1

INTEGRATED DISEASE

SURVEILLANCE PROJECT

TRAINING MANUAL FOR

STATE & DISTRICT

SURVEILLANCE OFFICERS

INTRODUCTORY MODULE ON

DISEASE SURVEILLANCE

Module -1

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CONTENTS

1. Introduction 3

2. Contents of Introduction to IDSP 4

3. Instruction for Trainees 5

4. Module Structure at a Glance 6

5. Introductory Module 6

6. Salient Points to Remember 6

7. Group Activities 8

8. Frequently Asked Questions 10

9. Handout on Introduction to Disease Surveillance 11

10. Evaluation Questions 18

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1. INTRODUCTION

Integrated Disease Surveillance Project (IDSP) is a decentralized, state based

Surveillance System in the country. IDSP is intended to detect early warning

signals of impending outbreaks and help initiate an effective response in a timely

manner. It is also expected to provide essential data to monitor progress of on

going disease control Programmes and help in allocating health resources more

optimally.

Not all outbreaks can be predicted or prevented. However, precautionary

measures can be taken within the existing health infrastructure to reduce risks

of outbreaks and to minimize the scale of the outbreak if it occurs. The

effectiveness with which national Programmes are implemented and monitored,

the alertness for identification of early warning signals and the capacity for

initiating recommended specific interventions in a timely manner are important

objectives of IDSP.

The District Surveillance Officers and Medical officers play an important role in

the surveillance activity, which can be listed as follows:

� Supervision and quality control of Active Surveillance by Health Workers in

the field

� Conduct Passive Surveillance of important diseases identified under IDSP

(refer to page 17)

� Supervise compilation and transmission of reports to District Surveillance

Officer at weekly intervals from PHCs and CHCs

� Integrate Selected Sentinel Private Practitioners in the Programme from the

area of activity

� Initiate emergency response to surveillance reports received in the unit

� Facilitate epidemic investigations and outbreak response by the District

Surveillance Unit.

� The Medical officers in both private sector and public sector will participate

in IDSP. While both groups will report diseases under surveillance, the pubic

sector MOs will be the primary efferent arm of surveillance. The type of

surveillance undertaken by the MOs will be presumptive in nature or

syndromic in nature. The health workers will undertake only syndromic

surveillance. This will be complimented by confirmed case surveillance by

the participating laboratories.

� The content and plan for training suggested in this training manual will need

to be suitably modified and updated with live examples and exercises to

make it more relevant to IDSP regionally.

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The Overall Training Strategy IDSP

TRAINEES TRAINERS Site Duration

I District and State Surveillance Level 1 – Selected National Regional / 6 days

team Level Training Institutions State

II Medical Officers of the PHCs, Level 2 – State and District District HQ 3 days

CHCs and Urban Health sector. Surveillance Team. Support from

MOs of the SPM departments Level 1 Trainers

of local Medical colleges. MOs

of NGOs / Mission Hospitals

III. Medical Officers of the Hospitals, Level 2 – State and District District HQ 1 day

Sub district Hospitals, Medical Surveillance Team. Support from

College Hospitals, SPPs, Level 1 Trainers

IV MPWs (Male / Female), Health CHC Team with selected MO CHC 2 days

Supervisors, NGO volunteers, PHCs. Support from Level 2

unregistered Medical practitioners Trainers.

V State and District level Level 1 trainers - Identified Regional/ 6 days

microbiologists / LT. Also have training institutions State

the urban health sector. Also

Microbiologists from local

Medical Colleges

VI Training for lab assistants at District Public Health District HQ 3 days

CHC / PHC laboratory staff

Representatives from

Level-1 institutions

VII Data entry operators Soft ware agency District HQ 2 days

VIII Data Managers district Identified training Regional/ 3 days

institutions state

2. CONTENTS OF INTRODUCTION TO IDSP

Overall Plan for the Workshop

Number of Trainees

1. There will be approximately 30 trainees per batch of training,

2. They will be trained in selected National level institutions,

Training Centers

The State and District Surveillance team will be trained at selected National

Level Training Institutions in the country. These institutions will be chosen on

basis of select criteria. Continued use of these training institutions will based on

the evaluation of their training activities.

