newars - rcdc.gov.bt · 2012 to incorporate web based reporting. in 2014, ... guideline including...

NEWARSNational Disease Surveillance and

Epidemiology Unit (NADSAE)

Royal Centre for Disease Control

2018 Revised NEWARS guideline

NEWARS

National Disease Surveillance and Epidemiology Unit (NADSAE)

Royal Centre for Disease Control

2018 Revised NEWARS guideline

All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means including photocopying, recording, or information storage and retrieval without prior permission in writing from Royal Centre for Disease Control.

ISBN: 978-99936-947-7-9

Give feedback on the book at:

www.rcdc.gov.bt

Printed in Bhutan

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National Early Warning, Alert & Response Surveillance

Preface

Bhutan has made considerable progress in preventing, controlling and eliminating important communicable diseases. However, the threat from emerging and re-emerging infectious diseases particularly zoonotic origin remain public health concern because of close interaction between human, domestic and wild animals. Further, chemicals and environmental related hazards are also public health concern. To detect emergence or incursion of new diseases or pathogens in time, a sound disease surveillance system is critical. High quality surveillance is also essential to determine disease burden, trend, seasonality to facilitate evidence based policy decision and intervention. Surveillance also helps in detecting early warning alerts for any events to response efficiently and develop preparedness plans.

Prior to 2009, the country had no systematic disease surveillance system. The Royal Center for Disease Control (RCDC) then known as the Public Health Laboratory established the notifiable diseases surveillance system (NDSS) for priority diseases of national concern and developed first edition of national notifiable disease surveillance guideline in 2010. The guideline was revised as 2nd edition in 2012 to incorporate web based reporting. In 2014, the NDSS guideline was revised to incorporate event-based surveillance (EBS) and renamed as “National Early Warning Alert and Response


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Surveillance (NEWARS)”.

The 2nd revision of NEWARS was deemed necessary to update various components of the guideline including the list of notifiable diseases and syndromes, case definitions and also incorporate electronic based NEWARS reporting through web-based and mobile short message service (SMS) which was developed and implemented in 2016. This 2nd edition is expected to help healthcare professionals and relevant stakeholders in implementing NEWARS effectively and efficiently to meets its objectives.

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Foreword

The Royal Center for Disease Control (RCDC) developed the first edition of National Notifiable Disease Surveillance (NNDS) guideline in 2010 and revised in 2012 to incorporate web based electronic reporting system. Subsequently, NNSD was reviewed and revised in 2014 as “National Early Warning Alert and Response Surveillance (NEWARS)” with incorporation of mobile short message service SMS and redesigned web based reporting.

This 2nd revision of NEWARS was necessary to update the various components of the guideline including the list of notifiable diseases and syndromes, case definitions and include electronic based reporting system for user guidance and reference.

The Ministry of Health would like to acknowledge all healthcare professionals, policy makers and relevant stakeholders for strong support in implementing the NEWARS successfully and we look forward for your continuous support and cooperation in implementation this revised NEWARS guideline.

(Dr. Ugyen Dophu)SECRETARYMinistry of Health


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Acknowledgment

Royal Centre for Disease Control (RCDC) would like to express deepest appreciation to all contributors who have developed 1st edition of National Early Warning Alert and Response Surveillance guideline. We are indebted for constant support and guidance rendered by the Dr. Karma Lhazeen, Director of Department of Public Health in completing 2nd edition of NEWARS guideline on time. Special thanks go to the healthcare professionals serving at various healthcare centers for providing valuable feedbacks during evaluation of NEWARS which were useful for revision of this guideline.

Dr. Sonam Wangchuk (M.Sc, PhD), Head, RCDC 1

Ms. Sonam Peldon (M.Sc Immunology), Dy. Chief Laboratory Officer1

Mr. Tshering Dorji (MBiotech, Food Microbiology), Dy. Chief Laboratory Officer1

Mr. Tsheten (MPH), Senior Laboratory Officer1

Mr. Thinley Jamtsho (B.Tech IT), Sr. ICT Officer1

Mr. Govinda Ghimeray (DIMS), ICT Technical Associate II 1

Mr. Jit Bahadur Darnal (CO/FETP), Clinical Officer1

1 Royal Center for Disease Control, Department of Public Health,, Ministry of Health

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List of abbreviations

ABD Acute Bloody Diarrhoea

AES Acute Encephalitis Syndrome

AFP Acute Flaccid Paralysis

ARI Acute Respiratory Infection

AWD Acute Watery Diarrhoea

ANT Anthrax

AFP Acute Flaccid Paralysis

AJS Acute Jaundice Syndrome

AHF Acute Haemorrhagic Fever

BHU Basic Health Unit

BMG Bacterial Meningitis

CDD Communicable Disease Division

CDC Centers for Disease Control and Prevention

CRS Congenital Rubella Syndrome

DHO District Health Office

DoPH Department of Public Health

DHF Dengue haemorrhagic fever

DPT Diphtheria, pertussis, tetanus

DSS Dengue shock syndrome

HAV Hepatitis A virus

HBV Hepatitis B virus

HCV Hepatitis C virus


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HDV Hepatitis D virus

FWR Fever with Rashes

FDP Food Poisoning

EBS Event-Based Surveillance

ER Emergency Room

IBS Indicator Based Surveillance

ICD-10: International Classification of DiseasesICT Information & Communication TechnologyIHR International Health Regulation

ILI Influenza like Illness

JE Japanese encephalitis

MoH Ministry of Health

MUM Mumps

NADSAE National Disease Surveillance & Epidemiology

NEWARS National Early Warning, Alert & Response Surveillance

OPD Outpatient Department

PHEIC Public Health Event of International Concern

PTS Pertusis

RKT Rickettsioses

SARS Severe Acute Respiratory Syndrome

TPF Typhoid/paratyphoid Fever

SFP Surveillance Focal Point

WHO World Health Organization

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Table of Contents1. Preface.........................................................2. Forward........................................................3. Acknowledgment..........................................4. List of Abbreviations.....................................5. Target Users.................................................6. Goal of guideline..........................................7. Core functions of NEWARS system.............8. Roles and responsibilities............................9. National Notifiable Disease Surveillance System.........................................................10. What is a Notifiable Disease Surveillance 11. System?.......................................................12. Criteria for identifying a disease or syndrome as a National notifiable disease or syndrome.................................................13. Sources of data for notifiable disease surveillance..................................................14. Bhutan notifiable diseases or syndromes list and case definitions................................15. How the national notifiable disease surveillance system (NDSS) works..............16. Identifying diseases and syndromes............17. Preparing Report (Data Collection, Collation and Reporting)..............................18. How to report weekly notifiable diseases or syndrome.................................................19. Immediately notifiable disease.....................20. How to report immediately notifiable diseases or syndrome?................................

134511111217

25

25

25

25

25

3636

36

3739

39


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21. What is an Event-based Surveillance?........ 22. What are the events of public health concern.........................................................23. Sources of events Information and reportable events.........................................24. Event information collection and reporting...25. Practical guide to using NEWARS information system.......................................26. User Registration..........................................27. SMS System.................................................28. Adding Second Mobile Number...................29. Change Mobile Number...............................30. Change Password/Password Reset............31. Request Health Center Change...................32. Check Dates for Epidemiological Week Number.........................................................33. Check Reporting Deadline...........................34. Check for NEWARS Support Team..............35. Check Weekly Disease List..........................36. Submit Weekly Report.................................37. Submit Zero Report......................................38. Check Immediate Reporting Disease/ syndromes List.............................................39. Submit Immediate Report ............................40. Submit Event Report....................................41. Update Event Report Cases/Deaths............42. Delete Weekly Report..................................43. Delete Immediate Report.............................

41

42

4446

66668587888989

909191929393

949595969797

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National Early Warning, Alert and Response Surveillance

System


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1. What is Surveillance?

Surveillance by definition is the ongoing systematic health related data collection, collation, analysis, and interpretation for use in planning, implementing, monitoring, and evaluating public health policies and practices.

1.1 Why to conduct Disease surveillance?

Disease surveillance system serves two key functions; early warning of potential threats to public health including emergence of new disease or pathogens and monitoring of national public health programmes progress and achievement towards prevention, control, elimination and eradication goals for various disease of national public health concern.

The early warning functions of surveillance are fundamental for national, regional and global health security. Recent outbreaks such as the severe acute respiratory syndrome (SARS) and avian influenza, demonstrate the importance of effective national surveillance and response systems. The International Health Regulations (IHR) 2005 underscore the commitment to the goal of global security and require all Member States to establish and implement effective surveillance and response systems to detect and contain public health threats of national and international concern.

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The monitoring of national public health programmes encompasses a variety of global, regional and national goals and targets such as control, elimination and eradication. Surveillance systems also serve to monitor trends of endemic diseases, and progress towards disease prevention, and control indicators and targets of national public health programmes.

1.2 What is National Early Warning Alert Response Surveillance?

The National Early Warning Alert and Response Surveillance (NEWARS) was introduced in 2014 as the national surveillance and response system for various priority diseases or syndromes of public health concern for early detection and efficiently response .

The 1st edition NEWARS was developed to replace previous National Notifiable Diseases Surveillance introduced in 2010 which was indicator based surveillance. The revision of the first edition NEWARS guideline was deemed necessary, as in the guideline required incorporation of additional information with the introduction of electronic web-based and mobile SMS reporting system for NEWARS. The 2nd edition of NEWARS guideline contains user module for electronic web-based and mobile SMS reporting to guide users for self-learning and implement NEWARS without having to wait for trainings.


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1.3 Who are NEWARS users?

This guideline is intended to provide ready reference and practical assistance in implementing NEWARS. The target audiences include Surveillance Focal Points (SFP), clinicians, nurses, laboratory staffs and other relevant healthcare professionals involved in the surveillance, District Health Officers (DHO) and National Program Officers (NPO).

1.4 What is the purpose of NEWARS guideline?

The purpose of having guideline is explain the procedure in conducting the NEWARS and uniform implementation starting from data collection, collation, reporting, analyzing, interpreting and take action to achieve quality surveillance. Further, NEWARS guideline also explains the roles and responsibilities of healthcare professionals working at all levels of health facilities including village health workers working in the community.

2. What are Objectives of NEWARS?

NEWARS has following objectives:

1. To prevent or minimize morbidity and mortality of diseases through:

• Monitoring trends of endemic diseases

• Early warning and detection of

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outbreaks/events in timely manner

• Providing an adequate and timely response

• Disease burden estimation and risk factor identification

2. To monitoring effectiveness of control programs through:

• Evaluation of national programmes interventions

• Resource prioritization and mobilization

3. Stimulate research on national priority diseases

The NEWARS is supplemented by sentinel surveillance like the influenza-like Illness surveillance, acute undifferentiated fever illness surveillance, measles and rubella surveillance, acute encephalitis syndrome surveillance, diarrhea surveillance, food-borne illness surveillance, etc which collects more information on diseases, risk factors and identify etiologic agents.

3. Core functions of NEWARS system

The core functions include case detection, registration, confirmation, reporting, data analysis and interpretation, share feedback and initiate public health action. The feedbacks are disseminated


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as reports and bulletin to the data providers, stakeholders and decision-makers.

3.1 Case detection

Case detection is the process of identifying cases (listed notifiable diseases and syndromes) and suspect outbreaks as per case definition in the Basic Health Units, Hospitals, Regional Referral Hospitals and National Referral Hospital.

3.2 Case registration

Case registration is the process of recording the cases identified. This requires a standardized register or forms to record minimal data elements on notifiable diseases, and syndromes required by NEWARS guideline.

3.3 Case confirmation

Case/outbreak confirmation refers to laboratory confirmation and epidemiological link to confirm case. Case confirmation is enhanced through collection of quality of specimens from detected cases, storage and transportation through samples referral system, networking and partnerships.

3.4 Reporting

Reporting is the process by which surveillance data collected through standard case investigation form or records are reported through formal reporting mechanism from the point of generation to concern agency.

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3.5 Data analysis and interpretation

Surveillance data should be analyzed routinely and interpreted for use in public health actions. Appropriate “alert” or “epidemic” threshold values for diseases of epidemic potential can be calculated and use for monitoring.

3.6 Epidemic preparedness

Epidemic preparedness refers to the existing level of preparedness for potential epidemics which includes availability of preparedness plans, stockpiling of medicines, consumables like reagents, PPE, designation of isolation facilities, setting aside of resources for outbreak response.

3.7 Response and control

Surveillance information should be used for appropriate public health response and control by healthcare professionals and policy makers. For an early warning system response, the capacity to respond outbreaks and emerging public health threats needs to be assessed periodically and scale-up. This can be done following a major outbreak response and containment to document the quality and impact of public health response and control.

3.8 Feedback

Feedback is an important end product of NEWARS which is shared in form of report, newsletter and bulletins. The findings in feedback should


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be translated in action into practices, planning interventions and policy discussion.

1. Attributes of NEWARS System

NEWARS constitute indicator-based surveillance (IBS) and event-based surveillance (EBS). Indicator-based surveillance involves reporting of cases and deaths of 11 weekly and 15 immediately reportable diseases and syndromes seen at health centers as per the case definitions by healthcare professionals. Weekly reportable diseases and syndromes should reported every MONDAY and TUESDAY whereas immediately reportable are reported immediately as and when cases are detected in NEWARS information system monitor by the National Disease Surveillance and Epidemiology (NADSAE) Unit at RCDC .

Event-based Surveillance involves ad-hoc reporting of any ‘unusual’ event, cluster of cases, death or healthcare professionals suspect outbreak. It should be reported IMMEDIATELY by healthcare professionals including other stakeholders like public, media, civil organizations, NGOs, etc. in NEWARS information system or to the National Disease Surveillance and Epidemiology (NADSAE) Unit at RCDC or health centers who in turn report to NADSAE.

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Tabl

e 1.

