[Audio] Good morning everyone. I am pleased to welcome you to this presentation by Dr Beauty Rani, MPH Batch 2023. Today's topic is Public Health Surveillance - an overview of its historical and modern day perspectives, criteria for selection of diseases for surveillance, objectives, and the different type of data collection methods. Let us start our journey and explore the world of Public Health Surveillance.. 

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Presented By Dr Beauty Rani MPH Batch 2023

[Audio] Surveillance of public health is a key element in monitoring and comprehending the wellbeing of the population. It encompasses the frequent, continuous collection, investigation, translation, and use of medical-related information for formulating, carrying out, and assessing public health initiatives. Surveillance can assist in discovering existing and potential threats to public health, in addition to evaluating the influence of the initiatives meant to resolve such issues.. 

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of health-related data needed for the planning, implementation, and evaluation of public health practice.” (WHO)

[Audio] In 1995, the National Apical Advisory Committee released a national surveillance program for communicable diseases, a major milestone in the history of public health surveillance in India. This was a response to the 1988 Cholera outbreak in Delhi and the 1994 plague outbreak in Surat. In 2004, the Integrated Disease Surveillance Project was launched to further strengthen the systems and processes of disease surveillance, eventually renamed the Integrated Disease Surveillance Program in 2008.. 

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1988 Cholera outbreak in Delhi and 1994 plague outbreak in Surat

 National Apical Advisory Committee (NAAC) in 1995

 1997,National Surveillance Program for Communicable Diseases

 Integrated Disease Surveillance Project – IDSP’ - 2004

 ‘Integrated Disease Surveillance Program’

[Audio] Considering selection criteria for surveillance of diseases is essential in order to guarantee effective public health action. Criteria should focus on conditions with high health impact, like malaria, non-communicable diseases and risk factors, and road traffic accidents. Additionally, diseases that have epidemic potential, like cholera and measles, should be taken into account. Moreover, diseases that are targets of national, regional, or international disease control programs, such as HIV, Tuberculosis, and Polio, should be considered. Obtaining this information can lead to considerable public health action and aid global health progress.. 

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Criteria for Selection of Diseases for Surveillance

Does the disease condition have high health impact (morbidity, mortality, disability) (Malaria, NCDs risk factors, Road Traffic Accidents (RTA)) Does it have significant epidemic potential? (Cholera, Measles) Is it a target of a specific national, regional or international disease control program? (HIV, TB, Polio) Will the information collected lead to significant public health action?

[Audio] Public health surveillance is a critical component of public health, aiding in outbreak detection and monitoring, the evaluation of prevention programs, and the identification of vulnerable populations and areas. Taking swift action to contain outbreaks, meet the needs of the public, and inform decisions made by public health authorities all depend on this activity. Data-driven decisions in public health are based on this information.. 

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Early detection of outbreaks.

 In order to trigger public health control measures


 Evaluation of effectiveness of prevention programmes

 Identification of high-risk groups, pockets of susceptible populations and geographical areas

[Audio] Surveillance of public health has become critical in a globally connected world in order to recognize possible health problems and respond rapidly and competently. It can be employed to track the transmission of diseases, identify risk factors, inform the public and health practitioners about current risks, and assess the success of preventive efforts. Types of surveillance include the tracking of cases, data collection techniques, case definitions, alert and response systems, aggregate, case based, sentinel, active, passive, lab-confirmed, syndromic, presumptive, event-based, and indicator-based.. 

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Public health Surveillance

 Based on Number of cases taken

 Based on method of data collection

 Based on case definition

 Based on early warning and response

 Aggregate

 Case Based

 Sentinel

 Active

 Passive

 Lab Confirmed

 Syndromic

 Presumptive

 Event Based

 Indicator Based

[Audio] Public health surveillance is an important tool to check the prevalence and the spread of communicable diseases. It can be employed in two ways: 1) Case-based, where every single case of a disease is vital for public health response; 2) Aggregate, which captures aggregate data from the community, such as the total number of suspected or confirmed cases of a particular disease by age group, geographical area, or over time. For example, aggregate surveillance can be used to monitor acute diarrhea cases reported in children.. 

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1) Case-based                         vs                Aggregate

employed when every single case of a disease is vital for public health response.

captures aggregate data from the community

For e.g. number of acute diarrhoea cases reported

[Audio] Public Health Surveillance is a useful method for assessing and keeping track of health problems. Active surveillance makes use of resources to contact providers to get reports about conditions. This technique guarantees full and precise data, and provides the capability to detect changes, outbreaks, and the effect of diseases - all indispensable for public health. Passive surveillance is dependent on accounts from health care providers, and while cheaper, the quality of the data is weaker than active surveillance. Examples of successful public health surveillance are dengue, polio, and HIV surveillance in antenatal visits.. 

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Based on Data Collection Passive
 Active Sentinel What is it ? Diseases are reported 
by health care providers
 Health agencies contact health providers seeking reports
 used when high-quality data are needed about a particular disease 
 Advantage Simple and inexpensive
 Ensures more complete reporting of conditions
 used to signal trends, identify outbreaks and monitor the burden of disease
 Disadvantage Limited by incompleteness of reporting and variability of quality
 Resource intensive
 Selected population may not be representative of whole population Example Surveillance for Dengue Surveillance for polio Surveillance for HIV in ANC visits

[Audio] Surveillance of public health is a potent strategy to find and monitor health developments. This involves searching for various diagnosis, including syndromic, presumptive, and lab-confirmed. It necessitates making diagnosis based on clinical pattern by paramedical personnel or on the basis of the typical history and clinical examination by medical officers. The goal is to differentiate illness clusters quickly and act quickly, thus decreasing morbidity and mortality. This technique is highly reliable and is conducted by health workers.. 

