Glimpses of IDSP works, West Bengal IDSP 2013.pdf · 2012 Glimpses of IDSP works, West Bengal 1...

Glimpses of

IDSP works,

West Bengal (2012)

Disease Surveillance: Down to Earth

Team IDSP, State Surveillance Unit, WB

2013 Vol. II

GOVERNMENT OF WEST BENGAL

DIRECTORATE OF HEALTH SERVICES

PUBLIC HEALTH BRANCH

SWASTHYA BHABAN, KOL - 91

Preface

7/23/2013 Glimpses of IDSP works…2nd Volume We are very pleased to publish the cumulative efforts of work

done by the State Surveillance Unit along with all District Surveillance Units across West Bengal working in tandem for IDSP as a team yet again. The compiled works which relates various activities such as Outbreak Investigation, Data Management, Program Evaluation, Entomological Survey and Lab Investigations. The compilations are fetched from the experience and /or achievements discussed by the various units of the State at Annual Meet 2013 held at Swasthya Bhaban.

The efforts that all of the DSUs of West Bengal have rendered to give a shape to the thoughts at State Annual Meet 2013 is highly appreciated. My heartful thanks to the Team IDSP, SSU, without whose indefatigable approach in making valuable suggestions and overall compilation, this publication would not have taken its final form.

Jt. Director of Health Services (PH & CD)

& State Surveillance Officer,

IDSP, SSU, WB

GOVERNMENT OF WEST BENGAL

DIRECTORATE OF HEALTH SERVICES

PUBLIC HEALTH BRANCH

SWASTHYA BHABAN, GN-29

SEC V, SALT LAKE

KOLKATA – 700 091

SWASTHYA BHABAN

Index

Article Page No.

Cholera: the lion’s share of diarrhoeal outbreaks in Birbhum 2011 & 2012 --------------------------------------------------- 1-2

Anecdote of ice cream poisoning in school children, Nadia, 2012 --------------------------------------------------------------- 3-4

Detection of early warning signals and impending outbreaks at grass root level… Purulia, 2012 --------------- 5-6

The challenges of dengue in West Bengal: an entomological perspective ------------------------------------------------ 7-8

A food borne outbreak due to contamination of ‘prasad’ in a local festival in Howrah District, 2012 -------- 9-10

Descriptive epidemiology of Japanese encephalitis in Jalpaiguri : 2011 & 2012 --------------------------------------- 11-12

Investigation of scrub typhus outbreaks ……. Darjeeling District, 2012 -------------------------------------------------- 13-14

A study on the knowledge of paramedical personnel in disease surveillance: Burdwan, 2012 --------------- 15-16

Experience of a dengue outbreak in rural areas, Purba Medinipur: 2012 ---------------------------------------------------- 17-18

Contaminated water sources led to a cholera outbreak: Malda, 2012 -------------------------------------------------------- 19-20

Good practices in Integrated Disease Surveillance Project (IDSP): Hooghly, 2012 ------------------------------------ 21-22

A brief epidemiological study on AES/Meningitis: Uttar Dinajpur, 2012 ---------------------------------------------------- 23-24

Multiple causative agents resulting in a fever outbreak in Dakshin Dinajpur: 2012. ---------------- 25-26

A Comprehensive action to control a dengue outbreak in Paschim Medinipur, 2012 ------------------------------ 27-28

Practices to improve IDSP reporting in North 24-Parganas ------------------------------------------------------------------------ 29-30

Status of weekly reporting in IDSP portal: Kolkata Municipal Corporation ---------------------------- 31-32

Contribution of District Priority Lab in the dengue outbreak in Mushidabad: 2012 ---------------------------------- 33-34

Tools for evaluation of IDSP reporting units: South 24 Parganas, 2012 ------------------------------------------------------ 35-36

Specific action plan reduced malaria & diarrhoea in endemic blocks: Bankura, 2012 -------------------------- 37-38

Programme evaluation of IDSP using a logframe approach: Cooch Behar, 2012 ------------------------------- 39-40

A study on epidemiology of lab-confirmed dengue cases in West Bengal, 2012 ------------------------------ 41-42

Evaluation of surveillance system for AES & JE in West Bengal, 2012 ------------------------------ 43-44

2012 Glimpses of IDSP works, West Bengal

1

Cholera : the lion’s share of diarrhoeal outbreaks in Birbhum 2011 & 2012 Dilip Dutta1, Prabhakar Sarkar2, Sudip Basani3 1Dy CMOH-II, 2Epidemiologist, DSU, 3Data Manager; Birbhum. Introduction: Integrated Disease Surveillance Project (IDSP) started from the year of 2007 in Birbhum. One of the main objectives of IDSP is early detection of disease outbreaks. Whenever there is a rising trend of illness of similar nature in any area, it is investigated by Medical officer / Rapid Response Teams (RRT) to verify, confirm and take up appropriate control measures for the outbreak.

Background information: A total of 23 outbreaks have been detected and investigated in two consecutive years i.e. 2011 & 2012. Out of 23 outbreaks, diarrhoeal disease outbreaks occurred 16 times. All these outbreaks were in rural areas. These were investigated within 24 hours and human sample were collected for lab investigation by 48 hours.

Disease Outbreaks occurred in 2011, 2012 & 2013 (up to 10.03.13)

Name of the Diseases 2011 2012 2013 up to 10.03.13

Acute Diarrhoeal Diseases 7 9 0

Food Poisoning 0 1 1

Fever 1 0 0

Chicken Pox 0 1 0

Dengue 1 0 0

JE 1 0 0

Kala-azar 1 1 0

Total 11 12 1

Year

ADD Outbreak Occurred

Outbreaks where human sample collected

% of human sample collection

Found Cholera

2011 7 7 100 6

2012 9 9 100 8

2 2

1 1

2 2 2 2

0

1

2

3

2011 2012

July August

September

November

In the year of 2011, 4 Cholera outbreaks occurred in the Month of August, 1 in September & another in November. In the next year, 6 Cholera outbreaks occurred in the Month of July and 2 in August.

Cholera outbreaks by week of onset, 2011 & 2012

Lab Investigation: Rectal Swabs were collected from acute diarrhea patients and samples were maintained in cold chain and sent to NICED, Kolkata for culture.

Glimpses of IDSP works, West Bengal 2012

2

Preventive measures taken:

Health awareness generation activities done in the affected communities.

Health camps organized in the affected areas.

Depot holders (ASHA & ANM) arranged for ORS and essential medicines.

Outbreak investigation done within 24hrs by DSU along with Block RRT.

Human Samples & water samples collected and sent to NICED within 48hrs of reporting for detecting the causative organism.

Recommendations & Conclusions:

Provision of safe drinking water for community.

Community and G.P level meeting on diarrhoeal diseases.

Advance stock of sufficient medicines & ORS should be available at SC level for the period from June to August.

Gearing up of Block level RRT for prompt action.

For collection of human samples Cary Blair media should be available at BPHC/ PHC level.

As we have seen that females are affected more in the outbreaks, awareness should reach the local women and the village level health committee.

Inter sector coordination should be developed to reduce diarrhoeal incidence & mortality. Local NGOs should be involved in this regard.

Age wise case distribution 2011 & 2012

Average 13.4 % cases belong to 0-5 yrs, 16.9 % cases belong to 6-14 yrs & rest 69.7% cases belong to 15 yrs & above

Average 6.3 % cases belong to 0-5 yrs ; 16.8 % cases belong to 6-14 yrs & rest 76.9% cases belong to 15 yrs & above.

Sex wise case distribution 2011 & 2012

Females are more affected than male in most of the diarrhoeal outbreaks in 2011 & 2012.

6.3 11.1 6.8 5.7 1.7 5.9

23.813.9

8.2 8.6

25.4 20.6

69.975.0

84.9 85.7

72.9 73.5

0.0

20.0

40.0

60.0

80.0

100.0

2011.002 2011.003 2011.004 2011.005 2011.006 2011.007

0-5 yrs

6-14 yrs

15 yrs &

Above

11.1 9.5 13.0 14.3 14.64.0

26.314.3

9.5 23.8 8.7 7.1 12.2

20.0

36.8 16.7

79.4

66.778.3 78.6

73.2 76.0

36.8

69.0

0.0

20.0

40.0

60.0

80.0

100.0

2012.004 2012.005 2012.006 2012.009 2012.013 2012.014 2012.015 2012.016

0-5 yrs

6-14 yrs

15 yrs &

Above

41.7530.56

54.79

30.56

54.24

38.24

58.2569.44

45.2

69.44

45.76

61.76

0

20

40

60

80

2011.002 2011.003 2011.004 2011.005 2011.006 2011.007

Male

Female 47.8638.10

56.5242.86 48.78

40.00 36.84 33.33

57.1461.90

43.48

57.1451.22

60.00 63.16 66.67

0

20

40

60

80

2012.004 2012.005 2012.006 2012.009 2012.013 2012.014 2012.015 2012.016

Male

Female


3

Anecdote of ice cream poisoning in school children, Nadia, 2012

Dr.Nitai Chandra Mandal1, Dr. Chanchal Majumder2 , Santanu Chakraborty3

1Dy.CMOH-II, 2Epidemiologist, 3Data Manager; Nadia.

Food poisoning is found to be one of the common public health emergencies in Nadia District. It

caused havoc amongst school children in Haringhata Block in 2012. The incidence has occurred in

Haripukuria High School, located at Haripukuria Village under Haripukuria Subcentre of Fatehpur

Gram Panchayet in Kalyani Sub Division. This is one of the oldest schools in the district with around

1100 student.

Sequence of events: On 18th April, 2012 at about 1.00 pm, BMOH of Haringhata block got a call from

a local panchayet member that a few students of Haripukuria High School fell sick after having ice

creams. The BMOH immediately informed the District Surveillance Officer and took his advice. At

about 1.15 pm teachers of Haripukuria High School took 11 students to Haringhata RH with

complaint of pain abdomen followed by vomiting & loose motion. On enquiry it revealed that they

had a common history of consumption of ice creams from a local vendor( feriwalah) at around 10.30

am. Symptoms started from 11.45 am onwards . BMOH rushed to the school along with a team of

MO and public health personnel. They, with the help of the teachers, took 11 samples of different

varieties of ice cream from the vendor and kept in a sterile container in a cold chain system

(vaccine carrier with 4 ice packs). A line list of students who took ice cream was prepared.

