1. Epidemiological Surveillance
Kumnuan Ungchusak
Bureau of Epidemiology
Department of Disease Control
Ministry of Public Health

2. Key points its significant surveillance system: How it works
Source of information
common weakness
how to improve
evaluation of surveillance system

3. Question : What are the role of these gods ?

4. Hakone’s Check point

5. I. The main purpose of Surveillance
Surveillance for
Knowledge of the distribution of health events
Rapid detection of outbreak
Public health planning and evaluation

6. II. Surveillance System: How it work?
1. Collection
Record and report
Collation:
data analysis
3. Information synthesis
4. Dissemination
timely
action oriented

7. III. Source of information
Morbidity
Mortality
Laboratory
Vaccines and drug
Outbreak news/ rumor
Vector
Behavior
Environmental
Demographic

8. Organization of Surveillance System
Ministry of Public Health
Dep of Disease Control
International Organization
Bureau of Epidemiology
Regional Disease Control Center
ข้อมูลรายงานโรค
Provincial Epidemiological Unit
ข่าวสาร/ข่าวกรอง
District Surveillance information center
Hospitals and clinic under universal coverage scheme
Hospitals
Under MOH
And universal coverage schemes
Private hospitals and clinics

9. Important CD Diseases Notification within 24 hours
1 SARS and Avian Flu Cholera Acute severely ill or death of unknown etiology Cluster of diseases with unknown etiology Anthrax Meningococcal meningitis Food poisoning outbreak Encephalitis Acute flaccid paralysis (AFP) Severe Adverse Events Following Immunization
๑๑ Diptheria ๑๒ Rabies

10. Important CD Diseases
1 Measles Pertussis Hand Foot and Mouth Diseases Influenza Leptospirosis Dysentery Severe pneumonia of unknown etiology Cluster of infectious cases Dengue/DHF

11. Weakness No action (surveillance for statistics)
No mandate (no receptor)
No funtional epidemiologist (CD4 <200)
No motivation

12. How to improve Surveillance

13. Surveillance and Rapid Response Team (SRRT)
Tsunami
Avian influenza
Cholera outbreak
Dengue

14. Surveillance and Rapid Response Team
Control action
ส่วนกลาง
C-SRRT
Intelligence
เขต
R-SRRT
Information
จังหวัด
P-SRRT
อำเภอ
D-SRRT
หมู่บ้าน
ตำบล
อสม ๑๐๐,๐๐๐

15. Influenza Pandemic 6 multi-countries 5. multiple outbreak
4. Confine easy H2H transmission
3. Human infection or inefficient H2H
2. Human at risk
1. New virus found

16. SRRTs Lay report Governor “SRRT ” 1030 Surveillance and Rapid Response
AI provincial Team (Human and Animal)
MoPH assigned “Mr. Bird Flu”
Health services
Governor
“SRRT ” 1030
Surveillance and
Rapid Response
Team
SRRTs
(800,000 village health volunteers & community leaders)
Lay report

17. (SRRT) Network Hospital Veterinarian Laboratory
History screening at all hospital
Testing of respiratory specimen
Survey of village and identify exposure
Active case finding and monitor
household member for 10 days
Antiviral prophylaxis for family member
of confirm H5 cases
Culling of affected poultry
Educated villagers to avoid risk
Laboratory
Pathologists

18. Early pandemic Alert phase 4 Isolation & treat Ro = 1.5 - 2
Operational criteria for action:
“5 or more cases within 10 days”
Epidemiological linkage
Human-to-human
Evidence of viral change
Isolation & treat
Antiviral prophylaxis for all contacts
Stop work /class in affected area
Ro =

19. Influenza A (H1) outbreak at Samutsakorn
1700 workers
ILI 180
stop work
Isolated dormitory
Daily temperature

20. Unknown pneumonia dead
SRRT: Prae
13 yrs old boy, fever 3 day
dead on arrival at district hospital , 6 April
3 out of 7 chicken died ??

21. Evaluation of surveillance system
Mandate
Structure
clear
unclear
staff
skill
equipment
funding
institution
functional
Input
Impact
Output
public health practice
morbidity
mortality
policy
information ( timely & action oriented)
investigation
implementation

22. Conclusion Surveillance to safeguard the people
Start with priority disease reporting
Timeliness is most crucial
Detection of outbreak
Investigation to know the cause