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Introduction to Understanding Surveillance Systems

In this video, Riris Adondo Ahmad, introduces the important function of surveillance. (Step 2.3)
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SPEAKER 1: Hi welcome. My name is Reyes Andonohama. I am a professor in public health at the faculty of Medicine and Public Health and Nursing Universitas Negeri Manado Indonesia. Today I will discuss about the importance of surveillance, and we will start with understanding the surveillance system. Surveillance system, this is a support system for public health action. Quality of surveillance is quite simply essential for any eradication program, because if you don’t know where the disease is circulating you don’t know if it is gone. Health surveillance is the ongoing systematic collection, analysis, and interpretation of health data essential for planning, implementing, and evaluating public health activities.
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Surveillance need to be linked to timely dissemination of data and therefore effective action can be taken to prevent the disease.
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The scope of surveillance is broad: from early warning system for rapid response in the case of communicable diseases, to the planned response in the case of chronic diseases, which generally have a longer time period between the exposure and the disease. As the eradication of wild poliovirus, or WPV, comes with increased surveillance– which detect the presence of the virus wherever it persists– become even more critical because it allows the earliest possible response to outbreaks, shows immunization teams where the greatest need is, and provide information to the decision makers tasked with allocating scarce public health dollars. Effective surveillance system are essential for the control of communicable diseases.
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Yet it is not only the quality of the data but also the response that makes the system effective. The polio surveillance system has the rates and technical capacity to serve as the foundation of the most effective global surveillance system ever developed. We’ll talk more about this as we go. A recent example highlights the importance of effective surveillance. In September 2015, Nigeria, one of the last three remaining polio endemic countries, was declared polio free by the World Health Organization after one year with no polio transmission. Nigeria was the last polio endemic country in Africa, so at this moment it seems as if the eradication effort in Africa was complete. People across the region celebrated.
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Just a year later there was a disturbing development. In August 2016, two years after the last reported cases of wild poliovirus type one, or WPV1, two new cases of WPV1 were reported from internally displaced population, or IDPs in Borno State. Genetic sequencing indicated that these cases were closely related to the 2011 WPV1 virus. The emergence of these two cases indicated prolonged circulation of WPV1 that went undetected because the area was inaccessible to polio program. A surveillance review in 2016 concluded that at least half of the settlements in the state had been inaccessible since 2014 due to restricted population movement and the lack of cellular network for mobile phone communication to support immunization and surveillance effort.
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The independent monitoring board for polio eradication saw this map of surveillance quality in Nigeria with a big caption. Many finds this hard to believe. Why? What’s going on? How could we fix it? Because this map shows that everything seems fine. The good news is that through the work of people across Nigeria surveillance has been improved since this time, and it appears that Nigeria has been truly polio-free since 2016. So for today’s topics we will discuss three things. One is understanding effective surveillance system, second surveillance as a decision support system for a planned response, and third surveillance as a tool for detection and outbreak response.

Riris Adondo Ahmad, MD, MPH, PhD
Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Indonesia

In the video, the lecturer describes a concerning scenario.

In August 2016, two years after the last reported case of wild polio virus Type 1 (WPV1) in Nigeria, two new cases of WPV1 were reported from internally displaced populations (IDPs) in Borno State. Genetic sequencing indicated that these cases were closely related to a 2011 polio virus. The emergence of these two cases indicated prolonged circulation of polio that went undetected because the area was inaccessible to the polio program. A surveillance review in 2016 concluded that at least half of the settlements in the state had been inaccessible since 2014, due both to restricted population movement, and lack of a mobile phone network to support immunization and surveillance efforts.

Why is this a major problem that many within polio eradication saw as nothing less than a crisis?

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Collecting and Using Data for Disease Control and Global Health Decision-Making

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