National Technical Guidelines For Integrated Disease Surveillance And .

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FEDERAL MINISTRY OF HEALTHNATIONAL TECHNICAL GUIDELINES FORINTEGRATEDDISEASESURVEILLANCEAND RESPONSE

Federal Ministry of Health,Federal Secretariat. Central Area AbujaNigeria Centre for Disease ControlPlots 801 & 804 Ebitu Ukiwe Street, Jabi- AbujaWorld Health Organization, Regional Office for AfricaWHO Health Emergency Programme,Brazzaville, Republic of CongoCentres for Diseases Control and PreventionCentre for Global HealthNational Technical Guidelines forIntegrated Disease Surveillance and ResponseTHIRD EDITIONCopyright @2019 Federal Ministry of Health - Nigeria Centre for Disease ControlThis publication was produced by Federal Ministry of Health - Nigeria Centre for Disease Control.All rights reserved.Design and Layout by Boboye Onduku/Blo’comms, 2019

NATIONAL TECHNICAL GUIDELINES FORINTEGRATEDDISEASESURVEILLANCEAND RESPONSETHIRD EDITIONFEDERAL MINISTRY OF HEALTH

CONTENTSABBREVIATIONSxGLOSSARY (DEFINITIONS OF KEY TERMS)xiFOREWORDxivACKNOWLEDGMENTSxvOVERVIEW OF THE THIRD EDITIONxviINTRODUCTION16Surveillance ApproachesIntegrated Disease Surveillance and Response Strategy10Different levels where surveillance activities are performed13IDSR and IHR (2005)15One Health and IDSR18Implementing Cross-border Activities In the Context of IDSR20IDSR and Disaster Risk Management21Priority Diseases, Conditions and Events Included in the IDSR21Annexes for Introduction24References491.0. DETECT AND RECORD CASES OF PRIORITY DISEASES501.1 Detection of Priority Diseases, Conditions and Events501.2. Indicator-Based Surveillance (IBS) and Event-Based Surveillance(EBS) Approaches Used to Detect Diseases, Conditions and Events521.3. Standard Case Definitions521.4 Establish Event-Based Surveillance (EBS) at all levels571.5 Update LGA Procedures for Surveillance and Response581.6 Role of the laboratory in surveillance and response611.7 Annexes to Chapter 1641.8 References83IINATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

CONTENTS2.0 REPORT PRIORITY DISEASES, CONDITION AND EVENT842.1 Immediate Reportable Diseases, Conditions and Events842.2 Weekly Reporting902.3 Report Monthly and Quarterly Routine Summary Information forOther Diseases of Public Health Importance912.4 Zero Reporting922.5 Summarize Immediate and Cased-based Reportable Diseases932.6 Improve Routine Reporting Practices932.7 Data protection and Security to Protect Patient’s Confidentiality1002.8 Annex to Chapter 21012.9 References1213.0 ANALYSE DATA1223.1 Receive, Handle and Store Data from Reporting Sites1233.2 Analyse Data by Time, Place and Person1273.3 Compare Analysis Results With Thresholds for Public Health Action1383.4 Draw Conclusions from the Findings to Generate Information1403.5 Summarize and Use the Analysis to Improve Public Health Action1423.6 Annexes to Chapter 31424.0 INVESTIGATE AND CONFIRM SUSPECTED OUTBREAKS ANDOTHER PUBLIC HEALTH EVENTS146i. Decide to investigate a reported outbreak or public health event148II. Verify the reported information149III. Record reported outbreaks, public health events and signals1504.1 Prepare to conduct an investigation1504.2 Verify and confirm the outbreak or event1554.3 Define and Search for Additional Cases157IIINATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

