Improving SARI Surveillance in Saint Lucia Ministry of Health, Wellness, Human Services and Gender Relations Saint Lucia Presented by: Saint Lucia Ministry of Health Team

COUNTRY PROFILE Saint Lucia is a small volcanic island located midway down the Eastern Caribbean chain, 40 km south of Martinique and 32km north of St. Vincent. The island has an area of 238 sq miles/616sq km (measuring 27 miles long and 14 miles wide). Population (2010 Census) : 166, 526 persons ( 82, 926 males and 83, 600 females) Population density : 796 persons per square mile.  Estimated mid-year population of 2015 is 173,638

Health care Facilities 2 General Hospitals Victoria located in the north St. Jude located in the south Primary health care services 33 Wellness centers 2 District hospitals 1 Private hospital 1 Polyclinic 8 health regions throughout the island 1 Psychiatric hospital 1 Drug Rehabilitation centre

Previous SARI Information System Data is collected by Infection Control Nurses SARI information is sent along with other disease information for addition to the case notification database (paper based) Denominator based Data is also sent in summary form to the Epi Unit Confirmatory lab results are sent on forms Collected from 32 Wellness centre, 2 public hospitals and 1 private hospital Data is collected from these sites and sent via email, fax or phone Data from the HMIS (which covers 28 Wellness centres) is sent via email Data is entered using excel

Data Analysis Analysis is done using excel. Incidence of cases by health region and settlement is done using 2015 population estimates as the denominator.

Alert threshold: The critical number of cases (or indicator, proportion, rate, etc.) that is used to sound an early warning, launch an investigation at the start of an epidemic and prepare to respond to the epidemic. Epidemic threshold: Is the critical number or density of susceptible hosts required for an epidemic to occur. The epidemic threshold is used to confirm the emergence of an epidemic so as to step-up appropriate control measures. Seasonal threshold: defines the start and end of the season (in this case for the specified syndrome). The two intensity thresholds, termed average and alert thresholds, describe relative seasonal intensity.

Limitations of Previous System Data is in summary form Missing important variables Sex Other Age groups Onset dates Vaccination information Travel history Comorbidities Risk factors Double entry of data by ICN’s No Standard Operating Procedure for Data management Time lag in the data entry of confirmatory lab results

SARI Data Analysis using Online System and Dashboard PAHOFlu Allows for multi user data entry in real time Immediate lab updates

Comorbidities (February-April) Risk Factors % of SARI Cases Asthma 61 Diabetes 9 Pulmonary 7 Immuno-compromised Renal complications 2

Use of GIS

Custom made SARI Surveillance form for use with smart devices.

The way Forward…. Continue fine tuning the online database Continue being vigilant with the data entry Implement the use of smart devices for data entry Publishing more in-depth SARI analyses in Weekly Syndromic Report Publish an article : Saint Lucia SARI Online Surveillance System, Year one.

Acknowledgements PAHO/ WHO Team CARPHA Team Saint Lucia Team Epidemiology Unit Laboratory Team Infection Control Nurses Special mention: Suriname Team

THANK YOU Gracias