Results of investigation: From the line list it revealed that altogether 90 students took ice-cream

from two vendors between 10.15 am to 10.50 am. Both the vendors brought same types of ice

cream from a nearby factory of Haringhata Block. Being informed by the BMOH, the BDO and the IC

of Haringhata PS reached the spot and sealed the said factory at once. The owner of the factory &

both the vendors were arrested. Total 59 students showed the symptoms i.e. pain in abdomen,

vomiting & purging, starting between 11.50 am to 2.pm. They were treated symptomatically. All of

them were released by 9 pm on same day except one who was kept till next morning on request.

There was no death. No more cases were found on follow-up visit on next two days.

The distribution of cases by gender and respective attack rates can be seen from the table below.

Category Students at risk Students affected Attack Rate (%) Death

Male 48 36 75 0

Female 42 23 55 0

Total 90 59 65.5 0

Shubhashish

Stamp


4

No of affected student over a period of time (consumption between 10.15-10.50am)

5

9

13

19

8

32 1

02468

101214161820

11.45-1

2pm

12.01-1

2.15pm

12.16 -1

2.30pm

12.31-1

2.45pm

12.46-1

.00pm

1.01-1

.15p

m

1.16- 1

.30pm

1.31-1

.45p

m

No Affected

The line list data were graphically analyzed and it was found that maximum no. of cases occurred approximately after 2 hours of consumption of suspected ice cream. However the time interval between exposure and onset of symptoms ranged from 1 hour to 31 /2 hrs. Attack rate among female students was found to be significantly lower than male, reason of which was not clear. Result of samples tested in State Public Health Laboratory are given in the table below.

Visit at the ice cream factory: The factory was a kucha-pucca room where the roof was improperly

covered with tiles. They used to store water from a nearby shallow tube well in an open pucca pit

and this water was used for preparation of ice creams. They had no license or registration under

Food Safety Act-2006 nor had any trade license from the Panchayat. Surroundings looked very

filthy. Different types of pots & containers containing water, coloring materials etc. were strewn in

and around the factory. Over-all impression: The condition was not suitable for preparation of any

food items for consumption of human beings.


5

Detection of early warning signals and impending outbreaks at grass root level; Make it easy: Purulia, 2012

Dr. Anil Dutta1; Satinath Bhuniya2; Samrat Sen3; Vidyasagar Singha4 1Dy. CMOH-II, 2Epidemiologist, 3Data Manager, 4Data Entry Operator; Purulia. Background:

Detection of Early Warning Signals or impending outbreak is the key to Integrated Disease

Surveillance Project. It can be done easily by comparing the number of cases of any disease with that

of the previous few weeks and the same period of previous years. Review of data and comparing it

at Sub-center level or at Block level is not a very easy task and in common practice nobody does so.

Until and unless health personnel review the data, the detection of EWS or impending outbreak will

remain unachieved. In this backdrop, DSU-Purulia has developed a mechanism to improve the

surveillance system of common diseases towards detection of EWS and impending outbreak. Display

of weekly trend of common diseases in a graph paper or art paper or flex makes it easy to compare

the number of cases with previous weeks of the current year and even with previous years if it

continued for consecutive years.

Unit -wise display strategy:

Type of unit Diseases for display

‘S’ unit at Sub-center

level

Weekly trend of Loose Watery Stool/ Diarrhoea,

cases of no dehydration & some dehydration

taken together

Weekly trend of

Fever (<7 days)

‘P’ unit at BPHC level Weekly trend of Acute Diarrhoeal Diseases in

comparison with the expected value

‘L’ unit at BPHC level Monthly trend of Malaria in comparison with

threshold value and expected value for the

current year

Action taken to implement the strategy:

(i) Sensitization meeting/ Training conducted for the Health Workers at Sub-center level. So far

most of the sub-centers under 10 blocks of Purulia district have started to display the weekly

trends of fever and loose watery stool separately.

(ii) Training conducted for Block Data Entry Operators to maintain the soft copy of (a) weekly trends

of diarrhea against the expected value (mean of last 3 years’ data); (b) Monthly trend of Malaria

against the threshold value (mean + 1.96 SD) and expected value (mean of last 3 years’ data) for

the year for the respective blocks.

(iii) Discussed the display strategy with the BMOHs during the District Level Review Meeting.

(iv) Visit by the DSO and IDSP staff from DSU to the Block and Sub-centers for follow up.

Discussion:

At sub-center level we have encouraged to display the trend of (i) Loose Watery Stool/ Diarrhoea

and (ii) all Fever Cases (< 7 days), because as a part of syndromic surveillance maximum cases come

under these two categories. Interpretation of any Early Warning Signal in terms of clear / sudden

increase of cases would be possible automatically by the health workers. As a result they would take

action accordingly followed by information dissemination to the higher authority.


6

ANM of Bongabari S/C under Purulia Block-II is explaing

weekly trend of Fever to the Dy. CMOH-II, Purulia

0

20

40

60

80

100

120

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

No

. o

f ca

ses

Weeks

Weekly Trend of Diarrhoea in Block Purulia-II in 2013 along with Expected Value

Weekly trend in 2013 Expected value for 2013

Purulia District being an endemic zone of Malaria is at the risk of outbreaks. Such outbreaks would

be detected by comparing the scenario of current year (‘L’ form data) with the Threshold Value

calculated for the year. Likewise, Expected Value has been calculated for Acute Diarrhoea (‘P’ form

data) for each block. Early Warning Signals may be detected by comparing the weekly data of

current year with the Expected Value calculated for the year. Outbreak data has been excluded

during calculation of Threshold Value and Expected Value. When the number of cases of current

week exceeds clearly the Expected Value, then an Action Alert would be interpreted.

By displaying the weekly trends of common diseases in the IDSP units at block and sub-center levels

the attention of the health managers and health workers involved in Public Health activities are

drawn towards review of the situation and taking necessary action.

Display at Kustaur BPHC (PRL-II). BPHN is explaining the scenario to the BMOH.

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

No.

of c

ases

Malaria Threshold Value for Purulia Block-II in 2013

Action Alert THRESHOLD VALUE -2013 Malaria in 2013


7

The challenges of dengue in West Bengal: an entomological perspective Dr.Surajita Banerjee1; Dr.Debjit Chakraborty2; Shubhashish Roy3; Palash Mondol4; Sanjib Kr. Saha5

1State Entomologist, 2State Epidemiologist,3State Data Manager, 4State Microbiologist, 5State Data

Entry Operator; West Bengal.

Background: Dengue continues to remain a disease of cocern in West Bengal, India. Both dengue

and chikungunya cases rises every alternate years. It has been also observed that the case burden of

these vector borne diseases increase every year indicating that we need to be more careful to

combat the disease.

July 2012, was observed as the anti

dengue month. The main emphasis was

given on IEC. Paper insertions were

given in the leading papers, IEC was

done through television channels, and

meetings were done with the districts

surveillance units. Funds were allotted

to them for mass awareness. Several

workshops were arranged, leaflets

distributed, awareness campaigns were

organized. School children training

programme were organized mainly to sensitize the mass regarding the symptoms, treatment and

precautionary measures required to control dengue.

Despite the entire efforts outbreak struck in the very next month and the number of cases were

reported more than the expected in Kolkata and its adjoining districts. The immediate need of the

hour was to find the loop hole of the system, because considering the incubation period of the

disease, 13 - 20 days (extrinsic period: 8-10 days + intrinsic period: 5-10 days) the transmission

began at least 2 weeks earlier, and somehow the signal was overlooked. Our aim was to find the

cause from an entomological point of view.

Objective:

1. To study the vector habit and habitat.

2. To search for the cause of sudden increase of cases.

Method:

1. Search for the vector and the breeding sites by entomological survey and calculate entomological parameters like House Index (HI), Container Index (CI), Breatue Index (BI)

2. Interviewing the residents and the health workers in the affected region.


8

Result:

Breeding sources found were abundant throughout the affected region. The residents of the housing

complex were careful to remove the indoor breeding

spots but they overlooked the immediate surrounding

environment, as most of them were unaware of the flight

distance of the vector. The breeding spots were found in

the common shared areas e.g garbage vat, gardens,

plastic cover over shanties etc.

HI, BI and CI were found to be high. Breeding spots were

found also at various construction sites e.g metro rail

project site, and public places e.g bus terminus, temples

courtyard etc. The identified vector was Aedes albopictus.

Aedes breeding was observed in unexpected places such

as in polluted water, places with plenty of sunlight (not

shaded, as usual breeding habitat) etc.

Conclusion:

Our survey reports in various areas revealed that the impact of IEC activities have worked to some

extent as the residents of several places were well aware of the potential breeding places of the

vectors and took proper care of them. But they neglected the breeding spots lying in the common

places of the complexes. The polythene covers used by the temporary shops and houses to protect

from rain water poses a serious problem and such places are often overlooked. Many such breeding

sites were too reclusive to be covered by vector control workers. Unfinished/ abandoned

construction sites are another problem of the city. It has become a hub of mosquito breeding to

affect its surrounding places.

Strong community participation is warranted at such sites. Awareness generation activities should

be accordingly planned. Such activities should emphasize on the flight range of Aedes mosquitoes

(100m) and the residents should be made aware that any breeding spot (which is not within their

personal property) lying in a common space within 100m can affect them. Control measures are also

necessary in major public places as the risk of transmission and spread to other regions is very high.

Authorities of construction sites should be made responsible.

Finally careful monitoring, regular entomological survey and fever survey should be carried on at all

urban and suburban areas throughout the year and not only in the “anti dengue month” to ensure,

preparedness to combat dengue outbreaks in near future.

