Generic System for the Epidemiologic Surveillance of Dengue: Elaboration process Presented by: Dr. Gamaliel Gutiérrez Regional Dengue Program PAHO/WHO Noviembre 2015

Dengue: First outbreaks in the Americas ’s Source: RUSH, A. B Medical Inquiries and Observations. Prichard & Hall, Philadelphia. GUBLER, D Dengue and Dengue Haemorrhagic Fever. CAB International

IMS-Dengue: Epidemiology Objectives: Strengthen the capabilities for an integrated analysis, early detection and timely response to an outbreak. Establish diagnostic definitions and case classifications for dengue. Generate the necessary information for decision making for prevention and control. Define the strategies for vaccination and evaluate its impact.

IMS-Dengue: Advances in the Epidemiology component More countries are systematically reporting dengue Availability of weekly bulletins in more then 20 countries Epidemiological alert systems Advances and improvements in the regional epidemiological reports: PLISA

Peru El Salvador Mexico Argentina Colombia Brazil Costa Rica Panama 8 countries

The Technical Advisory Group (TAG) recognizes the work towards a harmonized surveillance system and recommends that all countries contribute and participate in these efforts. PAHO/WHO needs to support the national regulatory authorities in defining the harmonized regulatory paths. The TAG considers that it is important for the dengue vaccine to be accessible to the smallest countries, if they desire the vaccine.

Objectives of the Generic Epidemiologic Surveillance of dengue 1.Early detection of the incidence of cases and/or outbreaks. 2.Describe the tendencies and distribution of the cases in time, place, and person. 3.Describe the circulation of the different serotypes and its clinical correlation. 4.Detect fatalities and unusual cases.

Objectives of the Generic Epidemiologic Surveillance of dengue 5.Characterize the burden of clinical severity by viral serotype. 6.Monitor the effectiveness of clinical management. 7.Integrated analysis including environmental surveillance and entomology. 5.Detect and monitor new tools and instruments.

Generic System for the Epidemiologic Surveillance of Dengue Standardization of the case reports Two surveillance methods: National and Sentinel Use of the environmental and entomological indicators

Estandarización en el reporte de casos de dengue Probable case A person who has presented fever or history of fever of 2 to 7 days of duration plus two or more of the following manifestations: 1.Nauseas and/or vomiting, 2.Exanthema, 3.Myalgia and/or arthralgia, 4.Headache and/or retro-orbital pain, 5.Petechia and/ or positive tourniquet test 6.Leucopenia 7.Any warning signs, or 8.Any severe manifestation + IgM positive or IgG ( ≥1,280), or Epidemiological linkage Confirmed case Every probably dengue case that has tested positive in at least one of the following laboratory tests: 1.RT- PCR conventional or in real time 2.NS1 positive 3.Viral isolation 4.Seroconversion of IgM or IgG in paired serum samples or a four fold rise of IgG 5.Immunohistochemistry

NATIONAL Methods in the Generic System for the Epidemiological Surveillance of dengue. SENTINEL Early detection of the incidence of cases and/or outbreaks. Describe the tendencies and distribution of the cases in time, place, and person. Describe the circulation of the different serotypes. Detect fatalities and unusual cases. Characterize the burden of clinical severity by viral serotype. Monitor for effectiveness of clinical management

Surveillance system Geographic locationCollection and information flow National Surveillance The entire national territory – with operational definition and performance indicators that have been harmonized at a regional level.  Minimum data  Weekly report Sentinel Surveillance Based on a sentinel area- One locality per country (countries with a greater extension have up to 2/3 localities) which is selected based on specific criteria and includes institutions within different levels.  Minimum data  Supplemented with clinical evolution and by laboratory confirmation  Integration with vectorial, and environmental surveillance and community conduct/  Monthly (or more) reports Methodology of the Generic System for the Epidemiologic Surveillance of dengue

Use of environmental and entomological indicators Access to improved water source Proper waste disposal Positive ovitraps Vaccines (date, dose, scheme)

Timeline for the implementation of the proyect Dec- Jan. JanFebMarAprMayJunJulAugSepOctNovDecJan- JulJulAugSepOctNovDec JanFebMarAprMayJunJulAugSepOctNovDec 2016 Preparation and elaboration of the generic protocol Protocol sent to the countries Pilot Phase Meeting to evaluate the pilot project Final adjustments to the document End of pilot project Protocolo modified for the Americas Monitoring and evaluation of the analysis Introduction of the protocol to the Americas

Summary; The Epidemiologic component of the IMS-Dengue is one of the most strengthened, with the most significant advances. The Generic System for the Epidemiological Surveillance of dengue includes: Standard definitions for dengue cases Two methods for surveillance: national and sentinel Integrates other components (socio-economic and entomologic) Countries have demonstrated great leadership in the implementation of this project, and soon it will be implemented in all of the Americas.

The Regional Working Group Thank you very much for your attention