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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                          STATES / UTs
      SUBMITTING STATUS
> 80% times reported                  Andhra Pradesh, Arunachal
(Consistently and timely reporting)   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.            State                       Year             Total
                                       2008   2009    2010   2011
      1       Karnataka                 54     97       90    110    351
      2       Tamil Nadu                50     113      90     49    302
      3       West Bengal               49     43       89     90    271
      4       Gujarat                   24     49       83    101    257
      5       Andhra Pradesh            72     64       75     39    250
      6       Maharashtra               99     27       65     32    223
      7       Uttar Pradesh             40     67       98     10    215
      8       Rajasthan                  8     43       84     50    185
      9       Madhya Pradesh            16     65       70     24    175
      10      Assam                     16     30       53     39    138
      11      Kerala                    17     47       53     19    136
      12      Orissa                    17     38       19     33    107
      13      Uttarakhand               27     30       25     21    103
      14      Punjab                    17     22       18     24    81
      15      Bihar                      1      6       21     25    53
      16      Haryana                   10      9       18     7     44
      17      Himachal Pradesh           3     13        7     1     24
      18      Arunachal Pradesh          6      6        6     5     23
      19      Chhattisgarh               1      7        2     4     14
      20      Jharkhand                  0      5        4     1     10
      21      Meghalaya                  5      3        2     0     10
      22      Tripura                    1      2        2     5     10
      23      Puducherry                 3      2        4     0      9
      24      Chandigarh                 3      3        2     0      8
      25      Sikkim                     3      0        2     3      8
      26      Delhi                      3      1        0     3      7
      27      Goa                        2      3        0     1      6
      28      Manipur                    1      2        2     1      6
      29      Mizoram                    5      0        0     0      5
      30      Jammu & Kashmir            0      0        2     2      4
      31      Nagaland                   0      1        2     0      3
      32      Daman & Diu                0      1        1     0      2
      33      Dadra and Nagar Haveli     0      0        1     0      1
      34      Andaman & Nicobar          0      0        0     0      0
      35      Lakshadweep                0      0        0     0      0
                    Total               553    799     990    699   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.             State                        Year                 Total
   No.
                                2008     2009          2010   2011