Name of the place HI(%) CI(%) BI

Ward No: 12 8.1 52 63.9

Ward no:22 20.3 46.3 59.2

Ward No:1 39.4 62.7 88.4

Ward No:11 34.2 44.4 80

Karunamoyee

Metro Rail

construction site &

bus terminus

NA 80.3 -

Ward No 13

(Howrah)

57 40.2 80.5

Diamond harbour

(Panchgram)

61.6 31.5 68.3


9

A food borne outbreak due to contamination of ‘prasad’ in a local festival in Howrah District, 2012

Dr.P.K.Das1; Raja Dasgupta2; Sk. Abid Ali3

1Dy.CMOH-II, 2Data Manager, 3Data Entry Operator; Howrah.

Notification of the outbreak:- on 14th March 2012 DSU, Howrah received information from BMOH,

Amta-II that a large number of cases of acute gastroenteritis were reported after taking ‘Maha pravu

prasad’ at a local holy festival in a village in this block. DSU immediately initiated investigations by

the district RRT. It had the objectives : 1. Estimate magnitude, 2. Manage cases, 3. Propose

recommendations.

Observations of district RRT :- People of Nowapara GP and Tajpur GP under Amta II Block were

mostly affected because the festival was held at adjacent part of those GPs. The patients

complained of falling sick with nausea, vomiting, diarrhoea etc. after taking ‘prasad’ of that festival.

Time interval between preparation and consumption of ‘prasad’ was too long. Some people

consumed the ‘prasad’ even after 24 hours from the time of preparation. ‘Prasad’ was prepared with

flattened rice, curd, molasses and cut fruits. Local tube well water was used.

Total 305 people were affected; out of them 91 were hospitalized. No death was reported in this

incident. Environmental inspection revealed improper handling and storage of the ‘prasad’.

Biological samples could not be collected but food and water samples were collected for laboratory

testing.


10

Distribution of cases by time of onset

Attack rate of gastroenteritis by age and sex

Age group (in Years)

Number of cases Population Attack rate (%)

0 – 15 54 665 8.12

15 – 25 49 367 13.35

25 - 45 136 596 22.81

>45 66 372 17.74

Sex Male 142 1040 13.65

Female 163 960 16.98

Total

305 2000 15.25

Conclusion:- People who consumed the ‘Maha Pravu Prasad’ on the next day of preparation,

suffered more than those who consumed it on the same day. Laboratory test of the food samples

isolated Gram +ve rod shaped beta haemolytic bacterium. The outbreak resulted from consumption

of ‘prasad’, which was unsafe by virtue of unhygienic processing and keeping under insanitary

conditions.

Recommendations :- Keep a close vigil on preparation and distribution of ‘prasad’ during local

festivals. Educate organizers and villagers regarding practices of safe food handling and proper

storage.


11

0

20

Jan

…

Ma

…

May

July

Se…

No

…

No

. of

case

s

Month

Fig. 1: Monthwise distribution of JE cases in Jalpaiguri (2011 &

2012)

No. of Cases in 2012

No. of Cases in 2011

Descriptive epidemiology of Japanese encephalitis in Jalpaiguri : 2011 & 2012

Debasis Mandal1, Nataraju S.M.2, Aparna Dutta3

1Dy CMOH-II, 2Epidemiologist, 3Data Manager; Jalpaiguri.

Introduction:

Japanese encephalitis (JE) is a viral disease that affects both animals and human. Pigs act as

reservoir and amplifier of the virus. It is transmitted by culex mosquitoes. In human, it

causes inflammation in the brain. The case fatality rate can be as high as 60% among those

with disease symptoms; 30% of those who survive suffer from lasting damage to the central

nervous system. In Jalpaiguri District a total of 39 seropositive cases of JE have been

detected through IDSP in the past two years (2011 & 2012). Among them 11 patients died.

This report highlights the surveillance of JE cases in Jalpaiguri District.

Methods:

Patients suffering from acute febrile illness of

variable severity associated with neurological

symptoms ranging from drowsiness or

irritability to meningitis or encephalitis were

considered as suspected case of JE. Table 1: Data showing JE sample testing

Serum samples of those suspected cases were sent to North Bengal Medical College &

Hospital, Siliguri, or School of Tropical Medicine, Kolkata for ELISA test. If a suspected case

was found seropositive for JE, then active search was done for any more cases in the

respective area.

Results:

In 2011, out of the serum samples of 147 serum

samples tested, 13 (8.8%) were found reactive

for JE. Among the 13 patients 5 were dead

(case fatality rate 38.5%). These 13 cases

belonged to 8 blocks of the district. In 2012, out

of 167 serum samples tested, 26 (15.6%) were

reactive for JE.

Year No. of samples tested for JE

No. of samples found positive for JE

2011 147 13

2012 167 26


12

Among the 26 patients, 6 were dead (case fatality rate 23%). These 26 cases belonged to 12

blocks (Table.1). In 2011 & 2012, JE cases were detected sporadically in different months of

the year but the seasonal peaks were observed in the months of June to September (Fig. 1).

In the available data it is observed that no cases of JE were seen in the age group 21-30

years but cases were detected in adults of other age groups as well as in children and the

elderly people (Fig. 2). The sero-positivity rate for JE was more in the female than in male in

both the years. Co-habitat of human with pigs was observed to be a common practice in the

affected places.

Discussion & Conclusion: The current data shows that JE is very prevalent in Jalpaiguri

district. The district reported the highest number of cases in West Bengal. The data of 2012

when compared to 2011 reflects that JE positive cases have increased while the case fatality

rate has decreased. The seasonality (June to September) pattern in the current data can be

utilised for timing the vector control measures. The co-habitat of human with pigs should be

avoided.

The surveillance data on JE is very limited. Therefore no comments should be made on the

age distribution of cases. JE vaccination has been started in the district since April, 2013

which may help in reduction of mortality and morbidity. The current surveillance methods,

vector control measures, IEC activities as well as vaccination will help the health system to

combat JE problem in the JE prevalent areas of Jalpaiguri District, though further monitoring

of the vector control measures and extensive active surveillance are required.


13

Investigation of scrub typhus outbreaks in Mirik Block & Kurseong

Municipality, Darjeeling District, 2012

Dr. Tulshi Pramanik1; Dibyendu Bhatta2

1 Dy.CMOH-II, 2 Data Manager; Darjeeling.

Background: Scrub Typhus or Bush Typhus had occurred in Darjeeling District in the Year 2010 &

2011 - in Kurseong Municipality & Mirik Block. The incident was investigated by the Dy.CMOH-II and

the diagnosis was serologically confirmed. In the year 2012, similar cases were again reported from

the above mentioned parts of the district. The cases were captured through the weekly reporting

system under IDSP.

Demography: i) Location –

( a) Tingling Tea Estate(TE) & Singbulli Tea Estate (TE)

under Mirik Block, GTA, Darjeeling

( b) Kurseong Municipality, GTA, Darjeeling

ii) Population –

(a) Mirik Block- 5739

(b) Kurseong Municipality - 25000

Notification: i) Mirik Block - on 15/8/12

ii) Kurseong Municipality – on 7/8/12


14

Symptoms: Fever, headache, muscle pain, cough & gastrointestinal symptoms.

Signs: Maculopapular rash, eschar, splenomegaly & lymphadenopathy.

Lab. Diagnosis: By Weil Felix Test.

Result:

Place No. of seropositive cases detected

Male Female Total

Mirik Block 13 16 29

Kurseong Municipality 25 35 60

There was no death in this outbreak. All cases responded to treatment with doxycycline.

Conclusion: i) Scrub Typhus in these areas is responsive to Doxycycline.

ii) Mass awareness to be generated on hygienic habits and preventive

measures against scrub typhus with the help of local community & PRI.


15

A study on the knowledge of paramedical personnel in disease surveillance: Burdwan, 2012 Dr.Dipayan Halder1; Nizamuddin Mondal2; Rajesh Mohanty3; Runa Laila4

1Dy.CMOH-II, 2Epidemiologist, 3Data Manager , 4Data Entry Operator; Burdwan.

Introduction: Integrated Disease Surveillance Project (IDSP) was introduced in the country in the

year 2004 with the main objective of detecting the impending outbreaks for early intervention. It is

also expected to provide essential data to monitor progress of ongoing disease control programs and

helps to allocate health resources more optimally. Part of success of the surveillance system would

depends on knowledge and attitude of the concerned staff who are involved in the surveillance

activites.

Role of the Paramedical personnel is important in IDSP for reporting the surveillance data, and their

knowledge and attitude about surveillance are critical aspect of this project. The present study was

conducted at District Surveillance Unit of Burdwan to assess the present knowledge of paramedical

personnel on surveillance and IDSP. The findings of this study will help to revamp the training

programme under IDSP for this category of personnel.

Aim: The study is aimed at identifying the present knowledge of paramedical personnel on present

surveillance related activities.

Objectives: i. To describe the present knowledge of the paramedical personnel on IDSP activities .ii.

To explore the practice of paramedical personnel on IDSP data and iii. To develop a future training

strategy for the target population based on the findings.

Methodology : Recently two training programmes were conducted on IDSP for paramedical

personnel and the participants were from throughout the district . A semi-structured questionnaire,

with open and close ended questions, was given to all training participants before starting the

training programme. Total 36 participants joined in the study from the category of BPHN/PHN, MT

Lab/Lab Tech, Pharmacist and Nurse.

Result : Total 36 respondents were included in this study . Out of which 52.7 % were

BPHN/PHN,30.5 were MT Lab./Lab Tech , 13.8 % were Pharmacist and 2.77% were Nursing

personnel.


16

Question 1 - What are the activities under IDSP :

Only 61 % respondents could answer correctly about IDSP activities and rest 39 % could not answer it properly. 42%, 21 % & 14% in the categories of MT Lab/Lab Tech, Pharmacist and BPHN/PHN respectively could not give the correct answer. Question 2 - Main objective of IDSP Figure -1

The above figures reflect that only 52 % could correctly mark the main objective of IDSP. Knowledge

gap was recorded in all categories of respondents with the maximum in MT Lab/Lab Tech followed

by Pharmacists and BPHN/PHN.