4.4 Develop a Line List and Record Information About the AdditionalCases1594.5 Analyse Data About the Outbreak1604.6 Report writing and dissemination of findings1634.7 Implement prevention and control measures1644.8 Conduct an assessment to Determine if the Event is a Potential PublicHealth Emergency of International Concern (PHEIC)1654.9 Maintain and intensify surveillance1664.10 Conducting Regular Risk Assessment After the Outbreak has beenConfirmed1664.11 Annexes to Chapter 41674.12 References1865.0 PREPARE TO RESPOND TOOUTBREAKS AND OTHER PUBLICHEALTH EVENTS1875.1 Establish a Permanent Public Health Emergency Operations Centre(Command and Control Centre) for Oversight Of Public HealthEmergency Preparedness and Response Activities1885.2 Establish a LGA, State, and National Public Health EmergencyManagement Committee (PHEMC)1905.3 Establish Public Health Emergency Management Subcommittees atall Levels1955.4 Establish Public Health Emergency Rapid Response Teams at allLevels2025.5 Risk Mapping for Outbreaks and Other Public Health Events2035.6 Resource Mapping2045.7 Prepare an Emergency Preparedness and Response Plan2045.8 Annexes to Chapter 52105.9 References215IVNATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

6.0 OVERVIEW ON HOW TO RESPOND TO OUTBREAKS AND OTHER 216PUBLIC HEALTH EVENTS6.1 Declaring an Outbreak and Activating the Response Structures2176.2 Mobilize Public Health Emergency Rapid Response Teams (PHERRT)for Immediate Action2176.3 Select and Implement Appropriate Public Health Response Activities2196.4 Provide Regular Situation Reports on the Outbreak and Events2336.5 Document the Response2346.6 Annexes to Chapter 62356.7 References2557.0 RISK COMMUNICATION AND COMMUNITY ENGAGEMENT2567.1 Risk Communication and Community Engagement In the Context ofIDSR2577.2 Key inter-linked Principles for Effective Communication2637.3 Create an Enabling Environment for Effective Communication to atrisk Populations2687.4 Communicating Before, During and after the Outbreak2697.5 Annexes to Chapter 72837.6 References2878.0 MONITOR, SUPERVISE, EVALUATE AND PROVIDE FEEDBACK TOIMPROVE THE SURVEILLANCE AND RESPONSE SYSTEM2888.1 Identify targets and indicators2908.2 Monitor Core Functions for IDSR at LGA level2928.3 Monitor Quality of IDSR Activities at LGA Level2968.4 Monitor Quality of Surveillance Activities at Community Level3018.5 Supportive Supervision and Feedback for Improving IDSR Activities303VNATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

8.6 Evaluate Effectiveness of Performance of The IDSR System3108.7 Annexes to Chapter 83148.8 References3429.0 SORMAS (eIDSR)3439.1 eIDSR in the Context of Health Management Information System3439.2 Rationale of eIDSR3439.3 Benefits of eIDSR3449.4 eIDSR Development and Implementation Process3459.5 Using eIDSR in Core Surveillance Functions3479.6 Roles and Responsibilities at Different Levels In the Context of Realtime Reporting and Outbreak/Emergency Management3499.7 Supervision, Monitoring and Evaluation3519.9 References35210. TAILORING IDSR TO EMERGENCY OR FRAGILE HEALTH SYSTEMCONTEXTS35310.1 Introduction35310.2 Health Information System in Emergency Contexts35410.3 Early Warning and Response35510.4 Implementation of IDSR in Humanitarian Emergencies35810.5 Various actors in enhancing IDSR to improve early warning andresponse36010.6 References371VINATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

