Integrated Disease Surveillance Programme

Activity (May 2016 )

Protecting People

Saving lives

Introduction

• IDSP is a Decentralized District-based System ofweekly

surveillance for communicable Diseases so that timelyand effective Public Health actions can be initiated inresponse to the incidence of Disease Outbreaks in theurban and rural Areas.

• Started in Jammu & Kashmir during FY 2006-2007 underNSPCD (National Surveillance Programme forcommunicable Diseases).

Objectives

To Detect early warning signals of impending outbreaks.

To Integrate, Co-ordinate and Decentralize surveillance activities

To establish system for quality Data collection, Reporting, Analysis and Feedback using IT.

To improve Laboratory Support for disease surveillance

Responsibilities

Strengthening of Epidemiological capabilities at State and

District level by training of District RRT and Health

personnel at the periphery.

Modernization and Computerization of State & District Epidemiology cell.

Strengthening of State / District Laboratories.

Improving Sub-District Mobility and Communication.

IEC Activities.

Expected Outcome

Early Detection of Outbreaks.

Early Institution of Containment Measures.

Reduction in Morbidity & Mortality.

Minimize Economic loss.

ADMINISTRATIVE STRUCTURE

CENTRAL SURVEILLANCE UNIT (CSU) New Delhi

STATE SURVEILLANCE UNIT (SSU) Barzulla, Srinagar

Kashmir Division has one State Surveillance Unit.

Two Sentinel Surveillance units one each at GMC Srinagar and SKIMS.

DISTRICT SURVEILLANCE UNIT (DSU)

• One DSU in each of the Twelve districts

Establishment of Rapid Response Team at Districts** Twelve Districts have established Rapid Response Team

DistrictSub Centres PHC/SDH/DH Laboratories

Anantnag 121 43 41

Budgam 116 58 36

Bandipora 71 36 42

Baramulla 115 54 25

Ganderbal 55 31 17

Pulwama 96 53 24

Kulgam 104 32 23

Srinagar 80 40 24

Kargil 131 22 12

Leh 114 18 1

Kupwara 198 47 44

Shopian 46 13 9

TOTAL 1247 447 298

Reporting units on IDSP Portal

Physical Performance

Indicators 20152016

(Ending May)

Number of Outbreaks Managed45 22

Reporting on Web Portal91.6 % 97 %

Laboratory tested performed3124 1290

Laboratory confirmed outbreaks in 2016 Measles = 2

Performance at a Glance

Performance Indicators 2012 2013 2014 2015

Outbreaks Managed 54 57 45 45

Laboratory tests conducted 1643 3345 2930 3124

Reporting on IDSP National WebPortal

63% 78% 84 % 91.6%

COMPARATIVE DETAILS

Salient features of activities since its inception in 2004• The percentage of reporting from Reporting units (RUs) from all the districts of Kashmirdivision(12 districts) has increased for past three years from 78 per cent in 2013 to 91.6 per cent in2015• The number of outbreaks have declined 57 in the year 2013 to 45 in the year 2015 because ofhealth education to the community at district level and control of outbreaks in timely manner as aresult of early intervention.• Awareness regarding communicable disease was given to the community both in print (Posters ,pamphlets ) and electronic media and as well on Social media• Awareness about emerging various viral disease like Influenza A H1N1 , MERS COv , Ebola Viraldisease (EVD) , Zika virus disease (ZIKV) was given to Health care workers and to the community .

