All information these cookies collect is aggregated and therefore anonymous. Taking these factors into account, the following actions should be reconsidered at each progressive stage of the field investigation: Adherence to these and other steps during epidemiologic field investigations can be integral to helping attain and optimize a scientifically rational basis for selecting and implementing public health interventions for controlling or terminating a problem. In contrast, attorneyswho either are representing plaintiff-patrons who putatively acquired their illnesses as a result of restaurant exposure or are defending a restaurant epidemiologically associated with a foodborne illness epidemicwill approach such a problem by using a legal framework for causation, which varies from epidemiologic causation (12). Three broad categories of determinants of human behavior will be discussed in this study session and you will have an opportunity to learn about the influence of these factors in determining human behavior. Preliminary control measures often can start on the basis of limited initial information and then be modified as investigations proceed. improving (secondary prevention) improving treatment and recovery (tertiary prevention). https://www.cdc.gov/vhf/ebola/clinicians/vaccine/index.html. Consequences to consider include the most common symptoms and syndrome caused, duration of illness, complications including hospitalization and case-fatality rates, need for treatment, and economic impact. Phase 3 trials are either completed and not published as yet, or ongoing. Tertiary prevention includes those preventive measures aimed at rehabilitation following significant illness. Public health interventions should be scientifically driven on the basis of established facts and data, current investigation findings, and knowledge from previous investigations and studies. Although salient sociopolitical forces (e.g., public fear or political outcry) might create pressures for rapid public health interventions, the interventions must be based on evidence. Epidemiologic field investigations usually are initiated in response to epidemics or the occurrence of other acute disease, injury, or environmental health problems. PRIMARY PREVENTION AND SECONDARY PREVENTION If overweight, aim for loss of 3-10% of body weight by caloric restriction and increased physical activity as part of comprehensive lifestyle program with focus on weight loss [Class I]. For any given problem, the type(s) and number of interventions to be implemented will vary, depending on the nature of the acute problem, including its cause, mode of spread, and other factors. For healthcare providers looking for information about the Ebola vaccine and vaccinating ACIP recommended groups, visit Ebola Vaccine: Information about Ervebo. For example, as indicated earlier in this chapter, excluding symptomatic employees and removing all possible existing sources of an enteric pathogen such as norovirus from a food preparation facility can be done regardless of the actual source of the outbreak (4). The criteria specified by Hilltemporality, strength of association, biologic gradient, consistency, plausibility, coherence, experiment, and analogyprovide a useful framework for assessing the strength of epidemiologic evidence developed during a field investigation. Click on various risk factors, demographics, diseases and conditions to see graphic comparisons. MMWR Morb Mortal Wkly Rep. 2015 Jan 16;64(1):20-7. Primary Prevention Primary prevention describes interventions aimed at preventing occurrences of disease, injury or disability. The MVA-BN-Filo component of the regimen is a multivalent vaccine based on modified vaccinia Ankara (MVA) vector expressing EBOV, Sudan virus, and Marburg virus glycoproteins and Tai Forest virus nucleoprotein, and is designed to provide immunity to the Sudan ebolavirus, Zaire ebolavirus, Tai Forest ebolavirus, and the Marburg virus. Emphasis of the primary prevention is, besides a sufficient calcium intake, to omit risk factors; with secondary prevention the use of medical treatments such as estrogens/gestagens, bisphosphonates, and recently also SERMs is applied. For most gastrointestinal outbreaks, selecting control measures depends on knowing whether transmission has resulted from person-to-person, foodborne, or waterborne spread and, if either of the two latter modes, on identifying the source. Accessibility StatementFor more information contact us atinfo@libretexts.orgor check out our status page at https://status.libretexts.org. Tertiary preventionthose preventive measures aimed at rehabilitation following significant illness. An experimental chimpanzee-derived adenovirus vector with an Ebola virus gene inserted that is still in early-stage trials. Phase 2 placebo-controlled trial of two vaccines to prevent Ebola in Liberia. [153]World Health Organization. The sore is the location where syphilis entered your body. 2020 [internet publication]. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Centers for Disease Control and Prevention. In his seminal article on criteria for assessing causal associations in epidemiology, Austin Bradford Hill concluded with a call for basing action on weighing the strength of the epidemiologic evidence against the severity of the consequences of delaying action and of taking premature action (1). Use of post-exposure prophylaxis after occupational exposure to Zaire ebolavirus. Interventions for preventing and controlling public health problemsincluding infectious disease outbreaks and noninfectious diseases, injuries, and disabilitiescan be approached through different classification schemes. http://www.ncbi.nlm.nih.gov/pubmed/27118786?tool=bestpractice.com 2018 May 18;217(suppl_1):S33-S39. Healthcare workers who may be exposed to infected patients should follow these steps: Practice proper infection control and sterilization measures, Isolate suspected patients from each other if possible, and confirmed patients from suspected patients, Avoid direct contact with bodies of people who have died from confirmed or suspected infection. Make sure that you are comfortable with the difference between primary prevention activities and secondary prevention activities. However, adapting certain intervention components might be necessary to make them more acceptable and responsive to the needs of the affected community, potentially affected persons, elected officials, and the media. This is a rapidly changing field. Prevention, as it relates to health, is really about avoiding disease before it starts. A hospital patients death from Legionnaires disease might lead to political pressure to consider closing the hospital. This vaccine has not yet been approved by the FDA for routine use. Here health educators such as Health Extension Practitioners can help individuals acquire the skills of detecting diseases in their early stages. [82]Centers for Disease Control and Prevention. Primary Care. Second Ebola vaccine to complement ring vaccination given green light in DRC. February 2016 [internet publication]. http://www.ncbi.nlm.nih.gov/pubmed/29788347?tool=bestpractice.com Relative emphasis of investigative and control efforts (intervention options) in disease outbreaks as influenced by levels of certainty about etiology and source or mode of transmission. One example is botulism, which is a low-probability but high-consequence event. Conteh MA, Goldstein ST, Wurie HR, et al. August 2018 [internet publication]. If exposure to body fluids from a patient with suspected infection has occurred, the person should immediately wash affected skin surfaces with soap and water and irrigate mucous membranes with copious amounts of water. Lancet Infect Dis. Human Behaviour and Health: 1, http://labspace.open.ac.uk/mod/oucontent/view.php?id=452836, Health Education, Advocacy and Community Mobilisation, http://labspace.open.ac.uk/mod/oucontent/view.php?id=452834&printable=1, status page at https://status.libretexts.org. September 2019 [internet publication]. In practice, however, control measures might be appropriate or warranted at any step in the sequence. [213]Savini H, Ficko C, Simon F. Post-exposure prophylaxis in Ebola virus disease: don't forget the psychological factors. Thank you for taking the time to confirm your preferences. Primary prevention includes those measures that prevent the onset of illness. Donning activities must be directly observed by a trained observer, and a final check performed before entering the patient care area, During patient care: PPE must remain in place and be worn correctly for the duration of exposure to potentially contaminated areas. The two doses of this vaccine use two different vaccine components (Ad26.ZEBOV and MVA-BN-Filo) and the regimen requires an initial dose and a booster dose 56 days later. { "1.01:_Introduction_to_Personal_Health_Overview_and_Objectives" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "1.02:_Health_and_Disease_Influence_of_Family_and_Community" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "1.03:_Three_Levels_of_Health_Promotion_Disease_Prevention" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "1.04:_Culture_Beliefs_Attitudes_and_Stigmatized_Illnesses" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "1.05:_Determinants_of_Health_Risk_Factors_and_Prevention" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()" }, { "00:_Front_Matter" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "01:_Introduction_to_Personal_Health" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "02:_Nutritional_Health" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "03:_Personal_Relationships_and_Violence" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "04:_Human_Sexuality_Contraception_and_Reproduction" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "05:_Physical_Activity" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "06:_Substance_Abuse_and_Addictions" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "07:_Aging_Dying_and_Death" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "08:_Diseases_and_Disorders" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "zz:_Back_Matter" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()" }, 1.3: Three Levels of Health Promotion/Disease Prevention, [ "article:topic", "license:ccbyncsa", "licenseversion:40" ], https://med.libretexts.org/@app/auth/3/login?returnto=https%3A%2F%2Fmed.libretexts.org%2FCourses%2FLumen_Learning%2FBook%253A_Contemporary_Health_Issues_(Lumen)%2F01%253A_Introduction_to_Personal_Health%2F1.03%253A_Three_Levels_of_Health_Promotion_Disease_Prevention, \( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}}}\) \( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash{#1}}} \)\(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\) \(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\)\(\newcommand{\AA}{\unicode[.8,0]{x212B}}\), 1.2: Health and Disease, Influence of Family and Community, 1.4: Culture, Beliefs, Attitudes, and