Strengthening Of Surveillance Research Articles

Cholera and diarrheal diseases in Cuamba District, Niassa Province, Mozambique: Systematic healthcare facility-based surveillance strengthening, characteristics of suspected cholera and diarrheal patients, and incidence of diarrheal diseases.

Mozambique is one of the countries in Africa that is continuously at risk of cholera outbreaks due to poor sanitation, hygiene, and limited access to potable water in some districts. The Mozambique Cholera Prevention and Surveillance (MOCA) project was implemented in Cuamba District, Niassa Province to prevent and control cholera outbreaks through a preemptive cholera vaccination, strengthened surveillance system for cholera and diarrheal diseases, and better understanding of cholera-related healthcare seeking behavior of local populations, which may further guide the national cholera control and prevention strategies. This article presents the surveillance component of the MOCA project. A prospective healthcare facility (HCF)-based surveillance of cholera and diarrheal disease was conducted in six HCFs in the District of Cuamba from March 2019 to December 2020. A systematic surveillance procedure has been put in place with capacity building in selected sentinel HCFs and a basic microbiology laboratory established on-site. Patients presenting with suspected cholera or other diarrheal symptoms were eligible for enrollment. Clinical data and rectal swab samples were collected for laboratory confirmation of Vibrio Cholerae and other pathogens. A total of 419 eligible patients from six HCFs were enrolled. The median age was 19.8 years with a similar age distribution between sentinel sites. The majority were patients who exhibited diarrhea symptoms not suspected of cholera (88.8%; n = 410). Among those, 59.2% (210/397) were female and 59.9% (235/392) were 15 years and above. There were 2 cholera cases, coming outside of the catchment area. The incidence of diarrheal diseases ranged from 40-103 per 100,000 population. No Vibrio cholerae was isolated among surveillance catchment population and Escherichia coli spp. (82/277; 29.6%) was the most common pathogen isolated. Efforts were made to strengthen the systematic surveillance of suspected cholera with standardised patient screening, enrolment, and diagnostics. The first basic microbiology laboratory in Niassa Province established in Cuamba District under the MOCA project needs to be integrated into the national network of laboratories for sustainability. No reports of laboratory confirmed cholera cases from the surveillance catchment area may be highly related to the pre-emptive oral cholera vaccine (OCV) mass vaccination campaign conducted in 2018 and the use of drugs by local populations prior to visiting the sentinel HCFs. Continued systematic cholera surveillance is needed to closely monitor the cholera endemicity and epidemics, and further evaluate the long-term impact of this vaccination. High incidence of diarrheal illnesses needs to be addressed with improved water, sanitation, and hygiene (WaSH) conditions in Cuamba District. Efforts integrated with the prioritization of prevention measures are fundamental for the control of cholera in the country.

Lessons learned for surveillance system strengthening through capacity building and partnership engagement in post-Ebola Guinea, 2015-2019.

The 2014–2016 Ebola outbreak in Guinea revealed systematic weaknesses in the existing disease surveillance system, which contributed to delayed detection, underreporting of cases, widespread transmission in Guinea and cross-border transmission to neighboring Sierra Leone and Liberia, leading to the largest Ebola epidemic ever recorded. Efforts to understand the epidemic's scale and distribution were hindered by problems with data completeness, accuracy, and reliability. In 2017, recognizing the importance and usefulness of surveillance data in making evidence-based decisions for the control of epidemic-prone diseases, the Guinean Ministry of Health (MoH) included surveillance strengthening as a priority activity in their post-Ebola transition plan and requested the support of partners to attain its objectives. The U.S. Centers for Disease Control and Prevention (US CDC) and four of its implementing partners—International Medical Corps, the International Organization for Migration, RTI International, and the World Health Organization—worked in collaboration with the Government of Guinea to strengthen the country's surveillance capacity, in alignment with the Global Health Security Agenda and International Health Regulations 2005 objectives for surveillance and reporting. This paper describes the main surveillance activities supported by US CDC and its partners between 2015 and 2019 and provides information on the strategies used and the impact of activities. It also discusses lessons learned for building sustainable capacity and infrastructure for disease surveillance and reporting in similar resource-limited settings.

Has COVID-19 suppressed dengue transmission in Nepal?

