Coauthors: Ms Christa Maria Joel and Ms Meera Ann John Supervisors: Dr Saurabh Kumar Department of Community Medicine Father Muller Medical College 3rd Year MBBS

1. VISIT TO INTEGRATED
DISEASE
SURVEILLANCE UNIT,
MANGALORE
12M5536: Christa Maria Joel
12M5571: Meera Ann John

2. Abbreviations and full forms:
IDSP: Integrated Disease Surveillance Project
IDSU: Integrated Disease Surveillance Unit
PHC: Primary Health Center
CHC: Community Health Center
CSU: Central surveillance unit
SSU: State Surveillance Unit
DSU: District Surveillance Unit
PSU: Primary Sampling Unit
SSPS: Selected Sentinel Private Sites
CMO: Chief Medical Officer
IMA: Indian Medical Association
NGO: Non Government Organisation
AFP: Acute Flaccid Paralysis
DF: Dengue Fever
JE: Japanese Encephalitis
ELISA: Enzyme Linked Immunosorbent Assay

3. Surveillance is defined as an ongoing,
systematic, collection, compilation, analysis,
interpretation and dissemination of the health data
for early detection and prediction of epidemics for
planning and implementation of prevention and
control measures, especially on a set of high
priority diseases and risk factors of
noncommunicable diseases and for evaluation of
control measures. It also helps in optimising the
allocation of resources.
The integrated disease surveillance project
is a decentralised, state based surveillance system
in the country. It was launched in November 2009.
The integrated disease surveillance unit is
supervised by district health and family welfare
committee. The aim of this program is at early
detection of warning signals of impending
outbreaks and initiation of effective response in a
timely manner. Surveillance is done by
paramedical staffs that have been trained to
identify certain clinical syndromes associated with
common communicable diseases in community.

4. 1
Figure 1- Chart showing report of communicable diseases in the district
It is called integrated because there is
incorporation of public sector, private sector and
community participation. There is incorporation of
communicable and non-communicable diseases.
There is incorporation of rural health systems and
urban health systems. There is incorporation of
medical colleges both government and private.
There is incorporation of various international
agencies.

5. 2
Objectives:
1.To establish a decentralised surveillance
system in the country.
2.To detect early warning signals of impending
outbreak.
3.To initiate control measures early, by
allocating the health resources more
efficiently.
4.To study the disease pattern and to identify
new emerging diseases.
5.To involve all stakeholders in surveillance.
6.To involve paramedical personnel in
surveillance system.
Types of surveillance in IDSP:
There are 3 parallel system of surveillance:
- Syndromic surveillance: Diagnosis is made by
the paramedical worker or community member
based on the clinical pattern and refer them to
the nearest PHC. It is a method of active
surveillance.

6. 3
Figure 2- S form or syndromic form
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7. Figure 3- chart showing the infectious diseases and the actions to be taken
- Presumptive surveillance: Diagnosis is made
by the medical officer of PHC based on
history and clinical examination.
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8. Figure 4- P form or presumptive form
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9. - Laboratory surveillance: Diagnosis is
confirmed by the appropriate laboratory
test. This report is made by medical
officer.
Figure 5- L form or laboratory form
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10. 8
Figure 6- table showing diseases under IDSP
Figure 7- table showing other conditions under IDSP

11. Working of IDSU:
The Dakshina Kannada district surveillance unit
receivers report from 374 subcenters, PHCs of 5
Taluk hospitals- Mangaluru, Belthangady, Puttur,
Sulia, Bantwal.
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Figure 8- flowchart showing the district surveillance committee

12. Figure 9- flowchart showing the structural framework
Figure 10- flowchart showing the structural framework of IDSP
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13. Surveillance actions:
- Feedback and sharing information by the
stakeholders such as medical officers of
primary health centers or community health
centers, district hospital, private practitioners.
- Response to the surveillance information,
should be in the form of guidelines, report.
- Level of response is specified in the form of
triggers. Trigger level 1: suspected or limited
outbreak- local response by MO. Trigger level
2: epidemic- local or regional response.
Trigger level 3: established outbreak- state
level response.
Warning signs of an impending outbreak:
- Clustering of cases or death in time and or
space.
- Unusual increase in cases or deaths.
- Even a single case of measles, AFP, cholera,
plague, DF or JE.
- Acute febrile illness of unknown etiology.
- Occurrence of two or more epidemiologically
linked cases of meningitis, measles.
- Unusual isolate
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14. - Shifting in age distribution of cases.
- High vector density
- Natural disasters.
Epidemic response:
- Definition of outbreak
- Confirmation of outbreak
- To assess the magnitude of the problem
- To study the distribution of the outbreak with
reference to time, place and person.
- To identify the source of infection and mode of
spread
- To implement control measures.
Intensifying the information, education and
communication activities by the following
measures:
- Organisation of workshops
- Review meetings
- Role of media
- Role play
- Interpersonal communication
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15. Monitoring and evaluation:
Number of performance indicators are identified
for monitoring and evaluation and would be used
in baseline sample surveys, midterm evaluation,
endline evaluation ensuring laboratory quality and
cost effective analysis.
Rapid response teams:
If a death due to a communicable disease is
reported in the district, IDSU will send a rapid
response team comprising of district officer,
physician, paediatrician, microbiologist,
epidemiologist to visit the house so as to avoid
family and community level fatalities.
Lab services:
The laboratory is divided into malaria clinic and a
general clinic. The malaria clinic receives
approximately 2000 samples annually from
peripheral units. Once a sample is tested positive
the respective PHC or subcentre start the patient
on treatment supplied by the government. The
general lab performs tests such as tests for purity
of drinking water, dengue IgM ELISA, hepatitis B
IgM ELISA, measles IgM ELISA etc.
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16. Figure 11- chart showing the malaria incidence in the district
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17. Figure 12- chart showing the water analysis report of the district
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Figure 13- chart showing the various lab reports

18. Other functions:
Largely involved in health education and activities
like distribution of pamphlets, seminars on newly
emerging communicable infections for health care
professionals, health education to children at
Anganwadi centers, health talks at village level.
Conclusion
The visit to IDSU was very informative. It gave us
a thorough knowledge of its capacity to detect,
report and effectively respond to major infectious
diseases.
Strengths: It helps in the reporting of suspect,
probable and confirmed cases- syndromic
reporting from periphery. It improves the
information available to the government health
services and private health care providers on a set
of high priority diseases and risk factors. The
IDSU is headed by a full time medical officer and
its labs have approved epidemiologist,
microbiologist and entomologist.
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19. A weekly surveillance report is prepared in the
IDSU which helps them in taking effective
responses.
Weaknesses: Expensive and time consuming,
inefficient for rare diseases or diseases with long
latency and loss to do a proper follow up.
Recommendations: There should be early
detection of outbreak to prevent endemics like
malaria endemics. There should be early
institution of containment measures. There should
be a drastic reduction in morbidity and mortality.
They should minimize economic loss.
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