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Annex 3.1. Syndromes and Communicable Diseases under Regional Surveillance



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




  1. 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)

  2. Behavioural surveillance (periodic sexual behaviour surveys among sub-groups, using quantitative and qualitative methods)

  3. Audits of coverage and quality of care for STI patients and people living with HIV/AIDS

  4. 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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