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Strengthening Outbreak Surveillance and Response in
the State of Orissa
through the India Field Epidemiology Training Programme (FETP)
The state of Orissa that is
prone to outbreaks of infectious diseases has benefited from a multi-disease
surveillance system since 2000. This surveillance system was put in place
with the assistance of the World Bank and is a direct consequence of the
response to the mega cyclone that devastated the East Coast in 1999. The
Orissa surveillance system focuses on a limited set of conditions, allowing
rapid detection of outbreaks and facilitating prompt responses.
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FETP scholars from Orissa and Faculty members at
the Konark temple during a field visit in September 2004
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The recruitment of scholars from Orissa for the India Field
Epidemiology Training Programme (FETP) has been an excellent complement to
the surveillance system in place in the state. Since 2002, four Orissan
scholars were recruited among clinicians and public health specialists of the
state to integrate the two-year training coordinated at the National
Institute of Epidemiology (NIE) located in Chennai, Tamil Nadu. NIE is part
of the Indian Council of Medical Research (ICMR). As part of their
assignment, the scholars alternated “contact sessions” in Chennai when they
received technical training and “field posting” sessions in their state where
they got involved in surveillance activities, outbreak investigations and
various special projects. A recent field visit in Orissa by Dr Ramakrishnan
Ramachandran, coordinator of the FETP, and Dr Yvan Hutin, WHO resident
advisor assigned to NIE to strengthen the FETP was an opportunity to review
progress in the state.
The FETP scholars of Orissa are able to offer substantial assistance
to the statewide surveillance system. First, they assist in the training and
supervision of surveillance officers at the district level. Second, they
participate in the data analysis and in the feedback loop. Third, they are in
a position to follow up on outbreak reports to investigate, identify sources
of infection and propose targeted recommendation measures. While the FETP
scholars assist in the state surveillance system, they can also benefit from
it as they obtain timely notifications of outbreaks that lead to
investigations and training opportunities.
Two recent outbreak investigations in Orissa illustrate the public
health benefit that comes from the collaboration between the multi-disease
statewide surveillance system and the FETP. In 2003, a cholera outbreak in a
village was linked to an unprotected well that had been contaminated by a
patient affected with the disease and who was living nearby. A prompt
investigation led to the identification of the source of infection. This
allowed recommending against the use of the incriminated well and for
appropriate constructions to prevent future occurrences. Early in 2004, a
large hepatitis E outbreak in a densely populated urban dwelling was linked
to a municipal water supply pumped from surface waters. This water source had
not been treated following a temporary break down at the water treatment
plant. Identification of this source of infection allowed public health
officials in the district to implement immediate control measures and to work
with the local authorities to identify mechanisms to put in place to ensure
the long-term safety of the municipal water system in order to prevent future
episodes.
As Orissa is preparing to send additional staff members to join the
Chennai-based FETP in 2005, the FETP is also planning to develop similar
success stories with Indian states in which the new Integrated Disease
Surveillance System (IDSP) will be launched. Priority appointment of FETP
scholars in such states will allow the same type of interactions between
surveillance and epidemic intelligence for the greater public health benefit
in India.
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