Integrated Disease Surveillance and Response: About Us
In response to the emergence of severe outbreaks of largely preventable diseases in African countries during the 1990s, the 46 Member States of the WHO African Regional Office for Africa (WHO/AFRO) met in Zimbabwe in 1998 to adopt Integrated Disease Surveillance and Response (IDSR) as a comprehensive regional framework for strengthening national public health surveillance and response systems in Africa. In 2006, WHO/AFRO Member States recommended that the International Health Regulations (IHR 2005) be implemented using the IDSR framework, especially for strengthening core capacities for surveillance and response.
The IDSR framework illustrates the functions, activities and skills required at each level of the health system to implement a coordinated, comprehensive surveillance and response system. Activities for each level of the system are designated for disease detection, reporting, analysis, investigation, response, communication, monitoring, evaluation and preparedness. This framework is illustrated in the IDSR Matrix (available in English, French and Portuguese).
The IDSR framework also specifies African public health priorities including 40 priority diseases and conditions that are known to afflict African communities. The list includes diseases of national and international concern in line with the IHR (2005). These diseases are largely preventable with well-known, available and efficacious responses. When a country adopts IDSR, they choose their own national priorities from this list and include any other diseases of concern according to the country’s epidemiologic profile.
The goal of IDSR is to strengthen surveillance and response capabilities at each level of the health system by building local capacities to detect, confirm and respond to emerging public health threats. IDSR also emphasizes the leveraging of strengths and areas of expertise through partnership and coordination.
Since 1998, when the Member States in AFRO adopted the IDSR strategy, CDC has played a leading role in designing, developing, implementing, monitoring and evaluating IDSR. With funding from USAID, CDC’s IDSR team collaborated with WHO/AFRO to lead the development of the IDSR framework and the design and development of the Technical Guidelines for Integrated Disease Surveillance and the IDSR Training Modules.
In addition, CDC programs across the agency reviewed and cleared summary guidelines for the 40 priority diseases, which include those diseases, syndromes and conditions targeted by the International Health Regulations (2005). In recognition that a comprehensive surveillance system is critical in the early detection and response to infectious diseases such as pandemic influenza, cholera, polio, meningococcal meningitis, viral hemorrhagic fevers and other acute disease outbreaks, several CDC programs have now incorporated IDSR strategies into their technical assistance initiatives.
Strengthening laboratory support to surveillance is a cornerstone of the IDSR strategy. The IDSR team works with CDC’s global laboratory programs to provide guidance on strengthening laboratory networks, accreditation, and external quality assurance for national public health laboratories.
IDSR focuses on the implementation of basic surveillance capabilities at each level of the health system – from community to health facility, to district, province and national levels where coordination with disease programs can put data to public health action. Unusual events are included in the IDSR framework and align with event based surveillance.
When there is enough capacity to carry out the IDSR skills and tasks that make up these capabilities economic modeling suggests that in an outbreak there will be a reduced number of sick patients, a reduced number of deaths, and a shorter time to the peak of an outbreak (Somda et al., 2010). We know that surveillance can save lives.
The IDSR strategy provides practical, basic steps to ensure that:
- Standard case definitions are used throughout the system to identify and report priority diseases, conditions, and events.
- Data thresholds are known and used to alert higher levels of a possible outbreak and to trigger local action for patient management and disease control.
- Suspected outbreaks or public health events are investigated and laboratory confirmation is obtained.
- Data analysis is emphasized throughout the continuum of disease surveillance activities – from reviewing routine disease monitoring data for unusual events or patterns to analysis of investigation data during an outbreak.
- Communication with communities and feedback to health staff are carried out effectively.
- Supervisory activities are guided by checklists that help to build capabilities sequentially.
- IDSR performance indicators are used to monitor the quality of the surveillance system and periodic evaluation are conducted routinely and action taken when problems are identified.
- More than 100 surveillance and disease experts from CDC, WHO, and Ministries of Health in African countries contributed to the concepts, approaches and technical requirements that comprise the IDSR strategy.
- Disease detectives in Field Epidemiology Training Programs learn IDSR skills and objectives in all courses.
- CDC and WHO/AFRO field tested the new IDSR eLearning course and materials in Malawi
- Since adapting IDSR to national contexts, many countries, such as Ethiopia and Kenya, publish weekly bulletins with reports on current disease trends and outbreak response.