Integrated Disease Surveillance and Response

(IDSR) Training
Third Edition

MODULE 1
Identify and Record cases of priority
diseases, conditions and events

1
 Outline of presentation-1
• The purpose of the module
• Learning Objectives
• Introduction to IDSR Matrix-"identify“
• Define terminologies
• Use of Indicator-based Surveillance (IBS) and Event-Based
Surveillance (EBS) approaches to detect diseases, conditions,
and events
• How diseases, conditions, and events come to the attention of
the health system
 Outline of presentation-2
• Use of standard case definitions to identify diseases for
reporting to the next level
• How to establish Event-Based Surveillance: Alert detection,
triaging and verification
• Update district procedures for surveillance and response
• Describe the role of the laboratory in detecting priority
diseases, events and conditions
• Practice Exercises
• Summary: Module 1
 Purpose of the module

• Provide guidance on:

 How to use standard case definitions to detect priority
diseases, conditions and events
 How to use EBS system for alerts detection, triaging and
verification to detect public health events
• Give the procedures required to plan for improvements of
surveillance and response activities at all levels of the health
system
 Learning Objectives
By the end of this module, participants will be able to:
1. Use standard case definitions to identify diseases, conditions
or events for reporting to the next level health system.
2. Understand the procedures required to improve and
response activities in their catchment area
3. Establish Event-Based Surveillance (EBS) system
4. Involve the community in disease surveillance
5. Improve local laboratory capacity to detect priority diseases,
events, and conditions
Introduction to IDSR Matrix-"identify“(P27-33)
 Annex A: IDSR matrix: Core functions and activities by health
system level
IDSR matrix is a table that summarizes the core IDSR functions and activities by each
level of the health system levels
Monitor,
Evaluate,
Analyze
Investigate Communi Supervise and
Levels Identify Report and Prepare Respond
and confirm cate risk provide
Interpret
feedback to
Improve
Community

Health Care
Facilities

Districts
National
MoHS
Point of
Entry
WHO
country
office

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Core IDSR functions and activities at community, health care facility
and district levels

Case Identification
Levels
• Use alert triggers to identify priority diseases, events, conditions or other
hazards in the community.
Community
• Support community in case finding and promote use of alert triggers

• Use standard case definitions to detect, laboratory confirm and record priority
diseases or conditions
Health Care • Collect and transport specimens for laboratory confirmation.
Facilities • Verify alert triggers from community
• Ensure appropriate storage of surveillance materials

• Support HCF to verify alerts from community

• Collect surveillance data from HCF and the community and review the
quality
Districts • Ensure reliable supply of data collection and reporting tools are available at
reporting sites
• Ensure all HCF have materials for laboratory collection and transport

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 Introduction

• Surveillance priorities may be communicable and non-

communicable diseases, conditions or events that include
national or local priorities

 E.g. Acute outbreaks and deaths or events

• Essential function of a PHS system is to be able to detect public

health threats and events or hazards
 Define the terminologies:

1. Standard case definition

2. Events
3. Alerts
4. Triage
5. Verification

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 Standard Case Definition

• A standard case definition is an agreed-upon set of criteria

used to decide if a person has a particular suspected disease or
condition. The definition specifies clinical criteria and
specifications on time, place and person.

• Mostly used in IBS approach to detect

diseases/conditions/events
 Event

• The International Health Regulations (IHR) define an event as a

“manifestation of disease or an occurrence that creates a
potential for disease”.

• It can include events that are infectious, zoonotic, food safety,

chemical, radiological or nuclear in origin and whether
transmitted by persons, vectors, animals, goods/food or
through the environment
 Alerts

• A alerts is a piece of data and/or information considered as

representing a potential acute risk to human health detected
through any source (EBS or IBS)
• Alerts are “raw data/information” and therefore need to be
verified for their authenticity (veracity) and conformity
(genuineness), by actively cross-checking the validity of the
information with reliable sources
• All alerts may not become events and as such needs to be
triaged and verified before response is initiated
 Triage

• The process of screening/sorting out the data and information

collected in the detection step to identify any alert that may
be of public health importance

• i.e. The screening out of mild/irrelevant events from potential

acute public health events and the cleaning to eliminate
duplicates and correct obvious mistakes
 Verification

• Is the pro-active crosschecking of the validity of the

alerts collected, by contacting the original source,
additional sources or by performing field
investigations

• Verification requires that hoaxes, false rumours and

artefacts are eliminated from further consideration
How diseases, conditions, events come to the attention of the
health system -1

• A person falls ill and seeks treatment from a HF.