Question 3 - Function of P Tally Sheet : 45% respondents believe that early warning signal can be

generated through Tally Sheets. 55% respondents were not convinced in this aspect. Lack of

knowledge was recorded in all categories of paramedical personnel.

Question 4 - Meaning of disease notification Figure -2

Figure -2 indicates 52.7% of respondents knew what is to be done for notifying a disease; rest did

not have the knowledge. Types of answers can be seen in the figure.

Conclusion: It is evident from the study that knowledge on surveillance as well as IDSP is lacking in

all categories of paramedical personnel. More intensive training is needed for these categories of

personnel.

25%

5.50%

52%

2.70% 6% 9%

0% 10% 20% 30% 40% 50% 60%

Sending S, P, & L Form to district

Keeping record for consumption of

medicines

Identifying impending outbreak for early response

Preparing data base for the district

None of the above other

8.3% 13.9% 16.6%

52.7%

8.5%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

Treating the Pt indoor Treating the PT Outdoor

Treating the PT free of cost

Registering the name of PT and informing the concerned authoritites

None of the above


17

Experience of a dengue outbreak in rural areas, Purba Medinipur: 2012 Dr Dilip Kumar Biswas1, Paramita Das (Ghorai)2

1Dy. CMOH-II, 2District Data Manager; Purba Medinipur.

Introduction: Dengue, a mosquito-borne (Aedes) viral disease, is found in tropical and sub-tropical

regions. West Bengal had a massive dengue outbreak reporting 3306 ELISA confirmed cases in 2012

as up to the 30th of September. A sudden rise of fever cases was reported from Ramnagar-II Block

(coastal block) of Purba Midnapore District in the same month. An exploratory study of the outbreak

has been documented here.

Objectives: 1) To investigate:

Distribution of dengue cases.

The risk factors for dengue transmission.

2) To recommend suitable preventive measures. Study area: Investigation was done in the four villages named Badalpur, Tajpur, Gopalpur and

Ramchandrapur under Ramnagar-II Block of Purba Medinipore District.

Total Population was 5381 and they were mainly farmer and labour by occupation. Data collection: Active surveillance was done by house to house survey in the villages and reports

were also collected for patients admitted at Bararankua Block Primary Health Center and Contai Sub-

divisional Hospital, those being the referral hospitals of this block.

Screening of the dengue cases: Screening of fever cases was done by Rapid Diagnostic Test kit for

anti-dengue IgM/IgG antibodies and NS1. Blood samples were then sent to the referral lab of

Midnapore Medical College for confirmation by MAC ELISA test.

Entomological survey was done for identification of mosquito larvae and to find out the vector

breeding sites.

Result: A total of 100 clinical dengue cases were identified at the four villages surveyed (Table-1).

The maximum no. of cases were reported from the village of Gopalpur (37% ; 37/100). Most of the

cases were in the age group of 15- 44 years (52% ; 52/100). Men were affected more than the

women, more so in the young and active age group. Some of these people had a history of migration

to dengue endemic areas from where dengue infection might have been acquired. Among the

clinical dengue cases, 79% (79/100) were Rapid NS1 positive and 72% (13/18) were MAC-ELISA

positive. All the cases recovered within 5-7 days except one (Case Fatality Ratio =1%). The epidemic

curve indicated that the onset of the outbreak was on 7th Sept- 2012, the peak was on 18th Sept-

2012 with a sharp decline thereafter and no case was reported after 28th Sept- 2012. (Fig1).


18

Table 1: Distribution of cases by age and sex at four dengue affected villages, Ramnagar-II Block

A total of 1137 houses in four villages (Gopalpur- 489, Badalpur- 208, Tajpur- 289 and

Ramchandrapur- 172) were surveyed for entomological purposes. About 8% (89/1137) of houses

showed positive for Aedes aegypti larvae. The House Index (HI), Container Index (CI) and Breteau

Index (BI) in the four villages were 2-13%, 2-23% and 2-18 respectively (Table 2), that were not

higher/much higher than the critical values, indicating a low but some risk of disease transmission.

The indices were maximum in Gopalpur Village.

Fig1: Epidemic curve of outbreak of dengue Table 2 : Larval indices by villages

In the month of August and September 2012, there was medium rainfall in the district, resulting in

water accumulation in dams, drains, ponds and other water bodies. Water accumulation was also

found in plastic cups, earthen pots, cocoanut shells, plastic packets, tyres etc. lying in the open that

facilitated mosquito breeding. Storing water in earthen tubs without cover for cattle was a common

practice.

IEC activities related to symptoms of the disease, breeding site clearance and personal protection

were performed which controlled the spread of the outbreak. Mosquito breeding sites were

destroyed in the affected areas. Orientation of the health personnel about case management and

control of dengue and coordination among different sectors for vector control were felt to be

important for prevention of further outbreaks.

Age (years)

Gopalpur Tajpur Badalpur Ramchandrapur Grand Total M F Total M F Total M F Total M F Total

1 - 4 1 0 1 0 0 0 1 1 2 0 0 0 3

5 - 14 2 6 8 2 2 4 2 0 2 2 1 3 17

15 - 44 11 8 19 7 6 13 7 7 14 5 1 6 52

> 45 4 5 9 4 2 6 6 2 8 2 3 5 28

Total 18 19 37 (37%)

13 10 23 (23%)

16 10 26 (26%)

9 5 14 (14%)

100

Villages HI CI BI

Gopalpur 13 23 18

Badalpur 3 10 5

Tajpur 2 2 2

Ramchandrapur 9 11 13


19

Contaminated water sources led to a cholera outbreak: Malda, 2012

Dr. Amitabha Mandal1; Arun Baidya2; Shaswati Chaki3; Mamun Hoque4,

1District Surveillance Officer,2Epidemiologist, 3Microbiologist, 4Data Manager; Malda.

Cholera is a diarrhoeal disease that can affect both children and adults (WHO 2004). An outbreak of

acute diarrhoea occurred at Naldubi Village, Old Malda Block, situated at both sides of NH-34. The

distance from nearest Sub Centre was 5 kms. Since there was no ASHA in the village, two link

persons (RCH) did the grass-root level activities with the help of ANM. A total population of 1,943

(Naldubi- 482), Behula Colony (874) and Rail Colony (587) were at risk and majority of them

belonged to SC/ST category. The colonies were slum in nature.

Epidemiological observation

The village is surrounded by the small river Behula (polluted by paper factory waste water),

brick field (ash and soil) and railway line. The families those were not having tube-wells used only

pond water for bathing and washing clothes and utensils. The children used to defecate openly at

the pond side. During rainy season, water streams into the pond. Private tube-wells were within 15

meters from pit latrines due to scarcity of land. The only source of drinking water was public tube-

well.

Major sign and symptoms: Loose/watery stools, vomiting, pain in abdomen and fever.

Case definition: Loose/watery stool 3 or more times in 24 hours, with or without vomiting.

Analysis

The outbreak started on 19/9/12 although first

case occurred (hospital record) in the village

on 14/9/12. The index case was a 10 year

female of Behula Colony on 21/9/12. The last

case occurred on 03/10/12. A good no. of the

cases was found to be clustered around the

pond. The residents of Rail Colony and Behula

Colony usually use this pond. All age groups

were affected and almost two-third of the cases (64 %) belonged to 5 to 34 years age group. Females

were more affected, compared to males up to 44 years. Under-5 children (15.8%) were also

affected. However no death occurred. There was an initial increase in cases on September 22,


20

H'hd with single case (n=83)

H'hd with two cases (n=11)

H'hd with three cases (n=2) H'hd with four cases (n=1) Tubewell (Public)

N

H

3

4

R

a

i

l

L

i

n

e

R

a

i

l

C

o

l

o

n

y

Behula River

River

Spot Map of Cholera Outbreak at Naldubi village, Old Malda Block, Malda, Sept-Oct 2012

N

Pond Pond

Behula Colony

Behula Bridge

Behula Colony

Naldubi

Factory Brick Field

Mahananda River

INDEX Open Space

followed by progressive decrease in cases. The later part of the epicurve was stretched due to

person-to-person transmission, which was consistent with outbreaks of cholera.

The tube-wells were disinfected with the help of Public Health Engineering Department

(PHED) and PRI members. District Surveillance Officer had a conversation with the proprietor

regarding disinfection of the pond. The very next day, health staff and the proprietor disinfected 8

places (ghats) of the pond and the outbreak was controlled soon.

Lab analysis

Seven stool samples were sent in transport media to the Referral Lab. Two of them were found

positive for V. cholerae (O group 1). Water samples collected from 6 sources (both pond and tube-

wells) showed the presence of coliform bacteria on H2S Strip Test.

Conclusion

Contamination of water sources was considered to be the main cause of the outbreak.

Control measure adopted

The district and block level teams (RRT) visited the area and conducted active case search

regularly. The following activities were adopted during the outbreak :

Immediate measures taken to stop the use of pond water by the villagers. Message was

given not to contaminate the water source by washing patients’ clothes in the pond.

A meeting was conducted with the villagers regarding disinfection, IEC, personal hygiene and

transportation of serious patients to hospital etc.

Campaign on sanitation, safe drinking water and hand washing practice.

Disinfection of tube-wells and 8 places (ghats) of the pond.

Treatment on site by a medical team with use of recommended antibiotics.

Arranging local depot holders for ORS etc. for emergency purpose.

Age group (years)

No. of cases % (n=114) Male Female

0-4 9 9 15.8 5-14 14 20 29.8 15-24 9 14 20.2 25-34 8 8 14.0 35-44 2 8 8.8 45-59 4 2 5.3 60+ 5 2 6.1

Total 51 63 - % 44.7 55.3 100


21

Good practices in Integrated Disease Surveillance Project (IDSP): Hooghly, 2012 Dr.S.Banerjee1; Dr. Subhasis Saha2; Dr M K Biswas3; Mamun Islam4; Kaushik Sen5,

1DSO, 2BMOH, Polba, 3Epidemiologist, 4Data Manager, 5Data Entry Operator; Hooghly.

Introduction:

IDSP has been operational in Hooghly District since 2006. The main goal of the project is to detect

Early Warning Signals of outbreaks, and to achieve this goal, we need to analyze data at the grass

root level.