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3)Syndromic     vs    Presumptive    vs     Lab Confirmed

Relies on diagnosis made on the basis of clinical pattern by paramedical personnel

Relies on diagnosis made on typical history and clinical examination by Medical Officers

Relies on clinical diagnosis confirmed by appropriate confirmatory laboratory test

objective is to identify illness clusters early, to mobilize a rapid response, thereby reducing morbidity and mortality.

validity higher than that of the syndromic and undertaken by the health worker

validity higher than that of the presumptive

[Audio] Surveillance for public health is an essential tool to safeguard the health of a population. India's Integrated Disease Surveillance Programme uses three types of surveillance: syndromic, presumptive and laboratory/confirmed. Syndromic surveillance is based on diagnosis based on the symptoms and patterns observed by healthcare providers and people in the community. There are seven diseases which are reported as part of this form of surveillance. Presumptive surveillance is based on a patient's medical history and clinical examination, and twenty-two diseases and conditions are reported under this form. Laboratory/confirmed surveillance is based on a medical diagnosis which is then verified through an appropriate test, with twelve diseases reported in this category. By using these three levels of surveillance, public health teams are able to better monitor, detect and respond to health incidents and outbreaks in India.. 

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Syndromic (S form) -Diagnosis is made on the basis of symptoms/ clinical pattern observed by paramedical personnel and members of the community. Seven main conditions are reported under this including:  Presumptive (P form) - Diagnosis is made based on history and clinical examination by Medical Officers. 22 diseases and conditions are listed under the reporting using the P form. Laboratory/Confirmed (L form)- Diagnosis is based on clinical diagnosis confirmed by an appropriate test. 12 diseases are reported under the L form.

[Audio] Surveillance of public health is a crucial element in preventing the propagation of sickness. EWAR works through two kinds of surveillance - indicator-based and event-based. Indicator-based surveillance searches for data regarding a population's health status, while event-based surveillance concentrates on the discovery of any strange or unexpected health situations. Both are vital instruments for keeping track of our society's health, and they can be used to quickly spot and address health issues.. 

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EWAR is an organized mechanism to detect as early as possible any abnormal occurrence or any divergence from the usual or normally observed frequency of phenomena.

[Audio] Indicator-based surveillance and event-based surveillance are two approaches for public health surveillance. Indicator-based surveillance involves focusing on known diseases and using structured information to identify disease outbreaks, trends and patterns. Data is derived from sources such as clinical records from hospitals, communities and laboratories. Event-based surveillance utilizes an all-hazards approach, allowing for known and unknown diseases to be monitored and reported on. Data from official sources as well as news media, social media and other online media sources can be used here. This approach is beneficial in detecting health events which can potentially be serious for public health and can provide early warnings of new, emerging and re-emerging risks to public health.. 

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Comparison of Indicator-Based Vs. Event-Based Surveillance
•
•
•
Indicator-Based Surveillance
Usually focuses on "known diseases"
Detects disease outbreaks and characterize disease
trends and patterns
Structured information (i. information that meets
specific criteria, such as case definitions, and is
organized in a pre-defined manner)
Data sources are from health system infrastructure,
such as clinical records from community, hospitals, or
laboratories
The surveillance system outputs indicators or
measures related to a particular health issue
•
•
•
Event-Based Surveillance
Usually takes an all-hazards appro<d can report on both
known and unknown diseases
Detects health events that can potentially pose a serious risk
to public health
Unstructured information (i,e, information that is not
organized in a pre-defined manner), including both verified
(e.g, information from experts, governments, and reputable
organizations) and unverified (e.g. rumors, claims, stories)
reporting
Data can be from official sources. news media. publicly
accessible social media, and other online media sources
The surveillance system outputs early warning signals of new,
emerging, and re-emerging threats to public health

[Audio] Structured information in public health surveillance is sourced from health system infrastructure such as clinical records from hospitals and laboratories. It is organized in a predefined manner and is used in event-based and indicator-based surveillance, which focuses on known diseases, detecting outbreaks and characterizing disease trends and patterns. Unstructured information on the other hand is composed of both verified sources, such as information from experts and government, and unverified sources like news media and publicly accessible social media. This type of data is used to provide early warning signals of new, emerging and re-emerging threats to public health.. 

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It focuses on known Diseases. Detects diseases outbreaks and characterize diseases trend and pattern Structured information Data source is from Health system Infrastructure such as clinical records from hospitals and laboratories. This system indicates data for a particular health issue

It reports both known and unknown diseases. Detect health Events that can potentially pose a serious risk to public health. Unstructured information including both verified (eg information from expert, govt.) and unverified (rumours, claims)  Data can be from news media, publicly accessible social media etc This system outputs early warning signals of new, emerging and re-emerging threats to public health

[Audio] Surveillance of public health is an essential tool for the prevention and cure of public health hazards. Data collection and evaluation are fundamental elements of the system which can enable the identification of potential issues and support the creation and implementation of strategies for controlling and avoiding any kind of disease. In the following speech, we will examine the different types of public health surveillance, such as event-based and indicator-based surveillance, and feature some illustrations of how they can be applied. For example, an alert can be sent to the health office by the Local Public Works Department or the Jal Board if the turbidity and pH levels of the local water source vary from normal. Also, reports of a foul stench due to sewage overflow can be tracked using event-based surveillance if brought to attention by resident of the area. Moreover, indicator-based surveillance can be employed to authenticate data from a Veterinary Lab regarding the cases of lab- verified A/H5N1 Influenza in a large commercial free-range broiler flock, or when reported by local media about an unusual die-off amongst backyard chickens.. 

