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Integrated Disease Surveillance Project (IDSP)

BACKGROUND
Integrated Disease surveillance Project (IDSP) is a decentralised disease surveillance project implemented in Odisha in 2006-07 intended to detect early warning signals of impending outbreaks and help initiate an effective response in a timely manner.
IDSP monitors core diseases of public health importance like Diarrhoea, Dysentry, Jaundice, Typhoid, Measles, Mqalaria, Dengue, Chikungunya, AES/JE, Leptospirosis, Anthrax, Swine flu, Bird flu etc. It assumes the role of state Health Control Room during natural calamities like flood, cyclone & Heat waves.
Current Status

1. One State Surveillance Unit and 30 District Surveillance units are functional with trained IT personnel, Hardware & Software & Video Conferencing set up.
2. State Surveillance Unit, District Surveillance Units & 3 Govt. Medical Colleges& hospitals of the state have been identified as training center for IDSP.
3. 30 ADMO (PH), 13 District Surveillance Medical Officers and 21 Epidemiologists, are present to support in effective monitoring and supervision of IDSP activities in the district.
4. �21 Epidemiologists, one Trg Consultant, two Microbiologists,30 Data Managers and 36 Data entry operators are placed at state and district level for data collection, compilation, analysis and onward transmission for report generation and follow up action at State & district Level respectively
5. 16 Rapid Response Team members (RRT) of vulnerable districts are trained and kept in readiness for outbreak investigation and response..
6. State Surveillance Unit (SSU) completed for one day training of district RRT in 16 vulnerable districts Bolangir, Angul, Bargarh, Dhenkanal, Ganjam, Gajapati, Keonjhar, Koraput, Malkangiri, Kandhamal, Mayurbhanj, Nuapada, Nabarangapur, Kalahandi, Rayagada & Sonepur) of our state during 2013-14
7. During 2013 Capacity building of 390 MOs, 12 epidemiologists, 2 microbiologists, 600 paramedical staff have been trained in IDSP Also 28 ADMO (PH) have been trained in two week FETP courses. 22 MOs have been trained for 6 days as RRT/TOT for IDSP.
8. Weekly data is analyzed each week to monitor trend and detect early warning signal of impending outbreaks.
9. State Surveillance Unit functions as state health control room during emergency like flood, Cyclone & heat wave, outbreaks it serves as control room it also functions as control room.
10. Disease surveillance Reports are being received on weekly basis from 1745 health facility level (CHC+SDH+DHH+Priv.hosp), 6688 Sub Centers & 382 laboratories.
11. Completeness of reporting in 2013: Completeness of weekly reporting with respect of Form S (Health Worker) ranges between 72 - 97% & Form P (Health Institution &Medical Officer) between 71 � 89% and Form L (Laboratories) between 65 � 88%.
12. Timeliness of reporting: All the districts are reporting on time each week since 2008 to till date.

Outbreak response & Investigation

1. One State Rapid Response Team/ 30 District Rapid Response Teams/377 Block Rapid Response Teams are identified to respond & investigate as & when situation arises for immediate containment of outbreaks at district & sub district level.
2. Each year guidelines on prevention & management of Acute Diarrhoeal Diseases are circulated sufficiently ahead �of monsoon season and districts are kept in readiness to adress the challenges of waterborne & vectorborne disease outbreaks during monsoon.
3. The Outbreaks are being investigated by Block/ District/ State Rapid Response Teams �for �immediate containment� measures.
4. �Suitable samples are collected for lab confirmation during the outbreaks
5. Media Scanning & rumor verification: Daily scanning of print & electronic media is being done by SSU& DSU. In 2013, 342 rumors were received, all of which were investigated by Block/ District/State RRT and 315 were confirmed..

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1. SSU, IDSP receives disease outbreak reports from the districts on weekly basis. Even NIL weekly reporting is mandatory and compilation of disease outbreaks/alerts is done on weekly basis. On an average 3-5 outbreaks are reported to SSU weekly. In 2013, 315 outbreaks were reported from January to December 2013. Majority of the reported outbreaks were of Acute Diarrheal diseases (47%), Food poisoning (20%), Measles (14%), etc. Viral hepatitis (5%), Chickenpox (6%) and Anthrax (3%).
2. In 2014, till May 31st -115 rumors were received, all of which were investigated by Block/ District/State RRT and 108 were �confirmed to be outbreaks of where 36 ADD, 37 Food Poisoining, 14 Measles and 9 were Jaundice.
3. The three Govt. Medical College & Hospitals of the state are functional as three State Referral Laboratories (SRLs) of the state linking to adjoining districts to conduct the laboratory confirmation of epidemic prone diseases such as Cholera, Viral Hepatitis, Measles, Meningitis, Diphtheria, Dengue, Chikungunya, AES/JE, Anthrax, Leptospirosis etc.
4. �District Public Health Laboratory at Koraput & 7 sentinel sites for Dengue are functioning & conducting laboratory tests.� During 2014, 18 samples are found positive for dengue.
5. Two State Public Laboratories Cuttack & BBSR conduct water & stool sampleanalysis. �ICMR supported labs at Rayagada & Kalahandi is also support for laboratory surveillance.
6. The district Public Health laboratory at Mayurbhanj and Kandhamal district will be functional during 2014.
7. In 2013, 60 % of the total outbreak samples were laboratory tested. The rectal swab, water sample, blood samples, smear samples were collected for isolation of etiologic agents.
8. In 2014 , May 31st � out of 108 outbreaks �63 outbreaks have been lab confirmed at State Referral Laboratories.

