Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
What is Public health Surveillance ?
Epidemiologic Surveillance is the systematic collection,
analysis, interpretation and dissemination of health data in
an ongoing basis

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
 Use of surveillance information:
Priority setting and planning
Resource mobilization and collection
Prediction and early detection of epidemics
Early and adequate detection/ response to epidemics
Monitoring and evaluation of intervention
Surveillance: Surveillance can be conducted:
Globally ( AIDS surveillance system managed, WHO),
Regional (polio surveillance in Latin America),
Institutional (hospital acquired, refugee camps).

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Sources of Data for Surveillance: The following are
some key sources of surveillance data, not all of which
are available in every country:
Census data: periodic enumeration of a population
Reports (birth & death certificates, autopsy, corpse exam)
Morbidity reports
Hospital data (discharge, surgical logs, infection)
Absenteeism records (school, workplace, claims)
Epidemic reports
Laboratory test utilization and result reports

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
 Drug utilization records and adverse drug reaction
Special surveys (e.g., research data)
Police records (especially for injury, alcohol risk)
Information on animal reservoirs and vectors (
rabies, plague)
Environmental data (hazard surveillance, water and
food testing)

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
Types of Surveillance
PASIVE: Is that in which health care providers send
reports based on a known set of rules and regulations
ENHANCED: Collection of additional data reported
under routine surveillance.
INTENSIFIED: The upgrading from passive to an
active surveillance system. Limited period (because of
out break)
ACTIVE: Surveillance where public health officials
seek reports from participants in the surveillance system
on a regular basis, rather than waiting for the report
Limited to specific diseases over a limited period
Bio - Lecture note, G/her B (BSc, MSc, Ass.
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Prof.)
 Conditions in which surveillance appropriate:
Periodic evaluation of ongoing programs - HIV/AIDS
Programs which have time limit of operation - Small pox
With the occurrence of unusual situations:
when a new disease/event discovered
when investigating a new mode of transmission
when a high-risk period is recognized
when a disease appears in a new geographic area or found to
affect a new subgroup of the population
When previously eradicated disease reappear

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
Features of good surveillance system
Uses combination of passive & active surveillance
Emphasize collection of minimum data in simplest
way.
Make sure that the data collected is useful for the
workers who collect the data.
Timely reporting.
Timely and comprehensive action.
both case detection and treatment
Strong laboratory services for accurate diagnosis

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
 Rationale for monitoring of Surveillance
Keep Standards
Maintain high quality
Good data + good analysis = good system = useful
Good data + bad analysis = bad system = useless

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
Evaluation of Surveillance: The following aspects of the
system should be assessed:
The importance to the public health:
Incidence and prevalence
Severity (case-fatality or death-to-case ratio)
Mortality (overall and age-specific mortality rates,
years of potential life lost)
Health care costs
Potential for spread
Preventability

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
 The objectives and operation of the system
The case definition of the health event
The population under surveillance
the time period for data collection (weekly, monthly,
annually)
What information is collected (Is it what programs
need?)
The reporting sources
How data are handled (transfers, delays,
confidentiality)
How data are analyzed (by whom? frequency)
How data are disseminated
Bio - Lecture note, G/her B (BSc, MSc, Ass.
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Prof.)
 The systems usefulness
Action taken to date as a result of the information
Future or potential uses
Cost or resource requirements for system operation
Attributes or qualities of the surveillance system
Simplicity
Flexibility
Acceptability
Sensitivity
Representativeness
Timeliness
Bio - Lecture note, G/her B (BSc, MSc, Ass.
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Prof.)
 Limitations of Surveillance System
Under reporting (such as due to lack of knowledge of
reporting requirements, negative attitudes toward
reporting)
Lack of representativeness of reported cases (such as
due to a bias toward reporting severe cases, or
increased likelihood of reporting after publicity)
Lack of timeliness
Inconsistency of case-definitions

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
Factors related to selection of disease for surveillance:
Magnitude of the disease
Feasibility of control measures
Need for monitoring and evaluating the performance of
a control program
Resource availability

