National Early Warning Alert Response Surveillance - PowerPoint Presentation

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National Early Warning Alert Response Surveillance (NEWARS)

Sonam

Wangchuk

Chief Laboratory Officer/MicrobiologistSlide2

Designated national focal point for Disease surveillance and Outbreak investigation.

Introduced National Notifiable Disease

Surveillance in 2010.Web based reporting system in 2012 but access limited to DHO and hospitals.Revised notifiable disease list and guideline in 2014.Redesigned web based and developed mobile SMS event reporting system in 2014 .

BackgroundSlide3

Why revised existing NNDS guideline

Most notifiable diseases were disease specific and need laboratory confirmation.

Require fill up of case investigation form for each reporting notifiable disease case.Operational issues in reporting from BHU’s and hospitals to DHO.No real-time reporting from BHU’s Slide4

Difference between NNDS and NEWARS guideline

NNDS was an indicator based surveillance.

Disease specific surveillance .Required case reporting and investigation NEWARS is both indicator and event based surveillance.Included both disease and syndromesCase reporting onlySlide5

Features and attributes of

IBS and EBSSlide6

1. Early warning to prevent or minimize morbidity and mortality through:

• Monitoring trends of endemic diseases

• Detecting outbreaks and events • Providing an adequate and timely response 2. Program monitoring for: • Planning, monitoring and evaluating disease control programs • Resource mobilization and allocation ObjectivesSlide7

Process of NNDSSlide8

Role and Responsibilities of Health Professionals/workers on NEWARS Slide9

Health professionals/workersSlide10

Designated Surveillance Focal Point

(SFP) at Health centersSlide11

Designated Surveillance Focal Point

(SFP) at Health centersSlide12

Designated Surveillance Focal Point

(SFP) at DHOSlide13

Designated Surveillance Focal Point

(SFP) at DHOSlide14
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NADSAE, PHLSlide16

NADSAE, PHLSlide17

NADSAE, PHLSlide18
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National Notifiable Disease Surveillance System Slide23

Operational aspect of NDSS systemSlide24

List of

Notifiable

Diseases/SyndromesSlide25

Diseases of epidemic potential in the community. • Vaccine preventable diseases.

• Diseases that are aimed for elimination.

• Disease with high morbidity and mortality. • Diseases which are of potential threat to international community (Public Health Emergencies International Concerns). Identification of disease/syndromeSlide26

Clinical Case definition of NDSlide27

Clinical Case definition of NDSlide28

Clinical Case definition of NDSlide29

Clinical Case definition of NDSlide30

Clinical Case definition of NDSlide31

Clinical Case definition of NDSlide32

Clinical Case definition of NDSlide33

Clinical Case definition of NDSlide34

Out Patient and observation Registers of 191 Basic Health Units.

Out Patient and admitted patient Registers of 31 District Hospitals.

Out Patient, admitted patient and Emergency Registers of 3 Referral Hospitals. Source of information/data for NDDSSlide35

Collect daily data in record logCollate data in a weekly report using “Weekly Reporting Form” (Annex 3) and report to DHO/ in system every Friday.

Report according to the Epidemiological week: Saturday to Friday.

Process of data collection and collation at health centersSlide36

Record cases into two outcome categories: Number of cases and number of deaths (if case has died it should be recorded as both case and death) Annex 3.Mark (e.g. tick) those cases in the register that are included in the “Weekly Reporting Form” so that it can be validated if needed during evaluation and monitoring process.

Process of data collection and collation at health centersSlide37

Mark (e.g. draw a line under) the last case in the register included in the weekly report. This way reporters know where to start looking for cases in the register the following week. Do Zero-reporting using the same form for weekly reporting form (

Annex 3).

Process of data collection and collation at health centersSlide38

At BHU and hospital levelBasic Health Units (BHUs) and hospitals SFP should report

every week on Friday.

The reports should be sent using SMS or internet to online system maintained by NADSAE and ICT Unit, PHL. At DHO levelThe DHO should monitor online reporting status and ensure all BHUs under its jurisdiction have reported by Friday. The DHO should call the BHUs and hospitals that fail to report through online or SMS. BHUs and hospitals should be encourage to report even if it is late through ‘Late Reporting Request’ and ask them to report on time. Report online every week on Monday. Data transfer and Frequency for ROUNTINE REPORTING at various levelSlide39

Referral hospital levelNational and regional referral Hospitals and Airport Health Service at Paro International Airport should report directly to the NADSAE, PHL

every week on Monday

using online system or SMS method. At PHLNADSAE will report to IHR National Focal Point (IHR NFP) if the reported information (priority diseases and syndromes, outbreak/event) is a Public Health Event of International Concern (PHEIC) after conducting risk assessment within 24 hours for onward reporting to WHO. Report to HIMS every month.Data transfer and Frequency for ROUNTINE REPORTING at various levelSlide40

Data transfer and Frequency for IMMEDIATE REPORTING at various levelSlide41

During the data collection, respective BHUs, hospitals, DHO SFP should validate all the data by cross checking once againThe correction should be made immediately at respective level if any discrepancy is found in the “Weekly Reporting Forms” (data cleaning).

NADSAE should also validate and cross-check data at national level and make necessary correction.

The NADSAE should manage all the data obtained from the online reporting system. The electronic data at ICT Unit should be backed up on a daily basis to avoid data lossData ManagementSlide42

At BHUs, and hospitals, SFP should analyze and interpret the compiled data in their respective health facility regularly,At district Health Office, DHO should analyze and interpret compiled data obtained from all the health facilities under its jurisdiction and

At national, NADSAE, PHL will analyze, and interpret compiled data obtained from all health facilities.

Data AnalysisSlide43

Case based analysis

Analyze aggregated data by person, place and time

Trend analysisWhat to analyzeSlide44

At district level, DHO should report back summarized data to respective BHUs and hospitals.At national level, NADSAE will publish quarterly Disease Surveillance bulletin.

FeedbackSlide45

M&ESlide46

Event Based Surveillance System Slide47

Event-based surveillance is rapid gathering of information about events that are a potential risk to public health and responding to events based on information verification and risk assessment.

The occurrence of disease in humans, such as clustered cases of a disease or syndromes,

Unusual disease patterns or unexpected deaths, Potential exposure for humans to events related to diseases and deaths in animals, Contaminated food products or water, and environmental hazards including chemical and radio-nuclear events. Event Based SurveillanceSlide48

Potential EventsSlide49

Reportable events and definitionSlide50

Reportable events and definitionSlide51

Operational Aspect of EBSSlide52

Responding an EventSlide53

Reporting of PHEICSlide54

Collection of an Event InformationSlide55

Assessment of an Event reportedSlide56

Assessment of an Event reported