The

mai

n fe

atur

es o

f IB

S a

nd E

BS

Feat

ures

Indi

cato

r-ba

sed

Surv

eilla

nce

Even

t-bas

ed s

urve

illan

ce

Dis

ease

or S

yndr

ome

Sel

ecte

d no

tifiab

le

dise

ase

or s

yndr

ome

Any

dis

ease

or h

ealth

eve

nt

Rep

ortin

g U

nit

Hea

lth fa

cilit

ies

Any

one

incl

udin

g he

alth

faci

litie

s

Rep

ortin

g fre

quen

cyIm

med

iate

ly

and

wee

kly

Imm

edia

tely

Rep

ortin

g fo

rmat

Sta

ndar

d N

one

for

othe

r st

akeh

olde

rs

but

stan

dard

for

mat

sho

uld

be u

sed

by

heal

thca

re p

rofe

ssio

nals

)

Rep

ortin

g m

etho

dsE

lect

roni

c W

eb

base

d an

d m

obile

S

MS

text

Ele

ctro

nic

Web

-bas

ed,

mob

ile S

MS

an

d ho

tline

pho

ne


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1. Roles and Responsibilities

All healthcare professionals working in different level of health facilities are responsible for implementing NEWARS activities. Therefore, it is important that every healthcare professional understand his/her roles and responsibilities as defined in this guideline. Healthcare professionals include specialists, medical doctors, clinical officers, health assistants, nurses, laboratory staffs or others working in various health facilities.

5.1 Clinicians Clinicians including specialists working in the health facilities are the first contact of cases and main source of information NEWARS. Clinicians should: 1 Identify cases of notifiable diseases or

syndromes based on case definition and collect information of cases on daily basis during OPD/IPD/Emergency/MCH/outreach clinic and record in registry or data collection format for weekly notifiable diseases (Annexure 1) and for immediately notifiable diseases (Annexure 2).

2 If data collection form is used, the form should be filed in the file name assigned by health facilities or handover the form to designated NEWARS focal points in the health centers on daily basis.

3 Detect and report immediately notifiable disease base on case definition or if clinicians suspect through NEWARS web based or mobile SMS within 24 hours of detection. Fill in the case investigation form for immediately notifiable diseases or syndromes detected, Use general case investigation form for those diseases

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that do not have specific investigation form (Annexure 3) Use specific form for Measles. (Annexure 4) Congenital Rubella Syndrome CRS, (Annexure 5) Diphtheria and Pertussis, (Annexure 6) Neonatal Tetanus (Annexure 7) Acute Flaccid Paralysis Surveillance (AFP,) (Annexure 8) and Acute Encephalitis Syndromme (AES) (Annexure 9) should be used for specific disease provided by respective programme).

5.2 Surveillance Focal Points (SFP):

To implement NEWARS effectively, two competent persons in each BHU, BHU-1, district hospitals, and referral hospitals should be designated as the Surveillance Focal Points (SFP). One of the SFPs should be designated as primary focal point and should be responsible for collection, collation and reporting data generated from the health facilities in NEWARS information system. In absence of the primary SFP, the second designated SFP should take up the responsibility. SFP should:

1. Compile NEWARS data collected by clinicians and relevant health professionals at the end of the day on daily basis or whatever mechanism put in place by respective health facilities management,

2. Collate the surveillance data of notifiable diseases or syndromes against specified age group and gender for the specific epidemiological


Page 20 of 144

week.

3. Refer case of immediately notifiable disease/syndrome to the nearest health facilities with laboratory facility (for BHU’s) for sample collection,

4. Report collated data on weekly basis through web based or mobile SMS on Monday and Tuesday for previous week and file forms at health centre.

5. Submit zero report if there is no case detected during the epidemiological week on Monday and Tuesday for previous week and file forms at health centre.

5.3 District Health Offices

District Health Offices should play important role in monitoring NEWARS reporting status of health centers under its jurisdiction. DHO or designated staff in DHO office should:

1. Monitor timeliness of NEWARS data reporting of their health centers.

2. Follow-up with late reporting or non-reporting healthcare centers.

3. Sensitize and conduct training of new recruits of health centers

4. Follow-up with the health centers whenever an immediately notifiable disease or syndrome

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is reported and activate District Health Rapid Response Team (DHRRT) to investigate immediately notifiable disease or syndrome reported if required.

5. Follow-up and monitor when events are reported and activate DHRRT to investigate the event, if required.

6. Ensure the investigation of outbreak initiated within 48 hours of receiving the verification and recommendation.

7. Analyze and interpret NEWARS data submitted by its health centers, prepare and disseminate feedback to health centers periodically,

8. Liaise and communicate with RCDC to sort out any issues related to NEWARS and seek assistance.

5.4 Laboratories in BHU I, district and referral hospitals:

Sample collection and testing by laboratory is critical in confirming etiology of notifiable disease reported including outbreak. Staff in a laboratory should:

1. Collect suitable specimen as per the Standard Operating Procedure (SOP).

2. Analyze samples and provide reports to the health centers,

3. Aliquot and store specimens at appropriate


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temperature in refrigerator or freezer and ship to RCDC in proper cold chain if required.

4. Liaise and communicate with reference laboratories at RCDC if required for any advice or assistance related to laboratory sample collection, shipment, diagnosis of notifiable diseases and events.

5.5 National Disease Surveillance and Epidemiology Unit, RCDC

National Disease Surveillance and Epidemiology (NADSAE) is the focal point for NEWARS. National surveillance focal at NADSAE should:

1. Follow up health centers to ensure timely and accurate reporting.

2. Routinely validate data reported by health centers.

3. Verify immediately notifiable diseass or syndromes reported by health centers.

4. Verify events reported and perform risk assessment.

5. Provide appropriate recommendation for immediately notifiable disease and syndrome reported and verify events within six hours and not later than 24 hours upon notification by health centers in NEWARS.

6. Coordinate response support for immediately notifiable disease and syndrome and events verified with health centers, district health rapid response team.

7. Lead national rapid response team to

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response outbreak/epidemic and pandemic of national and international public health concern.

8. Analyze surveillance data collected in NEWARS.

9. Prepare and disseminate monthly disease epidemiology report and quarterly disease surveillance bulletin to all health centers and relevant stakeholders.

10. Conduct training for health professionals on NEWARS.

Conduct periodic evaluation of NEWARS and update guideline and system.5.6 Reference Laboratories in RCDC

Reference laboratories play critical role in confirming etiology of notifiable disease and outbreaks. Reference laboratories should:

1. Provide confirmatory diagnosis for notifiable diseases and events.

2. Provide technical assistance to peripheral laboratories in sample collection, storage, shipment and diagnosis of diseases and events.

3. Support diagnostic supplies for all the district laboratories for diagnosis of notifiable and important public health diseases.

4. Provide prompt result for samples referred by health centers.


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5. Refer samples to supranational reference laboratories as and when required.

5.7 Information Technology (IT) Unit, RCDC

Information technology is the backbone for developing, updating and maintaining NEWARS information system. IT unit should:

1. Maintain and update web-based reporting system and data management applications.

2. Upgrade IT system as and when required.

3. Support health centers related to system problems.

4. Assist NADSAE in preparing monthly report and quarterly disease surveillance bulletin.

5. Supports NADSAE in training health professionals in NEWARS

5.8 National IHR Focal Point, Emergency Medical Service DivisionAs per the IHR 2005 guideline, any disease or events of international concern should be reported to WHO through National IHR focal Point that may constitute a Public Health Emergency of International Concern (PHEIC). National IHR Focal Point should:

1. Assess an outbreak or event reported and see if the event report falls under the

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purview of PHEIC using the “IHR (2005) Decision Instrument”.

2. Report to Health Emergency Operation Committee

3. Notify WHO country office if the event constitutes a PHEIC and help implement response measures.

4. Provide all relevant public health information to WHO if there is evidence of an unexpected or unusual public health event in the country.

5. Respond to WHO’s request for verification of reports from sources other than notifications or consultations of events.

5.9 Department of Public Health Related divisions under Department of Public

Health (DoPH), particularly Communicable Disease Division are the main stakeholder in NEWARS. Concerned programme under the Department should:

1. Define programme surveillance needs in NEWARS if require,

2. Support funding and training activities of health personnel at various health levels on NEWARS.

3. Mobilization resources to maintain and improve the quality of surveillance.


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Notifiable Disease Surveillance


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Notifiable Disease Surveillance

1. What is a Notifiable Disease Surveillance System?

National notifiable disease surveillance system is nation-wide indicator-based disease surveillance (IBS). The surveillance collects information for list of diseases or syndromes selected by the Ministry of Health and report timely by healthcare professionals as per the defined timeframe.

2. Criteria for selection of list of disease or syndrome

● Which have epidemic potential.● Which are vaccine preventable.● Which are aimed for elimination.● Which high morbidity and mortality.● Which are of potential threat to international

community (Public Health Emergencies of International Concerns).

3. Data Sources for notifiable disease surveillance Data form or registries of Out-patient, In-patient, Mother Child Health, Outreach and Emergency, outreach clinics of all health facilities.

4. List of national notifiable diseases or syndromes and case definitionsThe list of weekly and immediately notifiable diseases and syndromes and their case definition for surveillance purpose in given in the table-2 and 3 respectively:

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Tabl

e 2:

Lis

t of

wee

kly

notifi

able

dis

ease

s or

syn

drom

es a

nd i

ts c

ase

defin

ition

SND

isea

ses

or

synd

rom

esC

ode

Cas

e D

efini

tion

IA

cute

Blo

ody

Dia

rrhe

a 02

Any

per

son

with

acu

te d

iarr

hea

with

vis

ible

blo

od /

or

muc

us in

the

stoo

l

IIA

cute

Wat

ery

Dia

rrhe

a 03

Any

per

son

with

acu

te w

ater

y di

arrh

ea (p

assa

ge o

f 3 o

r m

ore

loos

e or

wat

ery

stoo

ls in

the

past

24

hour

s) w

ith

or w

ithou

t deh

ydra

tion

IIIA

cute

Ja

undi

ce

Syn

drom

e 07

Any

per

son

with

acu

te o

nset

of j

aund

ice

AN

D a

bsen

ce

of a

ny k

now

n pr

edis

posi

ng fa

ctor

s

OR

Acu

te il

lnes

s ty

pica

lly in

clud

e ac

ute

jaun

dice

dar

k ur

ine,

abr

upt o

nset

of f

ever

, mal

asie

, ano

rexi

a, n

ause

a,

and

vom

iting

IVA

cute

R

espi

rato

ry

Infe

ctio

n 08

Any

per

son

with

his

tory

of f

ever

or

mea

sure

d fe

ver

of

≥ 38

°C A

ND

cou

gh o

r sor

e th

roat

AN

D o

nset

with

in th

e la

st 7

day

s


Page 30 of 144

VD

engu

e fe

ver

10

Any

per

son

with

acu

te fe

brile

illne

ss o

f 2-7

day

s du

ratio

n w

ith t

wo

or m

ore

of t

he f

ollo

win

g: H

eada

che,

Ret

ro-

orbi

tal

pain

Mya

lgia

/ A

rthra

lgia

/ R

ash/

Hae

mor

rhag

ic

man

ifest

atio

ns/T

ourn

ique

t tes

t pos

itive

.(H

isto

ry o

f tra

vel/l

ivin

g to

the

ende

mic

are

a)

VI

Mum

ps

11

Any

per

son

with

acu

te o

nset

of

unila

tera

l or

bila

tera

l te

nder

, sel

f-lim

ited

swel

ling

of th

e pa

rotid

pre

-aur

icul

ar,

sub-

man

dibu

lar

or o

ther

sal

ivar

y gl

and,

last

ing

2 da

ys

or m

ore,

and

with

out o

ther

app

aren

t cau

se.

VII

Feve

r w

ith

Ras

h 13

Any

per

son

pres

entin

g w

ith fe

ver

and

mac

ula-

papu

lar

rash

(non

-ves

icul

ar)

VIII

Fo

od

-bo

rne

Illne

ss14

Any

per

son

expe

rienc

e ga

stro

inte

stin

al ill

ness

(vom

iting

or

abd

omin

al c

ram

ps o

r di

arrh

ea)

afte

r in

gest

ion

of

food

s or

drin

ks s

uspe

cted

to

be c

onta

min

ated

with

ba

cter

ia, c

hem

ical

sub

stan

ces

and

or to

xins

.

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IXT

yp

ho

id/

Par

atyp

hoid

/E

nter

ic fe

ver

21A

n ill

ness

with

pro

long

ed fe

ver (

>3 d

ays)

, con

stitu

tiona

l sy

mpt

oms

(e.g

. m

alai

se,

head

ache

, an

orex

ia)

AN

D

hepa

to-s

plen

omeg

aly

XS

ever

e A

cute

R

esp

ira

tory

In

fect

ion

23A

ny p

erso

n w

ith a

cute

resp

irato

ry in

fect

ion

with

: His

tory

of

feve

r or F

ever

≥ 3

8 ºC

AN

D C

ough

AN

D o

nset

with

in

the

last

10

days

AN

D re

quire

s ho

spita

lizat

ion.

XI

Ric

ketts

iose

s24

Any

pat

ient

with

an

acut

e un

diffe

rent

iate

d fe

brile

illn

ess

of ≥

5 d

ays

with

at-l

east

one

or

mor

e of

the

follo

win

g si

gns

and

sym

ptom

s: e

scha

r, he

adac

he, r

ash,

cou

gh,

gene

ral m

alai

se, m

yalg

ia, l

ymph

aden

opat

hy.


Page 32 of 144

Tabl

e 3:

Lis

t of i

mm

edia

tely

not

ifiab

le d

isea

ses

or s

yndr

omes

and

cas

e de

finiti

ons

Sl.

no.

Dis

ease

s/S

yndr

ome

SM

S

Cod

eC

ase

Defi

nitio

n

1A

nthr

ax10

0

Any

per

son

with

acu

te o

nset

of a

ny o

f the

follo

win

g cl

inic

al fo

rms:

and

has

an

epid

emio

logi

cal l

ink

to c

onfir

med

or s

uspe

cted

ani

mal

cas

es o

r co

ntam

inat

ed a

nim

al p

rodu

cts.

