VPD & IDsurv

Vaccine Preventable Disease &

An innovative Infectious Disease and

Serious AEFI surveillance system Dr. Ketan R. PatelResident DoctorCommunity Medicine Dept.

GMC Surat

Acknowledgement

Indian Academic of Pediatrics website

IDSurv.org website

Dr. Mohua Moitra

Background Disease surveillance is an important component of public

health programmes.

Surveillance of vaccine preventable diseases (VPDs) is a very important component in disease prevention as many infectious diseases are now being prevented by highly effective vaccines.

The number of effective vaccines is going to be increasing in coming time considering the rapid advancement in the field of vaccinology today

Surveillance methods 1) Active surveillance: Done actively by designated

persons at any health institutions or community. For eg. AFP surveillance done by NPSP.

2) Passive surveillance: where suspected or confirmed cases of a disease are reported routinely and passively from identified health facilities such as IDSP, IDSurv, etc.

3) Sentinel surveillance: where clinical cases are reported after lab confirmation from selected health institutions in relation to HIV, Rotavirus (IRSN), Hib-surveillance etc.

IRSN : Indian Rotavirus Surveillance Network

4) Population based surveillance: Conducted for selected groups with active diseases in a well-defined area/populations, such as Leprosy surveillance done by health worker in the village

5) Outbreak surveillance: where notification is done only whenever there is cluster of cases as per predefined norms, such as measles surveillance, diseases reported through IDSP and Fever surveillance done by PSM Dept. in New Civil Hospital campus in 2014.

Surveillance methods cont…

6) Case-based surveillance: where any suspected case is immediately notified for further investigations like AFP and AES surveillance.

7) Zero reporting: means reporting even when there is no case found like AFP surveillance.

Surveillance methods cont…

VPD SURVEILLANCE

(Vaccine Preventable Diseases)

Why VPD surveillance is necessary?

The goals of an effective disease surveillance system should serve the following functions:

To define epidemiology of a disease To identify high-risk populations and regions having high

transmission of the disease

To monitor progress of a disease control program To specify and monitor molecular epidemiology of an infectious

disease including identification of circulating strains of the pathogen responsible for the infectious disease

To monitor impact of the vaccination program on overall disease (VPD) epidemiology.

Current status of VPD surveillance in India

Vaccine preventable diseases (VPDs) are still responsible for over 500,000 deaths annually in India1.

There is lack of disease burden data on many important VPDs in India that results in the perception that the disease is not important public health problem.

Lack of baseline surveillance data also is a bottleneck in introduction of many new vaccines in the national immunization program (NIP) and also in monitoring the impact of vaccination provided through UIP

Source 1: World Health Organization (Regional Office for South-East Asia). Available online: http://www.searo.who.int/en/Section1226/Section2715.htm.

VPD Surveillance systems in IndiaFollowing are the key surveillance systems in India:

1) IDSP: (Integrated Disease Surveillance System) Nationwide outbreak surveillance system. Including measles, diphtheria, pertussis, AFP, hepatitis and AES.

2) CBHI/SBHI: (Central and State Bureaus of Health Intelligence) Nation-wide passive reporting system of suspected cases.

3) MEASLES: ICMR Selected practitioners and institutions provide clinical samples to NIV-Pune for measles virus isolation and genotyping. A type of case-based surveillance system.

4) AES / JE: NVBDCP and ICMR Facility based surveillance for acute encephalitis syndrome in endemic areas. It is run by Government of India under National vector-borne diseases control program.

AES: Acute Encephalitis syndrome, NIV Pune: National Institute of Virology, Pune

5) Multi centre PNEUMONIA and MENINGITIS surveillance : Established in preparation for Hib vaccine probe study. A type of case-based surveillance.

6) WHO-NPSP supported surveillance systems : Three different models for three different VPDs.

a) AFP and lab surveillance for poliovirus: Global eradication program.

b) Fever and rash for measles/rubella: National mortality reduction target; may be scaled up to a regional elimination goal.

c) Acute Encephalitis Syndrome (AES) for JE: Control program for endemic districts.

7) IDSurv― An Innovative Project to Report Infectious Diseases : IAP in collaboration with its Kutch branch, has started an Infectious Disease Surveillance and AEFI reporting system for reporting serious AEFI, known as IDSurv.org.

VPD Surveillance systems in India

IDSurv

Innovative Infectious Disease

and

Serious AEFI Surveillance System

History

Initially IDsurv.org was designed only for Kutch district

Indian Academy of Pediatrics in collaboration with its Kutch branch has started reporting system for the Infectious Disease Surveillance and serious AEFI

The standard case definitions for all the diseases covered under this project are provided on the website.

All the cases reported through various methods are collected in a single database in real time and reports are sent to all users on weekly basis.