11. SUMMARY GUIDELINES FOR SPECIFIC PRIORITY DISEASES11.0 Priority Disease/Event/Condition for IDSR11.1 Acute Haemorrhagic Fever Syndrome11.2 Acute viral hepatitis11.3 Adverse Events Following Immunisation (AEFI)11.4 Anthrax (Human).11.5 Buruli Ulcer (Mycobacterium ulcerans disease)11.6 Chikungunya11.7 Cholera11.8 Dengue Fever11.9 Diabetes11.10 Diarrhoea with blood (Shigella)11.11 Diarrhoea with dehydration in children less than 5 years of age11.12 Dracunculiasis11.13 Ebola or Marburg viral diseases11.14 Epilepsy11.15 Foodborne Illnesses11.16 Human influenza caused by a new subtype11.17 Hypertension11.18 Influenza-like Illness (ILI)11.19 Injuries (Road traffic accidents)11.20 Lassa and Crimean-Congo Haemorrhagic Fevers11.21 Leprosy11.22 Lymphatic Filariasis11.23 Malaria11.24 Malnutrition11.25 Maternal Deaths11.26 Measles11.27 Meningococcal NATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

11.28 Middle East respiratory syndrome (MERS)11.29 Monkeypox11.30 Neonatal tetanus11.31 New HIV/AIDS Cases11.32 Noma11.33 Onchocerciasis11.34 Perinatal (Stillbirths and Neonatal) Deaths11.35 Plague11.36 Poliomyelitis (Acute flaccid paralysis)11.37 Human Rabies11.38 Rift Valley Fever (RVF)11.39 Severe Acute Respiratory Infections (SARIs)11.40 Severe Acute Respiratory Syndrome (SARS)11.41 Severe Pneumonia in Children Under 5 Years of Age11.42 Sexually transmitted infections11.43 Smallpox (Variola)11.44 Trachoma11.45 Trypanosomiasis11.46 Tuberculosis11.47 Typhoid Fever11.48 West Nile Fever11.49 Yellow fever11.50 Zika11 51 Yaws and endemic syphilis or bejel11.52 COVID-19Annexes to Section 11ANNEX 11A: Adverse Event Following Immunisation – Investigation FormUnexplained Cluster of Health Events or DeathsANNEX 11B: Acute Flaccid Paralysis – Case Investigation Case FormANNEX 11C: Cholera - Case-Based Investigation FormANNEX 11D: Guinea Worm - Case Investigation FormANNEX 11E: Maternal and Perinatal Death - Reporting FormsANNEX 11F: Measles - Case Investigation FormANNEX 11G: Neonatal Tetanus - Case Investigation 1564573575NATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

ANNEX 11H Tuberculosis - MDR and XDR TB - Case-based Reporting FormANNEX 11I Viral hemorrhagic fever - case reporting formANNEX 11J Viral Hemorrhagic Fever – Case Investigation FormANNEX 11Ji Acute or Chronic Viral Hepatitis Case Investigation FormANNEX 11K IDSR Outbreak Line ListANNEX 11L Contact Listing Forms577579580583587588ANNEX 11M Community Alert Reporting FormANNEX 11N Community-Based Surveillance (CBS)SuspectedDiseases and Public Health Events MonthlyLog Sheet589590LIST OF REVIEWER/CONTRIBUTORSIX591NATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

ABBREVIATIONSAARAfter Action ReviewsAFPAcute Flaccid ParalysisAFROWHO Regional Office for AfricaCDCCenters for Disease Control and PreventionCEBSCommunity Event-based SurveillanceDPCDisease Prevention and Control DepartmentDRMDisaster Risk ManagementDSNODisease Surveillance and Notification OfficerEBSEvent-Based SurveillanceEPIExpanded Program on ImmunisationEPREmergency Preparedness and ResponseEVDEbola virus diseaseHCFHealthcare FacilityHIV/AIDSHuman Immunodeficiency Virus And Acquired Immune DeficiencySyndromeIDSRIntegrated Disease Surveillance And ResponseIBSIndicator Based SurveillanceIMSIncident Management SystemIPCInfection Prevention and ControlIHR 2005International Health Regulations (2005)JEEJoint External EvaluationLGALocal Government AuthorityMDRMultidrug ResistanceMoHMinistry of HealthNGONon Governmental OrganisationPHEICPublic Health Emergency Of International ConcernRRTRapid Response TeamSARSSevere Acute Respiratory SyndromeWHEWorld Health EmergencyWHOWorld Health OrganisationXDRExtensively drug-resistantXNATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

