Strengthen disease surveillance and outbreak response
Bangladesh has limited ability to get accurate data quickly from its 400-plus local disease reporting sites and integrate it at the sub-national and national levels. This three-year project will address that deficit, so that the country’s Institute of Epidemiology, Disease Control and Research (IEDCR) can track potential outbreaks and emerging threats that typically show up first in far-flung locations. As the government's mandated national institute for disease surveillance and outbreak response, IEDCR is committed to developing a modern and effective disease surveillance system. Despite much progress in recent years, including US CDC support for an internet-based reporting system for influenza, some gaps remain. IECDR is now seeking assistance from IANPHI to build on recent investments in surveillance to transform disease intelligence and response and improve health outcomes in Bangladesh.
Professor Mahmudur Rahman (pictured above), director of IEDCR, has worked closely with IANPHI project manager Allison Greenspan and policy advisor Dr. Sue Binder in developing a long-term project for IANPHI funding. During a site visit to Bangladesh in January 2010, IANPHI-Emory collaborated with Prof. Rahman and the IEDCR team to define the steps to take toward more effective evidence-informed public health decision-making and action.
The proposed project seeks strategic investments to strengthen surveillance for communicable conditions by further developing the CDC-funded web-based reporting system beyond the curent district- to national-level platform. These enhancements will improve the timeliness and completeness of disease reporting and analysis by expanding the system to the sub-district level. The effort will also provide a platform for a long-planned integrated approach to surveillance -- one that can be adapted nationwide for additional conditions and by additional users. Once the system is functional, it will be incorporated into the national surveillance system of the government of Bangladesh and maintained by the Ministry of Health and Family Welfare.
Enhancements to the national disease surveillance system will result in substantial integration and coordination of the various surveillance systems operating in Bangladesh, with benefits to other ministry offices and development partners. Additional proposed activities will fill critical needs for outbreak response, facilitate development of surveillance in new areas such as NCDs and injuries, and develop the basis for an integrated national public health laboratory system to support surveillance and other public health activities.
Given IEDCR’s strong leadership and capacity, substantive relationships with national and international partners, and potential for linkages with a proposed new Field Epidemiology and Laboratory Training Program (FELTP), this project will be a model for countries in Asia and Africa with pressing needs to expand evidence-based decision making.
Notes from the Field
Updated October 6, 2010 - Anthrax in Bangladesh: IEDCR continues investigation and control activities
On 18 August, 2010, IEDCR detected an outbreak of cutaneous anthrax in Sirajganj District through event-based surveillance, according to Director Mahmudur Rahman. A collaborative team of epidemiologists, physicians, veterinarians and anthropologists from IEDCR and ICDDR,B rushed to the field on 19 August to investigate the outbreak. Later on, six more outbreaks in Sirajganj and Pabna Districts were investigated by National Rapid Response Team (NRRT) of IEDCR. The team of IEDCR and ICDDR,B investigated the epidemiological, clinical, and exposure history of suspected human and animal illnesses. The team identified 168 cases and interviewed 146 cases from 11 villages of two districts. All cases had typical skin lesion of cutaneous anthrax and all of them were treated with Ciprofloxacin at least for 10 days. The team collected blood, vesicular smear and vesicular swab from patients, and the samples were tested at Microbiology laboratory, IEDCR where rod shaped Anthrax bacilli were identified. All human cases either had history of slaughtering sick animals or handling raw meat of sick animal or were present at slaughtering sites. The team identified 65 sick animals of which 43 (66%) were cattle and 22 (34%) were goats or sheep. Total 23 (35%) sick animal were slaughtered. Ninety percent (35/39) of the dead animals were thrown in water or in an open field. Only 4(6%) of those 65 sick or dead animals had a history of Anthrax vaccination in the past year. Later, more outbreaks of cutaneous anthrax were detected in different districts of the country. Since 18 August 2010, a total 479 cases of cutaneous anthrax have been detected from 8 districts as of 9 September 2010. By October 4, the human cases had risen to 607. IEDCR is closely monitoring the situation and coordinating with the Department of Livestock and other stakeholders to control the situation.The government has designed a livestock vaccination program targetting the affected districts, but expects to take a year to implement a program to cover the entire country given current manpower and infrastructure.
In 2009, after 24 years of last reported anthrax outbreak in Bangladesh, IEDCR documented three anthrax outbreaks in two districts of northwestern Bangladesh. Four more outbreaks were detected and investigated by IEDCR between April and June 2010. A total of 99 human cases of cutaneous anthrax were detected in those seven outbreaks.
For more information, visit www.iedcr.org
