COURSE 2 - MODULE 1- PART 1

Identify and record cases of priority diseases, conditions and events

MODULE 1-PART 1: Learning Objectives

Participants will be able to recall and understand:

1. Indicator-based Surveillance (IBS) approach to detect diseases, conditions, and events for reporting to the next level of the health system

2. Improve surveillance and response activities in their catchment area

3. Involve the community in disease surveillance

4. Improve local laboratory capacity to detect priority diseases, events, and conditions

Outline of COURSE 2 - Module 1 Part 1 (1)

• Introduction to IDSR Matrix-"identify“

• Use of Indicator-based Surveillance (IBS)

approach to detect diseases, conditions,

and events

• How diseases, conditions, and events

come to the attention of the health system

• Use of standard case definitions to identify

diseases for reporting to the next level

Outline of COURSE 2 - Module 1 Part 1 (2)

• Update district procedures for surveillance

and response

• Describe the role of the laboratory in

detecting priority diseases, events and

conditions

• Summary: Course 2-Module 1- Part 1

Purpose of Module 1 - Part 1

To provide guidance on:

• How to use standard case definitions to detect

priority diseases, conditions and events

• The procedures required to plan for improvements

of surveillance and response activities at all levels

of the health system

Introduction to IDSR Matrix-"identify“[Refer to the WHO 3rd Edition IDSR Technical Guidelines, Booklet 1, Annex A, pages 26-31]

Introduction

• Surveillance priorities may be communicable and non-communicable diseases, conditions or events that include national or local priorities

o E.g. Acute outbreaks and deaths or events

• Essential function of a PHS system is to be able to detect public health threats and events or hazards

What is ‘Standard Case Definition’

• A standard case definition is an agreed-upon set of criteria used to decide if a person has a particular suspected disease or condition.

The definition specifies clinical criteria and specifications on time, place and person.

• Mostly used in IBS approach to detect diseases/conditions/events

How diseases, conditions, events come to the attention of the health system -1

• A person falls ill and seeks treatment from a HF.

• Community members report unusual events or

occurrences at local levels such as:

o a cluster of deaths

o unusual disease pattern to the health facility

• Health staff who conduct active record reviews of

registers (clinical and laboratory)

How diseases, conditions, events come to the attention of the health system -2

• Media reports (Radio, television, newspapers), or

social media

• Vital events records show an increase in maternal

deaths

• Unusual reports of illness among health care workers

• An unusual death or number of deaths among

animals or birds

or

• An unusually high number of sick animals presenting

with the same symptoms

Explain IBS and EBS approaches used to detect diseases, conditions, and events -1

• The IDSR strategy uses both Indicator-based

Surveillance (IBS) and Event-Based Surveillance

(EBS) approaches to detect diseases, conditions,

and events

• All countries should establish EBS system

alongside with the IBS at all levels of the health

system

o i.e. At national, regional/provincial, district, health

facility and community levels

IBS and EBS approaches used to detect diseases, conditions, and events -2

• The IBS involves use of standard case definitions

to identify diseases, conditions, and events,

whilst EBS uses alerts detection, triaging and

verification to detect events

• IBS and EBS are integral component of the

routine IDSR activities of the surveillance staff

• Both IBS and EBS should use existing resources

and infrastructure set aside for routine IDSR

strategy

Use of Indicator-Based Surveillance Approach to detect diseases,

conditions and events

Use standard case definitions to identify diseases for reporting to the next level

• All cases (suspect, probable and confirmed) should always be recorded in a recognized facility register or logbook, and the IDSR reporting forms

Importance of standard case definition

• To help decide if a person has a presumed

disease

• To ensure that every case is diagnosed in the

same way, regardless of where or when it

occurred

• To initiate action for reporting and investigation

• Using standard case definitions is also important

in implementing the International Heath

Regulations (2005).

