BY: Dr. Olagoke A. Ewedairo NOTIFIABLE DISEASES BY: Dr. Olagoke A. Ewedairo

OUTLINE Introduction Definitions Reasons for disease notification Factors that determine diseases which require reporting Disease surveillance Integrated Disease Surveillance and Response Chain of notification

INTRODUCTION Disease surveillance and notification (DSN) is part of the Health Management Information System (HMIS) which comprises databases, personnel, and materials that are organized to collect data which are utilized for informed decision making.

Formal reporting of notifiable infectious diseases is a requirement placed upon health care providers by many regional and national governments, and upon national governments by the World Health Organization. Since 1969, WHO international health regulation (IHR) has required that all cases of the following diseases be reported to the organization:

Cholera, plague, yellow fever, small pox, relapsing fever and typhus Cholera, plague, yellow fever, small pox, relapsing fever and typhus. In 2005, the list was extended polio and SARS. Regional and national governments typically monitor a larger set of communicable diseases (around 80 in the U.S.) that can potentially threaten the general population. A disease might be added to the list as a new pathogen emerges, or a disease might be deleted as its incidence declines. 

Many governments (including Nigeria) have now enacted regulations for reporting of both human and animal (generally livestock) diseases.  This protects the public's health by ensuring the proper identification and follow-up of cases, appropriate treatment; trace contacts who need vaccines, treatment, quarantine, or education; investigate and halt outbreaks; eliminate environmental hazards; and close premises where spread has occurred.

DEFINITIONS Disease notification is a process of reporting the occurrence of disease or other health-related conditions to appropriate and designated authorities. A notifiable disease is any disease that is required by law to be reported to government authorities. 

A notifiable disease is one for which regular, frequent, and timely information regarding individual cases is considered necessary for the prevention and control of the disease. Physicians are required by law to report cases of certain infectious diseases. Unfortunately, many do not.

Family physicians as gate keepers have a major role to play in disease notification. A study by Bawa SB et al. in Yobe state showed that only 38.2% of the respondents were aware of the national disease surveillance system Survey people who have managed potentially notifiable diseases and those who actually notified.

REASONS FOR SURVEILLANCE Evaluate the effectiveness of control and preventative health measures Monitor changes in infectious agents e.g. trends in development of antimicrobial resistance Support health planning and the allocation of appropriate resources within the healthcare system. Identify high risk populations or areas to target interventions Provide a valuable archive of disease activity for future reference.

Factors that determine which diseases to be reported Its interest to national or international regulations or prevention programmes  Its national incidence  Its severity (potential for rapid mortality)  Its communicability/ Its potential to cause outbreaks Significant risk of international spread  The socio-economic costs of its cases  Its preventability  Evidence that its pattern is changing

DISEASE SURVEILLANCE Disease surveillance is the ongoing systematic collection, analysis and interpretation of data for use in planning, implementation and evaluation of public health practice The main role of disease surveillance and notification is to predict, observe, and minimize the harm caused by outbreak and pandemic situations. We can not talk about notifiable diseases without talking about surveillance

Surveillance of notifiable conditions helps public health authorities monitor the effect of notifiable conditions, measure disease trends, assess the effectiveness of control and prevention measures, identify populations or geographic areas at high risk, allocate resources appropriately, formulate prevention strategies, and develop public health policies. 

A key part of modern disease surveillance is the practice of disease case reporting. All the reportable diseases have case definition to help the health care provider clearly define the cases to be reported. For examples of some case definition click the link below: http://www.who.int/ihr/Case_Definitions.pdf

Case definition for notification of SARS under the IHR (2005) A notifiable case of SARS is defined as an individual with laboratory confirmation of infection with SARS coronavirus (SARS-CoV) who either fulfills the clinical case definition of SARS or has worked in a laboratory working with live SARS-CoV or storing clinical specimens infected with SARS-CoV.

Clinical case definition of SARS 1. A history of fever, or documented fever AND 2. One or more symptoms of lower respiratory tract illness (cough, difficulty breathing, shortness of breath) 3. Radiographic evidence of lung infiltrates consistent with pneumonia or acute respiratory distress syndrome (ARDS) or autopsy findings consistent with the pathology of pneumonia or ARDS without an identifiable cause 4. No alternative diagnosis can fully explain the illness

Integrated Disease Surveillance and Response To strengthen surveillance in Africa, the WHO regional office in Africa established the integrated disease surveillance and response (IDSR) in September 1998 when the 48th World Health Organization Regional Committee for Africa met in Harare, Zimbabwe. Member States adopted resolution AFR/RC48/R2 for improving the availability and use of data for public health action at all levels of national systems

GOALS OF IDSR The WHO goal of IDSR is to ensure that each Member State has the capacity to define, detect and respond to communicable public health threats. It aims to provide: Timely, complete, regular and high quality information Early detection and prediction of epidemics Objective assessment of interventions during epidemics; and Efficient monitoring of intervention programmes.

