JAPANESE ENCEPHALITIS INTRODUCTION AND STUDY

JAPANESE ENCEPHALITIS INTRODUCTION AND STUDY

1. Background Japanese encephalitis (JE) Leading cause of vaccine preventable encephalitis Causes acute encephalitis syndrome (AES) Case fatality rate (CFR): 10% - 30% Assam state accounts for 51% of JE burden in I ndia AES/JE surveillance system launched in November 2007 To detect outbreaks and prevent deaths due to AES/JE T o monitor disease trends and impact of control strategies

2. Objectives To describe AES/JE surveillance system in Assam To identify strengths and constraints of surveillance system To make recommendations to strengthen surveillance

3. METHODS

4. Study D esign Cross-sectional study Study Setting Barpeta district: h igh a ttack r ate Sivasagar district: high c ase f atality rate Sampling Line list all blocks in Barpeta (7) and Sivasagar (8) Selected two blocks (sub district) per district by simple r andom s ampling Sampled all health facilities in selected blocks

5. Selected Districts INDIA ASSAM BARPETA SIVASAGAR

6. Data Collection and Analysis Data collection Key informant interviews to describe system Review of records and reports from 2012 - 2013 Survey of health workers in health facilities Data analysis Epi-Info version 7 Calculated each indicator as proportion

7. Attributes Evaluated Timeliness Proportion of cases detected within one week of onset Proportion of health facilities reporting weekly Sensitivity: proportion of suspected cases identified at health facilities captured by surveillance system Representativeness Proportion of government health facilities reporting Proportion of private health facilities reporting

8. Attributes Evaluated Simplicity Proportion of health workers who felt format was simple Proportion of m edical o fficers knowing case definition Acceptability Proportion of completed forms sent Proportion of health workers who found reporting format time-consuming Usefulness Proportion of outbreaks detected

9. RESULTS

10. Case Definition AES Suspect : person of any age, at any time of year with the acute onset of fever and a change in mental status or new onset of seizures (excluding simple febrile seizures). Probable JE : a suspected case that occurs in close geographic and temporal relationship to laboratory-confirmed case of JE in the context of an outbreak. Laboratory-confirmed JE : a suspected case that has been laboratory-confirmed as JE.

11. AES-JE Surveillance System District Surveillance Unit State Surveillance Unit Presumptive Form (Probable cases) L aboratory Form (Laboratory confirmed cases) Portal Sub-center Primary Health Centre/Community Health Centre/Government/Private Hospitals Government/Private Laboratories Syndromic Form (Suspected cases)

12. AES-JE Surveillance System District Surveillance Unit State Surveillance Unit Presumptive Form (Probable cases) L aboratory Form (Laboratory confirmed cases) Portal Sub-center Primary Health Centre/Community Health Centre/Government/Private Hospitals Government/Private Laboratories Syndromic Form (Suspected cases) Passive surveillance weekly Active surveillance daily (outbreaks)

13. Selected Health Facilities District Selected Blocks No. of Health Facilities Government Private Barpeta Nityananda 14 1 Chenga 11 Sivasagar Galekey 5 1 Khelua 5 1 Total 35 3

14. Attributes Attribute Indicator Barpeta Sivasagar Timeliness Cases detected within one week 19/39 (49%) 89/102 (87%) Health facilities reporting weekly 20/26 (77%) 9/12 (75%) Sensitivity Suspected cases captured by surveillance system 22/22 (100%) 34/34 (100%) Representative Government health facilities reporting. 24/25 (96%) 10/10 (100%) Private health facilities reporting. 1/1 (100%) 1 /2 (50%)

15. Attributes Attribute Indicator Barpeta Sivasagar Simplicity Health workers who felt format was simple 25/26 (96%) 10/10 (100%) Medical officers with correct knowledge of case definition. 20/26 (77%) 9/12 (75%) Acceptability Completed forms sent 21/26 (81%) 9/12 (75%) Health workers who found f ormat time-consuming. 1/26 (4%) (0%) Usefulness Outbreaks detected 1/1 (100%) 2/2 (100%)

16. Limitation Data cannot be generalized Only two districts selected Only two blocks in each district

17. Conclusion Attributes Barpeta Sivasagar Sensitivity Good Good Usefulness Good Good Representativeness (government facilities) Good Good Representativeness (private facilities) Good Not satisfactory

18. Conclusion Attributes Barpeta Sivasagar Simplicity (format) Good Good Simplicity (case definition) Not satisfactory Not satisfactory Acceptability Satisfactory Not Satisfactory Timeliness (case detection) Not satisfactory Satisfactory Timeliness (weekly reporting) Not satisfactory Not satisfactory

19. Recommendations Communicate to all health facilities to ensure regular reporting Increase public awareness of disease and need to report early at nearest health facility Train regularly health workers on case definition, recording and reporting of cases

20. Acknowledgement Dr. B C Bhagabati, Co- Author & Placement Supervisor Dr. A C Baishya, Mentor & Director, Regional Resource Centre, Guwahati, Assam Staff, IDSP Assam District Surveillance Unit, Barpeta and Sivasagar Dr. Kayla Laserson, Country Director,CDC, India Dr.Samir Sodha, Resident Advisor, CDC, India Dr. Venkatesh, Director, NCDC, Delhi, India

21. THANK YOU