GLOSSARYDEFINITION OF TERMSAcuteAny disease having a rapid (sudden) onset and following a shortcourseAlertAn indirect early warning sign of a potential public health eventoccurring in a community under surveillance. Alerts must beinvestigated further and verified as to whether they represent atrue event or notChronicAny health condition that develops slowly or is of long durationand tends to result in some functional limitation and need forongoing medical careClusterAn aggregation of cases or health-related conditions in a givenarea, over a particular period, regardless of whether the numberof cases is more than expected in relation to time or place or bothDiseaseAn illness or medical condition, irrespective of origin or source,which presents or could present significant harm to animals,humans and plantsDisasterThe serious disruption of the functioning of a community ora society, causing widespread human, material, economicor environmental losses exceeding the ability of the affectedcommunity or society to cope using its own resourcesEliminationReduction to zero (or a very low defined target rate) of new casesin a defined geographical areaEndemicAn increase in the number of cases of a disease or an eventabove what is normally expected in that population in a givenarea over a particular period of timeEpidemicRefers to an increase in the number of cases of a disease or anevent above what is normally expected in that population in agiven area over a particular period of timeEpidemiological When a patient has or had exposure to a probable or confirmedlinkcaseEpidemiologyThe study of the distribution and determinants of health-relatedstates and the application of this information to controlling publichealth problemsEradicationThe purposeful reduction of specific disease prevalence to thepoint of continued absence of transmission in the worldAetiologyRefers to the cause, set of causes, or origin of a disease orconditionXINATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

GLOSSARYEventUnder the IHR (2005) (Article 1), an event is defined as ‘amanifestation of disease, or an occurrence that creates a potentialfor disease’ (with particular reference to public health eventsof international concern (PHEIC)). An emergency incident oroccurrence.An event may be insignificant or could be a significant occurrence,planned or unplanned (e.g. extreme weather event or massgathering), that may impact the safety and security of communities.NB: ‘Event’ and ‘incident’ are often used interchangeablyEWARSThis is a simple robust system designed to improve diseaseoutbreak detection in emergency settings such as countries inconflict or following a natural disaster.it detects and respondsrapidly to signals which may indicate outbreaks or clustersof epidemic prone diseases to prevent excess mortality andmorbidity among the target population.HealthmanagementinformationsystemA monthly reporting system for diseases, conditions, and risksthat is reported to the MOH from every healthcare facilityelectronically or on paperHumananimal andenvironmentA continuum of contacts and interactions among people,animals, their products, facilitating transmission of zoonoticinterface pathogens or shared health threatsIncidentAn occurrence or event, natural or human-caused, that requires anemergency response to protect life, property, or the environment.An incident may be geographically confined (for example, withina clearly delineated site or sites) or dispersed (for instance, awidespread power outage or an epidemic). Incidents may startsuddenly (for example, a chemical plant explosion) or gradually(a drought). They may be of very short duration (for example, acall for emergency medical assistance), or continue for monthsor even years. War-related disasters, public health and medicalemergencies, and other emergenciesIncidentManagementSystem (IMS)This is a standardised approach to emergency management,encompassing personnel, facilities, equipment, procedures, andcommunications operating within a common organisationalstructure.XIINATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

ational legal instrument that is binding in 196 countries.The regulations aim to help the international community preventand respond to acute public health risks that have the potential tocross borders and threaten people worldwideMultisectoralParticipation of more than one sector working together on ajoint programme or response to an event (for example, a jointinvestigation by public health and law enforcement)One HealthAn approach to address a shared health threat at the humananimal-environment interface, based on collaboration,communication, and coordination across all relevant sectors anddisciplines, with the ultimate goal of achieving optimal healthoutcomes for both people and animals. A One Health approachapplies to the local, regional, national and global levelsOutbreakThe occurrence of more cases of diseases, conditions or eventsthan expected in a defined geographical area and timePandemicAn epidemic occurring worldwide, or over a very wide area,crossing international borders and usually affecting a largenumber of peoplePoint of entryAny passage, via land, air or sea, for international entry or exit oftravellers, baggage, cargo, containers, conveyances, goods andpostal parcels as well as agencies and areas providing services tothem on entry or exitReporting siteA site which reports about surveillance and outbreak data to theLGA level. A reporting site includes all health facilities (public,private and quasi-governmental, faith based), standalonelaboratories and points of entry. A reporting site also containsevent reports from community surveillance and responseZoonotic disease An infectious disease that can be spread between animals andor zoonosispeopleXIIINATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

