Introduction to the Integrated Disease Surveillance Project IDSP training module for state and district surveillance officers Module 1

Learning objectives Define surveillance and explain important terminology in surveillance List all the components of the surveillance activities Specify the major objectives of the Integrated Disease Surveillance Project List types of surveillance carried out under the Integrated Disease Surveillance Project by different categories of staff Name all reporting units in the rural and urban areas of a district List all conditions under surveillance through primary health centre/community health centresystem

Health goals - India Eradicate polio 2005 Eliminate leprosy and yaws2005 Establish IDSP, NHA/Health Stats 2005 Zero-level growth of HIV/AIDS 2007 Eliminate Kala-Azar2010  Mortality by 50% - TB, malaria and other 2010  Prevalence of blindness to 0.5% 2010  IMR to 30/1000, MMR to 100/100, Eliminate lymphatic filariasis 2015

Public health surveillance Surveillance is defined as the ongoing systematic collection, collation, analysis and interpretation of data and dissemination of information to those who need to know in order that action be taken

Important information in surveillance Who get the disease? How many get them? Where they get them? When they get them? Why they get them? What needs to be done as public health response?

Why do we need to do surveillance? (1/2) Recognize cases or cluster of cases to trigger intervention to prevent transmission or reduce morbidity and mortality Assess the public health impact of health events or determine and measure trends Demonstrate the need for public health intervention programme and resources during public health planning

Why do we need to do surveillance? (2/2) Monitor effectiveness of prevention and control measures and prevent outbreaks Identify high risk groups or geographical areas to target interventions an guide analytic studies Develop hypotheses that lead to analytic studies about risk factors for disease causation, propagation or progression

Key elements of a surveillance system Detection and notification of health events Investigation and confirmation Collection of data Analysis and interpretation of data Feedback and dissemination of results Response – Action for prevention and control

1997-8: National Surveillance Programme for Communicable Diseases (NSPCD) Nodal point  National Institute for Communicable Diseases Implementing agencies  States and union territories Main components  Infrastructural strengthening - Laboratories  Human resources development  Uniform and regular reporting  Monitoring and evaluation Operational districts (Merged in IDSP Phase-I)

Objectives of NSPCD Strengthen district and state capabilities to promptly identify and respond to disease outbreaks Establish an early warning mechanism Laboratory strengthening and networking for rapid confirmation of diagnosis Effective use of surveillance data using rapid means for communication Institute appropriate and timely response for prevention and control of outbreaks

Objectives of NSPCD Improving technical capabilities of medical and paramedical personnel Up-gradation of laboratories at district, state and regional level Improving communication and data processing system Constitution of rapid response teams at district and state levels for early response Collaboration with ICMR, WHO and other concerned agencies/departments

Weaknesses in disease surveillance Lack of integration of private sector Poor laboratory capacity Blind spots in urban areas Slow, inefficient sharing of surveillance information at district level Limited capacity to undertake analysis and response at district level Non-inclusion of non communicable diseases

Surveillance strategy in the Integrated Disease Surveillance Project (1/2) District level is the basic functional unit for integrating surveillance functions All surveillance activities are coordinated and streamlined Resources are combined to collect information from single focal point at each level Several activities are combined into one integrated activity to take advantage of similar surveillance functions, skills, resources and target populations

Surveillance strategy in the Integrated Disease Surveillance Project (2/2) Integrates public and private sector by involving private practitioners and communities Addresses communicable and non communicable diseases Covers both rural and urban health systems Collaborates with private and public medical colleges

Objectives of the Integrated Disease Surveillance Project To establish a decentralized district based system of surveillance for communicable and non- communicable diseases so that timely and effective public health actions can be initiated in response to health changes in the urban and rural areas To integrate existing surveillance activities to avoid duplication and facilitate sharing of information across all disease control programmes and other stake holders so that valid data is available for health decision making in the district, state and national levels

Important components where additional inputs will be provided Strengthening of laboratories Improved information management system Human resource development Developing supporting structure for integration

What is integration? Sharing of surveillance information of disease control programmes Developing effective partnership with heath and non health sectors in surveillance Including communicable and non communicable diseases in the surveillance system Working with the private sector and non governmental organization Bringing academic institutions and medical colleges into disease surveillance

Classification of surveillance in IDSP Syndromic  Diagnosis made on the basis clinical pattern by paramedical personnel and members of community Presumptive  Diagnosis is made on typical history and clinical examination by medical officers Confirmed  Clinical diagnosis by medical officer and or positive laboratory identification

Conditions under regular surveillance Type of diseaseDisease Vector borne diseases Malaria Water borne diseases Diarrhea (Cholera) Typhoid Respiratory diseases Tuberculosis Vaccine preventable diseases Measles Disease under eradication Polio Other conditions Road traffic accidents International commitment Plague Unusual syndromes Meningo-encephalitis Respiratory distress Hemorrhagic fever

Other conditions under surveillance Type of surveillanceCategoriesConditions Sentinel surveillance STDs HIV/HBV/HCV Other conditions Water quality Outdoor air quality Regular surveys Non communicable disease risk factors Anthropometry Physical activity Blood pressure Tobacco, blood pressure Nutrition Blindness Additional state priorities Up to five diseases

State-specific diseases Madhya Pradesh, Uttaranchal  Diphtheria, neonatal tetanus, leprosy Maharashtra  Diphtheria, neonatal tetanus, leptospirosis Andhra Pradesh  Filariasis Karnataka  Filariasis, KFD & HGS, leptospirosis Tamil Nadu  Leprosy, leptospirosis Kerala  Leptospirosis Mizoram  Cancer, substance abuse, acid peptic disease, pneumonia

The limited number of conditions under surveillance Limited number of core diseases  Improves quality of surveillance  Reduces workload Diseases of regional importance  Under surveillance in addition to the core list Review and modification of the list according to needs at least once in two years Viral hepatitis and acute respiratory tract infection  Also under consideration at various levels  May be included subsequently

ActivitiesPeripheryDistrictState Detection and notification of cases Consolidation of data++++ Analysis and interpretation++++ Investigation and confirmation+++ + Feedback Dissemination+++ Action Surveillance activities at each level

Reporting units for disease surveillance Public sector (Exhaustive) Private (Sentinel) Rural Community health centres District hospitals Practitioners Hospitals Urban Urban hospitals ESI Railways Medical colleges Nursing homes Hospitals Medical colleges Laboratories

Role of district surveillance officers and medical officers Supervision and quality control of active surveillance by field staff Passive surveillance for diseases on the list Supervision of compilation and transmission of periodical reports Integration of sentinel private practitioners Emergency response to surveillance reports received Facilitation of outbreak investigation and response

Phases of implementation for the Integrated Disease Surveillance Project Phase I ( )  Madhya Pradesh, Andhra, Himachal, Karnataka, Kerala, Maharashtra, Mizoram, Tamil Nadu & Uttaranchal Phase II ( )  Chattisgarh, Goa, Gujarat, Haryana, Orissa, Rajasthan, West Bengal, Manipur, Meghalaya, Tripura, Chandigarh, Pondicherry, Nagaland, Delhi Ph III ( )  UP, Bihar, J&K, Punjab, Jharkhand, Arunachal, Assam, Sikkim, A&N Island, D&N Haveli, Daman & Diu, Lakshadweep