Notification of communicable diseases
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![Page 1: Notification of communicable diseases](https://reader036.fdocuments.in/reader036/viewer/2022081516/56812c27550346895d909799/html5/thumbnails/1.jpg)
NOTIFICATION OF COMMUNICABLE DISEASESProf. MW Gunathunga
IIM, 3rd July 2013
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Objectives • To learn what notification entails • To learn the process of notification of diseases in Sri
Lanka
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NOTIFICATION
•The act of reporting the occurrence of a communicable disease or of an individual affected with such a disease•A legal requirement •On suspicion of disease •Use a standard format (H-544) called notification form•At any setting – government or private
OPD, clinics, wards
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Notifiabe Disease Reporting System
Notifiable Disease
A disease that, by statutory requirements, must be reported to the public health authority in the relevant area when the diagnosis is made.
A disease deemed of sufficient public health importance to require that its occurrence be reported to health authorities.
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Legislature
• The Quarantine and Prevention of Disease Ordinance of 1897 and it's amendments
- Every practitioner treating a case of notifiable disease should notify
- Anyone failing to do so can be prosecuted in the Magistrate Court
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Notifiable Diseases• Group A - Cholera
- Plague- Yellow Fever
To: > DGHS > DDG (Public Health) > Epidemiologist > MOH > Regional epidemiologist
By telephone, fax or telegram and notification form
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Notifiable Diseases continued…• Group B
- Acute flaccid Paralysis
- Chicken pox
- Dengue fever / Dengue Haemorrhagic Fever
- Diphtheria
- Dysentery
- Encephalitis
- Enteric fever
- Food Poisoning
- Human Rabies
- Leptospirosis
- Malaria
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Notifiable Diseases continued…
• Group B continued… - Measles
- Meningitis - Mumps - Rubella & Congenital Rubella Syndrome- Severe Acute Respiratory Syndrome (SARS)- Simple continued fever for 7 days or more- Tetanus- Neonatal Tetanus- Tuberculosis (Pulmonary)- Typhus fever- Viral Hepatitis- Whooping cough- Leishmaniasis
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To Whom ?
AFP – To MOH, Epidemiologist and Regional Epidemiologist By telephone, fax or telegram and AFP notification form
Tuberculosis – To Director NPTCCD by TB notification form
SARS – To DGHS, DDG (PHS), Director (Quarantine), Port/ Air Port Health Officer, Epidemiologist, RE, MOH
Others – To MOH of the area of residence by notification form
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When to notify ?• As soon as the provisional diagnosis is made
NOT ON DISCHARGE !!!
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Community Ward Notification Register Hospital Notification Register
Notification Register
Investigation and reporting
Infectious DiseasesRegisterUpdate spot map
Patient / BHT in Hospital/GP
Notification Card
MOH
PHI
MOH
Weekly Return of Communicable Diseases
Epidemiology
UnitSpecial Surveillance Forms*
Weekly Epidemiological Report
Quarterly Epidemiological Bulletin
Regional Epidemiologist
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What are the diseases under special investigation?
-Diseases covered by the EPI (What are those ?)- Polio, Diphtheria, Pertussis, Tetanus and
Neonatal Tetanus, Measles, Rubella, Hep.B
- Japanese Encephalitis- Dengue Haemorrhagic Fever- Human Rabies- Cholera- Mumps- Meningitis- Chicken pox
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Limitations of Notifiable Disease Reporting System
1. Under reporting
2. Poor quality of reporting
- Incomplete
- Illegible
- Inaccurate
3. Lack of timeliness
4. Inconsistency of case definitions
5. Lack of representative ness of reported cases
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Lack of Representative ness
E.g. Measles Home - Not reported
GP – May be reported
Govt. Hospital - Reported
Private Hospital - ?
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Under reporting - Why ?
1. Lack of knowledge of the need for reporting
- Unaware of the responsibility
- Unaware what diseases to report
- Assume that someone else will report
- Unaware of how to and whom to report
2. Negative attitudes towards reporting
- Time consuming
- Lack of incentive
- Lack of feedback
- Distrust in the govt. / health system
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3. Misconceptions
- Reporting compromises patient-physician relationship
- Breaches confidentiality
- Wrong judgment that the disease is not serious
- Belief that public health measures do not work
- Belief that health department does not act on the reports.