Cut

aneo

us: s

kin

lesi

on e

volv

ing

over

1 to

6 d

ays

from

a p

apul

ar th

roug

h a

vesi

cula

r sta

ge, t

o a

depr

esse

d bl

ack

esch

ar in

varia

bly

acco

mpa

nied

by

oede

ma

that

may

be

mild

to e

xten

sive

.G

astr

oint

estin

al: a

bdom

inal

dis

tress

cha

ract

eriz

ed

by n

ause

a, v

omiti

ng, a

nore

xia

and

follo

wed

by

feve

r. Pu

lmon

ary

(inha

latio

n): b

rief p

rodr

ome

rese

mbl

ing

acut

e vi

ral r

espi

rato

ry il

lnes

s, fo

llow

ed b

y ra

pid

onse

t of

hyp

oxia

, dys

pnoe

a an

d hi

gh te

mpe

ratu

re, w

ith

X-r

ay e

vide

nce

of m

edia

stin

al w

iden

ing

of 144


2A

cute

Fla

ccid

P

aral

ysis

101

Any

chi

ld u

nder

fifte

en y

ears

of a

ge w

ith a

cute

flac

cid

para

lysi

s (A

FP)

whi

ch is

defi

ned

by s

udde

n on

set

of p

aral

ysis

occ

urrin

g in

all

parts

of t

he b

ody

and

is

char

acte

rized

by

: Dro

opin

g of

the

affe

cted

join

t (s)

, D

ecre

ase

or a

bsen

ce o

f res

ista

nce

of th

e af

fect

ed

mus

cles

whe

n pu

shin

g (R

efer

VD

CP

surv

eilla

nce

guid

elin

e).

OR

Acu

te F

lacc

id P

aral

ysis

is th

e su

dden

ons

et o

f w

eakn

ess

and

flopp

ines

s in

any

par

t of t

he b

ody

in

a ch

ild <

15

year

s of

age

or p

aral

ysis

in a

per

son

of

any

age

in w

hom

pol

io is

sus

pect

ed”

3A

cute

H

aem

orrh

agic

Fe

ver

Syn

drom

e 1

02

Any

per

son

with

acu

te o

nset

of f

ever

with

any

two

of th

e fo

llow

ing:

hae

mor

rhag

ic o

r pur

puric

rash

, ep

ista

xis

haem

atem

esis

, hae

mop

tysi

s, b

lood

in

sto

ols,

oth

er h

aem

orrh

agic

sym

ptom

and

no

know

n pr

edis

posi

ng h

ost f

acto

rs fo

r hae

mor

rhag

ic

man

ifest

atio

ns.


Page 34 of 144

4Av

ain

Influ

enza

103

A pe

rson

hos

pita

lized

with

with

acu

te o

nset

of f

ever

of

>38

°C a

nd c

ough

or s

ore

thro

at in

the

abse

nce

of o

ther

dia

gnos

es (A

RI)

and

had

expo

sure

to s

ick/

dead

bird

s O

R li

ving

in a

vill

age

with

co

nfirm

ed a

vian

influ

enza

in b

irds.

5B

acte

rial

Men

ingi

tis10

4

A pe

rson

pre

sent

ing

with

acu

te o

nset

of f

ever

(> 3

8.0

°C) A

ND

hea

dach

e A

ND

at l

east

one

of t

he fo

llow

ing

sign

s: n

eck

stiff

ness

, pro

ject

ile v

omiti

ng, a

ltere

d co

nsci

ousn

ess

(leth

argy

, del

irium

, and

com

a).In

ch

ildre

n le

ss th

an y

ear,

susp

ect m

enin

gitis

whe

n fe

ver a

ccom

pani

ed b

y bu

lgin

g fo

ntan

elle

.

6C

hole

ra10

5In

an

area

whe

re th

e di

seas

e is

not

end

emic

, sev

ere

dehy

drat

ion

or d

eath

from

acu

te w

ater

y di

arrh

oea

in

a pa

tient

age

d 5

year

s or

mor

e

of 144


7M

alar

ia10

6

Any

per

son

with

feve

r, ch

ills,

mya

lgia

s an

d ar

thra

lgia

s, h

eada

che

diar

rhea

, vom

iting

, and

non

-sp

ecifi

c si

gn a

nd th

e de

tect

ion

of P

lasm

odiu

m

spec

ies

by ra

pid

diag

nost

ic a

ntig

en te

stin

g o

r by

mic

rosc

opy

8M

easl

es/

Rub

ella

107

Any

per

son

pres

entin

g w

ith fe

ver w

ith m

acul

opap

ular

ra

sh (n

on-v

esic

ular

) or a

pat

ient

who

m a

hea

lth-c

are

wor

ker s

uspe

cts

has

mea

sles

or r

ubel

la ir

resp

ectiv

e of

the

age

9P

ertu

ssis

108

Any

per

son

with

a c

ough

last

ing

for a

t lea

st 2

wee

ks

with

at l

east

one

of t

he fo

llow

ing:

Par

oxys

m (i

.e. fi

ts

of c

ough

ing)

, ins

pira

tory

“who

opin

g” p

ost-t

ussi

ve

vom

iting

(i.e

. vom

iting

imm

edia

tely

afte

r cou

ghin

g)

with

out o

ther

app

aren

t cau

se O

R A

pnea

(with

or

with

out c

yano

sis)

in in

fant

s (a

ge <

1-ye

ar o

ld) w

ith

coug

h of

any

dur

atio

n O

R If

a p

hysi

cian

sus

pect

s pe

rtuss

is in

a p

atie

nt w

ith c

ough

of a

ny d

urat

ion


Page 36 of 144

10C

onge

nita

l R

ubel

la

Syn

drom

e (C

RS

)10

9

An

infa

nt w

ith a

t lea

st tw

o of

the

com

plic

atio

ns

liste

d in

(a) b

elow

or o

ne in

(a) a

nd o

ne in

(b):

(a)

Cat

arac

t(s),

cong

enita

l gla

ucom

a, c

onge

nita

l hea

rt di

seas

e, lo

ss o

f hea

ring,

pig

men

tary

retin

opat

hy.

(b) P

urpu

ra, s

plen

omeg

aly,

mic

roce

phal

y, m

enta

l re

tard

atio

n, m

enin

goce

phal

itis,

radi

oluc

ent b

one

dise

ase,

jaun

dice

that

beg

ins

with

in 2

4 ho

urs

afte

r bi

rth.

11R

abie

s (h

uman

)11

0

Any

per

son

with

an

acut

e ne

urol

ogic

al s

yndr

ome

(enc

epha

litis

) dom

inat

ed b

y fo

rms

of h

yper

activ

ity

(furio

us ra

bies

) or p

aral

ytic

syn

drom

es (d

umb

rabi

es)

that

pro

gres

ses

tow

ards

com

a an

d de

ath,

usu

ally

by

resp

irato

ry fa

ilure

, and

has

an

epid

emio

logi

cal l

ink

to

confi

rmed

or s

uspe

cted

ani

mal

cas

es o

r exp

osur

e to

co

ntam

inat

ed a

nim

al p

rodu

cts.

of 144


12

Sev

ere

Den

gue

or

Den

gue

hem

orrh

agic

fe

ver (

DH

F)

111

A a

ny p

erso

n ch

arac

teriz

ed b

y on

e or

mor

e of

th

e fo

llow

ing;

pos

itive

tour

niqu

et te

st; p

etec

hiae

, ec

chym

oses

, or p

urpu

ra; b

leed

ing

(muc

ous,

GI,

or

othe

r): h

emat

emes

is o

r mel

ena;

thro

mbo

cyto

peni

a;

or e

vide

nce

of p

lasm

a le

akag

e. T

he p

lasm

a le

akag

e is

man

ifest

ed b

y on

e or

mor

e of

the

follo

win

g fe

atur

es: (

Equ

al o

r les

s th

an 2

0% ri

se in

ave

rage

he

mat

ocrit

for a

ge a

nd s

ex; e

qual

or m

ore

than

20%

dr

op in

hem

atoc

rit fo

llow

ing

volu

me

repl

acem

ent

treat

men

t is

the

sign

s of

pla

sma

leak

age.

)

13N

eona

tal

Teta

nus

112

Any

new

born

with

a n

orm

al a

bilit

y to

suc

k an

d cr

y du

ring

the

first

two

days

of l

ife, A

ND

who

can

not s

uck

norm

ally

and

bec

ome

stiff

AN

D/O

R h

as c

onvu

lsio

ns

AN

D/O

R d

ied

betw

een

3 an

d 28

day

s of

age

.

14D

ipht

heria

113

A pe

rson

with

an

illne

ss c

hara

cter

ized

by

lary

ngiti

s O

R p

hary

ngiti

s O

R to

nsill

itis,

AN

D a

n ad

here

nt

mem

bran

e of

the

tons

ils, p

hary

nx o

r nos

e O

R *i

llnes

s in

volv

ing

the

muc

ous

mem

bran

e of

upp

er re

spira

tory

tra

ct w

ith m

arke

d sw

ellin

g of

nec

k (b

ull n

eck)


Page 38 of 144

15A

cute

E

ncep

halit

is

Syn

drom

e11

4

Acu

te o

nset

of f

ever

AN

D a

cha

nge

in m

enta

l st

atus

(inc

ludi

ng s

ympt

oms

such

as

conf

usio

n,

diso

rient

atio

n, c

oma,

or i

nabi

lity

to ta

lk) O

R n

ew

onse

t of s

eizu

res

(exc

ludi

ng s

impl

e fe

brile

sei

zure

s in

chi

ldre

n). M

ay a

lso

incl

ude:

incr

ease

d irr

itabi

lity,

so

mno

lenc

e or

abn

orm

al b

ehav

ior g

reat

er th

an th

at

seen

with

usu

al fe

brile

illn

ess.

of 144


5. How the notifiable disease surveillance system (NDSS) works?

The national NDSS is divided into two reporting system; weekly and immediately. The weekly reporting system collects information on occurrence of notifiable diseases or syndromes (Table 2) by clinicians/nurses/other healthcare professional every day. Cases are then collated and reported every week by designated surveillance (SFP) focal persons of healthcare centers. The reporting is done either through web-based or mobile SMS to RCDC. When no case is detected, SFP does weekly zero reporting to ensure that a health center has not detected any notifiable disease or syndrome. The Dzongkhag Health Offices (DHOs) monitors’ weekly reporting status and data quality of health center under his/her jurisdiction.

The immediately notifiable disease reporting system collects information on those diseases or syndromes (Table 3) by individual clinicians/nurses/other healthcare professional as and when cases are detected. The reporting is done either through web-based or mobile SMS and submit Case investigation form to NADSAE, RCDC. The surveillance officer of NADSAE unit verifies and provided recommendations for response.

The NADSAE analyzes data obtained from all healthcare centers and provides feedback in report or bulletin to all the reporting centers on monthly, quarterly and yearly basis in hard copy and uploads in RCDC website. The feedback is also


Page 40 of 144

disseminated to the Ministry of Health and relevant stakeholders.

Figure 1: Flowchart of notifiable disease surveillance

6. How to collect, collate and report weekly notifiable diseases and syndrome data?

6.1 Data Collection: The weekly reporting requires collecting information of ‘cases’ and ‘deaths’ of notifiable diseases and syndromes.

● Identify cases based on case definition and collect information of cases or deaths on daily basis from Out-patient/In-patient/Emergency/MCH/ Outreach clinics in weekly reporting form or suitable form developed by respective health centers or from registry.

● If OP/IP/Emergency/outreach clinic registry is used for data collection, make sure that an appropriate coding or identification mark

of 144


is used in the registry for easy data collation by surveillance focal point.

● If data collection form is used, file it in the file assigned or handover to surveillance focal point.

6.2 Data Collation: All ‘cases’ and ‘deaths’ of notifiable diseases and syndromes identified for the week should be collated.

● From “Weekly Reporting Form” (Annex 1) or other suitable form developed, collate data about cases or deaths identified during the epidemiological week calendar (that is the reporting period for every Epi Week should be from Monday to Sunday).

● All cases and deaths should be collated as per the age group and gender specified for each notifiable diseases or syndromes.

● For In-patient cases or deaths, review both the ‘admission diagnosis’ and ‘symptoms’ in the register to see if the cases or death meets the case definition.

● Mark (e.g. tick) those cases in the register that are included in the “Weekly Reporting Form” so that it can be validated if needed during evaluation and monitoring process.

● Mark (e.g. draw a line under) the last case in the register included in the weekly report. This will help the data collation for the subsequent week.

● Double check and validate data before reporting.


Page 42 of 144

6.3 Data reporting: All ‘cases’ and ‘deaths’ of notifiable diseases and syndromes identified and collated for the week should be reported.

● Either through web-based in RCDC website or mobile SMS every Monday and Tuesday for the previous epidemiological week. Healthcare centers reporting on Monday or Tuesday will be recorded as timely reporting.

● If no case or death of notifiable diseases or syndromes are detected for the week, zero-reporting should be done. Zero-reporting is an evidence of no case or death for the week.

6.4 Data Verification: Verification is important to improve and maintain data quality.

● Upon the submission of data from all healthcare centers, the designated surveillance officer at NADSAE, RCDC will verify all the data received in the system.

● If any discrepancy is observed in the reported data, the surveillance officer will call or email to the SFP of that particular healthcare center to verify once again by going through the data stored in hard copy and ask them to verify once again and make necessary changes if required.

7. How to report immediately notifiable diseases or syndrome?The list of immediately notifiable diseases or syndromes are public health important and even a single case requires reporting for follow up action.

of 144


7.1 Reporting: ● All healthcare professionals should report

any case or death of the immediately reportable disease or syndromes either through web-based or mobile SMS as soon as possible or within 12 hours of detection.

● Upon verification, the concerned health professional should fill up case investigation form (CIF) developed for specific disease or syndrome and submit the scan copy of CIF in the NEWARS system.

● Suitable sample should also be collected from case and send to RCDC for analysis.

● When no case is detected, SFP should submit weekly zero reporting to ensure that a health center has not detected any immediately notifiable disease or syndrome for that week.

7.2 Verification: ● Upon the submission of report by the

concerned healthcare professional, the designated surveillance officer at NADSAE, RCDC will verify the report.

● If any discrepancy is suspected, the surveillance officer will call and verify.

● The surveillance officer will verify CIF submitted and contact reported person if any there is any discrepancy or incomplete information.

