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

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

3. 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.

4. 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:

5. 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. 

6. 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.

7. 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. 

8. 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.

9. 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.

10. 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.

11. 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

12. 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

13. 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. 

14. 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:

15. 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.

16. 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

17. 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

18. 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.

19. 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

20. 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.

21. Make the initial report by the fastest means possible (telephone, text message, facsimile, , 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.

22. 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

23. 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.

24. 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)

25. 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

26. 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?

27. • 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?

28. 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

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

30. 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.

31. 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: accessed 26/01/2015
CDC technical guidelines for IDSR. Available at: Accessed on 26/01/2015