Methodology:

From the 1st day of IDSP in our district, our main aim is to motivate the Medical Officers & grass root

staff for the project. So, we have attended the monthly Block MIES Meetings and started phase-wise

training of MO/MPW/Pharmacist/LT/DEO/private lab etc.

Result :

We are presently getting analysis reports on IDSP data from 11 out of 18 blocks on a regular basis.

BMOHs & DEOs of those blocks have become involved in the analysis, as they can now easily detect

Early Warning Signals at their own level.

Sample Analysis :

Year-wise comparison of different symptom groups, Polba Block, 2010 to 2012

9425

3535

430

5971

1071

7

3611

346

6146

9146

3935

300

5982

0

2000

4000

6000

8000

10000

12000

Only Fever Cough with or without fever <2

weeks

With some / much Dehydration

With no Dehydration

2010 2011 2012


22

Recommendation:

1. IDSP Training is highly recommended for the ASHA-s.

2. State Surveillance Unit & Central Surveillance Unit may please consider only IDSP portal data

for smooth running of the program.

High Risk Sub centers for Fever cases, Polba Block, 2011

71

130

82

359

410

147

277

355

149

182

377

256

188

228

168

97108

5350

100

150

200

250

300

350

400

450

2010 2011 2012

POWNAN SULTANGACHA DUBIRVERI KAMDEVPUR HANRAL ESTA


23

A brief epidemiological study on AES/Meningitis: Uttar Dinajpur, 2012 Dr. P. C. Bag1, Neel Kamal2, Tuhin Chatterjee3

1Dy. CMOH-II, 2Epidemiologist, 3District Data Manager; Uttar Dinajpur.

Introduction:

Uttar Dinajpur is among the least developed districts of West Bengal. The sex ratio is 918 female per

1000 male and the population density is 956 per sq km (Census 2011). The District is surrounded by

Bihar in West, Darjeeling in North, Bangladesh & Dakshin Dinajpur in East and Malda District in

South. The literacy rate and health care facilities are less compared to the rest of the districts of the

state. Most of the population resides in rural area and predominant occupation is agriculture.

Objective:

To evaluate the current situation of suspected cases of AES & Meningitis in the district.

Method:

Cases, based on provisional diagnosis, were found from Raiganj District Hospital & Islampur Sub-

Divisional Hospital through weekly IDSP P-form reports in the year of 2012. We line listed all such

cases in Excel sheet and analyzed.

Case definition

Acute Encephalitis Syndrome:

A person of any age with acute onset of fever and any of the following:

Change in mental status (confusion, disorientation, coma, inability to talk)

New onset of seizures (excluding simple febrile seizure).

Other early clinical findings like an increase in irritability, somnolence or abnormal behavior

greater than that seen with usual febrile illness.

Viral Meningitis:

A case with fever > 38.5°C and one or more of the following:

Neck stiffness, severe unexplained headache, neck pain and 2 or more of the following -

Photophobia, nausea, vomiting, abdominal pain, pharyngitis with exudates

For children <2 years of age, a case is defined as a child with fever > 38.5°C and irritability or bulging

fontanelle.

Descriptive epidemiology:

We analyzed the data of N= 138 for block-wise distribution of cases, deaths & fatality rate of

AES/Meningitis.

34

7

22

8

19

3 3

27

12

3

10

1 4

2

7

0 0

4 2 1

29.41

14.29

18.18

25.00

36.84

0.00 0.00

14.81 16.67

33.33

0

5

10

15

20

25

30

35

40

Raiganj Kaliyaganj Itahar Hemtabad Karandighi Lodhan Chakulia Islampur Chopra Unknown

Cases

Deaths

Fatality Rate(%)


24

Distribution of cases by gender & age group was as follows.

Discussion:

The results show that more number of suspected cases were reported from peri-urban areas i.e.

Raiganj & Islampur Blocks where one District & one Sub-district Hospital are located respectively.

Karandighi has the highest rate of case fatality(36.8%)among all the blocks in the district due to AES

& Meningitis. The incidence is found to be highest among male children less than 6 years.

Conclusion:

Although the data reflects that good number of cases was reported in 2012 in this district but due to

the lack of proper coordination and sensitization among health care providers in terms of specimen

collection (CSF & Serum), only 1 CSF sample and serum were tested for JE which were found to be

negative. Hence, surveillance needs to be strengthened in this district particularly JE screening

mechanism to identify the causative organism.

39.86%

60.14% Female

Male

N= 138

(Count)

Incidence of AES/Meningitis per lakh population, Uttar Dinajpur District, 2012

Uttar Dinajpur 4.59

Males 5.35

Females 3.79

Children 0-6 years 12.76

Males 0-6 years 15.31

Females 0-6 years 10.06

>6 years 12.76

17.39%

21.74%

10.87% 15.94%

34.06% 0-1

2-5

6-9

10-15

>15

Age wise distribution Age groups

Gender wise distribution


25

Multiple causative agents resulting in a fever outbreak in Dakshin Dinajpur: 2012. Dr.Gaurab Roy1; Uttam Kumar Ghosh2

1Dy.CMOH-II, 2Data Manager; Dakshin Dinajpur.

Background:

Occurrence of AES & influenza are common in North Bengal districts like Dakshin Dinajpur and Uttar

Dinajpur. Occasionally malaria, dengue & chikungunya are reported sporadically. Outbreaks are

usually not reported and not investigated.

Observations:

Clusters of fever cases were found in Kumarganj and Khaspur blocks in August, 2012.

i) On 25th Aug-2012 two children from Narayanpur & Chakjayanti Villages were found to suffer from

high fever, headache, convulsion & loss of sensorium. Both were admitted to the District Hospital

(DH). Several villagers from Narayanpur, Munglishpur, Madhavpur suffered from fever, malaise,

anorexia, weakness and were admitted to Kumarganj BPHC & DH.

ii) From 26th August to 25th September 2012, a total of 380 cases from Narayanpur, Munglishpur,

Madhavpur, Laxmankuri, Pirojpur, Kuchila, Kamarara, Latmirajpur, Gobindapur and Tiroil suffered

from fever, malaise, anorexia, weakness. 37 of them were admitted to Kumarganj BPHC & DH and 12

cases were referred to North Bengal Medical College. Seven cases died in the incident.

Block-wise distribution of cases & deaths by age group and gender is shown in the tables.

Lab Investigation:

Serum samples of 208 cases were tested in DH & North Bengal Medical College. 8 cases were found

positive for dengue, 2 for chikungunya and 3 for JE, all by MAC ELISA.

Table 1 : Age and Sex wise distribution of cases of nine villages, Kumarganj Block, Aug-2012

Age group

(years)

Male Female Total Admission in

DH & BPHC

Referral to

Higher Unit

Death

0- <5 years 35 34 69 6 2 0

5-<15 years 52 55 107 7 3 2

15 years & > 104 98 202 22 5 3

Total 191 187 378 35 10 5

Total Population= 8012 AR= 4.7% CFR= 1.32%


26

Table 2 :Age and Sex wise distribution of cases of two villages of Khaspur Block, Aug 2012

Age group (years) Male Female Total Admission in

DH & BPHC

Refer to

Higher Unit

Death

0-5 Years 0 0 0 0 0 0

5-15 Years 2 0 2 2 2 2

>15 Years 0 0 0 0 0 0

Total 2 0 2 2 2 2

Total Population= 1600 AR= 0.125% CFR= 100%

Control measures:

Local health authorities initiated the control measures. The affected areas were visited by ASHAs,

ANMs, Health Supervisor, PHN, BPHN, MO and BMOH. Important control measures included

symptomatic treatment, lab investigation, health education and strengthened fever surveillance.

Further measures involved epidemiological investigation by a team of faculties from Malda Medical

College, visit by an entomological team from ICMR (Madurai) and focal IRS with DDT.

Conclusion:

It was a mixed outbreak of enchephalitis, Dengue & Chikungunya, also with suspected Influenza.

Recommendations:

a) Block RRT should be more alert.

b) Fever surveillance is to be improved.

c) Filling up of crucial vacant posts (MI, MT etc.).

d) Introduction of JE vaccine in routine immunization.


27

Comprehensive action to control a dengue outbreak in Paschim Medinipur,

2012

Dr. Pralay Acharya1, Anshuman Ghosh2, Priyadarshi Ghosh3

1 Dy CMOH-II, 2 Data Manager, 3 Data Entry Operator; Paschim Medinipur.

Background: The latter half of 2012 witnessed a massive dengue outbreak in Kolkata and its

adjoining areas in West Bengal. The outbreak hit West Midnapore almost at the same time

(31/08/2012) with the first case being reported from Kalgang village, GP no. 4, Midnapore Sadar

Block. Within the next few days 7 more cases were reported (5 from Kalgang village and 2 from ward

no 11, Midnapore Municipality) with one death (date of death- 03/09/2012). Actions were initiated

to control the outbreak at its source. A brief report is documented here.

Population at risk: Midnapore Municipality – 6224, Kalgang Village – 1132; i.e. 7356 in total.

Definition for suspected (clinical) cases of Dengue Fever: An acute febrile illness of 2-7 days

duration with 2 or more of the following – Headache, Retro-orbital pain, Myalgia, Arthralgia, Rash,

Haemorrhagic manifestation, Leucopoenia . This definition was followed in active search for cases.

Suspected cases were confirmed by: Either (a) NS1 Antigen ELISA Test (in case of 2-4 days duration

of fever) or (b) MAC ELISA IgM Test (in case of fever for 5 days or more). These tests were available

in the Referral Lab (IDSP) of Midnapore Medical Coillege.

Control measures taken: House to house survey was done for fever cases in 50 houses surrounding

each dengue case. For the purpose a two member team was engaged. They also searched for

breeding places of the vector and destroyed the sources during the survey. The plan was that if a

single suspected dengue case was found, surveying another 50 surrounding houses will be done.

Pyrethrum space spray and malathion fogging were done in the affected areas.