Following the report of the first COVID-19 case in Nepal on 23 January 2020, three major waves were documented between 2020 and 2021. By the end of July 2022, 986 596 cases of confirmed COVID-19 and 11 967 deaths had been reported and 70.5% of the population had received at least two doses of a COVID-19 vaccine. Prior to the pandemic, a large dengue virus (DENV) epidemic affected 68 out of 77 districts, with 17 932 cases and six deaths recorded in 2019. In contrast, the country's Epidemiology and Disease Control Division reported 530 and 540 dengue cases in the pandemic period (2020 and 2021), respectively. Furthermore, Kathmandu reported just 63 dengue cases during 2020 and 2021, significantly lower than the 1463 cases reported in 2019. Serological assay showed 3.2% positivity rates for anti-dengue immunoglobulin M antibodies during the pandemic period, contrasting with 26.9-40% prior to it. Real-time polymerase chain reaction for DENV showed a 0.5% positive rate during the COVID-19 pandemic which is far lower than the 57.0% recorded in 2019. Continuing analyses of dengue incidence and further strengthening of surveillance and collaboration at the regional and international levels are required to fully understand whether the reduction in dengue incidence/transmission were caused by movement restrictions during the COVID-19 pandemic.

The cost of care for children hospitalised with Invasive Group A Streptococcal Disease in Australia

BackgroundInvasive Group A Streptococcal (iGAS) disease exerts an important burden among Australian children. No Australian hospitalisation cost estimates for treating children with iGAS disease exist, so the financial impact of this condition is unknown.AimTo determine the minimum annual healthcare cost for children (< 18 years) hospitalised with iGAS disease in Australia from a healthcare sector perspective.MethodsA cost analysis including children with laboratory-confirmed iGAS disease hospitalised at the Royal Children’s Hospital (Victoria, Australia; July 2016 to June 2019) was performed. Results were extrapolated against the national minimum iGAS disease incidence. This analysis included healthcare cost from the 7 days prior to the index admission via General Practitioner (GP) and Emergency Department (ED) consultations; the index admission itself; and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations. Additional extrapolations of national cost data by age group, Aboriginal and Torres Strait Islander ethnicity and jurisdiction were performed.ResultsOf the 65 included children, 35% (n = 23) were female, 5% (n = 3) were Aboriginal and Torres Strait Islander, and the average age was 4.4 years (SD 4.6; 65% aged 0–4). The iGAS disease related healthcare cost per child was $67,799 (SD $92,410). These costs were distributed across the 7 days prior to the index admission via GP and ED consultations (0.2 and 1.1% of total costs, respectively), the index admission itself (88.7% of the total costs); and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations (5.3, 4.5 and 0.1% of total costs, respectively). Based on a national minimum paediatric incidence estimation of 1.63 per 100,000 children aged < 18 (95%CI: 1.11–2.32), the total annual healthcare cost for children with iGAS in 2019 was $6,200,862. The financial burden reflects the overrepresentation of Aboriginal and Torres Strait Islander people in the occurrence of iGAS disease. Costs were concentrated among children aged 0–4 years (62%).ConclusionAs these cost estimations were based on a minimum incidence, true costs may be higher. Strengthening of surveillance and control of iGAS disease, including a mandate for national notification of iGAS disease, is warranted.Trial registrationThe current study is a part of ongoing iGAS surveillance work across seven paediatric health services in Australia. As this is not a clinical trial, it has not undergone trial registration.

Costing electronic private sector malaria surveillance in the Greater Mekong Subregion

