Public Health Laboratory
Department of Public Health
Ministry of Health
National Early Warning Alert
Response Surveillance
(NEWARS)
Sonam Wangchuk
Chief Laboratory Officer/Microbiologist
www.phls.gov.bt
Background
 Designated national focal
point for Disease surveillance
and Outbreak investigation.
 Introduced National Notifiable
Disease Surveillance in 2010.
 Web based reporting system
in 2012 but access limited to
DHO and hospitals.
 Revised notifiable disease list
and guideline in 2014.
 Redesigned web based and
developed mobile SMS event
reporting system in 2014 .
www.phls.gov.bt
Why revised existing NNDS guideline
• Most notifiable diseases were disease
specific
and
need
laboratory
confirmation.
• Require fill up of case investigation
form for each reporting notifiable
disease case.
• Operational issues in reporting from
BHU’s and hospitals to DHO.
• No real-time reporting from BHU’s
www.phls.gov.bt
Difference between NNDS and
NEWARS guideline
• NNDS was an • NEWARS is both
indicator based
indicator and event
surveillance.
based surveillance.
• Disease specific • Included
both
surveillance .
disease
and
syndromes
• Required case
reporting
and • Case reporting only
investigation
www.phls.gov.bt
Features and attributes of
IBS and EBS
www.phls.gov.bt
Objectives
1. Early warning to prevent or minimize morbidity
and mortality through:
• Monitoring trends of endemic diseases
• Detecting outbreaks and events
• Providing an adequate and timely response
2. Program monitoring for:
• Planning, monitoring and evaluating disease
control programs
• Resource mobilization and allocation
www.phls.gov.bt
Process
of NNDS
www.phls.gov.bt
Public Health Laboratory
Department of Public Health
Ministry of Health
Role and Responsibilities of
Health Professionals/workers on
NEWARS
www.phls.gov.bt
Health professionals/workers
www.phls.gov.bt
Designated Surveillance Focal Point
(SFP) at Health centers
www.phls.gov.bt
Designated Surveillance Focal Point
(SFP) at Health centers
www.phls.gov.bt
Designated Surveillance Focal Point
(SFP) at DHO
www.phls.gov.bt
Designated Surveillance Focal Point
(SFP) at DHO
www.phls.gov.bt
www.phls.gov.bt
NADSAE, PHL
www.phls.gov.bt
NADSAE, PHL
www.phls.gov.bt
NADSAE, PHL
www.phls.gov.bt
www.phls.gov.bt
www.phls.gov.bt
www.phls.gov.bt
www.phls.gov.bt
Public Health Laboratory
Department of Public Health
Ministry of Health
National Notifiable Disease
Surveillance System
www.phls.gov.bt
Operational aspect of NDSS system
www.phls.gov.bt
List of Notifiable Diseases/Syndromes
www.phls.gov.bt
Identification of disease/syndrome
•
•
•
•
•
Diseases of epidemic potential in the community.
Vaccine preventable diseases.
Diseases that are aimed for elimination.
Disease with high morbidity and mortality.
Diseases which are of potential threat to
international
community
(Public
Health
Emergencies International Concerns).
www.phls.gov.bt
Clinical Case definition of ND
www.phls.gov.bt
Clinical Case definition of ND
www.phls.gov.bt
Clinical Case definition of ND
www.phls.gov.bt
Clinical Case definition of ND
www.phls.gov.bt
Clinical Case definition of ND
www.phls.gov.bt
Clinical Case definition of ND
www.phls.gov.bt
Clinical Case definition of ND
www.phls.gov.bt
Clinical Case definition of ND
www.phls.gov.bt
Source of information/data for NDDS
• Out Patient and observation Registers of 191
Basic Health Units.
• Out Patient and admitted patient Registers of 31
District Hospitals.
• Out Patient, admitted patient and Emergency
Registers of 3 Referral Hospitals.
www.phls.gov.bt
Process of data collection and collation at
health centers
• Collect daily data in
record log
• Collate data in a
weekly report using
“Weekly
Reporting
Form” (Annex 3) and
report to DHO/ in
system every Friday.
• Report according to the
Epidemiological week:
Saturday to Friday.
www.phls.gov.bt
Process of data collection and collation at
health centers
• Record cases into two outcome
categories: Number of cases and
number of deaths (if case has
died it should be recorded as
both case and death) Annex 3.
