Note: Due to the potential for international spread, conditions marked with ** are to be reported both immediately and either weekly or monthly as indicated
WEEKLY DATA COLLECTION
Syndromes (aggregate data):
Acute Flaccid Paralysis
Fever and haemorrhagic symptoms
Fever and neurological symptoms
Fever and respiratory symptoms (ARI) < 5 yrs
Fever and respiratory symptoms (ARI) ≥ 5 yrs
Fever and rash
Gastroenteritis < 5 year olds
Gastroenteritis ≥ 5 year olds
Undifferentiated fever <5
Undifferentiated fever ≥ 5 yrs
IMMEDIATE NOTIFICATION
**Cholera **Plague **Yellow Fever (Urban or Sylvatic) **Severe Acute Respiratory Syndrome
**Outbreaks/Clusters/Unusual events
FOUR-WEEKLY DATA COLLECTION
Confirmed cases (Age and sex specific):
Campylobacter
Chicken Pox (Varicella)
Cholera**
Ciguatera poisoning
Congenital Rubella Syndrome
Dengue fever
Dengue Haemorrhagic Fever/Shock Syndrome
Diphtheria
E. coli (pathogenic)
Influenza
Leprosy (Hansen's Disease)
Leptospirosis
Malaria
Measles
Meningitis due to Haemophilus influenzae
Meningococcal Infection due to Neisseria meningitidis
Mumps
Pertussis
Plague**
Pneumonia due to Haemophilus influenzae
Pneumonia due to Streptococcus pneumoniae
Poliomyelitis
Rabies
Rotavirus
Rubella
Salmonellosis
Shigellosis
Severe Acute Respiratory Syndrome**
Tetanus
Tetanus (neonatal)
Tuberculosis (pulmonary)
Tuberculosis (extra-pulmonary)
Typhoid and Paratyphoid Fevers
Viral Encephalitis / Meningitis
Viral Hepatitis A
Viral Hepatitis B
Yellow Fever (urban or sylvatic)**
QUARTERLY DATA COLLECTION
(Age and sex specific):
HIV
AIDS
Urethral Discharge
Gonorrhoea
Chlamydia
Non-Specific Urethritis (NSU)
Genital Ulcer
Syphilis
LGV
HSV
Chancroid
Vaginal Discharge
Gonorrhoea
Chlamydia
Trichomonas
Bacterial Vaginosis
Others
Ophthalmia Neonatorum
Gonorrhoea
Chlamydia
Others
Congenital Syphilis
No syndrome, but laboratory test positive (serology positive)
Syphilis
HSV
Chlamydia
Unit 4 HIV Case Surveillance
Unit 4
structure
The unit is divided into three sections. The sections are convenient blocks of material for a single study session. A final case study is provided for use upon completing all units.
This section focuses on case surveillance of HIV infection required for basic level HIV surveillance.
Introduction
At the beginning of the AIDS epidemic, CAREC promoted the use of the UNAIDS First Generation HIV/AIDS surveillance guidelines. The guidelines were focused on the reporting of AIDS cases and implementation of periodic and regular HIV sero-prevalence surveys (surveys that estimate HIV prevalence by testing blood for HIV antibody) among different population sub-sets. However, after 10 years of their implementation, serious shortcomings were identified, creating the need for the development of the Second Generation HIV/AIDS surveillance guidelines. These guidelines, created by WHO/UNAIDS in 2000, added three essential elements to the first generation HIV/AIDS surveillance guidelines:
-
reporting of persons diagnosed with HIV infection
-
classification of countries based on the level of the HIV epidemic to be used as a guide for the nature of the national response to the epidemic
-
behavioural surveillance surveys (BSS) to improve monitoring of behaviours that put individuals at risk of contracting HIV.
But, since the HIV epidemic is a rapidly evolving one, gaps were identified in the Second Generation HIV/AIDS surveillance guidelines as well. These gaps were addressed in the CAREC Third Generation HIV/AIDS/STI surveillance guidelines.
CAREC developed these Third Generation guidelines after numerous regional and international consultations on a new regional HIV/AIDS/STI surveillance framework. This framework puts emphasis on survey methodologies and minimum data requirements from each of its four components:
Third Generation HIV/AIDS/STI Surveillance, continued
-
Epidemiological (HIV, AIDS and STI surveillance, AIDS mortality data, periodic STI and HIV sero-prevalence surveys among different population sub-groups, HIV molecular epidemiology and STI and HIV antimicrobial resistance surveys)
-
Behavioural surveillance (periodic sexual behaviour surveys among sub-groups, using quantitative and qualitative methods)
-
Audits of coverage and quality of care for STI patients and people living with HIV/AIDS
-
Evaluation of specific prevention and control programmes (such as prevention of mother-to-child transmission).
Information from such activities will allow national HIV/AIDS control programmes to:
-
better understand and monitor sexual behaviours and practises driving the HIV/AIDS epidemic in a country or within a country
-
better assess HIV/AIDS/STI trends over time
-
direct public health actions to target vulnerable groups and the most prevalent risk behaviours
-
measure coverage and quality of care for people living with HIV/AIDS and STI patients
-
assess the impact of HIV/AIDS prevention and control programmes.
Current HIV/AIDS
surveillance
systems
Current HIV/AIDS/STI surveillance systems are heavily based on case reporting (surveillance system in which persons who are identified as meeting the case definition are reported to public health authorities) of AIDS, syndromic surveillance(surveillance system in which a diagnosis of the infection is made through the presence of symptoms using a standard case definition) of STI and a few HIV sero-surveys to determine HIV point prevalence (the amount of a particular disease present in a population at a single point in time) among pregnant women.
In each country, each new AIDS case is reported to the National Epidemiologist or, in some instances, to the National AIDS Programme Co-ordinator. The reporting form usually includes information on name (or coded identifier), age, sex, address, marital status, socio-economic status, reported mode of transmission, date of HIV diagnosis and date of AIDS diagnosis.
Sexual behaviour (number of partners, use of condoms, contact with sex workers, sexual orientation) and clinical information (major and minor signs, indicator disease) are sometimes also reported, as requested on
Current HIV/AIDS surveillance systems, continued
country reporting forms. In most cases, the same form is used to report HIV diagnosis and AIDS. Limited information is available on who fills out the forms, and where and when this occurs.
From the individual reports, the Epidemiology Units or National AIDS Programmes report aggregate data to CAREC using a quarterly reporting form that gathers information on sex, age groups and reported mode of
transmission. Although AIDS is internationally notifiable, some countries do not have a clear national policy on AIDS reporting.
Evaluations of the national surveillance systems, conducted by CAREC, have shown that the level of under-reporting of AIDS cases varies from country to country, ranging from 10% to 70%, with an overall level of under-reporting in CMCs estimated to be about 35%. This high level of under-reporting is related to the weaknesses of the surveillance systems. This is influenced by various factors, including multiple case definitions, lack of standardisation of systems and lack of human resources.
Among many lessons, it was recognised that there is a need:
-
to standardise and simplify surveillance systems for HIV and other STIs
-
to conduct training on “basic” HIV/STI surveillance
-
to address issues of confidentiality and data security.
The lessons learned will be addressed in this workshop.
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