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Jul 5, 2013

Assessment of Surveillance System in Maharastra, India



Monitoring the progress of the Integrated Disease Surveillance (IDS) strategy is an important component to ensure its sustainability in the state of Maharashtra in India. The purpose of the study was to document the baseline performance of the system on its core and support functions and to understand the challenges for its transition from an externally funded "project" to a state owned surveillance "program".


Multi-centre, retrospective cross-sectional evaluation study to assess the structure, core and support surveillance functions using modified WHO generic questionnaires. All 34 districts in the state and randomly identified 46 facilities and 25 labs were included in the study.


Case definitions were rarely used at the periphery. Limited laboratory capacity at all levels compromised case and outbreak confirmation. Only 53% districts could confirm all priority diseases. Stool sample processing was the weakest at the periphery. Availability of transport media, trained staff, and rapid diagnostic tests were main challenges at the periphery. Data analysis was weak at both district and facility levels. Outbreak thresholds were better understood at facility level (59%) than at the district (18%). None of the outbreak indicator targets were met and submission of final outbreak report was the weakest. Feedback and training was significantly better (p < 0.0001) at district level (65%; 76%) than at facility level (15%; 37%). Supervision was better at the facility level (37%) than at district (18%) and so were coordination, communication and logistic resources. Contractual part time positions, administrative delays in recruitment, and vacancies (30%) were main human resource issues that hampered system performance.


Significant progress has been made in the core and support surveillance functions in Maharashtra, however some challenges exist. Support functions (laboratory, transport and communication equipment, training, supervision, human and other resources) are particularly weak at the district level. Structural integration and establishing permanent state and district surveillance officer positions will ensure leadership; improve performance; support continuity; and offer sustainability to the program. Institutionalizing the integrated disease surveillance strategy through skills based personnel development and infrastructure strengthening at district levels is the only way to avoid it from ending up isolated! Improving surveillance quality should be the next on agenda for the state.


end the neglect

Jul 3, 2013

Dengue Virus and Japanese Encephalitis Virus Epidemiological Shifts in Nepal

This article report that there is an epidemiological shifts from high  burden Japanese Encephalitis (JE) in the past to Dengue Virus (DENV) infection at present in Nepal. This must be due to the introduction of JE vaccine. Initially, the Ministry of Health - Government of Nepal introduced  country- wide  JE mass vaccination successfully in phase - wise manner. Now, the mass vaccination is replaced with routine immunization through integration of this vaccine in National Immunation Program (NIP). As the key component of national JE control program, the country - wide laboratory based JE surveillance is going on. At this juncture, the publication of this article will provide a strong evidence for the policy makers to integrate and implement DENV laboratory surveillance in the country. This is also important to remember that an effective surveillance inplace will provide true epidemiological picture of the disease to Department of Health Service (DHS), Epidemiology and Disease Control Division (EDCD).      
Am J Trop Med Hyg. 2013 April 3; 88(4): 677–680. doi: 10.4269/ajtmh.12-0436
 Abstract of the article
"We report on the changing epidemiology of two important flaviviruses in Nepal: Japanese encephalitis (JE) and dengue viruses. Morbidity and mortality in Nepal is in the thousands since JE was introduced in 1978. Nepal launched an extensive laboratory-based JE surveillance in 2004. Nepal experienced a remarkable reduction in disease burden after mass immunizations from 2005 to 2010, when 2,040 JE infections and 205 JE-related deaths were confirmed. With its emergence in 2006, dengue has become a significant challenge in the country, highlighted by a sudden outbreak in 2010 that resulted in 359 confirmed dengue infections. Currently, both viruses cocirculate in Nepal. Here, we document the remarkable expansion of dengue in Nepal, which urgently requires national surveillance to refine the burden and make recommendations regarding control and prevention programs. We believe that the use of existing JE surveillance network for integrated dengue surveillance may represent the most appropriate alternative."

Jul 1, 2013

Viral Sovereignty

It is definitely a dangerous idea, when a government's health minister holds an opinion like "Viral Sovereignty", at the backdrop of Global Human - Avian Influenzae scare and its pandemic potential. I hope that all those who hold such an idea change their opinion for the shake of humankind.

Please read:

Mobile Apps. for public health profesionals

CDC has a number of mobile apps available on a variety of platforms, iOS, Android and Microsoft Windows 8. Download CDC's free mobile apps to your device today.

Jun 30, 2013

Immunolgy and microbiota

Nature Immunology
July 2013, Volume 14 No 7 pp645-763

"Interactions between the immune system and microbiota influence local and systemic immune homeostasis. Nature Immunology presents a series of specially commissioned articles that discuss the reciprocal regulation between the host immune system and commensal microbiota, the dynamic interactions between commensals and pathogens, and emerging information on how resident viruses might influence immune homeostasis. The web focus also includes highlights of recent research in this area."

Anuj in Himalayas

Hi i am connecting disqus with my blog for healthy interaction and open dialogue