7.3 Response: The concerned healthcare professional in

consultation with district health authority or hospitals management should initiate


Page 44 of 144

Figure 2: Flow chart for immediately reporting and response

the investigation of immediately reported diseases within six working hours after receiving the recommendations from

of 144


EVENT-BASED SURVEILLANCE


Page 46 of 144

EVENT-BASED SURVEILLANCE

1. What is an Event-based Surveillance?An event-based surveillance (EBS) is rapid gathering of information about any health event that poses potential risk to public health. EBS involves gathering of health information from various sources, conducting verification and performing risk assessment and providing appropriate recommendation /responses based on the outcome of verification and risk assessment. This information can be rumors, or any adhoc reports that are transmitted through formal channel by health professionals and community health workers and informal channels such as mainstream and social media, community leaders (Local Government), and non-governmental organizations related to;• Occurrence of disease or syndrome occurrence

in cluster in human,• Unusual pattern of disease or syndrome, • Unusual cluster of deaths,• Diseases and deaths in animals,• Contaminated food and food products, and

environmental hazards including chemical and radio-nuclear.

Unlike IBS, EBS is not based on the routine collection of data and automated thresholds for action but rather on unstructured descriptions and reports. However, EBS can complements IBS as IBS often fail to timely detect events of public health concern such as outbreak.

of 144


2. What are the events of public health concernAn event is considered public health concerns if:• Underlying agent, disease or mode of

transmission is new, newly discovered or unknown at the time of notification;

• Potential transmission through vectors, cargo or goods (including food products) and environmental dispersion;

• Unusual occurrence pattern for specific disease or syndrome, single or in cluster.

• Event related to exposure to biological (of infectious or non-infectious in nature), chemical agents or radio nuclear materials.

3. Sources of events Information Event-based surveillance (EBS) requires a multi-sectorial approach and relies on sources of information beyond conventional health system sources (e.g. indicator-based surveillance). Events are most likely to be detected in the community, institutes (schools, monasteries), army barrack, public functions (religious rites, festivals) and healthcare centers. Media is one of the important reporting sources and any event reported in TV, radio and print including news internet should be considered as an event reported.


Page 48 of 144

Tabl

e 4:

Sou

rce

of e

vent

repo

rt

Med

ical

Set

ting

Hea

lthca

re

faci

litie

s H

ospi

tals

, BH

Us

and

Sub

-pos

tH

ealth

Hel

p C

ente

r A

irpor

t Hea

lth S

ervi

ce U

nit,

and

grou

nd b

orde

r cro

ssin

g po

ints

Non

-hea

lth

orga

niza

tions

Vete

rinar

y se

rvic

es

Bhu

tan

Agr

icul

ture

and

Foo

d R

egul

ator

y A

utho

rity

Wild

life

Env

ironm

enta

l Hea

lth (N

EC

) P

harm

acy

Sal

e co

unte

rC

omm

unity

set

tings

Com

mun

ity

Villa

ge h

ealth

wor

kers

Vi

llage

ani

mal

hea

lth w

orke

rs

Mul

ti-S

take

hold

er T

ask

Forc

e (M

STF

) of

dis

trict

sC

omm

unity

lead

ers

Gen

eral

pub

lic

of 144


Med

iaM

edia

(pr

int,

radi

o, T

V, in

tern

et)

Inst

itute

s an

d

orga

niza

tion

Non

Gov

ernm

enta

l Org

aniz

atio

ns

Mili

tary

(Arm

y &

Pol

ice)

In

tern

atio

nal o

rgan

izat

ions

R

elig

ious

org

aniz

atio

ns, I

nstit

utes

, U

nive

rsiti

es,

and

Mun

icip

ality

4. E

vent

info

rmat

ion

colle

ctio

n A

ny e

vent

s to

be

repo

rted,

the

follo

win

g fir

st h

and

info

rmat

ion

shou

ld b

e co

llect

ed

1.

Wha

t do

you

wan

t to

repo

rt (N

ame

of s

uspe

ct e

vent

/out

brea

k)2.

W

hen

did

this

hap

pene

d (D

ate/

Tim

e of

eve

nt/o

utbr

eak)

?3.

W

here

this

did

hap

pene

d (lo

catio

n of

eve

nt/o

utbr

eak)

?4.

H

ow m

any

peop

le a

ffect

ed w

hen

you

dete

cted

(num

ber o

f cas

es)?

5.

List

com

mon

sig

ns a

nd s

ympt

oms?

6.

Add

ition

al in

form

atio

n us

eful

for v

erifi

catio

n an

d in

vest

igat

ion.


Page 50 of 144

5. Event Reporting

Any disease(s), death(s) or events that are considered as unusual by health professionals should be immediately reported as an event to NEWARS system not limited to the list defined in Table 5.

Event collected using (Annexure 10) should be reported immediately or within 24 working hours of detection at the health facility by the concerned health professional. Events can be reported by village health workers, schools and institutes, community group leaders, people working in NGO’s/CSO’s and general public including media persons through RCDC website. However, this may need sensitization of those stakeholders through various forums.

Those events which are considered Public Health Emergency of International Concerns (PHEIC) should be reported to WHO through IHR National Focal Point (NFP) in according to the decision chart (Annexure 4).

The events which have serious public health implication should be also reported to National Disaster Management Authority by Emergency Medical Service Division, Department of Medical Services as per Disaster Management Act of Bhutan 2013.

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Tabl

e 5:

Rep

orta

ble

Eve

nts

SNEv

ents

Defi

nitio

n1

Out

brea

ks o

f any

di

seas

eA

grou

p pe

ople

are

sic

k w

ith s

imila

r sym

ptom

s in

one

pla

ce

(e.g

. vill

age,

sch

ool,

heal

th fa

cilit

y, e

tc.)

at th

e sa

me

time.

2C

lust

er o

f unu

sual

de

ath(

s)

Two

or m

ore

peop

le d

ie o

f unk

now

n ca

use

afte

r suf

ferin

g fro

m s

imila

r sym

ptom

s in

one

pla

ce (e

.g. v

illag

e, s

choo

l, or

he

alth

faci

lity)

at t

he s

ame

time.

3Fo

od b

orne

illn

ess

A gr

oup

of p

eopl

e be

com

e si

ck o

r hav

e an

othe

r unu

sual

re

actio

n af

ter c

onsu

min

g th

e sa

me

food

or d

rinks

from

the

sam

e w

ater

sou

rce.

4E

xpos

ure

to

chem

ical

sA

grou

p of

peo

ple

beco

me

sick

or h

ave

anot

her u

nusu

al

reac

tion

afte

r bei

ng e

xpos

ed to

any

che

mic

al a

gent

.5

Em

ergi

ng

infe

ctio

us d

isea

seA

ny p

erso

n w

ith s

ympt

oms

you

have

not

see

n be

fore

or n

ot

seen

for a

long

tim

e in

a p

lace

.6

Zoon

otic

dis

ease

Peo

ple

and

anim

al b

ecom

e si

ck o

r die

at t

he s

ame

time

in a

lo

calit

y.


Page 52 of 144

6. Event Verification

Verification of events reported is important to validate information. Information validation absolutely necessary when the event is reported by other allied stakeholders or public.

NADSAE will verify the event by following-up with the reporting health center or other sources. Verification and validation of the reported event should be done immediately or within 6 hours after notification.

7. Event Risk Assessment

Risk assessment is important to understand the scale and magnitude of the event. All events reported following verification will be subjected to risk assessment by NADSAE to determine potential risk to public health and make necessary recommendation. The risk assessment will be done using following assessment questionnaires in the Table 6.

of 144


Tabl

e 6:

Crit

eria

for a

sses

smen

t of p

ublic

hea

lth ri

sk o

n fir

st re

porti

ng o

f an

even

t

SNQ

uest

ions

Yes

No

1Is

the

even

t rep

orte

d fro

m c

ongr

egat

ed o

r ins

titut

iona

l set

ting

(eg,

sc

hool

, dra

tsha

ng)?

2C

an th

e re

porte

d ev

ent c

ause

out

brea

ks w

ith h

igh

pote

ntia

l for

sp

read

?3

Is th

ere

a hi

gher

than

exp

ecte

d m

orbi

dity

from

the

dise

ase?

4Is

ther

e an

y m

orta

lity

repo

rted

from

this

eve

nt?

5Is

ther

e a

clus

ter o

f cas

es w

ith s

imila

r sym

ptom

s?

6C

ould

the

dise

ase

be c

ause

d by

a c

onta

min

ated

food

or w

ater

?

7D

oes

the

dise

ase

have

pos

sibl

e co

nseq

uenc

es f

rom

tra

de o

r tra

vel?

8A

re th

ere

any

asso

ciat

ed o

r pre

cedi

ng e

vent

s (i.

e. a

ttend

ing

pic-

nic,

spo

rts, f

estiv

al, f

uner

al, g

athe

ring,

etc

)?


Page 54 of 144

8. Event Response

Response to an event is an essential part of event-based surveillance. Once an event is verified as a potential risk to public health; the response should be initiated immediately by the concerned health center or by the DHRRT based on the level of risk assessed by NADSAE. The response must be initiated in the field within six working hours of risk assessment and recommendation. The investigating team (DHRRT) will submit the preliminary investigation report to NADSAE within 48 hours (Annexure 11) and update daily outbreak situation (Annexure 12). The detail response should be referred “Outbreak investigation and Response manual”. The information flow and the coordination mechanism during the public health events /outbreak should be carried out as per the existing SoP.

9. Reporting of Public Health Events of International Concern

The International Health Regulations (2005) requires notification of event that is public health event of international concerned. Any events of PHIC should be reported to National IHR Focal Point under EMSD by NADSAE for onward reporting to WHO.

of 144


Figure 3: Flowchart for event reporting and response


Page 56 of 144

of 144


Data Analysis, Feedback, Monitoring & Evaluation


Page 58 of 144

Data AnalysisTo understand specific patterns of notifiable diseas-es or syndromes occurrence and take necessary interventions, the data analysis and interpretation is important and should be done regularly at all lev-els. The health center should analyze their data, the District Health Office should analyze data obtained from all the health centers under its jurisdiction and the NADSE at national level.

1. Indicator-based Surveillance data analysisSurveillance data can be used to describe health problems in terms of time (week, month, year), place (village, gewog, district,) and person (age, sex). The data can also be used for assessment of following epidemiological parameters:

1. Long-term trend analysis: review your data for the following characteristics: Normal Dis-tribution, Abrupt changes, Cycles, Outliers

2. Seasonal patterns: to understand 3. Analyzing data by place: Analyzing data

according to place gives information about where a disease is occurring. Establishing and regularly updating a spot map of cas-es for selected disease can give ideas as to where, how and the disease is spreading.

A single case of immediately notifiable disease should be described using following parameters:

● Demographic and clinical characteristics of the case

● Place of occurrence● Identify risk factors● Behavioral patterns of the case● contact Tracing

of 144


Cluster of suspected cases should be investigated and analyzed for:

● Time and place of occurrence (epidemic curve)

● Demographic and clinical characteristics of the cases

● Identification of risk factors● Identification of the source and mode of

transmission of the disease● Geographical distribution of the cases● Identify the magnitude and association of

risk factors with the disease ● Visual demonstration of data with appropri-

ate graphs

2. FeedbackRegular feedback to all health centers and stake-holders is crucial to keep them motivated and im-prove the surveillance. The feedback is also es-sential to reinforce health staff’s effort to actively participate in the surveillance.

● Informal feedback by phone and email should also be used regularly and especially during outbreaks and Public Health Events at all level.

● At district level, DHO should provide ap-propriate feedback and share with respec-tive BHUs and hospitals. This will reinforce health professional efforts to raise aware-ness and improve their participation in the surveillance.

● At national level, NADSE, RCDC should pro-vide feedback through monthly and quarter-ly newsletter and bulletins and disseminate to all health centers and stakeholders. The


Page 60 of 144

monthly feedback can be summary of cases report and descriptive analysis for quarterly bulletin describing disease trend and situa-tion.

● In addition feedback through supervisory visit should be shared health centers and monitor implementation of follow-up actions.

Monitoring & EvaluationMonitoring and evaluation is an important compo-nent of any surveillance. In order to scale up re-sponse, all the stakeholders need to constantly re-view their performance in detecting, reporting and responding to diseases and events. The key activi-ties of healthcare professionals for the surveillance system at each administrative level are described under roles and responsibilities section.

Surveillance performance should be monitored & evaluated at each administrative level with aim to improve and sustain existing surveillance system. The DHO and NADSAE should monitor surveil-lance system at least once in a month with set of indicators as described below.

1. Indicators for Monitoring

1.1. Timeliness reporting.

The timeliness reporting should be monitored based on reporting schedule set for health centers of each administrative level. For an indicator-based surveillance, if BHUs and hospitals send report to NADSAE by Monday or Tuesday of subsequent week, it will be considered as timely reporting for

of 144


previous week. However, if health centers send report on Tuesday to Friday, it is considered as late report and later than that, it will be considered as not reported but record will be kept for future reference. For immediately notifiable disease and events, reporting within 24 hours of detection is considered timely report.

Timeliness is defined as the total number of reports received on time within the time period compared with the total number of reports expected within the time period (irrespective of the time of receipt in NEWARS surveillance system).

a. Timeliness for Weekly reporting: Calculated total number of reports received on time within the given week divided by total number of reports expected in the same week multiple by 100.

b. Timeliness for Immediately reporting: Calculated by total number of immediately notifiable diseases reported within 24 hours divided by total number of same notifiable diseases detected in the same week multiple by 100.

c. Timeliness Response for immediately reported disease Calculated by total number of immediately notifiable diseases responded within 6 hours after receiving recommendation divided by total number of same notifiable diseases detected in the


Page 62 of 144

same week multiple by 100.

d. Timeliness Response for events response Calculated by total number of events responded within 6 hours of event verification divided by total number of events detected in the same week multiple by 100. .

2. Completeness reporting

Completeness of reporting refers to total number of reports received in the system compared with number of reports expected in the same time period. Calculated by total number of reports received in a given month divided by total number of reports expected in the same month multiple by 100.

3. Evaluation of NEWARS

Evaluation of NEWARS will be conducted to assess its attributes such as sensitivity, specificity, positive predictive value, completeness, timeliness, usefulness, etc as per WHO and US CDC’s guideline of evaluating surveillance system. The period of evaluation will be need-based and the availability of funding source.