BackgroundPrivate sector malaria programmes contribute to government-led malaria elimination strategies in Cambodia, Lao PDR, and Myanmar by increasing access to quality malaria services and surveillance data. However, reporting from private sector providers remains suboptimal in many settings. To support surveillance strengthening for elimination, a key programme strategy is to introduce electronic surveillance tools and systems to integrate private sector data with national systems, and enhance the use of data for decision-making. During 2013–2017, an electronic surveillance system based on open source software, District Health Information System 2 (DHIS2), was implemented as part of a private sector malaria case management and surveillance programme. The electronic surveillance system covered 16,000 private providers in Myanmar (electronic reporting conducted by 200 field officers with tablets), 710 in Cambodia (585 providers reporting through mobile app), and 432 in Laos (250 providers reporting through mobile app).MethodsThe purpose of the study was to document the costs of introducing electronic surveillance systems and mobile reporting solutions in Cambodia, Lao PDR, and Myanmar, comparing the cost in different operational settings, the cost of introduction and maintenance over time, and assessing the affordability and financial sustainability of electronic surveillance. The data collection methods included extracting data from PSI’s financial and operational records, collecting data on prices and quantities of resources used, and interviewing key informants in each setting. The costing study used an ingredients-based approach and estimated both financial and economic costs.ResultsAnnual economic costs of electronic surveillance systems were $152,805 in Laos, $263,224 in Cambodia, and $1,310,912 in Myanmar. The annual economic cost per private provider surveilled was $82 in Myanmar, $371 in Cambodia, and $354 in Laos. Cost drivers varied depending on operational settings and number of private sector outlets covered in each country; whether purchased or personal mobile devices were used; and whether electronic (mobile) reporting was introduced at provider level or among field officers who support multiple providers for case reporting.ConclusionThe study found that electronic surveillance comprises about 0.5–1.5% of national malaria strategic plan cost and 7–21% of surveillance budgets and deemed to be affordable and financially sustainable.

Antimicrobial Use, Residues, Resistance and Governance in the Food and Agriculture Sectors, Tanzania.

All infections are potentially curable as long as the etiological agents are susceptible to antimicrobials. The increased rate at which antimicrobials are becoming ineffective is a global health risk of increasing concern that threatens withdrawal of beneficial antimicrobials for disease control. The increased demand for food of animal origin, in particular eggs, meat and milk has led to intensification and commercial production systems where excessive use and misuse of antimicrobials may prevail. Antimicrobials, handled and used by farmers and animal attendants with no formal education, may be predisposed to incorrect dosages, misuse, incorrect applications and non-adherence to withdrawal periods. This study was conducted to assess the regulatory roles and governance of antimicrobials, establish the pattern and extent of their use, evaluate the antimicrobial residues and resistance in the food animals and crop agriculture value chains, and relate these findings to existing strategies in place for combating the emergence of antimicrobial resistance in Tanzania. A multimethod approach (desk review, field study and interviews) was used. Relevant establishments were also visited. High levels of resistance to penicillin G, chloramphenicol, streptomycin and oxytetracycline have been reported, especially for Actinobacter pyogenes, Staphylococcus hyicus, Staphylococcus intermedius and Staphylococcus aureus from dairy cattle with mastitis and in humans. Similar trends were found in poultry where eggs and meat are contaminated with Escherichia coli strains resistant to amoxicillin + clavulanate, sulphamethoxazole and neomycin. An increasing trend of emerging multidrug resistant E. coli, Klebsiella pneumoniae, Staphylococcus aureus and Salmonella was also found in food animals. An increase in methicillin resistant Staphlococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL) in the livestock sector in Tanzania have been reported. The pathogens isolated in animals were resistant to ampicillin, augmentin, gentamicin, co-trimoxazole, tetracycline, amoxicillin, streptomycin, nalidixic acid, azithromycin, chloramphenicol, tylosin, erythromycin, cefuroxime, norfloxacin and ciprofloxacin. An increased usage of antimicrobials for prophylaxis, and therapeutics against pathogens and for growth promotion in livestock, aquaculture and crop production were observed. A One Health strategic approach is advocated to combat antimicrobial resistance (AMR) in the food and agriculture sectors in Tanzania. Practical recommendations include (a) legislation review and implementation; (b) antimicrobial use (AMU), AMR and antimicrobial residue (AR) awareness and advocacy among stakeholders along the value chain; (c) strengthening of surveillance and monitoring programs for AMU, AMR and AR; (d) enhanced development and use of rapid and innovative diagnostic tests and the promotion of biosecurity principles; and (e) good husbandry practices. The utilization of this information to improve public health policies and reduce the burden of AMR will be beneficial.