Comparative status of different Outbreaks in the state from 2012 to 2014 (up to 31 May )

Disaster Management & Response

1. The State Surveillance Unit assumes responsibility of State Health Control Room during disaster in addition to its regular responsibility.
2. Heat Stress Disorder: Each year from� March , state prepares for prevention of heat stress disorders with preparatory activities like intensifying health education, preposition of supplies & availability of heat stroke room at �health facility level.
3. 1381 beds, 337 AC, 855 Coolers are available in MCHs, DHH, SDH, CHC & PHC for Heat Stress Disorder Case Management.
4. �Till May 31st, 543 cases & 23 deaths are reported due to Heat Stroke Disorders.
5. Drawing experiences from dengue outbreak in the year 2011-2013 issues of manpower, logistic, investigation, reporting and media management etc necessary� preventive measures are being taken at district and sub district level for dengue diagnosis, case management and IEC/BCC activities.
1. The state experienced flood and cyclonic storm �PHAILIN� during the month of October 2013 across 14 district (Ganjam, Puri, Balasore, Bhadrak, Jajpur, Jagatsinghpur, Mayurbhanj, Kendrapara, Nayagarh, Sambalpur, Gajapati, Khurda, Kalahandi, and Nayagarh).�
2. State & District preparedness activities like micro-planning for Medical relief operations, manpower deployment, supply & prepositioning of drugs & disinfectants, additional mobility support, preventive disinfection of drinking water sources,� intensified IEC/BCC activities were undertaken both pre cyclone & post cyclone flood period that resulted in no major outbreak in the affected area.

Other Major Activities

1. Initiation of Multi-sectoral long term action plan under the Chairmanship of �Addl Chief Secretary, Odisha to develop� a� micro plan for connectivity, safe drinking water supply and IEC/BCC activities in all� vulnerable districts of the state to minimize the morbidity & mortality due to Water borne & Vector borne diseases.
2. Apart from Operational District Public Health Laboratory unit at Koraput, additional two District Public Health Laboratories are planned to function at Kandhamal and Mayurbhanj in 2014.
3. �Water Quality Monitoring :Ortho-toluidine & H2S test kits are being provided to the district and sub district level for effective routine monitoring of water quality which will reduce the water borne outbreaks.�
4. Intensive IEC/BCC activities will be further initiated regarding safe drinking water, hand washing, use of sanitary latrine & environmental sanitation, ORS use & preparation the in community by SIH & FW through a specioal campaign like NIDHI RATHA in July � August.
5. Vulnerable districts will be focused and specific action plan will be prepared to face the challenges in the districts for water & vector borne diseases.
6. Steps are being taken for involvement of private providers at major cities in disease surveillance activities.
7. Steps have been taken for training of Doctors, RRT members, urban disease surveillance, Data management
8. �FAQ booklets on diarrhoea, case definition chart, trigger events chart, Outbreak investigation steps, tally sheet for compilation of data are being circulated among MOs & Paramedicals to spread awareness.
9. Private Providers & Urban area dispensaries will be involved in weekly routine disease surveillance reporting.
10. �The three study project of IDSP are continuing in all the four identified blocks (Jayapatna, Jharigaon, Bhanjanagar, Bantala)of four districts ( Kalahandi, Nawaranpur, Ganjam & Angul) �to gather evidence about the risk factors for diarhoea.

Innovation �

• Disaster preparedness & Mitigation plan document hosted in the Odisha Govt. Website in August 2013.
• MPHS draft training module developed and provided to the lower stakeholders for skill up gradation.
• Rapid Response Team (RRT) �draft training module developed and used for trained all the vulnerable districts & blocks RRT members for dedicated robust outbreak investigation at district & block level.
• Handling project independently by IDSP for identifying the risk factor for diarrhea, hand washing practices among school students, lab surveillance & water quality monitoring etc.
• Mobile surveillance to track the dengue cases, AHINI cases, disseminates messages for disinfection of dug wells.
• Key informant at village level who have been working as volunteers for disseminating information of any unusual events at village level.
• Inter-sectoral convergence with related Deptt. of Govt. such as PRI,WCD,RD,H&UD, Industry, SC&ST, School & Mass, Works, ARD, Forest & Environment & Private Medical Colleges for better coordination of surveillance & containment measures during outbreaks.

State Surveillance Unit, IDSP
Directorate of Public Health, Odisha