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Monday through Saturday – 6 days

Content Time Day

1 Introductory Module on Disease Surveillance 2 Hrs 1

2 Management structure of IDSP 1 Hr 1

3 Module of Reporting Units, Participants and their Roles 2 Hrs 1

4 Private Sector Participation in Disease Surveillance 1 Hr 1

5 Diseases and Syndromes Under Surveillance: Case Definitions 4 Hrs 2

6 Laboratory Methods in IDSP for Confirmation of Diagnosis, 2 Hrs 2

Collection, Storage, Transportation of Specimen

7 Disease Surveillance: Basic epidemiology 3 Hrs 3

8 Analysis & Interpretation of Data 3 Hrs 3

9a Out Break Response Session-1 – Investigations 3 Hrs 4

9b Out Break Response Session-2 – Control and Feed back 3 Hrs 4

10 Surveillance of risk factors of Non-communicable disease 1 Hrs 5

11 Action, Response and Feedback

12 Monitoring, Supervision and Quality control 3 Hrs 5

13 Intra and Inter-sectoral Coordination & Social Mobilization 2 Hr 5

14 Human Resource Development in IDSP 1 Hr 6

15 Evaluation of Training sessions 1 Hr 6

Open Session and Feed back 1 Hrs 6

3 INSTRUCTIONS FOR TRAINEES

� These modules have been designed as a self-contained unit of learning. You

are expected to learn in small groups of 6-8 persons under the guidance of a

facilitator.

� You are expected to share your experiences with other trainees.

� The module has been divided into various units to cover various aspects of

the topic.

� The learning objectives of the unit will inform you what is expected from you

once you complete the unit

� Important teaching learning points have been provided separately so that

the participants can focus on these aspects thoroughly during the sessions.

It is important to understand these points well

� The Handout provided with the unit is more comprehensive and must be

read by the all the participants.

� Please go through each learning activity and complete the exercise(s) given

at the end of the unit.

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4. MODULE STRUCTURE AT A GLANCE

DURATION OF SESSION 120 MINUTES

Unit CONTENT METHODOLOGY TENTATIVE TRAINERS TEACHING

No DURATION AIDS

1. Introduction Lecture Followed by 20 Minutes 2-3 Per Training

to IDSP Module Reading Session Modules / Slide

and discussion 40 Minutes Projector / Over

Head Projector /

Power point

2. Exercises on Group Activity 60 Minutes Level One-1 Training

Introduction Plenary Trainer Modules

to IDSP Level two- 2

Trainers Exercises

5. INTRODUCTORY MODULE

Specific Learning OBJECTIVES

At the end of the session the participants would be able to

1 Define Surveillance and explain the important terminology in Surveillance

� Regular / Sentinel Surveillance

� Active /Passive Surveillance

� Outbreak

� Threshold

� Clustering

� Surveillance Response

� Feed back

2 List all the components of the surveillance activity

3 Specify the major objectives of the Integrated Disease Surveillance Project

4 List the types of surveillance carried out under IDSP by different categories

of staff

5 Name all reporting units in the rural and urban areas of a district

6 List all the conditions under surveillance through PHC/CHC system

6. SALIENT POINTS TO REMEMBER

1 Surveillance: is defined as the ongoing systematic collection, collation,

analysis, and interpretation of data and dissemination of information for

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public health action. Without action data collection is not surveillance.

Refer to Section 9.01 in the Handout to the module on introduction

2 Activities related with surveillance involve Collection of data, Compilation

of data, Analysis and Interpretation, Follow up Action and Feed back at

different levels of activity.

Refer to Section 9.02 and 9.03 in Handout to module on introduction

3 Activities related to case management of affected patients even though

important for public health system is not surveillance activity.

4 The main weakness of disease surveillance which IDSP is trying to

overcome are: Lack of integration of private sector in surveillance activity,

Poor laboratory capacity, Lack surveillance infrastructure in the urban

regions, slow and inefficient sharing of surveillance information at the

district level, Limited capacity to undertake analysis and response at the

district level, Non inclusion of NCDs in surveillance Programme.

Refer to National Project Implementation Plan (PIP) on present system of

surveillance.

5 In IDSP three parallel system of surveillance will be undertaken. They

are:

1) Syndromic surveillance (Suspect case) performed by the Health

workers/ MOs;

2) Presumptive surveillance (Probable case) based on history and

physical examination by qualified medical officers only; and

3) Laboratory surveillance (Confirmed case) by laboratories

participating in the Programme.

