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Biregional je presentation_surveilance

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Information about Biregional je presentation_surveilance
Health & Medicine

Published on February 15, 2014

Author: lankansikh

Source: slideshare.net

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JE surveillance in Sri Lanka country presentation for the 5th Bi-regional meeting on JE prevention and control Dr. Pushpa Ranjan Wijesinghe National Surveillance Focal Point Epidemiology Unit, Ministry of Health

Uses of surveillance data • Quantification of the disease frequency in the country – Information from 1985 to date • Identification of JE endemic areas in the country – Phase based immunization in 1989 • Identification of high risk groups for targeted vaccination – 1-10 age group till 2009 • Forecasting and Identification of JE outbreaks – Last major outbreak in 2002 (Ratnapura) • Designing and implementation of the JE control programme – Vector control and IEC before 1889 – Immunization program from 1989 • Evaluation of the JE control programme

Current use of surveillance data • Determination of the changing epidemiology – – – – Sporadic nature of cases since 2003 Changing age profile of JE cases Spatial change in disease transmission among humans Effectiveness of the immunization campaign • Verification of mounting rumors and anecdotal evidence that JE is on rise – Clinical fraternity , media • Appraisal of the effectiveness of the LJEV – Is the efficacious vaccine effective in the real world ? – Is one dose strategy the correct approach ?

Methods of Acute Encephalitis Syndromic surveillance • Routine communicable disease surveillance – – – – – – Acute Encephalitis - a notifiable disease Notification by all medical practitioners Notification on the basis of the tentative diagnosis Availability of surveillance case definition 100% field investigation by the Public Health Inspector Information to the national data base through the “weekly Return of Communicable Disease “ – Feed back of weekly consolidated information through the “ Weekly Epidemiological Report”

Methods of Acute Encephalitis Syndromic surveillance • Event Based Surveillance – Media surveillance for reported communicable disease outbreaks / clusters at the national level – Central rumour register – District rumour registers maintained by Regional Epidemiologists – Confirmation by the peripheral staff – Event assessment by the Regional Epidemiologist with central support

Methods of Acute Encephalitis Syndromic surveillance • Case–based Special Surveillance – Case based surveillance of all AES cases including JE – Obtaining in-depth information than through routine notification • Demographic, epidemiological, clinical , immunization and risk factors – 100% mandatory investigation of JE cases – Entry into the National JE registry – Quarterly Feed back in the Quarterly Epidemiological Bulletin – Annual surveillance information through the Annual health bulletin

Methods of Acute Encephalitis Syndromic surveillance • Laboratory surveillance – Sentinel hospitals based – National JE Reference Laboratory - Viral Laboratory at the Medical Research Unit – Accredited laboratory – Tests used • Detection of Ig M in serum and CSF

EPIDEMIOLOGICAL INFORMATION

JE specific morbidity Rate [per 100,000] & Case Fatality Ratio (%), 1985-2010 100 10 1 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 Morbidity 0.1 CFR 1 2 3 4 5 6 7 8 9 10

Distribution of suspected and confirmed JE cases Confirmed JE Year Suspected No. % 2006 130 26 20.0 2007 203 39 19.2 2008 261 31 11.8 2009 223 34 15.2 2010 215 27 12.5

Results of laboratory surveillance Total Number of AES Specimens Received in Lab Number of Positive Results Year Serum CSF Serum CSF Received Tested Received Tested JE Positive JE Positive 2009 142 142 568 568 15 ( 9.4%) 23 ( 4.1%) 2010 168 168 558 558 8( 4.7%) 19 (3.4%) 2011 43 43 187 187 3( 6.9%) 12( 6.4%)

Seasonal trend of AES reporting in Sri Lanka 2006 2007 50 45 40 35 30 25 20 15 10 5 0 2008 2009 2010 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Seasonal trend of JE reporting in Sri Lanka 16 14 12 2006 10 2007 8 2008 6 2009 2010 4 2 0 Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec

Spatial distribution of suspected and confirmed JE 2010 Reported AES cases Confirmed JE cases

Age distribution of confirmed JE cases Age group Year 2006 2007 2008 2009 2010 <1 year 01(03.8%) 1 (2.6%) 0 (0.0%) 2(5.9%) 1(3.7%) 1-4 03(11.4%) 3 (7.8%) 1 (3.2%) 4(11.8%) 6(22.2%) 5-9 00 (0%) 2 (5.2%0 1(3.2%) 2(5.9%) 1(3.7%) 10-14 3 (11.4%) 3 (7.8%) 1(3.2%) 2(5.9%) 1(3.7%) 15-19 1(3.8%) 1 (2.6%) 2 (6.4%) 2(5.9%) 2(7.4%) 20-24 1(3.8%) 3 (7.8%) 5(16.0%) 6(17.5%) 1(3.7%) 25-29 1(3.8%) 0 (0%) 1 (3.2%) 3(8.8%) 1(3.7%) 30-34 1(3.8%) 6 (15.6%) 1(3.2%) 3(8.8%) 3(11.1%) 35-39 1 (3.8%) 2 (5.2%) 1(3.2%) 0(0.0%) 1(3.7%) 40-44 0(0%) 1(2.6%) 3 (9.6%) 1(2.9%) 0(0.0%) 45-49 3(11.4%) 2 (5.2%) 3 (9.6%) 3(8.8%) 0(0.0%) 50-54 3 (11.4%) 5 (13.0%) 0 (0.0%) 1(2.9%) 3(11.1%) 55-59 1(3.8%) 1(2.6%) 2 (6.4%) 1(2.9%) 2(7.4%) >60 4(15.2%) 5 (13%) 7(22.4%) 2(5.9%) 5(18.5%) Unknown 3(11.4%) 4 (10.4%) 2 (6.4%) 2(5.9%) 0(0.0%) Total 26 39 31 34 27

Confirmed JE cases by immunization status

Challenges • Waning interest of the policy and decision makers on JE – declined disease burden – competing priorities • Improving the quality of surveillance information related to auxiliary laboratory investigations • Improving the coverage of specimens sent for confirmation of JE from sentinel hospitals • Sustainable logistics supply to the national reference laboratory • Improvement of etiological diagnosis of AES other than JE • Establishing sustainable private sector reporting

Solutions • Quarterly surveillance reviews at the – Advisory Committee of Communicable Diseases – Quarterly meeting of Regional Epidemiologists – District level reviews by Regional Epidemiologists • Mandatory investigation by Medical officers of Health • 100% case- based investigation for all confirmed JE cases • Complimentary lab information from the sentinel hospitals • Discussions with the clinicians and professional bodies • Back up funding from cost-savings and donor agencies • Proposed new system of mandatory reporting of aetiology by virologists and microbiologists for all tested AES specimens

Acknowledgements • Dr. Paba Palihawadana – Chief Epidemiologist • Dr.T.S.R. Pieris – EPI focal point • Dr.Geethani Galagoda - JE laboratory focal point , MRI – Colombo • Dr. Chatura Edirisuriya – Registrar in Public Health • Nipuni, Roshan and Inoka - JE surveillance team • Dr. Nihal Abeysinghe -WHO/SEAR

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