Integrated Disease Surveillance and

Response (IDSR) Training

Third Edition

Module 2
Report priority diseases, conditions and
events

1
 Outline of presentation
• The purpose of the module
• Learning Objectives
• Importance of reporting priority diseases, conditions and
events to the next level
• Report summary information for priority diseases, conditions
and events
• IDSR Reporting Tools: Paper-based and Electronic
• Improve routine reporting practices
• Summary
• Practice exercises
 The purpose of the module

• Provide guidance on how to report priority diseases,

conditions and events through all the levels of the
health systems.
• This module focuses on requirements for immediate
reporting with case-based data and regular (weekly,
monthly or quarterly) reporting of summary data.
• It introduces all the required IDSR reporting tools
both paper and electronic.
 Learning Objectives
Participant should be able to:
• Immediately report information about acute epidemic-prone
diseases or events.
• Immediately report information about diseases with the
potential to be public health events of national or international
concern.
• Regularly report summary disease information to the next level.
• Understand the use of electronic tools to facilitate timely
transmission of data.
• Review the flow of data to improve timely reporting in your area.
Importance of reporting priority diseases, conditions
and events to the next level-1

1. Immediate reporting (within 24 hours) of case based

information allows for early detection of public health
events.
2. Weekly aggregated reporting provides data for monitoring
trends of diseases, conditions or events to early detect
outbreaks.
3. Monthly/quarterly aggregated reporting provides data for
monitoring the health status of the population and impact of
disease specific programs, and for planning allocation of
resources.
Importance of reporting priority diseases, conditions
and events to the next level-2

4. Reliable reporting provides information for surveillance officers

from all levels and key decision makers to:
• Identify emerging problems and plan appropriate
responses.
• Take action in a timely way.
• Monitor disease trends in the area.
• Evaluate the effectiveness of the response.
 Immediately report information about acute
epidemic-prone diseases, conditions, events-1

• Immediate reporting means:

 Information about a disease, condition, event is reported
to the next level as soon as suspected.
 E.g. PHEIC, or required by IHR 2005.
• Information that is reported immediately, will generate an
alert and initiate case-based reporting system:
 E.g. single case or clusters of reportable events.
 Immediately report information about acute
epidemic-prone diseases, conditions, events-2

For events reported at PoE:

• Information is reported to the next level as well as
simultaneously to the IHR National Focal Point (NFP).
 Immediately report information about acute
epidemic-prone diseases, conditions, events-3

• Complete Case-based investigation form: preliminary

investigation of the suspected case.
• Collect Patient’s information on:
 Identification and demography.
 Geographical location.
 Date of onset of symptoms.
 Vaccination history.
 any relevant risk factors.
 Immediately report information about acute
epidemic-prone diseases, conditions, events-4

• Collect Patient’s information on:

 Contacts to the case(s).
 History of travel.
 History of exposure (e.g. Animal).
 History of vaccination.
 Laboratory results (if available)
 Framework of reporting immediate notifiable
events/disease

Turn to Section 2, Annex 2B of the 3rd Edition IDSR

Technical Guidelines for the Algorithm of reporting
immediate notifiable diseases, conditions and events
 Algorithm
of
reporting
immediate
notifiable
diseases/
conditions/
events

12
 Methods of immediate case-based reporting-1

• Make the initial report by the fastest means possible:

 E.g. Telephone, e-mail, radiophone, text message,
WhatsApp.
• HF notify DHMT immediately.
• Follow up initial verbal report with a written report using
IDSR case-based reporting form.
 Methods of immediate case-based reporting-2

• Complete and submit the form electronically to the next level

(where possible).
• If a laboratory specimen is requested:
 Ensure the patient’s identifying information on the
specimen, lab investigation form and case-based
reporting form all match.
Procedure for Notifying a potential public health emergency of
international concern (PHEIC) under IHR 2005

• If a PHEIC is detected at the District:

 District Surveillance Focal Person should report to the
National IHR Focal Point immediately using fastest
means.
 Same time notify the Regional/Provincial Surveillance
Officer.
• If a PHEIC is detected at Point of Entry:
 immediate reporting should also be made to the National
IHR Focal Point, while at the same time notifying the
district and region or province.
 Use of thresholds to initiate response-1

• Two types of thresholds used to initiate response:

 Alert threshold
 Action (epidemic) threshold
• Trained health care personnel should always determine
and monitor the thresholds
Thresholds for epidemic prone diseases, conditions or
events are shown in Section 11 of the 3rd Edition IDSR
Technical Guidelines
 Thresholds: situations or number of cases that will trigger a
response.

