Background

1. Sentinel Surveillance Model for Vaccine Preventable Childhood Infectious Diseases 15 July 2011National Centre for Disease Control, Delhi

2. Background Vaccine Preventable Childhood illnesses are an important cause of under-five mortality There is a need for Generating actionable data on disease occurrence and trends Evaluating the effectiveness of VPD control programs/policies Guiding program decisions Currently there is no reliable system present for the surveillance of VPDs in the country Good quality laboratory confirmed surveillance data can be collected from strategically located sentinel sites to deliver good quality actionable data

3. Objective To study the magnitude and epidemiology of selected childhood vaccine preventable diseases

4. Specific Objectives Disease trends Seasonality of disease Age & Gender distribution of cases Geographic distribution of the cases Vaccination status for suspected disease Laboratory data Proportion of lab confirmed cases Confirmation of aetiology To find out prevalent serotypes (e.g. Pneumococcus, H. Influenzae, Meningococcus, etc.) To find out the anti-biogram To stock isolates for future use

5. Types of models for surveillance of selected diseases

6. Models for sentinel surveillance of selected diseases • Sentinel surveillance model for Measles, Meningitis and Enteric fever at 30 Sentinel Sites • Surveillance for JE through the existing NVBDCP Sentinel sites • Diphtheria Surveillance from identified Infectious Disease Hospitals • Surveillance of Pertussis, Rota virus, Strepto. Pneumoniae, H. influenzae -B in a research mode from a few designated centers

7. Suggested model for Sentinel Surveillance for Measles, Meningitis & Enteric fever at 30 selected sites

8. Selection of sentinel site • 30 Medical institutions (Medical Colleges or other reputed Tertiary care Hospitals) along with attached 30 District Hospitals (thus total 60 data collection sites) have been chosen as sentinel sites • Inclusion criteria for final selection: • Willingness to participate as a sentinel site • Catering to a large number of VPD cases • Functional departments of Paediatrics and Microbiology • Geographic representation • The District Hospital linked with the Sentinel site • Samples to be collected from District Hospital • Chosen district is based on the location of the Sentinel site or where the Sentinel site has its field practice area

9. Data Flow SSU, IDSP State Surveillance Unit CSU, IDSP Central Surveillance Unit DSU, IDSP (District Surveillance Unit) Sentinel Site (Medical College Hospital / Tertiary Hospital) PSM Dept. District Hospital Pediatrics and Micro Departments

10. Role of Sentinel Site • Paediatric Dept: • Senior paediatric specialist - the nodal officer for the Sentinel site • All doctors to be sensitized regarding Standard Case definition • Treating pediatrician to put IDSP stamp on OPD card • Microbiology laboratory facilities: • At the identified Medical Institute level only • Laboratory staff of Sentinel Site to visit District Hospital for sample collection • Clinical samples: • Collection at the Centralized Sample Collection Centre/ Paediatric OPD and also from the District Hospital • Sample transportation to Microbiology dept. for laboratory investigation • Data collection: • Flexibility given to each Sentinel Site for data collection procedures • Unique ID number linking field data and lab data to be developed before surveillance activities begin

11. Functioning of the Sentinel Sites • Role of the Nodal officer of Sentinel site: • Supervise work of Data Entry Operator (DEO) and also ensure that data are collected when DEO is absent • Plan training of Pediatricians, Microbiologists, DEO and Lab technicians concerned with sentinel surveillance • Flexi-funds to Sentinel sites • Honorarium to any person may be considered for coordination for ensuring collection and transfer of data as well as collection and testing of clinical samples • Rs. 5000 pm would be provided to each department (Paediatrics, Microbiology and PSM) of the Medical Institution, as well as to the attached District Hospital • The laboratories of sentinel sites would be provided funds for reagents/ diagnostic kits/ consumables

