Post on 06-Apr-2018
8/3/2019 Disease Surveillance 03 - Complete
1/40
DISEASE
SURVEILLANCE
8/3/2019 Disease Surveillance 03 - Complete
2/40
DEFINITION
Ongoing and systematiccollection, analysis and
interpretation ofhealthdata and the timely
dissemination ofthis data topolicymakers andothers
(by WHO)
8/3/2019 Disease Surveillance 03 - Complete
3/40
OBJECTIVES
Scientific database forrecognition,evaluation, prevention and control of
disease for now and for the future
Detect and predict Outbreaks / Epidemics
Monitoring disease trends
Evaluating effectiveness of interventionand control measures (cost
effectiveness/success or failure rates)
8/3/2019 Disease Surveillance 03 - Complete
4/40
Monitor progress towards a controlobjective
Detect changes in health practices andbehaviors
Determine disease etiology and naturalhistory
Generate hypotheses and stimulate
research.
Determine appropriate and efficientallocation of resources and personnel anddevelopment of appropriate policies.
8/3/2019 Disease Surveillance 03 - Complete
5/40
SOURCES OF SURVEILLANCE DATA
8/3/2019 Disease Surveillance 03 - Complete
6/40
COMMUNICABLE
DISEASESURVEILLANCE
8/3/2019 Disease Surveillance 03 - Complete
7/40
MOH Disease Surveillance Systems
8/3/2019 Disease Surveillance 03 - Complete
8/40
Indicator based Surveillance
Clear definition of diseases
Diagnosis-based
Syndromic cases
8/3/2019 Disease Surveillance 03 - Complete
9/40
organized and rapid capture of information of
events that are a potential risk to public health,requiring immediate assessment & public health
response
Involves:
Events related to the occurrence of disease inhumans
Events related to potential exposures for
humans Relies on unstructured descriptions & reports by
media or other sources
A complement to indicator-based surveillance for
an early warning system
Event Based Surveillance
8/3/2019 Disease Surveillance 03 - Complete
10/40
Surveillance Mechanisms in Malaysia
1. Mandatory notifications2. Laboratory based surveillance
3. Clinical based surveillance
- National
- Syndromic
- Sentinel
4. Community based surveillance- Media surveillance
5. Other agencies
- Department of veterinary services (zoonosis)
- FOMEMA Sdn.Bhd. (foreign workers)
Indicator
based
surveillance
Event based
surveillance
8/3/2019 Disease Surveillance 03 - Complete
11/40
8/3/2019 Disease Surveillance 03 - Complete
12/40
HOW ITS DONE
1. MANDATORY NOTIFICATION
Mandatory notification - under Section 10(2) Act 342:
Prevention & Control of Infectious Disease Act 1988.
27 infectious diseases within 24 hrs/1 week.
Every medical practitioner notifies nearest District Health
Office
Compounded offenses if fail to notify
Notification phone & form fax/post/by hand Manual
System
8/3/2019 Disease Surveillance 03 - Complete
13/40
Notification by phone followed by
written notification (within 24 hours)
1. Dengue fever and dengue hemorrhagic fever
2. Yellow fever
3. Diphtheria
4. Ebola5. Food poisoning
6. Cholera
7. Plaque
8. Poliomyelitis9. Rabies
10. additional- SARS, AVIAN Flu, INFLUENZA H1N1 flu
13
8/3/2019 Disease Surveillance 03 - Complete
14/40
Written notification within one week
after diagnosis
11. Whooping cough
12. Measles
13. Dysenteries (all forms)
14. Gonnoccal infection (allforms)
15. Leprosy
16. Malaria
17. Myocarditis
18. Relapsing fever
19. Syphilis (all forms)
20. Tetanus (all forms)
21. Typhoid and paratyphoidfever
22. Typhus and otherricketsioses
23. Tuberculosis
24. Viral encephalitis
25. Viral hepatitis
26. Any other life-
threatening microbialinfection
27. HIV all forms
14
8/3/2019 Disease Surveillance 03 - Complete
15/40
Diagnosis by Consultant /Specialist/Medical Officer
(Clinical and /or lab confirm)
Notify
Verbal
Within 24 hrs
Written
Within 24hrs
Written
Within 1 week
State Health Office
Ministry of Health
DC
IDS
Hospital Record Office
District Health Office
Feedback
International
Dengue, DHF
Diphtheria
Yellow Fever
Food Poisoning
Cholera
Plague
Acute Polio
Rabies
Ebola
15
8/3/2019 Disease Surveillance 03 - Complete
16/40
8/3/2019 Disease Surveillance 03 - Complete
17/40
Communicable Diseases Control
Information System
Modules
Case Notification
Case Registration Case Investigation
Case Follow-up
Report
Query
Alarm
8/3/2019 Disease Surveillance 03 - Complete
18/40
2. LABORATORY BASED SURVEILLANCE
detect emerging pathogen strains.