Number of Outbreaks and Cases

Disease2016

Number Cases

Acute Respiratory Infection 1 15

Influenza A (H1N1) 0 0

Acute Diarrheal Disease 1 62

Measles 3 42

Hepatitis 3 88

Food Poisoning 0 0

Mumps 0 0

Chicken Pox 10 189

Enteric Fever 1 11

Dermatitis 0 0

Acute Viral Conjunctivitis 1 47

Hand Foot Mouth Disease 1 414

Pertusis 1 94

Total 22 outbreaks

S. No. District Percentage of Reporting (%)

1 Anantnag 1002 Budgam 993 Bandipora 1004 Baramulla 97.75 Ganderbal 95.56 Pulwama 1007 Kulgam 98.58 Srinagar 959 Kargil 90

10 Leh 92.511 Kupwara 10012 Shopian 100

Total Percentage 97%

District-wise Reporting status of SPL Forms on National PortalMay -2016

Laboratory WorkDistrict Priority Lab IDSP JLNM Hospital Srinagar

Diseases Covered

Air Borne Disease (ABD)

• Inf. A, B, Inf. A H1N1

• Measles

• Diphtheria

• Chicken pox

• Acute Respiratory Infection(ARI)

• Influenza like illness (ILI)

• Pneumonia

• Meningococcal Meningitis

Water Borne Disease (WBD)

• Enteric Fever

• Hepatitis A,E

• Acute Diarrheal Disease

• Bacillary Dysentery

• Viral Hepatitis

• Enteric Fever

• Typhoid Fever

• Cholera

• Fever of Unknown origin (PUO)

Vector Borne Disease (VBD)

• Dengue/DHF/DSS

• Malaria

• Chikungunya

• JE

• Zika Virus

Other (Specify) ANTI-HCV Other (Specify)HBSAG

Monthly- Comparative list of tests done at District Priority Lab IDSP

Name of test May - 2015 May - 2016

Total Water samples Tested 15 30

Blood Samples for Serology ( Typhi Dot / Measles)

10 11

Cultures to check sterility of OT’s 3 15

Stool culture 11 10

Rotavirus Ag from Stool 5 0

Blood Culture 15 20

Wound culture 9 15

Urine Culture 60 40

IgM to HAV & HEV by ELISA 63 52

Total 191 201

Laboratory confirmed outbreaks in 2016 Measles=2

Epidemic Action plan on Shri Amarnath ji Yatra 2016Preparedness for control of outbreaks

Surveillance strategicSurveillance of Epidemic prone diseases (Water Borne Diseases) by District Surveillance units Ganderbal and Anantnag.

Rapid Response Teams assigned in Ganderbal and Anantnag

Action Plan Regular random sampling of water at main base camps will be collected by DSUs of respective districts which will be tested in Public

health laboratory (PHL) at Barzulla and test results will be communicated to the concerned DSUs. Regular Health education to be given by CHOs and Health Educators to the pilgrims regarding safe drinking water and sanitation

through infographics.

Water collection bottles to be kept available at DSUs of each Districts.

Chlorine tablets to made available at the respective DSUs.

Posters and infographics to be displayed in Health camps and distributed to the pilgrims.

District Anantnag District Ganderbal State Surveillance Office

District Health Officer District Health Officer Epidemiologist

Epidemiologist Data Manager Microbiologist

Data Manager

RAPID RESPONSE TEAMS (RRTs) FOR ZIKA VIRUS DISEASE (ZIKV)KASHMIR DIVISION

District Designation

At Divisional

Level

State Surveillance Officer IDSP

State Epidemiologist IDSP

State Microbiologist IDSP

Anantnag Physician

Pediatrician

Epidemiologist

Budgam Physician

Pediatrician

District Health Officer

Bandipora Physician

Pediatrician

Epidemiologist

Baramulla Physician

Pediatrician

Epidemiologist

Ganderbal Physician

Pediatrician

District Health Officer

District Designation

Kulgam Physician

Pediatrician

Epidemiologist

Kupwara Physician

Consultant Medicine

Epidemiologist

Pulwama Physician

Pediatrician

District Health Officer

Srinagar Physician

Pediatrician

Epidemiologist

Microbiologist

Shopian Physician

Pediatrician

Epidemiologist

Leh Physician

Pediatrician

District Health Officer

Kargil Physician

Pediatrician

Epidemiologist

Passive surveillance of Hajj Piligrims at Srinagar International Airport for

MERS CoV and H1N1

Issuing Public Health Advisories to all districts on H1N1, Floods, Hepatitis, Measles, Gastroenteritis, ARI, Cholera,

Chicken Pox, Ebola, MERS-CoV from time to time.