    1    Andhra Pradesh           72      64            75           250
                                                              39
    2    Gujarat                  24      49            83           257
                                                              101
    3    Karnataka                54      97            90           351
                                                              110
    4    Maharashtra              99      27            65           223
                                                              32
    5    Punjab                   17      22            18            81
                                                              24
    6    Rajasthan                8       43            84           185
                                                              50
    7    Tamil Nadu               50      113           90           302
                                                              49
    8    Uttarakhand              27      30            25           103
                                                              21
    9    West Bengal              49      43            89           271
                                                              90
             Sub Total           400     488           619    516    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.               State                      Year                 Total
                                     2008   2009          2010   2011
    1       Andaman & Nicobar         0      0             0      0       0
    2       Arunachal Pradesh         6      6             6      5      23
    3       Assam                     16     30            53     39    138
    4       Bihar                     1      6             21     25     53
    5       Chandigarh                3      3             2      0       8
    6       Chhattisgarh              1      7             2      4      14
    7       Dadra and Nagar Haveli    0      0             1      0       1
    8       Daman & Diu               0      1             1      0       2
    9       Delhi                     3      1             0      3       7
    10      Goa                       2      3             0      1       6
    11      Haryana                   10     9             18     7      44
    12      Himachal Pradesh          3      13            7      1      24
    13      Jammu & Kashmir           0      0             2      2       4
    14      Jharkhand                 0      5             4      1      10
    15      Kerala                    17     47            53     19    136
    16      Lakshadweep               0      0             0      0       0
    17      Madhya Pradesh            16     65            70     24    175
    18      Manipur                   1      2             2      1       6
    19      Meghalaya                 5      3             2      0      10
    20      Mizoram                   5      0             0      0       5
    21      Nagaland                  0      1             2      0       3
    22      Orissa                    17     38            19     33    107
    23      Puducherry                3      2             4      0       9
    24      Sikkim                    3      0             2      3       8
    25      Tripura                   1      2             2      5      10
    26      Uttar Pradesh             40     67            98     10    215
                    Sub Total        153    311           371    183    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.              Disease/Illness                       Year            Total
                                              2008   2009     2010   2011
    1      Acute Diarrhoeal Disease            228    332      411    220   1191
    2      Food Poisoning                      50     121      188    158    517
    3      Measles                             40     44       94     103    281
    4      Chicken Pox                         12     45       47     47     151
    5      Malaria                             43     34       37     23     137
    6      Viral Hepatitis                     28     30       24     46     128
    7      Viral Fever                         31     37       40     16     124
    8      Chikungunya                         25     61       25     12     123
    9      Dengue                              42     20       40     14     116
   10      Cholera                             20     34       34     22     110
   11      Enteric Fever                        6     10       10      4     30
   12      Acute Encephalitis Syndrome          6      5       11      6     28
   13      Anthrax                              2      6        3      6     17
   14      Leptospirosis                        6      3        6      1     16
   15      Acute Respiratory Illness            4      3        3      1     11
   16      Dysentery                            0      1        3      3      7
   17      Kalazar                              1      0        3      3      7
   18      Meningitis                           2      3        1      1      7
   19      Scrub Typhus                         3      1        1      2      7
   20      Acute Flaccid Paralysis              1      0        0      5      6
   21      Mumps                                0      2        3      1      6
   22      PUO                                  1      2        1      0      4
   23      Diphtheria                           1      1        1      0      3
   24      Rubella                              0      1        2      0      3
   25      Cremian-Congo Haemorrhagic Fever     0      0        0      2      2
   26      Gas Poisoning                        0      1        0      1      2
   27      Acute Febrile Illness                1      0        0      0      1
   28      Buffalo pox                          0      1        0      0      1
   29      Epidemic dropsy                      0      0        1      0      1
   30      Kyasanur Forest Disease              0      0        0      1      1
   31      Pertussis                            0      0        1      0      1
   32      Viral Hepatitis B                    0      1        0      0      1
   33      Vitamin A Overdosage                 0      0        0      1      1
                          Total                553    799      990    699   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                    2009                    2010                      2011
                                                                                                                                   Total no.
                                  9 WB    Other           9 WB    Other           9 WB    Other             9 WB    Other              of
Sl.                              funded     26           funded     26           funded     26             funded     26           outbreaks
No.      Disease / Illness       States   States   Total States   States   Total States   States   Total   States   States   Total reported
1     Acute Diarrhoeal Disease    177       51     228    217      115     332    310      101     411      174      46       220    1191
2     Food Poisoning              38        12     50      67       54     121    108      80      188      125      33       158     517
3     Measles                     22        18     40      19       25     44     41       53       94      61       42       103     281
4     Chicken Pox                  7        5      12      16       29     45     13       34       47      29       18       47      151
5     Malaria                     29        14     43      14       20     34     16       21       37      17        6       23      137
6     Viral Hepatitis             16        12     28      12       18     30     16        8       24      37        9       46      128
7     Viral Fever                 26        5      31      30       7      37     32        8       40      12        4       16      124
8     Chikungunya                 22        3      25      53       8      61     17        8       25      11        1       12      123
9     Dengue                      30        12     42      11       9      20     27       13       40      12        2       14      116
10    Cholera                      9        11     20      26       8      34     21       13       34      16        6       22      110
11    Enteric Fever                4        2       6      8        2      10      3        7       10       2        2        4      30
12    AES / JE                     6        0       6      1        4       5      1       10       11       3        3        6      28
13    Anthrax                      1        1       2      2        4       6      1        2       3        4        2        6      17
14    Leptospirosis                5        1       6      2        1       3      5        1       6        1        0        1      16
15    Acute Resp. Illness          3        1       4      3        0       3      1        2       3        1        0        1      11
16    Dysentery                    0        0       0      1        0       1      1        2       3        2        1        3       7
17    Kalazar                      0        1       1      0        0       0      1        2       3        1        2        3       7
18    Meningitis                   2        0       2      1        2       3      0        1       1        0        1        1       7
19    Scrub Typhus                 2        1       3      0        1       1      0        1       1        1        1        2       7
20    AFP                          1        0       1      0        0       0      0        0       0        2        3        5       6
21    Mumps                        0        0       0      0        2       2      2        1       3        0        1        1       6
22    PUO                          0        1       1      2        0       2      1        0       1        0        0        0       4
23    Diphtheria                   0        1       1      0        1       1      0        1       1        0        0                3
24    Rubella                      0        0       0      0        1       1      1        1       2        0        0        0       3
25    CCHF                         0        0       0      0        0       0      0        0       0        2        0        2       2
