The Early Warning and Reporting System (EWARS) is a hospital-based sentinel surveillance system in Nepal that monitors six priority infectious diseases. EWARS was established in 1997 with 8 sentinel sites and has since expanded to 118 sites including central, provincial, and district hospitals. The main objectives of EWARS are to strengthen disease information flow and facilitate prompt outbreak response. Sentinel sites report disease data weekly or immediately to the Epidemiology and Disease Control Division, which analyzes trends, provides feedback, and coordinates rapid response teams if an outbreak is detected.

1. Early Warning and Reporting
System (EWARS)
(Source : DOHS annual report FY 2075/76)
Prepared by :-
Binam Raj Shrestha
Master of public health (MPH)

2. outline
• Background
• main objective
• Information flow mechanism and control room responsibilities:
• Main activities of control room are:
• Reference

3. Background
• EWARS is a hospital-based sentinel surveillance system the selected hospitals
send immediate and weekly reports(including zero reports) on six priority diseases
(Malaria, Kala-azar, Dengue, Acute Gastroenteritis (AGE), Cholera and Severe
Acute Respiratory Infection (SARI), and other epidemic potential
diseases/syndromes (like enteric fever, Leptospirosis, Hydrophobia,
Chickungunya etc.).
https://www.edcd.gov.np/section/surveillance-of-communicable-disease-program

4. • It is designed to provide timely report of selected epidemic prone , vector- born
,water and food borne diseases for the early detection of outbreaks.
• It was established in 1997 first in 8 sentinel sites and expanded to 24 sites in 1998,
26 sites in 2002, 28 sites in 2003,40 sites in 2008 and 82 sites in 2016.
• In may 2019 ,additional 36 sites (private hospitals and medical colleges across
Nepal)were declared as sentinel sites by the DoHS.

5. • The total numbers of current sentinel sites is 118. Sentinel sites include all the
central ,provincial, district hospitals , medical college including selected private
hospitals.
• The main objectives of EWARS is to strengthen the flow of information on
outbreak prone infectious disease and vector borne disease from the districts and
to facilitate prompt outbreak response to be carried out by rapid response
tram(RRT) at federal ,provincial and local level.

6. Main Objectives:
To develop a comprehensive and computerized database of infectious diseases of
public health importance
To monitor and describe trends of infectious diseases through a sentinel
surveillance network of hospitals followed by public health action and research
To receive early warning signals of diseases under surveillance and to detect
outbreaks

7. To initiate a concerted approach to outbreak preparedness, investigation and
response through different levels of RRT
To disseminate data/information on infectious diseases through an appropriate
feedback system.

8. The four basic elements of surveillance that were the cornerstones of EWARS
development:
Mechanism for hospital inpatient-ward-based case detection,
Laboratories for identifying and characterizing microbes,
Intact information systems and
Immediate response (information feedback and mobilization of investigative and
control efforts)

9. Information flow mechanism and control room
responsibilities:
Sentinel sites report immediately for events and weekly report for indicator based
to EDCD and VBDRTC
If necessary, EDCD confirm the cases from NPHL/reference laboratory test
EDCD initiate for control and prevention of disease with coordination of RRTs at
different levels

10. Mobilization of RRT at different levels for control and prevention of disease
If any error found in reporting system from Sentinel sites, EDCD provides the
feedback to concern sentinel sites

11. Main activities of control room are:
Maintenance of quality, accuracy, timeliness and completeness of data received
from EWARS sentinel sites.
Analysis of data from EWARS sites, monitoring of disease trends and notifying
concerned authorities when outbreaks are suspected or predicted.
Publication of EWARS bulletin every week on Sunday and sharing of electronic
report to all key personnel of MOHP, DoHS, Province health directorate, sentinel
sites and stakeholders

12. • A guide to Early Warning and Reporting System” was updated and
disseminated in 2019 in 2019 which can be accessed at EDCD website

13. Bibliography
• https://dohs.gov.np/wp-content/uploads/2020/11/DoHS-Annual-
Report-FY-075-76-.pdf
• https://www.edcd.gov.np/section/surveillance-of-communicable-
disease-program