National Disease Surveillance MechanismsNational Disease Surveillance Mechanisms

Aamer Ikram AFIPMuhammad Safdar NIH

Pakistan

BWC Experts Meeting UN Geneva

World a safer place World a safer place

ChallengesEmerging Infections Re-emerging Infections

Courtesy: National Geographic

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DAY

CASES

Early Outbreak Detection and ResponseEarly Outbreak Detection and ResponseFirst Case

Detection/Reporting

LabConf

Response

Opportunity for control

Snapshot Snapshot -- Health StatusHealth Status

lPopulation 163.76 M

lGrowth rate 1.73%

lEpidemic Transition– Communicable Disease Mortality - Decreasing

– Non-communicable Diseases Mortality - Rising

Priority Communicable DiseasesPriority Communicable Diseases

– Tuberculosis

– Viral Hepatitis B & C

– Malaria

– Hemorrhagic fevers (Dengue and CCHF)

– Polio, Measles & Other EPI diseases

– Water and food borne diseases

– Pandemic Influenza and other Zoonoses

Mechanisms under MoHMechanisms under MoHl Health Management Information System at the National

Health Information Resource Centre (NHIRC) l Diseases surveillance initiatives at NIH Pakistanl Public health testing for Communicable Diseases, Food &

Water at NIHl Surveillance systems of vertical preventive health

programs (TB, Hepatitis, Malaria, HIV/AIDS, Influenza, EPI, Polio)

l MoH-WHO Disease Surveillance and Response System in disaster hit areas

National Institute of HealthNational Institute of Health

lApex public health institute

Health Management Information SystemHealth Management Information Systeml Caters information needs of the MoH and

Provincial/District Health Departments

l 118 districts and approx 10,000 Public sector facilities

l 18 communicable diseases being reported

l Joint MoH, WHO, CDC and World Bank review/assessment of existing surveillance systems

Diseases surveillance initiatives at NIHDiseases surveillance initiatives at NIH

lNational and Provincial Task Forces on CDslNational Steering Committees (NSC)

– Avian/Pandemic Influenza (Joint NSC)– Field Epidemiology & Laboratory Training Program

lEarly detection, investigation and response to the outbreaks through Epidemic Investigation Cell

lDisease Early Warning System (DEWS)lSeasonal Awareness and Alert Letter (SAAL)

upcoming seasons

lField Epidemiology and Laboratory Training Programme (FELTP)

lFocal Point for IHR 2005lLegal framework for diseases surveillance lCapacity building of health professionals through

training workshops under WHO-MoH Program on:– Health Laboratory Support and – Disease Early Warning System (DEWS)

Diseases surveillance initiatives at NIHDiseases surveillance initiatives at NIH

Epidemic Investigation Cell (EIC) Epidemic Investigation Cell (EIC) 1. Nationwide monitoring 2. Technical support - guidelines,

SOPs, trainings and DEWS tools

3. Response when called by respective departments

4. International collaboration 5. Disease Early Warning System6. > 600 alert/outbreaks

responded since 1998

Disease Early Warning SystemDisease Early Warning System

lOperational since 1998 as a joint MOH/ WHO

initiative

l Early detection of outbreak

l Syndromic Case Definitions, Reporting Forms

and watch charts help in disease monitoring

lData analysis at facility/local level

DEWS DEWS ImplementationImplementation

More than 3500 health professionals trained

Pilot Areas

DEWS Case Definitions Tools

lMaster level training in collaboration with CDC

lRegular short courses

Field Epidemiology and Laboratory Training Field Epidemiology and Laboratory Training Programme (FELTP)Programme (FELTP)

Legal Framework for Diseases SurveillanceLegal Framework for Diseases Surveillance

lDevelopment of legal frame-work – collaborative initiative – MoH-NIH-CDC-WHO

lWould complement the dispensation of IHR 2005

LabLab--based surveillance projectsbased surveillance projects

lRegional Reference Lab for Polio Eradication with assistance from CDC, WHO, JICA and Rotary InternationallNational Lab-based Influenza Surveillance with

assistance from CDClMeningitis Lab-based Surveillance with assistance

from WHOlRota Virus Lab-based Surveillance

Disaster affected areasDisaster affected areas

lCollaborative initiative of MoH-WHO

lOperational areas:

– Earthquake affected

– Flood affected

– IDPs hosting areas

lSurveillance findings published as Weekly Morbidity and Mortality Report (WMMR)

Future DirectionsFuture Directions

l Implementation of the Integrated Disease

Surveillance Program (IDSP)

lMonitoring of infectious disease trends – animal

& plant

l Strengthening of Response Units

l Regional collaborative networking for a wider

response

Armed Forces Institute of PathologyArmed Forces Institute of Pathology

l Reference Diagnostic & Research Institute

l Inter-services Institutes & Military Hospitals

l Private Hospitals

lNotification of Infectious Diseases

lQuarterly Summary

l Instructions – Surgeon General Pak Army

Supporting ElementsSupporting Elements

lGlobal/Regional Surveillance

lLocal/International Notifications

lResearch Activities/Publications

» Pakistan Medical Research Council

» Universities/Medical Colleges

Professional BodiesProfessional Bodies

l Infectious Disease Society Pakistan

l Infection Control Society Pakistan

l Pakistan Association of Pathology

l Pakistan Biological Safety Association

“Without concerted and coordinated political action, the gains achieved in reducing the burden of infectious disease will be washed away as a new wave of preventable illnesses engulfs those least able to protect themselves”

~ Richard HortonLancet

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