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11.05.2019 Feature Article

Integrated Disease Surveillance Response- A Tool To Improve Public Health Surveillance And Response

Surveillance is the ongoing systematic collection, analysis and interpretation of health data. It includes the timely dissemination of result information to those who need them for action. Regardless of the type of surveillance, the important issue is that the health data is used for public health action. Disease control and prevention programs have been successful when resources were dedicated to detecting a target disease, obtaining laboratory confirmation of the disease and using threshold to initiate action at the district level.

Accordingly, the World Health Organization (WHO) Regional Officer for Africa proposed an Integrated Disease surveillance and Response (IDSR) approach for improving the public health surveillance and response in Africa region linking community, health facility, district and national level. IDSR promote rational use resources by integrating and streamlining common surveillance activities. IDSR take into account ONE WORLD-ONE HEALTH perspective which is a strategy that addresses event at the intersection of human, domestic animals and wildlife.

IDSR and IHR (2005)

The purpose of the International Health Regulations (IHR) is to prevent, protect against, control and provide public health response to the international spread of disease in ways that are relevant and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.

The scope of IHR has been expanded from cholera, plague and yellow fever to all public health emergencies of international concern. They include those caused by infectious diseases, chemical agents, radioactive materials and contaminated food. Since the goal of IDSR is to strengthen the overall national system for the surveillance of diseases particularly at district level and aims to ensure a continuous and timely provision and use of information for public health decision

making, IDSR offers to the implementation of IHR:

• An infrastructure and resources for surveillance, investigation, confirmation, reporting and response

• Experienced human resources

• Defined implementation process (sensitization, assessment, plan of action, implementation, monitoring, and evaluation)

• Generic guides for assessment; Plan of action development; Technical guidelines; training materials; tools and Standard Operating Procedures that incorporate IHR components.

Thus, IDSR is a system with the potential to ensure a reliable supply of information to the national level in order to fulfill IHR requirements. The IHR provide an opportunity to address the threat to international public health security and trade caused by reemerging and emerging infectious diseases including public health emergencies of international concern (PHEIC). They also provide an excellent opportunity to strengthen surveillance and response systems, and to act as a potent driver for IDSR implementation..

Importantly, Member States in the African Region recommended that IHR (2005) should be implemented in the context of IDSR. IHR is a binding and legal instrument. It calls for strengthening of national capacity for surveillance and control, including sites such as points of entry (i.e. ports, airports and ground crossings); prevention, alert and response to international public health emergencies; global partnerships and international collaboration; and highlights rights, obligations, procedures and monitoring of progress. Since the IHR (2005) came into force, some progress has already been noted, namely that all member states have designated an IHR national focal point and are in different stages of implementing IHR.

IHR (2005) is not a separate surveillance system but requires a “sensitive and flexible surveillance system that meets international standards”. IHR (2005) affects cross-border collaboration for particular key events and can easily be achieved when IDSR works. IHR (2005) has introduced the notion of “event-based” surveillance to IDSR in order to address rumors of “unexplained illness or clusters” as an event category for reporting from lower levels to national level. IDSR and IHR share common functions as described in the diagram below (detection, reporting, confirmation and verification, notification and reporting and timely response).

The IHR have practical implications for IDSR. In the IHR (2005), all public health conditions and events of international concern (PHEIC) should be detected, assessed and responded to timely, using an adapted response rather than preset measures. The IHR (2005) include the control of borders (ports, ground crossing Points of Entry) and containment at source of public health events. Because of the major role it plays for timely detection and verification of suspected public health emergencies, event-based surveillance is now part of IDSR and the IHR.

Objectives of Integrated Disease Surveillance and Response

The specific objectives of IDSR are to:

• Strengthen the capacity of countries to conduct effective surveillance activities: train personnel at all levels; develop and carry out plans of action; and advocate and mobilize resources.

• Integrate multiple surveillance systems so that forms, personnel and resources can be used more efficiently.

• Improve the use of information to detect changes in time in order to conduct a rapid response to suspect epidemics and outbreaks; monitor the impact of interventions: for example, 8 declining incidence, spread, case fatality, and to facilitate evidence-based response to public health events; health policy design; planning; and management

• Improve the flow of surveillance information between and within levels of the health system.

• Strengthen laboratory capacity and involvement in confirmation of pathogens and monitoring of drug sensitivity.

• Increase involvement of clinicians in the surveillance system.

• Emphasize community participation in detection and response to public health problems including event based surveillance and response in line with IHR

• Trigger epidemiological investigations in detection, investigation and reporting of public health problems, and in the implementation of effective public health interventions.

Table 1: Priority diseases, conditions and events for
Integrated Disease Surveillance and Response – 2010

Epidemic prone diseases Diseases targeted for
eradication or elimination
Other major diseases,
events or conditions of
public health importance
Acute haemorrhagic fever
Diarrhoea with blood (Shigella)
Meningococcal meningitis
Typhoid fever
Yellow fever
*Ebola, Marburg, Rift Valley, Lassa,
Crimean Congo, West Nile Fever
**National programmes may wish to
add Influenza-like illnesses to their
priority disease list
Buruli ulcer
Lymphatic filariasis
Neonatal tetanus
1Disease specified by IHR (2005) for
immediate notification
Acute viral hepatitis
Adverse events following
immunization (AEFI)
Diabetes mellitus
Diarrhoea with dehydration
less than 5 years of age
HIV/AIDS (new cases)
Injuries (Road traffic
Malnutrition in children under 5
years of age
Maternal deaths
Mental health (Epilepsy)
Severe pneumonia less than 5
years of age
Diseases or events of international concern
Human influenza due to a new subtype1
Any public health event of international or national concern
(infectious, zoonotic, food borne, chemical, radio nuclear, or
due to unknown condition.
Disease specified by IHR (2005) for immediate notification

Written by:

William Appiah

BSc. Physician Assistant Studies

University of Cape Coast

Level 200

Abigail Abrafi Asamoah Snr
Abigail Abrafi Asamoah Snr, © 2019

This author has authored 2 publications on Modern Ghana. Author column: AbigailAbrafiAsamoahSnr

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