IDSP – Integrated Disease Surveillance Project

Dr. Rizwan S A, M.D.,

IDSP – Integrated Disease Surveillance Project

Outline of Presentation

• What is Surveillance?• IDSP

– Phases of implementation– Components – Objectives– Classification of surveillance– Conditions under regular surveillance– Flow of information– Surveillance activities at each level– Surveillance committees at each level– Reporting– Surveillance action– Strengths– New initiatives

Surveillance

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 gets the disease?• How many get them?• Where they get them?• When they get them?• Why they get them?• What needs to be done?

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

IDSP

Phases of implementation

• Phase I (2004-05)– Madhya Pradesh, Andhra, Himachal, Karnataka, Kerala, Maharashtra,

Mizoram, Tamil Nadu & Uttaranchal

• Phase II (2005-06)– Chattisgarh, Goa, Gujarat, Haryana, Orissa, Rajasthan, West Bengal,

Manipur, Meghalaya, Tripura, Chandigarh, Pondicherry, Nagaland, Delhi

• Phase III (2006-07)– UP, Bihar, J&K, Punjab, Jharkhand, Arunachal, Assam, Sikkim, A&N

Island, D&N Haveli, Daman & Diu, Lakshadweep

Components

• Integrating & decentralizing disease surveillance & response mechanisms

• Strengthening Public Health Laboratories

• Using Information Technology and Networking in disease surveillance

• Human Resource Development

Objectives

• 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

What is integration?

• Sharing of surveillance information of various 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 of 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 confirmed by appropriate laboratory

identification

Conditions under regular surveillance

Type of disease Disease

Vector borne diseases Malaria

Water borne diseases Diarrhoea, Cholera, Typhoid

Respiratory diseases Tuberculosis

Vaccine preventable diseases Measles

Disease under eradication Polio

Other conditions Road traffic accidents

International commitment Plague

Unusual syndromes (Causing death/hospitalization)

Meningo-encephalitisRespiratory distressHemorrhagic feverOther undiagnosed condition

Other conditions under surveillance

Type of surveillance Categories Conditions

Sentinel surveillance STDs HIV/HBV/HCV

Other conditions

Water quality

Outdoor air quality

Regular periodic surveys

Non-communicable disease risk factors

AnthropometryPhysical activityBlood pressureTobacco, 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

Syndromic surveillance• Fever

– <7 days with no localizing signs – with rash– with altered sensorium/convulsions, – bleeding skin/gums– >7 days

• Cough >2 weeks• Acute Flaccid Paralysis• Diarrhea• Jaundice• Unusual events causing death/hospitalization

Flow of information

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

Activities Periphery District State

Detection and notification of cases

+++ ++ -

Consolidation of data + +++ +++

Analysis and interpretation + +++ +++

Investigation and confirmation +++ +++ +

Feedback + +++ ++

Dissemination + ++ ++

Action ++ +++ +

Surveillance activities at each level

District Surveillance Committee

Chairperson* District Surveillance Committee

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 Collector or District Magistrate

Chairperson* State surveillance committee

Director Health Service

Director Public Health (Co. Chair) Director Medical Education

RepresentativeWater Board

NGO

Medical CollegesState Coordinator

RepresentativeDepartment of Home

State Program ManagersPolio, Malaria, TB, HIV - AIDS

Head, State Public Health Lab

IMA RepresentativeRepresentative

Department of Environment State Surveillance Officer(Member Secretary)

State Training Officer

State Data Manager IDSP

State surveillance committee

* State health secretary

Chairperson*National surveillance committee

Director General Health Services(Co. Chair)

Director General ICMR

PD (IDSP)

JS (Family Welfare)

Director NICD

Director NIB

National Program ManagersPolio, Malaria, TB, HIV - AIDS

Consultants(IndiaCLEN / WHO / Medical College /others)

NGO

IMA Representative

RepresentativeMinistry of Home

RepresentativeMinistry of Environment National Surveillance Officer

(Member Secretary)

* Secretary health and secretary family welfare

National surveillance committee

ICMR

NationalPrograms

CBHI

NCDC

CSU

Outbreak investigation and rapid response

Non-communicable diseases

surveillance

MIS and report

Programme monitoring

NVBDCP RNTCP RCH NACP

W.H.O. E.M.R.

Linkages of the central surveillance unit at the central level

Reporting

Reporting Forms

• Form ‘S’ (Suspect Cases)

• Health Workers (Sub Centre)

• Form ‘P’ (Probable Cases)

• Doctors (PHC, CHC, Pvt. Hospitals)

• Form ‘L’ (Lab Confirmed Cases)

• Laboratories

Form Level of Laboratory Responsibility of Reporting

Form L1 Peripheral Laboratory at PHC/CHC Laboratory Assistants/Technicianthrough MO I/c

Form L2 District Public Health Laboratory,Labs of District Hospital, Privateand other Hospitals & Private Labs.

I/c Microbiologist/Pathologists

Form L3 Labs in Medical Colleges, othertertiary institutions,

Reference Labs.Head, Microbiologist Department

Laboratory Reporting

Warning Signals of an impending outbreak

• Clustering of cases/deaths in Time/Place• Unusual increase in cases/ deaths• Even a single case of measles , AFP, Cholera, Plague,

Dengue, or JE• Ac. febrile illness of unknown etiology• Two or more epidemiologically linked cases of outbreak

potential• Unusual isolates• Shifting in age• High or sudden increase in vector density• Natural Disaster

Surveillance Action

Preset trigger level with specific response for various levels

• Trigger Level 1 - Suspected limited outbreak– local response

• Trigger Level 2 - Epidemic– local & regional response

• Trigger Level 3 - Wide spread Epidemic– local, regional & state level response

Strengths of IDSP - 1

1. Functional integration of surveillance components of vertical programmes

2. Reporting of suspect, probable and confirmed cases (Standard case Definition)

3. Strong IT component for data analysis

4. Trigger levels for graded response

5. Action component in the reporting formats

6. Streamlined flow of funds to the districts

7. Standard Formats, Operations & Training Manuals

8. Involvement of Private Sector

New Initiatives - 1

1. Alerts through IDSP call center

Call Centre operational with 1075 toll free number since February 2008

2. E-learning

The objective of e-learning is to enhance the skills to a wide arena of health personnel.

Proposed components:– Discussion Forums– Online Survey & Assessment– Feedback– FAQs

Currently e-learning modules are being prepared

3. Media Scanning Cell• Objective:– To provide the supplemental information about outbreaks

• Method:– National and local newspapers, Internet surfing, TV

channel screening for news item on disease occurrence.• Benefits of Media Scanning:– Increases the sensitivity & strengthen the surveillance

system– Provide early warning of occurrence of clusters of diseases

New Initiatives - 2

Thank You