Sentinel Surveillance Model for Vaccine Preventable Childhood Infectious Diseases 15 July 2011 National Centre for Disease Control, Delhi

Sentinel Surveillance Model for

Vaccine Preventable Childhood Infectious

Diseases

15 July 2011National Centre for Disease

Control, Delhi

Background Vaccine Preventable Childhood illnesses are an important cause of

under-five mortality

There is a need for Generating actionable data on disease occurrence and trends Evaluating the effectiveness of VPD control programs/policies Guiding program decisions

Currently there is no reliable system present for the surveillance of VPDs in the country

Good quality laboratory confirmed surveillance data can be collected from strategically located sentinel sites to deliver good quality actionable data

Objective

To study the magnitude and epidemiology of selected childhood vaccine preventable diseases

Specific Objectives Disease trends Seasonality of disease Age & Gender distribution of cases Geographic distribution of the cases Vaccination status for suspected disease Laboratory data

Proportion of lab confirmed cases Confirmation of aetiology To find out prevalent serotypes

(e.g. Pneumococcus, H. Influenzae, Meningococcus, etc.)

To find out the anti-biogram To stock isolates for future use

Sl. no.

Selected Diseases Type of model proposed for surveillance

1. Measles Meningitis Enteric fever

Sentinel surveillance model at 30 Medical Colleges or tertiary care hospitals chosen as sentinel sites with the respective 30 District Hospitals linked to them

2. Japanese Encephalitis The surveillance for JE should be done through the existing NVBDCP Sentinel sites

3. Diphtheria Surveillance data to be collected from identified Infectious Disease Hospitals

4. PertussisRota virus Strepto. pneumoniaeHemophilus influenzae -B (HiB)

Data for surveillance to be collected in a research mode from a few designated centers

Types of models for surveillance of selected diseases

Models for sentinel surveillance of selected diseases

1. Sentinel surveillance model for Measles, Meningitis and Enteric fever at 30 Sentinel Sites

2. Surveillance for JE through the existing NVBDCP Sentinel sites

3. Diphtheria Surveillance from identified Infectious Disease Hospitals

4. Surveillance of Pertussis, Rota virus, Strepto. Pneumoniae, H. influenzae -B in a research mode from a few designated centers

Suggested model for Sentinel Surveillance for Measles, Meningitis & Enteric fever at 30 selected sites

Selection of sentinel site 30 Medical institutions (Medical Colleges or other reputed

Tertiary care Hospitals) along with attached 30 District Hospitals (thus total 60 data collection sites) have been chosen as sentinel sites

Inclusion criteria for final selection: Willingness to participate as a sentinel site Catering to a large number of VPD cases Functional departments of Paediatrics and Microbiology Geographic representation

The District Hospital linked with the Sentinel site Samples to be collected from District Hospital Chosen district is based on the location of the Sentinel site

or where the Sentinel site has its field practice area

Data Flow

Sentinel Site (Medical College Hospital / Tertiary

Hospital)

PSM Dept.

District HospitalPediatrics and Micro

Departments

SSU, IDSPState Surveillance UnitCSU, IDSP

Central Surveillance Unit

DSU, IDSP(District Surveillance Unit)

Role of Sentinel Site Paediatric Dept:

Senior paediatric specialist - the nodal officer for the Sentinel site All doctors to be sensitized regarding Standard Case definition Treating pediatrician to put IDSP stamp on OPD card

Microbiology laboratory facilities: At the identified Medical Institute level only Laboratory staff of Sentinel Site to visit District Hospital for sample collection

Clinical samples: Collection at the Centralized Sample Collection Centre/ Paediatric OPD and

also from the District Hospital Sample transportation to Microbiology dept. for laboratory investigation

Data collection: Flexibility given to each Sentinel Site for data collection procedures Unique ID number linking field data and lab data to be developed before

surveillance activities begin

Functioning of the Sentinel Sites Role of the Nodal officer of Sentinel site:

Supervise work of Data Entry Operator (DEO) and also ensure that data are collected when DEO is absent

