Evaluation of Acute Encephalitis Syndrome/ Japanese Encephalitis Surveillance System, Barpeta and Sivasagar Districts, Assam, India 2012-2013 Dr. Takujungla Jamir India Epidemic Intelligence Service (EIS) officer National Centre for Disease Control India

Background Japanese encephalitis (JE) Leading cause of vaccine preventable encephalitis Causes acute encephalitis syndrome (AES) Case fatality rate (CFR): 10% - 30% Assam state accounts for 51% of JE burden in India AES/JE surveillance system launched in November 2007 To detect outbreaks and prevent deaths due to AES/JE To monitor disease trends and impact of control strategies

Objectives To describe AES/JE surveillance system in Assam To identify strengths and constraints of surveillance system To make recommendations to strengthen surveillance

METHODS

Study Design Cross-sectional study Study Setting Barpeta district: high attack rate Sivasagar district: high case fatality rate Sampling Line list all blocks in Barpeta (7) and Sivasagar (8) Selected two blocks (sub district) per district by simple random sampling Sampled all health facilities in selected blocks

Selected Districts INDIA ASSAM SIVASAGAR BARPETA

Data Collection and Analysis Key informant interviews to describe system Review of records and reports from 2012 - 2013 Survey of health workers in health facilities Data analysis Epi-Info version 7 Calculated each indicator as proportion

Attributes Evaluated Timeliness Proportion of cases detected within one week of onset Proportion of health facilities reporting weekly Sensitivity: proportion of suspected cases identified at health facilities captured by surveillance system Representativeness Proportion of government health facilities reporting Proportion of private health facilities reporting

Attributes Evaluated Simplicity Proportion of health workers who felt format was simple Proportion of medical officers knowing case definition Acceptability Proportion of completed forms sent Proportion of health workers who found reporting format time-consuming Usefulness Proportion of outbreaks detected

RESULTS

Case Definition AES Suspect: person of any age, at any time of year with the acute onset of fever and a change in mental status or new onset of seizures (excluding simple febrile seizures). Probable JE: a suspected case that occurs in close geographic and temporal relationship to laboratory-confirmed case of JE in the context of an outbreak. Laboratory-confirmed JE: a suspected case that has been laboratory-confirmed as JE.

AES-JE Surveillance System State Surveillance Unit Portal District Surveillance Unit Syndromic Form (Suspected cases) Presumptive Form (Probable cases) Laboratory Form (Laboratory confirmed cases) Sub-center Primary Health Centre/Community Health Centre/Government/Private Hospitals Government/Private Laboratories

AES-JE Surveillance System State Surveillance Unit Active surveillance daily (outbreaks) Passive surveillance weekly Portal District Surveillance Unit Syndromic Form (Suspected cases) Presumptive Form (Probable cases) Laboratory Form (Laboratory confirmed cases) Sub-center Primary Health Centre/Community Health Centre/Government/Private Hospitals Government/Private Laboratories

Selected Health Facilities District Selected Blocks No. of Health Facilities Government Private Barpeta Nityananda 14 1 Chenga 11 Sivasagar Galekey 5 Khelua Total 35 3

Attributes Attribute Indicator Barpeta Sivasagar Timeliness Cases detected within one week 19/39 (49%) 89/102 (87%) Health facilities reporting weekly 20/26 (77%) 9/12 (75%) Sensitivity Suspected cases captured by surveillance system 22/22 (100%) 34/34 Representative Government health facilities reporting. 24/25 (96%) 10/10 Private health facilities reporting. 1/1 1/2 (50%)

Attributes Attribute Indicator Barpeta Sivasagar Simplicity Health workers who felt format was simple 25/26 (96%) 10/10 (100%) Medical officers with correct knowledge of case definition. 20/26 (77%) 9/12 (75%) Acceptability Completed forms sent 21/26 (81%) Health workers who found format time-consuming. 1/26 (4%) (0%) Usefulness Outbreaks detected 1/1 2/2

Limitation Data cannot be generalized Only two districts selected Only two blocks in each district

Conclusion Attributes Barpeta Sivasagar Sensitivity Good Usefulness Representativeness (government facilities) (private facilities) Not satisfactory

Conclusion Attributes Barpeta Sivasagar Simplicity (format) Good (case definition) Not satisfactory Acceptability Satisfactory Not Satisfactory Timeliness (case detection) (weekly reporting)

Recommendations Communicate to all health facilities to ensure regular reporting Increase public awareness of disease and need to report early at nearest health facility Train regularly health workers on case definition, recording and reporting of cases

Acknowledgement Dr. B C Bhagabati, Co- Author & Placement Supervisor Dr. A C Baishya, Mentor & Director, Regional Resource Centre, Guwahati, Assam Staff, IDSP Assam District Surveillance Unit, Barpeta and Sivasagar Dr. Kayla Laserson, Country Director,CDC, India Dr.Samir Sodha, Resident Advisor, CDC, India Dr. Venkatesh, Director, NCDC, Delhi, India

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