4. Supervisory Visit

Supervisory visit should aim to help the health staff to improve their knowledge and performance and not be a fault-finding exercise. Supervisors and health staff work should together review progress, identify problems, and develop feasible solution.

of 144


Supervisory visits should be conducted at least once a year to help the Surveillance Focal Point to improve their performance. During the visit, (positive feedback and improvements needed) should be provided to health professional. Gaps identified should be tackled on the spot if possible, or solved at a later stage. On-the-job training should also be provided to improve the quality of activities. Supervisory visit debriefing should be done to hospital management and district health authority. A report should be prepared after the visit and share to hospital management and concern Departments which should be used for future visits to follow up recommended actions.

Laboratory TestingLaboratory testing of specimens collected from sus-pected cases should be undertaken to identify the pathogens. This is an important part of the surveil-lance system to establish and understand disease etiology for clinical management. Some diseases or syndromes such as acute flaccid paralysis, fever and rash (suspected measles and rubella) require every case to be confirmed by laboratory testing. Refer Table 7 for detailed information on specimen collection, storage, transport and laboratory testing.


Page 64 of 144

of 144


Laboratory Sample Collection, Storage & Testing


Page 66 of 144

Tabl

e 7:

Det

ails

of l

abor

ator

y sa

mpl

es c

olle

ctio

n, s

tora

ge a

nd In

vest

igat

ion

SND

isea

se/

syn -

drom

es

Susp

ecte

d et

iolo

gyR

ecom

men

ded

sam

ples

Stor

age

cond

ition

Ship

men

t Te

mp.

Test

s

1 A

nthr

axBa

cillu

s an

thra

sis

1. S

kin

scra

ping

s an

d flu

ids

from

ve

sicl

es

Skin

scr

apin

gs a

nd fl

u-id

s fro

m le

sion

s; 2

-8

°C.

2-8

°CM

icro

scop

y

Bloo

d cu

l-tu

re

E

IA

PCR

2. B

lood

sam

ple

Bloo

d cu

lture

sho

uld

be in

ocu -

late

d im

med

iate

ly a

nd in

cuba

ted

at 3

7 °C

3. S

tool

/Rec

tal

swab

sSe

rum

sho

uld

be s

eper

ated

and

st

ored

at 2

-8 °C

up

to 1

wee

k or

-2

0 °C

if >

1 w

eek.

Rec

tal s

wab

s/St

ool;

Use

Mod

ified

C

ary

Blai

r Tra

nspo

rt (M

CB)

me -

dia.

Sto

re a

t 2-8

°C u

p to

1 w

eek

or -2

0 °C

if >

1 w

eek.

2Ac

ute

Bloo

dy

Dia

rrhea

an

d Ac

ute

Wat

ery

Dia

rrhea

Nor

oviru

s, A

stro

viru

s, R

otav

irus,

Ade

novi

rus,

H

epat

itis

viru

s, S

apov

irus,

Ent

amoe

ba, S

trong

y -lo

ide,

Mic

rosp

orid

ium

Shig

ella

spp,

Sal

mon

ella

spp

, Cam

pylo

bact

er s

pp,

Yers

inia

spp

, Vib

rio s

pp, C

ampy

loba

cter

spp

, D

iarrh

eage

nic

E.co

li, C

lost

ridiu

m s

pp

1. S

tool

/Rec

tal

swab

sR

ecta

l sw

abs/

Stoo

l; U

se M

odifi

ed

Car

y Bl

air T

rans

port

(MC

B) m

e -di

a. S

tore

at -

20 °C

if >

1 w

eek.

2-8

°C1.

Cul

ture

2.

Mi-

cros

copy

3.

EIA

4. P

CR

2. S

erum

Seru

m s

houl

d be

sep

erat

ed a

nd

stor

ed a

t 2-8

°C u

p to

1 w

eek

or

-20

°C if

>1

wee

k.

2. B

lood

sam

ple

Seru

m s

houl

d be

sep

erat

ed a

nd

stor

ed a

t 2-8

°C u

p to

1 w

eek

or

-20

°C if

>1

wee

k.

of 144


4Ac

ute

Ence

pha -

litis

Syn

-dr

ome

Stre

ptoc

occu

s pn

eum

onia

, Nei

sser

ia m

enin

giti-

des,

Hae

mop

hilu

s in

fluen

za, L

iste

ria m

onoc

yto-

gene

s, G

roup

B S

trept

ococ

ci, B

ruce

lla s

peci

es,

Salm

onel

la s

peci

es, M

.tube

rcul

osis

, Myc

opla

sma

pneu

mon

ia, T

repo

nem

a pa

llidum

, Lep

tosp

ira,

Orie

ntia

tsut

suga

mus

hi, R

icke

ttsia

typh

i, Pl

as-

mod

ium

spp

, Tox

opla

sma

gond

ii, N

aegl

eria

and

Ac

anth

amoe

ba, C

ystic

ercu

scel

lulo

sae,

Jap

anes

e En

ceph

aliti

s, D

engu

e,, C

hiku

ngun

ya, E

nter

ovi -

ruse

s, M

easl

es, M

umps

, Rub

ella

, Nip

ah v

irus,

H

erpe

s si

mpl

ex (H

SV),

Varic

ella

zos

ter (

VZV)

, H

uman

Her

pes

Viru

s-6

(HH

V-6)

, Eps

tein

Bar

r, Ad

enov

irus,

Cyt

omeg

alov

irus,

Cry

ptoc

occu

s ne

ofor

man

s, C

andi

da s

peci

es

1. C

SF (W

here

po

ssib

le)

2.

Blo

od s

ampl

e

Seru

m s

houl

d be

sep

erat

ed.

Stor

e se

rum

and

CSF

at a

t 2-8

°C

up

to 1

wee

k or

-20

°C if

>1

wee

k.

2-8

°C1.

Ser

olog

y

2.

EIA

(CSF

) 3.

Bac

teria

l An

tigen

test

5Ac

ute

Flac

cid

Para

lysi

s

Polio

viru

sSt

ool/

Rec

tal

swab

: 2 s

pec -

imen

s to

be

colle

cted

24

hour

s ap

art

Stoo

l sho

uld

be c

olle

cted

with

in

14 h

ours

follo

win

g on

set o

f par

al-

ysis

. Sto

red

at 2

-8 °C

or

at -

20

°C fo

r pro

long

ed s

tora

ge

2-8

°C1.

PC

R

6Ac

ute

Hae

m-

orrh

agic

Fe

ver

Syn -

drom

e

Crim

ean

Con

go H

emor

rhag

uc fe

ver,

Den

gue

vi-

rus,

Ebo

la-M

arbu

rg v

irus,

Den

gue,

Chi

kung

unya

, Ar

enav

irus,

Han

tavi

rus,

Kya

sanu

r for

est d

isea

se

viru

s, L

assa

Fev

er v

irus,

Lep

tosp

ira, R

icke

ttsia

ty

phi,,

Orie

ntia

tsut

suga

mus

hPla

smod

ium

Bloo

d sa

mpl

eSe

rum

sho

uld

be s

eper

ated

and

st

ored

at 2

-8 °C

up

to 1

wee

k or

-2

0 °C

if >

1 w

eek.

2-8

°C1.

Ser

olog

y

2.Pa

thog

en

dete

ctio

n (P

CR

)

7Ac

ute

Jaun

dice

Sy

n -dr

ome

Hep

atiti

s A,

B, C

, D &

E,

Lept

ospi

ra, S

alm

onel

la

spp,

Bru

cella

spp

, M. t

uber

culo

sis,

E.c

oli ,

HSV

, EM

B, C

MB,

Ent

ero

viru

s, A

deno

viru

s

Bloo

d sa

mpl

eSe

rum

sho

uld

be s

eper

ated

and

st

ored

at 2

-8 °C

up

to 1

wee

k or

-2

0 °C

if >

1 w

eek.

2-8

°C1.

Ser

olog

y

2. P

CR

3. B

acte

rial

cultu

re

8Ac

ute

Re -

spira

tory

In

fect

ion

Aden

o vi

ruse

s, R

hino

viru

s Pn

eum

ococ

cus

stre

ptoc

occu

s pn

eum

onia

e

R

espi

ra-

tory

syn

cytia

l viru

s Pa

ra in

fluen

zae

viru

s in

fluen

za

viru

s Av

ian

influ

enza

viru

s H

aem

ophi

lus

influ

enza

B

Legi

onel

la p

neum

ophi

la

Thro

at/N

asal

sw

abN

asal

/Thr

oat s

wab

s a

t 2-

8 °C

up

to 1

wee

k or

-20

°C if

>1

wee

k.2-

8 °C

PC

R


Page 68 of 144

9Ba

cter

ial

men

in-

gitis

Nei

sser

ia, S

trept

ococ

cus

grou

p B,

Hae

mop

hi-

lusi

nflue

nzae

, Lis

teria

mon

ocyt

ogen

es1.

CSF

2.

Blo

od

3.

Sto

ol

Bloo

d/C

SF c

ultu

re s

houl

d be

per

form

ed im

med

iate

-ly.

Se

rum

, and

SC

F sh

ould

be

sto

red

at 2

-8 °C

up

to 1

w

eek

or -2

0 °C

if >

1 w

eek.

R

ecta

l sw

abs/

Stoo

l; U

se M

odifi

ed

Car

y Bl

air T

rans

port

(MC

B) m

e -di

a. S

tore

at 2

-8 °C

up

to 1

wee

k or

-20

°C if

>1

wee

k.

2-8

°C1.

Bloo

d/C

SF

cultu

re

2.Se

rolo

gy

3.

Mol

ecul

ar

10D

engu

e fe

ver

Den

gue

viru

s ty

pe 1

,2,3

and

4Bl

ood

(Ser

um)

Seru

m s

houl

d be

sep

erat

ed a

nd

stor

ed a

t 2-8

°C u

p to

1 w

eek

or

-20

°C if

>1

wee

k.

2-8

°C1.

PCR

2.

Ser

olog

y

11D

ipht

he-

riaC

orne

ybac

teriu

m d

ipth

eria

e1.

Blo

od (s

erum

) 2.

Thr

oats

wab

3.

piec

es o

f pse

udo -

mem

bran

e

Seru

m s

houl

d be

sep

erat

ed

and

stor

ed a

t 2-8

°C u

p to

1

wee

k or

-20

°C if

>1

wee

k.

Thro

at s

wab

can

be

colle

cted

an

d pl

aced

in s

ilica

gel a

nd s

tore

at

2-8

°C

2-8

°C1.

Cul

ture

, 2.

Sero

logy

, 3.

Mol

ecul

ar

12Fe

ver

with

R

ash

Mea

sles

viru

s, R

ubel

la v

irus,

Var

icel

la z

oste

r vi

rus,

Typ

hus,

Ric

ketts

ial s

potte

d fe

ver

1. B

lood

(Ser

um)

2. T

hroa

tsw

abSe

rum

sho

uld

be s

eper

ated

and

st

ored

at 2

-8 °C

up

to 1

wee

k or

-2

0 °C

if >

1 w

eek.

Prep

are

Drie

d bl

ood

spot

for M

easl

es, R

ubel

la,

Ric

ketts

ia. d

ry a

nd s

tor a

t 2-8

°C

2-8

°C1.

Ser

olog

y 2.

Mol

ecul

ar

of 144


13Fo

od

born

e illn

ess

Salm

onel

laSh

igel

laC

ampy

loba

cter

jeju

niYe

rsin

ia e

nter

ocol

itica

E. c

oli

Enta

moe

ba h

isto

lytic

a B

cere

us C

lost

ridiu

m s

pp

1. V

omitu

s

2. G

astri

c co

nten

t 3.

Sto

ol

4. B

lood

5. F

ood

sam

ple

If im

med

iate

cul

ture

is n

ot

poss

ible

sto

re s

ampl

es a

t 2-8

°C

. Ser

um, v

omitu

s, g

astri

c co

nten

t and

food

sam

ples

sh

ould

be

stor

ed 2

-8 °C

up

to

1 w

eek

or a

t -20

°C if

>1

wee

k.

Fo

r sto

ol s

ampl

e us

e M

odifi

ed

Car

y Bl

air T

rans

port

(MC

B)

med

ia.

Stor

e at

2-8

°C u

p to

1 w

eek

or a

t -20

°C if

>1

wee

k.

2-8

°C1.

Bac

teria

l cu

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Page 70 of 144

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NEWARS Information System


Page 72 of 144

NEWARS Information System

NEWARS is meant to be the real-time surveillance and design to generate specific alerts for appropriate response and this can be achieved only if information technology (IT) based surveillance system is developed.

NEWARS information system was developed in-house by RCDC in 2014. The system was introduced and rolled out to all health centers in 2015. It is a centralized database that collects data from health centers across the country, either through web-based or mobile SMS technology, based on health centers accessibility to internet and mobile network.

The NEWARS system has three reporting platforms; Weekly, Immediately and Events report. The Figure 8 shows the flow of data in the NEWARS system.

Referral Hospitals

District Hospitals BHU I BHU II Satellite

ClinicOutreach

Clinic Subpost

General Public

District Health Office

Figure 8:NEWARS system data flow(need to change no. of diseases)

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1. Features of NEWAR information system

The system has all the required features to capture the entire process of reporting, alerts, notification and response mechanism.

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Figure 10: Alert and response mechanism for event report


Page 74 of 144

1. Practical guide to using NEWARS in-formation system (NEWARSIS)

Open a browser (Internet explorer, Chrome, Opera, Safari, etc) and type www.rcdc.gov.bt in the url bar. The RCDC web page below will be displayed. Best supported browser is google chrome with Screen resolution greater than 1024x768 pixels for NEWARSIS.

1.1 User Registration

1. To register in NEWARS, click on NEWARS dropdown menu and click on User Registration menu item.

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2. User registration form will be displayed as shown below.

3. Fill the user registration information as required by the system (Note: your username should be unique for the system and your mobile number should have eight digits and not already registered for NEWARS).