Plan training of Pediatricians, Microbiologists, DEO and Lab technicians concerned with sentinel surveillance

Flexi-funds to Sentinel sites Honorarium to any person may be considered for coordination for

ensuring collection and transfer of data as well as collection and testing of clinical samples

Rs. 5000 pm would be provided to each department (Paediatrics, Microbiology and PSM) of the Medical Institution, as well as to the attached District Hospital

The laboratories of sentinel sites would be provided funds for reagents/ diagnostic kits/ consumables

Role of Data Entry Operator at Sentinel Sites DEO recruitment

Post of DEO has been sanctioned at 26 Govt. Medical Institutions under IDSP

A new DEO may be appointed/trained for Sentinel surveillance activities at sites where none exists

Patients with IDSP stamped card to be referred by the treating clinician to the DEO

DEO to fill the Data-register with the data collected from the OPD IPD Lab

DEO would transfer data from register to a computer and send it by e-mail to DSU, SSU, CSU on weekly basis (Week = Monday to Sunday)

Role of State/District Surveillance Units, IDSP

Role of State Surveillance Officer (SSO) at the State level: Sanctioned funds (for logistics, manpower and procurement)

would be released through the concerned SSO SSO to monitor the expenditure of the sites Coordinate activities of the sentinel sites in the state

Role of concerned District Surveillance Officer (DSO) Assist Sentinel Site Nodal Officer in data collection and transfer

Respective DSU/SSU would utilize the surveillance data for response in conjunction with IDSP data

Role of Central Surveillance Unit (CSU), IDSP in Sentinel Surveillance Overall data compilation and analysis would be done at CSU, IDSP

at NCDC Additional manpower to be recruited at CSU:

4 Epidemiologists 1 Lab coordinator 1 Data Manager 2 Data Entry Operators

Epidemiologists would coordinate overall functioning of the sentinel sites and would be assisted by the Data Manager and the DEO in the analysis of the data of the entire country

Lab coordinator (Microbiologist) at the national level to ensure smooth functioning of the laboratories at all the Sentinel Surveillance sites

Monitoring of Sentinel Site activities Zonal coordinators

One coordinator identified for each zone Each Zonal coordinator to supervise and monitor five sentinel

sites under his/her respective Zone

Performance indicators for Sentinel surveillance: Consistency of reporting of sites per week: >80% Timeliness of reporting of sites per week: >80%

Implementation issues would be reviewed at CSU, IDSP/NCDC involving the nodal persons of sentinel sites after 3 months of initiation of data reporting

Review of the pilot project to be done after one year

Expansion of sentinel sites and/or disease syndromes may be considered later

List of Sentinel Sites for conducting Sentinel Surveillance for Meningitis,

Measles and Enteric fever1.GB Pant Hosptial, Port Blair2.Niloufer Hospital, Hyderabad 3.Guwahati Medical College, Guwahati4.Patna Medical College5.Government Medical College & Hospital 6.Pt. JN Memorial Medical College, Raipur7.Kalawati Saran Childrens’ Hospital, Delhi8.Goa Medical College, Bambolim, Panaji9.BJ Medical College, Ahmedabad10.PGIMS, Rohtak 11.Indira Gandhi Medical College, Shimla12.SKIMS, Srinagar 13.MGM Medical College, Jamshedpur14.Bangalore Medical College, Bangalore15.Govt. Med. College,

Thiruvananthapuram

16.MGM Medical College, Indore17.GS Medical college & KEM Hospital,

Mumbai 18.JN Hospital, JNIMS, Porompat, Imphal East19.NEIGRIHMS, Shillong20.SCB Medical College & Hospital, Cuttack21.JIPMER, Puducherry 22.Government Medical College, Patiala23.SMS Hospital, Jaipur 24.ICH & Hospital for Children, Chennai 25.Christian Medical College, Vellore 26.BRD Medical College, Gorakhpur27.BHU, Varanasi, Uttar Pradesh 28.KGMC (CSMMU UP), Lucknow 29.Govt. Doon Hospital, Dehradun30.Medical College and Hospital, Kolkata





