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DengueNet
in India
Weekly Epidemiological Record, 2004, 79(21): 201-203
Epidemic dengue fever (DF) and dengue haemorrhagic
fever (DHF) have emerged as a global public health problem in recent decades.
In fact, the problem has become hyperendemic in
many urban, periurban and rural areas, with
frequent epidemics. The South-East Asia Region is one of the regions at
highest risk of DF/DHF, accounting for 52% of the global risk. Dengue
outbreaks now occur in India, as in other high-burden countries in the
Region, such as Indonesia, Myanmar and Thailand.
Strengthening epidemiological and laboratory surveillance of dengue and
dengue haemorrhagic fever including, the
implementation of DengueNet , is one of the priorities of the global and regional
strategies for dengue prevention and control. DengueNet
is WHO’s global data management system created on
the Internet to collect and analyse standardized
epidemiological and laboratory surveillance data with the objective to
improve capacity for effective national and international planning for the
prevention and control of epidemic dengue and DHF.
Following the pilot use of DengueNet in the Americas, a joint WHO HQ/SEARO/WPRO meeting on DengueNet implementation in South-East Asia and the Western Pacific was held in Kuala Lumpur on 11-13 December 2003 .
The objective of the meeting was to expand the pilot project to these two
regions, building upon the lessons learned from the pilot project in the Americas. Based on the recommendations of this
meeting, two country workshops were organized in India in March 2004, supported by the WHO/CSR
and USAID project to strengthen surveillance in India. The first took place in New Delhi on 11-12 March 2004 with the northern
states and the second in Bangalore on 16-17 March 2004, with the southern states. WHO collaborating centres attended both meetings. The proceedings and
recommendations from the New Delhi meeting were discussed at the Bangalore meeting to ensure that the consensus
recommendations addressed national issues, needs and priorities. Experts from
health service departments of all states and the Delhi City Corporation, the
National Institute for Communicable Diseases (NICD), the National Institute
of Virology (NIV) in Pune, the WHO Department of
Communicable Disease Surveillance and Response, WHO Representative for India and SEARO participated.
The main objective of the workshops was to strengthen disease
surveillance and response to vector-borne diseases using DengueNet
as an entry point. Work focused specifically on assessing current
surveillance practices (including the use of case definitions, reporting
formats and mechanisms for flow of information), laboratory facilities and
tests for DHF, on identifying and strengthening regional collaborative
laboratories and on establishing a framework for participation in DengueNet.
Experiences both from India and from the region on surveillance and
control were discussed. The need for an integrated approach to surveillance
of vector-borne diseases and application of lessons and experiences from
malaria and other vector-borne diseases was identified. The consensus was to
implement DengueNet in accordance with the
Integrated Disease Surveillance Programme (IDSP) that is starting in India. This would require capacity building for
disease surveillance and response at national, state and district levels,
through training of health workers and programme managers and strengthening
of laboratory services.
Given the vastness of the country, the heterogeneity of the disease
burden and the organizational network, the group recommended piloting the
participation of selected states in global DengueNet
through focal points at state and national level. States in which
implementation would be piloted included Delhi, Karnataka, Maharashtra, Tamil Nadu and Uttaranchal. Maharashtra and Tamil Nadu
have a well developed disease surveillance system and a network of public
health laboratories at both district and state level, with strong linkages to
national-level laboratories. Delhi, following the recent dengue outbreak, has
significantly improved its surveillance system, including strengthening of
laboratory services. Uttaranchal, although lacking
a good network of laboratories, was included because of its close proximity
to Delhi.
It was also decided to designate two WHO laboratory collaborating centres (WHO CC) for northern and southern states to
ensure practical use of these facilities. Accordingly, NIV-Pune will continue as WHO CC for the south, and it is
recommended that WHO designate NICD to serve as WHO CC for the northern
states (following a request from NICD). The two centres
would be responsible for training, quality control, use of standard
procedures and networking at national and international level.
Based on the recommendations of the workshops, a follow-up meeting has
been planned to develop an activity plan for 2004 focusing on laboratory
strengthening, training, disease and vector surveillance, networking, information sharing and reporting to DengueNet.
NICD will take the lead role in this follow-up activity, which is scheduled
for the end of May 2004, working closely with all major stakeholders
.
Major stakeholders include the Indian Council for Medical Research, IDSP
Cell, Delhi City Corporation, NICD – WHO CC for Training and Epidemiology,
WHO CC for Rabies Epidemiology, WHO Regional Reference Laboratory for Polio
Surveillance, National Reference Laboratory for SARS and Avian Influenza, state
nodal officers of the pilot states and states that were not represented in
the earlier meetings, national-level institutes such as the Central Bureau of
Health Intelligence, Vector Control and Research Centre – WHO CC for
Filariasis and Vector Control, National Vector Borne Disease Control
Programme and NIV – WHO CC for Arboviral Disease
Diagnosis and Research and National Influenza Surveillance Centre.
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