Role of communities in case detection

• Facilitate early detection of priority diseases,

conditions and events using simplified case

definitions

• Community members should be oriented in

surveillance to actively participate in:

o Detecting, Reporting, Responding to and

Monitoring Health Events Related to

Human Or Animal in their Catchment Area

One Health Approach in identification of events-1

• Applies a holistic approach in detecting and

responding to possible public health events

• Detection at all levels to strengthen

collaboration across sectors,

• Jointly share responsibility of detecting events

which might have impact on human, animal

and environment

One Health Approach in identification of events-2

• Examples include:

o Detection of a rabid animal, which can facilitate

investigations of human cases of disease

o Reports of disease caused by exposure to

chemical hazards within the environment

o Detection of events at Points of Entry

• “All events detected should be shared with other

sectors as part of the One health approach”

Make standard case definitions available at health facilities and communities-1

• Distribute standard case definition (SCD) to

health facilities for use, as well as registers for

recording including Rumour Log Book

o SCD can be in the form of a poster or a small

pocket-sized booklet

• Health Facility (HF) personnel at all levels

including Points of Entry (PoE) should know and

have available SCD

Make standard case definitions available at health facilities and communities-2

• Distribute community level case definitions using

key signs and symptoms

• Ensure that health staff and CBS volunteers

know the process for reporting including reporting

levels

Update district procedures for surveillance and response

Update district procedures for surveillance and response-1

Activities to be done include:

1. At least once a year, update the information about

catchment area HF, PoE and labs

2. Include location of major public health programs in

your area that provide clinical services or public

health activities

3. Include list of the HF, PoE and other locations that

can report health information to the district

4. Update the list of focal surveillance officers in the

district

Update district procedures for surveillance and response-2

Activities to be done include:

5. Conduct risk mapping of all public health hazards

as specified by IHR (2005),

6. Identify potential Community representatives that

can be engaged in Community-based

Surveillance (CBS)

7. Distribute updated data collection forms, reporting

tools, line listing registers and technical guidelines

Role of the laboratory in detecting priority diseases,

conditions and events

Role of the laboratory in detecting priority diseases, conditions and events-1

• Several diseases or conditions have signs and

symptoms that are similar.

o For example, a child with fever and rash might be

diagnosed with measles, even though there could

be several causes for the child’s clinical

presentation.

• Laboratories should be used to detect pathogens that

have potential to spread.

Role of the laboratory in detecting priority diseases, conditions and events-2

• Laboratory confirmation in surveillance is essential

because laboratory results help to:

o Accurately diagnose illness in an individual patient,

o Verify the cause (or aetiology) of a suspected

outbreak

NB: It is necessary to initiate public health measures

even before laboratory confirmation has been

received

Specimen collection, storage and transportation procedures-1

• Collect appropriate specimen as per the standard

operating procedure of the specific disease.

• All specimens must be packed and labelled correctly

and accompanied with the correct laboratory forms.

• Minimize delays between collection of the specimen

and processing in the laboratory.

• Ensure health facilities have trained personnel and

adequate materials to enable sample collection.

Specimen collection, storage and transportation procedures-2

• A well-defined transportation process is required to

enable health facilities to understand how and where to

send samples.

• Disseminate information about triple packing and

shipping of infectious material as per national and

international SOPs.

Refer to Section 11 of the WHO 3rd edition IDSR

Technical Guidelines Booklet Six for recommended

laboratory procedures for confirming specific priority

diseases and conditions.

Specimen collection, storage and transportation procedure

• Demonstration:

o Laboratory specimen collection and storage materials

o Procedures for specimen collection, storage and transportation for selected diseases common in the country

Procedures in establishing a laboratory network

• Local focal persons at each level should maintain an updated list of the laboratories that have the capacity to perform required laboratory testing.

• Support laboratories within the network, through an MoU with laboratories outside that have the capacity for specific diagnostic procedures.

Sample List of national laboratories for confirming priority diseases and conditions

Priority disease, conditions and events Focal Person, Name of Lab, address, phone number, email

Polio Example: John Zimbe; National Laboratory, 145 Kenyatta Road,Pretoria, SA; 234-701342555

Cholera

HIV

Tuberculosis

Measles

Plague

Human influenza caused by a new subtype

Rift Valley disease

Dengue fever

Public health events of national or international concern

Anthrax

Chikungunya

Typhoid fever

Sample List of national laboratories for confirming priority diseases and conditions

• The IDSR strategy uses both Indicator-based Surveillance (IBS) and Event-Based Surveillance (EBS) approaches to detect diseases, conditions, and events.

• Use standard case definitions to ensure that cases and suspected cases are recorded accurately across your district.

• Update the information about your catchment area at least once a year so that you know who your target population is and the ongoing public health activities.

• Make sure local laboratories are included in the surveillance and laboratory networks.

Summary: Module 1-Part 1Course 2 - Module 1-Part 1