4. Surveillance of Pertussis, Rota virus, Strepto. Pneumoniae and H. influenzae -B in a research mode from a few designated centers

Suggested model for Sentinel Surveillance for Acute Encephalitis Syndrome (AES)/ Japanese Encephalitis (JE)

Link with NVBDCP for Sentinel Surveillance of AES/JE The surveillance of AES with special reference to JE

cases should be done at the Sentinel Sites identified by NVBDCP in the country

National Vector borne Disease Control Programme (NVBDCP) has identified and strengthened the diagnostic facilities at 51 sites for surveillance of AES/JE

Existing resources provided by NVBDCP would be adequate for surveillance of JE

Data would be collected from the existing system of NVBDCP





4. Surveillance of Pertussis, Rota virus, Strepto. Pneumoniae and H. influenzae -B in a research mode from a few designated centers

Suggested model for Sentinel Surveillance of Diphtheria at Infectious Disease Hospitals under IDSP

IDH network for Diphtheria Surveillance Surveillance data for Diphtheria cases would be collected from a the identified Infectious Disease Hospitals (IDH) under IDSP

ID Hospital (Ahmedabad) ID Hospital (Bangalore) Communicable Disease Hospital (Chennai) Maharishi Valmiki ID Hospital (Delhi) Sir Ronald Ross Fever Hospital (Hyderabad) Beleghata ID Hospital (Kolkata) Kasturba Hospital (Mumbai)

Under IDSP, the ID Hospitals have been strengthened with provision of ICT network Recruitment of DEO to enable reporting of data

ID Hospitals report simultaneously to District, State and Central Surveillance Units

A meeting involving these ID Hospitals would be called for implementing the sentinel surveillance mechanism





4. Sentinel Surveillance of infection/diseases due to Pertussis, Rota virus, Strepto. pneumoniae and H. influenzae - B in a research mode from a few designated centers

Suggested model for Sentinel Surveillance of Pertussis, Rota virus, Hemophilus influenzae- B and Strepto. Pneumoniae

Sentinel Surveillance in Research mode Surveillance data on infection/diseases due to Pertussis, Rota virus, Streptococcus pneumoniae and Hemophilus influenzae - B would be collected on a research mode from the identified centers:

AIIMS (Delhi) PGI (Chandigarh) CMC (Vellore) NICED (Kolkata) INCLEN ?

Some centers have already generated some data on diseases due to Rota virus and H. influenzae- B infection and these data may be reviewed to arrive at indicative estimates. These centers may be given the responsibility to generate further required data

A meeting involving these centers would be called for discussing the implementation strategy

Categories to be filled up in the Register for Sentinel Surveillance

ID No. Date of Registration/

Admission Name Age Sex Address Date of onset of illness Major presenting features Clinical Diagnosis Treatment history

Vaccination status of related disease Name of Vaccine No. of doses given

Lab tests Name of lab test done Lab diagnosis

H/O similar illness in neighborhood

Outcome Recovered/ Died/ LAMA

ID No.

Date of Registration/Admission

Name

Age Sex

Address

Date of onset of illness

Major presenting features

Clinical Diagnos

is

Treatment

historyVaccination status of related disease

Lab tests

H/O similar illness in neighborhood

Outcome (Recovered/Died/ LAMA)

Name of Vaccine

No. of doses given

Name of lab test done

Lab diagnosis

Format for filling up Register for Sentinel Surveillance

Diagnostic laboratory tests for Diseases under Sentinel

SurveillanceSl. No. Disease Causative agents Specific lab tests

1 Diphtheria, Pertussis

Corynebacterium diphtheriae Culture, toxigenicity testing

Bordetella pertussis Culture of naso-pharyngeal

aspirate / swab

2Meningitis /

AES

Neisseria meningitidis Bacterial culture of CSF, blood

Japanese Encephalitis virus ELISA

3 Enteric feverSalmonella enterica Serotype Typhi/ Paratyphi A

Culture of blood/stool/urine + serotyping

4Measles / Rubella

Measles virus ELISA

Rubella virus ELISA

Total Budget for Sentinel Surveillance of selected Vaccine Preventable Childhood Infectious Diseases

Sl. No.