 The action (epidemic) threshold for bacterial meningitis in countries of

the meningitis belt is 10 suspected cases per 100 000 inhabitants per
week, and the alert threshold is 3 suspected cases per 100 000
inhabitants per week.
 The epidemic threshold for malaria in some countries is 3rd Quartile of
confirmed malaria cases for the past 5 years; Alert threshold is 3rd
quartile/Median of confirmed malaria cases
 What about cholera?
 What about measles?

 What about Ebola, Lassa fever?

17
Use of thresholds to initiate response-2

• Alert: An alert threshold tells health staff and the

surveillance team that further investigation is needed.
• Action (Epidemic): An Action (epidemic) threshold
triggers a definite response. It marks the specific data or
investigation finding that signals an action beyond
confirming or clarifying the problem.
List of immediately reportable diseases, conditions
and events

• Turn to Section 2, page 79, Table 2.1 of the 3rd Edition IDSR
TGs
• Review the list of immediately reportable diseases and events
in the Table.
• Count the number of immediately reportable diseases that
are present in your district.
• Discuss importance of immediate reporting .
 Diseases, Conditions or Events Requiring Immediate Reporting

20
Report summary information for priority diseases,
conditions and events-1

Summary information is the:

• Total number of cases (suspected and laboratory confirmed)
and deaths seen in a particular time period
• E.g. weekly, monthly, or quarterly
Report summary information for priority diseases,
conditions and events-2

Routinely all Health facilities including referral or zonal or

teaching hospitals, private HF should report:
• Summary totals weekly and monthly/quarterly to the district
under their catchment area.
• In countries with sub-districts:
 Health facilities can submit data summaries to the sub-
districts for onward transmission to the districts.
 Report summary information for priority diseases,
conditions and events-3

• Districts should aggregate reports from all reporting sites and

provide summary totals to the provincial/regional and to
National/central level.

• Each level should note any unusual increases of diseases,

conditions or events seen during analysis of weekly/monthly
summary reports.

• The summary results should be analysed and the results used

for actions.
Report summary information for priority diseases,
conditions and events-4

Weekly summary reporting:

• Provides data for monitoring trends of diseases or conditions
to detect epidemics.
• After immediately notifying the next level about instances of
immediately reportable diseases, conditions or events, collect
and report weekly IDSR summary information.
Ensure that WHO weekly reporting format is adhered to across
all health facilities and districts
Report summary information for priority diseases,
conditions and events-5
Zero Reporting:
• During weekly reporting, use “zero reporting.”
• Record a 0 (zero) on the reporting form when no cases of an
immediately reportable disease have been diagnosed during
the week.
Monthly summary reporting:
• Monthly reporting about other endemic diseases is used for
monitoring progress with/impact of prevention and control
activities.
 IDSR Reporting Tools-1

• Paper-based IDSR reporting tools:

 IDSR Immediate case-based reporting form
 IDSR case-based laboratory reporting forms
 Line list reporting form
• Demonstration of IDSR reporting tools:
 Turn to Section 2, Annex 2F and 2G; Section 4 Annex 4E of
the 3rd Edition IDSR Technical Guidelines Booklets Two and
Three.
 IDSR weekly summary reporting form
AND
IDSR immediate case-based reporting/notification form

27
 IDSR Reporting Tools-2

• Electronic IDSR reporting tools:

 All the IDSR reporting paper-based forms are converted into
electronic forms using designated software.
 Computers/tablets and phones are used to capture all the
IDSR data and transmitted to next level by internet .
Improve routine reporting practices – 1/10

• In some health facilities, more than one person may be responsible for
recording information about patients seen in the facility.
• Each week, month, or quarter, a records clerk or statistician calculates
summaries for all the diseases and records them in a standard form.
• In outbreak scenarios, isolation units that are separate from health facilities
can be opened, and they will use a different register to record diseases or
events.
 It is important that this information be captured in the overall IDSR
weekly, monthly or quarterly summaries.
Improve routine reporting practices – 2/10

• Review the flow of information at the reporting site:

 Clinicians record information legibly in the patient registers
using the standard case definitions.
 Case-based reporting forms should be completed preferably
while the patient is still present.
 Record laboratory results in the patient register.
Improve routine reporting practices – 3/10

Review the flow of information at the reporting site:

• In Health Facilities with laboratories, laboratories should
record results of IDSR priority diseases in the laboratory
registers with linkage to epidemiologic data.
• Integration of laboratory results into the IDSR reporting forms
should be conducted at the health facility level.
• Records clerks or statisticians have summary forms that
contain spaces for recording cases and deaths due to the
priority diseases or conditions according to the standard case
definitions.
Improve routine reporting practices – 4/10

Review the flow of information at the reporting site:

• Health staff review the weekly, monthly and quarterly IDSR
data summary totals and provide comments on the forms
about results seen during data analysis.
• Health workers record the summary totals on a recommended
weekly, monthly and quarterly IDSR summary reporting form.
Improve routine reporting practices – 5/10

• Review data quality of the reporting site:

 Health workers should perform periodic checks on data
quality.
 It is recommended that countries conduct regular data
quality audits at the reporting sites using IDSR data quality
checklist.
 Refer to Section 2, Annex 2J of the 3rd edition IDSR
Technical Guidelines for IDSR data quality checklist.
 IDSR data quality checklist.

