VPD Surveillance

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VPD Surveillance
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Surveillance is the Ongoing systematic
collection, collation, and analysis of health
data and the dissemination of that information
to those who need to know so appropriate action
can be taken
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Surveillance is the continued vigil over the
occurrence and distribution of disease and
conditions which increase the risk of
disease transmission Surveillance is information
for action
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• A surveillance system should
• Describe each person having an infection or
  disease
• Determine source of infection and mode of
• transmission
• Identify exposed, susceptible person to whom the
• infection may have been transmitted
• Specify frequency of occurrence of infection
• in different population groups
• Prepare and distribute surveillance reports

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A major objective of disease surveillance is
To determine the extent of infections
and the risk of disease transmission so
control measures can be applied effectively and
disease can be prevented
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• Five functions of a surveillance system
• Case detection and notification
• Investigation and confirmation
• Data collection and consolidation
• Data analysis
• Information dissemination
• All done to guide public health action

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• Additional supporting functions
• of disease surveillance
• Setting standards (e.g case definition)
• Training and supervision
• Setting up laboratory support
• Establishing communication network
• Optimizing resource management
• Improve coordination/integration

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Surveillance tasks differ depending upon the level

• District level
• Provincial level
• Central or National level

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• Surveillance at the district level
• Diagnosis and case management
• Reporting of cases
• Simple tabulation and graphing of data

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• Surveillance at the Provincial level
• Case management for more difficult cases
• Analyze data from peripheral level for
  epidemiological links and trends
• Monitor data to check if control targets
  have been met
• Investigate suspected outbreaks.
• Feed back to the district
• Report to central level

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• Surveillance at the National level
• overall support and coordination of national
  surveillance activities.
• provision of laboratory diagnosis data
• analyze data from intermediate level for
• epidemiological links
• trends
• achievement of control targets.
• support intermediate level for outbreak control
• feed back to intermediate level, and report to
  WHO regional office

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• Information gathered from Disease Surveillance
  can be used to
• Estimate the magnitude of health problem
• Determine geographic distribution
• Portray natural history of a disease
• Detect epidemics
• Monitor changes in infectious agents
• Evaluate control measures
• Facilitate and improve planning
• Generate hypothesis and stimulate research

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• Sources of data for surveillance
• Notifiable disease reports
• Laboratory results
• Vital records
• Sentinel surveillance
• Birth/death registries
• Surveys
• Vaccine utilization records
• Vaccine adverse event reporting system

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Types of surveillance
Passive surveillance data are routinely
collected and forwarded to more central levels
Active surveillance data are sought out by
visiting or contacting a reporting
site Comprehensive surveillance data are
collected from numerous sites throughout a
country in order to achieve representation of
whole population Sentinel surveillance selected
sites report data, can be used to monitor trends
and collect detailed information, but may not
represent the entire country Community-based,
facility-based and laboratory-based surveillance
involve detection and notification by
communities, health facilities and laboratories
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• Prioritize which diseases need surveillance,
  diseases
• does the disease result in a high disease
  impact? (morbidity,
• mortality, disability)
• does the disease have a significant epidemic
  potential
• (cholera, measles)
• is the disease a specific target of a national /
  international
• control program
• will the collected information lead to
  significant public
• health action?

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• What needs to be addressed for each disease
• under surveillance?
• The case definition should be
• Clear
• Appropriate
• Consistent throughout the surveillance system
• The reporting mechanism should be
• Clear
• Efficient
• Appropriate reporting periodicity
• Available to all relevant persons
• The analysis of data should be
• Appropriate
• Allow for proper presentation
• Used for decision-making

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• The people doing the surveillance should
• Have a good understanding of the value of
  surveillance
• system
• Understand their surveillance task
• Have sufficient resources
• The personnel involved should receive
  appropriate
• Training
• Supervision
• The feed-back from central levels should be
• Appropriate in format
• Sufficient and frequent enough
• Motivating

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Objectives of Measles Surveillance in Pakistan

• Estimate disease burden
• Detect and characterize cases
• Detect and Investigate outbreaks
• Identify populations at risk
• Monitor program activities
• Evaluate and guide policy

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Basic Epidemiology

• Measles virus is RNA virus of the genus
  Morbillivirus, a member of the Paramyxoviridae
  family
• Exclusively human pathogen, no animal reservoir,
  no vector
• Transmitted by respiratory droplets, via aerosol
  and direct contact
• Average incubation period (from exposure to rash
  onset) is 14 days (range 7 18 days)
• Patients are contagious from 2 3 days before
  until 1 2 days after rash onset

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Main Characteristics

• Two components
• Routine Weekly Reporting
• Outbreak Detection and Investigation

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Routine Weekly Reporting

• Case-based
• Investigation of every suspected measles cases
  using standard Case Investigation Form (CIF) with
  blood specimen collection for confirmation of
  diagnosis
• Weekly reporting of all suspected measles cases
• Facility-based
• All government facilities and
• Private facilities included in weekly AFP zero
  reporting
• Laboratory Component
• IgM verification of all suspected cases

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Identification of Measles Suspected Cases

• Patients presenting at health facility satisfying
  case definition
• Patient with history of measles (satisfying case
  definition) and presenting common complications
  of measles within past one month at health
  facility

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Measles Case Definition Algorithm
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Action Points Health FacilitySuspected Measles
Case

• Record patients details in Measles Case
  Investigation Form (CIF)
• Arrange collection of blood specimen (3-5 ml) for
  IgM test
• Label specimen and record type and date of
  specimen collection in the measles CIF
• Sent specimen to EDO (Health) office in reverse
  cold chain along with a copy of CIF
• At the end of week (Saturday), compile all
  suspected cases in weekly report (Form B) and
  send to EDO (Health) office.
• IF NO CASES FOUND DURING THE WEEK, ZERO REPORT
  MUST BE SENT

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Action Points - District Level

• Gather weekly reports (Form B) from all reporting
  health facilities
• Assign EPID Number to all suspected cases
• Prepare weekly district compilation report
• Take data from weekly reports from health
  facilities and
• Case Investigation Form
• Separate serum from the whole blood specimen sent
  from health facilities (if not done already)
• Transship specimen collected from health
  facilities to National Measles Laboratory at NIH
  Islamabad with EPID number on its sticker
• Contd

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Action Points - District Level

• Check for outbreaks (see below in Outbreak
  Investigation)
• Analyze data (see below in Reporting)
• Epidemiology
• System indicators
• Send compilation report to provincial EPI office
  by Tuesday

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EPID Number - Suspected Case

• District Surveillance Coordinators (DSC) will
  allocate an unique EPID number to each suspected
  case with the following format
• Country code/Province Code/District ID/
  Year/Msl/Case Serial
• EPID Number on
• CIF
• Compilation report
• Sticker on specimen

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Trigger for Outbreak Investigation

• More than 5 suspected measles cases from one
  first level health care facility (RHC and below)
  in one week
• OR
• More than 5 suspected measles cases in a higher
  level facility coming from one geographical area
• OR
• Report of more than 5 suspected measles cases in
  one area by trained LHW

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Initial Outbreak Confirmation

• DSC with support of SO-WHO to confirm outbreak by
  visiting affected area (initial phase)
• Through community assessment with the goal to
  find cases in the past 30 days
• Arrange collection of at least 5 blood samples if
  already not done
• If confirmed
• Form investigation team

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Definition of Measles Outbreak

• More than 5 suspected measles cases including at
  least one laboratory confirmed measles case in
  the identified area during the recall period of
  30 days prior to investigation.

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