Level of Activity for Sentinel Surveillance

Total Average Cost at startup

including annual cost for 1st yr. (Rs. in lakhs)

Recurring cost per yr. (Rs. in lakhs)

1 Central Surveillance Unit (CSU) 58.6 54.3

2 Zonal coordinators (6 zones) 6.0 6.0

3Subtotal annual cost for 30 Sentinel sites for Sentinel Surveillance of Meningitis, Measles and Enteric Fever

690.2 541.8

4Subtotal annual cost for 7 ID Hospitals for Surveillance of Diphtheria

96.7 62.1

5

Subtotal annual cost for 5 Research Institutes for Surveillance of Pertussis, Rota virus, H. influenzae and Strepto. Pneumoniae

205.1 180.4

TOTAL 1056.6 844.5

Budget for Sentinel Surveillance at Zonal levels and Central level

Sl. No.

Level of Activity for Sentinel Surveillance

Total Average Cost at startup including annual cost for 1st yr. (Rs. in lakhs)

Recurring cost per yr. (Rs. in lakhs)

1 Central Surveillance Unit (CSU), IDSP 58.6 54.3

2 Zonal coordinators (6) (one at each zone responsible for 5 sentinel sites)

6.0 6.0

Subtotal annual cost 64.6 60.3

Sl. No.

Sub-activity

Total Avg. Cost at startup including

annual cost for 1st yr. (Rs. in lakhs)

Recurring cost per

yr. (Rs. in lakhs)

Per site For 30 sites

1 Laboratory tests 9.6 288 288

2 Flexi-fund to each dept (PSM, Pediatrics and Microbiology) and to each linked District Hospital

2.4 71.6 71.6

3 DEO salary (in those sites where DEO is not provided through IDSP consolidated salary of Rs 8500 pm; enhancable @ 5% pa)

1.0 30.6 32.1

4 Miscellaneous: Operational cost including stationeries, printing and communication, Training and Travel to Delhi to attend review meetings, etc.

10.0 300.0 150.0

Subtotal annual cost 23.0 690.2 541.8

Budget for Sentinel Surveillance of Meningitis, Measles and Enteric Fever at 30 identified Sentinel sites

Budget for Diphtheria Surveillance at the seven Infectious Disease Hospitals under IDSP

Sl. No.

Sub-activity

Total Average Cost at startup including annual

cost for 1st yr. (Rs. in lakhs)

Recurring cost per yr.

(Rs. in lakhs)

Per ID Hospital

For 7 ID Hospitals

1 Laboratory tests 1.0 7.0 7.0

2

Flexi-fund to each PSM, Paeds and Micro dept and to each linked District Hospital @ Rs.5000 each

1.8 12.6 12.6

3 DEO salary (@Rs 8500 pm) 1.0 7.1 7.5

4

Miscellaneous: Operational cost including stationeries and communication, Training and travel

10.0 70.0 35.0


Budget for Surveillance of Pertussis, Rota virus, H. influenzae and Strepto. pneumoniae at five Research Institutes

Sl. No.

Sub-activity

Total Average Cost at startup including annual cost for 1st

yr. (Rs. in lakhs)

Recurring cost per yr.

(Rs. in lakhs)

Per Research Institute

For 5 Research Institutes

1 Laboratory tests 27.6 138.0 138.0

2

Flexi-fund to each PSM, Paeds and Micro dept and to each linked District Hospital @ Rs.5000 each

2.4 12.0 12.0

3 DEO salary (@Rs 8500 pm) 1.0 5.1 5.4

4

Miscellaneous: Operational cost including stationeries and communication, Training and travel

10.0 50.0 25.0


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Documents

Sentinel Surveillance Model for Vaccine Preventable Childhood Infectious Diseases 15 July 2011 National Centre for Disease Control, Delhi