34
Improve routine reporting practices – 6/10
• Strengthen linkages between Laboratory and Surveillance
information:
 In case of a public health event, the laboratory where
confirmation took place is to report the laboratory results as
soon as the confirmation has been done to the respective
health facility and surveillance officer, and a simultaneous
report to the National level, as well as district or
region/province.
 To strengthen the linkages between epidemiological and
laboratory data, the case reported and the lab samples
should have the same unique ID.
Improve routine reporting practices – 7/10

• Strengthen linkages between Laboratory and Surveillance

information:
 The lab column of the IDSR Weekly or Monthly Summary
Reporting Forms should be regularly updated immediately
the respective disease lab results are ready.
 Liaise with the animal sector, so as to have a
comprehensive report also from Veterinary laboratory
especially if they have recorded any animal information
that might have risks to public health.
Improve routine reporting practices – 8/10

• Strengthen linkages between Laboratory and Surveillance

information:
 Ensure implementation of the One Health approach
(Agricultural, animal health, and other sectors) to improve
reporting of public health risks across all levels, with
emphasis also at the community level.
 Emphasize on strengthening the technical and community
capacities of staff for both human and
veterinarians/agricultural or food inspectors.
Improve routine reporting practices- 9/10

• Strengthen linkages between Laboratory and Surveillance

information:
 Interoperable and interconnected platforms with emphasis
on strengthening information systems within and between
the human and animal sectors would be ideal in enhancing
real time information sharing.
Improve routine reporting practices- 10/10

• Ensure Data protection and security to protect patients

confidentially:
 Use unique identifiers such as numbers instead of names.
 The identifiable data should be maintained where public
health surveillance interventions occur:
o E.g. At the health facility level
 Districts need to have guidelines on privacy and security of
health data, guided by the National level guidelines.
 Module 2 Summary-1

• Report priority diseases to the next health level at appropriate

time intervals.
• Know which diseases and events require immediate reporting
and which ones can be reported monthly.
• Be sure that you know who to send your reports to at the next
health level and what format you should send them in.
 Module 2 Summary-2

• Do your best to involve laboratories and community

stakeholders in the reporting process to foster communication
and develop a clear profile for the disease and target
populations.
• Aim at introducing electronic reporting to facilitate timely
reporting and early response to all public health emergencies.
 Practice Exercises-1/2

Instructions:
• Break into 5 small groups of a minimum of 3 people.
• Each group should select a leader and a rapporteur.
 The leader moderates the group discussions.
 Rapporteur documents the agreed answers by the group.
 Practice Exercises-2/2

• Instructions:
• Each group assigned an exercise (exercises 1 to 5 )
 Turn to your participants guide Module 2, pages 44 to 57
 Each group has 45 min to read, discuss and answer all
questions to the assigned exercise
 Group leaders present answers during plenary discussions:
o 5 min presentation; 10 min discussion
 Practice Exercises-3/2

Exercise 1 Case study

On 10 January 2018, Amina, a 25-year-old fish monger from Bibi neighbourhood
in Kati town (Njali District) reported to Kati Health centre complaining that she
has had watery diarrhoea for the past two days. She had also vomited twice that
morning. She lived in the same household with her three children, husband and
her step-mother. There have been episodes of cholera in a neighbouring Bahati
district in the last 3 months. Amina travelled there three days ago to go to her
auntie’s funeral.

1. When should the health staff report this case to the next level?
2. What information should be collected and reported about this case?
3. Use information from Amina’s case to record information on the form that is on
the next page. You may need to leave some rows blank because you may not
have all of the information you need.
 IDSR Case Report Form

45
 Practice Exercises-4/2
Exercise 2 Case study
In September 2017, a ship offloaded more than 500 tons of toxic waste in a country named
Majani. The waste was transferred into tankers owned by a local firm. The agreement was
that the waste would be treated and disposed of safely. Over a period of one week following
the offloading, approximately 600 to 1000 people presented at the local teaching hospital
for assessment and treatment. The patients included adults, many children and young
infants. There were three deaths reported, and these were patients who had died one day
after presenting with acute symptoms of nosebleed, nausea and vomiting, headache, skin
lesions, eye irritation and respiratory distress. Initial laboratory analyses indicated that the
substances had a strong smell and consisted of many toxic chemicals including
organochlorines and hydrogen sulphide. There were reports that public authorities may have
authorized local dumping of the substances because they were told it was sewage.

