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Surveillance: Participant Manual

About this manual

This manual contains a very brief outline of the session headings and key concepts from the training course on Surveillance.

A copy of this manual is intended to be provided to every participant attending the training course in Surveillance.

The 2014 Pedoman Teknis Surveilans Penyakit Hewan Menular (Technical guidelines for infectious animal disease surveillance) serves as the complete reference book for this training course, and will be provided to all participants.

This manual is arranged by session headings based on the order and content of the teaching sessions in a three-day training course prepared for delivery of the material.

Session 1 Welcome and Introduction

Course structure

            Session           Session title

            Session 1         Welcome and Introduction               

            Session 2         Overview of Surveillance

            Session 3         Surveillance objectives

            Session 4         Measures of disease

            Session 5         Structured surveys

            Session 6         Aggregation point surveillance and sentinel herd/flocks

            Session 7         Laboratory surveillance, syndromic surveillance, and negative reporting

            Session 8         The farmer reporting system (1)     

            Session 9         The farmer reporting system (2)     

            Session 10       Farmer reporting system (improving reporting rates); Participatory approaches to surveillance

            Session 11       iSIKHNAS and its role in surveillance           

            Session 12       Course Evaluation, Conclusion, and Closing            

Introduction

This course has been developed as part of the Australian-Indonesian Partnership for Emerging Infectious Diseases program to improve the collection, management and use of animal health information to improve capacity for effective disease control and prevention.

The training in surveillance has been developed for training of staff whose roles include decision-making about surveillance activities, including their planning and implementation.

The overall effect of improvements in animal disease control and prevention will be better health and well-being of the whole community.

What are we going to learn in the course?

Over the next three days we will be talking about:

• different approaches to animal disease surveillance

• the farmer reporting system, and how it might be improved

• accessing iSIKHNAS outputs for use in planning, managing and analysing surveillance activities.

By learning about each of these areas, participants will be gaining new skills.

What will you be able to do by the end of this course?

By the end of this course you will understand the different approaches to animal disease surveillance and be able to use this knowledge to contribute to effective surveillance of animal health problems for the benefit of Indonesian livestock and their owners.

Session 2 Overview of Surveillance

Key concepts

Surveillance is the systematic ongoing collection and analysis of information related to disease and timely distribution of information so that appropriate decisions can be made

The surveillance process involves multiple steps.

Surveillance data is used by decision-makers in many aspects of their work.

Surveillance is MORE than just watching for disease.

Surveillance information is of no value unless people who need to know about it are informed and can act on it.

These are the steps of the surveillance process:

1. find out about disease
2. report the findings
3. summarise and analyse the data
4. produce outputs for interpretation
5. make decisions based on the data and its interpretations.

We are very fortunate because all of the middle steps (reporting, summarising and analysing, preparation of outputs) can now be handled by iSIKHNAS.

iSIKHNAS is Indonesia's new animal health information system. The system uses every day technology in simple but clever ways to gather data from the field and make it immediately available to stakeholders in ways that are readily useful and meaningful.

Read more about how surveillance information is used in the Pedoman Teknis Surveilans Penyakit Hewan Menular, pp 5-6.

Session 3 Surveillance objectives

Video

[YouTube link Session 3 Surveillance Objectives]

Key concepts

Surveillance objectives can be grouped into two categories: surveillance for diseases that we do have, and surveillance for diseases that are not present.

Every surveillance activity must have a specific objective or purpose. No country can afford to do surveillance without a purpose, or out of interest alone.

There are many reasons for doing surveillance, but they can be grouped into two main categories, each of which has two sub-categories, as shown in the diagram above.

Doing surveillance for diseases that we DO have is easy to understand. Knowing how much disease we have, and where it is, is important. Decision-makers have to decide how much budget is needed for disease control activities, and where it should be spent. Finding every case of a particular disease becomes extremely important at the end of an eradication program, or where the disease is very important for public health reasons (such as rabies).

Doing surveillance for diseases that we do not have sometimes seems less important, but we need to do it to confirm that disease is not there, or to find it early if it gets in. Again, this knowledge is important for decision-makers, who need to know if they can stop expensive control programs because they are no longer needed. Sometimes, being able to show that disease is absent opens up new trade opportunities.

Session 4 Measures of disease

Video

[Internet link]

Key concepts

Case definition

A case definition is a set of standard criteria for deciding whether an individual animal has a particular disease or other aspect of interest.

Sign and syndrome

Sign: things that can be measured or observed about the animal's health

Syndrome: collection of signs

Measures of disease

Prevalence: "snapshot" of amount of disease present in a population at a particular point in time.

Incidence: new cases of disease occurring in a population within a defined period of time (several types of this measure).

