IDSP – Integrated Disease Surveillance Project
Dr. Rizwan S A, M.D.,
IDSP – Integrated Disease Surveillance Project
Outline of Presentation
• What is Surveillance?• IDSP
– Phases of implementation– Components – Objectives– Classification of surveillance– Conditions under regular surveillance– Flow of information– Surveillance activities at each level– Surveillance committees at each level– Reporting– Surveillance action– Strengths– New initiatives
Surveillance
Surveillance
• Surveillance is defined as the ongoing systematic collection, collation, analysis and interpretation of data and dissemination of information to those who need to know in order that action be taken.
Important information in surveillance
• Who gets the disease?• How many get them?• Where they get them?• When they get them?• Why they get them?• What needs to be done?
Key elements of a surveillance system
• Detection and notification of health events• Investigation and confirmation• Collection of data• Analysis and interpretation of data• Feedback and dissemination of results• Response – Action for prevention and control
IDSP
Phases of implementation
• Phase I (2004-05)– Madhya Pradesh, Andhra, Himachal, Karnataka, Kerala, Maharashtra,
Mizoram, Tamil Nadu & Uttaranchal
• Phase II (2005-06)– Chattisgarh, Goa, Gujarat, Haryana, Orissa, Rajasthan, West Bengal,
Manipur, Meghalaya, Tripura, Chandigarh, Pondicherry, Nagaland, Delhi
• Phase III (2006-07)– UP, Bihar, J&K, Punjab, Jharkhand, Arunachal, Assam, Sikkim, A&N
Island, D&N Haveli, Daman & Diu, Lakshadweep
Components
• Integrating & decentralizing disease surveillance & response mechanisms
• Strengthening Public Health Laboratories
• Using Information Technology and Networking in disease surveillance
• Human Resource Development
Objectives
• To establish a decentralized district based system of surveillance for communicable and non-communicable diseases, so that timely and effective public health actions can be initiated in response to health changes in the urban and rural areas
• To integrate existing surveillance activities to avoid duplication and facilitate sharing of information across all disease control programmes and other stake holders, so that valid data is available for health decision making in the district, state and national levels
What is integration?
• Sharing of surveillance information of various disease control programmes
• Developing effective partnership with heath and non health sectors in surveillance
• Including communicable and non communicable diseases in the surveillance system
• Working with the private sector and non governmental organization
• Bringing academic institutions and medical colleges into disease surveillance
Classification of surveillance in IDSP
• Syndromic– Diagnosis made on the basis of clinical pattern by
paramedical personnel and members of community
• Presumptive– Diagnosis is made on typical history and clinical
examination by medical officers
• Confirmed– Clinical diagnosis confirmed by appropriate laboratory
identification
Conditions under regular surveillance
Type of disease Disease
Vector borne diseases Malaria
Water borne diseases Diarrhoea, Cholera, Typhoid
Respiratory diseases Tuberculosis
Vaccine preventable diseases Measles
Disease under eradication Polio
Other conditions Road traffic accidents
International commitment Plague
Unusual syndromes (Causing death/hospitalization)
Meningo-encephalitisRespiratory distressHemorrhagic feverOther undiagnosed condition
Other conditions under surveillance
Type of surveillance Categories Conditions
Sentinel surveillance STDs HIV/HBV/HCV
Other conditions
Water quality
Outdoor air quality
Regular periodic surveys
Non-communicable disease risk factors
AnthropometryPhysical activityBlood pressureTobacco, blood pressure
Nutrition
Blindness
Additional state priorities Up to five diseases
State-specific diseases
• Madhya Pradesh, Uttaranchal – Diphtheria, neonatal tetanus, leprosy
• Maharashtra – Diphtheria, neonatal tetanus, leptospirosis
• Andhra Pradesh – Filariasis
• Karnataka – Filariasis, KFD & HGS, leptospirosis
• Tamil Nadu – Leprosy, leptospirosis
• Kerala – Leptospirosis
• Mizoram – Cancer, substance abuse, acid peptic disease, pneumonia
Syndromic surveillance• Fever
– <7 days with no localizing signs – with rash– with altered sensorium/convulsions, – bleeding skin/gums– >7 days
• Cough >2 weeks• Acute Flaccid Paralysis• Diarrhea• Jaundice• Unusual events causing death/hospitalization
Flow of information
Information flow of the weekly surveillance system
Sub-centres
P.H.C.s
C.H.C.s
Dist. hosp.
Programmeofficers
Pvt. practitioners
D.S.U.
P.H. lab.
Med. col.
Other Hospitals: ESI, Municipal Rly., Army etc.
S.S.U.
C.S.U.
Nursing homes
Private hospitals
Private labs.
