EPIDEMIOLOGICAL

SURVEILLANCE
EPIDEMIOLOGICAL SURVEILLANCE

The ongoing and systematic collection, analysis,

and interpretation of outcome specific data
essential to the planning, implementation,
and evaluation of public health practice ,
closely integrated with timely dissemination
of these data to those who need to know. The
final link of the
surveillance chain is the application of these
data to the control and prevention of human
disease and injury
TYPES OF SURVEILLANCE
Active
Enhanced passive
Passive surveillance
 HISTORICAL DEVELOPMENT

Monitoring of quarantine & isolation

activities
Modern surveillance: 17th century (John
Graunts Natural and political observations
made upon the bills of mortality (disease
specific death counts, death rates, disease
patterns)
1950 population-based surveillance
(communicable disease )
 The Benefits of Surveillance
PREDICTION OF THE PROBLEM
S
U
R MAGNITUDE OF THE PROBLEM

V
e
HEALTH DISTRIBUTION OF THE PROBLEM
I
PROBLEM L
L
A PRIORITY OF THE PROBLEM
N
C
e EVALUATION OF THE PROBLEM
 WHY DO IT ?
PURPOSE & USES
Detect epidemics
Estimate the magnitude of a problem
Determine the geographical distribution
Portray the natural history of a disease
Generate hypotheses and stimulate research
Evaluate control measures
Monitor changes in infectious agents
Facilitate planning
Document the distribution and spread of a health event
Test hypotheses about etiology
Monitor isolation activities
Identify research needs and facilitate epidemiologic and
laboratory research
-
THE CONCEPT OF SURVEILANCE
MAIN ACTIVITY:
ANALYSIS & INTERPRETATION

INFORMATION

ALERTNESS & RESPONSIVE

RESPONS NESS
TO DO AN APPROPRIATE ACTION
 WHAT ANALYSIS
WE DO ?
Behavior &
Environment
Physiology Disease:
Smoking
Alcohol drink Blood pressure Stroke
Physical activity Blood sugar Diabetes
Eating habit Cholesterol Cancer
Mobility Hematocrit, DHF
Hygiene/ sanitation trombocyt,
Vector

change of paradigm
 Scope of Analysis
DISEASE / PROBLEM DEVELOPMENT

1 2 3 4

Production of Environmental Biochemical, ILLNESS

contaminating contamination physiological DISABILITY
product change DEATH
(Biomarker)

Direction and area of surveillance

 Surveilance and
decision making process

Epidemiological surveillance process

Decision
Data Analysis / Out put making
collating
1 to 4 Interpretation Information
process
Surveillance to predict an outbreak

OUTBREAK 2001
2001 2002
OUTBREAK
Surveillance to predict an
outbreak
Data Analysis
 The most endemic area
Malaria only in hilly areas , not in low lands/agriculture area

Wanayasa
Banjarmangu

Wanadadi

Pungelan

Madukara
Purwonegoro

Pagedongan
Susukan
 An Epidemic without Surveillance
Primary 1st case Report Samples Lab Response
Case at HC taken result begins

masalah

Cases
Controlled cases

Time
 With adequate Surveillance
Response
PRIM HC REP SAMP RES begins

Potential
cases can be
CASES
prevented

DAY
The Proportion of cases with unknown
immunisation status
(according to age groups) 2004
 Percentage Achieved of measles Imunisation in
Indonesia 2000 s/d 2004

Approximately 90.6 % from 90.4 coverage % with unclear data source??


Principles of problem priority

1. Magnitude of the problem %

population affected yang
(incidence, prevalence, proportion)
2. seriousness of the problem
fatality, economic impact
3. Intervention effectivity How
powerful it is to change the
situation
Diagram of Determinant & Contributing
Factor of Measles mortality
Indirect
Health Problem Determinant Direct Indirect
Contributing
Contributing Contributing
stock &
Distribution
Population Program
high morbidity
interaction management
Planning

