The document provides an overview of the Integrated Disease Surveillance Programme (IDSP) in Tamil Nadu. It describes the objectives of early detection and response to outbreaks. It outlines the organizational structure at the state and district levels. It defines disease surveillance and the difference between active and passive surveillance. It lists the diseases under surveillance in IDSP and the different reporting forms used in weekly reporting. It also discusses outbreak reporting, the roles of different departments, confirming and investigating outbreaks, case definitions, descriptive epidemiology, and the purpose of outbreak investigations.

1. INTEGRATED DISEASE
SURVEILLANCE PROGRAMME
(IDSP)
OVERVIEW of IDSP
TRAINING FOR RRT-TOT & BLOCK HEALTH TEAM

2. In Tamil Nadu IDSP was launched in
August 2005

3. Objective of IDSP
• Major Objective:
• Early detection & response to outbreaks
• Early Warning Signals on impending outbreak.

4. Organogram @ SSU (State)
State Surveillance Officer
(SSO)/Joint Director
Director of Public Health and Preventive Medicine
(DPH&PM)
State Epidemiologist State Veterinarian
Consultant
(Finance)
Entomologist
State Lab Coordinator
State Data Manager
Data Entry Operators
State Microbiologist
Consultant
(Training)

5. Organogram @ DSU(District)
District Epidemiologist
District Surveillance Officer
(Deputy Director of Health Services)
District Data Manager
Data Entry Operators-2
(DSU & Medical College)
District Microbiologist
Lab Tech
Lab. Att

6. What is Surveillance?
Disease surveillance is defined by World
Health Organization (WHO) as “the
systematic ongoing collection, collation
and analysis of data for public health
purposes and the timely dissemination of
public health information for assessment
and public health response as necessary”
In short, surveillance is collection of
information for public health action.

7. 7
Active surveillance
• The system does not wait for:
• Case-patients to come to health care facilities
• Health care facilities to report cases
• Health care workers actively reach out to detect cases
• Surveillance comes in addition to routine health care delivery
• Example:
• Malaria surveillance in India
Active versus passive surveillance

8. 8
Passive surveillance
• Health care facilities or providers report cases as they present
in health care facilities
• No specific efforts are made to make sure all cases are
reported
• Surveillance is integrated to routine health care delivery
• Example:
• Surveillance of measles in India
Active versus passive surveillance

9. Diseases under Surveillance in IDSP
• Measles
• Diphtheria
• Pertussis
• Chicken Pox
• Malaria
• Dengue / DHF / DSS
• Chikungunya
• Meningitis
• Acute Encephalitis Syndrome
• Enteric Fever
• Fever of Unknown Origin (PUO)
• Acute Respiratory Infection (ARI) / Influenza
Like Illness (ILI)
• Pneumonia
• Acute Diarrhoeal Disease
(including Acute Gastroenteritis)
• Bacillary Dysentery
• Viral Hepatitis
• Leptospirosis
• Acute Flaccid Paralysis < 15
Years of Age
• Any other State Specific Disease
– Leprosy
• Dog Bite
• Snake Bite
• Unusual Syndromes

10. Reporting forms in IDSP –Weekly Reporting
S Form - Syndromic
P Form - Presumptive
L Form – Lab confirmed

11. Syndrome definition
The sudden occurrence of unusual events, in a geographical region,
causing death or hospitalisation and which does not confirm with the
standard case/ syndrome definitions under the existing surveillance
mechanism.
Syndromes – Examples
Fever
Jaundice
Paralysis
Diarrhoea
Maintain a Surveillance Register( Line list etc)

12. Form S – Syndromic Surveillance
DSU copy Institutional copy
Block copy

13. DSU copy
Institutional copy
Block copy
Form P – Presumptive Surveillance

14. DSU copy Institutional copy
Block copy
Form L – Laboratory Surveillance

15. Reporting units for disease
surveillance
Public sector
(Exhaustive)
Private
(Sentinel)
Rural •Community health centres
•District hospitals
•Practitioners
•Hospitals
Urban •Urban hospitals
•ESI
•Railways
•Medical colleges
•Nursing homes
•Hospitals
•Medical colleges
•Laboratories

16. State RRT
Member Designation Role and Responsibility
Team Leader
Additional Director of Vector borne
diseases
State Surveillance Officer Joint Director (Epi)
Organiser
State Epidemiologist State Epidemiologist IDSP
Over all monitoring the investigation of the
outbreak
Physician / Clinician Professor of Medicine – Chennai Clinical diagnosis of adult cases
Pediatrician
Professor of Pediatrics – Health and
Hospital, Egmore, Chennai.
Clinical diagnosis of pediatric cases
Microbiologist
DD (SPHL), attached to DPH&PM,
Chennai.
Laboratory Confirmation of Cases /
outbreaks
Entomologist
Chief Entomologist ( R ) O/o DPH&PM,
Chennai.
Identification of vectors and density and role
in transmitting the diseases under
investigation.
Animal Health Specialist
Joint Director – Animal Husbandry
department, Chennai.
Investigation and suggestive measures to
prevent Zoonotic diseases including
epizootic and pandemic diseases

17. Formation of District RRT – for Investigation
Member Designation Role and Responsibility
District Surveillance Officer Deputy Director of Health Services Organiser
Epidemiologist District Surveillance Officer (IDSP) –
Deputy Director of Health Services of
the respective District
Overall monitoring of the RRT for
Investigation.
Physician / Clinician Senior civil surgeon or Medical
specialist from near by Medical
College
Clinical diagnosis of adult cases
Pediatrician Senior Pediatrician from near by
Medical College
Clinical diagnosis of pediatric cases
Microbiologist From near by Medical Colleges Laboratory Confirmation of Cases / outbreaks
Entomologist District Entomologist / District Malaria
Officer of the respective District
Identification of vectors density, role in
transmitting the diseases under investigation,
initiating control and containment measures in
vector borne outbreaks.
Animal Health Specialist Joint Director / veterinary Officer of
the Animal Husbandry department of
the respective district.
Investigation and suggestive measures to
prevent Zoonotic diseases.