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The local Public works department/Jal board alerts health authority about abnormal turbidity and pH of local water source.

Local residents complain to their leader/association about stench from local water source due to sewage mixing

Confirmation of Veterinary Lab regarding occurrence of Lab confirmed A/H5N1 Influenza in a large commercial free-range broiler flock

Unusual die-off of birds is reported by local media among backyard chickens

[Audio] Public health surveillance is a crucial component of India's preventive healthcare system. Established by the Ministry of Health and Family Welfare, the Central Surveillance Unit works in tandem with the National Centre for Disease Control and each state has its own State Surveillance Unit with a State Surveillance Officer. Through these initiatives, India is taking proactive steps to protect its citizens from infectious diseases and to further strengthen its public health infrastructure in the future.. 

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Organisation of Disease Surveillance in India

CENTRAL SURVEILLANCE UNIT (CSU) Integrated with the National Centre for Disease Control (NCDC), New Delhi

STATE SURVEILLANCE UNIT    (SSU) SSU in each State/UT with a  State Surveillance Officer (SSO)

DISTRICT SURVEILLANCE UNIT (DSU) one DSU in each district  with a District Surveillance Officer DSO),   supported by 3 contractual staff

[Audio] Public health surveillance is an important part of improving the health of individuals and communities. For it to be effective, data must be collected, analyzed, interpreted and used to inform action that may help to prevent negative health outcomes. This slide recognizes the importance of data collection, analysis, interpretation and evaluation in turning data into informed action. Collecting data is the first step in this process, followed by assessing and analyzing the data, which leads to informed decisions and strategies. Evaluation is the next step, which is essential in measuring the effectiveness of current strategies and in providing insight into new strategies. Data is then interpreted to establish what action should be taken to mitigate negative health outcomes. Fundamentally, public health surveillance is a cycle of data collection, analysis, action, evaluation and interpretation.. 

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[Audio] Surveillance of public health is an essential element in the battle against disease and contagious health issues. Monitoring the population's health enables us to identify health problems before they turn into major issues and devise schemes to avert them. Through gathering information from different sources such as Sub Centers (SCs), Primary Health Centers (PHCs), Community Health Centers (CHCs), District Hospitals (DHs), Medical Colleges (MCs), Public Laboratories, Army, Municipal, Railways, Employees State Insurance Corporation (ESIC) and more, we can build up an understanding of the population's health and take preventive measures. Data Surveillance Units (DSU), Supervision Surveillance Units (SSU), and Conclusion Surveillance Units (CSU) are indispensable in the gathering, amalgamating, interpreting, and disbursing of data.. 

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Private Practitioner, Nursing Homes, Private Hospitals and Labs

[Audio] Surveillance of public health is a significant means of quantifying the impact of diseases such as malaria in India. Studies from 2015 to 2016 have demonstrated a reduction in both the prevalence and mortality linked to malaria. Amongst the districts of Rajasthan, those of Barmer, Bikaner, and Jodhpur appear to be particularly susceptible to the illness. This information can be employed to form public health prevention plans to assist in decreasing the impact of malaria in these districts, and also throughout India.. 

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Surveillance based estimation of burden of malaria in India, 2015–2016 |  Malaria Journal | Full Text

Trend of malaria prevalence and percentage of death due to malaria,... |  Download Scientific Diagram

Malaria prone districts (Barmer, Bikaner, and Jodhpur) of Rajasthan,... |  Download Scientific Diagram

Singh A, Mehra M, Kumar A, Niranjannaik M, Priya D, Gaurav K. Leveraging hybrid machine learning and data fusion for accurate mapping of malaria cases using meteorological variables in western India. Intelligent Systems with Applications . 2023;17(200164):200164. Available from: http://dx.doi.org/10.1016/j.iswa.2022.200164 Kumar A, Chaturvedi HK, Mohanty AK, Sharma SK, Malhotra MS, Pandey A. Surveillance based estimation of burden of malaria in India, 2015-2016. Malar J  2020;19(1):156. Available from: http://dx.doi.org/10.1186/s12936-020-03223-7  Kumar P, Pisudde P, Parth Sarthi P. Meteorological linkage of Malaria cases in the eastern state of India. J Clim Chang Health]. 2022;5(100064):100064. Available from: http://dx.doi.org/10.1016/j.joclim.2021.100064

[Audio] Surveillance of public health enables us to observe potential health perils and detect emerging trends. Examining the occurrence of diverse illnesses allows us to apply precautionary measures when needed. As an example, one occurrence of polio in an area is considered an outbreak which necessitates a suitable reaction. It is essential to evaluate the weekly data in order to determine the baseline figures and contrast them to pre-determined thresholds. These boundaries are worked out based on analyzing earlier data and give a good gauge for when public health action should be taken.. 

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Baseline value & crossing of threshold levels

usual level of the disease which may vary over time during the season and off season

number of cases in a particular week above which the health event is considered to be a signal to take a Public Health Action

Pre-existing National/Internationally developed thresholds- Based on historical data:

[Audio] Surveillance of public health is a key factor in recognizing and responding to potential outbursts. Enhanced detection and more accurate reporting have enabled enhanced control steps and improved accuracy when delivering data. Still, changes in case definitions, the formation of new labs, and incomplete accounts can lead to under-reporting, or inaccurate data. It is essential that we remain vigilant in monitoring this information and promptly react to any modifications that could have an effect on public health.. 