They are independent systems reporting separately to the district surveillance

officer.

Refer to Section 9.10 in the Handout to introduction

6 Additional inputs to surveillance as part of IDSP is in: Improving laboratory

diagnostic capacity at all levels; Improving communication through

improved use of computers for surveillance; Developing human resources

of personnel by providing training; and Developing infrastructure to

facilitate sharing of surveillance information at the district and state levels.

Refer to section 9.05 of the section on Handout to introductory module

7 Health workers and Medical officers may undertake surveillance through

syndromic diagnosis without specifying disease conditions. The main

syndromes are 1) Fever less than 1 week with a) Rash, b) Convulsions, c)

Bleeding d) without any localizing signs. The other syndromes include 2)

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Cough, 3) AFP 4) Jaundice 5) Unusual syndromes causing death or

hospitalization.

8 The MO may make presumptive diagnosis on the following conditions as

part of surveillance activity Malaria, Typhoid, Cholera, Tuberculosis,

Measles, Polio and Plague. Or other conditions like Meningo— encephalitis

and Acute Respiratory Distress Syndromes.

9 At the peripheral laboratory TB and Malaria will be confirmed by

laboratory. Rapid diagnostic test for Typhoid will be performed. By this, it

will remain as probable case of typhoid till the results are confirmed by

blood culture at the district laboratory.

10 The reporting units participating in IDSP are the following: PHC / CHC

and sentinel private hospitals/ Nursing homes / Clinics in the rural regions,

District Hospitals, ESI, Railway hospitals and Private hospitals / Private

Nursing homes in the urban regions. In addition all medical colleges will

participate as reporting units in IDSP.

11 The main reason why private sector participation is crucial to the success

of disease surveillance in India is 1). More than 70% of the first contact

health facilities are in the private sector, 2). The urban infrastructure for

surveillance is very weak.

Refer to module on private sector participation in IDSP for more details

12 The types of integration expected in IDSP include 1). Sharing of surveillance

information of diseases across disease control Programme Managers and

district administration, 2). Effective partnership with private sector 3)

Bringing Medical colleges into surveillance activity, 4). Set up a system of

surveillance, which would cater to both communicable and non-

communicable diseases important for the region.

Refer to Section 9.06 on Handout to module on introduction for more details

7. GROUP ACTIVITIES AND EXERCISES

Points For Discussion

Three Groups of 7-8 Participants

The Group Activity

� Selection of Group Leader

� Selection of Reporters

� Each group will discuss the two points for Group Discussion given

below

� At least one of the resource persons will join the Group

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Group Discussion Points

Discussion Point-1

Possible Reasons for inclusion as priority diseases in IDSP

Your state has identified the following diseases to be state specific

diseases:

—————————————————————————————————

Examine the same for priority disease based on the following criteria:

� Burden of Disease – Morbidity, Mortality, Disability etc

� Epidemic Potential

� Availability of public Health Action to prevent the diseases

� National and International commitment

Comment on the current list of diseases under surveillance in IDSP as

given in the manual

� Cholera

� Hepatitis

� Typhoid

� ARI

� Malaria

� Tuberculosis

� Measles

� Polio

� Unusual Syndromes causing death or hospitalization

� Plague

� Meningo- encephalitis, Acute Respiratory Distress Syndrome

� Hemorrhagic Fevers etc

Discussion Point-2

Discuss the rationale of 3 types of surveillance diagnosis in the Integrated Disease

Surveillance Project.

� Syndromic – diagnosis made on the basis of clinical pattern by

medical/paramedical personnel and Members of the community.

� Presumptive – diagnosis made on typical history and clinical

examination by Medical officers

� Confirmed – clinical diagnosis confirmed by an appropriate

laboratory test.

What are the implications of different surveillance diagnosis in interpretation of

data?

Syndromic Surveillance

The paramedical health staff will undertake disease surveillance based on broad

categories of presentation.

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What Diseases of Interest under IDSP can present with the following

syndromes?

1. Fever

� Less than 7 days duration without any localizing signs

� With Rash

� With Altered Sensorium or Convulsions

� Bleeding from Skin or mucus membrane

� Fever more than 7 days with or without localizing sings

2. Cough more than 3 weeks duration

3. Acute Flaccid Paralysis

4. Diarrhoea

5. Jaundice

6. Unusual Events causing death or hospitalization

In your opinion, what do you think the District Surveillance Officer should do

to facilitate the surveillance activity?