• Mark (e.g. tick) those cases in
the register that are included in
the “Weekly Reporting Form” so
that it can be validated if needed
during evaluation and monitoring
process.
www.phls.gov.bt
Process of data collection and collation at
health centers
• Mark (e.g. draw a line under)
the last case in the register
included in the weekly
report. This way reporters
know where to start looking
for cases in the register the
following week.
• Do Zero-reporting using the
same form for weekly
reporting form (Annex 3).
www.phls.gov.bt
Data transfer and Frequency for
ROUNTINE REPORTING at various level
At BHU and hospital level
• Basic Health Units (BHUs) and hospitals SFP should
report every week on Friday. The reports should be sent
using SMS or internet to online system maintained by
NADSAE and ICT Unit, PHL.
At DHO level
• The DHO should monitor online reporting status and
ensure all BHUs under its jurisdiction have reported by
Friday.
• The DHO should call the BHUs and hospitals that fail to
report through online or SMS. BHUs and hospitals should
be encourage to report even if it is late through ‘Late
Reporting Request’ and ask them to report on time.
• Report online every week on Monday.
www.phls.gov.bt
Data transfer and Frequency for
ROUNTINE REPORTING at various level
Referral hospital level
• National and regional referral Hospitals and Airport
Health Service at Paro International Airport should report
directly to the NADSAE, PHL every week on Monday
using online system or SMS method.
At PHL
• NADSAE will report to IHR National Focal Point (IHR
NFP) if the reported information (priority diseases and
syndromes, outbreak/event) is a Public Health Event of
International Concern (PHEIC) after conducting risk
assessment within 24 hours for onward reporting to
WHO.
• Report to HIMS every month.
www.phls.gov.bt
Data transfer and Frequency for
IMMEDIATE REPORTING at various level
www.phls.gov.bt
Data Management
• During the data collection, respective BHUs, hospitals,
DHO SFP should validate all the data by cross checking
once again
• The correction should be made immediately at respective
level if any discrepancy is found in the “Weekly Reporting
Forms” (data cleaning).
• NADSAE should also validate and cross-check data at
national level and make necessary correction.
• The NADSAE should manage all the data obtained from
the online reporting system. The electronic data at ICT Unit
should be backed up on a daily basis to avoid data loss
www.phls.gov.bt
Data Analysis
• At BHUs, and hospitals, SFP should analyze
and interpret the compiled data in their
respective health facility regularly,
• At district Health Office, DHO should analyze
and interpret compiled data obtained from all the
health facilities under its jurisdiction and
• At national, NADSAE, PHL will analyze, and
interpret compiled data obtained from all health
facilities.
www.phls.gov.bt
What to analyze
1. Case based
analysis
1. Analyze aggregated
data by person,
place and time
1. Trend analysis
Number of cases
15
14
case patients
13
case staff members
12
11
10
9
8
7
6
5
4
3
2
1
0
00-
06-
12-
27 August
18-
00-
06-
12-
28 August
18-
00-
06-
12-
29 August
Date and time of onset
www.phls.gov.bt
18-
00-
06-
12-
30 August
18- 00-
Feedback
• At district level, DHO
should
report
back
summarized
data
to
respective BHUs and
hospitals.
• At national level, NADSAE
will
publish
quarterly
Disease
Surveillance
bulletin.
www.phls.gov.bt
M&E
www.phls.gov.bt
Public Health Laboratory
Department of Public Health
Ministry of Health
Event Based Surveillance System
www.phls.gov.bt
Event Based Surveillance
• Event-based surveillance is rapid gathering of
information about events that are a potential risk
to public health and responding to events based
on information verification and risk assessment.
1. The occurrence of disease in humans, such as clustered
cases of a disease or syndromes,
2. Unusual disease patterns or unexpected deaths,
3. Potential exposure for humans to events related to diseases
and deaths in animals,
4. Contaminated food products or water, and environmental
hazards including chemical and radio-nuclear events.
www.phls.gov.bt
Potential Events
www.phls.gov.bt
Reportable events and definition
www.phls.gov.bt
Reportable events and definition
www.phls.gov.bt
Operational Aspect of EBS
www.phls.gov.bt
Responding an Event
www.phls.gov.bt
Reporting of PHEIC
www.phls.gov.bt
Collection of an Event Information
www.phls.gov.bt
Assessment of an Event reported
www.phls.gov.bt
Assessment of an Event reported
www.phls.gov.bt