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
 Selecting Priority disease for Surveillance:
Does the disease result in a high disease impact?
(Mortality, Disability, Morbidity)
Does it have a significant epidemic potential?
(E.g. Cholera, Meningitis, Measles)
Is it a specific target of a national, regional, or
international control program?
Is it disease with potential to rapidly spread across
national boundaries?
Will the information to be collected lead to significant
public health action?
(E.g. Immunization campaign)
Bio - Lecture note, G/her B (BSc, MSc, Ass.
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Prof.)
 Core activities of serveillance
Detection (identifying cases and outbreaks)
Registration
Conformation (Epidemiological and Laboratory)
Reporting (early warning and routine)
Analysis and interpretation
Response (preventive and control measures, out
break investigation, program adjustment, changes
in policy and planning)
Feedback
Evaluation and Monitoring
Bio - Lecture note, G/her B (BSc, MSc, Ass.
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Prof.)
Support activities of surveillance
Setting standardize:
Case definitions
Standard case management guidelines
Standard procedures for investigation
Training:
Surveillance
Epidemiology
Laboratory
Supervision
Communications: radio, fax, e-mail, phone, health updates
Providing Resources:
Human
Material
Financial

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
Integrated Disease Surveillance
and
Response (IDSR)

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
 IDSR Concept and Experience in Ethiopia:
Integrated disease surveillance and response (IDSR)
is an approach adapted to strengthen national disease
surveillance systems by coordinating and
streamlining all surveillance activities and ensuring
timely provision of surveillance data to all disease
prevention and control programs in order to initiate
timely response (intervention).

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
 IDSR in Ethiopia:
IDSR initiative was launched by the WHO-AFRO
(Africa regional office for WHO) in the second half of
the 1990s.
Since then the initiative has been adapted by many
African countries including Ethiopia.
In fact, Ethiopia was one of the countries in Africa that
has made good progress in IDSR implementation.

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
 Adaptation of the national guidelines and training
modules for IDSR,
Training modules were prepared
Training for professionals from national to woreda
level, and
Preparation and distribution of relevant forms are
completed.
Data collection and reporting using the IDSR guideline
and forms is also initiated

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
 Strategic objectives of IDSR:
Design disease surveillance system on priority
disease (???13)
Case- based reporting on selected diseases
Integrate all surveillance activities
Strengthen surveillance data management
Strengthen the capacity and involvement of
laboratories in IDSR

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
 Activities : IDSR to achieve objectives, it seeks to:
Strengthen the capacity of Woredas to conduct
effective surveillance activities
Integrate multiple surveillance systems so that forms,
personnel and resources can be used more efficiently
and effectively
Improve the use of information for decision making
Improve the flow of surveillance information
between and within levels of the health system

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
 Improve laboratory capacity in identification of
pathogens and monitoring of drug sensitivity
Increase the involvement of health workers in the
surveillance system.
Emphasize community participation in detection
and response to public health problems
Strengthen the involvement of laboratory personnel
in epidemiological surveillance

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
Disease of IDSR important:
List of Priority diseases in Ethiopia: Epidemic- born Disease
1. Cholera
2. Diarrhea with blood (Shigella)
3. Measles
4. Meningitis
5. Plague
6. HIV/AIDS
7. Viral Hemorrhagic fever
8. Yellow fever
9. Typhoid fever
10. Relapsing fever
11. Epidemic Typhus
12. Malaria
13. Bird flue

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
Disease of International Interest
Targeted for eradication
Dracunculiasis ( Guinea worm)
Poliomyelitis (Acute flaccid paralysis)
American Trypanosome / chagas disease
Leprosy
Lymphatic Filariasis
Measles
Targeted for reduced incidence/prevalence
?HBV
Malaria
Tuberculosis

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Prof.)
Targeted for reduced transmission
HIV/AIDS
Disease submitted to international health regulation
Cholera
Plague
Yellow Fever

Bio - Lecture note, G/her B (BSc, MSc, Ass.

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Bio - Lecture note, G/her B (BSc, MSc, Ass.
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Prof.)