SURVEILLANCE OF HEALTH EVENT

MDS (PUBLIC HEALTH DENTISTRY)

1. 1 SURVEILLANCE OF HEALTH EVENT SEMINAR NO:4

2. 2 Contents Introduction Goals of Public Health Surveillance History of Public Health Surveillance Uses of Public Health Surveillance Types of Public Health Surveillance Surveillance system attributes Public Health Surveillance process Public Health Surveillance in India Integrated Disease Surveillance Program (IDSP) National Surveillance Programme for Communicable Diseases (NSPCD) Conclusion

3. 3 Surveillance: An ongoing, systematic collection, analysis and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice . (WHO) Definition SURVEILLANCE IS- “INFORMATION FOR ACTION” Public health surveillance: The ongoing, systematic collection, analysis, and interpretation of health-related data essential to planning, implementation, and evaluation of public health practice , closely integrated with the timely dissemination of these data to those responsible for prevention and control. (Thacker and Beckelman , 1988)

4. 4 SURVEILLANCE Infectious diseases Chronic diseases Injury Health service uptake Vector distribution Environmental diseases

5. Goal of Public Health Surveillance Provide information that can be used for health action by public health personnel, government leaders, and the public to guide public health policy and programs. 5

6. 6 History of Public Health Surveillance

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9. 9 Uses of Public Health Surveillance

10. 10 An  effective surveillance  system has the following functions:   

11. Syndromic Surveillance 11 Types of Public Health Surveillance Limited by incompleteness of reporting and variability of quality Used in conjunction with specific epidemiologic investigation Sentinel Surveillance Reporting of health events by health professionals who are selected to represent a geographic area or a specific reporting group Can be active or passive Focuses on one or more symptoms rather than a physician-diagnosed or laboratory-confirmed disease Passive Surveillance Active Surveillance Diseases are reported by health care providers Health agencies contact health providers seeking reports Simple and inexpensive Ensures more complete reporting of conditions

12. 12 Surveillance may comprise:

13. 13 Surveillance System Attributes

14. 14 Source: https://www.youtube.com/watch?v=3IpE8dE4cVc Health event Action Detection and notification Health service Laboratory Data collection and storage Analysis and Interpretation Dissemination of findings

15. 15 Public Health Surveillance Process Data Collection Reported diseases or syndromes Electronic health records (e.g., hospital discharge data) Vital records (e.g., birth and death certificates) Registries (e.g., cancer, immunization) Surveys (e.g., National Health and Nutrition Examination Survey [NHANES]) Nationally Notifiable Disease Surveillance System (NNDSS) Internationally Notifiable Diseases: Reporting to WHO is required for cases of Smallpox Poliomyelitis (wild type) Human influenza caused by any new subtype Severe acute respiratory syndrome (SARS) Data Analysis Data Interpretation Data Dissemination Link to Action Data Collection

16. 16 Data Collection Data Analysis Data Interpretation Data Dissemination Link to Action Who will analyze the data? What methodology will they use? How often will they analyze the data? Surveillance Data Analysis by Place Map Courtesy of the New York City Department of Health and Mental Hygiene Data Analysis by Person Characteristic No. of Patients (%) Population at Risk Rate of Infection per Million Population Age (years) 0–19 2 (3) 2,324,081 0.9 20–29 1 (2) 1,553,981 0.6 30–39 3 (5) 1,549,111 1.9 40–49 1 (2) 1,177,190 0.8 50–59 9 (15) 867,331 10.4 60–69 12 (22) 814,838 16.0 70–79 18 (31) 534,785 33.7 ≥80 12 (20) 281,054 42.7 Age category (years) ≥50 52 (88) 2,498,008 20.8 <50 7 (12) 6,604,363 1.1 Sex Male 31 (53) 4,289,988 7.2 Female 28 (47) 4,812,383 5.8 Race White 41 (69) 5,983,901 6.9 Nonwhite 9 (15) 3,118,470 2.9 Unknown 9 (15) -- -- Borough or county of residence New York City Brooklyn (Kings) 3 (5) 2,300,664 1.3 Bronx 9 (15) 1,203,789 7.5 Manhattan 1 (2) 1,487,536 0.7 Queens 32 (54) 1,951,599 16.4 Staten Island (Richmond) 379,999 0.0 New York State Nassau 6 (10) 1,287,348 4.7 Westchester 8 (14) 847,866 9.1 Nash D, Mostashari F, Fine A, et al. Outbreak of West Nile virus infection in the New York City area in 1999. N Engl J Med. 2001;344:1807–14.