To predict and detect outbreak of disease.
To determine and monitor the circulation oforganism strains in the country.
To monitor the trend of anti-microbialresistance.
To facilitate outbreak identification andinvestigation through strain identification(sero-typing, phage typing etc)
8/3/2019 Disease Surveillance 03 - Complete
19/40
Pathogens identified for National
Laboratory SurveillanceSentinel Surveillance Dengue Influenza
Enterovirus
Viral National Surveillance Japenese encephalitis Mumps,Measles and Rubella
Non Viral PathogensHaemophilus influenzae type bNeisseriae meningitides
Salmonella typhiLeptospira sppVibrio choleraeSalmonella spp
19
8/3/2019 Disease Surveillance 03 - Complete
20/40
Flow of notification
Microbiology laboratories of
public and private hospitalsand private laboratories
IMR,
PHL Ipoh,other reference
laboratories
Isolates with lab.
Notification form
Notification form
(labsur
1/2002.pind 1)
Result
Surveillance Section,
Disease Control Division
Data analysis,
interpretation and
dissemination
FeedbackFeedback
20
8/3/2019 Disease Surveillance 03 - Complete
21/40
3. CLINICAL BASED SURVEILLANCE
a) SYNDROMIC SURVEILLANCE
- monitoring of the frequency of illnesses with aspecified set of clinical features in a givenpopulation without regard to specific diagnoses, if
any, that are assigned to them by physician
focuses on clinical syndrome before laboratoryconfirmation is available
NOT laboratory based BUT when supplementedwill enhance the power and specificity of thesystem
8/3/2019 Disease Surveillance 03 - Complete
22/40
Used for diseases where the initial
presentation likely to be nonspecific.
Use health-related data before adefinitive diagnosis.
Can signal sufficient probability of
an outbreak to warrant further PHresponse.
8/3/2019 Disease Surveillance 03 - Complete
23/40
Facilitate and speed up notification andresponse using clinical syndromes (early
detection of possible outbreak).
Alert attention to a problem at theearliest possible time and to promote
rapid investigation and containment ofoutbreak.
Complement other existing specificdisease notification especially for rapidresponse to newly emerging andreemerging diseases.
8/3/2019 Disease Surveillance 03 - Complete
24/40
Syndromes for notification
Acute neurological syndrome
Acute respiratory syndrome
Acute dermatological syndrome
Acute jaundice syndrome
Acute haemorrhagic syndrome
Acute diarrhoeal syndrome
24
8/3/2019 Disease Surveillance 03 - Complete
25/40
Notification procedure
The syndromic notification formKKM-syndsurv/2003.2
Sent
To DistrictHealth OfficeWithin 24 hours
If a definitive diagnosis is made
Notify under usual system
25
8/3/2019 Disease Surveillance 03 - Complete
26/40
Analysis & response
FLOW CHART
E D / A&E / Wards
District Health Office
Surveillance MOH State
Investigation
Notify SyndKKM-Syndsurv/2003.2
feedback
AnalysisInterpretationresponse
report
feedback
AnalysisInterpretationresponse
Syndromic Surveillance flowchart
26
8/3/2019 Disease Surveillance 03 - Complete
27/40
Malaysia Influenza Surveillance System
(MISS) Started in September 2003 2 major components:
Disease-based surveillance:
221 sentinel sites (inclusive of both government healthclinics & GPs)
Case definitionofinfluenza-like illness (ILI):Abrupt onset ofhigh grade fever (axilla > 38OC or oral > 38.5OC) with drycough within 48 hours and with any of the followingsymptoms; nasal congestion, sore throat, myalgia, vomiting(infants), convulsions (infants)
ILI definition under enhanced surveillance for H1N1: Aperson presenting with a sudden onset of fever 38oC andcough or sore throat, in the absence of other diagnosis (theonset of fever should be within 3 days of presentation and
fever should be measured at the time of presentation)
27
8/3/2019 Disease Surveillance 03 - Complete
28/40
Laboratory-based surveillance:
2 National Influenza Centres (NICs) :Institute of Medical Research (IMR) & University
Malaya Medical Centre (UMMC)
1 National Influenza Lab (NIL) :
National Public Health Laboratory Sungai Buloh,
Selangor
At least 2 sentinel sites per state for clinical
specimen collection
At least 5-10 specimens from ILI cases per clinic
per week should be collected
8/3/2019 Disease Surveillance 03 - Complete
29/40
4. COMMUNITY BASED SURVEILLANCE
(Media/Rumour Surveillance)
Provide an early warning sign in detecting potential
outbreak within and outside Malaysia.
