Download Sentinel Surveillance

Sentinel Surveillance Model
for
Vaccine Preventable
Childhood Infectious
Diseases
15 July 2011
National Centre for Disease Control, Delhi
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
Objective
To study the magnitude and epidemiology
of selected childhood vaccine preventable
diseases
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
Types of models for surveillance of selected diseases
Sl. Selected Diseases
no.
Type of model proposed for surveillance
1.
Measles
Meningitis
Enteric fever
Sentinel surveillance model at 30
Medical Colleges or tertiary care
hospitals chosen as sentinel sites with the
respective 30 District Hospitals linked to
them
2.
Japanese Encephalitis
The surveillance for JE should be done
through the existing NVBDCP Sentinel
sites
3.
Diphtheria
Surveillance data to be collected from
identified Infectious Disease Hospitals
4.
Pertussis
Rota virus
Strepto. pneumoniae
Hemophilus influenzae -B
Data for surveillance to be collected in a
research mode from a few designated
centers
(HiB)
Models for sentinel surveillance of
selected diseases
1.
Sentinel surveillance model for Measles, Meningitis
and Enteric fever at 30 Sentinel Sites
2.
Surveillance for JE through the existing NVBDCP
Sentinel sites
3.
Diphtheria Surveillance from identified Infectious
Disease Hospitals
4.
Surveillance of Pertussis, Rota virus, Strepto.
Pneumoniae, H. influenzae -B in a research mode
from a few designated centers
Suggested model for Sentinel
Surveillance for Measles, Meningitis
& Enteric fever at 30 selected sites
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
Data Flow
SSU, IDSP
State Surveillance Unit
CSU, IDSP
Central Surveillance Unit
DSU, IDSP
(District Surveillance Unit)
Sentinel Site
(Medical College Hospital / Tertiary
Hospital)
Pediatrics and Micro
Departments
PSM
Dept.
District Hospital
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
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

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)
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
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
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
List of Sentinel Sites for conducting Sentinel
Surveillance for Meningitis, Measles and Enteric fever
1.GB Pant Hosptial, Port Blair
2.Niloufer Hospital, Hyderabad
3.Guwahati Medical College, Guwahati
4.Patna Medical College
5.Government Medical College & Hospital
6.Pt. JN Memorial Medical College, Raipur
7.Kalawati Saran Childrens’ Hospital, Delhi
8.Goa Medical College, Bambolim, Panaji
9.BJ Medical College, Ahmedabad
10.PGIMS, Rohtak
11.Indira Gandhi Medical College, Shimla
12.SKIMS, Srinagar
13.MGM Medical College, Jamshedpur
14.Bangalore Medical College, Bangalore
15.Govt. Med. College,
Thiruvananthapuram
16.MGM Medical College, Indore
17.GS Medical college & KEM Hospital,
Mumbai
18.JN Hospital, JNIMS, Porompat, Imphal East
19.NEIGRIHMS, Shillong
20.SCB Medical College & Hospital, Cuttack
21.JIPMER, Puducherry
22.Government Medical College, Patiala
23.SMS Hospital, Jaipur
24.ICH & Hospital for Children, Chennai
25.Christian Medical College, Vellore
26.BRD Medical College, Gorakhpur
27.BHU, Varanasi, Uttar Pradesh
28.KGMC (CSMMU UP), Lucknow
29.Govt. Doon Hospital, Dehradun
30.Medical College and Hospital, Kolkata
Types of models for surveillance of selected
diseases
1.
Sentinel surveillance model for Measles, Meningitis
and Enteric fever at 30 Sentinel Sites
2.
Surveillance for JE through the existing NVBDCP
Sentinel sites
3.
Diphtheria Surveillance from identified Infectious
Disease Hospitals
4.
Surveillance of Pertussis, Rota virus, Strepto.
Pneumoniae and H. influenzae -B in a research mode
from a few designated centers
Suggested model for Sentinel Surveillance
for Acute Encephalitis Syndrome (AES)/
Japanese Encephalitis (JE)
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
Types of models for surveillance of selected
diseases
1.
Sentinel surveillance model for Measles, Meningitis and
Enteric fever at 30 Sentinel Sites
2.
Surveillance for JE through the existing NVBDCP Sentinel
sites
3.
Diphtheria Surveillance from identified Infectious Disease
Hospitals
4.
Surveillance of Pertussis, Rota virus, Strepto. Pneumoniae and H.
influenzae -B in a research mode from a few designated centers
Suggested model for Sentinel Surveillance
of Diphtheria at Infectious Disease
Hospitals under IDSP
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
Types of models for surveillance of selected
diseases
1.
Sentinel surveillance model for Measles, Meningitis
and Enteric fever at 30 Sentinel Sites
2.
Surveillance for JE through the existing NVBDCP
Sentinel sites
3.
Diphtheria Surveillance from identified Infectious
Disease Hospitals
4.
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
Suggested model for Sentinel
Surveillance of Pertussis, Rota virus,
Hemophilus influenzae- B and Strepto.
Pneumoniae
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
Categories to be filled up in the Register for
Sentinel Surveillance










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



Lab tests




Name of Vaccine
No. of doses given
Name of lab test done
Lab diagnosis
H/O similar illness in
neighborhood
Outcome