26    Gas Poisoning                0        0       0      1        0       1      0        0       0        1        0        1       2
27    Acute Febrile Illness        0        1       1      0        0       0      0        0       0        0        0        0       1
28    Buffalo pox                  0        0       0      1        0       1      0        0       0        0        0        0       1
29    Epidemic dropsy              0        0       0      0        0       0      0        1       1        0        0                1
30    Kyasanur Forest Disease      0        0       0      0        0       0      0        0       0        1        0        1       1
31    Pertussis                    0        0       0      0        0       0      1        0       1        0        0        0       1
32    Viral Hepatitis B            0        0       0      1        0       1      0        0       0        0        0        0       1
33    Vitamin A Overdosage         0        0       0      0        0       0      0        0       0        1        0        1       1
                         Total    400      153     553    488      311     799    619      371     990      516      183      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.        State / UT                     2008                                    2009                                  2010                                  2011                   Total no. of
No.                                                                                                                                                                                   outbreaks
                          Total   Lab Accessed    Lab confirmed   Total   Lab Accessed     Lab confirmed Total   Lab Accessed    Lab confirmed Total   Lab Accessed    Lab confirmed
                                                                                                                                                                                     reported by
                                  (includes lab                            (includes lab                         (includes lab                         (includes lab
                                                                                                                                                                                       State/UT
                                    confirmed)                               confirmed)                            confirmed)                            confirmed)
 1    Andaman Nicobar       0      0       0%       0     0%       0       0       0%        0     0%      0      0       0%       0     0%      0       0      0%      0      0%          0
 2    Andhra Pradesh        72     7      10%       3     4%       64     61      95%        7     11%    75      35      47%      3     4%     39      19      49%     2      5%         250
 3    Arunachal Pradesh     6      1      17%       1    17%       6       3      50%        2     33%     6      2       33%      1    17%      5       2      40%     0      0%          23
 4    Assam                 16     8      50%       8    50%       30     25      83%        8     27%    53      45      85%     18    34%     39      25      64%     9     23%         138
 5    Bihar                 1      0       0%       0     0%       6       3      50%        3     50%    21      9       43%      3    14%     25       5      20%     2      8%          53
 6    Chandigarh            3      3      100%      3    100%      3       2      67%        1     33%     2      2      100%      2    100%     0       0      0%      0      0%          8
 7    Chhattisgarh          1      0       0%       0     0%       7       5      71%        0     0%      2      1       50%      0     0%      4       2      50%     0      0%          14
 8    D & N Haveli          0      0       0%       0     0%       0       0       0%        0     0%      1      1      100%      0     0%      0       0      0%      0      0%          1
 9    Daman & Diu           0      0       0%       0     0%       1       1      100%       0     0%      1      0       0%       0     0%      0       0      0%      0      0%          2
10    Delhi                 3      3      100%      3    100%      1       0       0%        0     0%      0      0       0%       0     0%      3       3     100%     3     100%         7
11    Goa                   2      1      50%       1    50%       3       2      67%        1     33%     0      0       0%       0     0%      1       0      0%      0      0%          6
12    Gujarat               24     7      29%       3    13%       49     45      92%        10    20%    83      62      75%     14    17%     101     46      46%     13    13%         257
13    Haryana               10     7      70%       6    60%       9       8      89%        2     22%    18      16      89%      4    22%      7       3      43%     1     14%          44
14    Himachal Pradesh      3      0       0%       0     0%       13     12      92%        0     0%      7      5       71%      1    14%      1       1     100%     0      0%          24
15    Jammu & Kashmir       0      0       0%       0     0%       0       0       0%        0     0%      2      2      100%      1    50%      2       1      50%     0      0%          4
16    Jharkhand             0      0       0%       0     0%       5       4      80%        4     80%     4      2       50%      2    50%      1       0      0%      0      0%          10
17    Karnataka             54    19      35%      12    22%       97     94      97%        24    25%    90      79      88%     19    21%     110     72      65%     28    25%         351
18    Kerala                17     3      18%       2    12%       47     35      74%        9     19%    53      39      74%     12    23%     19       7      37%     4     21%         136
19    Lakshadweep           0      0       0%       0     0%       0       0       0%        0     0%      0      0       0%       0     0%      0       0      0%      0      0%          0
20    Madhya Pradesh        16     8      50%       8    50%       65     56      86%        7     11%    70      43      61%     12    17%     24       3      13%     0      0%         175
21    Maharashtra           99    44      44%      37    37%       27     21      78%        11    41%    65      47      72%     11    17%     32      19      59%     5     16%         223
22    Manipur               1      1      100%      0     0%       2       2      100%       1     50%     2      2      100%      2    100%     1       0      0%      0      0%          6
23    Meghalaya             5      1      20%       1    20%       3       3      100%       2     67%     2      0       0%       0     0%      0       0      0%      0      0%          10
24    Mizoram               5      1      20%       1    20%       0       0       0%        0     0%      0      0       0%       0     0%      0       0      0%      0      0%          5
25    Nagaland              0      0       0%       0     0%       1       1      100%       1    100%     2      2      100%      2    100%     0       0      0%      0      0%          3
26    Orissa                17     4      24%       3    18%       38     21      55%        4     11%    19      4       21%      3    16%     33       5      15%     1      3%         107
27    Puducherry            3      2      67%       2    67%       2       2      100%       1     50%     4      4      100%      4    100%     0       0      0%      0      0%          9
28    Punjab                17     2      12%       2    12%       22     15      68%        0     0%     18      11      61%      5    28%     24      14      58%     2      8%          81
29    Rajasthan             8      2      25%       1    13%       43     37      86%        8     19%    84      63      75%      9    11%     50      12      24%     2      4%         185
30    Sikkim                3      1      33%       1    33%       0       0       0%        0     0%      2      0       0%       0     0%      3       0      0%      0      0%          8
31    Tamil Nadu            50    16      32%      14    28%      113     99      88%        22    19%    90      68      76%     15    17%     49      28      57%     9     18%         302
32    Tripura               1      0       0%       0     0%       2       1      50%        1     50%     2      0       0%       0     0%      5       2      40%     1     20%          10
33    Uttar Pradesh         40     2       5%       2     5%       67     24      36%        0     0%     98      13      13%      1     1%     10       1      10%     1     10%         215
34    Uttarakhand           27    12      44%      11    41%       30     22      73%        1     3%     25      11      44%      3    12%     21       8      38%     1      5%         103
35    West Bengal           49    13      27%       7    14%       43     39      91%        7     16%    89      54      61%      6     7%     90      24      27%     4      4%         271
               Grand Total 553    168     30%     132    24%      799     643     80%       137    17%    990    622      63%     153   15%     699    302      43%     88    13%        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    Period between date of start of outbreak and date of response (first reported to
          by Rapid Response          a health worker at any health facility)
                                    Composition of outbreak response team
          Team
  3       Laboratory confirmation   Type of clinical specimen
          of outbreak               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   Use of epicurve, spot map, graphs?
          time, place and person
  7       Conclusion                Is source of the outbreak determined?
                                    Is mode of transmission established?
  8       Specific public health    Case management
          intervention measures     Control measures
                                    Outcome (CFR)
          undertaken
  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             % of response to disease
                                          specific outbreaks
                                               (n=699)
Investigation within 48 hours of
first case information             • 510 (73%)