In your opinion, what do you think the Medical Officers need to do to make

the IDSP function effectively?

8. FREQUENTLY ASKED QUESTIONS

1) Will IDSP increase the workload of the health workers in collecting

additional data and sending them to CHC or PHC?

There is practically no new activity planned at the periphery as part of

the IDSP. The current reporting of diseases by HWs will be further

facilitated by provided forms and formats specified for disease

surveillance. The total number of diseases under surveillance is also

reduced to improve quality of reporting. The net result is reducing the

workload on peripheral health worker for surveillance related work.

2) How much time commitment would be needed by the DSO for

surveillance related activity?

District Surveillance Officer plays a crucial role in IDSP and full time

commitment is necessary for the successful implementation of the

Programme.

3) Will the vertical disease control Programmes be compromised with

IDSP?

The Vertical Disease Control Programmes will continue to function and

has an important role in initiating effective implementation measures for

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control of specific diseases. Only the surveillance component of the

Programmes will be integrated through IDSP. This will avoid duplication

of resources and improve efficiency of surveillance activities. All the

information generated will be shared with all Programme managers at

the district and state level.

9. HANDOUT ON INTRODUCTION TO DISEASE SURVEILLANCE

There is no value to surveillance system unless the information is used for action

that prevents or control disease.

9.1 What is public health 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

A more complete definition of surveillance is: The ongoing systematic collection,

analysis and interpretation of health data essential to planning, implementation,

and evaluation of public health practice closely integrated with timely dissemination

of these date to those who need to know. The final link in the surveillance chain is

the application of these data to prevent and control diseases. A surveillance system

includes a functional capacity for data collection, analysis and dissemination linked

to public health programmes (CDC 1988)

Surveillance is the backbone of public health Programme and provides

information so that effective action can be taken to control and prevent disease

of public health importance.

In some cases action must be immediate – within hours – in order to prevent

large-scale epidemics and deaths, such as Cholera, Meningitis and Food Poisoning.

In others, control and prevention activities are long term response to information

about diseases as tuberculosis, HIV, and Non communicable disease risk factors,

for which action may be taken in weeks, months or even in years.

9.2 What are the Key Elements of a Surveillance System?

All surveillance systems involve six key elements:

� Detection and notification of health event

� Investigation & confirmation (Epidemiological, clinical, laboratory)

� Collection of data

� Analysis and interpretation of data

� Feed back and dissemination of results

� Response – a link to public health Programme specially actions for

prevention and control

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9.03. What are the levels where surveillance Activities are Performed ?

Activities Periphery District State

Detection and notification of cases +++ ++ -

Consolidation of data + +++ +++

Analysis and Interpretation + +++ +++

Investigation and confirmation +++ +++ +

Feed-back + +++ ++

Dissemination + ++ ++

Action ++ +++ +

- Nil + Some Activity ++ Considerable Activity +++ A great deal of Activity

9.4 Why do we need to do surveillance?

Uses of Surveillance:

� Recognize cases or cluster of cases to trigger interventions to prevent

transmission or educe morbidity and mortality

� Asses the public health impact of health events or determine and measure

trends

� Demonstrate the need for public health intervention Programmes and

resources and allocate resources during public health planning

� Monitor effectiveness of prevention and control measures and prevent

outbreaks

� Identify high-risk groups or geographical areas to target interventions an

guide analytic studies

� Develop hypothesis that lead to analytic studies about risk factors for

disease causation, propagation or progression.

9.5 The Strategy for Surveillance in IDSP

The IDSP proposes a comprehensive strategy for improving disease surveillance

and response through an integrated approach. This approach enables rational

use of resources for disease control and prevention. In the integrated disease

surveillance system:

� The district level is the basic functional unit for integrating surveillance

functions.

� All surveillance activities are coordinated and streamlined. Rather than

using scarce resources to maintain vertical activities, resources are

combined to collect information from a single focal point at each level.

� Several activities are combined into one integral activity to take advantage

of similar surveillance functions, skills, resources and target populations.

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� The IDSP integrates both public and private sector by involving the private

practitioners, private hospitals, private labs, NGOs, etc and also emphasis

on community participation.

� Integrates communicable and non-communicable diseases.