1. When should the health staff have reported this case to the next level?
2. What information should be collected and reported about this event?
3. What questions do you think the national IHR Focal Point should ask about this case?
Refer to the IHR decision instrument at the end of this module on pages 58 to 60 or Annex
2A of the International Health Regulations (2005)
 Practice Exercises-5/2
Exercise 3 Case study
On 17 of January 2017(3.00 am), a 23-year-old woman named Lambda died from severe acute respiratory
illness. Her death occurred within 48 hours of admission to a private hospital. The country, Ringah, had been
experiencing widespread infection of avian influenza outbreak among poultry. So the district team was asked
to investigate the case. The team learned that Lambda was first admitted to a private medical centre in the
city Sondu for her illness on 11 January 2017. She said her symptoms began on 8 January 2017. She
developed a high fever (above 380C), cough and shortness of breath and was referred to a private hospital
on 15 January 2017.
At the private hospital, the attending physician suspected infection with avian influenza because the patient
reported exposure history to poultry before her onset of illness. She had bought a chicken in the market on
21 December 2016, and the chicken had died during the trip back to her home. She was involved in de-
feathering and preparing the chicken when she got home. She was again involved in de-feathering and
preparation of poultry on the 24 December 2009. Lambda did not report any other exposure to poultry after
that (e.g., in the week before onset of her illness). The team also learned that the patient had been exposed
to her mother who died of acute viral pneumonia on 06 Jan 2017 (2:00 am). Due to the circumstances of her
death and exposure, the private Hospital immediately alerted the district health authorities after Lambda’s
death.

1. Use the information above to fill in the form on the next page.
2. What additional information is needed to complete the form?
 IDSR Case Report Form

48
 Practice Exercises-6/2
Exercise 4 – PART A
Instructions: There are two parts to this exercise. In Part A, you will look at a list of priority diseases,
conditions and events. You will use your experience from your own district (or facility) to record how often
you report information about each disease to the next level. Then you will compare your answer with the
recommendation in the guideline. You may do this exercise individually or in a small group with others who
work in the same district or area as you. Part B begins next slide
Disease Is this a priority disease How often are they What is the
or condition in your reported to the next recommendation for
country? level? frequency of reporting
from your national IDSR
guidelines?
Cholera

Bacterial meningitis

Viral Haemorrhagic Fevers (Ebola,

Marburg, Rift Valley Fever)
AFP (Suspected Poliomyelitis)

Dracunculiasis (Guinea Worm

Disease)
Neonatal tetanus

Tuberculosis
 Practice Exercises-7/2
Exercise 4 – PART B

Instructions: In this part of the exercise, answer the following questions using information about your own
district (or facility). Be prepared for a group discussion when everyone has completed this part of the
exercise.

1. What diseases or conditions do you report to the next level at least weekly? How do you report weekly
data to the next level? Is there a standard form that you use? What methods of communication do you
normally use for weekly reporting?
2. What diseases or conditions do you report to the next level at least monthly? How do you report monthly
data to the next level? Is there a standard form that you use? What methods of communication do you
normally use for monthly reporting?
3. What diseases do you report immediately in your district? Do you report case-based data?
4. Have you ever needed to report an unusual event or cluster due to an unknown cause? What were the
signs and symptoms that you reported?
 Practice Exercises-8/2
Exercise 5
THINGS TO LOOK FOR WITHIN HEALTH FACILITY

1. Who is responsible to report priority reportable diseases (health care provider, laboratory, institution)?
2. When was the last time a supervisor made a site visit to your facility?
3. How often do you report information to the next level?
4. Is there a standard method for reporting each immediate reportable disease?
5. Is there a standard method for summary reporting each priority disease?
6. Is there a standard method of reporting an outbreak?
7. Is the report case-based or aggregate format?
8. Is the reporting protocol process mapped out or summarized in narrative format and readily visible in the
facility (e.g., on the wall)?
9. For notifiable diseases, are “0” cases recorded and reported?
10. Are number of cases of notifiable diseases seen at the facility within a specified reporting period same as
that reported to the district level? (Randomly select 3 notifiable diseases and verify)
11. Are each of the immediately reportable diseases consistently reported in a timely manner?

List possible causes of omissions or problems in identification and reporting of priority diseases, conditions
and events. List recommended solutions, including target date and person responsible.
Thank you