Epidemiological Surveillance Kumnuan Ungchusak Bureau of Epidemiology Department of Disease Control Ministry of Public Health <kum@health.moph.go.th>

Key points its significant surveillance system: How it works Source of information common weakness how to improve evaluation of surveillance system

Question : What are the role of these gods ?

Hakone’s Check point

I. The main purpose of Surveillance Surveillance for Knowledge of the distribution of health events Rapid detection of outbreak Public health planning and evaluation

II. Surveillance System: How it work? 1. Collection Record and report Collation: data analysis 3. Information synthesis 4. Dissemination timely action oriented

III. Source of information Morbidity Mortality Laboratory Vaccines and drug Outbreak news/ rumor Vector Behavior Environmental Demographic

Organization of Surveillance System Ministry of Public Health Dep of Disease Control International Organization Bureau of Epidemiology Regional Disease Control Center ข้อมูลรายงานโรค Provincial Epidemiological Unit ข่าวสาร/ข่าวกรอง District Surveillance information center Hospitals and clinic under universal coverage scheme Hospitals Under MOH And universal coverage schemes Private hospitals and clinics

Important CD Diseases Notification within 24 hours 1 SARS and Avian Flu 2.Cholera 3. Acute severely ill or death of unknown etiology 4. Cluster of diseases with unknown etiology 5. Anthrax 6. Meningococcal meningitis 7. Food poisoning outbreak 8. Encephalitis 9. Acute flaccid paralysis (AFP) 10. Severe Adverse Events Following Immunization ๑๑ Diptheria ๑๒ Rabies

Important CD Diseases 1 Measles 2. Pertussis 3. Hand Foot and Mouth Diseases 4. Influenza 5. Leptospirosis 6. Dysentery 7. Severe pneumonia of unknown etiology 8. Cluster of infectious cases 9. Dengue/DHF

Weakness No action (surveillance for statistics) No mandate (no receptor) No funtional epidemiologist (CD4 <200) No motivation

How to improve Surveillance

Surveillance and Rapid Response Team (SRRT) Tsunami Avian influenza Cholera outbreak Dengue

Surveillance and Rapid Response Team Control action ส่วนกลาง C-SRRT Intelligence เขต R-SRRT Information จังหวัด P-SRRT อำเภอ D-SRRT หมู่บ้าน ตำบล อสม ๑๐๐,๐๐๐

Influenza Pandemic 6 multi-countries 5. multiple outbreak 4. Confine easy H2H transmission 3. Human infection or inefficient H2H 2. Human at risk 1. New virus found

SRRTs Lay report Governor “SRRT ” 1030 Surveillance and Rapid Response AI provincial Team (Human and Animal) MoPH assigned “Mr. Bird Flu” Health services Governor “SRRT ” 1030 Surveillance and Rapid Response Team SRRTs (800,000 village health volunteers & community leaders) Lay report

(SRRT) Network Hospital Veterinarian Laboratory History screening at all hospital Testing of respiratory specimen Survey of village and identify exposure Active case finding and monitor household member for 10 days Antiviral prophylaxis for family member of confirm H5 cases Culling of affected poultry Educated villagers to avoid risk Laboratory Pathologists

Early pandemic Alert phase 4 Isolation & treat Ro = 1.5 - 2 Operational criteria for action: “5 or more cases within 10 days” Epidemiological linkage Human-to-human Evidence of viral change Isolation & treat Antiviral prophylaxis for all contacts Stop work /class in affected area Ro = 1.5 - 2

Influenza A (H1) outbreak at Samutsakorn 1700 workers ILI 180 stop work Isolated dormitory Daily temperature

Unknown pneumonia dead SRRT: Prae 13 yrs old boy, fever 3 day dead on arrival at district hospital , 6 April 3 out of 7 chicken died ??

Evaluation of surveillance system Mandate Structure clear unclear staff skill equipment funding institution functional Input Impact Output public health practice morbidity mortality policy information ( timely & action oriented) investigation implementation

Conclusion Surveillance to safeguard the people Start with priority disease reporting Timeliness is most crucial Detection of outbreak Investigation to know the cause