A novel low-cost approach to estimate the incidence of Japanese encephalitis in the catchment area of three hospitals in Bangladesh

Acute meningoencephalitis syndrome surveillance was initiated in three medical college hospitals in Bangladesh in October 2007 to identify Japanese encephalitis (JE) cases. We estimated the population-based incidence of JE in the three hospitals\u27 catchment areas by adjusting the hospital-based crude incidence of JE by the proportion of catchment area meningoencephalitis cases who were admitted to surveillance hospitals. Instead of a traditional house-to-house survey, which is expensive for a disease with low frequency, we attempted a novel approach to identify meningoencephalitis cases in the hospital catchment area through social networks among the community residents. The estimated JE incidence was 2.7/100,000 population in Rajshahi (95% confidence interval [CI] = 1.8-4.9), 1.4 in Khulna (95% CI = 0.9-4.1), and 0.6 in Chittagong (95% CI = 0.4-0.9). Bangladesh should consider a pilot project to introduce JE vaccine in high-incidence areas

Low-Cost National Media-Based Surveillance System for Public Health Events, Bangladesh.

We assessed a media-based public health surveillance system in Bangladesh during 2010-2011. The system is a highly effective, low-cost, locally appropriate, and sustainable outbreak detection tool that could be used in other low-income, resource-poor settings to meet the capacity for surveillance outlined in the International Health Regulations 2005

Disease Surveillance System of Bangladesh: Combating Public Health Emergencies

Objectivea) To observe trends and patterns of diseases of public health importance and responseb) To predict, prevent, detect, control and minimize the harm caused by public health emergenciesc) To develop evidence for managing any future outbreaks, epidemic and pandemicIntroductionDisease surveillance is an integral part of public health system. It is an epidemiological method for monitoring disease patterns and trends. International Health Regulation (IHR) 2005 obligates WHO member countries to develop an effective disease surveillance system. Bangladesh is a signatory to IHR 2005. Institute of Epidemiology, Disease Control and Research (IEDCR <www.iedcr.gov.bd>) is the mandated institute for surveillance and outbreak response on behalf of Government of the People’s Republic of Bangladesh. The IEDCR has a good surveillance system including event-based surveillance system, which proved effective to manage public health emergencies. Routine disease profile is collected by Management Information System (MIS) of Directorate General of Health Services (DGHS). Expanded Program of Immunization (EPI) of DGHS collect surveillance data on EPI-related diseases. Disease Control unit, DGHS is responsible for implementing operational plan of disease surveillance system of IEDCR. The surveillance system maintain strategic collaboration with icddrr,b.MethodsThe IEDCR is conducting disease surveillance in several methods and following several systems. Surveillance data of priority communicable disease are collected by web based integrated disease surveillance. It is based on weekly data received from upazilla (sub-district) health complex on communicable disease marked as priority. They are: acute watery diarrhea, bloody dysentery, malaria, kala-azar, tuberculosis, leprosy, encephalitis, any unknown disease. Government health facilities at upazilla (sub-district) send the data using DHIS2. During outbreak, daily, even hourly reporting is sought from the concerned unit.Moreover, IEDCR conducts disease specific specialized surveillance systems. Data from community as well as from health facilities are collected for Influenza, nipah, dengue, HIV, cholera, cutaneous anthrax, non-communicable diseases, food borne illness. Data from health facilities are collected for antimicrobial resistance, rotavirus and intussusception, reproductive health, child health and mortality, post MDA-surveillance for lymphatic filariasis transmission, molecular xenomonitoring for detection of residual Wucheria bancrofti, dengue (virological), emerging zoonotic disease threats in high-risk interfaces, leptospirosis, acute meningo-encephalitis syndrome (AMES) focused on Japanese encephalitis and nipah, unintentional acute pesticide poisoning among young children. Data for event based surveillance are collected from usual surveillance system as well as from dedicated hotlines (24/7) of IEDCR, media monitoring, and any informal reporting.Case detection is done by syndromic surveillance, laboratory diagnosed surveillance, media surveillance, hotline, cell phone-based surveillance. Dissemination of surveillance is done by website of IEDCR, periodic bulletins, seminar, conference etc. Line listing are done by rapid response teams working in the surveillance sites. Demographic information and short address are listed in the list along with clinical and epidemiological information. Initial cases are confirmed by laboratory test, if required from collaborative laboratory at US CDC (Atlanta). When the epidemiological trend is clear, then subsequent cases are detected by symptoms and rapid tests locally available.ResultsIn 2017, 26 incidents of disease outbreak were investigated by National Rapid Response Team (NRRT) of IEDCR. In the same year, 12 cases of outbreak of unknown disease was investigated by NRRT of IEDCR at different health facilities. Joint surveillance with animal health is being planned for detection and managing zoonotic disease outbreaks, following One Health principles. Department of Livestock, Ministry of Environment and icddrb are partners of the joint surveillance based on One Health principles.Disease Control unit of DGHS, district and upazilla health managers utilizes the disease surveillance data for public health management. They analyze also the surveillance data at their respective level to serve their purpose.ConclusionsA robust surveillance is necessary for assessing the public health situation and prompt notification of public health emergency. The system was introduced at IEDCR mainly for malaria and diarrhea control during establishment of this institute. Eventually the system was developed for communicable disease, and recently for non-communicable diseases. It is effectively used for managing public health emergencies. Notification and detection of public health emergency is mostly possible due to media surveillance.Data for syndromic surveillance for priority communicable diseases is often not sent timely and data quality is often compromised. Tertiary hospitals are yet to participate in the web based integrated disease surveillance system for priority communicable diseases. But they are part of specialized disease surveillances. Data from specialized surveillance with laboratory support is of high quality.Evaluation of the system by conducting research is recommended to improve the system. Specificity and sensitivity of case detection system should also be tested periodically.ReferencesCash, Richard A, Halder, Shantana R, Husain, Mushtuq, Islam, Md Sirajul, Mallick, Fuad H, May, Maria A, Rahman, Mahmudur, Rahman, M Aminur. Reducing the health effect of natural hazards in Bangladesh. Lancet, The, 2013, Volume 382, Issue 9910IEDCR. At the frontline of public health. updated 2013. www.iedcr.gov.bdAo TT, Rahman M et al. Low-Cost National Media-Based Surveillance System for Public Health Events, Bangladesh. Emerging Infectious Diseases. Vol 22, No 4. 2016.<www.iedcr.gov.bd> accessed on 1 Oct 2018.

