Disease Surveillance & Research Section

Disease surveillance and research section is an integral part of Epidemiology and Disease Control Division (EDCD). This section came into existence in August 12, 2013 (Shrawan 28, 2070 BS). The mission of the communicable diseases Surveillance Section is to protect and improve the health of Nepalese citizens by tracking and responding to the occurrence of disease in the population across the country. The section conducts the surveillance of reportable diseases and is responsible for collecting, analyzing, interpreting, and reporting information for infectious diseases. This section also maintains a high level of data accuracy and quality, monitors disease trends for early detection and prompt response in case of any outbreak. It also assists in the development of public health policies, programme planning and implementation related to communicable diseases. 

The main scope of the communicable diseases surveillance and research section are as follows:

• Overall planning of communicable diseases related activities in line with the existing health policies
• Routine collection, analysis and dissemination of  data from sentinel sites (hospitals) for Early Warning And Reporting System (EWARS)
• Data collection, analysis and dissemination of information during events/outbreaks in coordination with respective sections
• Centralize data from various programme conducted by EDCD for dissemination
• Update and use EDCD server  for EWARS and IDSS
• Set up active surveillance system as per need
• Work as  a Secretariat of Water quality surveillance committee
• Conduct regular drinking water quality surveillance as guided by Nepal constitution 2072 and water quality surveillance guideline 2070
• Smooth running of EDCD’s Information control room
• Move forward with proposed Integrated Disease Surveillance System (IDSS)
• Implementing District Health Information System (DHIS2) platform for EWARS
• Regular dissemination of information related to EDCD through website
• Contribute to Programme Monitoring and Evaluation of all programme at EDCD
• Report progress of various EDCD activities to DOHS, MOHP, NPC, MOF and other stakeholders as per need
• Contribute to and jointly perform communicable diseases related research with programme sections

1. Surveillance of communicable disease programme

Surveillance of communicable diseases is a systematic and ongoing process of collecting information and analyzing data on cases of infectious diseases. It provides relevant information to decision makers for public health priorities and resource allocation. By this process, public health professionals can determine actions that are needed to prevent outbreaks and reduce the burden of diseases of communicable diseases. Given below are the surveillance activities operated through EDCD.

1.1 Early Warning And Reporting System (EWARS)

Early Warning And Reporting System (EWARS) is a hospital-based sentinel surveillance system currently identified in 81 hospitals covering all 75 districts of Nepal. EWARS is designed to complement the country’s Health Management Information System (HMIS) by providing timely reporting for early detection of selected vector-borne, water and food borne diseases with outbreak potential. It mainly focuses on the weekly reporting of detailed line list of cases and deaths (including "zero" reports) of six priority diseases/syndromes—Malaria, Kala-azar, Dengue, Acute Gastroenteritis (AGE), Cholera and Severe Acute Respiratory Infection (SARI), and other epidemic potential diseases/syndromes (like enteric fever, Leptospirosis, Hydrophobia, Chickungunya etc.). It equally focuses on immediate reporting (to be reported as soon as possible within 24 hours of diagnosis) of one confirmed case of Cholera, Kala-azar severe and complicated Malaria and one suspect/clinical case of Dengue as well as 5 or more cases of AGE and SARI from the same geographical locality in one week period.

EWARS Sentinel site reporting status

EWARS bulletin is produced every week on Sundays and shared to all the medical recorders, EWARS focal persons, rapid response team members, District Health Offices, Regional Health Directorates, all the divisions and centers of Department of Health Services, Secretary, MoHP, Chief-Secretary, and stakeholders through Email and uploaded to EDCD official website.

1.2 Active surveillance system of Infectious disease
Active surveillance of infectious disease is done if an outbreak has occurred or is suspected to keep close track to the number of cases. Designated officer regularly looks for diseases of interest using standard case definition for notifiable diseases and coordinates with other sections for necessary actions.

1.3 Water Quality Monitoring and Surveillance 
EDCD is a secretariat of Water Quality Surveillance Committee. Director of EDCD is the coordinator of the committee. The committee is responsible for following:

• Regular monitoring of drinking water quality from various sources and distribution sites
• Regular surveillance of water borne diseases and coordinate with different stakeholders for quality surveillance.
• Increase capacity of manpower through training, meeting, and other programmes for the surveillance of water quality of the district
• Facilitate testing of water quality if any waterborne disease epidemic occurs in the water distributed in the particular area
• Keep record of drinking water distribution system of country on the basis of Geographical Information System (GIS) and provide feedbacks to the responsible organization.

2. Communicable Disease Research Programme
This section contributes to and jointly perform communicable diseases related research with programme sections. It is also involved in dissemination of findings in national forums for necessary discussions and planning.

3. Progress So Far

3.1 Establishment of control room at EDCD 
Control room has been established under surveillance and research section of EDCD in technical support from WHO, NHSSP and GIZ with the following objectives: 

• Maintain quality, accuracy, timeliness and completeness of data received from EWARS sentinel sites.
• Analyze data received from EWARS sentinel sites, monitor disease trends and notify to the concerned authorities if any outbreak is suspected/predicted.
• Conduct active surveillance in case of any outbreak. Prepare daily situation update report and report to concerned authorities.
• Work closely with response section.

3.2 Expansion, sensitization and strengthen EWARS sentinel site

3.3 Launch of EDCD official website for information purpose
EDCD has launched official website featuring the complete organogram, its sections, programs, activities, and future plans of the division. The website is launched with the aim to help public health professionals, clinicians and all related stakeholders by making information easily accessible to them. Furthermore it will be a platform for everyone to share public health and clinical knowledge, research findings and experiences.

3.4 Regular publication of EWARS Bulletin

EWARS bulletin is produced every epidemiological week on Sundays and shared to all the medical recorders, EWARS focal persons, rapid response team members, District Health Offices, Regional Health Directorates, all the divisions and centers of Department of Health Services, Secretary, MoHP, Chief-Secretary, and stakeholders through Email and uploaded to EDCD official website.


4. Future Plan

• Move forward with proposed Integrated Disease Surveillance System (IDSS) through the support and coordination from all the sections under EDCD, with support of WHO-Nepal
• Expansion and strengthen Early Warning And Reporting System (EWARS) to represent all 75 districts of Nepal, with the support and coordination from all the sections under EDCD
• Compile all the data from different sections as a central storage and sharing of data through one-door policy
• Conduct surveillance and data collection regarding communicable and non-communicable diseases and work accordingly for the investigation
• Plan to implementation of District Health Information System (DHIS2) platform for EWARS
• To make non-functional EWARS sentinel sites into functional
• Capacity building of Medical Recorders, EWARS focal persons in districts, regional and national level