Innovation in Surveillance of Communicable and Non-Communicable Diseases

Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 1 |

3rd National Scientific Conference on Epidemiology

Innovation in Surveillance of

Communicable and Non-Communicable

Diseases

Dr Nirmal Kandel , MBBS, MA (Anthropology), MPH, EMBA

Public Health Specialist


Outlines

Surveillance, Uses and Components

Traditional Surveillance Design

Advances

Stepwise Approach – NCDs Surveillance

Universal Health Coverage and Surveillance


What is Surveillance

• Systematic, ongoing…

– Collection

– Analysis

– Interpretation

– Dissemination

• …of health outcome data

Health action

• investigation

• control

• prevention


Why we do surveillance

Estimation the size of health problem

Detection of outbreaks

Characterize disease trends

Evaluate interventions and preventive programmes

Provide information for health planning and financing

Identifying training needs in terms of categories and levels

Identify and prioritize research needs


Surveillance Support Functions

Standards and guidelines

Trainings

Supervisions

Communication facilities

Resources (including logistics) all type

Monitoring and Evaluation (M & E) and Coordination

Surveillance System Structure

Legislation (laws and regulations); including IHR (2005)

Surveillance strategy

Improve preparedness for surveillance and response

Surveillance implementation and stakeholders

Networking and partnerships

Core Functions of Surveillance

Case detection, registration and Confirmation

Reporting

Data Analysis and interpretation

Epidemic preparedness

Response and control

Feedback and evaluate

Surveillance Quality

Completeness and Timeliness

Usefulness and Simplicity

Acceptability and Flexibility

Sensitivity and Specificity

Positive predictive value

Representativeness

Components of Surveillance System


Surveillance Design

Traditional disease notification

Outbreak investigation

Cluster investigation

Active and Passive Surveillance

Enhanced surveillance

Sentinel surveillance

Emerging infectious diseases

– diagnosis-based surveillance

– syndromic surveillance

Molecular biology and

surveillance

Event Based Surveillance

Non – Traditional Surveillance


Traditional Disease Surveillance

SOURCE: Figure courtesy of Dr. Larry Madoff


Advances in Surveillance

Syndromic Surveillance

Electronic Health Records

Non traditional approaches

Event Based surveillance and Early Warning System

Integrated Diagnostic System

Pre-symptomatic Detection


Before going quick question…think

http://www.google.com/url?sa=i&source=images&cd=&cad=rja&docid=PYY738w6TqeFxM&tbnid=KtdhK8pYQWjBzM:&ved=0CAgQjRw4GQ&url=http%3A%2F%2Fdkidiscussion.blogspot.com%2F2012%2F03%2Fwere-facebook-friends.html&ei=_d-nUsKOOsHRrQe2noCwAQ&psig=AFQjCNEwdJbh-apwDFNFm__nirpGVKUwqA&ust=1386819966023143

http://www.google.com/url?sa=i&source=images&cd=&cad=rja&docid=igLZqtgXSSXDmM&tbnid=97gswPVFnhyxIM:&ved=0CAgQjRw&url=http%3A%2F%2Ftechnorati.com%2Fsocial-media%2Farticle%2Ftwitter-fakes-tweets-to-promote-twitter%2F&ei=GOCnUvj5IY3orQfy34DICQ&psig=AFQjCNEZ7U05Dn5676PnBlk59qkrgnGblg&ust=1386819992635855


Syndromic Surveillance

“Syndromic surveillance” is defined as the collection and analysis

of “health-related data that precede diagnosis and signal with

sufficient probability of a case or an outbreak to warrant further

public health response”

Source: Global Infectious Disease Surveillance and Detection: Assessing the Challenges -- Finding Solutions, Workshop Summary


Syndromic Analyses

Automated analyses identify unusual patterns and increases are investigated


Electronic Health Monitoring

SOURCE: Lombardo (2006)


Non Traditional Approaches

EIS and GOARN

Promed Mail

GPHIN

Health Map

MedIsy


EIS and DON

Event Information Sites (EIS) for National IHR Focal Points


Advances in Indonesia


Bulletins


GLEWS

One World – One Health and Emerging Disease Surveillance –

GLEWS - http://www.glews.net/

http://www.glews.net/


Surveillance Networks

Global Infectious Disease Surveillance and Early Warning Systems

– Promed


Framework for Internet Based Surveillance


Building Available Infrastructure

Source: Voxiva


How it works


Comprehensive Integrated Diagnostics System


Medical Tricorder

“integrated diagnostic

system” for field use

that can detect viruses,

bacteria, toxins,

The current prototype

relies on automated

real-time PCR


Host Based Pre-symptomatic Detection Event

Source: Johnston (2006)


Personalized Medicine Based Biosignatures


Some Innovations Used…….


Some Innovations Used…….


Use of Social Networks

I trace the passenger during

Pandemic 2009 H1N1 under

IHR (2005)

http://www.google.com/url?sa=i&source=images&cd=&cad=rja&docid=QXKjCrlsbns0bM&tbnid=INGpQQxM4s1mEM:&ved=0CAgQjRw4GQ&url=http%3A%2F%2Fen.wikipedia.org%2Fwiki%2FAirline_sex_discrimination_policy_controversy&ei=L-KnUoOHJIKQrQeG44HADg&psig=AFQjCNEVhhMS_UC4Xg80FGvDSsVwTK8Pbw&ust=1386820527658784



Step 3 (Biological)

Co

mp

lexit

y

Step 2 (Physical)

Step 1 (Verbal)

Core

Expanded

Optional

At each step

The WHO STEPwise approach to

surveillance of non-communicable disease risk factors

Sequential approach, step by step


• Coronary heart

disease

• Stroke

• Peripheral vascular

disease

• Several cancers

• COPD/emphysema

EndpointsIntermediate

Risk Factors

•Hypertension

•Blood lipids

•Obesity /

Overweight

• Diabetes

• Tobacco

• Diet

• Alcohol

• Physical Activity

Behavioural

Risk Factors

Non-modifiable

Risk Factors•Age•Sex

•Genes

Socio-economic,

Cultural & Environmental

Conditions

Figure 4 Example of Major Selected Non-Communicable

Disease (NCD) Risk Factors and Determinants

Source: World Health Organization (WHO)

Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 32 | Age

Foetal

life Adult Life Adolescence Infancy and

childhood

•SES

•Nutrition

•Diseases

•Linear

growth

•Obesity

•Obesity

•Lack of

activity

•Diet

•Alcohol,

•Smoking

•SE potential

•Established adult risk factors

(behavioural/biological)

•SES

•Maternal

nutritional

status &

obesity,

•Fetal

growth

Accumulated

risk

Range of

individual

risk Accumulated

risk

Life course approach for the prevention of

non communicable diseases


Surveillance Focus

Risk factor surveillance - for estimation and Prevention

Actual Burden of Diseases – Hospital records (HMIS)

– Mortality Statistics (Verbal Autopsy)

– Insurance data

– Funeral Services

– Drug Data



Universal Health Coverage

Universal Health Coverage – is defined as ensuring that all people

can use the promotive, preventive, curative, rehabilitative and

palliative health services they need, of sufficient quality to be

effective, while also ensuring that the use of these services does not

expose the user to financial hardship.


Thank You

Health & Medicine

Innovation in Surveillance of Communicable and Non-Communicable Diseases