NOTIFICATION OF COMMUNICABLE DISEASESProf. MW Gunathunga

IIM, 3rd July 2013

Objectives • To learn what notification entails • To learn the process of notification of diseases in Sri

Lanka

NOTIFICATION

•The act of reporting the occurrence of a communicable disease or of an individual affected with such a disease•A legal requirement •On suspicion of disease •Use a standard format (H-544) called notification form•At any setting – government or private

OPD, clinics, wards

Notifiabe Disease Reporting System

Notifiable Disease

A disease that, by statutory requirements, must be reported to the public health authority in the relevant area when the diagnosis is made.

A disease deemed of sufficient public health importance to require that its occurrence be reported to health authorities.

Legislature

• The Quarantine and Prevention of Disease Ordinance of 1897 and it's amendments

- Every practitioner treating a case of notifiable disease should notify

- Anyone failing to do so can be prosecuted in the Magistrate Court

Notifiable Diseases• Group A - Cholera

- Plague- Yellow Fever

To: > DGHS > DDG (Public Health) > Epidemiologist > MOH > Regional epidemiologist

By telephone, fax or telegram and notification form

Notifiable Diseases continued…• Group B

- Acute flaccid Paralysis

- Chicken pox

- Dengue fever / Dengue Haemorrhagic Fever

- Diphtheria

- Dysentery

- Encephalitis

- Enteric fever

- Food Poisoning

- Human Rabies

- Leptospirosis

- Malaria

Notifiable Diseases continued…

• Group B continued… - Measles

- Meningitis - Mumps - Rubella & Congenital Rubella Syndrome- Severe Acute Respiratory Syndrome (SARS)- Simple continued fever for 7 days or more- Tetanus- Neonatal Tetanus- Tuberculosis (Pulmonary)- Typhus fever- Viral Hepatitis- Whooping cough- Leishmaniasis

To Whom ?

AFP – To MOH, Epidemiologist and Regional Epidemiologist By telephone, fax or telegram and AFP notification form

Tuberculosis – To Director NPTCCD by TB notification form

SARS – To DGHS, DDG (PHS), Director (Quarantine), Port/ Air Port Health Officer, Epidemiologist, RE, MOH

Others – To MOH of the area of residence by notification form

When to notify ?• As soon as the provisional diagnosis is made

NOT ON DISCHARGE !!!

Community Ward Notification Register Hospital Notification Register

Notification Register

Investigation and reporting

Infectious DiseasesRegisterUpdate spot map

Patient / BHT in Hospital/GP

Notification Card

MOH

PHI

MOH

Weekly Return of Communicable Diseases

Epidemiology

UnitSpecial Surveillance Forms*

Weekly Epidemiological Report

Quarterly Epidemiological Bulletin

Regional Epidemiologist

What are the diseases under special investigation?

-Diseases covered by the EPI (What are those ?)- Polio, Diphtheria, Pertussis, Tetanus and

Neonatal Tetanus, Measles, Rubella, Hep.B

- Japanese Encephalitis- Dengue Haemorrhagic Fever- Human Rabies- Cholera- Mumps- Meningitis- Chicken pox

Limitations of Notifiable Disease Reporting System

1. Under reporting

2. Poor quality of reporting

- Incomplete

- Illegible

- Inaccurate

3. Lack of timeliness

4. Inconsistency of case definitions

5. Lack of representative ness of reported cases

Lack of Representative ness

E.g. Measles Home - Not reported

GP – May be reported

Govt. Hospital - Reported

Private Hospital - ?

Under reporting - Why ?

1. Lack of knowledge of the need for reporting

- Unaware of the responsibility

- Unaware what diseases to report

- Assume that someone else will report

- Unaware of how to and whom to report

2. Negative attitudes towards reporting

- Time consuming

- Lack of incentive

- Lack of feedback

- Distrust in the govt. / health system

3. Misconceptions

- Reporting compromises patient-physician relationship

- Breaches confidentiality

- Wrong judgment that the disease is not serious

- Belief that public health measures do not work

- Belief that health department does not act on the reports.

Exercise

You are the newly appointed MOH in Maharagama. You notice that although you receive many notifications from the SJGH, you do not receive as many from the other hospitals.

