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

2. 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

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

4. METHODS

5. 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

6. Selected Districts
INDIA
ASSAM
SIVASAGAR
BARPETA

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

8. 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

9. 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

10. RESULTS

11. 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.

12. 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

13. 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

14. 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

15. 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%)

16. 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

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

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

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

20. 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

21. 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

22. THANK YOU