disease surveillance 03 - complete

8/3/2019 Disease Surveillance 03 - Complete

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DISEASE

SURVEILLANCE


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DEFINITION

Ongoing and systematiccollection, analysis and

interpretation ofhealthdata and the timely

dissemination ofthis data topolicymakers andothers

(by WHO)


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OBJECTIVES

Scientific database forrecognition,evaluation, prevention and control of

disease for now and for the future

Detect and predict Outbreaks / Epidemics

Monitoring disease trends

Evaluating effectiveness of interventionand control measures (cost

effectiveness/success or failure rates)


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Monitor progress towards a controlobjective

Detect changes in health practices andbehaviors

Determine disease etiology and naturalhistory

Generate hypotheses and stimulate

research.

Determine appropriate and efficientallocation of resources and personnel anddevelopment of appropriate policies.


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SOURCES OF SURVEILLANCE DATA


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COMMUNICABLE

DISEASESURVEILLANCE


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MOH Disease Surveillance Systems


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Indicator based Surveillance

Clear definition of diseases

Diagnosis-based

Syndromic cases


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organized and rapid capture of information of

events that are a potential risk to public health,requiring immediate assessment & public health

response

Involves:

Events related to the occurrence of disease inhumans

Events related to potential exposures for

humans Relies on unstructured descriptions & reports by

media or other sources

A complement to indicator-based surveillance for

an early warning system

Event Based Surveillance


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Surveillance Mechanisms in Malaysia

1. Mandatory notifications2. Laboratory based surveillance

3. Clinical based surveillance

- National

- Syndromic

- Sentinel

4. Community based surveillance- Media surveillance

5. Other agencies

- Department of veterinary services (zoonosis)

- FOMEMA Sdn.Bhd. (foreign workers)

Indicator

based

surveillance

Event based

surveillance


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HOW ITS DONE

1. MANDATORY NOTIFICATION

Mandatory notification - under Section 10(2) Act 342:

Prevention & Control of Infectious Disease Act 1988.

27 infectious diseases within 24 hrs/1 week.

Every medical practitioner notifies nearest District Health

Office

Compounded offenses if fail to notify

Notification phone & form fax/post/by hand Manual

System


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Notification by phone followed by

written notification (within 24 hours)

1. Dengue fever and dengue hemorrhagic fever

2. Yellow fever

3. Diphtheria

4. Ebola5. Food poisoning

6. Cholera

7. Plaque

8. Poliomyelitis9. Rabies

10. additional- SARS, AVIAN Flu, INFLUENZA H1N1 flu

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Written notification within one week

after diagnosis

11. Whooping cough

12. Measles

13. Dysenteries (all forms)

14. Gonnoccal infection (allforms)

15. Leprosy

16. Malaria

17. Myocarditis

18. Relapsing fever

19. Syphilis (all forms)

20. Tetanus (all forms)

21. Typhoid and paratyphoidfever

22. Typhus and otherricketsioses

23. Tuberculosis

24. Viral encephalitis

25. Viral hepatitis

26. Any other life-

threatening microbialinfection

27. HIV all forms

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Diagnosis by Consultant /Specialist/Medical Officer

(Clinical and /or lab confirm)

Notify

Verbal

Within 24 hrs

Written

Within 24hrs

Written

Within 1 week

State Health Office

Ministry of Health

DC

IDS

Hospital Record Office

District Health Office

Feedback

International

Dengue, DHF

Diphtheria

Yellow Fever

Food Poisoning

Cholera

Plague

Acute Polio

Rabies

Ebola

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Communicable Diseases Control

Information System

Modules

Case Notification

Case Registration Case Investigation

Case Follow-up

Report

Query

Alarm


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2. LABORATORY BASED SURVEILLANCE

detect emerging pathogen strains.

To predict and detect outbreak of disease.

To determine and monitor the circulation oforganism strains in the country.

To monitor the trend of anti-microbialresistance.

To facilitate outbreak identification andinvestigation through strain identification(sero-typing, phage typing etc)


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Pathogens identified for National

Laboratory SurveillanceSentinel Surveillance Dengue Influenza

Enterovirus

Viral National Surveillance Japenese encephalitis Mumps,Measles and Rubella

Non Viral PathogensHaemophilus influenzae type bNeisseriae meningitides

Salmonella typhiLeptospira sppVibrio choleraeSalmonella spp

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Flow of notification

Microbiology laboratories of

public and private hospitalsand private laboratories

IMR,

PHL Ipoh,other reference

laboratories

Isolates with lab.

Notification form

Notification form

(labsur

1/2002.pind 1)

Result

Surveillance Section,

Disease Control Division

Data analysis,

interpretation and

dissemination

FeedbackFeedback

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3. CLINICAL BASED SURVEILLANCE

a) SYNDROMIC SURVEILLANCE

- monitoring of the frequency of illnesses with aspecified set of clinical features in a givenpopulation without regard to specific diagnoses, if

any, that are assigned to them by physician

focuses on clinical syndrome before laboratoryconfirmation is available

NOT laboratory based BUT when supplementedwill enhance the power and specificity of thesystem


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Used for diseases where the initial

presentation likely to be nonspecific.