FOREWORDCommunicable diseases are the most common causes of illness, disability and death in mostdeveloping countries. These include malaria, measles, cerebrospinal meningitis, cholera, yellowfever, Lassa fever, Tuberculosis, HIV/AIDS, pneumonia etc.The Federal Ministry of Health (FMOH) has developed programmes for the elimination,eradication, prevention and control of these diseases. Importantly, the Nigeria Centre for DiseaseControl (NCDC) was established by Act in November 2018 as an agency of FMOH, to lead theprevention, preparedness, detection and response to communicable diseases.While communicable diseases remain a challenge in Nigeria, the country has also recorded anincrease in the burden of non-communicable diseases. This further highlights the need to utilisesurveillance data for effective control.Disease surveillance is critical in helping countries monitor and evaluate emerging patterns andtrends of disease. The resultant effect of poor surveillance systems in countries, is poor controlmeasures which results in high mortality, morbidity and disability.characterisedThe World Health Regional Committees for Africa advocated for the adoption ofIDSR in 1998 at its 48th session. The aim of this strategy is to integrate multiple surveillancesystems so that human and other resources can be used more efficiently and effectively.Due to gaps identified in the IDSR strategy, in 2008, the WHO advocated for a review of thestrategy and came up with the first generic version of the revised national technical guidelineson IDSR which was adapted by all countries in the African region including Nigeria. Thereviewed generic version included some non-communicable diseases and the incorporation ofthe International Health regulations (IHR) 2005 into the national surveillance systems.The first edition of the IDSR Technical Guidelines (2002) was adopted and adapted by Nigeria.Following this, tremendous progress has been made in establishing a well-coordinated andintegrated surveillance system in the country. Capacities have also been built across all the levelsto detect, confirm and respond to public health threats.The second version of the IDSR Technical Guidelines was developed in response to severalfactors relevant to the last decade. In the last ten years, many changes have occurred inAfrica’s health, social, economic, environmental and technical environment. Between 2000 and2019 the emergence of new diseases, conditions and events resulted in the need to reviewthe recommendations for evolving public health priorities for surveillance and response. Thesechanges were also evident in Nigeria. Therefore, experts were invited from Departments andAgencies within the Federal Ministry of Health, Tertiary and Specialist Hospitals, States Ministry ofHealth, LGAs, academia and development partners to carry out a thorough review and validationof the second edition of the IDSR technical guidelines. This reviewed document also went throughseries of editing which gave birth to an all-encompassing document for disease surveillance andresponse.I recognise the efforts of NCDC in coordinating the review of Nigeria’s surveillance and responsestrategy. I am confident that this review will lead to the improvement of our health security inNigeria.DR. OSAGIE EHANIREHONOURABLE MINISTER OF HEALTHXIVNATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

