Public Health Surveillance: Framework, Types and Applications

PUBLIC HEALTH SURVEILLANCE
PRESENTED BY:
DR. SIDDHARTH KIMTEE
JUNIOR RESIDENT, DEPT. OF COMMUNITY MEDICINE
GANDHI MEDICAL COLLEGE BHOPAL
1

OUTLINE
 Definition
 Monitoring vs Surveillance
 Historical origin
 Purpose of Public health surveillance
 Steps of surveillance system
 Levels of Surveillance
 Types of Surveillance
 IDSP
 Nodal agency 2

SURVEILLANCE
 “sur” means “from above” and “veiller” means “to watch”
 CDC defines epidemiological surveillance as “the ongoing and systematic
collection, analysis and interpretation of health data essential to planning,
implementation and evaluation of public health practice and programmes
closely integrated with timely dissemination of these data to those who need
to know”.
 Surveillance systems are organized networks of people and activities dedicated
to managing and maintaining surveillance for specific conditions.
 Surveillance systems can operate at various levels within countries, from local
to national, or on a global scale.
 SURVEILLANCE IS- “INFORMATION FOR ACTION” 3

Surveillance systems are information loops or cycles that involve healthcare
providers, public health agencies and the public in a process of information
collection, analysis, interpretation and feedback. The cycle begins when events of
public health concern occur and is completed when information about these
events is made available and applied in public health programmes.
4
Public and healthcare providers
• Clinicians
• Laboratories
• Hospitals
Health department
Reporting
Feedback
Ref.: IAPSM Textbook of Community Medicine (2nd
Edition)

MONITORING VS SURVEILLANCE
5
Performance and analysis of routine
measurements aimed at detecting
changes in environment or health
status of a population.
Continuous scrutiny of factors that
determine occurrence distribution of
disease and other conditions of ill-
health.
One-time linear activity Continuous cycle
No feedback present Feedback present
No inbuilt action component In built action component present
Stops once disease is eliminated/
eradicated
Continue even after disease is
eliminated/ eradicated
Smaller concept Broader concept
Ref.:Textbook of Community Medicine by Rajvir Bhalwar

HISTORICAL ORIGINS OF
SURVEILLANCE
 The first recorded epidemic in history was the great pestilence in Egypt
during 3180 BC. This was the starting point of collecting and organizing data.
 The idea of collecting data, analyzing them and considering a reasonable
response stems from Hippocrates, a Greek physician who lived between 460
– 370 BC. In his book, ‘On Airs,Waters and Places’, when writing on disease
occurrence, Hippocrates made a distinction between the endemic state as the
steady state of the disease, and the epidemic as the abrupt change in
incidence of disease.
6

(Bernard C. K. 2012)
7
1633–1703
Samuel Pepys (1633-1703)
started epidemic field
investigation.
1807–1883
William Farr (1807-1883)
founded the modern concept
of surveillance.
1813–1858
John snow (1813-1858) linked
data to intervention .
1910–1993
Alexander Langmuir (1910-
1993) gave the first
comprehensive definition of
surveillance.
 John Graunt (1620-1674) was the first scientist who quantitively studied the
patterns of human disease, its possible causes and introduced systemic data
analysis.

PUROSE OF PUBLIC HEALTH
SURVEILLANCE
1. To define public health priorities.
2. To characterize disease patterns by time, place, person and disease
characteristics.
3. To detect epidemics.
4. To suggest hypotheses for further investigation.
5. To identify cases for epidemiological research.
6. To guide and evaluate prevention and control programmes, including
assessment of effectiveness and/or adverse consequences.
7. To facilitate planning, including projection of future trends and healthcare needs
9
Ref.: OxfordTextbook of Public Health (6th
Edition)

STEPS OF SURVEILLANCE SYSTEM
Detection and
notification of
health event
Investigation and
confirmation
(epidemiological, clinical,
laboratory)
Collection of
data
Analysis and
interpretation
of data
Action to be
taken
Feedback and
dissemination of
results.
10

LEVELS OF SURVEILLANCE
 Individual- level Surveillance: Monitoring and recording health data for
specific individuals to identify health risks, track treatment outcomes or ensure
compliance with care protocols.
Example
 Local- level Surveillance: Collection and analysis of health data within a
community or district to detect outbreaks, identify trends and allocate resources
effectively.
Example
11

 National- level surveillance: Systematic collection and analysis of health data
across the country to guide health policy, program planning and disease
prevention strategies.
Example
 International- level Surveillance: Collaboration across countries and
organizations to monitor global health trends, detect emerging diseases and
coordinate international responses.
WHO routinely conduct surveillance of diseases of public health
importance, so that nations can be timely warned if the disease trends changes
indicating potential epidemic threat.
Example
12

