Outbreaks

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Outbreak surveillance
Central Surveillance Unit, IDSP
Early Warning Signal (EWS) reports
• All SSUs are required to send EWS
reports (disease alerts/outbreaks) to CSU
on time every week for sharing with the
stakeholders
• Even ‘Nil’ reporting is mandatory
• An average of 20 States/UTs are reporting
every week
Total no. of outbreaks reported through IDSP by the
States/UTs in 2008-2011 (till 26th June 2011)
Year
All 35 States/UTs
9 WB funded States/UTs
2008
553
400 (72%)
2009
799
488 (61%)
2010
990
619 (63%)
2011
699
516 (74%)
(till 26th June )
Weekly EWS / Outbreak report submitting Status of States/UTs in
2011 (till 25th week ending on 26th June)
EWS/OUTBREAK REPORT
SUBMITTING STATUS
STATES / UTs
> 80% times reported
(Consistently and timely reporting)
Andhra Pradesh, Arunachal
Pradesh, Assam, Bihar, Jammu &
Kashmir, Karnataka, Kerala,
Madhya Pradesh, Manipur,
Meghalaya, Orissa, Punjab,
Rajasthan, Tamil Nadu, Tripura,
Uttarakhand, West Bengal
50 - 79 % times reported
Chandigarh, Daman & Diu, Goa,
Gujarat, Himachal Pradesh,
Maharashtra, Puducherry, Sikkim,
Uttar Pradesh
25 - 49 % times reported
Chhattisgarh, Delhi, Haryana,
Nagaland
< 25 % times reported
Lakshadweep, Mizoram, Jharkhand
Never reported
Andaman & Nicobar, Dadra & Nagar
Haveli
State-wise total no. of outbreaks reported through IDSP by all States/UTs in
2008, 2009, 2010 & 2011 (till 25th wk ending June 26th 2011)
Sl. No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
State
Karnataka
Tamil Nadu
West Bengal
Gujarat
Andhra Pradesh
Maharashtra
Uttar Pradesh
Rajasthan
Madhya Pradesh
Assam
Kerala
Orissa
Uttarakhand
Punjab
Bihar
Haryana
Himachal Pradesh
Arunachal Pradesh
Chhattisgarh
Jharkhand
Meghalaya
Tripura
Puducherry
Chandigarh
Sikkim
Delhi
Goa
Manipur
Mizoram
Jammu & Kashmir
Nagaland
Daman & Diu
Dadra and Nagar Haveli
Andaman & Nicobar
Lakshadweep
Total
2008
54
50
49
24
72
99
40
8
16
16
17
17
27
17
1
10
3
6
1
0
5
1
3
3
3
3
2
1
5
0
0
0
0
0
0
553
Year
2009
2010
97
90
113
90
43
89
49
83
64
75
27
65
67
98
43
84
65
70
30
53
47
53
38
19
30
25
22
18
6
21
9
18
13
7
6
6
7
2
5
4
3
2
2
2
2
4
3
2
0
2
1
0
3
0
2
2
0
0
0
2
1
2
1
1
0
1
0
0
0
0
799
990
Total
2011
110
49
90
101
39
32
10
50
24
39
19
33
21
24
25
7
1
5
4
1
0
5
0
0
3
3
1
1
0
2
0
0
0
0
0
699
351
302
271
257
250
223
215
185
175
138
136
107
103
81
53
44
24
23
14
10
10
10
9
8
8
7
6
6
5
4
3
2
1
0
0
3041
State-wise total no. of outbreaks reported through IDSP by the World Bank
funded States in 2008, 2009, 2010 & 2011 (till 25th wk ending June 26th 2011)
Sl.
No.