Caracterização epidemiológica da hanseníase nas regiões Norte e Nordeste do Brasil

Objetivo: avaliar o perfil epidemiológico da hanseníase nas regiões Norte e Nordeste do Brasil entre os anos de 2015 e 2018. Metodologia: trata-se de uma pesquisa epidemiológica descritiva, retrospectiva e com abordagem quantitativa. Os dados mostram a caracterização epidemiológica quanto ao sexo, faixa etária e classificação operacional dos casos confirmados de hanseníase nas regiões Norte e Nordeste do Brasil entre os anos de 2015 e 2018. Resultados: a avaliação dos dados epidemiológicos apontou o total de 63.051 casos diagnosticados de hanseníase nas regiões Norte e Nordeste no período analisado. Ao investigar o perfil dos casos confirmados de hanseníase, observou-se que 56% ocorreram no sexo masculino, a faixa etária mais acometida foi de 35 a 49 anos, equivalente a 28% dos casos, seguida dos indivíduos de 50 a 64 anos (25%) e de 20 a 34 anos (20%) e a classificação operacional mais incidente foi a multibacilar (74%). Conclusão: os achados refletem a necessidade de capacitação contínua dos profissionais de saúde que prestam assistência aos pacientes com hanseníase e o fortalecimento das ações de vigilância e controle epidemiológico.

An investment case for maternal and neonatal tetanus elimination

IntroductionGlobally, 13 countries have yet to eliminate maternal and neonatal tetanus. While efforts have improved access to tetanus toxoid containing vaccines (TTCVs) and increased clean delivery practices, reaching elimination targets (<1 case of neonatal tetanus per 1000 live births per district per year) may require significant resources to reach the remaining high risk and hard-to-reach districts. MethodsWe estimated the cost to achieve maternal and neonatal tetanus elimination (MNTE) in three years in the remaining 13 countries: Afghanistan, Angola, Central African Republic, Democratic Republic of the Congo, Guinea, Mali, Nigeria, Pakistan, Papua New Guinea, Somalia, South Sudan, Sudan, and Yemen. Costs were estimated for: (1) vaccination campaigns using standard TTCVs and TT-Uniject™ targeting women of reproductive age in high risk areas, (2) additional vaccinations delivered to pregnant women at antenatal care (ANC) clinics, (3) clean delivery and umbilical cord care promotion, (4) neonatal tetanus surveillance strengthening, and (5) validation activities. We forecasted the averted mortality to assess the cost-effectiveness of achieving MNTE. ResultsIt will cost an estimated US$197.7 million to realize MNTE over three years. These costs include $161.4 million for vaccination campaigns, $6.1 million for routine vaccination during ANC, $23.3 million for promotion of clean delivery practices, $4 million for surveillance, and $3 million for validation of MNTE. Achieving MNTE will avert approximately 70,000 neonatal deaths over ten years of vaccine protection, resulting in approximately 4.4 million life years gained. It will cost $2,900 per death averted and $45 per life year gained. ConclusionMaternal and neonatal tetanus can be eliminated with significant financial investment, high prioritization, and strong political will. While substantial costs must be incurred to reach hard-to-reach populations, MNTE should be accomplished as a matter of health equity, and will significantly contribute to reaching the United Nations' Sustainable Development Goals.

Study of genetic diversity, biofilm formation, and detection of Carbapenemase, MBL, ESBL, and tetracycline resistance genes in multidrug-resistant Acinetobacter baumannii isolated from burn wound infections in Iran

BackgroundAntimicrobial resistance in multidrug-resistant Acinetobacter baumannii (MDR-AB) isolated from burn wound infections is a major concern in intensive care or burns units worldwide, and molecular studies are considered critical strategies for control of MDR-AB outbreaks in this regard. Thus, in this study, antibiotic resistance, biofilm-forming ability, molecular epidemiology of MDR A. baumannii strains recovered from patients with burns were investigated in three major hospital centers of Iran.MethodsIn this cross-sectional research, 163 non-repetitive A. baumannii strains were tested for susceptibility to antimicrobial agents. Polymerase chain reaction (PCR) was performed to characterize ambler classes A, B, and D β-lactamases, ISAba1 and integrons, biofilm formation was also investigated. Clonal relatedness was analyzed using Pulsed-Field Gel Electrophoresis (PFGE).ResultsAmong 163 A. baumannii strains collected, 94.5% of them were Carbapenem-Non-Susceptible A. baumannii (CNSAB) and also 90.1 and 52.2% of them were Metallo-β-Lactamases (MBL) and Extended-Spectrum β-Lactamases (ESBL) producing isolates, respectively. Colistin and polymyxin B exhibited excellent activity against CNSAB strains. High prevalence of blaOXA − 23-like (85.1%), blaVIM (60.5%), blaPER − 1 (42.3%), tetB (67.8%), and Class 1 integrons (65.6%) were identified in CNSAB strains. ISAba1 element was associated with 42 (25.8%) and 129 (98.5%) of blaOXA-51-like and blaOXA-23-like genes, respectively. 6 clusters with the ability to form strong biofilms were found to be dominant and endemic in our entire areas.ConclusionsResults of the present study show that antimicrobial resistance in CNSAB isolates from burn wound infections in monitored hospitals in Iran is multifactorial, and also findings of the study suggested that local antibiotic prescription policies should be regularly reviewed, and efficient infection control measures should be observed. Therefore, further strengthening of surveillance of antimicrobial resistance is urgently needed in these regions.

