The document discusses surveillance of COVID-19, including definitions, objectives, and types of surveillance. Surveillance is defined as the ongoing collection and analysis of health-related data to improve public health. The objectives of COVID-19 surveillance are to rapidly detect cases and contain outbreaks. Types of surveillance discussed are active surveillance through house-to-house searches, passive surveillance through health facilities, and sentinel surveillance through targeted testing. Limitations include underdetection of mild and asymptomatic cases.
🔥HOT TOPIC🔥
Sharing my PowerPoint slides on 🐵 MONKEYPOX🐵
(a potential/sure shot question for MD exam)
This can be used for a 2 hour session of PG seminar since all the aspects of the disease are covered.
It includes a compilation of;
1. Infectious history (in detail)
2. Epidemiology (Global, local)
3. Case definitions
4. Clinical features
5. Differential diagnosis (including comparison with common DDs)
6. Complications
7. Investigations
8. Management
9. Vaccines
10. Other specific preventive measures
Share among Community Medicine residents for maximum reach and benefits...😊
Epidemiology of Non Communicable Diseases (NCDs)Prabesh Ghimire
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
Guidelines for Management of Outbreak in Healthcare Organizationdrnahla
Guidelines for Management of Outbreak in Healthcare Organization
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
This presentation contains in brief about various Non-communicable diseases (NCDs) and International interventions to combat NCDs. It also contains recent updates on current problem statement of common NCDs and updates on National Programme for Prevention and Control of non-Communicable Diseases (NP-NCDs).
National Leprosy Eradication Programme (NLEP) as on 08/12/2018Tapeshwar Kumar
Health Policy by Government of India under Ministry of Health & Family Welfare(Ministry of Health).
Better. Clarity on Google Drive Link:
https://drive.google.com/drive/folders/1L59zjagV1U4rzkEWe4eV7fW09Y6ZDA_M?usp=sharing
https://goo.gl/jAtCfv
You can remove footnote (TapeshwarAIIMS_3210/2015) by choosing the Header & Footnote option & deselecting it.
🔥HOT TOPIC🔥
Sharing my PowerPoint slides on 🐵 MONKEYPOX🐵
(a potential/sure shot question for MD exam)
This can be used for a 2 hour session of PG seminar since all the aspects of the disease are covered.
It includes a compilation of;
1. Infectious history (in detail)
2. Epidemiology (Global, local)
3. Case definitions
4. Clinical features
5. Differential diagnosis (including comparison with common DDs)
6. Complications
7. Investigations
8. Management
9. Vaccines
10. Other specific preventive measures
Share among Community Medicine residents for maximum reach and benefits...😊
Epidemiology of Non Communicable Diseases (NCDs)Prabesh Ghimire
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
Guidelines for Management of Outbreak in Healthcare Organizationdrnahla
Guidelines for Management of Outbreak in Healthcare Organization
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
This presentation contains in brief about various Non-communicable diseases (NCDs) and International interventions to combat NCDs. It also contains recent updates on current problem statement of common NCDs and updates on National Programme for Prevention and Control of non-Communicable Diseases (NP-NCDs).
National Leprosy Eradication Programme (NLEP) as on 08/12/2018Tapeshwar Kumar
Health Policy by Government of India under Ministry of Health & Family Welfare(Ministry of Health).
Better. Clarity on Google Drive Link:
https://drive.google.com/drive/folders/1L59zjagV1U4rzkEWe4eV7fW09Y6ZDA_M?usp=sharing
https://goo.gl/jAtCfv
You can remove footnote (TapeshwarAIIMS_3210/2015) by choosing the Header & Footnote option & deselecting it.
Outbreak management ppt comprises the definition , history , investigations and the steps of management of outbreak. This was my seminar and UG class tpoic
The Burden of Disease ( BOD) analysis describes in details the uses and effects of BOD. How to measure it. Special emphasis has been given in understanding HALY, DALY and QALY.
N.B: 1. Please download the ppt first, as the animations will act better then
2. There are few hidden slides in the presentation, which you may explore too.
Outbreak management ppt comprises the definition , history , investigations and the steps of management of outbreak. This was my seminar and UG class tpoic
The Burden of Disease ( BOD) analysis describes in details the uses and effects of BOD. How to measure it. Special emphasis has been given in understanding HALY, DALY and QALY.