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1. potential outbreak  2. better reporting  3. change in the detection and  4. possible data error

1. improved control measures  2. under-reporting because of incomplete reports  3. change in the detection and reporting

Ministry of Health, Family Welfare-Government of India. Trend of malaria parameters in India (2001- 2020(p)) Gov.in. [Available from:https://ncvbdc.mohfw.gov.in/index4.php?lang=1&level=0&linkid=427&lid=3705

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[Audio] Data reveals that males are more significantly affected by cases than females in general. A graph displays the age and gender wise distribution of cases, revealing that the most affected age group is 15 to 70. This highlights the necessity of considering individual features including age, gender, and religion in order to get a better comprehension of the consequences of cases.. 

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Attributes of person include age, gender, religion etc Graph shows age and gender wise distribution of cases Shows most affected age group is between 15 to 70 yrs Overall males are affected more than females.

[Audio] Timely sharing of information is vital to successful public health surveillance. Strategic decision making is enabled when stakeholders such as the National Vector Borne Disease Control Programme, District Malaria Officer, Malaria Specific Supervisors, State Program Officers, and Multipurpose Supervisors, among others, are regularly updated with relevant data in real-time. This helps them take preventive and control measures more quickly and efficiently.. 

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NVBDCP

 District Malaria Officer

 Malaria Specific Supervisor

 State Program Officer

 Multipurpose Supervisor 

 MPW

 Lady Health Visitor

 ANM

 ASHA

Jayswar H, Mishra AK, Sharma RK, Saha KB, Shukla MM, Suman L, editors. A model formalaria elimination based onlearnings fromtheMalaria Elimination Demonstration Project, Mandla district, Madhya PradeshHarsh Rajvanshi1 , Praveen K. Bharti2, Sekh Nisar1. In: Aparup Das2, Harpreet Kaur5, Anupkumar R Anvikar6, Azadar Khan7, Nilima Kshirsagar5, Aditya P Dash8 and Altaf A Lal1.

[Audio] Public health surveillance is a vital way to recognize and monitor the spread of disease in a neighborhood. This slide emphasizes Action Focus, a particular area in an area of malaria. This locality is graded as Active with continuous transference, Residual with transmission recently broken, or Cleared with no local transmission for more than 3 years. Knowledge and awareness of Focus Identification, Classification and Elimination is raised through comprehensive Information, Education and Communication (IEC) campaigns to communities, schools and local leaders. When it comes to efficient malaria prevention, Indoor Residual Sprays (IRS) and Space Sprays, Long-Lasting Insecticidal Nets (LLINs), and Larval Source Management must be considered.. 

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Focus – defined locality situated in malaria endemic area with continuous epidemiological factors for malaria transmission

Classification Active- focus with continuing transmission Residual- transmission interrupted recently (1-3 yrs) Cleared- no local transmission for more than 3 years

Focus Identification, classification and Elimination

 IEC that targets communities, schools, and local leader

 Entomological aspect

 Indoor Residual Sprays (IRS) and Space Sprays

 Long-Lasting Insecticidal Nets (LLINs)

 Larval Source Management

[Audio] Surveillance of public health is necessary to discern health trends and dangers and to permit informed decision-making. This is done by collecting, analysing, interpreting, and distributing information which is instrumental in the planning, implementation, and evaluation of public health action. In this presentation, we will discuss the construction of public health surveillance, its core and support functions, the surveillance strategy, the implementers and stakeholders, the timeliness and ease of the system, and the resources needed to guarantee efficient operation.. 

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Structure

 Legislation for surveillance

 Core functions

 Case detection and registration

 Quality

 Completeness

 Support functions

 Training

  Surveillance strategy

  Implementers and stakeholders

  Case confirmation and Reporting

 Data analysis and interpretation

  Epidemic preparedness

  Response and control

  Timeliness of reporting

 Simplicity of system

  Supervision

 Communication facilities

  Resources

Who.int. Available from: https://www.who.int/docs/default-source/documents/publications/gmp/malaria-surveillance-monitoring-and-evaluationa-reference-manual.pdf?sfvrsn=46489b3b_2

[Audio] Every sub-center in this overview of public health surveillance systems has a "S" form, which are paper forms filled at the sub-center level and passed upwards to the Primary Health Centre, Block PHC, or Community Health Centre. This information is then transferred from paper to electronic format and stored as spreadsheets or databases, which is forwarded to the district or state surveillance unit for further analysis. Data collect from all levels is organized in a hierarchical structure, being collected from village, sub-district, district, and state levels.. 

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Conventional IDSP’s Data Collection Process

One Consolidate "S"
form per Sub-center
per week
Paper forms
Sub Center
Primary Health Center
hand
(Auxiliary Nurse
Midwife, or Male
Health Worker)
Block PHC or
delivered
One Consolidate "P"
form/PHC/week +
"L" forms
hand Paper forms
delivered
Paper forms are
coverted in to
electronic data
Weekly household
visits to collect data
Laboratory
Community Health Center
(Medical Doctor +
helper)
B-PHC or CHC data
collected from PHCs
Presence
Email-
Web
Entry
Spreadsheets
Electronic data, kept
in the form of XL sheets
or on a DB/PortaI
District Surveillance Unit
(District Surveillance Officer,
Data Manager, Data Entry
Operator)
Laboratory Presence
State Surveillance Unit
(State Surveillance Officer,
Data Manager, Data Entry
Operator)
VILLAGE
(655075)
SUB-DISTRICT
(6267)
DISTRICT
(707)
STATE
(36 STATES/UTs)
Source: Karnataka Best Practice ppt @ Gujarat Summit 2019

[Audio] Public Health Surveillance is a complex system that entails advanced data networking and reporting. Data is aggregated from the village level and relayed to the different tiers of sub-district, district, and state. Mobile reporting and portal accessibility is employed so that data is concisely and accurately reported. Sub-centers, Primary Health Centers, and laboratories are linked through broadband connectivity, with each having their own district and state surveillance unit. Mobile reporting combines store and forward and near real-time features, providing access to data analytics and results to all levels for immediate action. This assemblage of elements culminates in the implementation of an extensive public health surveillance system.. 