18. OUTBREAK
•An outbreak is the occurrence of a
disease or syndrome clearly in
excess (or more than expected) in a
given area (such as clustering of
cases), over a particular period of
time or among a specific group of
people.

19. Surveillance and outbreak detection: Salmonella
Goldcoast strains by month of isolation, 1993-
1996
0
20
40
60
J M M J S N J M M J S N J M M J S N J M M J
Goldcoast
Threshold
Month
Number of isolates
1993 1994 1995 1996
Epidemic threshold facilitates detection

20. Early Warning Signal

21. OUTBREAK REPORTING
FIR –FIRST INFORMATION REPORT - immediately
Daily Report
Lab confirmation Report
RRT –RAPID RESPONSE TEAM - Interim Report
FINAL REPORT

22. Role of other departments
Epidemiology
Food safety
Clinicians
Laboratory
Media Authorities
Diagnostic
Clinical
Specimen
transfer
Dead Sick
Exposed
Surveillance
Investigation
Prediction
Supply
channels
Trace
back Decisions
Infrastructure
Regulations
Vaccinations etc
Vector
Reservoir
Investigation
Co-ordination

23. Confirm outbreak and diagnosis
• Laboratory confirmation – How many samples ?
• serology
• isolates, typing of isolates
• toxic agents
• Contact (visit) the laboratories
• Meet attending physicians
• Examine some cases
Not always necessary to confirm all the cases
but confirm a proportion
throughout the outbreak

24. Case definition
• Standard set of criteria for deciding if a person should be
classified as suffering from the disease
under investigation
• Criteria
• clinical and/or biological criteria
• time
• place
• person

25. Descriptive epidemiology
- Who are the cases? (person)- age,sex
- Where do they live? (place) –same location?
- When did they become ill? (time) –day,week etc

26. Time
Epi Curve
• Histogram
• Distribution of cases by time of onset of symptoms,
diagnosis or identification
• time interval depends on incubation period
Cases
0
1
2
3
4
5
6
7
8
9
10
1 2 3 4 5 6 7 8 9 10 11 12
Days

27. PERSON
S.Typhimurium infection
attack rates by age group,
Jura, May - June 1997
Age groups
(years)
nr of cases population Attack rate per
100,000
<1 2 3,200 63
1 - 5 36 16,000 225
6 - 14 22 30,300 72
15 - 64 29 159,500 18
> 65 9 39,100 22
Total 98 248,100 40

28. WORK
HOUSE
BROAD STREET
X
X
X
X
X
N
S
E
W
PUMP B
PUMP
PUMP C
PUMP A
PUMP
PLACE Distribution of cases
of cholera, London 1854

29. Points to be focused in an outbreak
• Vaccine preventable Disease
• Vaccination status, if vaccinated date and batch, name of the
vaccine, place of vaccine, age group distribution,
• Vector borne diseases
• Source, house index, larval density, etc in coordination in
Entomologist.
• Water Borne disease
• Mapping of Water source, source of infection, etc.

30. Purpose of Outbreak Investigation
To intervene & control
To prevent further Outbreak in future
Public Health plan
water borne – chlorination, leakage
vector borne – environmental, IEC
vaccine preventable - Immunization

31. Daily Reporting
Frequency – Daily before 12.00 Noon

32. Daily Reporting under IDSP
• Line List of admitted cases of ADD, fever syndrome, AES, AEFI and Jaundice
and all Lab confirmed cases with epidemic potential must be collected and
sent on daily basis to SSU in the prescribed format from the following units
• Government Medical College Hospitals and laboratories
• Government Head Quarters / Taluk Hospitals and labs
• Community Health Centers & Primary Health Centers and lab
• Private Hospitals and laboratories
• Zonal Entomological Team labs(ZET)
• At SSU the reports are analyzed and cross notified and feedback given to the
DD Health concern where there is impending epidemic.

33. Daily Report -1 (DR-1)
Admission cases
Column No. Heading
1 S.no
2 Date of Addmission
3 Name
4 Age (Yrs)
5 Sex (M/F)
6 Address : Village / Town
7 Name of the HUD
8 Name of the Block
9 Name of the PHC
10 Contact Number
11 Disease condition
12 Name of the Hospital / Institution
13 Remarks if any

34. Daily Report -2 (DR-2) Line List of Lab confirmed Cases
Column No. Heading
1 S.no
2 Date of onset
3 Date of Sample Taken
4 Date of Confirmation
5 Name
6 Age (Yrs)
7 Sex (M/F)
8 Address : Village / Town
9 Name of the HUD
10 Name of the Block
11 Name of the PHC
12 Contact Number
13 Diagnosis Lab Confirmed*
14 Name of the Institution / Lab Confirmed
15 Admission / any Other Remarks
* Dengue - IgM / NS1 Elisa, Dengue - IgM / NS1 Rapid Card Ted (RDT), Dengue - other (Please Mention the name of the
Test Done), Leptospirosis - Elisa / MAT, Leptospirosis - Card Test

35. THANK YOU