State
Year
Total
2008
2009
2010
1
Andhra Pradesh
72
64
75
2
Gujarat
24
49
83
3
Karnataka
54
97
90
4
Maharashtra
99
27
65
5
Punjab
17
22
18
6
Rajasthan
8
43
84
7
Tamil Nadu
50
113
90
8
Uttarakhand
27
30
25
9
West Bengal
49
43
89
400
488
619
Sub Total
2011
39
101
110
32
24
50
49
21
90
516
250
257
351
223
81
185
302
103
271
2023
State-wise total no. of outbreaks reported through IDSP by the non-WB funded
States in 2008, 2009, 2010 & 2011 (till 25th wk ending June 26th 2011)
Sl. No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
State
Andaman & Nicobar
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman & Diu
Delhi
Goa
Haryana
Himachal Pradesh
Jammu & Kashmir
Jharkhand
Kerala
Lakshadweep
Madhya Pradesh
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Puducherry
Sikkim
Tripura
Uttar Pradesh
Sub Total
Year
2008
0
6
16
1
3
1
0
0
3
2
10
3
0
0
17
0
16
1
5
5
0
17
3
3
1
40
153
2009
0
6
30
6
3
7
0
1
1
3
9
13
0
5
47
0
65
2
3
0
1
38
2
0
2
67
311
Total
2010
0
6
53
21
2
2
1
1
0
0
18
7
2
4
53
0
70
2
2
0
2
19
4
2
2
98
371
2011
0
5
39
25
0
4
0
0
3
1
7
1
2
1
19
0
24
1
0
0
0
33
0
3
5
10
183
0
23
138
53
8
14
1
2
7
6
44
24
4
10
136
0
175
6
10
5
3
107
9
8
10
215
1018
Disease-wise total no. of outbreaks reported through IDSP by all States in
2008, 2009, 2010 & 2011 (till 25th wk ending June 26th)
Sl. No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Disease/Illness
Acute Diarrhoeal Disease
Food Poisoning
Measles
Chicken Pox
Malaria
Viral Hepatitis
Viral Fever
Chikungunya
Dengue
Cholera
Enteric Fever
Acute Encephalitis Syndrome
Anthrax
Leptospirosis
Acute Respiratory Illness
Dysentery
Kalazar
Meningitis
Scrub Typhus
Acute Flaccid Paralysis
Mumps
PUO
Diphtheria
Rubella
Cremian-Congo Haemorrhagic Fever
Gas Poisoning
Acute Febrile Illness
Buffalo pox
Epidemic dropsy
Kyasanur Forest Disease
Pertussis
Viral Hepatitis B
Vitamin A Overdosage
Total
2008
228
50
40
12
43
28
31
25
42
20
6
6
2
6
4
0
1
2
3
1
0
1
1
0
0
0
1
0
0
0
0
0
0
553
2009
332
121
44
45
34
30
37
61
20
34
10
5
6
3
3
1
0
3
1
0
2
2
1
1
0
1
0
1
0
0
0
1
0
799
Year
2010
411
188
94
47
37
24
40
25
40
34
10
11
3
6
3
3
3
1
1
0
3
1
1
2
0
0
0
0
1
0
1
0
0
990
Total
2011
220
158
103
47
23
46
16
12
14
22
4
6
6
1
1
3
3
1
2
5
1
0
0
0
2
1
0
0
0
1
0
0
1
699
1191
517
281
151
137
128
124
123
116
110
30
28
17
16
11
7
7
7
7
6
6
4
3
3
2
2
1
1
1
1
1
1
1
3041
Disease-wise total no. of outbreaks reported through IDSP by all States
in 2008, 2009, 2010 & 2011 (till 25th wk ending June 26th)
2008
Sl.
No.