17. 17 Data Collection Data Analysis Data Interpretation Data Dissemination Link to Action Data interpretation is closely coupled with data analysis Health agency newsletters, bulletins, or alerts Surveillance summaries and reports Medical and epidemiologic journal articles Press releases and social media Data Dissemination Target Audiences Public health practitioners Clinicians and other health care providers Policy and other decision makers Community organizations The general public Data Dissemination

18. 18 Data Collection Data Analysis Data Interpretation Data Dissemination Link to Action Link to Action Monitor trends and patterns in disease, risk factors, and agents Source: Centers for Disease Control and Prevention (CDC). National Notifiable Diseases Surveillance System and Supplemental Pertussis Surveillance System and 1922-1949, passive reports to the US Public Health Service. Atlanta, GA: US Department of Health and Human Services, CDC. Available at: http://www.cdc.gov/pertussis/images/incidence-graph.jpg. Pertussis (Whooping Cough) Cases, by Year — United States, 1922–2000

19. 19 Public Health Surveillance-Based Action

20. 20 India needs effective disease surveillance and equity in health delivery programs for taking corrective actions to improve health conditions of vulnerable populations. The outbreaks of plague (1994, 2002), malaria(1995), dengue (2006) in different parts of the country further highlighted the weaknesses in the surveillance system. Public Health Surveillance in India Pilot, E., Roa , R., Jena, B., Kauhl , B., Krafft , T. and Murthy, G.V.S., 2017. Towards Sustainable Public Health Surveillance in India: using routinely collected electronic emergency medical service data for early warning of infectious diseases.  Sustainability ,  9 (4), p.604.

21. 21 “ India’s Public Health Surveillance by 2035 ” is a continuation of the work on Health Systems Strengthening. This paper is a joint effort of Health Vertical, NITI Aayog, and Institute for Global Public Health, University of Manitoba, Canada with contributions from technical experts from the Government of India, States, and International agencies. Public Health Surveillance (PHS) cuts across primary, secondary, and tertiary levels of care.

22. 22 Vision Statement In 2035, India’s Public Health Surveillance will: Be a predictive, responsive, integrated and tiered system of disease and health surveillance that is inclusive of prioritized, emerging and re-emerging communicable and non-communicable diseases and conditions. Readiness for actions at community, facility and health and governance systems are key aspects of the response. Be a system that is primarily based on de-identified individual level patient information which includes health care facility and laboratory data as key sources, amongst others. Serve public-good through the provision of meaningful ‘information for action’ to relevant stakeholders^, with due attention to privacy and confidentiality of the individual, and enabled with a client feedback mechanism. Provide regional/global leadership in compliance with International Health Regulations and management of events that constitute a Public Health Emergency of International Concern

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24. 24 Examples of action at different levels

25. 25 National Surveillance Programme for Communicable Diseases (NSPCD) NSPCD was launched by the Centre in 1997-98 in five pilot districts of the country (centrally sponsored scheme) and over the years extended to cover 101 Districts in all 35 states and UTs in the country. In this programme the states were the implementing agencies and NICD Delhi was the Nodal agency for coordinating the activities. This programme was based on outbreak reporting (as and when outbreaks occur) with weekly reporting of epidemic prone diseases directly from Districts (including nil reporting) to the Centre.