Use health-related data before adefinitive diagnosis.

Can signal sufficient probability of

an outbreak to warrant further PHresponse.


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Facilitate and speed up notification andresponse using clinical syndromes (early

detection of possible outbreak).

Alert attention to a problem at theearliest possible time and to promote

rapid investigation and containment ofoutbreak.

Complement other existing specificdisease notification especially for rapidresponse to newly emerging andreemerging diseases.


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Syndromes for notification

Acute neurological syndrome

Acute respiratory syndrome

Acute dermatological syndrome

Acute jaundice syndrome

Acute haemorrhagic syndrome

Acute diarrhoeal syndrome

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Notification procedure

The syndromic notification formKKM-syndsurv/2003.2

Sent

To DistrictHealth OfficeWithin 24 hours

If a definitive diagnosis is made

Notify under usual system

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Analysis & response

FLOW CHART

E D / A&E / Wards

District Health Office

Surveillance MOH State

Investigation

Notify SyndKKM-Syndsurv/2003.2

feedback

AnalysisInterpretationresponse

report

feedback

AnalysisInterpretationresponse

Syndromic Surveillance flowchart

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Malaysia Influenza Surveillance System

(MISS) Started in September 2003 2 major components:

Disease-based surveillance:

221 sentinel sites (inclusive of both government healthclinics & GPs)

Case definitionofinfluenza-like illness (ILI):Abrupt onset ofhigh grade fever (axilla > 38OC or oral > 38.5OC) with drycough within 48 hours and with any of the followingsymptoms; nasal congestion, sore throat, myalgia, vomiting(infants), convulsions (infants)

ILI definition under enhanced surveillance for H1N1: Aperson presenting with a sudden onset of fever 38oC andcough or sore throat, in the absence of other diagnosis (theonset of fever should be within 3 days of presentation and

fever should be measured at the time of presentation)

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Laboratory-based surveillance:

2 National Influenza Centres (NICs) :Institute of Medical Research (IMR) & University

Malaya Medical Centre (UMMC)

1 National Influenza Lab (NIL) :

National Public Health Laboratory Sungai Buloh,

Selangor

At least 2 sentinel sites per state for clinical

specimen collection

At least 5-10 specimens from ILI cases per clinic

per week should be collected


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4. COMMUNITY BASED SURVEILLANCE

(Media/Rumour Surveillance)

Provide an early warning sign in detecting potential

outbreak within and outside Malaysia.

Media reporting :

Obtain report on possible infectious diseases occurring

locally and in other countries

Monitor global and local situation

Verify the rumours through investigation for decision onfurther action or to dismiss it.

Provide alert if necessary

Initiate data gathering from surveillance

Collaborate with other agencies in surveillance


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Source of Information for

Rumour Surveillance

Printed media e.g. local newspapers

Internet

Television & radio Phone calls

E-mails from public

E-mail discussion group e.g. ProMed-mail Word-of-mouth of public or health staff from

different levels

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MOBILISING COMMUNITIES

Active method of community based surveillance Community leader / Institutions were asked to

report/inform unusual event caused by infectious

disease to health office/offices, verify and take

action

Health staffs were asked to gather information

from:

Police stations

Private clinics / hospitals

Pharmacies

This can be done daily or once in two days.31


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FLOW CHART OF RUMOURS SURVEILLANCE FROMPRINTEDMEDIA

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FLOW CHART OF RUMOURS SURVEILLANCE FROMINTERNET

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5. OTHER AGENCIES

- Department of veterinary services (zoonosis)- FOMEMA Sdn.Bhd.

(foreign workers health screening)


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MOH Disease Surveillance System

Indicator based

Event Based (Rumour Surveillance)

Early Warning

Syndromic Notification

Cluster Reporting

Rumour Surveillance

Event Based Surveillance

Need to strengthen for early detection of newinfections/ unusual events/ events of potential for

major outbreak or pandemic


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NONCOMMUNICABLEDISEASE

SURVEILLANCE


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Problem :

Worldwide, noncommunicable

diseases (NCD) currently represent43% of the burden of disease and are

expected to be responsible for 60%

of the disease burden and 73% of all

deaths by 2020.

WHO NCD Surveillance strategy


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Objective: A comprehensive analysis of the availability

of data on the main risk factors for NCDs

worldwide,analysis of the global distribution and trends,

summary of the challenges.


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Strategy:

A global strategy for NCD risk factorsurveillance has been developed basedon the concept of a STEPwise approach

to NCD Surveillance (STEPS).


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WHO STEPwise approach to surveillance

(STEPS)

Simple and standardized method for collecting,analysing and disseminating data in WHO membercountries.

There are currently two primary STEPS surveillancesystems:

1) the STEPwise approach to risk factor surveillance;

2) the STEPwise approach to Stroke surveillance.

disease surveillance 03 - complete

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