A38 Genomic epidemiology quantifies gaps in Aedes-borne virus transmission in the Americas

The rapid spread and severity of pathogens, such as Zika (ZIKV) and Chikungunya (CHIKV) viruses in the Americas, demonstrate the need for a better understanding of when and where outbreaks emerge. Sequence evolution of these viral pathogens occurs simultaneously with geographic spread, which allows phylodynamic processes to be recovered from genomic data. Here, we used time-calibrated phylogeographic analyses implemented in a Bayesian phylogenetic framework to characterize the date of introduction of ZIKV, CHIKV, dengue, and yellow fever viruses in different geographic regions of the Americas. To estimate ‘surveillance gaps’, we compared the estimated dates of introduction of these pathogens to the first confirmations of virus circulation in the region. Datasets included all publicly available geo-referenced and time-stamped genetic data from the Americas. A series of environmental and ecological covariates will be tested to infer what factors are associated with the delayed detection of arbovirus transmission in each geographic region. These results will provide important information on where to concentrate surveillance strengthening measures in order to prevent future mosquito-borne virus epidemics.

ADAPTATION MECHANISMS OF 14-YEAR ADOLESCENTS LIVING IN HIGH AND MIDDLE LATITUDES OF THE EUROPEAN PART OF RUSSIA TO TECHNOGENIC POLLUTION OF SETTLEMENT ZONES (LITERATURE REVIEW)

The review of literature data on adolescents' adaptation to a high level of technogenic pollution, taking into account the geographic latitude of the residence was made. For this purpose, we compared physical development indices, physical health level, as well as the state of the oxygen transport system and the immune system of adolescents living since birth in the middle latitudes or in the European North in conditions of high or low levels of technogenic pollution. The results of the authors' own research were presented. The surveyed 14-year-olds (girls and boys) were divided into four groups, living in four settlements (Sedyu, Yaransk, Ukhta and Kirov) since birth and meeting the specified conditions. It was stated that adaptation mechanisms of 14-year-olds to the high level of technogenic pollution of residential areas were strengthening of erythropoiesis and immune surveillance, and payment for adaptation was a change in physical development rates, a decrease in physical health level and decrease in the monocyte content. It was shown that the mechanism of adaptation of 14-year-olds for residence in the European North in conditions of low level of technogenic pollution consisted in immune surveillance strengthening, and the payment for adaptation was the reduction of red blood cells.