Disease / Illness
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Acute Diarrhoeal Disease
Food Poisoning
Measles
Chicken Pox
Malaria
Viral Hepatitis
Viral Fever
Chikungunya
Dengue
Cholera
Enteric Fever
AES / JE
Anthrax
Leptospirosis
Acute Resp. Illness
Dysentery
Kalazar
Meningitis
Scrub Typhus
AFP
Mumps
PUO
Diphtheria
Rubella
CCHF
Gas Poisoning
Acute Febrile Illness
Buffalo pox
Epidemic dropsy
Kyasanur Forest Disease
Pertussis
Viral Hepatitis B
Vitamin A Overdosage
Total
9 WB
funded
States
Other
26
States
177
38
22
7
29
16
26
22
30
9
4
6
1
5
3
0
0
2
2
1
0
0
0
0
0
0
0
0
0
0
0
0
0
400
51
12
18
5
14
12
5
3
12
11
2
0
1
1
1
0
1
0
1
0
0
1
1
0
0
0
1
0
0
0
0
0
0
153
2009
9 WB
funded
Total States
228
50
40
12
43
28
31
25
42
20
6
6
2
6
4
0
1
2
3
1
0
1
1
0
0
0
1
0
0
0
0
0
0
553
217
67
19
16
14
12
30
53
11
26
8
1
2
2
3
1
0
1
0
0
0
2
0
0
0
1
0
1
0
0
0
1
0
488
Other
26
States
115
54
25
29
20
18
7
8
9
8
2
4
4
1
0
0
0
2
1
0
2
0
1
1
0
0
0
0
0
0
0
0
0
311
2010
9 WB
funded
Total States
332
121
44
45
34
30
37
61
20
34
10
5
6
3
3
1
0
3
1
0
2
2
1
1
0
1
0
1
0
0
0
1
0
799
310
108
41
13
16
16
32
17
27
21
3
1
1
5
1
1
1
0
0
0
2
1
0
1
0
0
0
0
0
0
1
0
0
619
Other
26
States
101
80
53
34
21
8
8
8
13
13
7
10
2
1
2
2
2
1
1
0
1
0
1
1
0
0
0
0
1
0
0
0
0
371
2011
Total
9 WB
funded
States
Other
26
States
411
188
94
47
37
24
40
25
40
34
10
11
3
6
3
3
3
1
1
0
3
1
1
2
0
0
0
0
1
0
1
0
0
990
174
125
61
29
17
37
12
11
12
16
2
3
4
1
1
2
1
0
1
2
0
0
0
0
2
1
0
0
0
1
0
0
1
516
46
33
42
18
6
9
4
1
2
6
2
3
2
0
0
1
2
1
1
3
1
0
0
0
0
0
0
0
0
0
0
0
0
183
Total no.
of
outbreaks
Total reported
220
1191
158
517
103
281
47
151
23
137
46
128
16
124
12
123
14
116
22
110
4
30
6
28
6
17
1
16
1
11
3
7
3
7
1
7
2
7
5
6
1
6
0
4
3
0
3
2
2
1
2
0
1
0
1
1
1
1
0
1
0
1
1
1
699
3041
No. of disease outbreaks for which Laboratory facilities accessed and etiology confirmed by the States/UTs through IDSP
in 2008, 2009, 2010 and 2011 (till 26th June 2011)
Sl.