Adequate samples sent for lab      • In 302 (43%) outbreaks, appropriate
                                     human samples sent for lab
investigation within 4 days
                                     investigation
                                   • 88 (13%) outbreaks etiologically
                                     confirmed

Availability of final outbreak
report                             • 5%
          Quality Assessment of Outbreaks
 reported by 9 WB funded States in 2011 (till 26 June)
               using 3 Essential Criteria

        Essential criteria             % of response to disease
                                          specific outbreaks
                                               (n= 516)
Investigation within 48 hours of
first case information             • 385 (75 %)

Adequate samples sent for lab      • In 242 (47 %) outbreaks, appropriate
                                     human samples sent for lab
investigation within 4 days
                                     investigation
                                   • 66 (13 %) outbreaks etiologically
                                     confirmed
Availability of final outbreak
report                             • 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.    Lab confirmation of diagnosis needs appropriate
      clinical (human) samples to be sent for lab tests
2.    Identification and Training of Epidemiologists,
      Microbiologists, Entomologists and RRT members at
      DSU / SSU levels
3.    Existence of a written case management protocol for
      any epidemic should be made available by the State at
      each PHC/CHC/District level
4.    Competency assessment tool to be utilized for
      improving the quality of outbreak investigations and
      reporting (by the Epidemiologists and Surveillance
      Officers)
      Thank you

idsp.outbreakcell@gmail.com

				
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