Post-flood Disease Surveillance System in Private Healthcare Facilities, Kerala, India, August 2018

  • Public health surveillance
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Background:
Kerala state in India suffered the worst flood ever in August 2018, affecting 5.4 million people and caused 483 deaths. Considering the potential risk of communicable diseases, we established private healthcare facilities (PHF) disease surveillance to identify early warning signals for outbreaks.

Methods:
We initiated a daily disease surveillance system from PHF in 12/14 flood-affected districts with >30% water-logging for >3 days. Based on the WHO Early Warning Alerts and Response Network tool and the Integrated Disease Surveillance Programme’s (IDSP) syndromic and presumptive case definitions for 13 diseases, we sensitized PHF to report cases through MS Excel, web application or text messaging. Data were collated at district and state levels for disease trends and outbreaks, and shared with the state/district surveillance units.

Results:
We completed 276 sensitization meetings and 754 PHF visits. A total of 10,222 cases from 476 PHF (201 existing and 275 new) were reported during 26 August to 19 September 2018 [fever-52%, acute respiratory infection (ARI)-12%, leptospirosis-9%, acute diarrheal disease (ADD)-8%, dengue-7%, viral hepatitis-4% and others-8%]. About 50% leptospirosis cases were reported from Ernakulum and Kozhikode districts [median age-42 years, (range <1-85), 61% males]; 65% dengue cases from Ernakulum, Kannur, and Thrissur districts [median age-32 years, (range <1-87), 62% males]; and 59% of viral hepatitis cases from Ernakulum and Malappuram districts [median age-42 years, (range <1-85), 63% males]. In collation with IDSP data, alerts were generated for leptospirosis, dengue, viral hepatitis, ARI and ADD cases for health departments for outbreak response. Public health response within 24 hours by state government, including revised disease management advisories for PHF likely limited morbidity and mortality during outbreaks.

Conclusion:
We successfully established and strengthened disease surveillance system (136% increased reporting) in PHF during the flood response. Disease alerts helped in release of revised treatment guidelines and prompt public health response.

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