N.B: 1. Please download the ppt first, as the animations will act better then
2. There are few hidden slides in the presentation, which you may explore too.
The Gibraltar COVID-19 Cohort: Determining the True Incidence and Severity Ra...asclepiuspdfs
COVID-19 is a new infectious disease with an unclear incidence and an unknown rate of progression to severe disease. The Gibraltar COVID-19 Cohort utilises two distinct cohorts - a clinical cohort and a random population based cohort -, to provide an accurate assessment of case severity rate. Design: Retrospective analysis of a SARS-CoV2 RT-PCR point prevalence study and a RT-PCR confirmed positive clinical case cohort to calculate case severity rates. Settings and Participants: Over a three day period nasopharyngeal swabs were sampled from a randomly selected 1.2% of the population of Gibraltar and then analysed via RT-PCR to determine the background incidence of COVID-19 infection. The results were then analysed and compared to the clinical case cohort. The rate of progression to severe COVID-19 disease in those with COVID-19 infection was then calculated.
COVID-19: A guide for Medical Officers in Primary Health Centres. All Details...Shivam Parmar
Disclaimer -
The Content belongs to rajswasthya.nic.in (Govt. of Rajasthan) Sharing here is just to spread awareness about Covid-19.
http://www.rajswasthya.nic.in/PDF/PPT%20for%20MOs%20at%20PHCs%20for%20COVID19%20management%2009052020%20(1).pdf
The 2019–20 coronavirus pandemic is an ongoing pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[4] The outbreak was first identified in Wuhan, Hubei, China, in December 2019, and was recognized as a pandemic by the World Health Organization (WHO) on 11 March 2020.[5] As of 25 March, more than 422,000 cases of COVID-19 have been reported in more than 190 countries and territories, resulting in more than 18,900 deaths and more than 109,000 recoveries.
CORONA VIRUS & it’s effect on daily lifeDanao Maibam
The world is facing a challenging. An essential key to combat COVID-19 is to be educated and be familiar to the disease itself and to plan strategies that will help the world win the fight against the crisis.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
2. Learning objectives
Definition of Surveillance
Introduction of COVID-19
Objectives of surveillance
Different types of surveillance
Limitations of surveillance
2
3. Definition : Surveillance
Surveillance is defined as an “ongoing, systematic collection,
analysis, interpretation, and dissemination of data regarding a
health-related event for use in public health action to reduce
morbidity and mortality and to improve health.”(1)
3
4. Epidemiology of COVID-19
• Agent- Corona virus belongs to large family of RNA viruses, some causing
infection to human and others to animals.
• The etiologic agent for present pandemic of COVID -19 is SARS CoV2 which is a
novel corona virus.
• Transmission of coronavirus can occur via respiratory secretion.
• The incubation period for COVID-19 is thought to extend to 14 days, with a
median time of 4-5 days from exposure to symptoms onset.(2)
• Most common symptoms are fever, fatigue, dry cough, sore throat and breathing
difficulty. Gastrointestinal symptoms include diarrhea and nausea/vomiting.
4
5. Definitions to learn
Case definition
1. Suspect case
2. Probable case
3. Laboratory confirmed case
Contact definition
1. High risk contact
2. Low risk contact
5
6. Suspect case
Acute onset of two or more of the following symptoms
8.Sore throat
9.Running nose
10.Shortness of breath
11.Loss of appetite in adults
12.Nausea/vomiting
13.Diarrhoea
14.Altered mental status.(3)
1.Fever with or without chills
2.Cough
3.Loss of taste
4.Loss of smell
5.General weakness
6.Headache
7.Myalgia
6
7. Probable case
A. A suspect case who is a contact of a confirmed case OR
epidemiologically linked to a cluster of confirmed cases
OR
B. An asymptomatic person who is a high risk contact of a confirmed case
OR epidemiologically linked to a cluster of confirmed cases
OR
C. If clinically suspected by a physician
OR
D. Death, not otherwise explained, in an individual with respiratory
distress preceding death AND who was a contact of a probable or
confirmed case or epidemiologically linked to a cluster of confirmed
cases.(3)
7
8. Laboratory confirmed case
A person with laboratory confirmation of Covid-19
infection, irrespective of clinical signs and symptoms.(3)
8
9. Definition of a Contact
A contact is a person that is involved in any of the following:
Providing direct care without proper personal protective equipment (PPE)
for COVID-19 patients
Staying in the same close environment of a COVID-19 patient (including
workplace, classroom, household, gatherings).