� Integration of both rural and urban health systems as rapid urbanization

has resulted in the health services not keeping pace with the growing

needs of the urban populace. The gaps in receiving health information from

the urban areas needs urgently to be bridged.

� Integration with the medical colleges both private and public

� The main components of IDSP include Laboratory strengthening, improved

information management system, Human resource development and

developing supporting structure for integration.

9.6 Objectives of Integrated Disease Surveillance Project

The overall general objective of the IDSP is to provide a rational basis for decision-

making and implementing public health interventions that are efficacious in

responding to priority diseases. Keeping this in mind the main objectives of the

IDSP are:

1. 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 challenges in

the urban and rural areas

2. To integrate existing surveillance activities (to the extent possible without

having a negative impact on their activities) so as to avoid duplication and

facilitate sharing of information across all disease control programmes and

other stakeholders so that valid data is available for health decision making

at district, state and national levels.

What is Integration?

In IDSP, different types of integration are proposed. These include:

1. Sharing of surveillance information of disease control programmes

2. Developing effective partnership with health and non-health sectors in

surveillance

3. Including Non-communicable and Communicable diseases in the

surveillance system

4. Effective partnership of private sector and NGOs in surveillance activities

5. Bringing Academic institution and Medical colleges into the primary public

health activity of disease surveillance.

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9.7 Important Information in Disease Surveillance

To plan any disease control Programme and to identify and control outbreaks, it

is important to know the following:

� Who get the diseases?

� How many get them?

� Where they get them?

� When they get them?

� Why they get them?

� What needs to be done as public health response?

9.8 Components of the Surveillance Activity

There are five steps in the surveillance procedure, which must be carried out at

each level, starting from the primary Health Centre (PHC). Each level must have

the capacity for analyzing and using surveillance data for early detection,

prevention and control of outbreaks. These include:

� Collection of data

� Compilation of data

� Analysis and interpretation

� Follow up action

� Feedback

9.9 Prerequisites for effective surveillance

� Use of standard case definitions

� Ensure regularity of the reports

� Action on the reports

For developing an effective disease surveillance system, the district health officer/

PHC medical officer must also be clear about:

� What information to gather?

� How often to compile and analyze the data?

� How often and to whom to report?

� What proforma or formats to use?

� What action to take?

The data collected should be uniform, regular and timely. Standard case

definitions are important to ensure uniformity in reporting so that all reporting

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units use the same criteria for reporting cases. It is also important to have a list

of all reporting units so that the regularity and timeliness of the reports is

checked. If no cases are seen, a nil report should be submitted. All levels in the

system must:

� Have the standard case definitions

� Have a list of all reporting units

� Monitor receipt of reports in time

� Monitor completeness of reports

The standard case definition of diseases is given in a separate manual.

Depending on the level of expertise and specificity disease surveillance in IDSP

will be of three categories.

9.10 Classification of Surveillance in IDSP:

� Syndromic–diagnosis made on the basis clinical pattern by paramedical

personnel and Members of the community.

� Presumptive–diagnosis made on typical history and clinical examination by

Medical officers

� Confirmed– clinical diagnosis by a medical officer and / or positive laboratory

identification.

Important Components of IDSP where additional Inputs will be provided:

1. Laboratory Diagnosis of diseases – Improving the quality of laboratory

services at the periphery and at the district levels

2. Improving communication through establishment of dial up network and

rapid flow of digital transfer of information from periphery to district and

from district to the state level.

3. Improving administrative structures so that better sharing of information

and responses will take place

4. Improving human resource to under take surveillance by providing training

at different levels of surveillance.

9.11 Reporting Units participating in regular passive surveillance under IDSP:

The Syndrome of fever will kept under regular passive surveillance at the

periphery by the reporting units in both public and private sector in rural and

urban areas of the district. Primarily Passive Surveillance will be undertaken at

all reporting units by the Medical Officer. Each reporting unit will be provided a

unique identifier so that computerization and identity and type can be recognized.

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Reporting Units for Disease Surveillance

PUBLIC HEALTH SECTOR PRIVATE HEALTH SECTOR

RURAL CHCs, District Hospitals Sentinel Private practitioners and

Sentinel hospitals.

URBAN Urban Hospitals, ESI / Railway / Sentinel Private nursing homes, sentinel

Medical college hospitals. hospitals, Medical colleges, Private and

NGO laboratories

1. Sub-centre - Health Worker / ANM reports all patients fulfilling the clinical

syndrome from PHC, private clinic, Hospital etc.