Stigmatized Illnesses, Health Education, Advocacy and Community Mobilization Chapter: 4. These basic dichotomies are illustrated in Figure 11.1 by four examples that represent the extremes. If infection is suspected, the patient should be put in isolation and all healthcare workers in contact with the patient should wear personal protective equipment. Both categories encompass some of the same options and thus are not completely mutually exclusive. In this chapter, the model used to systematically identify and characterize the spectrum of intervention options for outbreaks and other acute health threats focuses on two basic biologic and environmental dimensions: (1) interventions that can be directed at the source(s) of most infectious and other disease-causing agents and (2) interventions that can be directed at persons susceptible to such agents (Box 11.2). Efficacy and effectiveness of an rVSV-vectored vaccine in preventing Ebola virus disease: final results from the Guinea ring vaccination, open-label, cluster-randomised trial (Ebola a Suffit!). The immediate action drills to take in the event of a high-risk exposure (needle stick injury and mucous membrane splash) should be clear to all healthcare workers. The vaccine is administered as a 2-dose heterologous course, given 8 weeks apart. Secondary prevention aims to detect and treat disease or its complications at an early stage, before symptoms or functional losses occur, thereby minimizing morbidity and mortality. Use shelter-in-place (i.e., reverse quarantine). Interventions targeting specific aspects of the relation between the host, environment, and disease-or injury-causing agent; Primary, secondary, and tertiary prevention options; and, Haddons injury prevention model, which keys on intervention strategies at the preevent, event, and postevent phases (. It is believed to occur naturally in specific animal populations that live in multiple sub-Saharan African countries. In the areas where EVD is most common, Ebola virus is believed to spread at low rates among certain animal populations. These entities need to be aware of the possibilities, the ongoing risks (if any), and how best to address them given the level of information available. 2021 Aug 25;30 (3):177-186. doi: 10.1055/s-0041-1731273. Now more than ever, health promotion is crucial for our survival, not only to protect ourselves but also to protect those around us. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Patients in the treatment arm received the vaccine immediately, while vaccination was delayed by 21 days in the control arm. This is the first FDA-approved vaccine for Ebola. Phase 2 placebo-controlled trial of two vaccines to prevent Ebola in Liberia. World Health Organization. PEP is recommended in high-risk patients (e.g., people with broken skin or mucous membrane contact with an infected patient (alive or deceased) or their body fluids, a penetrating sharps injury, or contact with contaminated gloves or clothing). During any outbreak, multiple groups of persons might be exposed, affected, or involved in some respect. It is a live attenuated vaccine which contains vesicular stomatitis virus that has been modified to contain a protein from the Zaire ebolavirus. [212]Fischer WA Nd, Vetter P, Bausch DG, et al. These same concerns commonly confront epidemiologists during field investigations. Each stage has different signs and symptoms. https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html, Donning: PPE must be donned correctly in proper order before entry into the patient care area. We take your privacy seriously. [211]Wong KK, Davey RT Jr, Hewlett AL, et al. Current Status of Primary, Secondary, and Tertiary Prevention of Coronary Artery Disease Int J Angiol. Kennedy SB, Bolay F, Kieh M, et al. Centers for Disease Control and Prevention. Secondary Prevention Secondary prevention, a form of early disease detection, identifies individuals with high risk factors or preclinical diseases through screenings and regular care to prevent the onset of disease. https://www.who.int/news-room/detail/23-09-2019-second-ebola-vaccine-to-complement-ring-vaccination-given-green-light-in-drc. Primary prevention aims to prevent disease or injury before it occurs. The greater the severity, the sooner a public health intervention is expected. Interventions Directed at Susceptible Persons or Animals. In the prototypic investigation, control measures are formulated only after other steps have been implemented (see Chapter 3). These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. It is also recommended for healthcare personnel involved in the care and transport of patients with suspected or confirmed Ebola virus infection at special pathogens treatment centers, and people who work in Laboratory Response Network facilities that handle specimens that might contain replication-competent Ebola virus(Zaire ebolavirus) in the US. Ebola (Ebola virus disease): prevention and vaccine. Avoid contact with bats, forest antelopes, and nonhuman primates (such as monkeys and chimpanzees) blood, fluids, or raw meat prepared from these or unknown animals (bushmeat). You will be subject to the destination website's privacy policy when you follow the link. If, at a subsequent point, the nature of the risk for infection is more sharply defined, then additional, tailored corrective measures can be directed at the source and/or mode of spread. The social determinants of health framework also provides a guide to prevention, which requires changing both . Use contact tracing, partner notification, and treatment. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1 The most effective prevention interventions identify and . For example, an outbreak of Salmonella enterica serovar Typhimurium across multiple states during 2008 required extensive multipronged epidemiologic field investigations and analytic (case control) studies before peanut butter and peanut buttercontaining products were identified as the transmission vehicles (6). 2 2016 Aug 1;63(3):376-9. Secondary prevention. http://www.ncbi.nlm.nih.gov/pubmed/29582761?tool=bestpractice.com, Use of this content is subject to our disclaimer. http://www.ncbi.nlm.nih.gov/pubmed/26321189?tool=bestpractice.com. Remember that primary prevention activities will actually stop the illness happening, while secondary activities stop the illnesses getting worse. Clinical surveillance and evaluation of suspected Ebola cases in a vaccine trial during an Ebola epidemic: the Sierra Leone trial to introduce a vaccine against Ebola. During the 20142015 Ebola virus disease epidemic in parts of West Africa, many US jurisdictions, often for political reasons, implemented strict quarantine and health monitoring for persons who had traveled to an affected country, despite these persons having no history of exposure to anyone with Ebola virus infection (15). Table Chemoprevention and Immunization for Older Patients Table Lifestyle Measures That Help Prevent Common Chronic Diseases Screening Among certain sectorsfor example, the legal profession, private enterprise, and even regulatory agenciesacceptance of epidemiologic conclusions has been slower, in part because of the nature of causation in epidemiology: epidemiologic evidence establishes associations, not hard, irrefutable proof. August 2018 [internet publication]. Guidance on personal protective equipment to be used by healthcare workers during management of patients with confirmed Ebola or persons under investigation for Ebola who are clinically unstable or have bleeding, vomiting, or diarrhea in US hospitals, including procedures for donning and doffing PPE. Similarly, clusters of a healthcare-associated infectionespecially among postsurgical or immunocompromised patientsare often investigated because of the potential for serious complications and greatly prolonged hospitalization, the possibility of iatrogenic illness as an avoidable medical event, and the immediate need to resolve questions about the safety of continuing to admit patients to the hospital (2). Secondary prevention includes those preventive measures that lead to early diagnosis and prompt treatment of a disease, illness or injury. When living in or traveling to a region where Ebola virus is potentially present, there are a number of ways to protect yourself and prevent the spread of EVD. Although this sort of prompt and appropriate response addresses the possibility of continued transmission on the basis of known agent-specific facts and experience, epidemiologists sometimes need to extend the investigation, depending on the circumstances and needs (e.g., when a trace-back is indicated to identify a continuing primary source for a restaurant-associated outbreak, such as shellfish or lettuce that was contaminated before being harvested) (5). Secondary prevention is the early detection and early treatment of health conditions, with the aim of curing or lessening their impacts. CDC: the buddy system The Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) produce detailed guidance on PPE: CDC: guidance on personal protective equipment (PPE) to be used by healthcare workers during management of patients with confirmed Ebola or persons under investigation (PUIs) for Ebola No patients who received the vaccine developed Ebola virus infection 10 days or more after randomization in the immediate-treatment arm; however, cases occurred in unvaccinated patients in the comparison group. In the areas where EVD is most common, Ebola virus is believed to spread at low rates among certain animal populations. 22017 Feb 4;389(10068):505-18. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32621-6/fulltext, http://www.ncbi.nlm.nih.gov/pubmed/28017403?tool=bestpractice.com. Notify health officials if you have direct contact with the body fluids of an infected patient. 1990;132:9196. 2017 Oct 12;377(15):1438-47. It may also be considered in patients with intact skin-only contact with an infected patient (alive or deceased) or their body fluids. As part of the deliberation about when and how to intervene, effective and continuous communication with all concerned entities is essential. For example, years elapsed after field studies had clearly implicated antecedent aspirin use as a risk factor for Reye syndrome (10) before industry and the Food and Drug Administration accepted the association and issued warnings to that effect. That does not confer upon us a freedom to ignore the knowledge we already have, or to postpone the action that it appears to demand at a given time. The vaccine has been authorized under exceptional circumstances, and is not appropriate for an outbreak response where immediate protection is necessary. Examples include screening for high blood pressure and breast self-examination. alleviate the burden. Cookies used to make website functionality more relevant to you. Guidelines for the management of pregnant and breastfeeding women in the context of Ebola virus disease. Breast self-examination is a good example of secondary prevention. CDC twenty four seven. If there is a partial or total breach in PPE (e.g., gloves separate from sleeves leaving exposed skin, a tear develops in an outer glove, a needlestick) during patient care, the healthcare worker must move immediately to the doffing area to assess the exposure and implement the facility exposure plan, if indicated. Describe the role of the community health nurse in primary, secondary, and tertiary prevention through tasks such as case finding, reporting, data collection, analysis, and follow-up. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Implement all reasonable empiric interventions. N Engl J Med. Isolate infected persons, including cohorting, if needed. These interventions are grouped according to those that can be directed at the source(s) of most infectious and other disease-causing agents and those that can be directed at persons susceptible to such agents. HPV vaccination; From 30 years of age for women from the general population and 25 years of age for women living with HIV: All women as needed: Girls and boys should also be offered, as appropriate. A randomized, placebo-controlled phase II trial found that an antibody response to vaccination with ChAd3-ZEBOV or rVSV-ZEBOV was observed in 71% to 84% of active-vaccine recipients versus 3% of placebo recipients by 1 month. ATOD prevention is categorized by three types of strategies: Primary, Secondary, and Tertiary prevention. It is usually the first point of contact for . Primary, Secondary, and Tertiary Prevention Strategies in Early Childhood Supports Scientific advances in the late 20th century led to dramatic progress in public understanding of how experiences and environments shape brain health and impact developmental trajectories. Your feedback has been submitted successfully. The three levels of prevention are primary, secondary, and tertiary. For example, in a suspected restaurant-associated foodborne illness outbreak, restaurant patrons, the public, owners and management, media, attorneys, and public health officials are each likely to have a different threshold for judging the degree of association between eating food from the restaurant and illness. Think about your experience of health education, whether as an educator or recipient of health education. the focus is on the causes of crime rather than its effects; the goal is to significantly reduce or eliminate the factors that can to lead crime. These cookies may also be used for advertising purposes by these third parties. 2017 Nov 15. pii: S1473-3099(17)30677-1. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30677-1/fulltext, http://www.ncbi.nlm.nih.gov/pubmed/29153266?tool=bestpractice.com. In primary prevention, a disorder is actually prevented from developing. In this situation, the public health field epidemiologists concerns might focus especially on the criteria of strength of association and dose-response effect between exposure to a certain food item and illness, whereas a restaurant patrons primary concern is simply plausibility. This is shown below in Table 1. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1. In the US, the Centers for Disease Control and Preventions Advisory Committee on Immunization Practices recommends pre-exposure vaccination for adults 18 years of age who are at highest risk for potential occupational exposure to Ebola virus because they are responding to an outbreak, work as healthcare personnel at a federally designated Ebola treatment center in the US, or work as laboratorians or other staff members at biosafety level 4 facilities in the US. The consequences, even more than the probability, tend to drive perception of the importance of intervening. They help us to know which pages are the most and least popular and see how visitors move around the site. [79]Centers for Disease Control and Prevention. Use barrier methods (e.g., face masks, condoms). https://www.cdc.gov/mmwr/volumes/71/wr/mm7108a2.htm?s_cid=mm7108a2_w. Field investigations often occur in the public limelight, whether intentionally or not. It has been defined as the plans for, and the measures taken, to prevent the onset of a disease or other health problem before the occurrence of the undesirable health event. Moreover, at any step in the investigation, evidence that satisfies a specific criterion might be unavailable. Note an example of possible health education interventions at each level where you think health education can be applied. Avoid funeral or burial practices that involve touching the body of someone who died from EVD or suspect EVD. Portions of this chapter as incorporated within previous editions of this book were adapted from Goodman RA, Buehler JW, Koplan JP. This recommendation includes adults who are. During epidemics, direct contact with any dead body should be avoided. Key factors that influence decisions about the timing and choice of public health interventions include a carefully crafted balance among. This section examines three highly interrelated key determinants: severity of the problem, levels of certainty about key epidemiologic factors, and causation criteria. It is recommended by WHOs Strategic Advisory Group of Experts (SAGE) on Immunization as part of a broader set of Ebola outbreak response tools. eCollection 2021 Sep. Selection from measures listed in Box 11.2 and other alternatives might be considered at any stage of a field investigation. Cookies used to make website functionality more relevant to you.