When we measure disease, we have to be sure that everyone is talking about the same thing. This is why we use case definitions, because this gives us a standard set of criteria for deciding what is a case, and what is not. The criteria for a case definition can be based on one or more clinical signs, or other information about the situation (epidemiological data), or laboratory data, or a combination of these things.

Prevalence is a measure of how much disease is present in a population at a particular point in time. This measure uses both the number of cases (determined using the appropriate case definition) AND the "population-at-risk", which is the number of animals (or herds, or flocks, or villages, whatever the case definition uses) that could be cases.

Incidence tells us about how fast disease is moving through a population. Here we count the number of new cases that have occurred within a specified time period. If we do not included any information about the population-at-risk, then our measure is simply incidence. If we include the population-at-risk at the beginning of the time period, then this is cumulative incidence. If we have even more information available exactly how much time each member of the population is at risk during the time period then we can calculate incidence rate.

Session 5 Structured surveys

Key concepts

Structured surveys are a way of gathering information about individuals. A sample of the population is studied.

A representative survey is one where every element in the population has the same chance of being sampled. Representative surveys are very good for estimating disease prevalence.

A risk-based survey is one where certain elements of the population are much more likely to be sampled than others. This is useful when you want to show evidence of absence of disease. Resources are allocated to look hard for disease where it is likely to be.

A survey is a data collection tool used to gather information about individuals. There are many, many types of survey. Surveys collect information from a subset or sample of the population.

A representative survey is arranged so that every element of the population has the same chance of being selected for the survey. These types of surveys have to be carefully planned, to make sure that this is the case. Representative structured surveys are particularly good for providing unbiased estimates of prevalence (how much disease is present).

Sometimes you do not want every element of the population to have an equal chance of being selected. Sometimes, you want to find disease, if it is there. Surveys like this are called "risk-based", because high-risk sites or individuals are more likely to be sampled than are low-risk ones. These types of surveys cannot provide unbiased estimates of prevalence. They can also provide good evidence for disease freedom. The planning and analysis of risk-based surveys needs expert advice.

Conducting a survey is less expensive than doing a census, where every member of the population is studied. Because you have control over the design of a survey, you control the quality of the data. Surveys can be repeated, to see how the situation changes over time

Session 6 Aggregation point surveillance, and sentinel herds/flocks

Key concepts

Aggregation point surveillance

This is surveillance that is conducted at places where animals are brought together for other reasons, such as abattoirs or markets. Many animals can be sampled. However, you do not have control over the number, type, or origin of the animals available for sampling, and the animals may not be completely representative of the population.

Sentinel surveillance

Sentinel herd or flock surveillance involves the repeated testing of susceptible animals that are located in an area of high importance. This type of surveillance only suits certain diseases (for example, vector-borne diseases), and tends to be very expensive.

Aggregation point surveillance is conducted at places where animals are brought together, such as at abattoirs, livestock markets, or dipping facilities. Animals that are sent to the aggregation point tend to be healthier than the general population, so the results may show a ‘healthy animal bias’. If disease is found in any of the samples, it can be hard to trace back to find where the animal came from. Aggregation point surveillance can provide estimates of prevalence of certain diseases (recognising the possibility of bias). It can provide a way of monitoring the progress of a disease control program. Aggregation point surveillance can also assist in providing confidence in freedom from certain diseases.

Sentinel herd or flock surveillance involves the repeated testing of a group of susceptible animals that are strategically located in an area of high risk or importance. Sentinel herd surveillance tends to be very expensive, and not very well-liked by farmers, as the repeated sampling can be inconvenient for them, and they must keep the same animals for a long time. However, it can provide very good information about the presence or absence or spread of certain diseases in the area where the herd or flock is located.

Session 7 Laboratory surveillance, syndromic surveillance, and negative reporting

Key concepts

Laboratories do more than process samples collected as part of active surveillance activities. They are also a source of passive surveillance data.

Syndromic surveillance is the analysis of reported signs or syndrome data, looking for unusual patterns.

The absence of reports of priority disease could mean no disease present, but could also mean that no one was looking. Submission of a negative report confirms the absence of priority disease in the reporter's area.

Syndromic surveillance and negative reporting are particularly useful for priority diseases.

iSIKHNAS makes collecting and analysing passive surveillance data very easy.

Passive surveillance data comes from activities that are conducted for purposes other than surveillance. Active surveillance consists of activities that are conducted for the purpose of obtaining surveillance data. Passive surveillance data can be very useful, and is usually quite inexpensive compared to the cost of active surveillance. Data from laboratory submissions from disease investigations is passive surveillance data. Analysis of the information accompanying a laboratory submission along with the investigation results can form an important part of a country’s animal health surveillance system. If information about the signs or syndrome affecting the animals is collected, analysis of these data for trends and patterns can be performed, and this is called syndromic surveillance. Syndromic surveillance is very useful for early warning of the incursion of important diseases that we do not have, and is also good for providing evidence of absence of important diseases.