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
State / UT
2008
Total
Andaman Nicobar
0
Andhra Pradesh
72
Arunachal Pradesh
6
Assam
16
Bihar
1
Chandigarh
3
Chhattisgarh
1
D & N Haveli
0
Daman & Diu
0
Delhi
3
Goa
2
Gujarat
24
Haryana
10
Himachal Pradesh
3
Jammu & Kashmir
0
Jharkhand
0
Karnataka
54
Kerala
17
Lakshadweep
0
Madhya Pradesh
16
Maharashtra
99
Manipur
1
Meghalaya
5
Mizoram
5
Nagaland
0
Orissa
17
Puducherry
3
Punjab
17
Rajasthan
8
Sikkim
3
Tamil Nadu
50
Tripura
1
Uttar Pradesh
40
Uttarakhand
27
West Bengal
49
Grand Total 553
Lab Accessed
(includes lab
confirmed)
0
7
1
8
0
3
0
0
0
3
1
7
7
0
0
0
19
3
0
8
44
1
1
1
0
4
2
2
2
1
16
0
2
12
13
168
0%
10%
17%
50%
0%
100%
0%
0%
0%
100%
50%
29%
70%
0%
0%
0%
35%
18%
0%
50%
44%
100%
20%
20%
0%
24%
67%
12%
25%
33%
32%
0%
5%
44%
27%
30%
2009
Lab confirmed
0
3
1
8
0
3
0
0
0
3
1
3
6
0
0
0
12
2
0
8
37
0
1
1
0
3
2
2
1
1
14
0
2
11
7
132
0%
4%
17%
50%
0%
100%
0%
0%
0%
100%
50%
13%
60%
0%
0%
0%
22%
12%
0%
50%
37%
0%
20%
20%
0%
18%
67%
12%
13%
33%
28%
0%
5%
41%
14%
24%
Total
Lab Accessed
(includes lab
confirmed)
0
64
6
30
6
3
7
0
1
1
3
49
9
13
0
5
97
47
0
65
27
2
3
0
1
38
2
22
43
0
113
2
67
30
43
799
0
61
3
25
3
2
5
0
1
0
2
45
8
12
0
4
94
35
0
56
21
2
3
0
1
21
2
15
37
0
99
1
24
22
39
643
0%
95%
50%
83%
50%
67%
71%
0%
100%
0%
67%
92%
89%
92%
0%
80%
97%
74%
0%
86%
78%
100%
100%
0%
100%
55%
100%
68%
86%
0%
88%
50%
36%
73%
91%
80%
2010
Lab confirmed Total
0
7
2
8
3
1
0
0
0
0
1
10
2
0
0
4
24
9
0
7
11
1
2
0
1
4
1
0
8
0
22
1
0
1
7
137
0%
11%
33%
27%
50%
33%
0%
0%
0%
0%
33%
20%
22%
0%
0%
80%
25%
19%
0%
11%
41%
50%
67%
0%
100%
11%
50%
0%
19%
0%
19%
50%
0%
3%
16%
17%
0
75
6
53
21
2
2
1
1
0
0
83
18
7
2
4
90
53
0
70
65
2
2
0
2
19
4
18
84
2
90
2
98
25
89
990
Lab Accessed
(includes lab
confirmed)
0
35
2
45
9
2
1
1
0
0
0
62
16
5
2
2
79
39
0
43
47
2
0
0
2
4
4
11
63
0
68
0
13
11
54
622
0%
47%
33%
85%
43%
100%
50%
100%
0%
0%
0%
75%
89%
71%
100%
50%
88%
74%
0%
61%
72%
100%
0%
0%
100%
21%
100%
61%
75%
0%
76%
0%
13%
44%
61%
63%
2011
Lab confirmed Total
0
3
1
18
3
2
0
0
0
0
0
14
4
1
1
2
19
12
0
12
11
2
0
0
2
3
4
5
9
0
15
0
1
3
6
153
0%
4%
17%
34%
14%
100%
0%
0%
0%
0%
0%
17%
22%
14%
50%
50%
21%
23%
0%
17%
17%
100%
0%
0%
100%
16%
100%
28%
11%
0%
17%
0%
1%
12%
7%
15%
0
39
5
39
25
0
4
0
0
3
1
101
7
1
2
1
110
19
0
24
32
1
0
0
0
33
0
24
50
3
49
5
10
21
90
699
Lab Accessed
(includes lab
confirmed)
0
19
2
25
5
0
2
0
0
3
0
46
3
1
1
0
72
7
0
3
19
0
0
0
0
5
0
14
12
0
28
2
1
8
24
302
0%
49%
40%
64%
20%
0%
50%
0%
0%
100%
0%
46%
43%
100%
50%
0%
65%
37%
0%
13%
59%
0%
0%
0%
0%
15%
0%
58%
24%
0%
57%
40%
10%
38%
27%
43%
Total no. of
outbreaks
Lab confirmed
reported by
State/UT
0
2
0
9
2
0
0
0
0
3
0
13
1
0
0
0
28
4
0
0
5
0
0
0
0
1
0
2
2
0
9
1
1
1
4
88
0%
5%
0%
23%
8%
0%
0%
0%
0%
100%
0%
13%
14%
0%
0%
0%
25%
21%
0%
0%
16%
0%
0%
0%
0%
3%
0%
8%
4%
0%
18%
20%
10%
5%
4%
13%
0
250
23
138
53
8
14
1
2
7
6
257
44
24
4
10
351
136
0
175
223
6
10
5
3
107
9
81
185
8
302
10
215
103
271
3041
Monitoring quality of outbreak
investigations
Competency Assessment Tool for
Outbreak Investigations
Sl. No.
