iii.Integrated Disease Surveillance Project

At national level Integrated Disease Surveillance Project (IDSP) was launched by Hon’ble Union Minister of Health & Family Welfare in November 2004. It is a decentralized, State based Surveillance Program in the country. It is intended to detect early warning signals of impending outbreaks and help initiate an effective response in a timely manner.

Major components of the project are:

(1) Integrating and decentralization of surveillance activities;

(2) Strengthening of public health laboratories;

(3) Human Resource Development – Training of health care workers involved

(4) Use of Information Technology

In Sikkim, Integrated Disease Surveillance Project was launched in Ph III (2006-07) on 1st April 2006.

Currently surveillance is working on three aspects of diseases surveillance.

  Syndromic - Diagnosis made on the basis clinical pattern by paramedical personnel and members of community. This include fever, fever with rashes, fever with bleeding, diarrhea without dehydration, diarrhea with so much dehydration, diarrhea with blood, cough less than 3 weeks and more than 3 weeks, fever with daze or semi/unconsciousness.

  Presumptive - Diagnosis is made on typical history and clinical examination by medical officers. This includes Acute Diarrheal diseases, Acute Respiratory Diseases, Measles, Chicken Pox, Dengue, Bacillary Diarrhea, Viral Hepatitis, Enteric fever, Malaria, Chikungunya fever, Acute Encephalitis syndrome, meningitis, diphtheria, pertusis, pneumonia, Fever of unknown disease, acute paralysis, leptospirosis, dog-bite, snake bite, diabetes, Hypertension, cardio vascular diseases, and motor vehicle acciodents.

  Confirmed - Clinical diagnosis by medical officer and or positive laboratory identification. This includes typhoid fever, dengue, hepatitis, malaria, tuberculosis, cholera, shigella dysentery, diphtheria, chikungunya, meningococcal meningitis, leptospirosis and others.

Apart from these diseases, in 2010 IDSP included some of the non- communicable diseases/syndrome for its surveillance. They were diabetes, hypertension, cardio vascular diseases, and motor vehicle accidents.

Physical Activities

1. Human Resource Development – To provide better technical expertise to system GOI has provided contractual staffs (Epidemiologist, Entomologist, Financial consultants, Microbiologists, Data manager, Data Entry operators and others). A total of 22 staffs are working in IDSP in which 15 staffs are on Contractual Basis. Appointment of DEO and DM was done in year 2007-08 and also two Data Manager & two Microbiologist were appointed in year 2011-2012. There is also a provision of capacity building for all human resource available in the State through routine training of health care workers involved in IDSP. For this purpose GOI provides a separate fund.

Manpower of IDSP, Sikkim

DESIGNATION / SSU / DSU / MEDICAL COLLEGE. / TOTAL / NATURE OF POST / STATUS
SSO / 1 / 1 / Regular / Active
DSO / 4 / 4 / Regular / Active
Training Consultant / 1 / Contractual / Inactive
Epidemiologist / 1 / 1 / Contractual / Inactive
Entomologist / 1 / 1 / Contractual / Active
Financial Consultant / 1 / 1 / Contractual / Active
Data Manager / 1 / 4 / 5 / Contractual / Active
Data Entry Operator / 1 / 4 / 1 / 6 / Contractual / Active
Microbiologist / 2 / 2 / Contractual / Active

2. Strengthening of public health laboratories –

In order to strengthen the laboratory facilities to support IDSP, GOI has provided human resources, various kits and fund for infrastructural development. At present IDSP is working with laboratories in most of the health institutions (24 L-PHC, 4 L-district, 1 in STNM and 1 in CRH, Tadong

Sl. NO / District / State / Laboratory
1 / State / STNM
2. / Medical College Manipal / CRH
3. / East / 8 PHC and 1 District Lab
4. / West / 7 PHC and 1 District Hospital
5. / North / 3 PHC and 1 District Hospital
6. / South / 6 PHC and 1 District Hospital
7. / Private Labs / 4 Private Practitioner Labs in the State.

