INTEGRATED DISEASE SURVEILLANCE PROJECT

Dr.J.Nuchin M.D., M.B.A. DCA.

Epidemiologist 5-03-2011

PRESENTATION

NSPCD- National Surveillance programme on Communicable disease Programme

IDSP

Lessons Learnt/Issues

NATIONAL SURVEILLANCE PROGRAMME FOR COMMUNICABLE DISEASE-NSPCD

Over the last 30 years more than 30 new diseases have emerged and some of the old diseases like TB, Malaria, Plague etc started re-emerging with wide geographical rapid spread.

It is so common in developing countries due to many reasons.

In India, recent outbreaks of Plague in Surat (1994), resurgence of Malaria in 1995 and Dengue haemorrhagic syndrome in Delhi (1996) caused much concern to the Government Of India.

It caused much morbidity and mortality with significant economic consequences.

Though many reasons are there for all these, weak Surveillance system in the country was one of the major factors.

In order to strengthen the Surveillance system, in the year 1997-98, MOHFW,GOI, launched National surveillance Programme for Communicable Diseases (NSPCD), so that early warning signals of diseases could be recognized and appropriate public health action taken timely to control and prevent the further spread.

NSPCD-1997-98

In this programme the states are the implementing agencies and NICD Delhi is the Nodal agency for coordinating the activities.

This programme is based on outbreak reporting (as and when outbreaks occur) with weekly reporting of epidemic prone diseases directly from Districts (including nil reporting) to the Centre.

DISEASES/PATHOGENS COVERED UNDER NPSCDS

Epidemic prone communicable diseases- including

Acute diarrhoeal diseases –Cholera etc

Malaria, Dengue, Japanese encephalitis

Enteric infections including Typhoid

Plague

Viral hepatitis Measles

Leptospirosis Meningitis

Pathogens with bioterrorism potential

Viral haemorrhagic fevers

Drug resistant pathogens Poliomyeilitis

To further strengthen the programme a project (2005-2012) was drafted with the help of World Bank with major modifications in the programme.

As a result IDSP was launched in the country.

INTEGRATED DISEASE SURVEILLANCE PROJECT-2004-05The Integrated Disease Surveillance Programme,

(IDSP), launched by Government of India, Ministry of Health & Family Welfare (MOHFW) in November 2004, and supported by World Bank.

It is a decentralized, integrated, State based Surveillance Program intended to detect early warning signals of impending outbreaks and help initiate an effective and timely response.

In Belgaum district IDSP was implemented in 2005

Major Objective: Early detection of Early Warning Signals of an impending outbreak and help initiate an effective response in a timely manner.

Major components: Integration and Decentralization of Surveillance activities

Strengthening of Public Health Laboratories

Human Resource Development - Training of SSO, DSO, RRT, other medical and paramedical staff

Use of Information Technology for collection, collation, compilation, analysis & dissemination of data

What is Surveillance?Surveillance is a French word meaning “watch with

attention, suspicion and authority”

Epidemiological surveillance is defined as “the ongoing and systematic collection, compilation, analysis and interpretation of health data in the process of describing and monitoring a health event” (CDC)

Simplest definition of Surveillance is data collection for action.

Surveillance may also be defined as “regular and systematic collection of data on the disease incidence for the purpose of appropriate action”.

INTEGRATION ?

CMDs with NCDsState and CentreHFW and Private clinics/Hospitals/Medical

colleges/NGOsNational programmesPolice, PCBs, Water supplyIEC activitiesTrainingFormation of committees to oversee

integration

EWSS? OF AN IMPENDING SIGNALS

Clustering of cases/deaths in time/place Unusual increase in cases/deaths Even a single case of measles, AFP, cholera,

plague, dengue and JEAcute febrile illness of unknown etiology Shifting in age distribution of cases High vector density Natural disasters

USES?

1. Incidence/Prevalence2. Geographical distribution of a disease------- TPP/CDC3. Monitoring disease trend over a long period4. Prediction of diseases-by previous outbreaks5. Planning, Evaluation of public health intervention and

programmes.6. Detect the factors/conditions responsible for occurrence/spread7. With the help of excellent lab diagnostic facilities, we can detect

the diseases early and control/prevent the spread of disease.8. With the help of uniform standard “case definition” we can

detect the diseases and initiate early control/prevent the spread of disease as well.

Surveillance methods

1) Routine reporting system2) Active and passive surveillance3) Sentinel reporting system4) Surveys and special studies5) Case and outbreak investigations

Keep your laboratory clean

A DYNAMIC VISION OF SURVEILLANCE

Collect and transmit

data

Analyzedata

Feedbackinformation

Make decisions

All levels use information

to make decisions

Surveillance

EXPECTED OUTCOME

Early detection of outbreaks

Early institution of containment measures

Reduction in morbidity & mortality

Minimize economic loss

What are the diseases?