AEFI: Adverse Event Following Immunization

In case a disease outbreak is recorded on the system, email and SMS alert are sent to all users instantaneously.

After interest shown in this project by IAP COI and CIAP. MOU was signed between IAP Kutch Branch and CIAP to make this project available nationwide for all IAP members.

Initially only 9 diseases where under surveillance. Hepatitis and acute encephalitis surveillance was added later on

History

IAP COI: IAP Committee on Immunization, CIAP: Clinical Information Access Portal

To develop an early warning system for pediatric vaccine preventable diseases in India

To generate data on burden of vaccine preventable diseases in India

To generate data on Severe AEFI in India

Objectives of IDsurv

1. Acute Bacterial Meningitis2. Acute Encephalitis Syndrome3. Chicken pox4. Pertussis5. Dengue6. Diphtheria

Recently they have started surveillance for AEFI on the IDsurv platform with support Government of India. Only serious AEFI reported that include:

Death Hospitalization Clustering of cases Disabilities

7. Typhoid 8. Pneumonia9. Hepatitis10. Measles11. Mumps

At present only eleven key infectious diseases are targeted for surveillance under this project and they include:

How to Report a case on Idsurv ?

There are 4 modes to report a case:

1. Laptop or computer

2. Mobile

3. By sending appropriate codes through SMS to 57333

4. By calling the IVR system on 02653090533 from your registered

mobile number and follow the instructions to report a case.

1. Reporting a case through website: First, one should go to the site

www.idsurv.org and click on login and a panel will open. Enter your Username

and Password. You will be redirected to your account. Click on Report a Case’.

Select the diagnosis. Enter patient's details including all other details and click on

submit. A reference number will be generated for the patient and given to you.

2. Reporting case through mobile:

In mobile there are two methods

i. Log in to your account on

m.idsurv.org. Click on report a

case and fill up the form and

click on submit.

ii. Download mobile Application

named “IDsurve’’

3. Reporting a case through sms : Type 'IT' space 'IDS' space 4-

letter 'code of the disease' space 'age' in months space 'sex' space

'severity of disease' space ‘microbial diagnosis established’ space

‘immunization status’ space ‘outcome’ and send it to 57333. The

details about SMS codes are provided on the website.

4. Reporting a case through IVR To report a case using IVR

system, call 02653090533 using your registered mobile number

and follow the instructions. It usually takes less than 2 minutes to

register the case. You can enter the details later.

How to report an Adverse Event Following Immunization (AEFI)?

An AEFI is defined as “a medical incident that takes place after an immunization

Only serious AEFI that includes deaths, hospitalization, clustering of cases, and disability is reported to the system.

To report serious AEFI cases click on “report an AEFI” and fill in all the fields regarding patient, AEFI and the vaccine, and then click on “save”.

One can view the AEFI cases reported by clicking on 'View/ Update AEFI cases reported by me'.

Once a serious AEFI reported through this system, automated e-mail intimation is sent to the designated government authority for further necessary actions.

Who can see the cases reported by me?

Anybody who opens idsurv.org can see the cases

But the identity of the doctor and patient is kept confidential and provided only to Government authorities if requested by them.

How to view surveillance data available at IDSurv?

The data can be viewed either on a map, table or charts.

Google map showing total number of cases along with break-up of the cases reported from a particular district.

The charts display the total number of all the eleven ID cases reported so far along with data

An early warning system (IDsurv alerts) is being introduced on the site

When the system detects unusually high number of cases being reported of a particular disease in a geographical area in a short period of time, an automatic (SMS and Email) alert is sent to all the registered users and government authorities in that area and same is also reflected on the website.

Early warning system/ IDsurv alerts

The IDSurv has a great potential in fulfilling the need of infectious disease surveillance of the country. It can provide VPD reporting in the country especially amongst the practicing pediatricians.

The user-friendly system and easy display of the data should provide motivation to pediatricians in private sector.

So far, 10,146 cases of all the eleven IDs are reported through this project from all over the country2.

The total number of registered users is only 602 that represent around 3% of total membership of IAP in the country2.

The majority of cases register either had no immunization or were only partially immunized.

Current status of IDSurv

Source 2: IAP Guidebook on Immunization 2013–14 available online: http://iapindia.org/files/IAP%20Guidelines/IAP%20Guidebook%20on%20Immunization%202013-14.pdf

Limitation

All VPDs (Vaccine Preventable Diseases) are not covered under IDsurv.

Most of the Pediatric doctors are not aware about this surveillance system. Only few Pediatric doctors are aware about this project and doing regular reporting.

Registering of the cases on this website require the motivation and support form the private Pediatric doctors.

Registering of cases not done from the Government hospitals.