TYPES OF SURVEILLANCE
Active Surveillance
Passive Surveillance
Sentinel Surveillance
Behavioral Surveillance
Nutritional Surveillance
14

ACTIVE SURVEILLANCE
• It is used when there is an indication that something unusual is occurring or disease is
highly contagious, fatal or in the process of elimination.
• The system does not wait for:
o Case-patients to come to health care facilities
o Health care facilities to report cases
• Health care workers actively reach out to detect cases
• Surveillance comes in addition to routine health care delivery
• Disadvantage: high use of resources (expensive) and difficult to conduct
• Example 15

PASSIVE SURVEILLANCE
• In this type of surveillance, criteria are established for reporting diseases, risk
factors or health related events.
• Health practitioners are notified of the requirements and they report events as
they come to their attention.
• Advantage: Simple to conduct and relatively inexpensive
• Disadvantage: Vulnerable to incompleteness
• Example
16

SENTINEL SURVEILLANCE
• This system is used when high quality of data is required about a particular
disease.
• It deliberately involves only a limited network of large hospitals with high case
load of that disease. Similarly good laboratory facilities and qualified as well as
trained staff can identify these diseases.
• Some common sentinel sites includes Antenatal clinics, STD clinics etc.
• Data collected can be used to signal trends, identify outbreaks and monitor the
burden of disease in a community.
• Example
17

BEHAVIORAL SURVEILLANCE
• It is a surveillance tool designed to track trends in HIV-related knowledge,
attitudes and behaviours in populations at risk of HIV and sexually transmitted
infections (STIs).
• Behavioural surveillance is defined as ongoing systematic collection, analysis and
interpretation of behavioural data relevant to understanding trends in the
transmission of HIV and STIs.
• In low-level and concentrated HIV epidemics, surveillance systems for HIV
should rely to the large extent on behavioural data as they help us to understand
the potential dynamics of HIV and STI epidemics.
• Example
18

NUTRITIONAL SURVEILLANCE
• It is an important tool for identifying existing system for collecting information on the current
and future magnitude, distribution and causes of malnutrition in populations with emphasis on
PEM.
• It helps to assist governments and international agencies in policy formulation, program
planning, management and evaluation.
• Nutritional surveillance process includes routine collection and compilation of data to know
about the details of nutrition related disease.
• Initially it was presumed that there are some diseases which occur due to nutritional
deficiencies (e.g. anaemia, rickets and osteoporosis) but later it was noticed that it includes
wide range of morbidities (e.g. obesity, hypertension, cancers, coronary heart disease, and
dental caries). 19

COMPILATION AND TRANSMISSION OF
DATA
• The cases that have been detected and recorded need to be compiled and
transmitted to the next level on regular basis once a week or daily.
• This could be done on a fixed date from each type of unit. All reporting
units/centers will provide zero reporting if no cases were detected.
• The designation of the person responsible for data compilation and transmission at
each level has been identified (pharmacist, computer statistical officer, lab technician
and medical officer).
• The health workers, medical officers of PHCs and sentinel private practitioners will
provide regular reports on prescribed formats on every Monday.
20

ANALYSIS AND INTERPRETATION
• The analysis should be encouraged at each level of surveillance system.
• Data are analyzed by count, divide and compare principles and then displayed by
time, place and person analysis.
• The workers should learn to interpret the data they are collecting and thereby
they will have better understanding of the needs of their community.
• The surveillance data can be easily tabulated in three ways: summary tables,
disease charts and maps, which show the number of cases of disease for each
reporting week and month. Data after analysis becomes useful information for
action.
21

ACTION
• Watching without doing is just a waste of seeing. Similarly, SURVEILLANCE
WITHOUT ACTION IS USELESS.
• Examples
22

FEEDBACK
• To ensure that reporting units at various levels remain motivated and involved
in the surveillance process, there must be regular communication back from
higher levels of programme management to lower levels .
• The feedback should include comments on the performance and quality in
recording and reporting of cases and suggestions in solving problems in
collection of data.
23

IDSP
• In the year 2004 Government of India with World Bank assistance has
launched a project intends to cover all states by phased manner.
• IDSP is a decentralized, state-based surveillance programme in the country.
• It is intended to detect early warning signals of impending outbreaks and help
initiate an effective response in a timely manner.
• It is also expected to provide essential data to monitor progress of on-going
disease control programmes and help allocate health resources more
efficiently.
24

OBJECTIVES OF IDSP
1. Integrate all existing surveillance activities of national disease
control/eradication programmes at the district level.
2. Establish system of data collection, collation, compilation, analysis and
feedback by using information technology.
3. Improve laboratory support for disease surveillance.
4. Develop human resources for disease surveillance and action.
5. Involve all stake holders including private sectors and communities in
surveillance.
25