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VILLAGE
(655075)
SUB-DISTRICT
(6267)
DISTRICT
(707)
STATE
Mobile reporting
Portal access
Mobile reporting
Portal access
Mobile Reporting
Portal access
Sub Center or
Health Sub Center
Primary Health Center
L*oratory Presence
Block PHC or
Community Health Center
Broadband Connectivity
Presence
District Surveillance
Unit
Broadbaxi Connectivity
Laboratory Presence
State Surveillance
Unit
Satellite-based
a Of
Of
Person'S reside•rRe
(36 STATES/UTs) Mobile Reporting
Data Entry Data
Computer Center
Proposed System: Portal access allows reporting of all data from DSU, CSU, SSU to CSU/IDSP in near real-time.
Mobile reporting is both store and forward and near real-time. Data analytics and results will be accessible at all
levels for action.
Source: Karnataka Best Practice ppt @ Gujarat Summit 2019

[Audio] Public health surveillance aims to identify health patterns, trends, and opportunities of individuals, communities, or populations. This slide exhibits the system utilized for this purpose, including the State Surveillance Unit, the Community Private Identified Sub-Center, the District Surveillance Unit, the Primary Health Center, the Central Surveillance Unit, the Integrated Disease Surveillance Program or IDSP portal, and Government or Private Hospitals. All these components collaborate to offer a complete view of public health surveillance.. 

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[image] STATE
SURVEILLANCE
UNIT (SW)
COMMUNITY PRIVATE IDENTIFIED
SUB - CENTER (SC)
DISTRICT
SURVEILLANCE
UNIT (DSU)
PRIMARY HEALTH
INTERNET
GOVT. / PRIVATE
CENTRAL
SURVEILLANCE
UNIT (CSU)
IDSP PORTAL
www.id nic.in
HEALTH CENTER
INSTITUTION
CENTER (PHC)
offer GOVT.
HOSPITAL

[Audio] Public health surveillance is an essential component of public health efforts. To improve public health surveillance, two national programs - IDSP and IHIP - are implemented. IDSP gathers aggregated data, whereas IHIP captures disaggregated data and links data from S, P, L, and EWS forms. IHIP facilitates electronic collection and transmission of surveillance data, as well as realtime or daily surveillance reporting instead of weekly reporting. Additionally, the IHIP system permits surveillance for 33+ health conditions, geocoded data and analyzed reports that can be accessed on mobile and other electronic devices. It further enables easier initiation and monitoring of outbreak investigations. To meet the needs of special events, such as COVID-19, INSACOG (WGS), post disaster and mass gatherings, a special surveillance module has been added to IHIP and used successfully during the 2019 Kumbh Mela. This presentation provides an overview of the features, components, and benefits of public health surveillance.. 

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IDSP IDSP-IHIP Captures aggregated data only Captures disaggregated data (Case based surveillance) No linkage of data from S, P and L forms Links data from S, P, L, EWS form Paper based data collection Electronic collection & transmission of surveillance data Weekly Surveillance reporting Realtime or daily surveillance reporting Monitor 18 health conditions Monitor 33+ health conditions Data not geocoded Has all data geocoded for geographic reference Additional Features of IDSP-IHIP: Provides analyzed reports on mobile or other electronic devices Outbreak investigation activities can be initiated and monitored electronically Integrates data  from other ongoing disease surveillance programs Special surveillance modules added e.g. COVID-19, INSACOG (WGS), Post disaster, Mass gatherings (Used successfully during Kumbh Mela 2019) etc.

[Audio] Surveillance of public health is a major component of healthcare in India. Despite considerable difficulties in implementation, it is essential to acknowledge that the current system is inadequate with inconsistent coverage. This leads to detached and segregated tasks, programs and facilities, along with comparatively minimal involvement from the private sector. Furthermore, basic public health capacity has not been effectively trained, while insufficient use of digital, social and printed media implies that non-communicable disease surveillance is not given adequate attention and there is an inadequate and elementary method of occupational health surveillance. To ensure that India's surveillance system is able to meet the requirements of its populace, these difficulties must be addressed.. 

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Challenges in India’s existing public health surveillance

Implementation challenges – patchy surveillance, not comprehensive Surveillance functions in vertical silos of programmes and institutions Private sector involvement in surveillance is limited Human resource challenges Training of public health core-capacity:  Limited use of digital, social and print media in surveillance: Limited focus on non-communicable disease surveillance Fragmented and minimalistic approach in occupational health surveillance

[Audio] Surveillance of public health is a valuable instrument for accumulating, evaluating and utilizing universal data about health dangers and hazard factors from around the world. By following and monitoring changing situations in various nations, we achieve priceless knowledge regarding how global health conditions are evolving. This is especially accurate in the matter of contagious diseases, and also intentional utilization of biological substances or toxins to cause harm. By staying one step in front of these difficulties, we can make better readiness and response tactics.. 

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collection, analysis and use of standardized information about health threats or their risk factors from more than one country, and usually world-wide.

Surveillance mainly focuses on infectious diseases. But global systems also seek to identify deliberate use of biological agents or toxins to cause harm

[Audio] At the end of our presentation on Public Health Surveillance, I'd like to express my gratitude for your attention in learning about the essential operations that keep the world safe and healthy. Several public health surveillance schemes take place worldwide, including GOARN (Global Outbreak and Response Network), GISRS (Global Influenza Surveillance and Response System), GPLN (Global Polio Laboratory Network), the Global Project on Anti-Tuberculosis Drug Resistance Surveillance, as well as GLASS (Global Antimicrobial Resistance Surveillance System). Those multiple initiatives cooperate in order to identify, analyze, and avert or control the diffusion of public health hazards. By remaining informed and reacting rapidly and intelligently to arising public health risks, we can aid in making the world a healthier and safer place. Thank you.. 