12. Role of Data Entry Operator at Sentinel Sites • DEO recruitment • Post of DEO has been sanctioned at 26 Govt. Medical Institutions under IDSP • A new DEO may be appointed/trained for Sentinel surveillance activities at sites where none exists • Patients with IDSP stamped card to be referred by the treating clinician to the DEO • DEO to fill the Data-register with the data collected from the • OPD • IPD • Lab • DEO would transfer data from register to a computer and send it by e-mail to DSU, SSU, CSU on weekly basis (Week = Monday to Sunday)

13. Role of State/District Surveillance Units, IDSP • Role of State Surveillance Officer (SSO) at the State level: • Sanctioned funds (for logistics, manpower and procurement) would be released through the concerned SSO • SSO to monitor the expenditure of the sites • Coordinate activities of the sentinel sites in the state • Role of concerned District Surveillance Officer (DSO) • Assist Sentinel Site Nodal Officer in data collection and transfer • Respective DSU/SSU would utilize the surveillance data for response in conjunction with IDSP data

14. Role of Central Surveillance Unit (CSU), IDSP in Sentinel Surveillance • Overall data compilation and analysis would be done at CSU, IDSP at NCDC • Additional manpower to be recruited at CSU: • 4 Epidemiologists • 1 Lab coordinator • 1 Data Manager • 2 Data Entry Operators • Epidemiologists would coordinate overall functioning of the sentinel sites and would be assisted by the Data Manager and the DEO in the analysis of the data of the entire country • Lab coordinator (Microbiologist) at the national level to ensure smooth functioning of the laboratories at all the Sentinel Surveillance sites

15. Monitoring of Sentinel Site activities • Zonal coordinators • One coordinator identified for each zone • Each Zonal coordinator to supervise and monitor five sentinel sites under his/her respective Zone • Performance indicators for Sentinel surveillance: • Consistency of reporting of sites per week: >80% • Timeliness of reporting of sites per week: >80% • Implementation issues would be reviewed at CSU, IDSP/NCDC involving the nodal persons of sentinel sites after 3 months of initiation of data reporting • Review of the pilot project to be done after one year • Expansion of sentinel sites and/or disease syndromes may be considered later

16. List of Sentinel Sites for conducting Sentinel Surveillance for Meningitis, Measles and Enteric fever • GB Pant Hosptial, Port Blair • Niloufer Hospital, Hyderabad • Guwahati Medical College, Guwahati • Patna Medical College • Government Medical College & Hospital • Pt. JN Memorial Medical College, Raipur • Kalawati Saran Childrens’ Hospital, Delhi • Goa Medical College, Bambolim, Panaji • BJ Medical College, Ahmedabad • PGIMS, Rohtak • Indira Gandhi Medical College, Shimla • SKIMS, Srinagar • MGM Medical College, Jamshedpur • Bangalore Medical College, Bangalore • Govt. Med. College, Thiruvananthapuram • MGM Medical College, Indore • GS Medical college & KEM Hospital, Mumbai • JN Hospital, JNIMS, Porompat, Imphal East • NEIGRIHMS, Shillong • SCB Medical College & Hospital, Cuttack • JIPMER, Puducherry • Government Medical College, Patiala • SMS Hospital, Jaipur • ICH & Hospital for Children, Chennai • Christian Medical College, Vellore • BRD Medical College, Gorakhpur • BHU, Varanasi, Uttar Pradesh • KGMC (CSMMU UP), Lucknow • Govt. Doon Hospital, Dehradun • Medical College and Hospital, Kolkata

17. Types of models for surveillance of selected diseases • Sentinel surveillance model for Measles, Meningitis and Enteric fever at 30 Sentinel Sites • Surveillance for JE through the existing NVBDCP Sentinel sites • Diphtheria Surveillance from identified Infectious Disease Hospitals • Surveillance of Pertussis, Rota virus, Strepto. Pneumoniae and H. influenzae -B in a research mode from a few designated centers

