Innovation in Surveillance of Communicable and Non-communicable Diseases http://nirmalkandel.com/wp-content/uploads/2014/03/Innovation-in-Surveillance.pdf

1. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
1 |
3rd National Scientific Conference on
Epidemiology
Innovation in Surveillance of
Communicable and Non-Communicable
Diseases
Dr Nirmal Kandel , MBBS, MA (Anthropology), MPH, EMBA
Public Health Specialist

2. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
2 |
Outlines
 Surveillance, Uses and Components
 Traditional Surveillance Design
 Advances
 Stepwise Approach – NCDs Surveillance
 Universal Health Coverage and Surveillance

3. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
3 |
What is Surveillance
• Systematic, ongoing…
– Collection
– Analysis
– Interpretation
– Dissemination
• …of health outcome data
Health action
• investigation
• control
• prevention

4. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
4 |
Why we do surveillance
 Estimation the size of health problem
 Detection of outbreaks
 Characterize disease trends
 Evaluate interventions and preventive programmes
 Provide information for health planning and financing
 Identifying training needs in terms of categories and levels
 Identify and prioritize research needs

5. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
5 |
Surveillance Support Functions
Standards and guidelines
Trainings
Supervisions
Communication facilities
Resources (including logistics) all type
Monitoring and Evaluation (M & E) and Coordination
Surveillance System Structure
Legislation (laws and regulations); including IHR (2005)
Surveillance strategy
Improve preparedness for surveillance and response
Surveillance implementation and stakeholders
Networking and partnerships
Core Functions of Surveillance
Case detection, registration and Confirmation
Reporting
Data Analysis and interpretation
Epidemic preparedness
Response and control
Feedback and evaluate
Surveillance Quality
Completeness and Timeliness
Usefulness and Simplicity
Acceptability and Flexibility
Sensitivity and Specificity
Positive predictive value
Representativeness
Components of Surveillance System

6. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
6 |
Surveillance Design
 Traditional disease notification
 Outbreak investigation
 Cluster investigation
 Active and Passive Surveillance
 Enhanced surveillance
 Sentinel surveillance
 Emerging infectious diseases
– diagnosis-based surveillance
– syndromic surveillance
 Molecular biology and
surveillance
 Event Based Surveillance
 Non – Traditional Surveillance

7. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Traditional Disease Surveillance
SOURCE:Figure courtesy of Dr. Larry Madoff

8. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Advances in Surveillance
 Syndromic Surveillance
 Electronic Health Records
 Non traditional approaches
 Event Based surveillance and Early Warning System
 Integrated Diagnostic System
 Pre-symptomatic Detection

9. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
9 |
Before going quick question…think

10. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
10 |
Syndromic Surveillance
“Syndromic surveillance” is defined as the collection and analysis
of “health-related data that precede diagnosis and signal with
sufficient probability of a case or an outbreak to warrant further
public health response”
Source: Global Infectious Disease Surveillance and Detection:Assessing the Challenges -- Finding Solutions,Workshop Summary

11. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Syndromic Analyses
Automated analyses identify unusual patterns and increases are investigated

12. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Electronic Health Monitoring
SOURCE: Lombardo (2006)

13. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Non Traditional Approaches
 EIS and GOARN
 Promed Mail
 GPHIN
 Health Map
 MedIsy

14. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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EIS and DON
Event Information Sites (EIS) for National IHR Focal Points

15. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Advances in Indonesia

16. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Bulletins

17. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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GLEWS
 One World – One Health and Emerging Disease Surveillance –
GLEWS - http://www.glews.net/

18. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Surveillance Networks
 Global Infectious Disease Surveillance and Early Warning Systems
– Promed

19. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Framework for Internet Based Surveillance

20. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Building Available Infrastructure
Source:Voxiva

21. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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How it works

22. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Comprehensive Integrated Diagnostics System

23. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
23 |
Medical Tricorder
“integrated diagnostic
system” for field use
that can detect viruses,
bacteria, toxins,
The current prototype
relies on automated
real-time PCR

24. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Host Based Pre-symptomatic Detection Event
Source: Johnston (2006)

25. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Personalized Medicine Based Biosignatures

26. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Some Innovations Used…….

27. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
27 |
Some Innovations Used…….

28. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
28 |
Use of Social Networks
I trace the passenger during
Pandemic 2009 H1N1 under
IHR (2005)

29. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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30. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
30 |
Step 3
(Biological)
Complexity
Step 2
(Physical)
Step 1
(Verbal)
Core
Expanded
Optional
At each step
The WHO STEPwise approach to
surveillance of non-communicable disease risk factors
Sequential approach, step by step

31. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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• Coronary heart
disease
• Stroke
• Peripheral vascular
disease
• Several cancers
• COPD/emphysema
Endpoints
Intermediate
Risk Factors
•Hypertension
•Blood lipids
•Obesity /
Overweight
• Diabetes
• Tobacco
• Diet
• Alcohol
• Physical Activity
Behavioural
Risk Factors
Non-modifiable
Risk Factors
•Age
•Sex
•Genes
Socio-economic,
Cultural & Environmental
Conditions
Figure 4 Example of Major Selected Non-Communicable
Disease (NCD) Risk Factors and Determinants
Source: World Health Organization (WHO)

32. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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Age
Foetal
life
Adult LifeAdolescenceInfancy and
childhood
•SES
•Nutrition
•Diseases
•Linear
growth
•Obesity
•Obesity
•Lack of
activity
•Diet
•Alcohol,
•Smoking
•SE potential
•Established adult risk factors
(behavioural/biological)
•SES
•Maternal
nutritional
status &
obesity,
•Fetal
growth
Accumulated
risk
Range of
individual
risk
Accumulated
risk
Life course approach for the prevention of
non communicable diseases

33. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
33 |
Surveillance Focus
 Risk factor surveillance - for estimation and Prevention
 Actual Burden of Diseases
– Hospital records (HMIS)
– Mortality Statistics (Verbal Autopsy)
– Insurance data
– Funeral Services
– Drug Data

34. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
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35. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
35 |
Universal Health Coverage
Universal Health Coverage – is defined as ensuring that all people
can use the promotive, preventive, curative, rehabilitative and
palliative health services they need, of sufficient quality to be
effective, while also ensuring that the use of these services does not
expose the user to financial hardship.

36. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
36 |
Thank You