• Community members report unusual events or
occurrences at local levels such as:
 a cluster of deaths
 unusual disease pattern to the health facility
• Health staff who conduct active record reviews of
registers (clinical and laboratory)
 How diseases, conditions, events come to the
attention of the health system-2

• Media reports (Radio, television, newspapers), or social media

• Vital events records show an increase in maternal deaths
• Unusual reports of illness among health care workers
• An unusual death or number of deaths among animals or birds
or
• An unusually high number of sick animals presenting with the
same symptoms.
 Detecting diseases, conditions and events

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Use standard case definitions to identify diseases for
reporting to the next level

• All cases (suspect, probable and confirmed) should always be

recorded in a recognized facility register or logbook, and the
IDSR reporting forms
 Importance of standard case definition

 To help decide if a person has a presumed disease

 To ensure that every case is diagnosed in the same way,

regardless of where or when it occurred

 To initiate action for reporting and investigation

 Using standard case definitions is also important in

implementing the International Heath Regulations (2005).
 Role of communities in case detection

 Facilitate early detection of priority diseases, conditions and

events using simplified case definitions

 Community members should be oriented in surveillance to

actively participate in:

 Detecting, Reporting, Responding to and Monitoring

Health Events Related to Human Or Animal in their
Catchment Area
One Health Approach in identification of events-1

 Applies a holistic approach in detecting and responding to

possible public health events

 Detection at all levels to strengthen collaboration across

sectors,

 Jointly share responsibility of detecting events which might

have impact on human, animal and environment
One Health Approach in identification of events-2

 Examples include:
 Detection of a rabid animal, which can facilitate
investigations of human cases of disease
 Reports of disease caused by exposure to chemical
hazards within the environment
 Detection of events at Points of Entry
 “All events detected should be shared with other sectors as
part of the One health approach”
Make standard case definitions available at health
facilities and communities-1

 Distribute standard case definition (SCD) to health

facilities for use, as well as registers for recording
including Rumour Log Book
 SCD can be in the form of a poster or as a small
pocket-sized booklet
 HF personnel at all levels including PoEs should know
and have available SCD
Make standard case definitions available at health
facilities and communities-2

 Distribute community level case definitions using key signs and

symptoms

 Ensure that health staff and CBS volunteers know the process
for reporting including reporting levels
How to identify and use the standard case definitions

• Examples of case definitions for priority diseases in the

country’s national surveillance programme:
 Turn to Section 1, Annex 1A, page 80 of the 3rd Edition
IDSR TG where the case definitions begin.
 Find the case definition for cholera.
 Read the case definition for a suspected case and
confirmed case.
 Why are there two different case definitions.
standard case definitions for priority diseases, conditions and events

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28
 Use of Event-Based Surveillance Approach to
detect signals for verification as events

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 Functions of EBS at all levels

Fn 5: Risk Assessment

Fn 4: Verification (determine if an alert is true and confirm as an event)

Fn 3: Triage (determine if alert is genuine PH event and not duplicate)

Fn 2: Alert Reporting (inform the DHMT about the alert)

Fn 1: Alert detection (rumours from catchment area, report from CHW etc)
Steps for conducting EBS at Health Facilities

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 Steps for conducting EBS in health facilities-1

Step 1: Alert detection

• Select and train Health Facility EBS focal persons.
 Existing health facility surveillance focal persons
can be trained to perform this role.
• Sensitize healthcare professionals e.g. clinicians,
nurses, IPC officers to recognize alerts and report
them immediately.
 Examples of Health Facility EBS Alerts and Codes

Code Health Facility EBS Alerts to be reported

Any severe illness in health staff after taking care of a patient with
01
similar illness

Large, sudden increase in admission for any severe illness of the

02
same type

Any severe, unusual, unexplainable illness including a failure to

03
respond to standard treatment

04 Increased use of a particular medicine

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 Steps for conducting EBS in health facilities-2