2. PHC / CHC Medical Officers report as probable cases of interest where this

cannot be confirmed by laboratory tests at the peripheral reporting units

and as confirmed when the laboratory information is available as in case of

Blood smear +ve Malaria and Sputum AFB +ve Tuberculosis.

3. Sentinel Private Practitioners, District Hospitals, Municipal Hospitals, Medical

colleges, Sentinel hospitals, NGOs - Medical Officers report as probable

cases of Interest.

9.12 Syndromes under Surveillance:

The paramedical health staff will undertake disease surveillance based on broad

categories of presentation. The following clinical syndromes will be under

surveillance in IDSP:

1. Fever

� Less than 7 days duration without any localizing signs

� With Rash

� With Altered Sensorium or Convulsions

� Bleeding from Skin or mucus membrane

� Fever more than 7 days with or without localizing signs

2. Cough more than 3 weeks duration

3. Acute Flaccid Paralysis

4. Diarrhoea

5. Jaundice

6. Unusual Events causing death or hospitalization

These syndromes are intended to pick up all priority diseases listed under regular

surveillance at the level of the community under the Integrated Disease

Surveillance Project

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Fever with & without localizing signs Malaria, Typhoid, JE, Dengue, Measles

Cough more than 3 weeks Tuberculosis

Acute Flaccid Paralysis Polio

Diarrhoea Cholera

Jaundice Hepatitis, Leptospirosis, Dengue, Malaria, Yellow fever

Unusual Syndromes Anthrax, Plague, Emerging epidemics

9.13 Core Conditions under surveillance in IDSP

(i) Regular Surveillance:

Vector Borne Disease : 1. Malaria

Water Borne Disease : 2. Acute Diarrhoeal Disease (Cholera)

: 3. Typhoid

Respiratory Diseases : 4. Tuberculosis

Vaccine Preventable Diseases : 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. Meningoencephalitis/Respiratory

(Causing death / hospitalization) Distress, Hemorragic fevers, other

undiagnosed conditions

(ii) Sentinel Surveillance

Sexually transmitted diseases/Blood borne : 10. HIV/HBV, HCV

Other Conditions : 11. Water Quality Monitoring

: 12. Outdoor Air Quality

(Large Urban centers)

(iii) Regular periodic surveys:

NCD Risk Factors : 13. Anthropometry, Physical activity, Blood

Pressure, Tobacco, Nutrition etc.

(iv) Additional State Priorities : Each state may identify up to five additional conditions for

surveillance.

Do surveillance for disease conditions important for public health action:

� The number of core diseases are limited to improve quality of surveillance

and to reduce workload on the peripheral health worker.

� Diseases and other conditions of regional importance will be under

surveillance in addition to the above core list in all states.

� The list will be reviewed and modified according the needs of surveillance

at least once in 2 years

� Viral Hepatitis and ARI are also under active consideration at various

levels and may be included subsequently.

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10. EVALUATION QUESTIONS

Choose the Most optimum Answer for the following:

1. IDSP is ……………..Centered in its activity (Country, State, District, CHC)

2. One of the important reasons why a disease condition is included for surveillance

in the IDSP Programme is because …… (emerging disease, High case fatality,

treatment costs very high, Affects special groups, Availability of public health

response).

3. Integration of IDSP means ………………(Inclusion of private sector in its activities,

Inclusion of NCD in surveillance, Sharing of surveillance information with all stake

holders in the district, Inclusion of Non health sector in surveillance activity, All the

above, None of the above)

4. IDSP will help to monitor….of Disease (Incidence, Prevalence, Trends, Burden)

5. Integration of Medical Colleges will help ………………in IDSP (to recruit large

number of subjects with disease, to detect outbreaks early, in urban surveillance,

monitor quality of surveillance)

6. The medical officers will perform ………….. (Syndromic Surveillance, Probable

Disease based surveillance, confirmed case surveillance, All the above, None of

the above)

Choose True or False

1. Disease surveillance is undertaken to assess the burden of disease in the

community.

2. Disease Surveillance is collection, analysis and interpretation of data for public

health action.

3. Additional Inputs in surveillance through IDSP is Strengthening of laboratory,

Improving communication and providing essential training.

4. New Groups of people are recruited to do surveillance in IDSP separate from

existing system.