Traveling together in close proximity (1 m) with a symptomatic person who
later tested positive for COVID-19.(4)
9
10. High risk contact
Person who touched body fluids of a patient.
Person who had direct physical contact with the body of a patient including
physical examination without PPE.
Touched or cleaned the linens, clothes, or dishes of a patient.
Lives in the same household as the patient.
Anyone in close proximity (within 3 ft) of the confirmed case without
precautions.
Passenger in close proximity (within 3 ft) of a conveyance with a symptomatic
person who later tested positive for COVID-19 for more than 6 hours.(4)
10
11. Low risk contact
• Person who shared the same space (Same class for school/worked
in same room/similar and not having a high risk exposure to
confirmed or suspect case of COVID-19).
• Person who travelled in same environment (bus/train/flight/any
mode of transit) but not having a high-risk exposure.(4)
11
12. Objectives of surveillance
Enable rapid detection, isolation, testing, and management of cases.
Identify, follow-up and quarantine contacts.
Detect and contain clusters and outbreaks among vulnerable populations.
Monitor longer term epidemiologic trends and monitor trends in covid-19
deaths.
Evaluate the impact of the pandemic on health care systems and society.
12
13. Different types of surveillance
Active surveillance : House to house search to identify suspect cases
Passive surveillance : Data collected from patients themselves reporting
to health facilities
Sentinel surveillance : A method for identifying missing cases and
supplementing the notified cases.(5)
13
14. COVID-19 : Active surveillance
The residential areas were
divided into sectors for
ASHAs/ANMs/AWWs each
covered 100 houses
They performed active house to house visit daily
for line listing family members and those having
symptoms and also contacts of the confirmed
cases and informed higher officer,
The suspects were isolated.
The higher officer collect data from health
workers, collate and provide the cumulative
data to the control room by 4 pm daily,and also
visit houses, make arrangements for suspect
cases to designated treatment facility.(6)
District level
The control room in turn
inform the officer for
surveillance of contacts
State/National level
In the initial phase of COVID-19
14
15. Containment zone and buffer zone
The containment zone is defined based on
• Index case or cluster which will be the
designated epicenter
• Geographical distribution of cases
around epicenter
• Local administrative boundaries of
urban town/city
Buffer zone
Buffer Zone is an area around the
Containment Zone, where new cases most
likely to appear.(7)
15
16. Activity in containment zone
Isolation and quarantine
Enhanced IEC
Ban local mass gathering
Closure of schools, offices, colleges
Environment disinfection
Control room establishment
Mobile specimen collection units
16
18. COVID- 19 : Passive surveillance
In the initial phase of pandemic
All health facilities in the containment zone and buffer zone were listed as a
part of mapping exercise.
Such facilities reported clinically suspect cases of COVID-19 on real time basis
(including ‘Nil’ reports) to the control room at the district level
After community transmission, individual case identification, contact tracing,
and quarantining were no longer necessary.
Now, Surveillance of COVID-19 is going on for ILI (Influenza Like Illness) / SARI
(Severe Acute Respiratory Illness) cases in health facilities or outreach mobile
units or through fever clinics.
18
19. Sentinel Surveillance :
To monitor the trend in prevalence of SARS-COV2 infection at district level
Sentinel group
• Low risk population: Outpatient attendees (non-ILI patients) and
pregnant women
• High risk population: health care workers
Sentinel grp
Throat/nasal
swabs for RT-PCR
tests
Blood samples for
IgG antibodies for
ELISA testing.