Corporate hospitals
Activities Periphery District State
Detection and notification of cases
+++ ++ -
Consolidation of data + +++ +++
Analysis and interpretation + +++ +++
Investigation and confirmation +++ +++ +
Feedback + +++ ++
Dissemination + ++ ++
Action ++ +++ +
Surveillance activities at each level
District Surveillance Committee
Chairperson* District Surveillance Committee
District Surveillance Officer (Member Secretary)
CMO(Co. Chair)
RepresentativeWater Board
Superintendent Of Police
IMA Representative
NGORepresentative
District PanchayatChairperson
Chief District PHLaboratory
Medical CollegeRepresentative
if any
RepresentativePollution Board
District Training Officer(IDSP)
District Data Manager(IDSP)
District Program ManagerPolio, Malaria, TB, HIV - AIDS
* District Collector or District Magistrate
Chairperson* State surveillance committee
Director Health Service
Director Public Health (Co. Chair) Director Medical Education
RepresentativeWater Board
NGO
Medical CollegesState Coordinator
RepresentativeDepartment of Home
State Program ManagersPolio, Malaria, TB, HIV - AIDS
Head, State Public Health Lab
IMA RepresentativeRepresentative
Department of Environment State Surveillance Officer(Member Secretary)
State Training Officer
State Data Manager IDSP
State surveillance committee
* State health secretary
Chairperson*National surveillance committee
Director General Health Services(Co. Chair)
Director General ICMR
PD (IDSP)
JS (Family Welfare)
Director NICD
Director NIB
National Program ManagersPolio, Malaria, TB, HIV - AIDS
Consultants(IndiaCLEN / WHO / Medical College /others)
NGO
IMA Representative
RepresentativeMinistry of Home
RepresentativeMinistry of Environment National Surveillance Officer
(Member Secretary)
* Secretary health and secretary family welfare
National surveillance committee
ICMR
NationalPrograms
CBHI
NCDC
CSU
Outbreak investigation and rapid response
Non-communicable diseases
surveillance
MIS and report
Programme monitoring
NVBDCP RNTCP RCH NACP
W.H.O. E.M.R.
Linkages of the central surveillance unit at the central level
Reporting
Reporting Forms
• Form ‘S’ (Suspect Cases)
• Health Workers (Sub Centre)
• Form ‘P’ (Probable Cases)
• Doctors (PHC, CHC, Pvt. Hospitals)
• Form ‘L’ (Lab Confirmed Cases)
• Laboratories
Form Level of Laboratory Responsibility of Reporting
Form L1 Peripheral Laboratory at PHC/CHC Laboratory Assistants/Technicianthrough MO I/c
Form L2 District Public Health Laboratory,Labs of District Hospital, Privateand other Hospitals & Private Labs.
I/c Microbiologist/Pathologists
Form L3 Labs in Medical Colleges, othertertiary institutions,
Reference Labs.Head, Microbiologist Department
Laboratory Reporting
Warning Signals of an impending outbreak
• Clustering of cases/deaths in Time/Place• Unusual increase in cases/ deaths• Even a single case of measles , AFP, Cholera, Plague,
Dengue, or JE• Ac. febrile illness of unknown etiology• Two or more epidemiologically linked cases of outbreak
potential• Unusual isolates• Shifting in age• High or sudden increase in vector density• Natural Disaster
Surveillance Action
Preset trigger level with specific response for various levels
• Trigger Level 1 - Suspected limited outbreak– local response
• Trigger Level 2 - Epidemic– local & regional response
• Trigger Level 3 - Wide spread Epidemic– local, regional & state level response
Strengths of IDSP - 1
1. Functional integration of surveillance components of vertical programmes
2. Reporting of suspect, probable and confirmed cases (Standard case Definition)
3. Strong IT component for data analysis
4. Trigger levels for graded response
5. Action component in the reporting formats
6. Streamlined flow of funds to the districts
7. Standard Formats, Operations & Training Manuals
8. Involvement of Private Sector
New Initiatives - 1
1. Alerts through IDSP call center
Call Centre operational with 1075 toll free number since February 2008
2. E-learning
The objective of e-learning is to enhance the skills to a wide arena of health personnel.
Proposed components:– Discussion Forums– Online Survey & Assessment– Feedback– FAQs
Currently e-learning modules are being prepared
3. Media Scanning Cell• Objective:– To provide the supplemental information about outbreaks
• Method:– National and local newspapers, Internet surfing, TV
channel screening for news item on disease occurrence.• Benefits of Media Scanning:– Increases the sensitivity & strengthen the surveillance
system– Provide early warning of occurrence of clusters of diseases
New Initiatives - 2
Thank You