FAKTOR-FAKTOR RISIKO YANG BERHUBUNGAN DENGAN KEJADIAN LUAR BIASA DIFTERI DI NEGARA BERKEMBANG

Latar Belakang: Difteri adalah salah satu penyakit yang dapat dicegah oleh vaksin. Namun dalam sepuluhtahun terakhir dilaporkan terjadi peningkatan insiden difteri yang memicu terjadinya kejadian luar biasa dinegara berkembang. Penelitian ini bertujuan untuk mengetahui faktor risiko yang berhubungan dengantingginya insiden difteri di negara berkembang.Metode: Metode penelitian yang digunakan yaitu Preferred Reporting Items for Systematic Reviews andMeta-Analyses (PRISMA). Literatur yang sesuai ditelusuri dari database elektronik Pubmed, Proquest,Science Direct, Scopus, and EBSCO. Kriteria inklusi yang digunakan yaitu kasus terjadi di negaraberkembang, hasil penelitian berhubungan dengan faktor risiko terkait kejadian luar biasa difteri, dan desainstudi penelitian adalah studi observasional.Hasil Penelitian: Diperoleh 10 artikel penelitian yang berlokasi di India, Thailand, Lao PDR, Brazil,Dominican Republic, South Africa, dan Nigeria. Cakupan vaksinasi yang rendah, status vaksinasi tidaklengkap atau tidak di vaksinasi sama sekali serta akses yang buruk ke layanan perawatan kesehatan merupakanfaktor utama yang terkait langsung dengan terjadinya kejadian luar biasa difteri di sebagian besar negara.Faktor sistem pelayanan kesehatan seperti ketersediaan anti-toksin Difteri serta kemampuan tenaga kesehatandalam diagnosis dini dan penanganan segera juga memainkan peran penting dalam mengendalikan kejadianluar biasa Difteri. Hasil studi juga menyoroti peningkatan risiko infeksi pada orang dewasa karenamemudarnya tingkat antibodi di masa dewasa.Kesimpulan: Rendahnya cakupan imunisasi, sulitnya akses pada pelayanan imunisasi, dan rendahnya tingkatpendapatan merupakan faktor yang memicu timbulnya kejadian luar biasa difteri di negara berkembang.Penguatan surveilans dan sistem pelayanan kesehatan sangat diperlukan untuk mengatasi kejadian luar biasadifteri.Kata kunci: Kejadian luar biasa, difteri, vaksinasi, faktor risiko

Who Lyon Office: Supporting countries in achieving the international health regulations (2005) core capacities for public health surveillance

Introduction The International Health Regulations (IHR) are a legally binding agreement revised in 2005 and endorsed by 196 countries. Through the IHR, countries obliged themselves to develop, strengthen and maintain a set of minimum core capacities for surveillance and response at all levels of the country (i.e. local, intermediate, national level). These capacities include: the detection of any unexpected public health event at all times and in all areas of the country; the immediate reporting of these events to the upper level; the immediate implementation of preliminary control measures; the notification to the World Health Organization (WHO) of any potential public health emergency of international concern. These requirements provide a paradigm change in national public health surveillance, with an emphasis put in the early detection and response to any type of public health event. Global guidance and tools are useful to support countries in achieving the IHR core capacities for surveillance and response. Methods Established in 2001, the WHO Lyon Office is part of the WHO Health Emergencies Programme and aims to support countries in achieving the IHR core capacities. The Laboratory and Surveillance Strengthening team is in charge of developing global guidance and tools and providing support to priority countries for public health surveillance strengthening. Results Over the years, the WHO Lyon office has developed guides, training materials, and provided financial and technical assistance to public health surveillance systems in resource-limited countries. To strengthen the early detection and response function of the public health surveillance system, WHO has published two guides: “Implementation of Early warning and response with a focus on event-based surveillance” and “Coordinated public health surveillance between points of entry and national health surveillance systems”. An implementation toolbox is available for the later guide to support countries in assessing their existing capacities, developing a tailored action plan, and implementing the action plan for capacity strengthening. An electronic tool (Argus) has been developed to facilitate the reporting and management of public health surveillance data in respect of the integrated Disease Surveillance and Response technical guidelines, the WHO Regional Office for Africa surveillance strategy. A systematic literature review has been performed to understand how to better involve the community in event detection and prepare a roadmap to strengthen so-called community-based surveillance. Additional topics of interest to achieve IHR core capacities for public health surveillance have been identified and will lead to additional activities. Conclusions In many countries, achievement of the IHR core capacities for surveillance and response needs appropriate global guidance and tools, but also international cooperation among all stakeholders to ensure priority needs are supported first and in a coherent manner. The presentation of the WHO Lyon Office activities for public health surveillance strengthening may be the occasion to highlight priority needs and create new partnerships.

Surveillance to Track Progress Toward Polio Eradication - Worldwide, 2016-2017.