High measles High rate of Low

immunization distance
mortality under nutrition
coverage Access to service

Number of unit
Service

Poor medical
Low quality
service Lost opportunity Waiting time
 Deciding the pathway of problem
solving
Health Problem Determinant Direct Indirect Indirect
Contributing Contributing Contributing

x
x x
x
x

x
 Deciding target objectives
DETERMINANT DIRECT INDIRECT INDIRECT INDIRECT
CONTRIBUTING CONTRIBUTING CONTRIBUTING CONTRIBUTING
FACTOR FACTOR-level 1 FACTOR-level 2 FACTOR-level 3
High morbidity
Low Imunisation Access to service Duration of services
coverage Waiting time

goal
Objective Objective Objective Objective

Reduce measles Increase

Immunisation Increase Reduce waiting 60 % of the
morbidity rate coverage for immunisation time in clinic available clinics
among underfive underfive in district service from 25 to from 2 hour to provide services
X from 60 % 35 children per 1 hour in 1 year from 6 hours tp 8
in district of X menjadi 75 % in 1 day in one year hours per day in 1
year year
from 250/1000
menjadi
100/1000 in five
year

DEVELOP RECOMMENDED ALTERNATIVE ACTIVITIE

Creating a new surveillance system

BAsIC PRINCIPLEs
 REGULATIONS RELATED TO
SURVEILANCE ACTIVITIES
1. UU No 4 1984 about communicable disease
outbreak
2. UU No. 22 1999 (revision UU No.32 2004) about
Provincial government
3. UU No. 25 1999 (revision UU No.33 2004) about
balance of financial responsibility between
central government and provincial government
4. UU no 25 2000 about Propenas
 PP No. 25 year 2000 :
The distribution of right/responsibility for
central and peripheral government
(autonomy)

Health sector (under J point)
Epidemiological surveillance and control of
communicable disease and outbreak is the
responsibility of provincial/peripheral
government
 SURAT KEPUTUSAN
HEALTH MINISTER OF RI
No 1116 / MENKES / SK / VIII / 2003
About

GUIDELINES OF EPIDEMIOLOGICAL
SURVEILLANCE SYSTEM FOR HEALTH
 SCOPE OF EPIDEMIOLOGICAL
SURVEILLANCE OF HEALTH
1. Communicable disease epidemiological surveillance
2. Communicable disease epidemiological surveillance
3. Epidemiological surveillance for environmental health
and behaviour
4. Epidemiological surveillance for health problem
5. Epidemiological surveillance for health matra
Scope of STP (Surveilans terpadu
penyakit)
1. STP with data source from Puskemas
2. STP with data source from hospitals
3. STP with data source from laboratories
4. STP with data source from disease epidemics & food
poisoning (outbreak)
5. STP with data source from Sentinel Puskesmas
6. STP with data source from Sentinel hospitals
25 STP diseases
(Puskesmas data source )
1. Cholera 14. Clinical malaria
2. Diarrhea 15. Malaria Vivax
3. Bloody diarrhea 16. Malaria Falcifarum
4. Clinical Typhoid fever 17. Mix malaria
5. Smear positive pulmonal TB 18. Dengue Hemorrhagic Fever
6. Clinical pulmonal TB 19. Dengue Fever
7. PB Leprae 20. Pneumonia
8. MB Leprae 21. Syphilis
9. Measles 22. Gonorrhea
10. Diphtheria 23. Frambusia
11. Pertussis 24. Filariasis
12. Tetanus 25. Influenza
13. Clinical hepatitis
29 STP diseases (Hospitals data source)
1. Cholera 14. Clinical malaria
2. Diarrhea 15. Malaria Vivax
3. Bloody diarrhea 16. Malaria Falcifarum
4. Clinical Typhoid fever 17. Mix malaria
5. Smear positive pulmonal TB 18. Dengue Hemorrhagic Fever
6. Clinical pulmonal TB 19. Dengue Fever
7. PB Leprae 20. Pneumonia
8. MB Leprae 21. Syphilis
9. Measles 22. Gonorrhea
10. Diphtheria 23. Frambusia
11. Pertussis 24. Filariasis
12. Tetanus 25. Influenza
13. Clinical hepatitis 26. Encephalitis
27. Meningitis
28. Typhoid fever (widal +)
29. Hepatitis (HbS Ag + )
8 STP diseases (Laboratories data source)
1. Cholera
2. Typhoid Widal /culture(+)
3. Diphtheria
4. Hepatitis HBsAg(+)
5. Vivax Malaria
6. Falcifarum Malaria
7. Mix malaria
8. Enterovirus
20 STP noncommunicable diseases
( sentinel Hospitals data source )
1. Angina pectoris 11. Diabetes melitus (DM) malnutrition
2. Acute myocard infarct (AMI) 12. Diabetes melitus (DM) YTD lainnya
3. Subsecuence MI 13. Diabetes melitus (DM) YTT
4. Essential Hipertension (primer) 14. cervix cancer
5. Heart hipertension 15. breast cancer
6. Renal hipertension 16. Liver & biliaric duct intra-liver cancer
7. Heart and renal hipertension 17. bronchus & lung cancer
8. Secondary Hipertension 18. COPD
9. Insulin dependent DM 19. Traffic Accidents
20. Psychotic disorders
10.Non insulin-dependent DM
 Focus of Epidemiological
Surveillances 2004-2009
1. Improve activities/quality of Surveilans
Terpadu Penyakit (STP)
2. Improve activities/quality of integrated-
Surveillance of AFP, measles & NT
3. Improve activities/quality of Early
detection & control of epidemics
Focus of Epidemiological
Surveillances 2004-2009
4. Improve special & disease priority
surveilance system
5. Develop network of epidemiological
surveillance, vertical & horizontal
6. Improve the quality of human
resources
Integrated-special surveillance

