1. Surveillance System in the Philippines
DEPARTMENT OF HEALTH
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
Surveillance System in the Philippines
Ebola Training
11-13 November 2014

2. Outline Brief Background Information IHR
Surveillance Systems in the Philippines
2. Surveillance and Response for EVD

3. Our world is changing as never before
Populations grow and move…
Microbes adapt…
Public health risks increase…
Diseases travel fast…
Health security is at stake

4. International Health Regulations (2005)
World Health Organization
15 April, 2017
International Health Regulations (2005)
A global legal instrument for global public health security
Came into force on 15 June 2007*
Preventing the international spread of disease while avoiding unnecessary interference with international transport and trade
Legally binding for 194 countries and WHO that have agreed to play by the same rules to secure international health. 4

5. New IHR – New obligations
Designation of responsible authorities
Functional national IHR Focal Points
Consultations, notification, verification, information sharing
Assessment and public health response
Strengthening of the core capacity for surveillance &response
Points of entry
core capacity
Public health measures
health documents (Ship Sanitation Control Certificate…)
Charges
Collaboration and assistance
Human rights, including treatment of personal data
Transport and handling of biological substance and materials
IHR Expert Roster, Emergency/Review Committee
Other legal aspects: rejection/reservation, disputes etc

6. IHR requirements on POE

10. Statement on the 3rd meeting of the IHR Emergency Committee regarding the 2014 Ebola outbreak in West Africa
It was the unanimous view of the Committee that the event continues to constitute a Public Health Emergency of International Concern (PHEIC).
The Committee reiterated its recommendation that there should be no general ban on international travel or trade
Recommendations for States with intense Ebola transmission (Guinea, Liberia, Sierra Leone) States should maintain and reinforce high-quality exit screening of all persons at international airports, seaport, and major land crossings, for unexplained febrile illness consistent with potential Ebola infection
Other details

11. Surveillance Systems in the Philippines
Indicator based - PIDSR
Event-based – ESR, SPEED

12. Trigger events for strengthening Surveillance

13. What is PIDSR

14. Components of PIDSR Case-based/Indicator-based Event-based a. ESR
b. SPEED

15. Figure 2: Conceptual Framework for the Philippine Integrated Disease Surveillance and Response (PIDSR)

16. Category 1 – Immediately reportable diseases/syndromes/events
Acute flaccid paralysis “hot case”
Anthrax
Human avian influenza
Severe acute respiratory syndrome (SARS)
Adverse event following immunization (AEFI)
Any disease outbreak
Any clustering of patients with similar disease,symptoms or syndromes
Meningococcal disease
Immediate reporting upon laboratory confirmation
Poliomyelitis
Cholera
Measles
HIV/AIDS (HIV Registry)

17. Category 2 – Weekly reportable diseases/syndromes/events
Acute bloody diarrhea
Acute hemorrhagic fever syndrome
Acute viral hepatitis
Acute flaccid paralysis
Bacterial meningitis
Cholera
Dengue
Diphtheria
Influenza
Japanese encephalitis
Leptospirosis
Malaria
Neonatal tetanus
Non-neonatal tetanus
Paralytic shellfish poisoning
Pertussis
Rabies
Typhoid and paratyphoid fever

20. Event-based Surveillance & Response (ESR)
Complements existing indicator-based disease surveillance (PIDSR) in detecting IHR events w/ added advantage of rapid reporting, greater geographic spread & relatively low cost
Can be rumours & other reports transmitted through routine reporting system or reports from media, health workers & NGOs
Reports may be formal or informal through phone calls or text messages

22. Surveillance in Post Extreme Emergencies and Disasters (SPEED)
Objectives
Detect early unusual increase of communicable and non-communicable conditions related to emergencies and disasters
Monitor health trends for appropriate public health action
Enable identification of appropriate response to handle the emergency
A tool for decision-making in disaster response

24. Surveillance Systems Time O EVENT 24 hrs 48 hrs 72 hrs Day 4 ...Day N
PIDSR
ESR
RAPID ASSESSMENT
Early Warning System
SPEED
Activated
Deactivated
There are information management systems in place e.g. the Philippine Integrated Disease Surveillance and Response System (PIDS –R) and the Health Emergency Management Staff Health Emergency Alert Reporting System. In health emergencies, within hours, a Rapid Assessment is conducted. At the 48 hr, an early warning system (SPEED) is activated , which continues until conditions are seen that will need to deactivate the system. 24

25. Ebola Virus Disease Surveillance and Reporting

26. Possible points of detection of EVD cases
National surveillance systems should be capable of detecting suspected cases
Clinicians and health care workers understand and implement:
EVD case definition
Safe specimens collection and shipment for laboratory confirmation
Reporting mechanism, including IHR notification to WHO
Any case with Ebola virus infection (i.e. suspect, probable, confirmed), any unusual health event possibly associated with Ebola virus infection, should be reported to WHO through the National International Health Regulations (IHR) Focal Point.
Source: WHO

27. Case Definition

28. Case Definition

29. Case Definition

30. EVD Surveillance Procedure

31. EVD Surveillance Procedure

32. Roles of Hospitals and Other Health Facilities

33. EVD Surveillance Submit Case Notification Form w/in 24 hrs PUI
EVD Cases
NEC
Collection of specimen
PUI
EVD suspect/
probable
RITM
Fill out & submit Case Investigation Form & Laboratory Request Form
2 days
Release of results to PUI/patient. Reporting Unit, NEC

34. Surveillance Flow Chart

35. Control the outbreak National leadership and risk communication
Outbreak control measures to stop transmission:
Clinical Management and IPC
Epidemiological investigation, surveillance and laboratories
Behavioral and social interventions
Logistics

36. General strategy to CONTROL Ebola outbreak
15/04/2017
General strategy to CONTROL Ebola outbreak
Women, associations Traditional healers
Opinion leaders
Anthropological
evaluation
Infection
control
Triage
In/out
Barrier
nursing
Behavioural and
social
interventions
Psycho-
social
support
Formal and informal
modes of communication
Clinical case
Management
Organize
funerals
Social and
Cultural
practices
Clinical trials
Ethics committee
Ethical
aspects
Communication
Press
Journalists
Medias
Coordination
Duty of care
Research
Active
case-finding
Security
Police
Control of vectors and reservoirs in
nature
Epidemiological investigation,
surveillance
and laboratory
Figure 7. Structure organisationnelle des différents comités intervenant dans les activités de lutte contre les épidémies de fièvres hémorragiques à virus Ebola ou Marburg
Logistics
Lodging
Food
Follow-up
of contacts
Social and
Epidemiological
mobile teams
Specimens
Laboratory
testing
Finances
Salaries
Transport
Vehicles
Search the source
Database
analysis

37. Why do we need to prepare?
Past experiences clearly demonstrated that emerging diseases/events will continue to occur…
Emerging diseases are unpredictable in the changing world…
Effective preparedness planning definitely minimize the impact on health, economic and social disruption

38. Thank You