1.4. Click submits registration details button as shown in the Figure …...


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2. Change Password/Mobile No/Centre Change

1. Click on NEWARS menu dropdown and click on Password/Mobile No/Center Change menu item to change password, mobile number and health center.

2. Password Reset, Mobile No Change and Centre Change page will be displayed

3. To reset password, type your username in username textbox under password Reset if you are a registered user. Mobile number verification against

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your username is necessary to reset password. The new password will be sent to your registered mobile number and email.

4. Click Reset Password button to submit.

5. To change your mobile number, you need to type your username and existing registered mobile number followed by new one that you want to replace with.

6. Click Change Mobile No button to submit.

7. To change health center, type your username and then select name of health center that you are registered from drop down list, followed by the new health center you want to transfer your user details to and then mention reason for change of health center for verification and approval by the system manager.

8. Click Submit Center Change Request button to submit

3. Web Reporting

To report weekly, immediate and event through web,

1. Scroll down the web page and look for System User Login Form.

2. Click on Select System and select RCDC Surveillance.

3. Type your username and password and


Page 78 of 144

click on login button to access RCDC Surveillance System Dashboard.

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6. Click on User Profile menu to change designation, email ID, mobile number, and register second mobile number.

7. Users can also change password, send health center change request from Dashboard using button Change Password and Change Center respectively.

Online disease reporting

1. To access NEWAR System, click on National Early Warning, Alert and Response Surveillance Information System and you will be directed to National Early Warning, Alert and Response Surveillance Information System dash board where indicators for Weekly, Immediate and Event Report is displayed.

3.1. Submit Weekly Report:

1. Click on Weekly manual the left-hand side of Dashboard.


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2. Weekly report management page will be displayed. This page will have record of recent/previously submitted weekly reports.

3. To add weekly report, Click on Add Weekly Report button at the top right-hand side of the Weekly Report Manager. Weekly Report page/form for submitting report will be displayed.

4. Select Year and Week you of your report. Reporter name and health center and unit will automatically selected by the system.

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5. Type number of cases and deaths under specific age group against disease or syndrome.

6. Click Submit Weekly Report button. Alert box on the browser will display with message “report submitted successfully” or “Report Submission Failed”. If report submission fail, correct the report and submit again.

7. To Edit Weekly Report, go back to weekly report manager page and click on Update button at end (under action)against the week and year you want to edit. Weekly report edit form will be displayed.


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Make changes in number of cases and deaths under specific age group against disease or syndrome if there is any and click on Update Weekly Report button. Alert box on the browser will be displayed with message either “report update successfully” or “Report update Failed”. If report submission fails, correct and submit again.

8. If there is no case or death for the epidemiology week, Select Year and Week and click on Submit Weekly Report button. The report will be saved as ZERO report.

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3.2. Immediate Report:

1. Click on Immediate menu item at the left-hand side of Dashboard.

2. Immediate Report Manager page will be displayed. This page will have records of previous/recent immediate reports submitted.

3. To add immediate report, Click on Add Immediate Report button at the top right-hand side of the Immediate Report Manager page.


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4. A form for submitting Immediate Report will display.

5. Type in or select the case date from calendar box. Tick/check in checkbox against the immediate disease or syndrome to be reported.

6. Enter number of cases and deaths under specific age group against disease of syndrome.

7. Click on Submit Immediate Report button. Alert box on the browser will display with message either “report submitted successfully” or “Report Submission Failed”. If report submission fail, correct the report and submit again.

8. To Edit Immediate Report, go back to Immediate Report Manager page. Click on Update button under Action row against the date you want to edit. Form for editing the report will be displayed. Make any necessary changes and click on Update Immediate Report button. Alert box on the browser will be displayed with message either “report update successfully” or “Report update Failed”. If report submission fail, correct and submit again.

//edited till here

9. To submit case investigation form (CIF), go to Immediate Report Manager (immediate report dashboard) and click Manage Button under CIF menu against specific disease/syndrome for that particular date. CIF Manager Page will be displayed.

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10. Enter patient information and click on Save Patient Info button. Click Update button under Action menu in CIF Manager Page to edit existing Patient info OR to fill up Investigation datail.

11. Enter all information required in CIF and click Update button under each sub-heading/information section.

12. Click Upload CIF button at top right-hand side to upload CIF files (pdf/Doc/xls/jpg/png/gif) if online CIF information could be not submitted.

Add Immediate Report Form


Page 86 of 144

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3.3. Event Report

1. Click Event menu item at the left side of Dashboard.

2. Event Report Manager (Event Report Dashboard) page will be displayed. This page will have record of previous/recent event reports submitted.

3. To submit event report, Click on Add Event Report button at the top right-hand side of the Event Report Manager page. Event reporting page/form will be displayed.

4. Enter information as required.

5. Click on Report Event button to submit event report. Alert box on the browser will be displayed with the message “report submitted successfully” or “Report Submission Failed”. If report submission fail, correct and submit again.

6. To update case/death number on daily


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basis, click on update button button under case/death menu in Event Report Manager page against the event you want to update the case/death. Update Event Case Death page will be displayed. Click on Add Case/Death button at top right-hand side. A form will be displayed where you need to fill date, case and death detail. Click on Submit Case/Death button. Case/death update must be donetill event is declared over.

7. Click on Manage button under Linelist menu against the event at Event Report Manager page to submit line-list.

8. Click on Manage/Add button under Response(Res) menu against the event at Event Report Manager page to submit event response reports

9. To add response, Select appropriate response from response dropdown list. Select appropriate response type (Preliminary/Final report) to be submitted. Add brief summary report of event and upload event response report and click on Submit Response button to submit to complete response for an event.

10. After response report submission is completed, Event Response Manager Page will be displayed and under Gallery, click on Add button to upload photo of event. Report

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can be view, update or delete by clicking appropriate button display in the Event Response Manger page. Second response can be added by clicking on Add Response button at top right-hand side of the response manager page.


Page 90 of 144

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4. Data export

1. Click Report menu at the left side of Dashboard.


Page 92 of 144

2. Report Manager page will be displayed.

3. Click appropriate button to view weekly, immediate and event indicators and reports

4. Click Export button to export data in excel file.

Figure 15: Report Manager Dashboard

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5. SMS System

Unlike web system, SMS works based on keywords (codes) and it is important to know and remember all keywords. Mobile SMS options can be used where the is no internet connectivity at health facility.

5.1 Understanding SMS keywords.To know all SMS keywords for NEWARS system, type “Newars” and send to SMS hotline number 7712399. User will receive SMS reply with all help keywords used in NEWARS for SMS application.

5.2. User Registration

To send user registration request, Compose the message using the format:

REGUSER<singlespace>preferred_username*FullName*Designation*Center Name and send to 7712399.


Page 94 of 144

First SMS reply will be received from system stating registration request has been received.

Second SMS will be received stating approval of registration with username and system generated password (below is an SMS reply example).

To check user registration details, type CHKUSER on message box and send it to SMS hotline number. Details of registration will be received (below is an SMS reply example).

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5.3. Adding Second Mobile Number

To register second mobile number, Compose the message using the format:

ADDMOBILE<single space>SECOND_MOBILE_Number and sent it to 7712399. SMS reply will be received stating mobile 2 has been added in the system (below is an SMS reply example). After that reporting can be done from both mobile number.


Page 96 of 144

5.4. Change Mobile Number

to change mobile number, Compose the message using the format:

CHGMOBILE<single space>New_Mobile_Number and send to 7712399. SMS reply will be received stating mobile number submitted to the system has been changed (below is an SMS reply example). Once system changes your previously registered mobile number to new mobile number, system will not accept any reports from previously registered mobile number.

5.5. Change Password/Password Reset

To change or reset password, Compose the message using the format:

CHGPASSWORD<single space>New_Password and sent to 7712399. SMS reply will be received stating password has been changed with your username. [this is useful in case of forgotten username or password] (below is an SMS reply example).

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5.6. Request Health Center Change

To request health center change, compose the messageusing the format:

CHGCENTER<single space>New_Center_Name and send to 77123999.

First SMS reply will be received from system stating change center request has been received. User registration details will still under old health center and place reports will be placed to hold health center unless it is approved.

Second SMS will be received stating request to change center has been approved by the system administrator (below is an SMS reply example). After this SMS, system will place report to changed health center as your user registration details are transferred in the system.


Page 98 of 144

5.7. Check Dates for Epidemiological Week Number

To check dates for epidemiological week number, compose message in followingformat,

CHKWEEK<single space>Week_Number.

SMS reply will be received with dates of given epidemiological week of the current year (below is an SMS reply example).

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5.8. Check Reporting Deadline

To check reporting deadlines, compose message with keywordCHKDEADLINE. SMS reply will be received with deadline dates for weekly, immediate and event (below is an SMS reply).

5.9. Check for NEWARS Support Team

Compose message with keyword CHKSUPPORT and send to7712399. SMS reply will be received with the names of surveillance officer and IT focal persons at RCDC (below is an SMS reply).


Page 100 of 144

5.10. Check Weekly Disease List

To check weekly reportable diseases/syndromes, compose sms with keyword HLPWKDID and send to 7712399. SMS reply will be received disease code with disease and syndromes abbreviation (below is an SMS reply).

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5.11. Submit Weekly Report

Compose the SMS report using the format:

WK<single space>WeekNo.Year (YY)*WKDID-AG.Case.Death,AG.Case.Death*WKDID-AG.Case.Death and send it to 7712399.

SMS reply will be received acknowledging successfully submission of the report (below is an example of SMS reply).

5.12. Submit Zero Report

To submit Zero report, compose the SMS report using the format:

ZERO<single space>WeekNo.Year(YY) and send to 7712399.

SMS reply will be received acknowledging successfully submission of zero report (below is an example of SMS reply).


Page 102 of 144

5.13. Check Immediate Reporting Disease/syndromes List

Compose SMS with keywordHLPIMDID and send to7712399 to check immediate reporting disease/ syndrome list.

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5.14. Submit Immediate Report

Compose the SMS report using the format :

IM<single space>DD.MM.YY*IMDID-AG.Case.Death ,AG.Case .Death* IMDID-AG.Case .Death,AG.Case.Death and send it to7712399.


5.17. Submit Event Report

To submit event report, compose the SMS report using the format:

EVT<single space>DD.MM.YY*Event Name*Event Location*No. of Population Affected(Number) and send to 77123999.



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5.18. Update Event Report Cases/Deaths

Compose the SMS report using the Format:

EVTUPDATE<single space>DD.MM.YY*EventID-AdditionalCase.AdditionalDeath and send to 77123999.


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5.19. Delete Weekly Report

Compose the SMS report using the Format:

DELWK<single space>Week No. Year(YY) and send 77123999. SMS reply will be received acknowledging successfully submission of the weekly report (below is an example of SMS reply).

5.20. Delete Immediate Report

Compose the SMS report using the format:

DELIM<Single Space>DD.MM.YY(Case Date)and send to 77123999. Note: All the reports submitted for that particular case date will be deleted from the system.

SMS reply will be received acknowledging successfully deletion of the immediate report (below is an example of SMS reply).


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Important Points for SMS reporting:

1. You should not be repeating DiseaseId in a weekly/Immediate report

2. You should not be repeating ageGroupId within a diseaseId for weekly/Immediate report

3. There is always *(asterisk) infront of Disease Id and –(Hyphen) after the Disease ID

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References1. National Early Warning, Alert & Response

Surveillance, 1st edition 2014, Public Health Laboratory, DoPH, Ministry of Health, Bhutan 2014

2. National Immunization Policy and Strategic Guidelines, Vaccine Preventable Disease Program DoPH, Ministry of Health, Bhutan 2011

3. Disease outbreak investigation and Control manual, 1st ed. 2015, DoPH, 0oH, Bhutan

4. WHO communicable diseases surveillance and response system, guide for monitoring and evaluating WHO/CDS/EPR/LYO/2006.2

1. WHO recommended strategies for the prevention and control of communicable diseases, WHO/CDS/CPE/SMT/2001.13

2. CDC; Framework for Evaluating Public Health Surveillance Systems for Early Detection of Outbreaks Vol. 53 / RR-5,MMWR, May 7, 2004

3. Operational manual for district surveillance unit, Directorate General of Health Services, Ministry of Health and Family Welfare,New Delhi.

4. Communicable diseases surveillance, Centre for Health protection, Hong Kong, Version 2.

5. Management Protocol Manual, Communicable Disease Control Unit, Public Health, Manitoba Health. 2006*

6. Park, K. Textbook of Preventive & Social Medicine, 14th edition, M/s Banaras Bhanot, 1994.


Page 108 of 144

7. LAO EWARN manual, year 2012 by NCLE and WHO

8. A guideline to establishing Event Based Surveillance, World Health Organization Western Pacific Region (2008), ISBN 978 92 9061 321 3

9. International Health Regulation, World Health Organization (2005), World Health Assembly 58, Geneva

10. Guideline for Evaluating Surveillance System, Bureau of Epidemiology, Ministry of health, Thailand; ISBN 974 297 264 8

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ssVi

llage

Geo

gD

istri

ct

If ch

ild is

≤ 5

yea

rs g

et th

e va

cci-

natio

n de

tails


Page 114 of 144

Clin

ical

info

rmat

ion

(ple

ase

tick

agai

nst t

hose

are

pre

sent

)

Sig

n an

d S

ympt

om

(tick

)

Dat

e of

O

nset

Sig

n an

d S

ympt

om (t

ick)

Dat

e of

Ons

et

Feve

r now

(>

) 38C

Pet

echa

ie/e

chym

ose

Hea

dach

e

Any

ble

edin

g di

sord

ers

Ski

n R

ashe

s

Alte

red

cons

ciou

snes

s

Mya

lgia

C

onvu

lsio

n

Vom

iting

O

ther

sym

ptom

s S

peci

fy

Tem

pera

ture

Pul

sB

PG

CS

Gen

eral

con

ditio

n (s

peci

fy)

of 144


Patie

nt S

tatu

s H

ospi

taliz

ed c

ase

Hos

pita

l Adm

issi

onD

oAD

oD

Sta

tus

Rec

ov-

ered

still

sic

kD

ied

If re

ferr

ed: N

ame

of H

ospi

tal

Dia

gnos

is

Epid

emio

logi

cal i

nfor

mat

ion

H/o

sim

ilar i

llnes

s in

fam

ilyYe

sN

oU

nkno

wn

Trav

el H

isto

ry (3

-21

days

bef

ore

the

onse

t of s

ympt

oms)

Yes

No

Unk

now

n

Trav

el d

ate

from

Trav

el p

lace

His

tory

of c

onta

ct w

ith s

ick

anim

als

Yes

No

Unk

now

n

Evi

denc

e o

f dis

ease

like

rabi

es/

anth

rax/

bird

-flu

in a

nim

alYe

sN

oU

nkno

wn

Any

his

tory

of d

isea

ses

outb

reak

in

the

com

mun

ityYe

sN

oU

nkno

wn

Nam

e of

out

brea

k:


Page 116 of 144

Labo

rato

ry In

form

atio

n at

Loc

al le

vel

Labo

rato

ry

test

Res

ults

Rem

arks

Low

est w

hite

bl

ood

cells

Pla

tele

ts

coun

t

Blo

od U

rea

Cre

atin

ine

Rap

id te

st

resu

lt S

peci

fy

Blo

od C

/s

CS

F cu

lture

Any

oth

er te

st

done

of 144


Sam

ples

tran

sfer

to R

CD

C f

or :

Nam

e of

H

ealth

Cen

ter

Nam

e of

in

vest

igat

or

Con

tact

# o

f Inv

estig

ator

Dat

e o

f in

vest

igat

ion


Page 118 of 144

Annexure 4. MR Case investigation form

of 144



Page 120 of 144

Ann

exur

e 5.

