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A Term paper presentation to fulfill the partial
requirement of BPH THIRD SEMESTER
[TPP 5.1 BASIC EPIDEMIOLOGY-II]
Prepared by
 SAgun PAudel
Presented with:
 Rajesh kumar Yadav
 Purnima Timilsina
 Kalpana Gurung
LA GRANDEE International college, Pokhara
03/08/2012

3. Public health Surveillance
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Public health surveillance is the On-going, systematic
collection, analysis, and interpretation of health-related
data and dissemination for use in the planning,
implementation, and evaluation of public health practice on
a specific disease or other health-related event. Such
surveillance can:
 serve as an early warning system for impending public
health emergencies;
 document the impact of an intervention, or track
progress towards specified goals; and
 monitor and clarify the epidemiology of health problems,
to allow priorities to be set and to inform public health
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policy and strategies

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Better surveillance data lead to a more rational
establishment of priorities. More timely and
accurate data facilitate earlier epidemic detection
and control. With better surveillance data, the
impact of intervention activities and other public
health programs can be evaluated more
accurately.
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5. Uses of Public Health Surveillance
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Public Health Surveillance has many uses;
 Monitoring trends in health events.
 Guiding decision making and action to reduce
morbidity and mortality
 Detecting cases for intervention, evaluate control
and prevention measures.
 Guiding planning, implementation and evaluation of
public health programs, providing a basis for
epidemiological research.
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 Estimate magnitude of the problem.
 Portray the natural history of a disease.
 Determine distribution and spread of illness.
 Detecting potential outbreaks and threats to
public health.
 Monitor changes in infectious agents.
 Directing public health interventions
 Generate hypotheses, stimulate research.
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7. Flowchart of Surveillance Data
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8. Objective:
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General Objectives:
 To Study the Public health surveillance system
at national & international level.
Specific Objectives:
 To study the Public health surveillance frame
work, guidelines and strategies.
 To study the public health surveillance of Nepal.
 To study the Joint National/International Review
of Acute Flaccid Paralysis (AFP) Surveillance –
Nepal.
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9. METHODOLOGY
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Secondary data
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10. Finding and discussion
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Disease surveillance being a critical component of
the health system in generating essential
information for optimal health care delivery and a
cost-effective health strategy, WHO has been
making continuous efforts very actively in
developing and strengthening disease
surveillance during the last three decades. At
present, surveillance activities in the Region are
through several vertical surveillance systems
resulting in duplication of efforts and resources.
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Many of them do not adequately address
surveillance issues, namely, objective assessment
of estimation of disease burden, identification of risk
groups, spread of the disease, detection of early
warning signals, anticipation and prediction of
outbreaks, understanding drug resistance, etc.
The current global trend is to move towards
integrated disease surveillance activities that
maintain essential resources, planning, monitoring
and evaluation so as to monitor the quality of
prevention and control activities and assess their
impact on various diseases. 03/08/2012

12. Proposed SEAR Strategy for
Integrated Disease Surveillance
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The Global Meeting on Communicable Diseases
Surveillance, including Epidemic-prone and/or
Vaccine Preventable Diseases, held at
Cairo, Egypt, in January 2001, recommended
integrated multi-disease surveillance as a means
of achieving efficiency and effectiveness in
surveillance.
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an integrated approach to surveillance will require
a functional change in the existing surveillance
system.
The integrated surveillance will sum up all
surveillance activities, which will merge into a
national integrated disease surveillance
programme. It will envisage all surveillance
activities in a country as a common public service
which carries out many functions using similar
structures, processes and personnel.
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The guiding principles in integration will be primarily
to enhance effectiveness and cost efficiency and to
meet the objectives of disease prevention and
control through improvement of core and support
functions of surveillance.
Capacity building, laboratory strengthening and
quality assurance should be pro-actively supported
and promoted. General guiding principles like
simplicity, usefulness, flexibility, accessibility to the
data etc. should also be attended too.
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The strategy envisions that by the year 2010 all
the Member States in the.
SEA Region will establish a functional, effective
coordinated integrated disease surveillance
system that will satisfy all disease surveillance
partners and ensure continuous, accurate, timely
and complete information for disease prevention,
control, elimination and eradication.
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16. The strategy framework broadly
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covers:
(a) Developing a and private sectors
consensus, (h) Capacity building,
(b) Phasing, (i) Community
(c) Establishing a strong participation,
coordination mechanism, (j) Use of new electronic
(d) Evaluating existing tools, and
surveillance systems, (k) A syndromic approach.
(e) Advocacy,
(f) Resource generation,
(g) Involvement of NGOs 03/08/2012