26. 26 Main components: To establish Early Warning System (EWS) so as to institute appropriate and timely response for prevention & control of outbreaks Every state/UT and all the 101 districts had a trained multi-disciplinary Rapid Response Team Rapid communications (through e-mails & fax) Strengthening of state and district laboratories for rapid confirmation of diagnosis Capacity development of health staff in the districts IEC (information, education and communication)

27. 27 Districts covered under NSPCD 1997-98 (25 districts) 1998-99 (20 districts) 2000-01(35 districts) 2001- 02 (20+1 districts*) * The district of Shimla taken as a special case during 2002-03

28. 28 Diseases/pathogens covered: Epidemic prone communicable diseases- acute diarrhoeal diseases including cholera, viral hepatitis, dengue, Japanese encephalitis, meningitis, measles, viral haemorrhagic fevers, leptospirosis, others. Pathogens with bioterrorism potential Drug resistant pathogens

29. 29 Expected outcome: Early detection of outbreaks Early institution of containment measures Reduction in morbidity & mortality Minimize economic loss

30. 30 The intent of the program is: to detect early warning signals of impending outbreaks to help initiate an effective response in a timely manner to provide essential data to monitor progress of on-going disease control programs to help allocate health resources more efficiently Launched by Union Minister of Health and Family Welfare on 8th November 2004 as a decentralized, state-based surveillance program. INTEGRATED DISEASE SURVEILLANCE PROGRAM (IDSP)

31. 31 The IDSP has categorized the public health response in order to address concerns raised through surveillance by three levels: M any states have also instituted ‘Media Scanning and Verification Cells’ as a function of the SSU, and very often, these serve as the ‘Early Warning System’ for a political and programmatic response to a disease outbreak.

32. 32 Surveillance activities in India are largely either Event Based Surveillance or Indicator Based Surveillance. Event based Surveillance is usually restricted to events of public health importance, whereas indicator-based surveillance includes monitoring of trends, occurrence of new events or compilation and analyses of a number of events. A ctivities that contribute to Disease Surveillance is: Notification Sentinel surveillance Active and passive surveillance Vector surveillance Laboratory surveillance Sample surveys Registries Outbreak investigation Special studies

33. 33 The Organization of Disease Surveillance in India:

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35. 35 Phase II (05-06) : – Chattisgarh , Goa, Gujarat, Haryana, Orissa, Rajasthan, West Bengal, Manipur, Meghalaya, Tripura, Chandigarh, Pondicherry, Nagaland, Delhi Phase-I (04-05): Madhya Pradesh, Andhra, Himachal, Karnataka, Kerala, Maharashtra, Mizoram, Tamil Nadu & Uttaranchal Phase III (06-07): UP, Bihar, J&K, Punjab, Jharkhand, Arunachal, Assam, Sikkim, A&N Island, D&N Haveli, Daman & Diu, Lakshadweep Phasing of Integrated Disease Surveillance Project

36. 36 Target diseases in IDSP:

37. 37 COVID-19 AND SURVEILLANCE-VISION 2035

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39. 39 INFORMATION LOOP OF PUBLIC HEALTH SURVEILLANCE

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42. 42 The Way Forward: Public Health Surveillance in India

43. 43 References Park, Park’s Textbook of Preventive &Social Medicine, 25th Edition, Jabalpur: Banarsidas Bhanot,2019. Rothman, K., Greenland, S., & Lash, TL. (2008).  Modern Epidemiology, 3rd Edition . Lippincott Williams & Wilkins. Pilot, E., Roa , R., Jena, B., Kauhl , B., Krafft , T. and Murthy, G.V.S., 2017. Towards Sustainable Public Health Surveillance in India: using routinely collected electronic emergency medical service data for early warning of infectious diseases.  Sustainability ,  9 (4), p.604. Declich , S. and Carter, A.O., 1994. Public health surveillance: historical origins, methods and evaluation.  Bulletin of the World Health Organization ,  72 (2), p.285. https://www.cdc.gov/training/publichealth101/surveillance.html#anchor_resources – Public Health Surveillance https://www.who.int/immunization/monitoring_surveillance/burden/vpd/en/ - Public Health Surveillance https://niti.gov.in/index.php/node/1395 - Vision 2035 Public Health Surveillance In India