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National Disease Surveillance MechanismsNational Disease Surveillance Mechanisms
Aamer Ikram AFIPMuhammad Safdar NIH
Pakistan
BWC Experts Meeting UN Geneva
World a safer place World a safer place
ChallengesEmerging Infections Re-emerging Infections
Courtesy: National Geographic
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1 4 7 10 13 16 19 22 25 28 31 34 37 40
DAY
CASES
Early Outbreak Detection and ResponseEarly Outbreak Detection and ResponseFirst Case
Detection/Reporting
LabConf
Response
Opportunity for control
Snapshot Snapshot -- Health StatusHealth Status
lPopulation 163.76 M
lGrowth rate 1.73%
lEpidemic Transition– Communicable Disease Mortality - Decreasing
– Non-communicable Diseases Mortality - Rising
Priority Communicable DiseasesPriority Communicable Diseases
– Tuberculosis
– Viral Hepatitis B & C
– Malaria
– Hemorrhagic fevers (Dengue and CCHF)
– Polio, Measles & Other EPI diseases
– Water and food borne diseases
– Pandemic Influenza and other Zoonoses
Mechanisms under MoHMechanisms under MoHl Health Management Information System at the National
Health Information Resource Centre (NHIRC) l Diseases surveillance initiatives at NIH Pakistanl Public health testing for Communicable Diseases, Food &
Water at NIHl Surveillance systems of vertical preventive health
programs (TB, Hepatitis, Malaria, HIV/AIDS, Influenza, EPI, Polio)
l MoH-WHO Disease Surveillance and Response System in disaster hit areas
Health Management Information SystemHealth Management Information Systeml Caters information needs of the MoH and
Provincial/District Health Departments
l 118 districts and approx 10,000 Public sector facilities
l 18 communicable diseases being reported
l Joint MoH, WHO, CDC and World Bank review/assessment of existing surveillance systems
Diseases surveillance initiatives at NIHDiseases surveillance initiatives at NIH
lNational and Provincial Task Forces on CDslNational Steering Committees (NSC)
– Avian/Pandemic Influenza (Joint NSC)– Field Epidemiology & Laboratory Training Program
lEarly detection, investigation and response to the outbreaks through Epidemic Investigation Cell
lDisease Early Warning System (DEWS)lSeasonal Awareness and Alert Letter (SAAL)
upcoming seasons
lField Epidemiology and Laboratory Training Programme (FELTP)
lFocal Point for IHR 2005lLegal framework for diseases surveillance lCapacity building of health professionals through
training workshops under WHO-MoH Program on:– Health Laboratory Support and – Disease Early Warning System (DEWS)
Diseases surveillance initiatives at NIHDiseases surveillance initiatives at NIH
Epidemic Investigation Cell (EIC) Epidemic Investigation Cell (EIC) 1. Nationwide monitoring 2. Technical support - guidelines,
SOPs, trainings and DEWS tools
3. Response when called by respective departments
4. International collaboration 5. Disease Early Warning System6. > 600 alert/outbreaks
responded since 1998
Disease Early Warning SystemDisease Early Warning System
lOperational since 1998 as a joint MOH/ WHO
initiative
l Early detection of outbreak
l Syndromic Case Definitions, Reporting Forms
and watch charts help in disease monitoring
lData analysis at facility/local level
lMaster level training in collaboration with CDC
lRegular short courses
Field Epidemiology and Laboratory Training Field Epidemiology and Laboratory Training Programme (FELTP)Programme (FELTP)
Legal Framework for Diseases SurveillanceLegal Framework for Diseases Surveillance
lDevelopment of legal frame-work – collaborative initiative – MoH-NIH-CDC-WHO
lWould complement the dispensation of IHR 2005
LabLab--based surveillance projectsbased surveillance projects
lRegional Reference Lab for Polio Eradication with assistance from CDC, WHO, JICA and Rotary InternationallNational Lab-based Influenza Surveillance with
assistance from CDClMeningitis Lab-based Surveillance with assistance
from WHOlRota Virus Lab-based Surveillance
Disaster affected areasDisaster affected areas
lCollaborative initiative of MoH-WHO
lOperational areas:
– Earthquake affected
– Flood affected
– IDPs hosting areas
lSurveillance findings published as Weekly Morbidity and Mortality Report (WMMR)
Future DirectionsFuture Directions
l Implementation of the Integrated Disease
Surveillance Program (IDSP)
lMonitoring of infectious disease trends – animal
& plant
l Strengthening of Response Units
l Regional collaborative networking for a wider
response
Armed Forces Institute of PathologyArmed Forces Institute of Pathology
l Reference Diagnostic & Research Institute
l Inter-services Institutes & Military Hospitals
l Private Hospitals
lNotification of Infectious Diseases
lQuarterly Summary
l Instructions – Surgeon General Pak Army
Supporting ElementsSupporting Elements
lGlobal/Regional Surveillance
lLocal/International Notifications
lResearch Activities/Publications
» Pakistan Medical Research Council
» Universities/Medical Colleges
Professional BodiesProfessional Bodies
l Infectious Disease Society Pakistan
l Infection Control Society Pakistan
l Pakistan Association of Pathology
l Pakistan Biological Safety Association
“Without concerted and coordinated political action, the gains achieved in reducing the burden of infectious disease will be washed away as a new wave of preventable illnesses engulfs those least able to protect themselves”
~ Richard HortonLancet