Epidemiological Surveillance Epidemiological Surveillance

Kumnuan UngchusakBureau of Epidemiology

Department of Disease ControlMinistry of Public Health

<kum@health.moph.go.th>

Key points

• its significant• surveillance system: How it works• Source of information• common weakness• how to improve• evaluation of surveillance system

Question : What are the role of these gods ?

Hakone’s Check point

Surveillance for• Knowledge of the distribution of health events• Rapid detection of outbreak • Public health planning and evaluation

I. The main purpose of Surveillance

II. Surveillance System: How it work?II. Surveillance System: How it work?

1. Collection•Record and report

2. Collation: • data analysis

3. Information synthesis

4. Dissemination• timely• action oriented

III. Source of information

1. Morbidity2. Mortality3. Laboratory4. Vaccines and drug5. Outbreak news/ rumor6. Vector7. Behavior8. Environmental8. Demographic

Organization of Surveillance SystemOrganization of Surveillance System

Ministry of Public Health

Dep of Disease Control

International Organization

Bureau of Epidemiolog

yProvincial

Epidemiological Unit

Private hospitals and

clinics

Hospitals and clinic under universal coverage scheme

District Surveillance information

centerHospitals

Under MOH

And universal coverage schemes

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Regional Disease Control Center

Important CD Diseases

Notification within 24 hours

1 SARS and Avian Flu 2.Cholera 3. Acute severely ill or death of unknown etiology 4. Cluster of diseases with unknown etiology 5. Anthrax 6. Meningococcal meningitis 7. Food poisoning outbreak 8. Encephalitis 9. Acute flaccid paralysis (AFP) 10. Severe Adverse Events Following Immunization

๑๑ Diptheria ๑๒ Rabies

Important CD Diseases

1 Measles 2. Pertussis 3. Hand Foot and Mouth Diseases 4. Influenza 5. Leptospirosis 6. Dysentery 7. Severe pneumonia of unknown etiology 8. Cluster of infectious cases 9.

Dengue/DHF

Weakness

• No action (surveillance for statistics)

• No mandate (no receptor)

• No funtional epidemiologist (CD4 <200)

• No motivation

How to improve Surveillance

Surveillance and Rapid Response Team (SRRT)Surveillance and Rapid Response Team (SRRT)

• Tsunami• Avian influenza• Cholera outbreak• Dengue

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D-SRRT

P-SRRT

R-SRRT

C-SRRT

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Surveillance and Rapid Response Team

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Intelligence

Control action

Information

1. New virus found

2. Human at risk

3. Human infection or inefficient H2H

4. Confine easy H2H transmissionConfine easy H2H transmission

5. multiple outbreak

6 multi-countriesInfluenza Pandemic

“SRRT ” 1030

Surveillance and

Rapid Response

Team

Health services

SRRTs

AI provincial Team (Human and Animal)

MoPH assigned “Mr. Bird Flu”

(800,000 village health volunteers & community leaders)

Lay report

Governor

NetworkNetwork

• History screening at all hospital• Testing of respiratory specimen • Survey of village and identify exposure• Active case finding and monitor household member for 10 days• Antiviral prophylaxis for family member of confirm H5 cases• Culling of affected poultry• Educated villagers to avoid risk

(SRRT)Hospital

Laboratory

Veterinarian

Pathologists

Early pandemicAlert phase 4

Ro = 1.5 - 2

Operational criteria for action:“5 or more cases within 10 days”

• Epidemiological linkage• Human-to-human• Evidence of viral change

• Isolation & treat• Antiviral prophylaxis

for all contacts• Stop work /class

in affected area

Influenza A (H1) outbreak at Samutsakorn

• 1700 workers• ILI 180• stop work• Isolated dormitory• Daily temperature

SRRT: Prae• 13 yrs old boy, fever 3 day• dead on arrival at district hospital , 6 April• 3 out of 7 chicken died ??

Unknown pneumonia dead

Evaluation of surveillance systemEvaluation of surveillance system

• clear• unclear

• institution• functional

• staff• skill• equipment• funding

• information ( timely & action oriented)• investigation• implementation

• public health practice• morbidity• mortality• policy

MandateMandate StructureStructure

InputInput

OutputOutputImpactImpact

ConclusionConclusion

1. Surveillance to safeguard the people2. Start with priority disease reporting3. Timeliness is most crucial4. Detection of outbreak5. Investigation to know the cause