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Exercise
You are the newly appointed MOH in Maharagama. You notice that although you receive many notifications from the SJGH, you do not receive as many from the other hospitals.
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You explore further into the matter. You find that the PHI is unable to locate the house of the patient in most notifications
How would you improve the system ?
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Problems - Not notifying- Poor quality notifications
Who ? Govt. Medical Officers esp. Intern MO’sGPsOther medical practitionersPrivate hospitals
How ? -Create awareness and knowledge on proper notification-Address misconceptions-Provide frequent feedback-Show them the benefits
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Indoor Morbidity & Mortality Reporting
Coding according
to ICD
Quarterly
BHT
Medical Records Office
Indoor Morbidity
Mortality Register
Indoor Morbidity and Mortality Return
Medical Statistician
Annual Health Bulletin
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Limitations of Indoor Morbidity & Mortality Reporting
• Coverage
What exactly do IMMR data represent ?
▪ No. of admissions, not cases
▪ OPD ? Private Hospitals ?
▪ Disability ?
▪ Mortality – only hospital deaths
• Quality ▪ Diagnosis not written
▪ Incorrect Diagnosis / symptoms as diagnosis
▪ Lack of timeliness
▪ Lack of facilities for record keeping
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Laboratory surveillance
What is lab-based surveillance ?
Using information generated in labs for surveillance
E.g. MRI lab Epid. Unit
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What are the advantages of lab surveillance ?
• Immediate information on rare or significant diseases
• Reporting of confirmed diagnosis• Completeness of lab data• Ability to obtain information of patients seen by many physicians
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What are the disadvantages of lab surveillance ?
• Non availability of epidemiological information • Lack of representative ness
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Reporting from Special Campaigns
- Routinely reported
- From Malaria, Filariasis, STD, Rabies and Respiratory diseases control programme
- Morbidity and Mortality data
- Collected by the campaigns from hospitals
- Data is sent to Epidemiology Unit
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Sentinel Surveillance
Surveillance based on the collection of data from a sample (random or non-random) of collecting sites as indicator data for the rest of the population, in order to identify cases of a disease early or to obtain indicative data about trends of a disease or health event.
Uses active surveillance approach
Conducted usually by ICNO
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Sentinel’ Sites - Depends on the diseaseE.g. Dengue –all hospitals Leptospirosis, Hep B – Selected
hospitals
For few selected diseasesAFP, Measles, Japanese Encephalitis, Dengue, Hepatitis B, Leptospirosis
Sentinel populations – E.g. Pregnant mothers for syphillis
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• What are the advantages of sentinel surveillance ?
• Improves timeliness in reporting• Improves accuracy of data• Improves completeness of data• Only on selected sites• Cost effective
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Disadvantages of sentinel surveillance
• Lack of representativeness
• Participation rates may be low and limited to those with great interest or capability
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Sample Surveys
• Surveys carried out on specific diseases / risk factors on representative samples
• Usually for research purposes
• One-time process
• Estimates prevalence of disease more accurately
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Outbreak Investigation
• Investigation of disease outbreaks
(What is an outbreak ?)• Carried out by a team –MOH, RE, Clinicians, PHIs
• Involves hospital and the field• Purpose is to identify the source of infection and initiate appropriate control measures
• A report is produced
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Thank you !
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List of Notifiable diseases• Group - A• Cholera• Plague• Yellow Fever
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Group B• Acute Poliomyelitis / Acute Flaccid Paralysis• Chicken pox• Dengue Fever / Dengue Haemorrhagic Fever• Diphtheria• Dysentery• Encephalitis• Enteric Fever• Food poisoning• Human Rabies• Leptospirosis• Malaria• Measles• Meningitis• Mumps• Rubella / Congenital Rubella Syndrom• Simple Continued Fever of over 7 days or more• Tetanus• Neonatal Tetanus• Typhus Fever• Viral Hepatitis• Whooping Cough• Tuberculosis
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Mechanism of Data Collection
•Bed Head Ticket•Notification Card•Notification Register (Ward)•Notification register (Institution)
Hospitals •In-patients Register
Medical Officer of Health
Medical Statistics Unit
EpidemiologyUnit
(CentralLevel)
Regional Epidemiologist
(DistrictLevel)
Activated Passive
Surveillance
•Notification Register•Weekly Return•ID Register Special
CampaignsPublic Health Inspector
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Reference• Website of Epidemiology Unit, Ministry of Health
http://www.epid.gov.lk