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The Global Outbreak and Response Network (GOARN)

The Global Influenza Surveillance and Response System (GISRS)

The Global Polio Laboratory Network (GPLN)

The Global Project on Anti-Tuberculosis Drug Resistance Surveillance

The Global Antimicrobial Resistance (AMR) Surveillance System (GLASS)

Various types of Global Health Surveillance

Public Health Surveillance : An Overview 

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Good morning everyone. I am pleased to welcome you to this presentation by Dr Beauty Rani, MPH Batch 2023. Today's topic is Public Health Surveillance - an overview of its historical and modern day perspectives, criteria for selection of diseases for surveillance, objectives, and the different type of data collection methods. Let us start our journey and explore the world of Public Health Surveillance.

avatar

Surveillance of public health is a key element in monitoring and comprehending the wellbeing of the population. It encompasses the frequent, continuous collection, investigation, translation, and use of medical-related information for formulating, carrying out, and assessing public health initiatives. Surveillance can assist in discovering existing and potential threats to public health, in addition to evaluating the influence of the initiatives meant to resolve such issues.

In 1995, the National Apical Advisory Committee released a national surveillance program for communicable diseases, a major milestone in the history of public health surveillance in India. This was a response to the 1988 Cholera outbreak in Delhi and the 1994 plague outbreak in Surat. In 2004, the Integrated Disease Surveillance Project was launched to further strengthen the systems and processes of disease surveillance, eventually renamed the Integrated Disease Surveillance Program in 2008.

Considering selection criteria for surveillance of diseases is essential in order to guarantee effective public health action. Criteria should focus on conditions with high health impact, like malaria, non-communicable diseases and risk factors, and road traffic accidents. Additionally, diseases that have epidemic potential, like cholera and measles, should be taken into account. Moreover, diseases that are targets of national, regional, or international disease control programs, such as HIV, Tuberculosis, and Polio, should be considered. Obtaining this information can lead to considerable public health action and aid global health progress.

Public health surveillance is a critical component of public health, aiding in outbreak detection and monitoring, the evaluation of prevention programs, and the identification of vulnerable populations and areas. Taking swift action to contain outbreaks, meet the needs of the public, and inform decisions made by public health authorities all depend on this activity. Data-driven decisions in public health are based on this information.

Surveillance of public health has become critical in a globally connected world in order to recognize possible health problems and respond rapidly and competently. It can be employed to track the transmission of diseases, identify risk factors, inform the public and health practitioners about current risks, and assess the success of preventive efforts. Types of surveillance include the tracking of cases, data collection techniques, case definitions, alert and response systems, aggregate, case based, sentinel, active, passive, lab-confirmed, syndromic, presumptive, event-based, and indicator-based.

Public health surveillance is an important tool to check the prevalence and the spread of communicable diseases. It can be employed in two ways: 1) Case-based, where every single case of a disease is vital for public health response; 2) Aggregate, which captures aggregate data from the community, such as the total number of suspected or confirmed cases of a particular disease by age group, geographical area, or over time. For example, aggregate surveillance can be used to monitor acute diarrhea cases reported in children.

Public Health Surveillance is a useful method for assessing and keeping track of health problems. Active surveillance makes use of resources to contact providers to get reports about conditions. This technique guarantees full and precise data, and provides the capability to detect changes, outbreaks, and the effect of diseases - all indispensable for public health. Passive surveillance is dependent on accounts from health care providers, and while cheaper, the quality of the data is weaker than active surveillance. Examples of successful public health surveillance are dengue, polio, and HIV surveillance in antenatal visits.

Surveillance of public health is a potent strategy to find and monitor health developments. This involves searching for various diagnosis, including syndromic, presumptive, and lab-confirmed. It necessitates making diagnosis based on clinical pattern by paramedical personnel or on the basis of the typical history and clinical examination by medical officers. The goal is to differentiate illness clusters quickly and act quickly, thus decreasing morbidity and mortality. This technique is highly reliable and is conducted by health workers.

Surveillance for public health is an essential tool to safeguard the health of a population. India's Integrated Disease Surveillance Programme uses three types of surveillance: syndromic, presumptive and laboratory/confirmed. Syndromic surveillance is based on diagnosis based on the symptoms and patterns observed by healthcare providers and people in the community. There are seven diseases which are reported as part of this form of surveillance. Presumptive surveillance is based on a patient's medical history and clinical examination, and twenty-two diseases and conditions are reported under this form. Laboratory/confirmed surveillance is based on a medical diagnosis which is then verified through an appropriate test, with twelve diseases reported in this category. By using these three levels of surveillance, public health teams are able to better monitor, detect and respond to health incidents and outbreaks in India.

Surveillance of public health is a crucial element in preventing the propagation of sickness. EWAR works through two kinds of surveillance - indicator-based and event-based. Indicator-based surveillance searches for data regarding a population's health status, while event-based surveillance concentrates on the discovery of any strange or unexpected health situations. Both are vital instruments for keeping track of our society's health, and they can be used to quickly spot and address health issues.

Indicator-based surveillance and event-based surveillance are two approaches for public health surveillance. Indicator-based surveillance involves focusing on known diseases and using structured information to identify disease outbreaks, trends and patterns. Data is derived from sources such as clinical records from hospitals, communities and laboratories. Event-based surveillance utilizes an all-hazards approach, allowing for known and unknown diseases to be monitored and reported on. Data from official sources as well as news media, social media and other online media sources can be used here. This approach is beneficial in detecting health events which can potentially be serious for public health and can provide early warnings of new, emerging and re-emerging risks to public health.

