NURS 11: Nursing

Informatics
Week 10: Health Informatics in Disease Surveillance
Introduction
• Disease surveillance is recognized as the cornerstone of public health
decision-making and practice. Surveillance data provide information
which can be used for priority setting, policy decisions, planning,
implementation, resource mobilization and allocation, prediction and
early detection of epidemics. A surveillance system can also be used for
monitoring, evaluation and improvement of disease prevention and
control programs. Also, the surveillance system generates data that is
helpful to the Public Health Officials in understanding the existing and
emerging infectious and non-infectious diseases. Without these quality
data, interventions may become misguided and wasteful.
• The Philippine Integrated Disease Surveillance and Response (PIDSR) of the Epidemiology Bureau
(EB) is an integrated approach for strengthening the Philippine epidemiologic surveillance and
response system. It was established in 2007 following the International Health Regulations (IHR)
call for a stronger surveillance system.
• The Public Health Surveillance Division (PHSD) of EB supports the Republic Act (RA) No. 11223
“Universal Health Care (UHC) Act” and RA No. 11332 “Mandatory Reporting of Notifiable Diseases
and Health Events of Public Health Concern Act" thus, PIDSR is hereby enhanced to integrate
Epidemic-prone Disease Case Surveillance (EDCS) and Event-based Surveillance and Response
(ESR) surveillance activities and response at all level of Epidemiology and Surveillance Units
(ESUs).
• Epidemic-prone Disease Case Surveillance (EDCS) - refers to a surveillance system to monitor
trends, alert, and epidemic thresholds of diseases with epidemic potential as well as diseases for
elimination and eradication.
• Event-based Surveillance and Response (ESR) - refers to the organized and rapid capture of
information about events that are a potential risk to public health including events related to the
occurrence of a disease in humans and events related to potential risk-exposures in humans.
Framework of
Public Health
Surveillance
and Action in
the
Philippines
Goal and Objectives
• To support the health sector in reducing morbidity and mortality from
diseases of public health importance through an institutionalized,
functional integrated disease surveillance and response system.
• Objectives
1. To continually improve capacities at the national and regional levels to
efficiently and effectively manage national and sub-national
surveillance and response system.
2. To mobilize and empower LGUs in the establishment and
institutionalization of disease surveillance and response system.
3. To support health sector capacity development for sustainable disease
surveillance and response system.
4. To enhance utilization of disease surveillance data for decision making,
policy development, program management, planning, monitoring and
evaluation at all levels.
Features of PIDSR
1. Integrated in terms of the use of standard case definitions, surveillance core activities (detection, registration, reporting,
confirmation, analysis, feedback) and resources.
2. Capacity for early detection of epidemics.
3. Integrated response to epidemics and other public health threats.
4. Utilizes case-based, laboratory-based and event-based surveillance approaches to enhance sensitivity and specificity of
the system.
5. Strengthens local capacity for surveillance and response. This includes involvement of the community in disease
surveillance activities. The primary role of the LGU is to provide appropriate intervention to emerging diseases,
epidemics and other public health threats.
6. Established capacity of laboratories and strengthened involvement in disease surveillance system.
7. Efficient and effective management of surveillance data (e.g., collection, analysis, interpretation and dissemination) and
use of information for decision-making, including monitoring and evaluation of intervention programs at all levels.
8. Open lines of communication with established feedback loop at all levels.
Identifying Cases: Use of Standard Case
Definitions for Surveillance
• A standard case definition for surveillance is a set of criteria that is used to determine if a person
has a particular disease, syndrome or condition and if the case should be included in reporting and
investigation.
• Using the same case definition throughout the entire surveillance system allows data from all
reporting units to be compared consistently and ensures accurate tracking of particular diseases,
syndromes or conditions.
• The DRUs should strictly use the standard case definitions for each of the notifiable diseases,
syndromes or conditions. This is to ensure a consistent and accurate identification of cases
throughout the system.
• Cases are further classified to indicate whether cases are suspect, probable or confirmed. These
definitions were designed for surveillance purposes only and are not intended for use in managing
cases nor to indicate intention to treat.
• Note that Case definitions are not sufficient for establishing a medical diagnosis and should not be
relied upon to initiate therapy.
Identifying Cases: Use of Standard Case
Definitions for Surveillance
• A 3-tiered system with the following levels is used:
• - Suspected case: indicative clinical picture without being a confirmed or probable
case
• - Probable case: clear clinical picture, or linked epidemiologically to a confirmed
case;
• Note: A "case with an epidemiological link" is a case that has either been exposed to
a confirmed case, or has had the same exposure as a confirmed case (e.g. eaten the
same food, stayed in the same hotel, etc).
• - Confirmed case: verified by laboratory analysis.
Note: The classification on these different levels might vary according to the
• epidemiology of the individual diseases.
• Unless specifically stated, only symptomatic cases are to be reported. Asymptomatic
infections are to be regarded as cases, however, if the infection has therapeutic or public
health implications.
Partners in Detecting and Reporting Cases
• Disease Reporting Advocates (DRAs)-are health workers and other individuals who
have attended orientation on the PIDSR and committed to actively participate in reporting. They can
be any of the following:
• - Communityleaders–e.g.BarangayCaptain,TribalLeader
• - BarangayHealthWorker
- FaithHealer/TraditionalHealer
- PrivatePractitioners
• Disease Surveillance Coordinators (DSCs)- are staff of government and
non-government health facilities (hospitals, private clinics, RHUs) officially designated as disease
surveillance coordinator by the head of the facility and are trained on PIDSR.
• Disease Surveillance Officers (DSOs)- are fulltime staff of the Epidemiology and
Surveillance Unit (ESU) of the CHOs (chartered cities), PHOs and CHDs who has received training
on basic epidemiology, public health surveillance and PIDSR; and, are officially designated as
Disease Surveillance Officer by the head of office. Ideally a DSO should either be a physician or a
nurse.