SURVEILLANCE GROUP OF DISEASES DISEASESTO BE PLACED UNDER
SURVEILLANCE
Regular surveillance Water borne Acute diarrheal diseases
Bacillary dysentery
Viral Hepatitis
Enteric fever
Vector borne Malaria
Dengue/ DHF/ DSS
Chikungunya
Acute encephalitis syndrome / JE
Vaccine Preventable diseases Measles
Pertussis
Diphtheria
Respiratory Diseases Chickenpox
Meningitis
ARI
Pneumonia
26

27
SURVEILLANCE GROUP OF DISEASES DISEASESTO BE PLACED UNDER
SURVEILLANCE
Regular surveillance Diseases under eradication Acute Flaccid Paralysis
Other diseases Leptospirosis
Fever of Unknown Origin
Dog bite
Snake bite
Unusual clinical syndrome Unusual syndrome NOT captured above
Sentinel surveillance STD’s/ Blood borne diseases HIV, HBV, HCV
Other conditions Water quality
Outdoor air quality
Regular periodic
surveys
NCD risk factors Anthropometry, physical activity, BP,
tobacco use, Nutritional status and
blindness
Additional state
priorities
Each state may identify up to 5
additional conditions
-
Ref.:Textbook of Community Medicine by Rajvir Bhalwar

SURVEILLANCE IN PRACTICE
There are three parallel systems of surveillance under IDSP:
1.Syndromic surveillance: It is conducted by field/community workers based on
predefined symptoms. So this helps in finding out suspected cases from
community. Example: For RTI and STI cases we conduct syndromic
surveillance.
2.Presumptive surveillance: All the suspected cases are referred to medical
officers for confirmation. Doctor confirms the case based on sign and
symptoms. It gives idea of probable cases.
3.Laboratory surveillance: Probable cases are subjected to laboratory
investigations for confirmation.Then finally we know the confirmed cases. 28

REPORTING FORMATS UNDER IDSP
29
FORM FILLED BY:
Form ‘S’ (Suspect Cases) Health Workers (Sub Centre)
Form ‘P’ (Probable Cases) Doctors (PHC, CHC, Pvt. Hospitals)
Form ‘L’ (Lab Confirmed Cases) Laboratories

33
Ref.: https://ihip.mohfw.gov.in/idsp/#!/pform

INFORMATION FLOW OF THE WEEKLY
SURVEILLANCE SYSTEM
3
4
Sub-centres
P.H.C.s
C.H.C.s
Dist. hosp.
Programme
officers
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

DISTRICT SURVEILLANCE COMMITTEE
35
Chairperson*
District Surveillance
Committee
District Surveillance Officer
(Member Secretary)
CMO
(Co. Chair) Representative
Water Board
Superintendent
Of Police
IMA
Representative
NGO
Representative
District Panchayat
Chairperson
Chief District PH
Laboratory
Medical College
Representative
if any
Representative
Pollution Board
DistrictTraining Officer
(IDSP)
District Data Manager
(IDSP)
District Program Manager
Polio, Malaria,TB, HIV - AIDS
* District Collector or District Magistrate

36
Stakeholders of District Surveillance Committee from Madhya Pradesh

Chairperson*
State surveillance
committee
Director Health Service
Director Public
Health (Co. Chair) Director Medical Education
Representative
Water Board
NGO
Medical Colleges
State Coordinator
Representative
Department of Home
State Program Managers
Polio, Malaria, TB, HIV - AIDS
Head, State Public
Health Lab
IMA
Representative
Representative
Department of Environment State Surveillance Officer
(Member Secretary)
State Training Officer
State Data Manager IDSP
STATE SURVEILLANCE COMMITTEE
37
* State health secretary

38
Stakeholders of state Surveillance Committee from Madhya Pradesh

Chairperson*
National surveillance
committee
Director General
Health Services
(Co. Chair)
Director General
ICMR
PD
(IDSP)
JS
(FamilyWelfare)
Director
NICD
Director
NIB
National Program Managers
Polio, Malaria,TB, HIV - AIDS
Consultants
(IndiaCLEN / WHO
/ Medical College
/others)
NGO
IMA
Representative
Representative
Ministry of Home
Representative
Ministry of Environment
National Surveillance Officer
(Member Secretary)
* Secretary health and
secretary family welfare
NATIONAL SURVEILLANCE COMMITTEE
39

ICMR
National
Programs
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
40

NODAL
AGENCY
• The National Centre for
Disease Control
(NCDC)
• Responsible for
facilitating the prevention
and control of diseases
through disease
surveillance, outbreak
investigations and rapid
response to outbreaks
across the country. 41

A Good surveillance system does not necessarily
ensure making of right decisions; but it reduces the
chances of wrong ones!
42

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