Awareness Generation: The most effective way to reduce dengue burden is mass awareness. Hence

steps were taken to create mass awareness on Dengue & its prevention by insertions in local daily

newspaper. Posters & leaflets, audio-visual spots in local cable channels and mike publicity were

also used as IEC methods.

In short, IEC mainly focused on symptoms of dengue, blood testing facilities, home-based patient

care & preventive measures to be taken with “Do’s & Don’ts”.


28

Sensitization: Sensitization of MOs, Rural Local Practitioners, Private Doctors and Doctors of

Midnapore Medical College was done in collaboration with Indian Medical Association with a focus

on diagnostics and proper case management.

Treatment facility: Treatment for the IgM reactive cases was arranged in Midnapore Medical College

& Hospital. Only one case had to be referred to a higher centre. All medicines and diagnostics were

made available free of cost for the convenience of the common people.

Figure 1: Showing Day wise dengue trend for the situation analysis

Conclusion: Prompt and focused actions helped to control the dengue outbreak within 3 weeks

without any further spread.

1

2

0

2

0

1

0

1

0 0

1

2

3

No

of

case

s

Date

Day wise trend of Dengue


29

Practices to improve IDSP reporting in North 24-Parganas Dr. B.K.Pal1; Dr. S.Mitra (Choudhury)2; Tanbir Hussain3; Shiladitya Halder 1Dy CMOH-II, 2Epidemiologist, 3Data Manager, 4Data Entry Operator; North 24 Parganas.

Introduction: Many people think of surveillance as particularly concerning the control of

communicable diseases, and historically this was its original purpose. Perhaps the earliest recorded

use of surveillance was in 1348 when the public health authorities in Venice boarded arriving ships

to see if anyone on board had Plague, and if so, to prevent them from leaving the ship.

William Farr who is the father of modern surveillance, collected, analyzed and interpreted data on

vital statistics and disseminated the information in regular reports and in papers submitted to

medical journals.

A key use of surveillance is to identify an outbreak of disease at an early stage, so that measures can

be taken to prevent its spread.

More recently, the technique of surveillance has also been used in the control of non-communicable

diseases such as cancer, atherosclerosis and other health problems such as injecting drug use and

injuries caused by motor vehicles, and also exposures such as environmental hazards or specific

behaviours.

Surveillance has been defined as: “The ongoing systematic collection, analysis and interpretation of

health data essential to the planning, implementation and evaluation of public health practices,

closely integrated with the timely dissemination of these data to those who need to know. The final

link in the surveillance chain is the application of these data to prevention and control. A surveillance

system includes a functional capacity for data collection, analysis and dissemination linked to public

health programmes.”

Methodology: IDSP REPORTING STATUS 2012

95% of the sub centre (total units -742) reports regularly in “S” form. 84% of the Presumptive

reporting units (total units-85) report regularly in “P” forms. 87% of the Laboratory reporting units

(total units-41) report regularly in “L” forms. Our target is to achieve 100% reporting within 2013.

All the reporting scenario of IDSP discussed above is shown below.

Comparison of sub-centre and P Form reporting in last 3 years (2010, 2011, 2012)

Status of S Form reporting last three

years

0

200

400

600

800

1 5 9 13 17 21 25 29 33 37 41 45 49

No of Weeks

No

of

S/C

2010

2011

2012

Target

Status of 'P' Form reporting last three years

0

20

40

60

80

100

1 5 9 13 17 21 25 29 33 37 41 45 49

No of Weeks

No

of r

ep

ortin

g u

nit

2010

2011

2012

Target


30

Comparison of ‘L’ Form reporting in last 3 Years Outbreak Investigation of North 24 Pgs

Supervision, monitoring and Evaluation

All reporting units are regularly visited and if any discrepancies noticed, on the spot clarifications

given.

We have made three different checklists for three different reporting units such as Subcentre,

Primary Health Centre and hospitals.

Status of Data Analysis and Feedback

• District Surveillance Unit (IDSP) of North 24 Parganas analyzes data of IDSP Weekly.

• After analyzing the data, DSU gives its feedback to the concerned authority.

• The analyzed data is used to identify epidemic alert.

• If any discrepancy has noticed, query to head of the concerned unit and action taken as early

as possible.

• Outbreak Response: According to the magnitude of the outbreak District RRT moves

immediately and initiates intervention.

Operational Constraints

• North 24 Parganas is the 2nd Largest District in India with a huge population of 10,082,852.

• It consists of 5 subdivisions, 22 blocks and 28 municipalities which make it hard to cater all

the areas.

• ‘P’ Report: not generated as per Tally sheet from OPD due to 70% newly appointed medical

officers who are not IDSP trained and few of them are not motivated.

• Failure of internet connection in some blocks often causes poor online reporting.

In order to be effective, a surveillance system must be practical, uniform and rapid.

Status of 'L' Form reporting last three years

0

5

10

15

20

25

30

35

40

45

1 5 9 13 17 21 25 29 33 37 41 45 49

No of Weeks

No

of

rep

ort

ing

un

its 2010

2011

2012

Target

Out Break Response 2010 2011 2012No. of outbreak reported 14 7 10

No. of outbreak investigated 14 7 10

No. of sample collected and send to Lab.

for confirmation8 3 8

Lab Confirmation (Y/N) Y Y Y


31

Status of weekly reporting in IDSP portal: Kolkata Municipal Corporation Dr. Basudeb Mukhopadhyay1, Joydeep Roy2

1Municipal Surveillance Officer, 2Data Manager; KMC.

Performance in IDSP portal at a glance(upto week 10):

P F

orm

su

bm

issi

on

sta

tus

of

20

13

1. All the Dispensaries of KMC are reporting ≥ 80% of time.

2. All the Private setups are reporting ≥ 80% of time.

3. All of the Govt. setups are reporting ≥ 80% of time.

L Fo

rm s

ub

mis

sio

n s

tatu

s o

f 2

01

3

1. Total reporting units (RUs) are 218, i.e. highest no. of RUs among all districts of W.B.

2. All RUs reported ≥ 80% of time.

3. All Govt. setups reported ≥ 80% of time.

4. Among Privates Labs. Total no. of RUs are 65, i.e. highest no. of RUs among all districts of W.B. More than 92.3% RUs reported ≥ 80% of time.

S Fo

rm s

ub

mis

sio

n s

tatu

s o

f 2

013

1. More than 97.3% of RUs are

reporting ≥ 80% of time.


32

Initiatives taken by KMC

Reports received by e- mail, fax, messenger.

An appeal was made to all private set-ups to share information earlier.

Municipal Commissioner issued a letter mentioning Section 471 of KMC Act 1980 wherein

information on infectious diseases is to be given to KMC.

If there is delay in reporting from any unit, the staff of IDSP contacts over telephone or

personally visits to the reporting unit.

Benefits of Surveillance

After receiving the line list of cases, verification of address is done at ward level.

Appropriate action is taken from the basis of verification report.

As an outcome, KMC has been able to set-up a database of various diseases and take proper

action for those diseases.


33

Contribution of District Priority Lab in the dengue outbreak in Mushidabad: 2012

Dr. Bhaskar Baisnab1; Syed Towfique Rahaman2; Rupa Kundu3

1ACMOH, (Kandi) 2Data Manager, 3Microbiologist,(Dist. Priority Lab); Murshidabad.

Introduction:

Murshidabad is a highly populated district having 22 blocks (2210 villages) and 9 towns.

Area of the district is 5324 sq kms and Census population (2011) is 71,02,430, (Male-

36,29,595 and Female-34,72,835).

In 2012 when the whole state is going through a severe outbreak of Dengue, this district has

also faced the same situation.

Laboratory Findings:

District Priority Laboratory (DPL) under IDSP in District Hospital, Murshidabad has started

Dengue ELISA testing (IgM ELISA &NSI ELISA test).

NS1 ELISA - for patients having fever for less than five days and IgM ELISA - for patients

having fever for five days or more (from the onset of fever).

The total no. of test done during Aug ’12 to Dec’12 was 595 out of which 145 were reactive.

The monthly data of Dengue testing is given below:

AUG'12 SEP'12 OCT'12 NOV'12 Total

Total No. of IgM ELISA Test 5 92 138 20 255

Total No. of IgM Reactive cases 4 37 40 8 89

Total No. of NS1 ELISA Test 0 143 101 96 340

Total No. of NS1 Reactive Cases 0 22 16 18 56

Descriptive Epidemiology:

Out of 595 dengue suspected cases 338 (71%) were male and 118 (29%)were female.

In both male & female, the maximum no. of dengue suspected cases occurred between

15-29 yrs of age (Male-130 & Female-56, so a total of 186 out of 595 i.e. 31.3%).

Similarly, the minimum no. of dengue suspected cases occurs at 60 yrs of age & above

(Male-13 & Female- 9, so a total of 22 out of 595 i.e. only 3.7%).

0

20

40

60

80

100

120

140

AUG'12 SEP'12 OCT'12 NOV'12

TOTAL No. OF IgM ELISA TESTED TOTAL No. OF POSITIVE CASES

0

50

100

150

AUG'12 SEP'12 OCT'12 NOV'12

TOTAL No. OF NSI ELISA TESTED TOTAL No. POSITIVE CASES


34

Distribution of suspected dengue cases by age

group and sex:

Block-wise map is given below:

Maximun no. of dengue suspected cases has been reported from Beharampur Block,

Berhampur Municipal Area and from a few of its surrounding blocks as shown below.

0

20

40

60

80

100

120

140

160

180

200

Male

Female

Total

0

5

10

15

20

25

30

35

40

45

50

No

of

case

s re

po

rte

d Suspected Dengue cases by blocks, Murshidabad, 2012


35

Tools for evaluation of IDSP reporting units: South 24 Parganas, 2012

Dr.D.Halder1; Niladri Sekhar Karmakar2; Moumita Chakrabarty3 1Ex-Dy.CMOH-II, 2 Data Manager, 3 Epidemiologist; South 24-Parganas.

INTRODUCTION: It has been felt by the Public Health Managers of the district that a tool for evaluation of the IDSP

program at the grass root level is essential. Based on this, we thought of developing a format

through which the Data Manager can evaluate the program as well as cross check the data.