17. The major operational thrust areas
are:
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(1) To include under integrated surveillance 16
epidemic-prone communicable diseases, three
communicable diseases under
eradication/elimination, three communicable
diseases of major public health importance, four
non-communicable diseases and eight risk
factors for Non-communicable diseases in
phases during the next decade with immediate
emphasis on epidemic prone diseases; and
priority communicable diseases.;
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(2) Capacity building covering epidemiology,
laboratory, communication including use of
computer and acquiring competence in data
handling;
(3) Understanding vectors and animal reservoirs;
(4) anti-microbial drug resistance;
(5) Involvement of the private sector, and
(6) Feedback.
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The disease surveillance system in Nepal has
been integrated with the health management
information system (HMIS) which conducts
routine surveillance activities. The early warning
reporting system (EWARS) is activated at
sentinel surveillance centres and provides early
notifications about diseases under sentinel
surveillance. Rapid response teams (RRT)
report daily when there is an outbreak of disease
under surveillance. Reporting is carried out
through health workers, NGOs/INGOs, media
and through adhoc reporting. 03/08/2012

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 Malaria, kala-azar, Japanese encephalitis,
lymphatic filariasis, leprosy, HIV/AIDS, STDs,
human rabies, snake-bites, ARI, diarroheal
diseases, EPI diseases, meningitis, dengue,
typhoid fever, viral hepatitis, UTI and influenza
are the diseases under the routine surveillance
system and case definitions and standards are
available.
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 All the clinically suspected cases are reported to
the intermediate level by peripheral level health
workers with available information and with
supportive laboratory data, if available. Clinical
samples are sent to Regional and central
laboratories for confirmation. All these cases are
reported to HMIS routinely. Anti-microbial
resistance surveillance on
vibrio, shigella, pneumococci, streptococci
pneumonia, heamophilus influnzae and
Neissseria gonorrhoeae is institutionalized.
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Joint National/International Review of
Acute Flaccid Paralysis (AFP)
Surveillance – Nepal
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24. Surveillance Structure
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AFP surveillance is well established in Nepal and,
although integrated with other disease reporting, it
has special status as evidenced by the monitoring
of specific performance indicators, zero reporting,
and active surveillance.
Public health staff appears motivated,
conscientious, well trained, and aware about AFP
notification and investigation procedures at all
levels – even among the FCHVs working at the
village level. As discussed earlier, the SMOs are
key focal persons for AFP surveillance in the
districts/regions.
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 After PEN was established, guidelines
specifically for AFP surveillance were developed
in 1998. These were updated in 2003 and again
in 2005 to include additional priority VPDs. The
guidelines and manuals for AFP and EPI
surveillance activities were readily available in
the SMO field locations visited. Display of EPI
data, including spot maps of AFP cases and
surveillance indicators were prominently
displayed. Polio eradication and AFP posters
were also noticeable at all levels including the
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sub-health posts.

26. The different components of the
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AFP surveillance system are;
 Immediate reporting,Case investigation
 Active surveillance
 Zero reporting
 Surveillance of Acute Flaccid Paralysis
(AFP) cases: Nepal continues to maintain
certification standard AFP surveillance since
2000. There are 15 surveillance medical
officers based in ten field offices supported by
WHO conducting surveillance and also
assisting national counter parts in the field of
vaccine preventable diseases.
 Active surveillance 03/08/2012

27. Surveillance Quality Indicators, Nepal 2001 –
2006 (as of 31 July 2006).
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1- Number of AFP cases per 100 000 children under 15 years of age. 2006 AFP Rate annualized as of week 30, 2006.
2-Number of discarded AFP cases per 100 000 children under 15 years of age. The 2006 non-polio AFP Rate annualized
as of week 30, 2006.
3- Percent with two specimens 24 hours apart and within 14 days of paralysis onset
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28. Nepal Surveillance medical officers
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[SMO] Network
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29. Conclusion
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In conclusion WHO urges all the Member
Countries to initiate the process of reviewing their
existing surveillance systems and implement an
integrated national disease surveillance
programme by merging all surveillance systems
through consensus among all the partners and
stakeholders and mobilizing resources for the
same.
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The Nepal Ministry of Health, Department of
Health Services should be commended for an
efficient and well-integrated AFP surveillance,
strong EPI coverage, and commitment to polio
eradication. All these areas appear to have been
strengthened over the last several years due to
strong leadership and motivated staff at all
levels. However, it is likely that wild poliovirus
continues to circulate in high-risk areas of Nepal.
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31. Recommendations
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• The FCHVs should be mobilized to raise
awareness and encourage health institutions and
private practioners at community levels in border
areas to report AFP cases immediately to SMOs
and health services.
• Unless circumstances change substantially in
2006, no additional AFP surveillance review is
required this year. Ongoing monitoring of the
sensitivity of the surveillance system should
continue and the need for another AFP review in
2007 assessed. 03/08/2012

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• SMOs should continue to increase awareness on
AFP among private practioners, traditional healers
and local community health staff and leaders, in
order to improve timely notification and
investigations.
• Nepal should continue to review its Plan of
Action for Responding to Polio Outbreaks in order
to ensure that it is up to date with the latest WHO
and ACPE recommendations.
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33. References:
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• A report of Joint National/International Review of
Acute Flaccid Paralysis (AFP) Surveillance –
Nepal.
• Regional Strategy for Integrated Disease
Surveillance Report of an Intercountry
Consultation Yangon, Myanmar, 21-24 August
2002
• Polio fact sheet-NEPAL WHO
• World Health Organization.
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