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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-encephalitis
Respiratory distress
Hemorrhagic fever
Other undiagnosed condition
Other conditions under surveillance
Type of surveillance
Sentinel surveillance

Categories

Conditions
HIV/HBV/HCV

Other
conditions

Regular periodic surveys

STDs

Water quality

Noncommunicable
disease risk
factors

Anthropometry
Physical activity
Blood pressure
Tobacco, blood pressure

Outdoor air quality

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

Programme
officers

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

P.H.C.s
C.H.C.s

Pvt. practitioners

D.S.U.
Dist. hosp.

Nursing homes
Private hospitals

Med. col.
Private labs.
P.H. lab.

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

Corporate
hospitals
Surveillance activities at each level
Activities

Periphery

District

State

+++

++

-

Consolidation of data

+

+++

+++

Analysis and interpretation

+

+++

+++

+++

+++

+

Feedback

+

+++

++

Dissemination

+

++

++

Action

++

+++

+

Detection and notification of
cases

Investigation and confirmation
District Surveillance Committee
District Program Manager
Polio, Malaria, TB, HIV - AIDS

CMO
(Co. Chair)

Representative
Water Board

Chief District PH
Laboratory

Superintendent
Of Police

District Data Manager
(IDSP)

Chairperson*
District Surveillance Committee

Representative
Pollution Board

IMA
Representative

NGO
Representative

District Training Officer
(IDSP)

Medical College
Representative
if any

District Panchayat
Chairperson
District Surveillance Officer
(Member Secretary)

* District Collector or District Magistrate
State surveillance committee
Director Public
Health (Co. Chair)

Director Medical Education

Director Health Service
Representative
Water Board

State Program Managers
Polio, Malaria, TB, HIV - AIDS

NGO

State Data Manager IDSP

Chairperson*
State surveillance committee

Medical Colleges
State Coordinator

Head, State Public
Health Lab
Representative
Department of Home

State Training Officer

Representative
Department of Environment

* State health secretary

IMA
Representative
State Surveillance Officer
(Member Secretary)
National surveillance committee
Director General
Health Services
(Co. Chair)

Director General
ICMR
PD
(IDSP)

National Program Managers
Polio, Malaria, TB, HIV - AIDS
JS
(Family Welfare)

Chairperson*
National surveillance
committee

IMA
Representative

Director
NICD

NGO

Director
NIB

Consultants
(IndiaCLEN / WHO
/ Medical College
/others)
Representative
Ministry of Environment

* Secretary health and secretary family welfare

Representative
Ministry of Home
National Surveillance Officer
(Member Secretary)
Linkages of the central surveillance unit at the
central level
W.H.O.

Outbreak investigation
and rapid response

E.M.R.

NCDC
Non-communicable
diseases
surveillance

MIS and report

CSU

ICMR

NVBDCP

RNTCP

National
Programs

CBHI

RCH

Programme monitoring

NACP
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
Laboratory Reporting
Form

Level of Laboratory

Responsibility of
Reporting

Form L1 Peripheral Laboratory at PHC/CHC

Laboratory
Assistants/Technician
through MO I/c

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

I/c
Microbiologist/Pathologists

Form L3 Labs in Medical Colleges, other
tertiary institutions,

Reference Labs.
Head, Microbiologist
Department
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
New Initiatives - 2
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
Thank You

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Integrated Diseases Surveillance Project - IDSP India

  • 1. IDSP – Integrated Disease Surveillance Project Dr. Rizwan S A, M.D.,
  • 2. IDSP – Integrated Disease Surveillance Project
  • 3. 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
  • 5. 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.
  • 6. 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?
  • 7. 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
  • 9. 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
  • 10. Components • Integrating & decentralizing disease surveillance & response mechanisms • Strengthening Public Health Laboratories • Using Information Technology and Networking in disease surveillance • Human Resource Development
  • 11. 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
  • 12. 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
  • 13. 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
  • 14. 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-encephalitis Respiratory distress Hemorrhagic fever Other undiagnosed condition
  • 15. Other conditions under surveillance Type of surveillance Sentinel surveillance Categories Conditions HIV/HBV/HCV Other conditions Regular periodic surveys STDs Water quality Noncommunicable disease risk factors Anthropometry Physical activity Blood pressure Tobacco, blood pressure Outdoor air quality Nutrition Blindness Additional state priorities Up to five diseases
  • 16. 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
  • 17. 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
  • 19. Information flow of the weekly surveillance system Sub-centres Programme officers C.S.U. S.S.U. P.H.C.s C.H.C.s Pvt. practitioners D.S.U. Dist. hosp. Nursing homes Private hospitals Med. col. Private labs. P.H. lab. Other Hospitals: ESI, Municipal Rly., Army etc. Corporate hospitals
  • 20. Surveillance activities at each level Activities Periphery District State +++ ++ - Consolidation of data + +++ +++ Analysis and interpretation + +++ +++ +++ +++ + Feedback + +++ ++ Dissemination + ++ ++ Action ++ +++ + Detection and notification of cases Investigation and confirmation
  • 21. District Surveillance Committee District Program Manager Polio, Malaria, TB, HIV - AIDS CMO (Co. Chair) Representative Water Board Chief District PH Laboratory Superintendent Of Police District Data Manager (IDSP) Chairperson* District Surveillance Committee Representative Pollution Board IMA Representative NGO Representative District Training Officer (IDSP) Medical College Representative if any District Panchayat Chairperson District Surveillance Officer (Member Secretary) * District Collector or District Magistrate
  • 22. State surveillance committee Director Public Health (Co. Chair) Director Medical Education Director Health Service Representative Water Board State Program Managers Polio, Malaria, TB, HIV - AIDS NGO State Data Manager IDSP Chairperson* State surveillance committee Medical Colleges State Coordinator Head, State Public Health Lab Representative Department of Home State Training Officer Representative Department of Environment * State health secretary IMA Representative State Surveillance Officer (Member Secretary)
  • 23. National surveillance committee Director General Health Services (Co. Chair) Director General ICMR PD (IDSP) National Program Managers Polio, Malaria, TB, HIV - AIDS JS (Family Welfare) Chairperson* National surveillance committee IMA Representative Director NICD NGO Director NIB Consultants (IndiaCLEN / WHO / Medical College /others) Representative Ministry of Environment * Secretary health and secretary family welfare Representative Ministry of Home National Surveillance Officer (Member Secretary)
  • 24. Linkages of the central surveillance unit at the central level W.H.O. Outbreak investigation and rapid response E.M.R. NCDC Non-communicable diseases surveillance MIS and report CSU ICMR NVBDCP RNTCP National Programs CBHI RCH Programme monitoring NACP
  • 25. 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
  • 26.
  • 27.
  • 28.
  • 29. Laboratory Reporting Form Level of Laboratory Responsibility of Reporting Form L1 Peripheral Laboratory at PHC/CHC Laboratory Assistants/Technician through MO I/c Form L2 District Public Health Laboratory, Labs of District Hospital, Private and other Hospitals & Private Labs. I/c Microbiologist/Pathologists Form L3 Labs in Medical Colleges, other tertiary institutions, Reference Labs. Head, Microbiologist Department
  • 30. 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
  • 31. 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
  • 32. 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
  • 33. 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
  • 34. New Initiatives - 2 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