OBJECTIVES:

• Development and testing of format for evaluation

• Evaluation by indicators

• Review at the district level with the help of indicators

• Rectification

METHODOLOGY: A format has been developed and the Data Manager (IDSP) visited 08 BPHC-s, 12 PHC-s and 8 Sub-

centres of South 24-Parganas District in 6 months. He cross checked data, assessed logistics,

evaluated program and identified gaps (if any).

RESULT: P register was in vogue in the district. We found that, not a single P register (n=20) was filled up by

the Medical Officers. Pharmacists filled up 80% and 20% were filled up by some other staff. Only

35% (7/20) BPHC & PHCs sent weekly reports within Wednesday to the District.

39% (11/28) BPHC, PHC & SC maintained completeness of reports. Data sent from different units to

the higher units matched in 71% case. Regarding logistics we found that P register and P forms were

not in stock in 60% of reporting units (n=20) and printed S forms were not in stock in 75% of

Subcentres.

CONCLUSION: Poor response from Medical Officers has to be taken care of by providing quality training. Timeliness

& completeness of weekly reporting and data quality were very poor which has to be corrected by

discussion with the Block Level Managers. Timely placement of indent for logistics followed by

supply from the district level is to be ensured. From the experience of administering the format we

concluded that this small but useful tool may be used to evaluate important aspects of the Program.


36

FORMAT FOR EVALUATION OF IDSP PROGRAM TO BE USED BY DATA MANAGER DURING THEIR VISIT

Name of the Data Manager

Date of Visit

Place of Visit

Name of the Head of Office

Contact No.

1 P Register Filled By MO Pharmacist Other

2 P Form Complete Incomplete

3 P Form Sent to Higher Centre Wednesday After Wednesday

4 Compare Report of P Form with District Report Matched Not Matched

5 L Register Maintained Not Maintained

6 L Form Sent to Higher Centre By Wednesday After Wednesday

7 Compare Report of L Form with District Report Matched Not Matched

8 S Register Maintained Not Maintained

9 S Form Sent to Higher Centre Wednesday After Wednesday

10 Compare Report of S Form with District Report Matched Not Matched

11 P Register In Stock Not In Stock

12 P Form In Stock Not In Stock

13 L Register In Stock Not In Stock

14 L Form In Stock Not In Stock

15 S Register In Stock Not In Stock

16 S Form In Stock Not In Stock


37

Specific action plan reduced malaria & diarrhoea in endemic blocks: Bankura, 2012 Dr.Debasish Roy1; Barnali Majumdar2; Ripan Midya3 1Dy.CMOH-II, 2Epidemiologist,3Data Manager; Bankura.

INTRODUCTION: Integrated Disease Surveillance Project (IDSP) aims to reduce the disease mortality and burden

through continuous scrutiny and to initiate an effective response in timely manner through early

detection of the disease trend and outbreaks. An effort has been initiated from the DSU of Bankura

to plan actions to reduce the prevalent diseases like Malaria and Diarrhoea in the endemic blocks of

Bankura.

Action Taken:

1. Involvement of the Govt., Non-govt. bodies and NGO s to make the project successful.

2. Improvement of IDSP weekly reporting system to maintain timeliness and consistency.

3. Monitoring and analysis of the weekly reports to detect and control outbreak.

4. Prompt biological sample collection as a part of outbreak investigation and implementation

of control measures.

5. Imparting training to sensitize the health personnel at different levels.

RESULTS:

The reporting status (in P, L, S forms) has been improved and for the last three years (2010-

12).Overall it has been remained above 84%. The timeliness and consistency of the surveillance

status in Bankura, Bishnupur, Khatra, Medical College (BSMCH), SDH (Khatra & Bishnupur), Private

Nursing Homes and Private Laboratories have been maintained to be 100%. Regular training has

been done to sensitize the health personnel of different levels.

Performance in IDSP Training in 2011-12 & 2012-13

In Ranibandh, the highly endemic block for malaria, the number of malaria cases has been reported

to be less in comparison to the last year. The peak of disease occurrence has been found to be

between Week 33 and 35 i.e. in the post monsoon period. This might have been possible due to

regular monitoring and proper implementations of the control measures like spray, etc. [See graph

below]

A decline in incidence of Acute Diarrhoeal Diseases (ADD) has been observed in the district from

2011 to 2012. Regular surveillance has been maintained and disinfection of water sources has been

done immediately when required, that helped in reduction of cases in 2012.

Period

MO MT BPHN & PHN DEO

In Position Trained In Position Trained In Position Trained Trained

Apr-2011 to

Mar-2012 210 68 51 32 38 19 40

Apr-2012 to

Feb-2013 15 17


38

Malaria Cases

0

20

40

60

80

100

120

22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52

Period or Week

No

. o

f C

ases

2011

2012

No. of lab confirmed malaria cases reported by weeks, Ranibandh Block, 2011 & 2012

Care has been taken in reporting

outbreaks. 12 outbreaks have

occurred in the district in 2012. The

diseases which comprised of

Mumps (1), ADD (9) and Food

Poisoning (2). During the outbreaks the Block RRT and the District RRT have been actively involved.

IEC has been done on maintenance of proper sanitation and hygiene. In ADD & Food Poisoning

outbreaks, samples of water, food and stools have been tested in Referral Labs to identify the

disease aetiology. Out of the 9 ADD outbreaks, Vibrio cholerae has been found in 6 outbreaks and

E.coli in 2. Both V. cholera and E. coli have been isolated in 3 outbreaks. A total of 850 cases have

been reported in the ADD outbreaks in 2012. There have been 2 deaths (Case Fatality Rate 0.2%).

CONCLUSION:

IDSP has been playing an important role in the disease surveillance. Careful analysis of the weekly

reports has been helping in identifying the disease status up to the block level. Regular monitoring of

the report can generate the early warning signal of an outbreak. One should feel the pulse and take

prompt action to control outbreak.

Our effort has been directed to identify the endemic blocks for Malaria & ADD and to plan actions

for reducing disease burden and controlling outbreaks. However 11 deaths in malaria in 2012

(highest after 2008) have indicated the loop holes in the control programme. Such lacunae should

be identified to make our system more robust, which will help in the improvement of the disease

status throughout the district in future.

Disinfection of tube well, pond and well in the district, 2012

District Tube well Pond Well Remarks

Bankura 1800 160 468 Disinfection done


39

Programme evaluation of IDSP using a logframe approach: Cooch Behar, 2012

Dr. Jagannath Sarkar1, Tapan Sarkar2

1Deputy CMOH-II, 2 Data Manager; Cooch Behar.

Background: Integrated Disease Surveillance Project (IDSP) was started in the district in 2007. After

about 5 years of functioning, we took an initiative to evaluate the project. We compared the

different indicators for the year 2011 and 2012 with an objective to assess the progress (if any) of

IDSP in the different parameters over these years.

Method: Collection of surveillance data, compilation and regular & timely reporting is a mainstay of

IDSP. Availability of manpower and capacity building of the available personnel through training &

supervision are important for the success of the Project. We made the evaluation by the three main

arm indicators e.g. involvement of the staff, status of their training and status of the routine

reporting (completeness, timeliness and consistency of reporting).

Observation: In Cooch Behar there are 47-health facilities (PHC to District Hospitals), 56 microscopic

centers and 406 sub-centers. There was some improvement in manpower position in the health

facilities over the years from 2011 to 2012. Such changes in terms of Medical Officers, Laboratory

Technicians, Pharmacists, Indoor Nurses and Health Supervisors, Health Assistants (Male) and ANMs

are shown in the table below.

40% of health facilities were able to utilize IDSP funds during the financial year 2010-11, whereas in

2011-12 the proportion of such facilities rose up to 90%. Capacity building of the personnel might

have been an important factor behind this. The interval between weekly data collection and

transmission decreased from 1-3 days (median 2 days) in 2011 to 1-2 days (median 1 day) in 2012.

District health officials supervised 61 of 407 sub centers (15%) once in a year. Medical Officers

supervised 115 of 406 sub centers (28%) once in every quarter and Health Supervisors/ PHN/ BPHN

supervised 208 of 406 sub centers (51%) once in a month in 2011. In 2012, these figures respectively

increased to 37% (151 of 407 sub centers), 58% (235 of 406 sub centers) and 81% (329 of 406 sub

centers).

In the output side, completeness & timeliness of weekly reporting have also improved to some

extent in 2012, as compared to the previous year. Unit-wise consistency of reporting has also

improved. The details are given in the table (see next page).

That mortality due to malaria and diarrhea has declined in the district, might owe in part to

improvement in surveillance.

Recommendations:

Based on the study results, we recommend for

1) Filling up of vacancies of health staff as much as possible.

2) Staff training to be completed.

3) Manage to further increase supervision and monitoring activity by officials & supervisors.


40

Selected indicators of IDSP in Cooch Behar : Comparison for the years 2011 and 2012

2011 2012 2011 2012 Gain%

Indicators n/N n/N % %

Input HA /HS & ANM in position 1074/1484 1134/1484 72 76 4

Laboratory technician in position 46/54 45/54 85 83 -2

Medical officer in position 190/277 237/277 68 85 17

Pharmacist position 57/62 57/62 91 91 0

Indoor Nurse 579/664 632/664 87 95 8

Reporting Format available in blocks adequate adequate 100 100 0

HA /HS & ANM trained 557/1074 896/1134 52 79 17

Laboratory technician trained 32/46 42/45 70 93 23

Medical officer trained 67/190 205/237 35 86 49

Pharmacist trained 51/57 55/57 89 99 7

Process

Indoor Nurse 311/579 518/632 53 81 18

Sub center visited by DSO 61/406 151 /406 15 37 +22

SC visited by other IDSP Staff 10/406 25 /406 2 6 +4

% facility sent reports in quality and

quantity 85 95 +10

IDSP review held at district level Monthly Monthly 0

Median interval between weekly

data collection & sending +- 2 +- 1 1

Output

HA of SC fulfilling target of sending

reports 70% 85% 15%

Health facility sent reports in ‘P’ form 88 93 5

Facility sent report in ‘L’ form 100 100 0

Reports sent full and in time 81 87 6

Outcome

Consistency of sending reports S-67,P-82,

L-98

S-89,P-97,L-100 S-22,P-15,

L-2

Gain in parameters of programme 2011 2012

Malaria Cases=251187, Death=03 Case= 209083,Death=0

Diarrhea Cases=167077 ,Death=05 Case=163347, Death=0


41

A study on epidemiology of lab-confirmed dengue cases in West Bengal, 2012

Palash Mondal1, Dr. Surajita Banerjee2, Dr. Debjit Chakroborty3, Shubhashish Roy4, Dr. Prasanta Biswas5

1 State Microbiologist, 2State Entomologist, 3State Epidemiologist, 4State Data Manager, 5Asst. Malariologist, WB.

Introduction: The dengue viruses, a group of four closely related viruses, are transmitted to humans

through the bite of an infected mosquito (Aedes aegypti, the primary vector). Once infected the

mosquito remains infected for life, transmitting the virus to susceptible individuals during feeding.

