In the case of salmonellosis, the first symptoms are evident during the first hours of the disease. Then, there is the development of dyspepsia that involves nausea and vomiting, spastic abdominal pain, and diarrhea. The first thing that needs to be done by a medical professional is to interview a patient in order to establish which tests are needed for the further diagnostics. Then, a clinician will order the bacteriological and serological analyses required to confirm the diagnosis of salmonellosis. The materials for the bacteriological tests are blood, feces, urine, vomit, gastric washings, bile, and pus from the foci of inflammation.
The ways of contracting salmonellosis are diverse. The most common source of salmonellosis is food, mostly the meat of animals and birds, and eggs. Germs enter the products with insufficient thermal processing such as a half-baked steak, raw eggs and soft-boiled or fried eggs. The improper storage and violation of basic rules of personal hygiene are also contributing factors to the possibility of contracting salmonellosis. The source of infection may also be animals, mostly domestic (cattle, pigs, cats, dogs), and birds. People, sick or healthy carriers of Salmonella infection, when the person is a source of infection to others, but he does not get sick, can also be transmitters of salmonellosis. The contamination is also possible through the contact with water during drinking or bathing. Therefore, in order to detect Salmonella cases and stop the disease from spreading, the epidemiologists must thoroughly interview patient zero, determine the source, and eliminate the threat.
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The main elements of the disease surveillance system consist of three subsystems: informational, diagnostic, and management. The informational subsystem must provide to the epidemiological department of the territorial center of hygiene and epidemiology the information about the following factors: infectious diseases for the past number of years, the infection pathogens and biological properties, the sanitary-hygienic condition of the territory and epidemiologically significant objects, the ongoing anti-epidemic measures and the quality of their performance. The information provided to the epidemiology department is a subject to the retrospective epidemiological analysis, in which the identified risk, risk areas, and risk time are used to assess the effectiveness of control activities. The diagnostic subsystem provides the following: the information about the current incidence (after one day, five days, ten days, and a month), the changes in social and environmental factors that may affect the incidence of infectious diseases, the information obtained in the survey of epidemic foci, and the information about the quality of implementation of anti-epidemic measures. The management subsystem combines the information received from the previous two subsystems to make the decisions regarding the disease. If every subsystem performs effectively, completes its objectives, and establishes proper communication with other subsystems, the surveillance system will be productive. However, there are several more recommendations for a communicable disease surveillance, including include the increase of the awareness of medical professionals about the disease, the simplification of the process of the report, frequent feedback between the elements of the system, and the expansion of the system, which means the involvement of competent laboratories.
Diagram of the flow of information in the Caribbean communicable disease surveillance system.
To evaluate the Caribbean disease surveillance system, there is the need to identify its strengths and weaknesses. The strengths include the following: the Caribbean medical professionals are very competent and acquainted with the reporting system, so they can be trusted by health providers. The report process is simplified by the well-established contact between doctors and patients, which means that health care providers can operate faster and with fresh information. As the result of the connection between patients and doctors, medical professionals have full access to the information about the population at risk and they can gather more data through the direct contact. The weaknesses include the reporting of the information about the diseases from clinicians to the health care system as insufficient and fragmentary. In addition, there is a lack in laboratories, which means that the diagnostic subsystem is fragile and it cannot present sufficient information. The epidemiology methods are underdeveloped and they cannot positively establish possible future outbreaks. The system has a bureaucratic features, which involves reports passing through numerous agencies before reaching the destination, which can lead to the loss of information and increase the time of response.
The recommendations for improving the Caribbean diseases surveillance system include the upgrade of the laboratories. They need to establish which diseases require extensive diagnosis. Additionally, they need to report directly to CAREC because the time of response is too long, and they need to use an electronic way of submitting data and the results of the tests. Another area that needs improving is epidemiology. There is a complete lack of resources necessary to establish a connection between the diseases and the location of the source of outbreaks.
One of the most important things that can encourage the acceptance of surveillance systems is to simplify the process of reporting. The medical forms should be reduced to include only the most important things, and the system needs to be completely computerized to decrease the time of response. Another way is to educate the laboratories and clinicians about the benefits of epidemiology. They need to be aware of its advantages and how it can simplify things for them and reduce the possibility of possible outbreaks. Finally, it is necessary to encourage every link in the surveillance system, demonstrate the positive results of their action to enforce the changes, and transform them into habits.