Notification of communicable diseases

1. Notification of communicable diseases Prof. MW Gunathunga IIM, 3rd July 2013

2. Objectives • To learn what notification entails • To learn the process of notification of diseases in Sri Lanka

3. NOTIFICATION • The act of reporting the occurrence of a communicable disease or of an individual affected with such a disease • A legal requirement • On suspicion of disease • Use a standard format (H-544) called notification form • At any setting – government or private OPD, clinics, wards

4. Notifiabe Disease Reporting System Notifiable Disease A disease that, by statutory requirements, must be reported to the public health authority in the relevant area when the diagnosis is made. A disease deemed of sufficient public health importance to require that its occurrence be reported to health authorities.

5. Legislature • The Quarantine and Prevention of Disease Ordinance of 1897 and it's amendments - Every practitioner treating a case of notifiable disease should notify - Anyone failing to do so can be prosecuted in the Magistrate Court

6. Notifiable Diseases • Group A - Cholera - Plague - Yellow Fever To: > DGHS > DDG (Public Health) > Epidemiologist > MOH > Regional epidemiologist By telephone, fax or telegram and notification form

7. Notifiable Diseases continued… • Group B - Acute flaccid Paralysis - Chicken pox - Dengue fever / Dengue Haemorrhagic Fever - Diphtheria - Dysentery - Encephalitis - Enteric fever - Food Poisoning - Human Rabies - Leptospirosis - Malaria

8. Notifiable Diseases continued… • Group B continued… - Measles - Meningitis - Mumps - Rubella & Congenital Rubella Syndrome - Severe Acute Respiratory Syndrome (SARS) - Simple continued fever for 7 days or more - Tetanus - Neonatal Tetanus - Tuberculosis (Pulmonary) - Typhus fever - Viral Hepatitis - Whooping cough - Leishmaniasis

9. To Whom ? AFP – To MOH, Epidemiologist and Regional Epidemiologist By telephone, fax or telegram and AFP notification form Tuberculosis – To Director NPTCCD by TB notification form SARS – To DGHS, DDG (PHS), Director (Quarantine), Port/ Air Port Health Officer, Epidemiologist, RE, MOH Others – To MOH of the area of residence by notification form

10. When to notify ? • As soon as the provisional diagnosis is made NOT ON DISCHARGE !!!

11. CommunityWard Notification Register Hospital Notification Register Notification Register Investigation and reporting Infectious Diseases Register Update spot map Patient / BHT in Hospital/GP Notification Card MOH Weekly Epidemiological Report Quarterly Epidemiological Bulletin PHI Epidemiology Unit MOH Special Surveillance Forms* Weekly Return of Communicable Diseases Regional Epidemiologist

12. What are the diseases under special investigation? -Diseases covered by the EPI (What are those ?) - Polio, Diphtheria, Pertussis, Tetanus and Neonatal Tetanus, Measles, Rubella, Hep.B - Japanese Encephalitis - Dengue Haemorrhagic Fever - Human Rabies - Cholera - Mumps - Meningitis - Chicken pox

13. Limitations of Notifiable Disease Reporting System • Under reporting 2. Poor quality of reporting - Incomplete - Illegible - Inaccurate • Lack of timeliness • Inconsistency of case definitions 5. Lack of representative ness of reported cases

14. Lack of Representative ness E.g. Measles Home - Not reported GP – May be reported Govt. Hospital - Reported Private Hospital - ?

15. Under reporting - Why ? • Lack of knowledge of the need for reporting - Unaware of the responsibility - Unaware what diseases to report - Assume that someone else will report - Unaware of how to and whom to report • Negative attitudes towards reporting - Time consuming - Lack of incentive - Lack of feedback - Distrust in the govt. / health system

16. Misconceptions - Reporting compromises patient-physician relationship - Breaches confidentiality - Wrong judgment that the disease is not serious - Belief that public health measures do not work - Belief that health department does not act on the reports.

17. Exercise You are the newly appointed MOH in Maharagama. You notice that although you receive many notifications from the SJGH, you do not receive as many from the other hospitals.

18. You explore further into the matter. You find that the PHI is unable to locate the house of the patient in most notifications How would you improve the system ?