They cause a disease known as dengue fever, but they can also cause a more severe form of illness

known as dengue hemorrhagic fever, which potentially can be fatal. The incidence of both forms of

the disease has been increasing dramatically in recent years. Dengue viruses belong to the genus

flavivirus within the Flaviviridae family, having four serotypes DENV-1-4. Annually, dengue virus is

responsible for up to 100 million cases of dengue fever and more than 500,000 cases of dengue

hemorrhagic fever.

Dengue fever is characterized by high fever (duration: 2-7 day), severe headache, pain behind the

eyes (retro-orbital pain), joint & bone pain, rash, myalgia, leucopenia and mild bleeding. In addition

to these symptoms, the more severe form of the disease can lead to breathing difficulty, severe

bleeding, shock, and possibly death (however, when recognized early and treated by maintaining

body fluid volumes, mortality rates can be reduced to less than 1%).

Dengue infection occurs predominantly in tropical & subtropical climates around the world, mostly

in urban & semi-urban areas, and usually during the rainy season – the time when these regions are

inhabited by large numbers of the particular type of mosquitoes that carry the virus.

In the year 2012, there was a Dengue epidemic since the Month of August in the state of West

Bengal. 6456 dengue reactive cases were line-listed along with 11 deaths in 2012.

Objective: Early detection of Dengue by ELISA technique in both Govt. & Private Institutions for

identification of dengue as well as prompt reporting.

Method: Serological assays are most commonly used for diagnosis of dengue infection as they are

relatively inexpensive & easy to perform compared with other cultures or nucleic acid-based

methods.

a) MAC-ELISA: Dengue-specific IgM in the test serum is detected by first capturing all IgM

using human-specific IgM bound to a solid phase. The assay uses a mixture of four dengue

antigens (usually derived from dengue virus-infected cell culture supernatants or infected

suckling mouse brain preparations). Compared to the Haemagglutination Inhibition Assay as

the gold standard, MAC-ELISA shows a sensitivity and specificity of 90% and 98%

respectively, in samples collected after 5 days of fever. False-positive results, due to dengue-

specific IgG and cross-reactivity with other Flaviviruses, is a limitation of the MAC-ELISA.

b) NS1-ELISA: NS1 is a glycoprotein produced by all Flaviviruses and is essential for viral

replication and viability. Because this protein is secreted into the bloodstream, many tests

have been developed to diagnose DENV infections using NS1. These tests include NS1-

antigen-capture ELISA, lateral flow antigen detection and can be found in the samples

http://www.bcm.edu/molvir/index.cfm?pmid=16524#Virus

http://www.bcm.edu/molvir/index.cfm?pmid=16524#mortality


42

collected before 5 days of fever. NS1 antigen detection kits are now commercially available.

As yet, these kits do not differentiate between the different DENV serotypes.

Initially in our State (both Govt. & Pvt. Institutions), dengue detections were done by Dengue IgM

ELISA (MAC-ELISA) technique. But after the onset of dengue epidemic in West Bengal, Dengue NS1-

ELISA technique has been taken as another ELISA technique for dengue detection (approved by the

Govt. of India). In this event, forty institutions (Both Govt. and Pvt.) have participated in daily dengue

reporting at our end (State Surveillance Unit-SSU).

Result & observation: In the year 2012,

approximately twenty five thousand serum and

a few CSF samples were tested for Dengue

ELISA, out of which 6456 were Dengue reactive

(positivity rate = approx. 26%). Most of these

cases (6420) were detected during the dengue

epidemic in the state. Initially in the month of

Aug, 12 dengue positivity rate of the state was

14.4% but in the month of Oct, 12 it raises upto

31.2% and finally it came down to 24.9%, in the

month of Dec, 12.

Fig: Month-wise Positivity rate of Dengue, WB,

2012

Discussion: Out of 6456 reactive cases

3929 were male (60.86%) and 2527 were

female (39.14%). The maximum no. of

dengue reactive cases came under 15-<35

years age group, followed by 5-<15, 35-

<55, 55> & 0-<5 years age group. The no.

of sero-positives were more in male than

in female irrespective of the age group, as

shown in the table.

Table- Age & sex wise distribution of

dengue reactive cases in WB (2012)

Future plan of work: From laboratory investigation point of view, we have some information in the

form of line lists regarding dengue reactive patients and data capture has improved than the

previous years, though the clinical information of the patients are still lacking. So, it’s not possible to

identify from the data base the type of dengue i.e. whether the detected dengue belongs to 1)

Classical Dengue, 2) Dengue Haemorrhagic Fever (DHF) or 3) Dengue Shock Syndrome (DSS). Dengue

IgM-ELISA or Dengue NS1-ELISA does not reveal this. At the same time, we also cannot interpret

which serotype the detected dengue belongs to. So, arrangements for molecular biological

investigations are felt to be necessary for sero-typical classification of Dengue virus prevailing in the

state.

Age M (%) F (%) TOTAL

0-<5 224 58.0 162 42.0 386

5-<15 795 59.6 538 40.4 1333

15-<35 1894 62.9 1119 37.1 3013

35-<55 746 58.7 526 41.3 1272

55> 270 59.7 182 40.3 452

TOTAL 3929 60.9 2527 39.1 6456

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

Aug Sep Oct Nov Dec

Positivity rate


43

Evaluation of surveillance system for AES & JE in West Bengal, 2012 Dr. Debjit Chakraborty1; Shubhashish Roy2; Dr.Dipankar Maji3

1 State Epidemiologist, 2 State Data Manager, 3 State Nodal Officer; West Bengal.

OBJECTIVE: To assess the AES & JE surveillance system in terms of certain key indicators. METHODOLOGY: Review of records, analysis of data. RESULTS:

Acceptability

Table 1: Participation of Districts i.e. Districts submitted line list in 2011 & 2012

2011 2012

# districts which submitted AES line list 2 (Jalpaiguri, Nadia) 17

# districts which did not submit AES line list 17 2 (N24Pgs, S24Pgs)

% of districts that submitted AES line list 10.5 % 89.5 %

Only two (10.5%) districts participated in the AES surveillance in 2011 by submitting the line lists of

AES cases admitted in the facilities of the respective districts. But in 2012, 15 more districts started

sending line lists to State Surveillance Unit (SSU).

Table 2: Overall consistency of reporting in P form (consistent = reported in 52 weeks) in 2012

number of reporting units number of consistent reporting units % of consistency

W.Bengal 2183 127 5.8

Overall consistency of reporting in P form is very poor in the state. Status in Burdwan and Uttar

Dinajpur remained to be the worst (0% consistency).

Simplicity

Table 3: Overall % of completeness of line list in 2012

number of cases reported in line list number of completed line list % of completeness

DSU* 719 583 81.08

Labs 1107 999 90.24

* DSU = District Surveillance Unit

In 2012, most (10) of the DSUs achieved 100% or near 100% ( > 90%) completeness of line list.

However, three DSUs (Burdwan, Purba Medinipur and Paschim Medinipur) performed poorly in this

respect. Overall completeness percentage was just higher than 80%.. Burdwan Medical College

maintained 100% completeness. Overall completeness for Labs was just above 90%.


44

Representativeness

Fig 1: District-wise proportion of tested AES cases out of all tested AES cases, 2012

Jalpaiguri, Burdwan and D. Dinajpur contributed to a major proportion of lab tested AES cases of the

state. Districts in the western part of the state like Purba Medinipur, Paschim Medinipur, Purulia etc

were found to have a very low contribution. These findings suggest that lab testing of AES cases has

been concentrated in districts having a JE screening lab in geographical proximity.

Fig 2: District-wise comparison of lab tested AES out of reported AES in 2012

In 2012, Jalpaiguri, Dakshin Dinajpur, Coochbehar and Nadia were the districts having around 50 -

70% testing performance which suggests that those districts also reported a considerable number of

untested AES cases in addition to those reported by the labs. Districts like N24 Pgs and S24 Pgs have

not submitted line list in 2012 and these were the only two districts showing 100% of cases tested. It

clearly indicated that only tested cases of those districts were reported from different labs and no

additional AES case was reported by DSU itself. Districts like Uttar Dinajpur, Darjeeling, Purulia etc

exhibited a very poor JE screening performance.

Burdwan 18%

Rest of the Burdwan divison

13%

Jalpaiguri 23%

D.Dinajpur 13%

Rest of the Jalpaiguri divison

8%

Howrah 6%

Kolkata 6%

Rest of the Presidency divison

13%

0 50

100 150 200 250 300 350 400

Ban

kura

Bir

bh

um

Bu

rdw

an

Co

och

beh

ar

D.D

inaj

pu

r

Dar

jeel

ing

Ho

ogh

ly

Ho

wra

h

Jalp

aigu

ri

Ko

lkat

a

Mal

da

Mu

rsh

idab

ad

Nad

ia

Pu

rba

Med

inip

ur

Pas

chim

Med

inip

ur

Pu

rulia

No

rth

24

PG

s

Sou

th 2

4 P

Gs

Utt

ar D

inaj

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r

Total AES

AES tested for JE

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