Global efforts to eradicate polio began in 1988, and four of the six World Health Organization (WHO) regions currently have achieved poliofree certification. Within the remaining two regions with endemic poliomyelitis (African and Eastern Mediterranean), Afghanistan, Nigeria, and Pakistan have never interrupted transmission of wild poliovirus (WPV). The primary means of detecting poliovirus transmission is surveillance for acute flaccid paralysis (AFP) among children aged <15 years, combined with collection and testing of stool specimens for detection of WPV and vaccine-derived polioviruses (VDPVs)* in WHO-accredited laboratories within the Global Polio Laboratory Network (GPLN) (1,2). AFP surveillance is supplemented by environmental surveillance for polioviruses in sewage from selected locations. Genomic sequencing of isolated polioviruses enables the mapping of transmission by time and place, assessment of potential gaps in surveillance, and identification of the emergence of VDPVs (3). This report presents poliovirus surveillance data from 2016-2017, with particular focus on six countries in the Eastern Mediterranean Region (EMR) and 20 countries in the African Region (AFR) that reported WPV or circulating VDPVs (cVDPVs) during 2011-2017. Included in the 20 AFR countries are the three most affected by the 2014-2015 Ebola virus disease (Ebola) outbreak (Guinea, Liberia, and Sierra Leone), even though only one (Guinea) reported WPV or cVDPVs during the surveillance period. During 2017, a total of 14 (70%) of the 20 AFR countries and five (83%) of the six EMR countries met both surveillance quality indicators at the national level; however, provincial-level variation was seen. Surveillance strengthening activities are needed in specific countries of these regions to provide evidence supporting ultimate certification of the interruption of poliovirus circulation.

Behavioral, biological or systemic changes? Impact of SMS-based surveillance strengthening in a low-resource setting

Behavioral, biological or systemic changes? Impact of SMS-based surveillance strengthening in a low-resource setting

Supporting surveillance capacity for antimicrobial resistance: Laboratory capacity strengthening for drug resistant infections in low and middle income countries

Development of antimicrobial resistance (AMR) threatens our ability to treat common and life threatening infections. Identifying the emergence of AMR requires strengthening of surveillance for AMR, particularly in low and middle-income countries (LMICs) where the burden of infection is highest and health systems are least able to respond. This work aimed, through a combination of desk-based investigation, discussion with colleagues worldwide, and visits to three contrasting countries (Ethiopia, Malawi and Vietnam), to map and compare existing models and surveillance systems for AMR, to examine what worked and what did not work. Current capacity for AMR surveillance varies in LMICs, but and systems in development are focussed on laboratory surveillance. This approach limits understanding of AMR and the extent to which laboratory results can inform local, national and international public health policy. An integrated model, combining clinical, laboratory and demographic surveillance in sentinel sites is more informative and costs for clinical and demographic surveillance are proportionally much lower. The speed and extent to which AMR surveillance can be strengthened depends on the functioning of the health system, and the resources available. Where there is existing laboratory capacity, it may be possible to develop 5-20 sentinel sites with a long term view of establishing comprehensive surveillance; but where health systems are weaker and laboratory infrastructure less developed, available expertise and resources may limit this to 1-2 sentinel sites. Prioritising core functions, such as automated blood cultures, reduces investment at each site. Expertise to support AMR surveillance in LMICs may come from a variety of international, or national, institutions. It is important that these organisations collaborate to support the health systems on which AMR surveillance is built, as well as improving technical capacity specifically relating to AMR surveillance. Strong collaborations, and leadership, drive successful AMR surveillance systems across countries and contexts.

Supporting surveillance capacity for antimicrobial resistance: Laboratory capacity strengthening for drug resistant infections in low and middle income countries.

Development of antimicrobial resistance (AMR) threatens our ability to treat common and life threatening infections. Identifying the emergence of AMR requires strengthening of surveillance for AMR, particularly in low and middle-income countries (LMICs) where the burden of infection is highest and health systems are least able to respond. This work aimed, through a combination of desk-based investigation, discussion with colleagues worldwide, and visits to three contrasting countries (Ethiopia, Malawi and Vietnam), to map and compare existing models and surveillance systems for AMR, to examine what worked and what did not work. Current capacity for AMR surveillance varies in LMICs, but and systems in development are focussed on laboratory surveillance. This approach limits understanding of AMR and the extent to which laboratory results can inform local, national and international public health policy. An integrated model, combining clinical, laboratory and demographic surveillance in sentinel sites is more informative and costs for clinical and demographic surveillance are proportionally much lower. The speed and extent to which AMR surveillance can be strengthened depends on the functioning of the health system, and the resources available. Where there is existing laboratory capacity, it may be possible to develop 5-20 sentinel sites with a long term view of establishing comprehensive surveillance; but where health systems are weaker and laboratory infrastructure less developed, available expertise and resources may limit this to 1-2 sentinel sites. Prioritising core functions, such as automated blood cultures, reduces investment at each site. Expertise to support AMR surveillance in LMICs may come from a variety of international, or national, institutions. It is important that these organisations collaborate to support the health systems on which AMR surveillance is built, as well as improving technical capacity specifically relating to AMR surveillance. Strong collaborations, and leadership, drive successful AMR surveillance systems across countries and contexts.