CR

S C

ase

inve

stig

atio

n fo

rm

Cas

e ID

: Reg

ion:

Dis

tric

t:

Dat

e of

not

ifica

tion:

___

/___

/___

D

ate

of in

vest

igat

ion:

___

/___

/___

Dat

e of

repo

rtin

g: _

__ /_

__ /_

__

A. I

dent

ifica

tion

Nam

e of

the

child

: ___

____

____

____

____

____

____

____

____

_ Se

x: M

ale

Fem

ale

Dat

e of

birt

h: _

__ /_

__ /_

__ if

not

ava

ilabl

e –

age

in m

onth

s___

__ A

ddre

ss:_

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

Plac

e in

fant

del

iver

ed: _

____

____

____

____

____

____

_N

ame

of m

othe

r:__

____

____

____

____

____

____

____

__

B. C

linic

al s

igns

and

sym

ptom

s

Ges

tatio

nal a

ge (w

eeks

) at b

irth:

____

__ B

irth

wei

ght (

gram

s): _

____

____

____

____

____

____

_

of 144


Gro

up A

(ple

ase

com

plet

e al

l)G

roup

B (p

leas

e co

mpl

ete

all)

Con

geni

tal h

eart

dis

ease

: Ye

s N

o U

nkno

wn

Purp

ura:

Ye

s N

o U

nkno

wn

If y

es, s

peci

fy d

efec

t:___

____

____

____

____

____

___

Mic

roce

phal

y:

Ye

s N

o U

nkno

wn

Cat

arac

ts:

Yes

No

Unk

now

nM

enin

goen

ceph

aliti

s Y

es N

o U

nkno

wn

Con

geni

tal g

lauc

oma:

Yes

No

Unk

now

nJa

undi

ce:

Yes

No

Unk

now

n

Pigm

enta

ry re

tinop

athy

: Ye

s N

o U

nkno

wn

Sple

nom

egal

y:

Ye

s N

o U

nkno

wn

Hea

ring

impa

irmen

t:

Ye

s N

o U

nkno

wn

Dev

elop

men

tal d

elay

: Ye

s N

o U

nkno

wn

R

adio

luce

nt b

one

dise

ase:

Yes

No

Unk

now

n

Oth

er a

bnor

mal

ities

: Yes

No

If y

es p

leas

e de

scrib

e:__

____

____

____

____

____

____

____

____

____

Nam

e of

phy

sici

an w

ho e

xam

ined

infa

nt:_

____

____

____

____

____

____

____

____

____

____

____

____

__

City

/tow

n/vi

llage

:___

____

____

____

____

____

____

____

____

____

____

Tel

epho

ne:_

____

____

____

____

____

__

Pres

ent s

tatu

s of

infa

nt: A

live

Dea

d

If de

ad, c

ause

of d

eath

: ___

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____


Page 122 of 144

Aut

opsy

con

duct

ed: Y

es N

o U

nkno

wn

Aut

opsy

find

ings

:___

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

___

Aut

opsy

dat

e:__

___/

____

/___

____

C. M

ater

nal h

isto

ry/A

nten

atal

car

e

Num

ber o

f pre

viou

s pr

egna

ncie

s:

Mot

her’s

age

(yea

rs):

Vacc

inat

ed a

gain

st ru

bella

: Yes

No

Unk

now

n If

yes

, giv

e da

te: _

__/_

__/_

__

Rub

ella

like

illn

ess

durin

g pr

egna

ncy:

Yes

No

Unk

now

n If

yes

, Mon

th o

f pre

gnan

cy:_

____

____

____

__

Mac

ulop

apul

ar ra

sh: Y

es N

o U

nkno

wn

If y

es, d

ate

of o

nset

___/

___/

___

Lym

ph n

odes

sw

olle

n: Y

es N

o U

nkno

wn

If y

es, d

ate

of o

nset

___/

___/

___

Art

hral

gia/

arth

ritis

: Yes

No

Unk

now

n If

yes

, dat

e of

ons

et__

_/__

_/__

_

Oth

er c

ompl

icat

ions

Yes

No

Unk

now

n If

yes

, dat

e of

ons

et__

_/__

_/__

_

Was

rube

lla la

bora

tory

-con

firm

ed in

the

mot

her Y

es N

o U

nkno

wn

If ye

s, w

hen

(dat

e): _

__/_

__/_

__

of 144


Was

the

mot

her e

xpos

ed d

urin

g pr

egna

ncy

to p

erso

n of

any

age

with

mac

ulop

apul

ar (e

.g. n

ot v

esic

ular

) ra

sh

illne

ss w

ith fe

ver Y

es N

o U

nkno

wn

If y

es, w

hen

(dat

e): _

__/_

__/_

__

Mon

th o

f pre

gnan

cy:_

____

____

____

____

____

____

____

__D

escr

ibe

whe

re:_

____

____

____

____

____

____

____

____

__

Did

the

mot

her t

rave

l dur

ing

preg

nanc

y: Y

es N

o U

nkno

wn

If ye

s, w

hen

(dat

e): _

__/_

__/_

__

Mon

th o

f pre

gnan

cy:_

____

____

____

____

____

____

____

__ D

escr

ibe

whe

re:_

____

____

____

____

____

_

D. I

nfan

t/chi

ld la

bora

tory

inve

stig

atio

ns

Firs

t spe

cim

en:

Spec

imen

col

lect

ed: Y

es N

o U

nkno

wn

Type

of s

peci

men

: Ser

um T

hroa

t sw

ab U

rine

Oth

erD

ate

of s

peci

men

col

lect

ion:

___

/___

/___

Dat

e sp

ecim

en s

ent:

___/

___/

___

Dat

e sp

ecim

en re

ceiv

ed in

Lab

: ___

__/_

___/

____

_


Page 124 of 144

Rub

ella

IgM

: Not

test

ed P

ositi

ve N

egat

ive

In p

roce

ss I

ncon

clus

ive

Rub

ella

IgG

: Not

requ

ired

Not

test

ed P

ositi

ve N

egat

ive

In p

roce

ss I

ncon

clus

ive

Seco

nd s

peci

men

:Sp

ecim

en c

olle

cted

: Yes

No

Unk

now

n N

ot re

quire

dTy

pe o

f spe

cim

en: S

erum

Thr

oat s

wab

Urin

e C

ereb

rosp

inal

flui

d O

ther

Dat

e of

spe

cim

en c

olle

ctio

n: _

__/_

__/_

__ D

ate

spec

imen

sen

t: __

_/__

_/__

_D

ate

spec

imen

rece

ived

in L

ab: _

____

/___

_/__

___

Rub

ella

IgM

: Not

requ

ired

Not

test

ed P

ositi

ve N

egat

ive

In p

roce

ss I

ncon

clus

ive

Rub

ella

IgG

: Not

requ

ired

Not

test

ed P

ositi

ve N

egat

ive

In p

roce

ss I

ncon

clus

ive

Sust

aine

d Ig

G le

vel*:

IgG

not

test

ed Y

es N

o In

pro

cess

(*su

stai

ned

IgG

leve

l on

at le

ast 2

occ

asio

ns b

etw

een

6 an

d 12

mon

ths

of a

ge)

Rub

ella

viru

s is

olat

ion:

Not

test

ed P

ositi

ve N

egat

ive

In p

roce

ss

Rub

ella

PC

R: N

ot d

one

Pos

itive

Neg

ativ

e In

pro

cess

Gen

otyp

e___

____

of 144


Dat

e of

labo

rato

ry re

sult

(firs

t val

idat

ed re

sult)

repo

rted

: ___

_/__

__/_

___

E. F

inal

cla

ssifi

catio

n

CR

S D

isca

rded

If d

isca

rded

, ple

ase

spec

ify:_

____

____

____

____

____

____

____

____

____

____

_

Cas

e cl

assi

ficat

ion

as L

abor

ator

y-co

nfirm

ed C

linic

al

Cla

ssifi

catio

n by

orig

in: E

ndem

ic I

mpo

rted

Im

port

-rel

ated

Unk

now

n

Dat

e of

fina

l cla

ssifi

catio

n: _

___/

____

/___

_

Inve

stig

ator

:___

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

___


Page 126 of 144

Ann

exur

e 6:

Cas

e In

vest

igat

ion

Form

for D

ipht

heria

/Per

tuss

is

Cas

e id

entifi

catio

n nu

mbe

r:

1. R

epor

ting

inve

stig

atio

n in

form

atio

n

Dat

e of

cas

e re

port

ed: _

/_/_

Rep

orte

d by

:

Title

/des

igna

tion:

Dat

e of

cas

e in

vest

igat

ed: _

/_/_

Cas

e in

vest

igat

ed b

y:Ti

tle/d

esig

natio

n:

Dat

e of

cas

e ve

rified

: _/_

/_Ve

rified

by:

Title

/des

igna

tion:

Rep

ortin

g he

alth

faci

lity:

2. P

erso

nal i

nfor

mat

ion:

Patie

nt's

nam

e:N

atio

nalit

y:N

atio

nal

Non

-nat

iona

l

Sex:

Mal

e Fe

mal

eD

ate

of b

irth:

_/_

/_A

ge: Y

ears

___M

onth

__

Fath

er's

nam

e:M

othe

r's n

ame:

of 144


Pres

ent a

ddre

ss: V

illag

e/ci

ty

Gew

og

Dis

t:

Chi

ld b

elon

gs to

mig

rato

ry fa

mily

/com

mun

ity: Y

es N

o U

nkno

wn

If ye

s, s

peci

fy: M

igra

tion

Nom

ad

Con

stru

ctio

n si

te O

ther

s, s

peci

fy

3. H

ospi

taliz

atio

n: Y

es

No

If ye

s, n

ame

of h

ospi

tal:

Dat

e of

adm

issi

on: _

/_/_

Dat

e of

dis

char

ge: _

/_/_

4. V

acci

natio

n st

atus

: Any

vac

cine

rece

ived

: Ye

s N

o U

nkno

wn

If re

ceiv

ed, e

ncirc

le v

acci

nes

rece

ived

irre

spec

tive

of a

ge w

hen

they

wer

e re

ceiv

ed

At b

irth

6 w

eeks

10 w

eeks

14 w

eeks

9 mon

ths

24 m

onth

s6

year

s

OPV

0O

PV1

OPV

2O

PV3

MM

R1

MM

R2

Td b

oost

er

BC

GPe

nta1

Pent

a2Pe

nta3

D

T


Page 128 of 144

Hep

B0

(birt

h do

se)

IPV

O

PV b

oost

er

Sour

ce o

f vac

cina

tion

stat

us: b

y ca

rd/h

isto

ry__

____

____

____

____

____

___

Dat

e of

last

dos

e of

vac

cine

: For

dip

hthe

ria (T

d, P

enta

vale

nt, D

T), F

or P

ertu

ssis

(Pen

tava

lent

): _/

_/_

In c

ase

of N

eona

tal t

etan

us -

mot

her's

vac

cina

tion

hist

ory

TT (T

d):1

2 B

oost

er U

nkno

wn

Dat

e of

last

dos

e of

Td:

_/_

/_

5. C

linic

al s

ympt

oms:

Dur

atio

n of

illn

ess

in d

ays:

Dip

hthe

ria

Dat

e of

ons

et o

f fev

er w

ith s

ore

thro

at: _

/_/_

Sore

thro

at: Y

es N

o

Feve

r: Y

es N

oG

reyi

sh w

hite

adh

eren

t mem

bran

e in

thro

at: Y

es N

o

of 144


Red

ness

of t

onsi

ls: Y

es

No

Hoa

rsen

ess

of v

oice

: Ye

s N

o

Diffi

culty

in s

wal

low

ing:

Yes

No

Bul

l nec

k: Y

es N

o

Diffi

culty

in b

reat

hing

: Yes

No

Pert

ussi

s

Cou

gh m

ore

than

2 w

eeks

: Yes

No

Paro

xysm

s:Ye

s N

o

Cou

gh le

adin

g to

vom

iting

: Yes

No

Who

op: Y

es N

o

Cya

nosi

s: Y

es N

oH

isto

ry o

f act

ive

TB/o

ther

chr

onic

UR

TI: Y

es N

o

Apn

oea:

Yes

No

Spec

ialis

t phy

sici

an s

tron

gly

sugg

est p

ertu

ssis

:Yes

No


Page 130 of 144

Ann

exur

e 7.