DISEASES UNDER THE SURVEILLANCE PROJECT

(i) Regular Surveillance:

Vector Borne Disease 1) Malaria

Water Borne Disease 2) ADDs (Cholera) and 3) Typhoid

Respiratory Diseases 4)Tuberculosis

V P Ds 5) Measles

Diseases under eradication

6) Polio

Other Conditions 7) Road Traffic Accidents(Linkup with police computers)

Other International commitments

8) Plague

Unusual clinical syndromes

9)Menigoencephalitis/Respiratory(Causing death / hospitalization) Distress Hemorrhagic fevers, other undiagnosed conditions

Sentinel Surveillance

Sexually transmitted diseases/Blood borne

10) HIV/HBV, HCV11

Other Conditions : (Large Urban centers)

11) Water Quality12) Outdoor Air Quality ( In Metropolitan cities)

(iii) Regular periodic surveys:

NCD Risk Factors : 13) Anthropometry, Physical activity, Blood Pressure, Tobacco, Nutrition, Blindness

Additional State Priorities : Each state may identify up to five additional conditions for surveillance.

Note: GOI may include in a public health emergency any other unusual health condition.

Project funds could be used for such emergencies

LABORATORY ROLE IN IDSP

LAB ROLE IN THE SUCCESS OF SURVEILLANCE Right sample Time of collection Right quantity Transportation Right lab for the disease

Different levels of laboratories under IDSP

Peripheral labs and microscopic centres

L1 labs

District public health laboratory

L2 labs

Disease based state laboratories

L3 labs

Regional laboratories and quality control laboratories

L4 labs

Disease based reference laboratories

L5 labs

EFFECTIVE SURVEILLANCE DEPENDS ON

Quality of data Regularity of reporting Timely reporting Ensuring adequate coverage Standard case definition- From all reporting

Units

RRT CONSISTS OFDSO

Epidemiologist

Physician

Paediatrician

Microbiologist

Entomologist

Laboratory technician

Health worker

A driver with a vehicle

TYPES OF CASE DEFINITIONS IN USE

Case definition

Criteria Users

Syndromic(suspect)“S” forms

Clinical pattern Paramedical personnel and members of community

Presumptive(Probable)“P” forms

Typical history and clinical examination

Medical officers of primary and community health centres

Confirmed“L1/L2” forms

Clinical diagnosis by a medical officer and positive laboratory identification

Medical officer and Laboratory staff

More

specifi

city

Collection

IDSP – INDIA : STRUCTURE Central Surveillance

Unit (CSU)

State Surveillance Unit (SSU)

District Surveillance Unit (DSU)

Reporting Unit (RU)

Surveillance Unit- Belgaum

DATA FLOW AND FEEDBACK: LEVEL BY LEVEL

Centre

State

District

Primary / Community health centre

Data Feedback

Community

INFORMATION FLOW OF THE WEEKLY SURVEILLANCE SYSTEM

Sub-centres

P.H.C.s

C.H.C.s

Dist. hosp.

Programmeofficers

Pvt. practitioners

D.S.U.

P.H. lab.

Med. col.

Other Hospitals: ESI, Municipal Rly., Army etc.

S.S.U.C.S.U.

Nursing homes

Private hospitals

Private labs.

Corporate hospitals

Chairperson –Deputy Commissioner

District Surveillance Officer (Member Secretary)

CMO(Co. Chair)

RepresentativeWater Board

Superintendent Of Police

IMA Representative

NGORepresentative

District PanchayatChairperson

Chief District PHLaboratory

Medical CollegeRepresentative

if any

RepresentativePollution Board

District Training Officer(IDSP)

District Data Manager(IDSP)

District Program ManagerPolio, Malaria, TB, HIV - AIDS

DISTRICT SURVEILLANCE COMMITTEE

Superintendent of hospitals

Outpatient register Inpatient

slip

Reporting unit

Case

Lab slip

Inpatient register

Lab registerCommon reporting

form P

Computer(District)

Form L

District public health

laboratory

District surveillance

officer

Feedback

Weekly

Weekly

Weekly

Immediately

+

LESSONS LEARNT

NSPCD IDSP

No budget for NSPCD nodal cell IDSP cell in Ministry with budget

No integration Integration

No budget for retraining Budget for retraining

Feedback inadequate Adequate feedback planned

Weak IT component Strong IT component

Weak state ownership (selected districts)

Strong state ownership (all districts)

Slow financial flow Fast financial flow

Weak M & E, supervision Strong M & E, supervision

Poor advocacy Advocacy at all levels