Media reporting :
Obtain report on possible infectious diseases occurring
locally and in other countries
Monitor global and local situation
Verify the rumours through investigation for decision onfurther action or to dismiss it.
Provide alert if necessary
Initiate data gathering from surveillance
Collaborate with other agencies in surveillance
8/3/2019 Disease Surveillance 03 - Complete
30/40
Source of Information for
Rumour Surveillance
Printed media e.g. local newspapers
Internet
Television & radio Phone calls
E-mails from public
E-mail discussion group e.g. ProMed-mail Word-of-mouth of public or health staff from
different levels
30
8/3/2019 Disease Surveillance 03 - Complete
31/40
MOBILISING COMMUNITIES
Active method of community based surveillance Community leader / Institutions were asked to
report/inform unusual event caused by infectious
disease to health office/offices, verify and take
action
Health staffs were asked to gather information
from:
Police stations
Private clinics / hospitals
Pharmacies
This can be done daily or once in two days.31
8/3/2019 Disease Surveillance 03 - Complete
32/40
FLOW CHART OF RUMOURS SURVEILLANCE FROMPRINTEDMEDIA
32
8/3/2019 Disease Surveillance 03 - Complete
33/40
FLOW CHART OF RUMOURS SURVEILLANCE FROMINTERNET
33
8/3/2019 Disease Surveillance 03 - Complete
34/40
5. OTHER AGENCIES
- Department of veterinary services (zoonosis)- FOMEMA Sdn.Bhd.
(foreign workers health screening)
8/3/2019 Disease Surveillance 03 - Complete
35/40
MOH Disease Surveillance System
Indicator based
Event Based (Rumour Surveillance)
Early Warning
Syndromic Notification
Cluster Reporting
Rumour Surveillance
Event Based Surveillance
Need to strengthen for early detection of newinfections/ unusual events/ events of potential for
major outbreak or pandemic
8/3/2019 Disease Surveillance 03 - Complete
36/40
NONCOMMUNICABLEDISEASE
SURVEILLANCE
8/3/2019 Disease Surveillance 03 - Complete
37/40
Problem :
Worldwide, noncommunicable
diseases (NCD) currently represent43% of the burden of disease and are
expected to be responsible for 60%
of the disease burden and 73% of all
deaths by 2020.
WHO NCD Surveillance strategy
8/3/2019 Disease Surveillance 03 - Complete
38/40
Objective: A comprehensive analysis of the availability
of data on the main risk factors for NCDs
worldwide,analysis of the global distribution and trends,
summary of the challenges.
8/3/2019 Disease Surveillance 03 - Complete
39/40
Strategy:
A global strategy for NCD risk factorsurveillance has been developed basedon the concept of a STEPwise approach
to NCD Surveillance (STEPS).
8/3/2019 Disease Surveillance 03 - Complete
40/40
WHO STEPwise approach to surveillance
(STEPS)
Simple and standardized method for collecting,analysing and disseminating data in WHO membercountries.
There are currently two primary STEPS surveillancesystems:
1) the STEPwise approach to risk factor surveillance;
2) the STEPwise approach to Stroke surveillance.