Collection and analysis
Data on demography collected, analyzed locally for action using
standard indicator(person, place, time)and for trend analysis.(8)
10 health
facilities/
Distric
19
21. Hospital based surveillance
21
No of new confirmed cases hospitalized
No of confirmed cases discharged or
recovered
No of deaths among confirmed cases
Percent of hospital or ICU beds occupied
Proportion of hospitalized COVID-19 cases
No of confirmed cases among HCW
No of confirmed case deaths among HCW
Estimate of excess mortality
Patients with confirmed COVID-19
admitted to hospital or death should be
notified to national public health
authorities within 24 hours of
identification
22. Laboratory based surveillance :
Lab confirmed cases reported within 24 hrs
Both for NAAT (nucleic acid amplification test)
and Rapid antigen test.(9)
22
23. Digital surveillance
• Digital surveillance systems are helpful
in disease containment during pandemic
• In India Aarogya Setu mobile app is a
COVID- 19 tracking app
• It helps in contact tracing
• It also help identification and prevention
of potential risk of infection
23
24. COVID-19 recent situation in India (10,11)
Active cases 741830
Deaths 165101*
* COVID-19 INDIA as on : 05 April 2021, 08:00 IST (GMT+5:30) https://www.mohfw.gov.in/#
24
25. Limitations of surveillance :
o Mild and sub-clinical cases are usually not seeking treatment
o Mild cases usually avoid hospital unless it is necessary
o The clinically detected cases represent only the tip of ice-berg
of the actual infected Covid-19 cases
o Lack of timeliness and completeness of reports are other
problems
25
26. References :
1. (CDC. Updated guidelines for evaluating public health surveillance systems. MMWR 2001;50 (No. RR-13)
2. CDC. Healthcare Workers [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2021 Feb 4]. Available from:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
3. 53461816061605246727.pdf [Internet]. [cited 2021 Feb 4]. Available from:
https://ncdc.gov.in/WriteReadData/l892s/53461816061605246727.pdf
4. 45899555761592998400.pdf [Internet]. [cited 2021 Feb 4]. Available from:
https://ncdc.gov.in/WriteReadData/l892s/45899555761592998400.pdf
5. Park K. Textbook of Preventive and Social Medicine. 25th edition: Bhanot Publishers;(2019)page 47
6. UpdatedContainmentPlanforLargeOutbreaksofCOVID19Version3.0.pdf [Internet]. [cited 2021 Feb 4]. Available from:
https://www.mohfw.gov.in/pdf/UpdatedContainmentPlanforLargeOutbreaksofCOVID19Version3.0.pdf
7. ContainmentandSurveillanceManualforSupervisorsincontainmentzones.pdf [Internet]. [cited 2021 Feb 4]. Available from:
https://www.mohfw.gov.in/pdf/ContainmentandSurveillanceManualforSupervisorsincontainmentzones.pdf
8. DistrictlevelFacilitybasedsurveillanceforCOVID19.pdf [Internet]. [cited 2021 Feb 5]. Available from:
https://www.mohfw.gov.in/pdf/DistrictlevelFacilitybasedsurveillanceforCOVID19.pdf
9. Public health surveillance for COVID-19: interim guidance [Internet]. [cited 2021 Jan 24]. Available from:
https://www.who.int/publications-detail-redirect/who-2019-nCoV-surveillanceguidance-2020.8
10. india-situation-report-53.pdf [Internet]. [cited 2021 April 5]. Available from: https://cdn.who.int/media/docs/default-
source/wrindia/situation-report/india-situation-report-53.pdf?sfvrsn=49c97b8d_4
11. Latest covid 19 india report - Google Search [Internet]. [cited 2021 April 5]. Available from:
https://www.google.com/search?q=Latest+covid+19+india+report&rlz=1C1CHBF_enIN924IN924&oq=Latest+covid+19+india+rep
ort&aqs=chrome..69i57.21266j0j4&sourceid=chrome&ie=UTF-8
12. Sentinel-Surveillance-Report-Modified.docx-1.pdf [Internet]. [cited 2021 Feb 5]. Available from: https://dhs.kerala.gov.in/wp-
content/uploads/2020/05/Sentinel-Surveillance-Report-Modified.docx-1.pdf 26