INTEGRATED DISEASE SURVEILLANCE PROJECT

(IDSP)

TRAINING MANUAL

FOR

STATE & DISTRICT SURVEILLANCE

OFFICERS

March 2005March 2005March 2005March 2005March 2005

Government of India

Directorate General of Health Services

Ministry of Health and Family Welfare

Nirman Bhawan, New Delhi

ABBREVIATIONS

ABER Annual Blood Examination Rate

AFB Acid Fast Bacilli

AFP Acute Flaccid Paralysis

AIDS Auto Immune Deficiency Syndrome

ANC Ante Natal Care

ANMs Auxiliary Nurse Midwife

API Annual Parasitic Incidence

ARI Acute Respiratory Infection

AWWs Angan Wadi Workers

BMI Body Mass Index

CDC Centers for Disease Control and Prevention

CFR Case Fatality Rate

CHC Community Health Center

CME Continued Medical Education

CMO Chief Medical Officer

CSF Cerebrospinal Fluid

CSU Central Surveillance Unit

CVD Cardio-Vascular Disease

DEIT District Epidemic Investigation Team

DF Dengue Fever

DGHS Directorate General fo Health Services

DH District Hospital

DHF Dengue Haemorrhagic Fever

DHO District Health Officer

DHS Director of Health Services

DIO District Immunization Officer

DME Director of Medical Education

DMO District Malaria Officer

DSO District Surveillance Officer

DSS Dengue Shock Syndrome

DSU District Surveillance Unit

DTO District Tuberculosis Officer

ELISA Enzyme-linked Immuno-sorbent Assay

EQAS External Quality Assurance System

ESI Employee’s State Insurance

ETB Extra-pulmonary Tuberculosis

FW Family Welfare

GIS Geographical Information System

HA Health Assistants

HAV Hepatitis A Virus

HBV Hepatitis B Virus

HCV Hepatitis C Virus

HDV Hepatitis D Virus

HEV Hepatitis E Virus

HRD Human Resource Development

HIV Human Immunodeficiency Virus

IAP Indian Association of Pediatrics

ICMR Indian Council of Medical Research

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IDSP Integrated Disease Surveillance Project

IEC Information Education Communication

IgG Immunoglobulin G

IgM Immunoglobulin M

IMA Indian Medical Association

IT Information Technology

JE Japanese Encephalitis

LT Lab Technician

MHO Medical & Health Officer

MO Medical Officer

MoH & FW Ministry of Health & Family Welfare

MOU Memorandum of Understanding

MP Malarial Parasite

MPW Multi Purpose Workers

M&E Monitoring & Evaluation

NACO National AIDS Control Organization

NCD Non Communicable Diseases

NFHS National Family Health Survey

NGO Non Governmental Organization

NICD National Institute of Communicable Diseases

NIE National Institute of Epidemiology

NPSP National Polio Surveillance Project

OPD Out Patient Department

OPV Oral Polio Vaccine

ORS Oral Rehydration Solution

OT Ortho toludine

PCR Polymerase Chain Reaction

PH Public Health

PHC Primary Health Center

PF Plasmodium falciparum

POL Petrol Oil Lubricants

PTB Pulmonary Tuberculosis

QA Quality Assurance

QC Quality Control

RCH Reproductive & Child Health

RMP Registered Medical Participationer

RNTCP Revised National TB Control Programme

RRT Rapid Response Team

RT Radical Treatment

RTA Road Traffic Accidents

SHGs Self Help Group

SPPs Sentinel Private Practioners

SPR Slide Positivity Rate

SSU State Surveillance Unit

TB Tuberculosis

URTI Upper Respiratory Tract Infection

VPD Vaccine Preventable Disease

VTM Viral Transport Medium

WHO World Health Organisation

CONTENTS

Module Subject Page No.

1. Introductory Module 1

2. Management Structure 19

3. Reporting Units, Participants and their roles 31

4. Private Sector Participation 49

5. Case Definitions 65

6. Laboratory Methods 93

7. Basic Epidemiology 137

8. Outbreak Investigation 159

9. Analysis and Interpretation of Data 183

10. Feedback 209

11. Monitoring, Supervision and Quality Control 223

12. Intra and Intersectoral Coordination and Social Mobilization 233

13. Human Resources Development 243

14. Surveillance of Risk Factors of NCD 257