valuable feedback to field workers is a weekly report accompanied by background information.

____13. The national authority responsible for coordinating health activities after a disaster should be part of the Health Ministry or other principal health provider during normal times.

____14. An outbreak of communicable disease due to a disaster will be evident within two to three months.

____15. Infection rates in Latin American and Caribbean hospitals normally run as high as 20 percent.

____16. In a developing country, the interruption of basic public health services after disaster is often the result of the diversion of staff and financial resources to the relief efforts beyond the critical period.

____17. It is unlikely that a disease will be introduced into a disaster area through relief food supplies since they are usually tinned or processed.

____18. Once a rapid survey of a population establishes the level of communicable disease after a disaster, it is quite easy to decide on control measures.

____19. The diseases included in the national surveillance program of each country do not vary considerably.

____20. Experienced physicians from affected areas may fail to consider introduced diseases in their differential diagnosis.

____21. Epidemics can best be avoided by bringing people together in groups since discipline can be maintained and major risks avoided.

Disaster Development Problem

After reading about the disaster described below, you are to make decisions and answer questions relating to this disaster. For each question, record your responses on the answer sheet provided (see page 5) before going on to the next question.

(A) Flood

Background

A major flood has occurred in a Latin American country, where over 2,000 people died as a result of the disaster.

The flood, which occurred overnight, completely covered several towns. As a result of this, the affected area of approximately 100,000 people (approximately 40 towns) became isolated due to the total destruction of roads and other means of communication in the area. Sanitation and local health facilities have been damaged and mosquito control programs have been interrupted.

Problem (A-1)

The potential risk of communicable diseases after a disaster such as this is influenced by six types of adverse change.

List three of them.

Problem (A-2)

There are three ways in which susceptible populations may be exposed to communicable disease.

List two of them.

Problem (A-3)

A good predisaster surveillance system existed in the more densely populated northern section of the disaster area, but there is little predisaster epidemiologic data available about the rural, less densely populated southern section and no effective surveillance system.

As communications are slowly being reestablished, which of the following are appropriate?

Answer "A " for appropriate or "I" for inappropriate for each statement below:

____A new surveillance system should be established for the entire area, designed for this specific disaster.

____The existing surveillance system should be used for the northern area, and a traditional surveillance system should be implemented in the southern area during the immediate postdisaster period.

____Only official data sources should be used since unofficial sources, such as newspapers, may exaggerate problems or report rumors.

____Ad hoc relief teams in the disaster area are good sources of information, particularly in the southern area.

____It is of little value to receive reports of symptoms since surveillance must be in terms of specific diseases.

Problem (A-4)

Flood waters have receded in the northern section and people have returned to their homes. However, low-lying parts of the southern area are still flooded and a decision has been made to evacuate some areas and establish tent camps.

The national epidemiologist is involved in electing the camp sites. He has five major criteria.

List three of them.

Problem (A-5)

Most problems caused by the flood are being brought under control and most of the health systems and services are returning to their predisaster levels. More resources and equipment, used for urgent problems during the immediate postdisaster period, are becoming available to the epidemiologic surveillance teams and they are under great stress carrying out surveillance activities.

A rumor arises that an outbreak of influenza in a remote part of the southern region is spreading into an epidemic. Which of the following actions are appropriate?

Answer "A" for appropriate or "I" for inappropriate for each statement below:

____Have a respected national authority deny the rumor until more information is available.

____Try to contact health units in the area by radio to obtain more information.

____Take an epidemiologist away from other duties and send him to the area to investigate.

____Dispatch supplies of gamma globulin and influenza vaccine to the area for a mass immunization program, in case the rumor proves to be true.

____Cases of influenza in the area are confirmed by physicians in the area, so it is not necessary to use busy laboratory personnel and equipment to confirm the diagnoses.

Final Examination

Answer Sheet

(A-1) List three types of adverse change after a disaster that influence potential risk of communicable diseases.

1._____________________

2._____________________

3._____________________

(A-2) List two ways in which susceptible populations may be exposed to communicable disease.

1._____________________

2._____________________

(A-3) Answer "A" for appropriate or '7" for inappropriate for each statement below:

____A new surveillance system should be established for the entire area, designed for this specific disaster.

____The existing surveillance system should be used for the northern area, and a traditional surveillance system should be implemented in the southern area during the immediate postdisaster period.

____Only official data sources should be used since unofficial sources, such as newspapers, may exaggerate problems or report rumors.

____Ad hoc relief teams in the disaster area are good sources of information, particularly in the southern area.

____It is of little value to receive reports of symptoms since surveillance must be in terms of specific diseases.

(A-4) List three criteria, important to the national epidemiologist, in selecting sites for tent camps.

1. _____________________

2. _____________________

3. _____________________

(A-5) Answer "A" for appropriate or "I" for inappropriate for each statement below:

____Have a respected national authority deny the rumor until more information is available.

____Try to contact health units in the area by radio to obtain more information.

____Take an epidemiologist away from other duties and send him to the area to investigate.

____Dispatch supplies of gamma globulin and influenza vaccine to the area for a mass immunization program, in case the rumor proves to be true.

____Cases of influenza in the area are confirmed by physicians in the area, so it is not necessary to use busy laboratory personnel and equipment to confirm the diagnoses.

Course evaluation

Self Study Course on Epidemiologic Surveillance

1. What is your present position?___________________________________________

2. How many years have you spent in disaster-related work?_____________________

3. How many years of formal education do you have?

____0 to 6 years
____7 to 12 years
____12 to 16 years
____more than 16 years

4. How was the level of content in this course?

____too difficult
____about right
____too easy

5. Was the course material relevant to your work?

____yes
____no

6. How useful to you were the various components of the course? (Circle)

	Very Useful		OK		Not Useful
Study Guide	1	2	3	4	5
Textbook (PAHO Sci. Pub. #420)	1	2	3	4	5
Self-Assessment Tests	1	2	3	4	5

7. How valuable to you was the total course? (Circle)

Very Valuable		Of Some Value		Not Valuable
1	2	3	4	5

8. Additional comments_____________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Please return this to:
Disaster Management Center
UW-Extension Engineering
432 North Lake Street
Madison, WI 53706, USA

Thank you for taking a moment to complete this Course Evaluation.