ACKNOWLEDGEMENTSThe third edition of the Integrated Disease Surveillance and Response (IDSR) TechnicalGuidelines was prepared by the WHO Health Emergencies (WHE) Programme with theactive participation and involvement of programmes dealing with disease surveillanceat the WHO Regional Office for Africa (AFRO), Brazzaville, Congo and with technicalreviews provided by the U.S. Centers for Disease Control and Prevention (CDC) and theU.S. Agency for International Development (USAID).The purpose of revising these IDSR technical guidelines was to:(a)Align with the current situation and needs of the Member States.(b)Align with the objectives, targets and elements of the WHO Africa Region’s strategyfor health security and emergencies 2016–2020.(c)Update the guidelines with contemporary information, taking into considerationnew developments such as: emerging and re-emerging priority diseases, conditionsand events.(d)Incorporate recent recommendations from expert panels on strengthening the IHR,2005 that are underpinned on the One Health approach.(e)Holistically address disaster risk management (DRM) strategies.(f)Take into account lessons learnt from the unprecedented EVD outbreak in WestAfrica, polio eradication and other humanitarian crises.(g)Take advantage of technology advancement and utilize the opportunities offeredby the internet and mobile phones to scale up the implementation of real timecommunity event-based surveillance (CEBS), with robust geographical informationsystem (GIS) platforms.(h)Scale up other electronic surveillance systems and incorporate new ways forcapacity building using the IDSR eLearning toolsThe final draft was peer reviewed by the ad hoc task force as well as during a finalpartner consultative meeting held in March 2018.In Nigeria, the adaptation of this technical guidelines involved input from ******XVNATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

OVERVIEW OF THE THIRDEDITIONThe previous edition of the guidelines has been revised in order to incorporate lessonslearnt from previous epidemics, new frameworks or strategies, such as the strategy forhealth security and emergencies, the revised IHR monitoring and evaluation framework,the initiatives for enhancing prevention, detection and response to public health events(GHSA, One Health, DRM), key regional strategies and rising non-communicabledisease threats and road traffic injuries in the context of development of resilient healthsystems. The revised guidelines also aim to address implementation of the IHR (2005)requirements and capacities for surveillance and response. These guidelines are adaptedto reflect national priorities, policies and public health structures, and used in conjunctionwith other similar guidelines/strategies or initiatives. Overall, the revised guidelines haveincorporated the following:(a) Strengthening indicator-based surveillance with better analysis, reporting and use ofroutine data for decision making(b) Strengthening event-based surveillance(c)Improving community-based surveillance(d) Improving cross-border surveillance and response(e) Scaling up e-IDSR implementation(f)Improving reporting and information sharing platforms(g) Sharing improved data between sectors(h) Tailoring IDSR to emergency or fragile health system contexts(i)Establishing Public Health Emergency Operation Centre (PHEOC)(j)Revised list of priority diseasesThe guidelines are intended for use as:(a) A general reference for surveillance activities across all levels(b) A set of definitions for thresholds that trigger some action for responding to specificdiseases or conditions(c)A stand-alone reference for level-specific guidelines(d) A resource for developing training, supervision and evaluation of surveillanceactivities(e) A guide for improving early detection and preparedness for outbreak responseXVINATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

OVERVIEW OF THE THIRD EDITIONThese guidelines are to be used by health care workers at all health care levels (publicand private), where illness is presented for the first time. Additionally, this documentshould be used by:(a) Disease surveillance managers and officers at all levels(b) IHR national focal points(c)Health authority at point of entry(d) Hospital managers, clinicians and infection control officers(e) National laboratory directorates(f)Veterinary and wildlife health officers(g) Environmental health officers and sanitarians(h) Local Government Areas (LGA) health management teams(i)Physician assistants/clinical officers(j)Public health staff(k)Medical doctors(l)Nurses(m) Pharmacists(n) Health facility managers(o) Medical and nursing educators(p) Other health educators(q) Communication officers(r)Logisticians(s)Laboratory personnel(t)Community leaders, ward leaders, councilors and LGA/state political officers(u) Other public health experts and practitioners in specialised institutions(v)Public health training institutions(w) Other health partners including NGOs(x)(y)Statisticians and data managersOther Ministries Departments and Agencies (MDAs)XVII NATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