Three IDSR forms are used for reporting disease conditions IDSR 001, IDSR 002, and IDSR 003 A study by Nnebue CC et al. in Enugu state reported only 33.3, 31.1, and 33.7% of respondents knew the specific uses of forms IDSR 001, IDSR 002, and IDSR 003 respectively. Survey how many have heard of IDSR

IDSR form 001: For immediate/case based reporting of diseases. Immediate reporting allows for timely action to be taken to prevent the re-emergence or rapid transmission of epidemic prone diseases or events, especially diseases due to highly pathogenic and lethal infectious.

Make the initial report by the fastest means possible (telephone, text message, facsimile, e-mail, radiophone). Follow up the initial verbal report with a written report of the case-based report form. IDSR 001A when the case is suspected and IDSR 001B when there is laboratory confirmation. Below is a list of diseases/events requiring immediate reporting.

Diseases/Events reported with form IDSR 001 Acute Flaccid Paralysis (AFP) Diarrhoea with blood (Shigella) Typhoid fever Yellow fever Acute hemorrhagic fever syndrome Dracunculiasis Any public health event of international Influenza due to new subtype (Ebola, Marburg, Lassa Fever, RVF, concern (infectious, zoonotic, food borne, Maternal death Crimean-Congo) Measles chemical, radio nuclear or due to an Adverse event following immunization Meningococcal meningitis unknown condition) Neonatal tetanus (AEFI) Plague Anthrax Rabies (confirmed cases) Chikungunya Cholera SARS Cluster of SARI Smallpox

IDSR form 002: For weekly reporting of new cases of epidemic/pandemic prone diseases. IDSR form 003: For routine monthly notification of other diseases of public health importance.

Diseases that require monthly reporting Acute viral hepatitis Leprosy (quarterly) Sexually transmitted diseases (STIs) AIDS (New Cases) Lymphatic Filariasis Buruli ulcer Malaria Trachoma Diabetes mellitus Malnutrition in children under 5 years Trypanosomiasis Diarrhoea with severe dehydration in children under 5 years of age Tuberculosis (quarterly) Mental health (Epilepsy) Underweight Newborns (less than 2500 g) HIV (new detections) Noma Onchocerciasis Hypertension Severe pneumonia in children under 5years of age Influenza-like illness Injuries (Road Traffic Accidents)

CHAIN OF REPORTING HCP DNO LG MOH WHO/CDC FMOH SMOH Key: HCP: Health care providers DNO: Disease notification officer LG MOH: Local Government Medical Officer of Health SMOH: State Ministry of Health FMOH: Federal Ministry of Health

Analysis of data. Questions to ask Have any priority diseases or other public health events of concern been detected during the reporting period (this week, for example)? Is an epidemic or unusual public health event suspected? • Of the cases, deaths or events detected, how many were confirmed? • Where did they occur? • How does the observed situation compare to previous observation periods of time this year? For example, when compared to the start of the reporting period, is the problem increasing?

• Are the trends stable, improving or worsening? • Is the reported surveillance information representative enough of the reporting site’s catchment area? Out of all the sites that should report, what proportion has actually reported? • How timely were the data received from the reporting sites?

REASONS FOR NOT REPORTING Do not know reporting is required Do not know how to report Do not have reporting materials Do not know numbers to call Assume someone else will report it Do not think reporting is of any use No time to report/forgot to report

Case study Let Someone describe the case definition for Ebola Virus Disease and describe the chain of reporting for the case.

CONCLUSION Disease notification and appropriate data collection for analysis is an important part of health care provider’s responsibilities. It ensures adequate information is available for effective planning and running of the healthcare system Healthcare providers should therefore be familiar with notifiable diseases and the appropriate channel of notification.

References Nnebue CC, Onwasigwe CN, Adogu PO, Onyeonoro UU. Awareness and knowledge of disease surveillance and notification by health-care workers and availability of facility records in Anambra state, Nigeria. Niger Med J 2012;53:220-5 Bawa SB1, Olumide EA, Umar US. The knowledge, attitude and practices of the reporting of notifiable diseases among health workers in Yobe State, Nigeria. Afr J Med Med Sci. 2003 Mar;32(1):49-53. World Health Organization. Integrated disease surveillance programme. Available at: http://www.who.int/csr/labepidemiology/projects/surveillance/en/ accessed 26/01/2015 CDC technical guidelines for IDSR. Available at: http://www.cdc.gov/globalhealth/dphswd/idsr/pdf/Technical%20Guidelines/IDSR%20Technical%20Guidelines%202nd%20Edition_2010_English.pdf Accessed on 26/01/2015