Public Health LaboratoryDepartment of Public Health

Ministry of Health

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National Early Warning Alert Response Surveillance

(NEWARS)

Sonam WangchukChief Laboratory Officer/Microbiologist

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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 .

Background

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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

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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 syndromes

• Case reporting only

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Features and attributes of IBS and EBS

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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

Objectives

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Process of NNDS

Public Health LaboratoryDepartment of Public Health

Ministry of Health

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Role and Responsibilities of Health Professionals/workers on

NEWARS

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Health professionals/workers

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Designated Surveillance Focal Point (SFP) at Health centers

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Designated Surveillance Focal Point (SFP) at Health centers

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Designated Surveillance Focal Point (SFP) at DHO

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Designated Surveillance Focal Point (SFP) at DHO

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NADSAE, PHL

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NADSAE, PHL

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NADSAE, PHL

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Public Health LaboratoryDepartment of Public Health

Ministry of Health

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National Notifiable Disease Surveillance System

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Operational aspect of NDSS system

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List of Notifiable Diseases/Syndromes

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• 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/syndrome

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Clinical Case definition of ND

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Clinical Case definition of ND

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Clinical Case definition of ND

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Clinical Case definition of ND

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Clinical Case definition of ND

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Clinical Case definition of ND

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Clinical Case definition of ND

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Clinical Case definition of ND

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• 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 NDDS

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• Collect daily data in record log

• Collate 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 centers

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• 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 centers

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• 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 centers

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At BHU and hospital level• Basic 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 level• The 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 level

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Referral hospital level• National 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 PHL• NADSAE 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 level

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Data transfer and Frequency for IMMEDIATE REPORTING at various level

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• During the data collection, respective BHUs, hospitals, DHO SFP should validate all the data by cross checking once again

• The 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 loss

Data Management

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• 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 Analysis

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1. Case based analysis

2. Analyze aggregated data by person, place and time

3. Trend analysis Number of cases

15

14 case patients

13 case staff members

12

11

10

9

8

7

6

5

4

3

2

1

0

00- 06- 12- 18- 00- 06- 12- 18- 00- 06- 12- 18- 00- 06- 12- 18- 00-

27 August 28 August 29 August 30 August

Date and time of onset

What to analyze

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• At district level, DHO should report back summarized data to respective BHUs and hospitals.

• At national level, NADSAE will publish quarterly Disease Surveillance bulletin.

Feedback

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M&E

Public Health LaboratoryDepartment of Public Health

Ministry of Health

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Event Based Surveillance System

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• 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.

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

2. Unusual disease patterns or unexpected deaths, 3. Potential exposure for humans to events related to diseases

and deaths in animals, 4. Contaminated food products or water, and environmental

hazards including chemical and radio-nuclear events.

Event Based Surveillance

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Potential Events

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Reportable events and definition

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Reportable events and definition

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Operational Aspect of EBS

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Responding an Event

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Reporting of PHEIC

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Collection of an Event Information

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Assessment of an Event reported

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Assessment of an Event reported