IntroductionIntroductionThe 2006 National Population Census estimated the Nigerian population at140 million, with an annual growth rate of 3.2%. In 2000, the World HealthOrganisation ranked Nigeria’s overall health system performance as 187th among191 member states. The health indicators for Nigeria are currently worse than theaverage for sub Saharan Africa; for example, infant mortality rate (IMR) is 78 out of1000, under 5 years mortality rate is 147 out of 1000, and the maternal mortalityrate (MMR) is 640 out of 100,000.1Diseases such as malaria, diarrheal diseases, acute respiratory infections andvaccine preventable diseases (VPDs) account for at least 90% of childhoodmorbidity and mortality and other childhood health problems in Nigeria. Otherdiseases like Lassa fever, Cerebrospinal Meningitis (CSM) and measles continueto occur with increased frequency in epidemic proportions and produce highestcase fatality rate. Nigeria, like all other countries in the region, is affected by theHIV/AIDS pandemic with a national prevalence rate of 1.5% (2018). In 2006,the country experienced outbreak of highly pathogenic Avian Influenza (H5N1) inpoultry and in 2007, a human case was recorded.2In September 1998, the 48th World Health Organisation Regional Committeefor Africa met in Harare, Zimbabwe. Through resolution AFRO/RC48/R2,Member States adopted integrated disease surveillance as a regional strategy forstrengthening weak national surveillance systems in the African region. Until 2008,the diseases under the Integrated Disease Surveillance and Response (IDSR) weremainly those diseases that were targeted for eradication, elimination, epidemicprone and some communicable diseases of public health importance.With the epidemiologic transition, non-communicable diseases now contribute asignificant burden of morbidity and mortality in Africa. Nigeria, like other developingcountries, is facing a double burden of both communicable diseases and NonCommunicable Diseases (NCDs). This guideline was revised to include emergingand re-emerging diseases and conditions such as monkeypox, Congenital RubellaSyndrome (CRS) and dog bite (Rabies).1NATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

1. INTRODUCTIONOn 23rd of May 2005, the 58th World Health Assembly adopted the InternationalHealth Regulations in Geneva, Switzerland through Resolution WHA58.3. TheInternational Health Regulations entered into force on 15th June, 2007.The availability of accurate, up-to-date, reliable, and relevant health data andinformation is essential for strengthening and managing the health system.Currently, there is paucity of relevant health data for policy decision and planning.The implementation of the health reform agenda, including strategies and actionplans, is hampered by the dearth of reliable data on health parameters at all levelsof the health system. When information flow exists, it has remained exclusivelyvertical, from the periphery to the center, with little feedback.1This IDSR guideline is developed to guide the collection, collation, analysis andcommunication of data for diseases of public health importance in Nigeria. This isto ensure that data is collected and used for public health action.2NATIONAL TECHNICAL GUIDELINES FOR INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

1. INTRODUCTIONWhat is Disease Surveillance?Surveillance is the ongoing systematic collection, analysis, andinterpretation of health data. It includes the timely dissemination of theresulting information to those who need them for action. Surveillance isalso essential for planning, implementation, and evaluation of publichealth practice. Data collected at health facility level is compiled and sentto the next level and regular feedback is shared with the lower level.A standard case definition is used to identify such priority diseases orevents and the laboratory is recognised as an important component ofpublic health surveillanceSeveral types of surveillance are used in national programmes. The choiceof method depends on the purpose of the surveillance action. In general,types of surveillance methods describe: Focused location for surveillance (such as health facility-basedsurveillance or community-based surveillance). Designated or representative health facility or reporting site for earlywarning of epidemic or pandemic events (sentinel surveillance). Surveillance conducted at laboratories for detecting events or trendsnot necessarily evident at other

1.2. Indicator-Based Surveillance (IBS) and Event-Based Surveillance (EBS) Approaches Used to Detect Diseases, Conditions and Events 52 1.3. Standard Case Definitions 52 1.4 Establish Event-Based Surveillance (EBS) at all levels 57 1.5 Update LGA Procedures for Surveillance and Response 58 1.6 Role of the laboratory in surveillance and response 61

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