19. Problems - Not notifying - Poor quality notifications Who ? Govt. Medical Officers esp. Intern MO’s GPs Other medical practitioners Private hospitals How ? -Create awareness and knowledge on proper notification -Address misconceptions -Provide frequent feedback -Show them the benefits

20. Indoor Morbidity & Mortality Reporting BHT Annual Health Bulletin Coding according to ICD Quarterly Medical Records Office Medical Statistician Indoor Morbidity Mortality Register Indoor Morbidity and Mortality Return

21. Limitations of Indoor Morbidity & Mortality Reporting • Coverage What exactly do IMMR data represent ? ▪ No. of admissions, not cases ▪ OPD ? Private Hospitals ? ▪ Disability ? ▪ Mortality – only hospital deaths • Quality ▪ Diagnosis not written ▪ Incorrect Diagnosis / symptoms as diagnosis ▪ Lack of timeliness ▪ Lack of facilities for record keeping

22. Laboratory surveillance What is lab-based surveillance ? Using information generated in labs for surveillance E.g. MRI lab Epid. Unit

23. What are the advantages of lab surveillance ? • Immediate information on rare or significant diseases • Reporting of confirmed diagnosis • Completeness of lab data • Ability to obtain information of patients seen by many physicians

24. What are the disadvantages of lab surveillance ? • Non availability of epidemiological information • Lack of representative ness

25. Reporting from Special Campaigns - Routinely reported - From Malaria, Filariasis, STD, Rabies and Respiratory diseases control programme - Morbidity and Mortality data - Collected by the campaigns from hospitals - Data is sent to Epidemiology Unit

26. Sentinel Surveillance Surveillance based on the collection of data from a sample (random or non-random) of collecting sites as indicator data for the rest of the population, in order to identify cases of a disease early or to obtain indicative data about trends of a disease or health event. Uses active surveillance approach Conducted usually by ICNO

27. Sentinel’ Sites - Depends on the disease E.g. Dengue –all hospitals Leptospirosis, Hep B – Selected hospitals For few selected diseases AFP, Measles, Japanese Encephalitis, Dengue, Hepatitis B, Leptospirosis Sentinel populations – E.g. Pregnant mothers for syphillis

28. What are the advantages of sentinel surveillance ? • Improves timeliness in reporting • Improves accuracy of data • Improves completeness of data • Only on selected sites • Cost effective

29. Disadvantages of sentinel surveillance • Lack of representativeness • Participation rates may be low and limited to those with great interest or capability

30. Sample Surveys • Surveys carried out on specific diseases / risk factors on representative samples • Usually for research purposes • One-time process • Estimates prevalence of disease more accurately

31. Outbreak Investigation • Investigation of disease outbreaks (What is an outbreak ?) • Carried out by a team –MOH, RE, Clinicians, PHIs • Involves hospital and the field • Purpose is to identify the source of infection and initiate appropriate control measures • A report is produced

32. Thank you !

33. List of Notifiable diseases • Group - A • Cholera • Plague • Yellow Fever

34. Group B • Acute Poliomyelitis / Acute Flaccid Paralysis • Chicken pox • Dengue Fever / Dengue Haemorrhagic Fever • Diphtheria • Dysentery • Encephalitis • Enteric Fever • Food poisoning • Human Rabies • Leptospirosis • Malaria • Measles • Meningitis • Mumps • Rubella / Congenital Rubella Syndrom • Simple Continued Fever of over 7 days or more • Tetanus • Neonatal Tetanus • Typhus Fever • Viral Hepatitis • Whooping Cough • Tuberculosis

35. Mechanism of Data Collection Hospitals • In-patients Register • Bed Head Ticket • Notification Card • Notification Register • (Ward) • Notification register • (Institution) Regional Epidemiologist (District Level) Activated Passive Surveillance Medical Officer of Health Medical Statistics Unit Epidemiology Unit (Central Level) • Notification • Register • Weekly Return • ID Register Special Campaigns Public Health Inspector

38. Reference • Website of Epidemiology Unit, Ministry of Health http://www.epid.gov.lk