Avian Influenza
 KLASIFIKASI KASUS A.I. (WHO)

KASUS SUSPEK

1. Demam ( 38C) disertai dengan batuk dan

atau pilek dan atau sakit tenggorokan,
dengan salah satu keadaan :
2. Satu minggu terakhir mengunjungi
peternakan tempat KLB A.I.
3. Kontak dengan kasus konfirmasi
4. Bekerja di lab yang memproses sampel A.I.
baik pada binatang ataupun manusia
 KLASIFIKASI KASUS A.I. (WHO)

KASUS PROBABEL

Kasus suspek diikuti dengan salah satu keadaan

1. Hasil pemeriksaan lab. terbatas untuk Influenza

tipe A (H5N1), seperti H.I. test
2. Dalam waktu singkat menjadi Pnemonia / Gagal
Nafas / Meninggal
3. Terbukti tidak ada penyebab lain
 KLASIFIKASI KASUS A.I. (WHO)

KASUS KONFIRMASI

Kasus suspek atau probabel

didukung oleh salah satu hasil laboratorium :

1. Kultur virus : Virus Influensa H5N1

2. PCR : Influenza H5N1
3. Titer antibodi terhadap H5 meningkat 4 kali
STAGING OF AI PANDEMIC IN HUMAN

A. Interpandemic Stage :

Phase 1 : Low Risk For Human

Phase 2 : High Risk For Human
STAGING OF AI PANDEMIC IN HUMAN
B. Pandemic Allert Stage :
Phase 3 : No or only Ineffective human to human
transmission
Phase 4 : Evidence for human to human (limited)
Phase 5 : Significant increased human to human
STAGING OF AI PANDEMIC IN HUMAN

C. PANDEMIC STAGE

Phase 6 : Human to human (large area)

 ALUR PIKIR
SE AI TERINTEGRASI
Manajemen Program DEPTAN
A
R I
E N SEHAT
A T
E Host Agent Envir
K G
E R SAKIT
R A
J S
A I
Manajemen Program DEPKES

D D Informasi DIMANFAATKAN BERSAMA DEPTAN & DEPKES

E E Time MELALUI
P P Place JEJARING SURVEILANS TERINTEGRASI
T K Person
A E
N S

Disepakati:
Surveilans Rutin Siapa berbuat apa
Pencegahan Kapan, Dimana
Penyelidikan Mekanisme kerja
Penanggulangan Instrumen / Format
 PRINSIP TANGGUNG JAWAB
SE A.I. TERINTEGRASI
D
D Periode
Interpandemi (Fase 1 & 2) E
E
P
P Periode
Waspada pandemik (Fase 3,4 & 5) K
T
E
A
Periode S
N Pandemik (Fase 6)
 Pengorganisasian & Mekanisme kerja
(berlaku untuk masing-masing tingkatan)
Tim SE AI terintegrasi
Tingkat Nasional, Propinsi, Kabupaten/Kota

Forum
Sharing Data
Hasil SE Hewan & Hasil SE Manusia
Kajian Bersama

Rekomendasi

Respon Cepat Terintegrasi dgn Leading

- Unggas & Faktor Risiko Deptan
- Manusia Depkes