1. Integrated Disease Surveillance and Response: a strategy for strengthening national public health surveillance systems
DPHSWD Resident Advisor Orientation
Helen N. Perry, PhD
IDSR Team Lead
Public Health Systems Strengthening Branch
August 8, 2011

2. IDSR is a WHO AFRO strategy CDC is key technical partner supported with USAID funding * * * * First Annual IDSR Taskforce Meeting Harare, Zimbabwe November 2, 2000

3. Thousands of cases in East Africa
Mid-1990s Cholera
Thousands of cases in East Africa
Meningococcal Meningitis
300,000 cases and 35,000 deaths
1996 Yellow fever
Reported outbreaks in 7 countries
In mid-1990s, Africa experienced several devastating outbreaks – (I then say the 4 instances on the slide).
This situation led African countries to request WHO-AFRO and their technical partners to work with countries to improve surveillance capacity for detecting and responding to diseases that impact African communities.
Ebola
Zaire and Gabon
High case fatality rates 68% to 90%

4. IDSR priority diseases: 1998-2008
Epidemic prone diseases
Cholera
Diarrhea with blood
Measles
Meningitis
Plague
Viral hemorrhagic fevers
Yellow fever
Diseases for elimination/eradication
Acute flaccid paralysis / poliomyelitis
Dracunculiasis
Leprosy
Neonatal tetanus
Diseases of public health importance
AIDS
Diarrhea with dehydration <5 y old
Malaria
Onchocerciasis
Pneumonia < 5 y old
Sexually transmitted infections
Trypanosomyasis
Tuberculosis
Diseases targeted by IHR (2005)
IDSR aimed to prioritize the leading causes of illness, death and disability in the African region and in 2008, began to incorporate the diseases and conditions targeted by the revised International Health Regulations such as pandemic influenza.

5. Planning an integrated system: a matrix of skills and activities Perry et al, BMC Medicine 2007
This the framework that illustrates how IDSR implementation aims to improve the generic functions of surveillance across all levels of the health system. This includes the support functions of laboratory, training, logistics, and communications.

6. Guidelines for IDSR WHO-CDC IDSR Guidelines Ghana IDSR Guidelines
As part of the implementation process, countries adapted generic guidelines in order to incorporate their particular disease priorities and national context. This is an example of the guidelines for Ghana.
WHO-CDC IDSR Guidelines
Ghana IDSR Guidelines

7. Examples of action thresholds
An example of the disease specific thresholds: epidemic-prone diseases such as cholera, eradication programs such as polic and endemic epidemics in Africa such as malaria. Each threshold is linked to action.

8. IDSR performance indicators
Summary and case-based data reported on time to next level
Trend analysis for priority diseases is current
Reported outbreaks are investigated
Reported outbreaks are laboratory confirmed
Response implemented for confirmed outbreak and evaluated
to illustrate what IDSR hopes to see as success, these are the core IDSR indicators that describe what we hope to accomplish at this point in the initiative. Progress towards implementation is being measured through evidence of improved timely reporting, reporting of case-based data, data analysis at local levels, investigation and laboratory confirmation of outbreaks, and an appropriate response. Several disease programs have CFR targets, and IDSR provides data to those programs so that can monitor their disease targets.

9. Role of laboratory in IDSR
Confirm epidemics
Monitor trends
An integral component of IDSR involves inclusion and strengthening of the laboratory for confirming epidemics and monitoring trends.

10. Laboratory performance indicators
Laboratory data is reported on time.
Transport of adequate specimens to referral laboratory
Supervision and quality control at periphery
Correct culture and antimicrobial results for bacterial specimens
Participate in outbreak investigation
Participate in External Quality Assurance Program
IDSR promoted laboratory indicators to monitor progress towards functional laboratory surveillance programs in countries. A successful public health laboratory system is one where … (and then I read/paraphrase the indicators).

11. 2010 - Preparedness at country level:
existence of guidelines, regulations, and policies
Item
No of Countries
(43 of 45 responses) %
(n=43 ) 1
Have national guidelines for IDSR 41
95.3 2
Have regulations governing public health surveillance 30
69.8 3
Have national policy for IDSR implementation 33
76.7 4
Have a national budget line for IDSR 22
51.2 5
Receive funds from donors
Ref: WHO-AFRO and CDC-IDSR team (2011). Draft summary results from the IDSR Rapid Assessment of IDSR Implementation in African countries. CDC authors include C. Alu (OSELS), T.Taylor (NCEZID), K.Embrey (ASPH Fellow) and H. Perry (DPHSWD)

12. International health regulations (2005)
Call for surveillance and response capacity at all levels of the health system

14. ( Epidemic prone diseases
Diseases targeted for eradication or elimination
Other major diseases of public health importance
Cholera1
Meningococcal meningitis
Diarrhoea with blood (Shigella)
Viral hemorrhagic fevers*1
Dengue
Typhoid fever
Yellow fever 1
Measles
Influenza-like illness
Plague 1
Anthrax
Chikungunya
1 Disease specified by IHR (2005) for notification.
*Ebola, Marburg, Rift Valley, Lassa, Crimean Congo, West Nile Fever
Neonatal tetanus
Poliomyelitis 1 (AFP)
Dracunculiasis
Leprosy
Onchocerciasis
Buruli ulcer
Filariasis
Noma
Diarrhoea with dehydration <5
Severe pneumonia
New HIV/AIDS
STIs
Tuberculosis
Malaria
Trypanosomiasis
Trachoma
Acute viral hepatitis
Rabies
Malnutrition
Maternal deaths
Hypertension
Diabetes mellitus
Adverse events following immunization (AEFI)
Diseases or events of international concern
In addition to those noted in other columns
Any public health event of international concern (infectious, zoonotic, food borne, chemical, radio nuclear, or due to unknown condition)
Draft July 15, 2010

15. Revised IDSR Technical Guidelines – October 2010
International Health Regulations (2005)
Non-communicable diseases
New public health priorities (e.g., pandemic influenza)
Focus on community surveillance
Preparedness
Disease specific fact-sheets

17. IDSR and FELTP
FELTP practicum opportunities at district and national levels
Detecting public health communicable and non-communicable events
Conducting training for district level
Evaluating IDSR components
Participating in laboratory network
Innovative problem solving-
FELTP graduates become national leaders for surveillance, laboratory and response capacities

18. Summary
IDSR is a framework for strengthening public health surveillance and response at all levels of the health system
IDSR and FELTP work together to reduce illness, death and disability and contribute to healthier African and global communities

19. THANK YOU IDSR PARTNERS WHO-AFRO CDC-Atlanta USAID Africa Bureau
WHO ISTs
Ministries of Health