Costs of hospitalization with respiratory syncytial virus illness among children aged < 5 years and the financial impact on households in Bangladesh, 2010

Background Respiratory syncytial virus (RSV) is the leading cause of acute respiratory illness in young children and results in significant economic burden. There is no vaccine to prevent RSV illness but a number of vaccines are in development. We conducted this study to estimate the costs of severe RSV illness requiring hospitalization among children 50% families borrowed money to meet treatment cost. We estimated that the median direct cost of RSV-associated hospitalization in children aged < 5 years in Bangladesh was US$10 million (IQR: US$ 7-16 million), the median indirect cost was US$ 3.0 million (IQR: 2-5 million) in 2010. Conclusion: RSV-associated hospitalization among children aged < 5 years represents a substantial economic burden in Bangladesh. Affected families frequently incurred considerable out of pocket and indirect costs for treatment that resulted in financial hardship

Outbreak of Mass Sociogenic Illness in a School Feeding Program in Northwest Bangladesh, 2010

BACKGROUND: In 2010, an acute illness outbreak was reported in school students eating high-energy biscuits supplied by the school feeding programme in northwest Bangladesh. We investigated this outbreak to describe the illness in terms of person, place and time, develop the timeline of events, and determine the cause and community perceptions regarding the outbreak. METHODS: We defined case-patients as students from affected schools reporting any two symptoms including abdominal pain, heartburn, bitter taste, and headache after eating biscuits on the day of illness. We conducted in-depth interviews and group discussions with students, teachers, parents and community members to explore symptoms, exposures, and community perceptions. We conducted a questionnaire survey among case-patients to determine the symptoms and ascertain food items eaten 12 hours before illness onset, and microbiological and environmental investigations. RESULTS: Among 142 students seeking hospital care, 44 students from four schools qualified as case-patients. Of these, we surveyed 30 who had a mean age of 9 years; 70% (21/30) were females. Predominant symptoms included abdominal pain (93%), heartburn (90%), and bitter taste (57%). All students recovered within a few hours. No pathogenic Vibrio cholerae, Shigella or Salmonella spp. were isolated from collected stool samples. We found no rancid biscuits in schools and storage sites. The female index case perceived the unusually darker packet label as a "devil's deed" that made the biscuits poisonous. Many students, parents and community members reported concerns about rumors of students dying from biscuit poisoning. CONCLUSIONS: Rapid onset, followed by rapid recovery of symptoms; female preponderance; inconsistent physical, microbiological and environmental findings suggested mass sociogenic illness rather than a foodborne or toxic cause. Rumours of student deaths heightening community anxiety apparently propagated this outbreak. Sharing investigation results and reassuring students and parents through health communication campaigns could limit similar future outbreaks and help retain beneficiaries' trust on nutrition supplementation initiatives