Structured information in public health surveillance is sourced from health system infrastructure such as clinical records from hospitals and laboratories. It is organized in a predefined manner and is used in event-based and indicator-based surveillance, which focuses on known diseases, detecting outbreaks and characterizing disease trends and patterns. Unstructured information on the other hand is composed of both verified sources, such as information from experts and government, and unverified sources like news media and publicly accessible social media. This type of data is used to provide early warning signals of new, emerging and re-emerging threats to public health.

Surveillance of public health is an essential tool for the prevention and cure of public health hazards. Data collection and evaluation are fundamental elements of the system which can enable the identification of potential issues and support the creation and implementation of strategies for controlling and avoiding any kind of disease. In the following speech, we will examine the different types of public health surveillance, such as event-based and indicator-based surveillance, and feature some illustrations of how they can be applied. For example, an alert can be sent to the health office by the Local Public Works Department or the Jal Board if the turbidity and pH levels of the local water source vary from normal. Also, reports of a foul stench due to sewage overflow can be tracked using event-based surveillance if brought to attention by resident of the area. Moreover, indicator-based surveillance can be employed to authenticate data from a Veterinary Lab regarding the cases of lab- verified A/H5N1 Influenza in a large commercial free-range broiler flock, or when reported by local media about an unusual die-off amongst backyard chickens.

Public health surveillance is a crucial component of India's preventive healthcare system. Established by the Ministry of Health and Family Welfare, the Central Surveillance Unit works in tandem with the National Centre for Disease Control and each state has its own State Surveillance Unit with a State Surveillance Officer. Through these initiatives, India is taking proactive steps to protect its citizens from infectious diseases and to further strengthen its public health infrastructure in the future.

Public health surveillance is an important part of improving the health of individuals and communities. For it to be effective, data must be collected, analyzed, interpreted and used to inform action that may help to prevent negative health outcomes. This slide recognizes the importance of data collection, analysis, interpretation and evaluation in turning data into informed action. Collecting data is the first step in this process, followed by assessing and analyzing the data, which leads to informed decisions and strategies. Evaluation is the next step, which is essential in measuring the effectiveness of current strategies and in providing insight into new strategies. Data is then interpreted to establish what action should be taken to mitigate negative health outcomes. Fundamentally, public health surveillance is a cycle of data collection, analysis, action, evaluation and interpretation.

Surveillance of public health is an essential element in the battle against disease and contagious health issues. Monitoring the population's health enables us to identify health problems before they turn into major issues and devise schemes to avert them. Through gathering information from different sources such as Sub Centers (SCs), Primary Health Centers (PHCs), Community Health Centers (CHCs), District Hospitals (DHs), Medical Colleges (MCs), Public Laboratories, Army, Municipal, Railways, Employees State Insurance Corporation (ESIC) and more, we can build up an understanding of the population's health and take preventive measures. Data Surveillance Units (DSU), Supervision Surveillance Units (SSU), and Conclusion Surveillance Units (CSU) are indispensable in the gathering, amalgamating, interpreting, and disbursing of data.

Surveillance of public health is a significant means of quantifying the impact of diseases such as malaria in India. Studies from 2015 to 2016 have demonstrated a reduction in both the prevalence and mortality linked to malaria. Amongst the districts of Rajasthan, those of Barmer, Bikaner, and Jodhpur appear to be particularly susceptible to the illness. This information can be employed to form public health prevention plans to assist in decreasing the impact of malaria in these districts, and also throughout India.

 Singh A, Mehra M, Kumar A, Niranjannaik M, Priya D, Gaurav K. Leveraging hybrid machine learning and data fusion for accurate mapping of malaria cases using meteorological variables in western India. Intelligent Systems with Applications . 2023;17(200164):200164. Available from: http://dx.doi.org/10.1016/j.iswa.2022.200164 Kumar A, Chaturvedi HK, Mohanty AK, Sharma SK, Malhotra MS, Pandey A. Surveillance based estimation of burden of malaria in India, 2015-2016. Malar J  2020;19(1):156. Available from: http://dx.doi.org/10.1186/s12936-020-03223-7  Kumar P, Pisudde P, Parth Sarthi P. Meteorological linkage of Malaria cases in the eastern state of India. J Clim Chang Health]. 2022;5(100064):100064. Available from: http://dx.doi.org/10.1016/j.joclim.2021.100064 


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Surveillance of public health enables us to observe potential health perils and detect emerging trends. Examining the occurrence of diverse illnesses allows us to apply precautionary measures when needed. As an example, one occurrence of polio in an area is considered an outbreak which necessitates a suitable reaction. It is essential to evaluate the weekly data in order to determine the baseline figures and contrast them to pre-determined thresholds. These boundaries are worked out based on analyzing earlier data and give a good gauge for when public health action should be taken.

Surveillance of public health is a key factor in recognizing and responding to potential outbursts. Enhanced detection and more accurate reporting have enabled enhanced control steps and improved accuracy when delivering data. Still, changes in case definitions, the formation of new labs, and incomplete accounts can lead to under-reporting, or inaccurate data. It is essential that we remain vigilant in monitoring this information and promptly react to any modifications that could have an effect on public health.

 Ministry of Health, Family Welfare-Government of India. Trend of malaria parameters in India (2001- 2020(p)) Gov.in. [Available from:https://ncvbdc.mohfw.gov.in/index4.php?lang=1&level=0&linkid=427&lid=3705 

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Data reveals that males are more significantly affected by cases than females in general. A graph displays the age and gender wise distribution of cases, revealing that the most affected age group is 15 to 70. This highlights the necessity of considering individual features including age, gender, and religion in order to get a better comprehension of the consequences of cases.