Advisories & Surveillance

•As per the directions received from EMR , the Information in terms of IEC material with helpline numbers were given to Hajj pilgrims.

30th Sept - 14th October 2015

HELP-DESK for MERS COv Hajj Pilgrims at Srinagar International Airport

All private Hospitals of Kashmir province are informed to submit P and L

forms on regular and timely manner ( Letter with Hard copies of P and L ) form already submitted to concerned institutes

Issuing Public Health Advisories to all districts on Zika Virus (ZIKV)

Posters and infographics to be displayed in Health camps and distributed to the pilgrims during Shri Amarnathji Yatra 2016.

Innovations by the State IDSP Unit• Epidemic Action plan on Shri Amarnath ji Yatra 2016 Surveillance of Epidemic prone diseases (Water Borne Diseases) by District Surveillance units Ganderbal andAnantnag. Rapid Response Teams assigned in Ganderbal and Anantnag

• Passive surveillance of Hajj Pillgrims at Srinagar International Airport for MERS CoV and H1N1

• Issuing Public Health Advisories to all districts on H1N1, Floods, Hepatitis, Measles, Gastroenteritis, ARI, Cholera, Chicken Pox, Ebola, MERS-CoV from time to time

• Issuing Public Health Advisories to all districts on Zika Virus (ZIKV)

• Posters and infographics to be displayed in Health camps and distributed to the pilgrims during ShriAmarnathji Yatra 2016.

• Initiative taken to validate and verify S,P and L surveillance data in districts. Direction to DSU to conduct surprise visits for verification of S,P and L forms.

• Visits by a team from the state surveillance office to Districts for monitoring activities at District surveillance units.

• Inclusion of Private Hospitals and Nursing Homes in IDSP Surveillance system.

Media ScapeRegarding alerts, activities and information of Outbreaks, some articles and advisories are published in print media like newspapers etc to aware general public about the possible prevention and containment procedures.

Issued ‘Advisories’ as Infographics"Started implementing on infograhics in IDSP Kashmir, as we have frequent outbreaks of ADD, ARI , VPD,WBD in our valley. These infographics can be printed and displayed at your Health institutions and at the time of outbreaks distributed among the community. The first of this series is on the topic of Measles which is attached here"CMOs of the districts are asked to all the BMOs of their districts and as such the information will finally reach to the community at large.

New Approved Labs under IDSP

District Approved Status

Anantnag and Baramulla 2013-14 Not established (no funds received from GoI for the establishment of Labs)

Pulwama, Kupwara & Budgam 2014-15 Not established (no funds received from GoI for the establishment of Labs)

Establishment of IDSP Public Health Laboratory at three Districts viz. Anantnag, Baramulla and Budgam. Laboratory Items (Media & Serology Kits for investigation of Outbreaks like Dysentery ,Cholera Hepatitis A & E, Measles, Dengue, &) Repairing of Laboratory Equipments.

Expected Laboratory Targets for coming quarters.

Category Sanctioned Vacant In position Name of District with vacancy

Epidemiologist 13 4 9 Budgam, Leh, Ganderbal, Pulwama

Microbiologist 2 0 2 -

Entomologist 1 1 0 SSU

State Training Consultant 1 1 0 SSU

Consultant Finance &

Procurement Officer1 0 1

_

State Veterinary

Consultant1 1 0 SSU

Data Manager 13 1 12 Baramulla

Data Entry Operator 15 5 10 Srinagar(3), Leh(1), Anantnag(1)

Grand Total 46 12 34 -

CATEGORIZED MANPOWER STATUS (as on May - 2016)

* Due to lack of Funds during 2014-15 and 2015-16, the vacancies could not be filled.

