Compiling the weekly surveillance report and detecting alerts

Reports expected: 8. Received: 7 (Fond-Rouge missing). Completeness: 7 / 8 = 87.5%, above the 80% target.

Received before Monday 07/09 at 12:00: La Source, Morne-Vert, Trois-Ponts, Saint-Luc and Palmiste-Haut, i.e. 5. Timeliness: 5 / 8 = 62.5%, below the target.

Follow-up: HC Fond-Rouge (missing report, to be obtained by phone, including a "zero cases" report if that is the case; it had 2 AWD cases in week 35); Belle-Rive (one day late) and Cap-Ouest (two days late) for timeliness. Belle-Rive, which has cases and a death, is the most important to follow up.

AWD cases: 8 + 2 + 13 + 3 + 20 + 0 + 5 = 51, of which under 5: 3 + 0 + 4 + 1 + 6 + 0 + 2 = 16, i.e. 31.4%. Week 35 (same 7 facilities): 3 + 1 + 4 + 2 + 7 + 0 + 5 = 22: cases have more than doubled.

Deaths: 3. Overall case fatality rate: 3 / 51 = 5.9%; Belle-Rive 1 / 13 = 7.7%; Saint-Luc 2 / 20 = 10%. Far above the 1% target: a sign of late or inadequate case management (access to care, rehydration).

Incidence per 10,000: La Source 8/18,500 = 4.3; Morne-Vert 2/12,000 = 1.7; Belle-Rive 13/9,800 = 13.3; Trois-Ponts 3/21,000 = 1.4; Saint-Luc 20/35,000 = 5.7; Cap-Ouest 0; Palmiste-Haut 5/10,400 = 4.8 (to be checked). Overall: 51 / 114,300 x 10,000 = 4.5. Belle-Rive has the highest incidence, even though Saint-Luc has the most cases.

Malaria: Belle-Rive excluded (71 positive results for 64 tests, impossible). Tests 120 + 85 + 140 + 210 + 40 + 55 = 650; positives 18 + 9 + 22 + 35 + 6 + 8 = 98; positivity 15.1%.

• Belle-Rive: 71 positive tests for 64 tests performed: impossible. Call the facility manager and check the laboratory register (possible transposition, or positive tests from another period).
• Palmiste-Haut: all values identical to week 35: report probably copied. Check against the week 36 consultation registers; if there really are 5 cases, the alert applies.
• Fond-Rouge: report missing: there is no way of knowing whether there are zero cases or unreported cases; it must not be counted as zero.
• Morne-Vert: a suspected measles case appears only in the weekly report; check whether it was notified immediately as the rule requires, and whether a sample was taken.
• Cap-Ouest: zero AWD cases for two weeks, at a time of rising cases in the department: plausible but to be confirmed (genuinely verified "zero cases" or a cell left blank?).

• Saint-Luc hospital: 20 cases (5 or more), increase from 7 to 20 (more than doubled) and 2 deaths: AWD alert.
• Belle-Rive dispensary: 13 cases, from 4 to 13 (more than tripled) and 1 death: AWD alert.
• HC La Source: 8 cases (5 or more) and from 3 to 8 (more than doubled): AWD alert.
• HC Palmiste-Haut: 5 cases: threshold reached; the data is suspect, but the alert is passed on with the note "data to be checked" rather than held back.
• HC Morne-Vert: 1 suspected measles case: immediate notification, sample collection and investigation.
• Not concerned: Trois-Ponts (from 2 to 3, neither doubled nor 5 cases), Cap-Ouest (0), Fond-Rouge (no data).

Transmission: the same day, without waiting for the full compilation, to the surveillance officer of the departmental team and to my supervisor (the organisation's health coordinator), by phone and then in writing, according to the department's alert pathway. The assistant passes on the information; they do not communicate the figures to the press or to partners without authorisation.

Example: "Subject: AWD and measles ALERT, week 36, Port-de-Paix area. Week 36: 51 AWD cases in 7 facilities out of 8 (Fond-Rouge not received), against 22 in week 35, 31% of them in children under 5; 3 deaths (case fatality rate 5.9%). Thresholds exceeded: Saint-Luc (20 cases, 2 deaths), Belle-Rive (13 cases, 1 death, incidence 13.3 per 10,000), La Source (8 cases), Palmiste-Haut (5 cases, data being checked). One suspected measles case in Morne-Vert, sample to be confirmed. Checks in progress: Fond-Rouge report, Belle-Rive malaria data. Compilation file attached. Contact: [name, phone]."