Timely sharing of information is vital to successful public health surveillance. Strategic decision making is enabled when stakeholders such as the National Vector Borne Disease Control Programme, District Malaria Officer, Malaria Specific Supervisors, State Program Officers, and Multipurpose Supervisors, among others, are regularly updated with relevant data in real-time. This helps them take preventive and control measures more quickly and efficiently.

Public health surveillance is a vital way to recognize and monitor the spread of disease in a neighborhood. This slide emphasizes Action Focus, a particular area in an area of malaria. This locality is graded as Active with continuous transference, Residual with transmission recently broken, or Cleared with no local transmission for more than 3 years. Knowledge and awareness of Focus Identification, Classification and Elimination is raised through comprehensive Information, Education and Communication (IEC) campaigns to communities, schools and local leaders. When it comes to efficient malaria prevention, Indoor Residual Sprays (IRS) and Space Sprays, Long-Lasting Insecticidal Nets (LLINs), and Larval Source Management must be considered.

Surveillance of public health is necessary to discern health trends and dangers and to permit informed decision-making. This is done by collecting, analysing, interpreting, and distributing information which is instrumental in the planning, implementation, and evaluation of public health action. In this presentation, we will discuss the construction of public health surveillance, its core and support functions, the surveillance strategy, the implementers and stakeholders, the timeliness and ease of the system, and the resources needed to guarantee efficient operation.

 Who.int. Available from: https://www.who.int/docs/default-source/documents/publications/gmp/malaria-surveillance-monitoring-and-evaluation---a-reference-manual.pdf?sfvrsn=46489b3b_2 

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Every sub-center in this overview of public health surveillance systems has a "S" form, which are paper forms filled at the sub-center level and passed upwards to the Primary Health Centre, Block PHC, or Community Health Centre. This information is then transferred from paper to electronic format and stored as spreadsheets or databases, which is forwarded to the district or state surveillance unit for further analysis. Data collect from all levels is organized in a hierarchical structure, being collected from village, sub-district, district, and state levels.

Public Health Surveillance is a complex system that entails advanced data networking and reporting. Data is aggregated from the village level and relayed to the different tiers of sub-district, district, and state. Mobile reporting and portal accessibility is employed so that data is concisely and accurately reported. Sub-centers, Primary Health Centers, and laboratories are linked through broadband connectivity, with each having their own district and state surveillance unit. Mobile reporting combines store and forward and near real-time features, providing access to data analytics and results to all levels for immediate action. This assemblage of elements culminates in the implementation of an extensive public health surveillance system.

Public health surveillance aims to identify health patterns, trends, and opportunities of individuals, communities, or populations. This slide exhibits the system utilized for this purpose, including the State Surveillance Unit, the Community Private Identified Sub-Center, the District Surveillance Unit, the Primary Health Center, the Central Surveillance Unit, the Integrated Disease Surveillance Program or IDSP portal, and Government or Private Hospitals. All these components collaborate to offer a complete view of public health surveillance.

Public health surveillance is an essential component of public health efforts. To improve public health surveillance, two national programs - IDSP and IHIP - are implemented. IDSP gathers aggregated data, whereas IHIP captures disaggregated data and links data from S, P, L, and EWS forms. IHIP facilitates electronic collection and transmission of surveillance data, as well as realtime or daily surveillance reporting instead of weekly reporting. Additionally, the IHIP system permits surveillance for 33+ health conditions, geocoded data and analyzed reports that can be accessed on mobile and other electronic devices. It further enables easier initiation and monitoring of outbreak investigations. To meet the needs of special events, such as COVID-19, INSACOG (WGS), post disaster and mass gatherings, a special surveillance module has been added to IHIP and used successfully during the 2019 Kumbh Mela. This presentation provides an overview of the features, components, and benefits of public health surveillance.

Surveillance of public health is a major component of healthcare in India. Despite considerable difficulties in implementation, it is essential to acknowledge that the current system is inadequate with inconsistent coverage. This leads to detached and segregated tasks, programs and facilities, along with comparatively minimal involvement from the private sector. Furthermore, basic public health capacity has not been effectively trained, while insufficient use of digital, social and printed media implies that non-communicable disease surveillance is not given adequate attention and there is an inadequate and elementary method of occupational health surveillance. To ensure that India's surveillance system is able to meet the requirements of its populace, these difficulties must be addressed.

Surveillance of public health is a valuable instrument for accumulating, evaluating and utilizing universal data about health dangers and hazard factors from around the world. By following and monitoring changing situations in various nations, we achieve priceless knowledge regarding how global health conditions are evolving. This is especially accurate in the matter of contagious diseases, and also intentional utilization of biological substances or toxins to cause harm. By staying one step in front of these difficulties, we can make better readiness and response tactics.

At the end of our presentation on Public Health Surveillance, I'd like to express my gratitude for your attention in learning about the essential operations that keep the world safe and healthy. Several public health surveillance schemes take place worldwide, including GOARN (Global Outbreak and Response Network), GISRS (Global Influenza Surveillance and Response System), GPLN (Global Polio Laboratory Network), the Global Project on Anti-Tuberculosis Drug Resistance Surveillance, as well as GLASS (Global Antimicrobial Resistance Surveillance System). Those multiple initiatives cooperate in order to identify, analyze, and avert or control the diffusion of public health hazards. By remaining informed and reacting rapidly and intelligently to arising public health risks, we can aid in making the world a healthier and safer place. Thank you.