Public Health Laboratory Department of Public Health Ministry of Health National Early Warning Alert Response Surveillance (NEWARS) Sonam Wangchuk Chief Laboratory Officer/Microbiologist

 Designated national focal point for Disease surveillance and Outbreak investigation.  Introduced National Notifiable Disease Surveillance in  Web based reporting system in 2012 but access limited to DHO and hospitals.  Revised notifiable disease list and guideline in  Redesigned web based and developed mobile SMS event reporting system in Background

Why revised existing NNDS guideline Most notifiable diseases were disease specific and need laboratory confirmation. Require fill up of case investigation form for each reporting notifiable disease case. Operational issues in reporting from BHU’s and hospitals to DHO. No real-time reporting from BHU’s

Difference between NNDS and NEWARS guideline NNDS was an indicator based surveillance. Disease specific surveillance. Required case reporting and investigation NEWARS is both indicator and event based surveillance. Included both disease and syndromes Case reporting only

Features and attributes of IBS and EBS

1. Early warning to prevent or minimize morbidity and mortality through: Monitoring trends of endemic diseases Detecting outbreaks and events Providing an adequate and timely response 2. Program monitoring for: Planning, monitoring and evaluating disease control programs Resource mobilization and allocation Objectives

Process of NNDS

Public Health Laboratory Department of Public Health Ministry of Health Role and Responsibilities of Health Professionals/workers on NEWARS

Health professionals/workers

Designated Surveillance Focal Point (SFP) at Health centers

Designated Surveillance Focal Point (SFP) at Health centers

Designated Surveillance Focal Point (SFP) at DHO

Designated Surveillance Focal Point (SFP) at DHO

NADSAE, PHL

NADSAE, PHL

NADSAE, PHL

Public Health Laboratory Department of Public Health Ministry of Health National Notifiable Disease Surveillance System

Operational aspect of NDSS system

List of Notifiable Diseases/Syndromes

Diseases of epidemic potential in the community. Vaccine preventable diseases. Diseases that are aimed for elimination. Disease with high morbidity and mortality. Diseases which are of potential threat to international community (Public Health Emergencies International Concerns). Identification of disease/syndrome

Clinical Case definition of ND

Clinical Case definition of ND

Clinical Case definition of ND

Clinical Case definition of ND

Clinical Case definition of ND

Clinical Case definition of ND

Clinical Case definition of ND

Clinical Case definition of ND

Out Patient and observation Registers of 191 Basic Health Units. Out Patient and admitted patient Registers of 31 District Hospitals. Out Patient, admitted patient and Emergency Registers of 3 Referral Hospitals. Source of information/data for NDDS

Collect daily data in record log Collate data in a weekly report using “Weekly Reporting Form” (Annex 3) and report to DHO/ in system every Friday. Report according to the Epidemiological week: Saturday to Friday. Process of data collection and collation at health centers

Record cases into two outcome categories: Number of cases and number of deaths (if case has died it should be recorded as both case and death) Annex 3. Mark (e.g. tick) those cases in the register that are included in the “Weekly Reporting Form” so that it can be validated if needed during evaluation and monitoring process. Process of data collection and collation at health centers

Mark (e.g. draw a line under) the last case in the register included in the weekly report. This way reporters know where to start looking for cases in the register the following week. Do Zero-reporting using the same form for weekly reporting form (Annex 3). Process of data collection and collation at health centers

At BHU and hospital level Basic Health Units (BHUs) and hospitals SFP should report every week on Friday. The reports should be sent using SMS or internet to online system maintained by NADSAE and ICT Unit, PHL. At DHO level The DHO should monitor online reporting status and ensure all BHUs under its jurisdiction have reported by Friday. The DHO should call the BHUs and hospitals that fail to report through online or SMS. BHUs and hospitals should be encourage to report even if it is late through ‘Late Reporting Request’ and ask them to report on time. Report online every week on Monday. Data transfer and Frequency for ROUNTINE REPORTING at various level

Referral hospital level National and regional referral Hospitals and Airport Health Service at Paro International Airport should report directly to the NADSAE, PHL every week on Monday using online system or SMS method. At PHL NADSAE will report to IHR National Focal Point (IHR NFP) if the reported information (priority diseases and syndromes, outbreak/event) is a Public Health Event of International Concern (PHEIC) after conducting risk assessment within 24 hours for onward reporting to WHO. Report to HIMS every month. Data transfer and Frequency for ROUNTINE REPORTING at various level

Data transfer and Frequency for IMMEDIATE REPORTING at various level

During the data collection, respective BHUs, hospitals, DHO SFP should validate all the data by cross checking once again The correction should be made immediately at respective level if any discrepancy is found in the “Weekly Reporting Forms” (data cleaning). NADSAE should also validate and cross-check data at national level and make necessary correction. The NADSAE should manage all the data obtained from the online reporting system. The electronic data at ICT Unit should be backed up on a daily basis to avoid data loss Data Management

At BHUs, and hospitals, SFP should analyze and interpret the compiled data in their respective health facility regularly, At district Health Office, DHO should analyze and interpret compiled data obtained from all the health facilities under its jurisdiction and At national, NADSAE, PHL will analyze, and interpret compiled data obtained from all health facilities. Data Analysis

1.Case based analysis 1.Analyze aggregated data by person, place and time 1.Trend analysis What to analyze

At district level, DHO should report back summarized data to respective BHUs and hospitals. At national level, NADSAE will publish quarterly Disease Surveillance bulletin. Feedback

M&E

Public Health Laboratory Department of Public Health Ministry of Health Event Based Surveillance System

Event-based surveillance is rapid gathering of information about events that are a potential risk to public health and responding to events based on information verification and risk assessment. 1.The occurrence of disease in humans, such as clustered cases of a disease or syndromes, 2.Unusual disease patterns or unexpected deaths, 3.Potential exposure for humans to events related to diseases and deaths in animals, 4.Contaminated food products or water, and environmental hazards including chemical and radio-nuclear events. Event Based Surveillance

Potential Events

Reportable events and definition

Reportable events and definition

Operational Aspect of EBS

Responding an Event

Reporting of PHEIC

Collection of an Event Information

Assessment of an Event reported

Assessment of an Event reported