Cas

e In

vest

igat

ion

Form

for N

eona

tal T

etan

us

Neo

nata

l Tet

anus

Chi

ld n

orm

al in

0-2

day

s:Ye

s N

oO

nset

3-2

8 da

ys

of a

ge:Y

es N

o

Inab

ility

to s

uck

and

cry:

Yes

No

Stiff

ness

: Yes

No

Spas

m/s

eizu

re: Y

es N

oIf

yes,

pre

cipi

tate

d by

stim

uli:

Yes

No

Del

iver

y: In

stitu

tiona

l hom

e ot

hers

, spe

cify

:

If ho

me

deliv

ery,

birt

h at

tend

ed b

y:

Any

sub

stan

ce a

pplie

d on

cor

d: Y

es N

oIf

yes,

spe

cify

:

Ence

phal

itic

Feve

r: Y

es N

oSe

izur

e:Ye

s N

o

of 144


Para

lysi

s: Y

es N

oN

eck

rigid

ity:

Yes

No

Unk

now

n

Hea

dach

e:Ye

s N

o U

nkno

wn

Unc

onsc

ious

-ne

ss:Y

es N

o

Unk

now

n

Cha

nge

in m

enta

l sta

tus:

Yes

No

Any

oth

er,

spec

ify:

6. T

reat

men

t his

tory

Ant

ibio

tic s

tart

ed b

efor

e sa

mpl

e co

llect

ion:

Yes

No

Unk

now

n

If ye

s, P

enic

illin

Azi

thro

myc

in E

ryth

rom

ycin

Cla

rithr

omyc

in C

otrim

oxaz

ole

Cla

rithr

omyc

in T

etra

cycl

ine

Dox

ycyc

line

Am

oxic

illin

Am

pici

llin

Cef

exim

e

Oth

ers,

spe

cify

:

Dip

hthe

ria a

ntito

xin:

Yes

No

Unk

now

n N

ot a

pplic

able


Page 132 of 144

7. C

onta

ct h

isto

ry

His

tory

of c

onta

ct w

ith la

bora

tory

con

firm

ed c

ase:

Yes

No

If ye

s, c

ase

ID n

o of

labo

rato

ry c

onfir

med

cas

e:

Sim

ilar s

ympt

oms

in o

ther

hou

seho

ld c

onta

cts:

Yes

No

If ye

s, n

o of

cas

es:

Det

ails

:

Sim

ilar s

ympt

oms

in o

ther

nei

ghbo

rhoo

d/w

orkp

lace

/sch

ool c

onta

cts:

Yes

No

If ye

s, n

o of

cas

es:

D

etai

ls:

8. T

rave

l his

tory

: Tra

vel o

f sus

pect

ed c

ase

with

in 2

1 da

ys p

rior t

o on

set (

indi

cate

dat

e an

d pl

ace

of d

ate

line

Plac

e of

vis

it:

of 144


Req

uire

s cr

oss

notifi

catio

n: Y

es N

o

If ye

s, d

ate

of

cros

s no

tifica

tion:

_/

_/_

In c

ase

of n

eona

tal t

etan

us, n

ame

the

plac

e of

del

iver

y:

9. H

isto

ry o

f vis

it to

ano

ther

hea

lth c

ente

r afte

r the

dat

e of

ons

et: Y

es N

o

If ye

s, d

ate

of v

isit:

_/_

/_N

ame

of h

ealth

ce

nter

:


Page 134 of 144

Ann

exur

e 8.

AFP

Cas

e in

vest

igat

ion

form

1. R

epor

t/Inv

estig

atio

n in

form

atio

n

Nam

e of

inve

stig

ator

____

____

____

_

Dat

e C

ase

Rep

orte

d: _

____

____

____

____

____

Titl

e: _

____

____

____

____

____

____

Dat

e C

ase

Inve

stig

ated

: ___

____

____

____

____

Nam

e of

BH

U/H

ospi

tal:

2. C

ase

Iden

tifica

tion

Cas

e id

entifi

catio

n no

: BH

U --

---/--

---/--

---

Patie

nt’s

nam

e:__

____

____

____

____

____

____

____

____

_ Se

x: M

ale

Fem

ale

Dat

e of

Birt

hday

-----

/-----

/-----

Age

:Yea

r ___

____

Mon

ths_

____

__

Add

ress

to fi

nd th

e ch

ild fo

r fol

low

up

in 6

0 da

ys:_

____

____

____

____

____

____

____

____

____

_

Villa

ge: _

____

____

____

___

Gew

og :

____

____

____

____

_ D

zong

khag

___

____

____

____

_

Perm

anen

t Add

ress

(if d

iffer

ent)_

____

____

____

____

____

____

____

___

Mob

ile N

o:---

------

---

3. H

ospi

taliz

atio

n: Y

es N

o

D

ate

of H

ospi

taliz

atio

n: --

---/--

---/--

---

Nam

e of

the

hosp

ital:

____

____

____

____

____

____

___H

ospi

tal r

egis

trat

ion

num

ber:

____

____

____

__

of 144


4. Im

mun

izat

ion

His

tory

:

Tot

al O

PV d

oses

rece

ived

thro

ugh

rout

ine

EPI:

____

____

__

To

tal O

PV d

oses

rece

ived

thro

ugh

NID

S: _

____

____

____

_

D

ate

of la

st d

oes

of O

PV (r

outin

e):_

____

____

____

____

D

ate

of I

PV --

------

------

------

------

------

------

------

------

---

5. S

igns

and

Sym

ptom

s:

Dat

e of

par

alys

is o

nset

:___

____

____

____

____

__

Num

ber o

f day

s fr

om o

nset

to m

axim

um p

aral

ysis

:___

____

____

____

____

____

____

___

Acu

te F

lacc

id p

aral

ysis

:

Yes

No

Unk

now

n

Flac

cid

para

lysi

s:

Ye

s N

o U

nkno

wn

Any

inje

ctio

ns d

urin

g th

e 30

day

s be

fore

par

alys

is o

nset

: Yes

No

Unk

now

n

Feve

r on

day

of p

aral

ysis

ons

et: Y

es N

o U

nkno

wn

Asy

mm

etric

al P

aral

ysis

: Yes

No

Unk

now

n

Asc

endi

ng p

aral

ysis

: Yes

No

Unk

now

n

Sens

atio

n Lo

ss: Y

es N

o U

nkno

wn

D

esce

ndin

g pa

raly

sis:

Yes

No

Unk

now

n

Site

(s)o

f par

alys

is: r

ight

s ar

ms

/Lef

t arm

/Rig

ht le

gs/ L

eft l

egs/


Page 136 of 144

6. S

tool

Spe

cim

en C

olle

ctio

n:

D

ate

Col

lect

ed

D

ate

Sent

Labo

rato

ry R

esul

t (ci

rcle

)

Stoo

l 1:_

____

____

___

__

____

____

_ P1

P2

P3

Wild

/Vac

cine

Pe

ndin

g

N

PEV

N

egat

ive

Stoo

l 2:_

____

____

___

__

____

____

_ P1

P2

P3

Wild

/Vac

cine

Pe

ndin

g

N

PEV

N

egat

ive

7. 6

0 D

ay F

ollo

w-u

p Ex

amin

atio

n: Y

es N

o: D

ate:

____

____

____

____

_ If

No,

why

?___

____

____

Die

d? (C

ircle

): Ye

s/N

o

If Ye

s, d

ate:

___

____

____

_ if

died

, cau

se: _

____

____

___

Res

idua

l par

alys

is p

rese

nt: Y

es N

o

Site

of P

aral

ysis

: rig

ht a

rm/le

ft ar

m/ r

ight

leg/

left

leg/

othe

rs (d

escr

ibe)

___

____

____

____

__

Nam

e of

exa

min

er:…

……

……

……

……

…..

Des

igna

tion…

……

…

C

lass

ifica

tion…

……

……

……

..

8. O

utbr

eak

Res

pons

e: D

one:

Yes

/No

Dat

e:__

____

____

_ If

No.

why

?___

____

____

____

If ye

s, d

ate

begu

n: _

____

____

____

Se

tting

: Urb

an/R

ural

Targ

et p

opul

atio

n of

< 5

yrs

: ___

____

____

____

____

____

Num

ber <

5 im

mun

ized

: ___

____

___

of 144


9. F

inal

Cla

ssifi

catio

n

a.C

onfir

med

Pol

io: Y

es N

o.

b.Po

lio c

ompa

tible

: Yes

No

c. If

dis

card

ed, w

hy?

(Tic

k)

If di

scar

ded,

wha

t wer

e th

e fin

al d

iagn

osis

: Gui

llian

Bar

re S

yndr

ome

Tran

sver

se M

yelit

is T

raum

atic

Neu

ritis

O

ther

------


Page 138 of 144

Ann

exur

e 9.

AES

Cas

e In

vest

igat

ion

Form

Hos

pita

l Reg

istr

atio

n N

o: _

____

____

____

AES

No:

___

____

____

____

____

__ 1.

Inve

stig

atio

n In

form

atio

n:

N

ame

of In

vest

igat

or(s

): __

____

____

____

____

___

Dat

e C

ase

Rep

orte

d: _

____

/___

___

/___

___

D

esig

natio

n: _

____

____

____

____

_D

ate

Cas

e In

vest

igat

ed: _

___

/ ___

_ / _

___

2. C

ase

Iden

tifica

tion:

Pa

tient

’s N

ame:

___

____

____

____

____

Dat

e of

Birt

h: _

___

/ ___

_ /_

__ _

_

A

ge: y

ears

___

mon

ths

___

Sex:

___

Pare

nts

Nam

e :

____

____

____

____

____

____

___

Pe

rman

ent a

ddre

ss:

Mob

ile N

o

:___

____

____

____

___

Vi

llage

:___

____

____

____

_

G

ewog

:___

____

____

____

_R

esid

ing

Add

ress

___

____

____

____

____

____

____

Dzo

ngkh

ag:_

____

____

____

3. H

ospi

taliz

atio

n: Y

es/N

o

D

ate

of H

ospi

taliz

atio

n: _

____

_ / _

____

__ /

____

____

_N

ame

of H

ospi

tal:_

____

____

____

____

____

___

C

linic

al D

iagn

osis

:___

____

____

____

____

____

Out

com

e: R

ecov

ered

com

plet

ely

/Rec

over

ed w

ith d

isab

ility

/ Dea

th/U

nkno

wn

of 144


4. S

ign

and

Sym

ptom

s:D

ate

of o

nset

of s

ympt

oms:

___

____

/___

____

_/__

____

__R

apid

Ons

et: Y

es /

No

/ Unk

now

n

Cha

nge

in m

enta

l sta

tus:

Yes

/ N

o / U

nkno

wn

Hea

dach

e: Y

es /

No

/ Unk

now

n

Seiz

ure:

Yes

/ N

o / U

nkno

wn

Nec

k St

iffne

ss: Y

es /

No

/ Unk

now

n

S

tupo

r: Y

es /

No

/ Unk

now

nPa

resi

s : Y

es /

No

/ Unk

now

n

Trav

el H

isto

ry (2

wee

ks b

efor

e th

e on

set):

Yes

/ N

o / U

nkno

wn

If ye

s, w

here

: ___

____

____

____

____

____

_

5. S

peci

men

s C

olle

ctio

n

Spec

imen

s ty

peD

ate

of s

ampl

e co

llect

edD

ate

of s

ampl

e se

nt to

Lab

(RC

DC

)

Seru

m 1

Seru

m 2

CSF

6. C

ase

Cla

ssifi

catio

n: L

ab c

onfir

med

/ Pr

obab

le /A

ES-o

ther

age

nt /A

ES-u

nkno

wn


Page 140 of 144

7. S

igna

ture

of i

nves

tigat

or:_

____

____

____

____

____

_Mob

ile N

o:

Cas

e D

efini

tion

of A

ES: C

linic

ally

, a c

ase

of A

cute

Enc

epha

litis

Syn

drom

e (A

ES) i

s de

fined

as

a pe

rson

of

any

age,

in a

ny g

eogr

aphi

cal r

egio

n, a

t any

tim

e of

yea

r with

the

acut

e on

set o

f fev

er a

nd a

cha

nge

in m

enta

l st

atus

(inc

ludi

ng s

ympt

oms

such

as

conf

usio

n, d

isor

ient

atio

n, c

oma,

or i

nabi

lity

to ta

lk) A

ND

/OR

new

ons

et

of s

eizu

res

(Exc

ludi

ng fe

brile

sei

zure

s).

of 144


Annexure 10: Event Reporting Form

EVENT REPORTING FORM

Reporting Site: _________________________Date of Reporting: _________________________

What do you want to report?(Name of event/suspected out-break):*

When did this happen?(Date/Time of Event):*

Where did this happen?(Location of Event):*

Number of people affected:*

Number of people died:*

Mention common signs & symptoms(Clinical Information):

Do you have any other information?:

Reported by _______________ _____________ No Mobile: _____________Dated._____________


Page 142 of 144

Annexure 11. Preliminary Report of an outbreak Preliminary Report of an outbreak Background

● When was event detected and notified in NEWARS?

● When and where has outbreak occurred?● How did the health center come to know

about the outbreak? (Example: was out-break reported in social media or cluster of cases visited the health center).

Findings● How many cases/death were detected? ● What are the common signs and symp-

toms?● Was the causative agent identified?● What are the possible research hypotheses

on the source of outbreak?● Specify if there was any preceding event

before the outbreak?● Any other information if available.

Action taken● How were patients managed?● Include what public health interventions

were taken such as active case searching, contact tracing, mass vaccination, etc.

● Were any recommendations provided for implementation?

● Were any logistics and supports arranged?● Any other information if available.

of 144

National Early Warning, Alert & Response SurveillanceA

nnex

ure

12. D

aily

Out

brea

k R

epor

t

Dat

eTY

PE

0-29

D1-

11M

1-4Y

5-9Y

10-1

4Y15

-19Y

20-2

4Y25

-49Y

50-6

4Y65

+YM

FM

FM

FM

FM

FM

FM

FM

FM

FM

F

C

ase

Dea

th

C

ase

Dea

th

C

ase

Dea

th

C

ase

Dea

th

C

ase

Dea

th

C

ase

Dea

th

C

ase

Dea

th

C

ase

Dea

th


Page 144 of 144

C

ase

Dea

th

C

ase

Dea

th

C

ase

Dea

th

C

ase

Dea

th

newars - rcdc.gov.bt · 2012 to incorporate web based reporting. in 2014, ... guideline including...

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