Step 2: Reporting Alerts

• Clinicians, nurses etc. should report alerts to Health
Facility EBS Focal Persons/surveillance Focal Persons in
the health facilities.
• Health Facility EBS Focal Persons/surveillance Focal
Persons should report to the district health team
immediately.
 by phone call, SMS, or in person on the same day.
 Steps for conducting EBS in health facilities-3

Step 3: Triaging and verification

• The district health team upon receipt of report of alerts
should triage and verify all alerts within 24 hours of alerts
detection using the verification tool
• In case of true event immediate investigations and
response measures is implemented as per the existing
IDSR structures
• The district health team should provide regular feedback
to the reporting health facilities
Role of the laboratory in detecting
priority diseases,
conditions and events
 Role of the laboratory in detecting priority diseases,
conditions and events-1

 Several diseases or conditions have signs and symptoms

that are similar.
 For example, a child with fever and rash might be
diagnosed with measles, even though there could be
several causes for the child’s clinical presentation.
 Laboratories should be used to detect pathogens that
have potential to spread.
 Role of the laboratory in detecting priority diseases,
conditions and events-2

• Laboratory confirmation in surveillance is essential

because laboratory results help to:
 Accurately diagnose illness in an individual patient,
 Verify the cause (or aetiology) of a suspected
outbreak
NB: It is necessary to initiate public health measures even
before laboratory confirmation has been received
Specimen collection, storage and transportation
procedures-1
• Collect appropriate specimen as per the standard
operating procedure of the specific disease.
• All specimens must be packed and labelled correctly
and accompanied with the correct laboratory forms.
• Minimize delays between collection of the specimen
and processing in the laboratory.
• Ensure health facilities have trained personnel and
adequate materials to enable sample collection.
Specimen collection, storage and transportation
procedures-2
• Use the defined transportation system to send samples
to the laboratory

• Disseminate information about triple packing and

shipping of infectious material as per national and
international SOPs.

Refer to Book 2 Section 11 of the 3rd edition IDSR Technical

Guidelines for recommended laboratory procedures for
confirming priority diseases and conditions.
Specimen collection, storage and transportation procedure

• Demonstration:
 Laboratory specimen collection and storage
materials
 Procedures for specimen collection, storage and
transportation for selected diseases common in
the country
Procedures in establishing a laboratory network

• Local focal persons at each level should maintain an

updated list of the laboratories that have the
capacity to perform required laboratory testing.
• Support laboratories within the network, through an
MoU with laboratories outside that have the
capacity for specific diagnostic procedures.
Sample List of national laboratories for confirming priority diseases
and conditions
Priority disease, conditions
Focal Person, Name of Lab, address, phone number, email
and events

Polio Example: Samba ; CPHRL Freetown

Cholera

HIV

Tuberculosis
Measles
Plague

Human influenza caused by a new subtype

Rift Valley disease

Dengue fever

Public health events of national or

international concern

Anthrax
Chikungunya
Typhoid fever
 Practice Exercises-1/2

Instructions:
• Break into 6 small groups of a minimum of 3 persons.
• Each group should select a leader and a rapporteur:
• The leader moderates the group discussions.
• Rapporteur documents the agreed answers by the
group.
 Practice Exercises-2/2

Instructions:
• Each group assigned an exercise (exercises 1 to 6).
• Turn to your participants guide pages 69 to 81.
• Each group has 25 min to read, discuss and answer
all questions to the assigned exercise.
• Group leaders present answers during plenary
discussions:
• 5 min presentation; 10 min discussion.
 Summary: Module 1

• The IDSR strategy uses both Indicator-based

Surveillance (IBS) and Event-Based Surveillance (EBS)
approaches to detect diseases, conditions, and events.
• Use standard case definitions to ensure that cases and
suspected cases are recorded accurately across your
district.
• Use EBS to detect and verify alerts for confirmation as
public health event.

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 Summary: Module 2

• Update the information about your catchment area at

least once a year so that you know who your target
population is and the ongoing public health activities.

• Make sure local laboratories are included in the

surveillance and laboratory networks.

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 Summary: Module 2

• The IDSR strategy uses both Indicator-based

Surveillance (IBS) and Event-Based Surveillance (EBS)
approaches to detect diseases, conditions, and events.

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Thank you