Recovered/ Died/ LAMA
Format for filling up Register for Sentinel
Surveillance
ID
N
o.
Date of
Registr
ation/
Admiss
ion
Addre
ss
Nam
e
Age
Date of
onset of
illness
Major
presenti
ng
features
Clinical
Diagnos
is
Treatme
nt
history
H/O similar illness
in neighborhood
Vaccination status
of related disease
Lab tests
Sex
Name of
Vaccine
No. of
doses
given
Name
of lab
test
done
Lab
dia
gno
sis
Outc
ome
(Rec
over
ed/Di
ed/
LAM
A)
Diagnostic laboratory tests for Diseases
under Sentinel Surveillance
Sl.
No.
1
2
Disease
Diphtheria,
Pertussis
Meningitis /
AES
3
Enteric fever
4
Measles /
Rubella
Causative agents
Specific lab tests
Corynebacterium diphtheriae
Culture, toxigenicity testing
Bordetella pertussis
Culture of naso-pharyngeal
aspirate / swab
Neisseria meningitidis
Bacterial culture of CSF, blood
Japanese Encephalitis virus
ELISA
Salmonella enterica
Serotype Typhi/ Paratyphi A
Culture of blood/stool/urine
+ serotyping
Measles virus
ELISA
Rubella virus
ELISA
Total Budget for Sentinel Surveillance of selected
Vaccine Preventable Childhood Infectious Diseases
Sl.
No.
Level of Activity for Sentinel
Surveillance
Total Average
Cost at startup
including annual
cost for 1st yr.
(Rs. in lakhs)
Recurring cost per yr.
(Rs. in lakhs)
1
Central Surveillance Unit (CSU)
58.6
54.3
2
Zonal coordinators (6 zones)
6.0
6.0
3
Subtotal annual cost for 30 Sentinel
sites for Sentinel Surveillance of
Meningitis, Measles and Enteric Fever
690.2
541.8
4
Subtotal annual cost for 7 ID Hospitals
for Surveillance of Diphtheria
96.7
62.1
5
Subtotal annual cost for 5 Research
Institutes for Surveillance of Pertussis,
Rota virus, H. influenzae and Strepto.
Pneumoniae
205.1
180.4
1056.6
844.5
TOTAL
Budget for Sentinel Surveillance at
Zonal levels and Central level
Sl.
No.
Level of Activity
Sentinel Surveillance
1
Central Surveillance Unit
(CSU), IDSP
2
for Total Average Cost at
startup including
annual cost for 1st yr.
(Rs. in lakhs)
Recurring
cost per yr.
(Rs. in lakhs)
58.6
54.3
Zonal coordinators (6)
(one
at
each
zone
responsible for 5 sentinel
sites)
6.0
6.0
Subtotal annual cost
64.6
60.3
Budget for Sentinel Surveillance of Meningitis, Measles and
Enteric Fever at 30 identified Sentinel sites
Sl.
No.
Sub-activity
Total Avg. Cost at
startup including
annual cost for 1st yr.
(Rs. in lakhs)
Per site
For 30 sites
Recurring
cost per
yr. (Rs. in
lakhs)
1
Laboratory tests
9.6
288
288
2
Flexi-fund to each dept (PSM, Pediatrics
and Microbiology) and to each linked
District Hospital
2.4
71.6
71.6
DEO salary (in those sites where DEO is
not provided through IDSP consolidated
salary of Rs 8500 pm; enhancable @ 5%
pa)
1.0
30.6
32.1
Miscellaneous: Operational cost including
stationeries, printing and communication,
Training and Travel to Delhi to attend
review meetings, etc.
10.0
300.0
150.0
23.0
690.2
541.8
3
4
Subtotal annual cost
Budget for Diphtheria Surveillance at the seven
Infectious Disease Hospitals under IDSP
Sl.
No.
Sub-activity
Total Average Cost at startup
including annual cost for 1st
yr. (Rs. in lakhs)
Per ID
Hospital
For 7 ID
Hospitals
Recurring
cost per yr.
(Rs. in
lakhs)
1
Laboratory tests
1.0
7.0
7.0
2
Flexi-fund to each PSM, Paeds
and Micro dept and to each
linked District Hospital @
Rs.5000 each
1.8
12.6
12.6
3
DEO salary (@Rs 8500 pm)
1.0
7.1
7.5
4
Miscellaneous: Operational
cost including stationeries and
communication, Training and
travel
10.0
70.0
35.0
13.8
96.7
62.1
Subtotal annual cost
Budget for Surveillance of Pertussis, Rota virus, H. influenzae and
Strepto. pneumoniae at five Research Institutes
Sl.
No.
Sub-activity
Total Average Cost at startup
including annual cost for 1st
yr. (Rs. in lakhs)
Per Research
Institute
For 5
Research
Institutes
Recurring
cost per yr.
(Rs. in
lakhs)
1
Laboratory tests
27.6
138.0
138.0
2
Flexi-fund to each PSM, Paeds
and Micro dept and to each
linked District Hospital @
Rs.5000 each
2.4
12.0
12.0
3
DEO salary (@Rs 8500 pm)
1.0
5.1
5.4
4
Miscellaneous:
Operational
cost including stationeries and
communication, Training and
travel
10.0
50.0
25.0
Subtotal annual cost
41.0
205.1
180.4
THANK YOU