However, absence of reports of signs or syndromes consistent with priority disease could just mean that no one was looking for disease (absence of surveillance!). However, submission of a negative report confirms that the surveillance system is operational and that priority diseases were not observed.

Session 8 Farmer reporting system (1)

Key concepts

The farmer reporting system is a passive surveillance approach that relies on farmers observing sick animals and seeking help from para-veterinarians or veterinarians.

It has comprehensive coverage of the population.

Good for detecting disease, providing evidence of disease freedom, and case-finding for disease with obvious clinical signs.

The basic steps in the farmer reporting system are:

• animal becomes sick

• farmer notices sick animal

• farmer decides to get help

• farmer contacts para-veterinarian or veterinarian

• para-veterinarian or veterinarian examines animal (disease investigation)

• samples collected and submitted (sometimes)

• information about case are recorded

Surveillance information is of no value unless people who need to know about it are informed and can act on it, so this last step is very important. Fortunately, iSIKHNAS means that information can be recorded quickly and easily, and becomes immediately available to those who need to know about it.

The farmer reporting system is continuous and ongoing. It has excellent population coverage, and because it is a passive surveillance system, there are few costs associated with the generation of the surveillance data. This system is one of the best ways of finding out about new or emerging diseases, and it can provide good evidence for freedom from disease. It can also be good for finding cases of disease. However, it is not particularly useful for determining prevalence of disease, although it can provide some idea about changing levels of disease in an area.

Session 9 Farmer reporting system (2)

Key concepts

There are multiple steps between an animal becoming sick and submission of disease reports.

Considering these steps helps us to determine what affects farmer reporting.

iSIKHNAS handles the passive surveillance data from the farmer reporting system very well.

Farmers are not all equally likely to notice and report disease. This is why the farmer reporting system cannot give truly reliable estimates of disease prevalence. A low number of disease reports might mean that there is not much disease in the area, or it could mean that a new veterinarian or para-veterinarian is working in the area, and the farmers do not yet trust this person.

The farmer reporting system will not be very good at detecting disease if farmers are reluctant or unable to report disease to the veterinary authorities. A very important part of this workshop is the work that your group will be doing in thinking about the factors that might affect farmer reporting. Here are some reasons it is worthwhile trying to improve the farmer reporting rates:

• Indonesia is very fortunate, because iSIKHNAS captures information about all farmer disease reports, not just the ones that result in laboratory submissions.

• The information from field and laboratory submissions is linked, so field diagnoses can easily be confirmed or updated.

• Reporting is standardised. Everyone submitting to iSIKHNAS records data in the same way, so data can be compared from all over the country.

• Summary and analysis is instantaneous. Data is available right away to those who need it, in a form they can use.

Improving farmer reporting rates will help give iSIKHNAS more data to work with.

Session 10 Farmer reporting system (improving reporting rates); Participatory approaches to surveillance

Key concepts

Participatory approaches to surveillance can be very good for detecting cases of disease or contributing to evidence of disease freedom.

Extensive and ongoing training is needed for the practitioners, and this can be expensive.

Managing and making use of the surveillance information can be difficult.

Principles of participatory approaches:

• farmers have valuable technical knowledge

• visitors ("technical experts") are not familiar with local situations

• flexibility in approach is important - must adapt to suit individual circumstances

• social context of a disease is important

• information is collected in a variety of ways, then cross-checked.

Participatory approaches use participatory methods, which are a set ("toolbox") of excellent communication skills and strategies, and include:

• semi-structured interviewing

• focus-group discussions

• ranking and scoring activities

• visualisation techniques.

Participatory approaches to disease surveillance involve the use of participatory methods in disease surveillance activities.

Session 11 iSIKHNAS and its role in surveillance

Key concepts

iSIKHNAS is Indonesia's integrated real-time information system for collecting, managing, reporting and using data to support animal health and production.

iSIKHNAS gets the right information, at the right time, to the right people, in the right form to enable good evidence-based decision-making.

iSIKHNAS belongs to the Government of Indonesia.

Wiki (documentation) - www.isikhnas.com/wiki

Online data access - www.isikhnas.com

There are many ways to get data into and out of iSIKHNAS, including: SMS, instant messaging, web browser, email.

There is immediate access to the data for all registered users (except farmers who only have access to their own data, for privacy).

The automated output reports can be customised for different needs. Users get the data they need for their job, when they need it.

The focus of this session is exploring iSIKHNAS, so that you can find the information you need. And if you need reports that are not currently available, we will request that these be created for you.