You explore further into the matter. You find that the PHI is unable to locate the house of the patient in most notifications

How would you improve the system ?

Problems - Not notifying- Poor quality notifications

Who ? Govt. Medical Officers esp. Intern MO’sGPsOther medical practitionersPrivate hospitals

How ? -Create awareness and knowledge on proper notification-Address misconceptions-Provide frequent feedback-Show them the benefits

Indoor Morbidity & Mortality Reporting

Coding according

to ICD

Quarterly

BHT

Medical Records Office

Indoor Morbidity

Mortality Register

Indoor Morbidity and Mortality Return

Medical Statistician

Annual Health Bulletin

Limitations of Indoor Morbidity & Mortality Reporting

• Coverage

What exactly do IMMR data represent ?

▪ No. of admissions, not cases

▪ OPD ? Private Hospitals ?

▪ Disability ?

▪ Mortality – only hospital deaths

• Quality ▪ Diagnosis not written

▪ Incorrect Diagnosis / symptoms as diagnosis

▪ Lack of timeliness

▪ Lack of facilities for record keeping

Laboratory surveillance

What is lab-based surveillance ?

Using information generated in labs for surveillance

E.g. MRI lab Epid. Unit

What are the advantages of lab surveillance ?

• Immediate information on rare or significant diseases

• Reporting of confirmed diagnosis• Completeness of lab data• Ability to obtain information of patients seen by many physicians

What are the disadvantages of lab surveillance ?

• Non availability of epidemiological information • Lack of representative ness

Reporting from Special Campaigns

- Routinely reported

- From Malaria, Filariasis, STD, Rabies and Respiratory diseases control programme

- Morbidity and Mortality data

- Collected by the campaigns from hospitals

- Data is sent to Epidemiology Unit

Sentinel Surveillance

Surveillance based on the collection of data from a sample (random or non-random) of collecting sites as indicator data for the rest of the population, in order to identify cases of a disease early or to obtain indicative data about trends of a disease or health event.

Uses active surveillance approach

Conducted usually by ICNO

Sentinel’ Sites - Depends on the diseaseE.g. Dengue –all hospitals Leptospirosis, Hep B – Selected

hospitals

For few selected diseasesAFP, Measles, Japanese Encephalitis, Dengue, Hepatitis B, Leptospirosis

Sentinel populations – E.g. Pregnant mothers for syphillis

• What are the advantages of sentinel surveillance ?

• Improves timeliness in reporting• Improves accuracy of data• Improves completeness of data• Only on selected sites• Cost effective

Disadvantages of sentinel surveillance

• Lack of representativeness

• Participation rates may be low and limited to those with great interest or capability

Sample Surveys

• Surveys carried out on specific diseases / risk factors on representative samples

• Usually for research purposes

• One-time process

• Estimates prevalence of disease more accurately

Outbreak Investigation

• Investigation of disease outbreaks

(What is an outbreak ?)• Carried out by a team –MOH, RE, Clinicians, PHIs

• Involves hospital and the field• Purpose is to identify the source of infection and initiate appropriate control measures

• A report is produced

Thank you !

List of Notifiable diseases• Group - A• Cholera• Plague• Yellow Fever

Group B• Acute Poliomyelitis / Acute Flaccid Paralysis• Chicken pox• Dengue Fever / Dengue Haemorrhagic Fever• Diphtheria• Dysentery• Encephalitis• Enteric Fever• Food poisoning• Human Rabies• Leptospirosis• Malaria• Measles• Meningitis• Mumps• Rubella / Congenital Rubella Syndrom• Simple Continued Fever of over 7 days or more• Tetanus• Neonatal Tetanus• Typhus Fever• Viral Hepatitis• Whooping Cough• Tuberculosis

Mechanism of Data Collection

•Bed Head Ticket•Notification Card•Notification Register (Ward)•Notification register (Institution)

Hospitals •In-patients Register

Medical Officer of Health

Medical Statistics Unit

EpidemiologyUnit

(CentralLevel)

Regional Epidemiologist

(DistrictLevel)

Activated Passive

Surveillance

•Notification Register•Weekly Return•ID Register Special

CampaignsPublic Health Inspector

Reference• Website of Epidemiology Unit, Ministry of Health

http://www.epid.gov.lk