Cameroon Event-Based Surveillance (GHSA) in Action

“If there had been an early warning system in place before the Ebola outbreak in West Africa in 2014, a major disaster may have been averted,” says Dr. Luc Christian Gwom, Cameroon Ministry of Health (MoH). This sentiment is shared by Dr. Etoundi, the Director of the Directorate for the Fight against Disease, Epidemics, and Pandemics (DLMEP) in Cameroon.

In the past five years, Cameroon’s health system has faced many epidemics and threats, such as Ebola, polio, measles, cholera, avian flu, monkeypox. It has often taken a long time for public health authorities to learn about these events, and to connect the dots during a public health emergency. In order to reduce the time it takes to detect and promptly respond, the Cameroon MoH is launching a new, faster way to identify and report early warning signs called event-based surveillance, or EBS.

EBS is different from traditional types of surveillance, which use case definitions to collect data about patients at hospitals on a regular basis. EBS is a more ad hoc system that uses a wide variety of reporters, including community health workers, community members, doctors, and school teachers. These health informants immediately report to the public health system when they identify a potential signal of an event. This includes signals such as a cluster of 2 of more people from the same community with similar symptoms, or any patient displaying symptoms that are unusual or rarely seen.

To help demonstrate the feasibility of EBS in Cameroon, the DLMEP decided to implement two pilot projects: a community EBS in two districts, Bétaré-Oya and Deido, and an Unusual Respiratory EBS in hospitals in the capital city Yaoundé. If successful, these two projects will be integrated into Cameroon’s national Integrated Disease Surveillance and Response (IDSR) platform.

Representatives from the Ministry of Health (MoH), National Public Health Laboratory, and Centre Pasteur Laboratory Cameroon (CPC) participated in a training of trainers with U.S. CDC on Unusual Respiratory Event Based Surveillance.

Working with the community to detect and report early warning signs

Cameroon public health leaders at the Ministry of Health and U.S. Centers for Disease Control and Prevention (CDC) organized a train-the-trainer (TOT) session to teach district-level epidemiologists and healthcare workers about EBS. The participants were taught how to train other public health staff and key health informants to detect and report signals. During this TOT session, 43 medical doctors, epidemiologists, and key members of public health system were trained. Through the following cascade-style training, 3,000 community healthcare workers from the Bétaré-Oya and Deido districts were trained on EBS.

Training of hospital healthcare workers to detect and report unusual events

In light of Cameroon’s history of avian influenza outbreaks, Cameroon is piloting Unusual Respiratory EBS where clinicians are trained to recognize and report signals that could represent potential public health events. Dr. Richard Njouom, Head of the Virology Department at the Centre Pasteur Cameroon (CPC) said “We recently heard of a strain of H5N8 flu circulating in poultry since December 2016. We didn’t know if there had been any human cases. It is now very late for us in Yaoundé to learn about this, months after the fact. We need a hospital EBS system in place to help identify events as they occur.” If a person with exposure to poultry had presented to a hospital with respiratory illness, clinicians trained by the Unusual Respiratory EBS system would identify this as a signal. Signals in this EBS system include severe acute respiratory infection (SARI) in a person after exposure to sick/dead animals or SARI in a healthcare worker after treating patients with similar illness.

Cameroon 2017 community event based surveillance Training of Trainers Workshop

Forty healthcare workers from 10 hospitals in Yaoundé were trained to detect and report unusual respiratory signals to the public health system. These trainings also empowered nearly two dozen staff at the Cameroon MoH, Centre Pasteur Laboratory Cameroon, and the National Public Health Laboratory to understand and implement key concepts of EBS such as signal detection, triage, risk assessment, monitoring and building successful partnerships for public health practice.

Learning from the experience

Early results from the two pilot projects have shown how successful an EBS system can be in Cameroon. In the first few months, the EBS pilots have already reported over 570 early warning signals that led to the detection and response of 112 public health events including cases of measles and yellow fever. The U.S. Embassy has highlighted the project’s accomplishments through a diplomatic cable sent to US government agency leaders.

About This Story

This story illustrates Cameroon’s commitment to the Global Health Security Agenda (GHSA). Working with CDC’s Division of Viral Diseases and Division of Global Health Protection, Cameroon is building early warning capacities for infectious diseases. The country continues to work closely with local and international organizations, such as WHO and U.S. government agencies, to accelerate progress towards the GHSA.