18. Suggested model for Sentinel Surveillance for Acute Encephalitis Syndrome (AES)/ Japanese Encephalitis (JE)

19. Link with NVBDCP for Sentinel Surveillance of AES/JE • The surveillance of AES with special reference to JE cases should be done at the Sentinel Sites identified by NVBDCP in the country • National Vector borne Disease Control Programme (NVBDCP) has identified and strengthened the diagnostic facilities at 51 sites for surveillance of AES/JE • Existing resources provided by NVBDCP would be adequate for surveillance of JE • Data would be collected from the existing system of NVBDCP

20. Types of models for surveillance of selected diseases • Sentinel surveillance model for Measles, Meningitis and Enteric fever at 30 Sentinel Sites • Surveillance for JE through the existing NVBDCP Sentinel sites • Diphtheria Surveillance from identified Infectious Disease Hospitals • Surveillance of Pertussis, Rota virus, Strepto. Pneumoniae and H. influenzae -B in a research mode from a few designated centers

21. Suggested model for Sentinel Surveillance of Diphtheria at Infectious Disease Hospitals under IDSP

22. IDH network for Diphtheria Surveillance • Surveillance data for Diphtheria cases would be collected from a the identified Infectious Disease Hospitals (IDH) under IDSP • ID Hospital (Ahmedabad) • ID Hospital (Bangalore) • Communicable Disease Hospital (Chennai) • Maharishi Valmiki ID Hospital (Delhi) • Sir Ronald Ross Fever Hospital (Hyderabad) • Beleghata ID Hospital (Kolkata) • Kasturba Hospital (Mumbai) • Under IDSP, the ID Hospitals have been strengthened with provision of • ICT network • Recruitment of DEO to enable reporting of data • ID Hospitals report simultaneously to District, State and Central Surveillance Units • A meeting involving these ID Hospitals would be called for implementing the sentinel surveillance mechanism

23. Types of models for surveillance of selected diseases • Sentinel surveillance model for Measles, Meningitis and Enteric fever at 30 Sentinel Sites • Surveillance for JE through the existing NVBDCP Sentinel sites • Diphtheria Surveillance from identified Infectious Disease Hospitals • Sentinel Surveillance of infection/diseases due to Pertussis, Rota virus, Strepto. pneumoniae and H. influenzae - B in a research mode from a few designated centers

24. Suggested model for Sentinel Surveillance of Pertussis, Rota virus, Hemophilus influenzae- B and Strepto. Pneumoniae

25. Sentinel Surveillance in Research mode • Surveillance data on infection/diseases due to Pertussis, Rota virus, Streptococcus pneumoniae and Hemophilus influenzae - B would be collected on a research mode from the identified centers: • AIIMS (Delhi) • PGI (Chandigarh) • CMC (Vellore) • NICED (Kolkata) • INCLEN ? • Some centers have already generated some data on diseases due to Rota virus and H. influenzae- B infection and these data may be reviewed to arrive at indicative estimates. These centers may be given the responsibility to generate further required data • A meeting involving these centers would be called for discussing the implementation strategy

26. ID No. Date of Registration/ Admission Name Age Sex Address Date of onset of illness Major presenting features Clinical Diagnosis Treatment history Vaccination status of related disease Name of Vaccine No. of doses given Lab tests Name of lab test done Lab diagnosis H/O similar illness in neighborhood Outcome Recovered/ Died/ LAMA Categories to be filled up in the Register for Sentinel Surveillance

27. Format for filling up Register for Sentinel Surveillance

28. Diagnostic laboratory tests for Diseases under Sentinel Surveillance

29. Total Budget for Sentinel Surveillance of selected Vaccine Preventable Childhood Infectious Diseases

30. Budget for Sentinel Surveillance at Zonal levels and Central level

31. Budget for Sentinel Surveillance of Meningitis, Measles and Enteric Fever at 30 identified Sentinel sites

32. Budget for Diphtheria Surveillance at the seven Infectious Disease Hospitals under IDSP

33. Budget for Surveillance of Pertussis, Rota virus, H. influenzae and Strepto. pneumoniae at five Research Institutes

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