1. IDSP – Integrated Disease Surveillance Project
Dr. Rizwan S A, M.D.,

2. IDSP – Integrated Disease Surveillance Project

3. Outline of Presentation
• What is Surveillance?
• IDSP
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Phases of implementation
Components
Objectives
Classification of surveillance
Conditions under regular surveillance
Flow of information
Surveillance activities at each level
Surveillance committees at each level
Reporting
Surveillance action
Strengths
New initiatives

4. Surveillance

5. Surveillance
• Surveillance is defined as the ongoing systematic
collection, collation, analysis and interpretation of
data and dissemination of information to those who
need to know in order that action be taken.

6. Important information in surveillance
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Who gets the disease?
How many get them?
Where they get them?
When they get them?
Why they get them?
What needs to be done?

7. Key elements of a surveillance system
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Detection and notification of health events
Investigation and confirmation
Collection of data
Analysis and interpretation of data
Feedback and dissemination of results
Response – Action for prevention and control

8. IDSP

9. Phases of implementation
• Phase I (2004-05)
– Madhya Pradesh, Andhra, Himachal, Karnataka, Kerala, Maharashtra,
Mizoram, Tamil Nadu & Uttaranchal
• Phase II (2005-06)
– Chattisgarh, Goa, Gujarat, Haryana, Orissa, Rajasthan, West Bengal,
Manipur, Meghalaya, Tripura, Chandigarh, Pondicherry, Nagaland,
Delhi
• Phase III (2006-07)
– UP, Bihar, J&K, Punjab, Jharkhand, Arunachal, Assam, Sikkim, A&N
Island, D&N Haveli, Daman & Diu, Lakshadweep

10. Components
• Integrating & decentralizing disease surveillance &
response mechanisms
• Strengthening Public Health Laboratories
• Using Information Technology and Networking in disease
surveillance
• Human Resource Development

11. Objectives
• To establish a decentralized district based system of
surveillance for communicable and non-communicable
diseases, so that timely and effective public health actions can
be initiated in response to health changes in the urban and rural
areas
• To integrate existing surveillance activities to avoid
duplication and facilitate sharing of information across all
disease control programmes and other stake holders, so that
valid data is available for health decision making in the
district, state and national levels

12. What is integration?
• Sharing of surveillance information of various disease control
programmes
• Developing effective partnership with heath and non health
sectors in surveillance
• Including communicable and non communicable diseases in
the surveillance system
• Working with the private sector and non governmental
organization
• Bringing academic institutions and medical colleges into
disease surveillance

13. Classification of surveillance in IDSP
• Syndromic
– Diagnosis made on the basis of clinical pattern by
paramedical personnel and members of community
• Presumptive
– Diagnosis is made on typical history and clinical
examination by medical officers
• Confirmed
– Clinical diagnosis confirmed by appropriate laboratory
identification

14. Conditions under regular surveillance
Type of disease
Disease
Vector borne diseases
Malaria
Water borne diseases
Diarrhoea, Cholera, Typhoid
Respiratory diseases
Tuberculosis
Vaccine preventable diseases
Measles
Disease under eradication
Polio
Other conditions
Road traffic accidents
International commitment
Plague
Unusual syndromes
(Causing death/hospitalization)
Meningo-encephalitis
Respiratory distress
Hemorrhagic fever
Other undiagnosed condition

15. Other conditions under surveillance
Type of surveillance
Sentinel surveillance
Categories
Conditions
HIV/HBV/HCV
Other
conditions
Regular periodic surveys
STDs
Water quality
Noncommunicable
disease risk
factors
Anthropometry
Physical activity
Blood pressure
Tobacco, blood pressure
Outdoor air quality
Nutrition
Blindness
Additional state priorities
Up to five diseases

16. State-specific diseases
• Madhya Pradesh, Uttaranchal
– Diphtheria, neonatal tetanus, leprosy
• Maharashtra
– Diphtheria, neonatal tetanus, leptospirosis
• Andhra Pradesh
– Filariasis
• Karnataka
– Filariasis, KFD & HGS, leptospirosis
• Tamil Nadu
– Leprosy, leptospirosis
• Kerala
– Leptospirosis
• Mizoram
– Cancer, substance abuse, acid peptic disease, pneumonia

17. Syndromic surveillance
• Fever
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<7 days with no localizing signs
with rash
with altered sensorium/convulsions,
bleeding skin/gums
>7 days
Cough >2 weeks
Acute Flaccid Paralysis
Diarrhea
Jaundice
Unusual events causing death/hospitalization

18. Flow of information

19. Information flow of the weekly
surveillance system
Sub-centres
Programme
officers
C.S.U.
S.S.U.
P.H.C.s
C.H.C.s
Pvt. practitioners
D.S.U.
Dist. hosp.
Nursing homes
Private hospitals
Med. col.
Private labs.
P.H. lab.
Other Hospitals:
ESI, Municipal
Rly., Army etc.
Corporate
hospitals