A descentralização da Vigilância em Saúde em Minas Gerais: caracterização dos serviços municipais, 2014

Introduction : The Health Surveillance Strengthening Project implemented in 2012 in Minas Gerais -subsidized by a local diagnosis- aimed at decentralizing Health Surveillance. Objectives : To characterizes the local Health Surveillance services in the state of Minas Gerais in 2014. Method : Descriptive study that analyzed 527 (62%) out of a total of 853 counties. The common variables to the Health Surveillance areas were instruments of management, financing, professional category, qualification and information system. Specific variables to the Health Surveillance areas were characterized infrastructure, reference services and actions. Frequencies, medians, interquartile differences and Spearman’s coefficient (p< 0.05) were analyzed. Results : An association among mana-gement tools, availability of professional categories, information system and population size (p<0.001) was observed. Insufficient infrastructure in the Sanitary and Environmental Surveillance and predominance of programmatic actions against monitoring actions were observed. Conclusions : The challenge of Health Surveillance demands confrontations in the field of management, practices and financing.

Malaria surveillance and use of evidence in planning and decision making in Kilosa District, Tanzania

Background: Since 2001, Tanzania has been making concerted efforts to strengthen its Integrated Disease Surveillance and Response system. In this system, malaria is one of the priority diseases that are to be reported monthly. The objectives of this study were to (i) assess malaria surveillance system at facility and district levels to identify key barriers, constraints and priority actions for malaria surveillance strengthening; and (ii) to explore the use of evidence in health planning and decision making at these levels.Methods: The study was carried in Kilosa District in central Tanzania, during October 2012 and involved health facility workers and members of the district health management team. The existing information system on malaria was evaluated using a structured questionnaire and check list. Data collection also involved direct observations of reporting and processing, assessment of report forms and reports of processed data.Results: Three district officials and 17 health facility workers from both public and private health facilities were interviewed. Of the 17 informants, 15 were familiar with disease surveillance functions. A good percentage (47%, 8/17) received training on disease surveillance during the previous two years. Public transport and motorcycles were the main means of reporting epidemiological information from facility to district level. Most of the health facilities (93%, 14/15) faced difficulties in submitting reports due to lack of resources and feedback from the district authority. Analysis of malaria data was reported in 52.9% (9/17) of the facilities, but limited to malaria incidence per age groups. Challenges in data analysis included unavailability of compilation books; lack of computers; poor data storage; incomplete recording; lack of adequate skills for data analysis; and increase in workloads. Data at both facility and district levels were mainly used for quantification and forecasting of drug requirements.Conclusion: Malaria surveillance system in Kilosa district is weak and utilization of evidence for planning and decision making is poor. Capacity strengthening on data analysis and utilization should be given a priority at both facility and district levels of the health systems in Tanzania.

Experiences From Developing and Upgrading a Web-Based Surveillance System for Malaria Elimination in Cambodia.

Strengthening the surveillance component is key toward achieving country-wide malaria elimination in Cambodia. A Web-based upgraded malaria information system (MIS) was deemed to essentially act as the central component for surveillance strengthening. New functionality (eg, data visualization) and operational (eg, data quality) attributes of the system received particular attention. However, building from the lessons learned in previous systems’ developments, other aspects unique to Cambodia were considered to be equally important; for instance, feasibility issues, particularly at the field level (eg, user acceptability at various health levels), and sustainability needs (eg, long-term system flexibility). The Cambodian process of identifying the essential changes and critical attributes for this new information system can provide a model for other countries at various stages of the disease control and elimination continuum. Sharing these experiences not only facilitates the establishment of “best practices” but also accelerates global and regional malaria elimination efforts. In this article, Cambodia’s experience in developing and upgrading its MIS to remain responsive to country-specific needs demonstrates the necessity for considering functionality, operationalization, feasibility, and sustainability of an information system in the context of malaria elimination.