Year Doctors /Paramedics Trained

2010-11 220

2011-12 185

2012-13 -

2013-14 130

2014-15 -

2015-16 -

Trainings Conducted under IDSP(2010-11 to 2015-16)

Year 2012 2013 2014 2015

Manpower Filled 66% 75% 75 % 76 %

Manpower trained nil 130 nil nil

Strategic Health Operations Centre (SHOC)

• Establishment of Crisis Management Center at State Surveillance

unit Barzulla Srinagar during Sept Floods 2014.

• Establishment of Control Room at State Surveillance unit Barzulla Srinagar for

MERS CoV, Zika Virus and influenza H1N1

RRT IDSP during floods 2014 Ex-Union Minister for Health on visit to Control room – during

Floods2014

• House to House Survey of Community need Health Assessment during Floods 2014

RRT IDSP during Surveillance for Inf H1N1

H1N1 Screening Status

Period Samples collected Positive

Oct 2014 to April 2015 71 24

Oct 2015 to April 2016 54 0

DSU Pulwama to Block Tral, Pulwama and Pampore, Pulwama(Dated: 12-19 May 2016)

DSU Srinagar to Zone Batmaloo, Srinagar

(Dated: 03 May 2016)

Visits by District Surveillance Units for validation of S,P and L surveillance data

DSU Bandipora

DSU Shopian

Acute Respiratory Infection (ARI) - Inf. A, B, Inf. A H1N1,Measles,Chicken pox, Acute Respiratory,Diphtheria,Pneumonia,Meningococcal Meningitis

Water Borne Disease- Enteric Fever,Hepatitis A,E, Diarrhea, Dysentery,Typhoid Fever,Cholera,Feverof Unknown origin

Vector Borne Disease- Dengue,Malaria,Zika Virus,Chikungunya,JE

Surveillance during Disasters- Floods, Earthquakes

Hospital Infection Control- for control of Nosocominal infection

Water Quality Monitoring- To check the contamination of drinking water

Laboratory Surveillance of Communicable Disease

Testing Facility 1 : District Priority Laboratory DPL, JLNM Hospital, SrinagarTesting Facility 2: Provincial Public Health Laboratory PHL, State Surveillance Unit, Srinagar

Recent Outbreaks at a Glance

Hand Foot and Mouth Disease in District Leh(HFMD)

Number of cases 414Villages affected: Choglamsar, Saboo,Leh, Solar colony, Hemis, Igoo, Taru, Meru, Bogdang, Augling, Meru, Bema

Population of affected area: 28853

Age group affected: < 10 years.

Date of Outbreak : 02/05/2016

47 cases detectedAffected Population= 168

ACUTE VIRAL CONJUNCTIVITIS

Affected District LehAffected Village TarukAffected school Residential school taruk

Outbreak of Chicken Pox in District KulgamDate of Outbreak : 06/05/2016

Number of cases: 50 Village affected: Block D H Pora, Village Nagam

Population of affected area: 2789

Age group affected: 4 – 11 years.

Outbreak of ADD in BaramullaAcute Diarrheal Disease

Number of cases: 60

Villages affected: Boniyar Sub center Hundi Village Hundi

Population of affected area: 736

Age group affected: 2 to 60 years

Date of Outbreak : 13/05/2016

District and village affected: Natipora, Madrasa Babul Aloom, SrinagarNumber of students enrolled in a school : 120

Number of cases: 22 Age group affected: 06- 18 years Control measures performed: Health education to madrasa authorities was imparted regarding the disease and its preventive measures. Isolation of patients and systematic treatment with medicines was advised in case of fever.

Outbreak of Chicken Pox in SrinagarDate of outbreak: 13-05-2016

Outbreak of Chicken Pox during 2015

THANK YOU