20. Surveillance activities at each level
Activities
Periphery
District
State
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Consolidation of data
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Analysis and interpretation
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Feedback
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Dissemination
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Detection and notification of
cases
Investigation and confirmation

21. District Surveillance Committee
District Program Manager
Polio, Malaria, TB, HIV - AIDS
CMO
(Co. Chair)
Representative
Water Board
Chief District PH
Laboratory
Superintendent
Of Police
District Data Manager
(IDSP)
Chairperson*
District Surveillance Committee
Representative
Pollution Board
IMA
Representative
NGO
Representative
District Training Officer
(IDSP)
Medical College
Representative
if any
District Panchayat
Chairperson
District Surveillance Officer
(Member Secretary)
* District Collector or District Magistrate

22. State surveillance committee
Director Public
Health (Co. Chair)
Director Medical Education
Director Health Service
Representative
Water Board
State Program Managers
Polio, Malaria, TB, HIV - AIDS
NGO
State Data Manager IDSP
Chairperson*
State surveillance committee
Medical Colleges
State Coordinator
Head, State Public
Health Lab
Representative
Department of Home
State Training Officer
Representative
Department of Environment
* State health secretary
IMA
Representative
State Surveillance Officer
(Member Secretary)

23. National surveillance committee
Director General
Health Services
(Co. Chair)
Director General
ICMR
PD
(IDSP)
National Program Managers
Polio, Malaria, TB, HIV - AIDS
JS
(Family Welfare)
Chairperson*
National surveillance
committee
IMA
Representative
Director
NICD
NGO
Director
NIB
Consultants
(IndiaCLEN / WHO
/ Medical College
/others)
Representative
Ministry of Environment
* Secretary health and secretary family welfare
Representative
Ministry of Home
National Surveillance Officer
(Member Secretary)

24. Linkages of the central surveillance unit at the
central level
W.H.O.
Outbreak investigation
and rapid response
E.M.R.
NCDC
Non-communicable
diseases
surveillance
MIS and report
CSU
ICMR
NVBDCP
RNTCP
National
Programs
CBHI
RCH
Programme monitoring
NACP

25. Reporting
Reporting Forms
• Form ‘S’ (Suspect Cases)
• Health Workers (Sub Centre)
• Form ‘P’ (Probable Cases)
• Doctors (PHC, CHC, Pvt. Hospitals)
• Form ‘L’ (Lab Confirmed Cases)
• Laboratories

29. Laboratory Reporting
Form
Level of Laboratory
Responsibility of
Reporting
Form L1 Peripheral Laboratory at PHC/CHC
Laboratory
Assistants/Technician
through MO I/c
Form L2 District Public Health Laboratory,
Labs of District Hospital, Private
and other Hospitals & Private Labs.
I/c
Microbiologist/Pathologists
Form L3 Labs in Medical Colleges, other
tertiary institutions,
Reference Labs.
Head, Microbiologist
Department

30. Warning Signals of an impending outbreak
• Clustering of cases/deaths in Time/Place
• Unusual increase in cases/ deaths
• Even a single case of measles , AFP, Cholera, Plague,
Dengue, or JE
• Ac. febrile illness of unknown etiology
• Two or more epidemiologically linked cases of outbreak
potential
• Unusual isolates
• Shifting in age
• High or sudden increase in vector density
• Natural Disaster

31. Surveillance Action
Preset trigger level with specific response for various levels
• Trigger Level 1 - Suspected limited outbreak
– local response
• Trigger Level 2 - Epidemic
– local & regional response
• Trigger Level 3 - Wide spread Epidemic
– local, regional & state level response

32. Strengths of IDSP - 1
1.
Functional integration of surveillance components of
vertical programmes
2. Reporting of suspect, probable and confirmed cases
(Standard case Definition)
3. Strong IT component for data analysis
4. Trigger levels for graded response
5. Action component in the reporting formats
6. Streamlined flow of funds to the districts
7. Standard Formats, Operations & Training Manuals
8. Involvement of Private Sector

33. New Initiatives - 1
1. Alerts through IDSP call center
Call Centre operational with 1075 toll free number since
February 2008
2. E-learning
The objective of e-learning is to enhance the skills to a wide
arena of health personnel.
Proposed components:
– Discussion Forums
– Online Survey & Assessment
– Feedback
– FAQs
Currently e-learning modules are being prepared

34. New Initiatives - 2
3. Media Scanning Cell
• Objective:
– To provide the supplemental information about outbreaks
• Method:
– National and local newspapers, Internet surfing, TV
channel screening for news item on disease occurrence.
• Benefits of Media Scanning:
– Increases the sensitivity & strengthen the surveillance
system
– Provide early warning of occurrence of clusters of diseases

35. Thank You