TOOL INDICATORS
1
Is it an outbreak?
(Verification of rumor / media alert done or not)
Was the outbreak informed/ identified by weekly data analysis?
2
Timeliness of Response
by Rapid Response
Team
Period between date of start of outbreak and date of response (first reported to
a health worker at any health facility)
Composition of outbreak response team
3
Laboratory confirmation
of outbreak
Type of clinical specimen
Transport media
Results
4
Case definition
What working case definition was used?
5
Active case finding
Was active house to house case search done?
What population was covered?
Line listing to compile cases from health facility records and active case
search
6
Description of cases in
time, place and person
Use of epicurve, spot map, graphs?
7
Conclusion
Is source of the outbreak determined?
Is mode of transmission established?
8
Specific public health
intervention measures
undertaken
Case management
Control measures
Outcome (CFR)
9
Recommendations
What recommendations were proposed?
Were they implemented?
10
Feedback given or not
Written feedback
Post- outbreak review
Quality Assessment of Outbreaks
reported by all States in 2011 (till 26 June)
using 3 Essential Criteria
Essential criteria
Investigation within 48 hours of
first case information
Adequate samples sent for lab
investigation within 4 days
Availability of final outbreak
report
% of response to disease
specific outbreaks
(n=699)
• 510 (73%)
• In 302 (43%) outbreaks, appropriate
human samples sent for lab
investigation
• 88 (13%) outbreaks etiologically
confirmed
• 5%
Quality Assessment of Outbreaks
reported by 9 WB funded States in 2011 (till 26 June)
using 3 Essential Criteria
Essential criteria
Investigation within 48 hours of
first case information
Adequate samples sent for lab
investigation within 4 days
Availability of final outbreak
report
% of response to disease
specific outbreaks
(n= 516)
• 385 (75 %)
• In 242 (47 %) outbreaks, appropriate
human samples sent for lab
investigation
• 66 (13 %) outbreaks etiologically
confirmed
• 4%
Improving Outbreak detection and reporting
1. Early detection and response to outbreaks by identifying
EWS from routine analysis of surveillance (S,P,L) data at
DSU/CHC/PHC levels (by identifying any unusual rise in
no. of cases)
2. Ensure 100% reporting of EWS/outbreaks by all
States/Districts (even “NIL” reporting is mandated)
•
•
•
every week
on time
in the prescribed format
3. Avoid incomplete/incorrect data entry in the EWS format
– Date of start & reporting of outbreak to be
mentioned for all outbreaks
– “Population affected” is the “Population at risk”
Improving the quality of outbreak
investigations, reporting and response
1.
2.
3.
4.
Lab confirmation of diagnosis needs appropriate
clinical (human) samples to be sent for lab tests
Identification and Training of Epidemiologists,
Microbiologists, Entomologists and RRT members at
DSU / SSU levels
Existence of a written case management protocol for
any epidemic should be made available by the State at
each PHC/CHC/District level
Competency assessment tool to be utilized for
improving the quality of outbreak investigations and
reporting (by the Epidemiologists and Surveillance
Officers)
Thank you
[email protected]
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