3. Use of Information Technology – All DSUs and SSU is well allied with Telephone, Fax Machines, Computers with Internet, EDUSAT & VSAT application facilities. Routine data is entered through the web based IDSP-portal (), VSAT has been installed in all four Districts, State and Medical College Manipal, Hospital except Singtam where the installation is incomplete.

At present EDUSAT & VSAT facilities has been disrupted from the CSU due to no signal across the country.

EDU-SAT/ V-SAT STATUS

Sl NO / District / State / EDU SAT /VSAT / Broadband
1 / State / Installed *** / Working and installed on 2012
2. / Medical College Manipal / Installed *** / Not installed
3. / East / Installation incomplete / Working and installed on 2008
4. / West / Installed *** / Working and installed on 2008
5. / North / Not installed due to lack of Equipments. / Working and installed on 2008
6. / South / Installed *** / Working and installed on 2008

*** EDUSAT & VSAT facilities have been disrupted from the CSU due to no signal across the country.

4. Reporting –

 Presumptive form (P), Syndromic form (S), Lab form started form PHC, sub-center, DH, STNM and Medical College and also from Private practitioners.

 Weekly outbreak reporting from sub-centre – PHC- District SSU-CSU Delhi. Currently State has 177 reporting units [District -4, PHC 24, PHSC 146, STNM Hospital and CRH Tadong,( Hospital & Medical College)].

 Four private Labs reporting started from 46th week Nov 2008. Reporting form Private Practitioner around Gangtok started in Jan 2009.

 From May 2010 the Reporting on four Non-Communicable diseases have been added in the P-form for integrating the diseases (Hypertension, Cardiovascular diseases, diabetes, and Motor vehicle accidents). S-form and L-form is functional in pre- existing form.

Sl NO / District / State / P / L / S / Year of start of Reporting
1 / State / 1 / 1 / 0 / June 2008
2. / Medical College Manipal / 1 / 1 / 0 / June 2008
3. / East / 8 / 8 / 48 / June 2008
4. / West / 8 / 8 / 41 / June 2008
5. / North / 5 / 5 / 19 / June 2008
6. / South / 7 / 7 / 39 / June 2008
7. / Private Practitioner and Labs / 3 / 3 / 0 / 2009
8 / Private Lab(Gangtok) / 0 / 1 / 0 / April 2012
9 / Urban Health Post (Arithang) / 0 / 0 / 1 / April 2012

Disease Outbreaks detected in the state of Sikkim from 2008 to till date.

Disease Outbreaks / Source of data for identification of these outbreaks / Outbreaks investigated by State / District RRT / Remarks
Focal Outbreak of Dysentry detected in March 2008. / Reported by DSO West. / District RRT West / Controlled in time.
Focal Outbreak of Measles detected in June 2008. / Reported by Health Worker, STNMH / State RRT / Controlled in time.
Focal Outbreak of Measles detected in August 2008. / Reported by Health Worker, Gyalsing Hospital. / District RRT West. / Controlled in time.
Outbreak of Bird-flu at Ravangla, South Sikkim in Jan 2009. / CMO (South). / Central, State, and District RRT’s. / Controlled in time.
Outbreak of Fever Cases with rashes at Pelling, W.Sikkim in March 2009 / DSO (West) / DSO (West) with MPHW Pelling. / Controlled in time.
Outbreak of Chicken-pox at
Enchey Gumpa and Deorali in April 2009. / Dr. Peegy (STNMH). / IEC teams. / Controlled in time.
Outbreak of Gastroenteritis and Viral Hepatitis at Nimtar (E. Sikkim) in May 2009. / Mr. S.D Dhakal Dir. (HRDD). / State RRT. / Controlled in time.
Outbreak of fever cases from Jorethang PHC in July 2009. / CMO (South) / District RRT (South) / Controlled in time.
Focal outbreak of Measles Detected in 2010 / Reported by M.O Mangalbaria, West Sikkim / MO PHC and District RRT and CMO West / Controlled in time
Focal outbreak of Chickenpox Detected in March 2011 / Reported by Ribdi PHSC under Sombaria PHC / MO PHC and District RRT / Controlled in time
Focal outbreak of Measles Detected in March 2011 / Reported by Thingling PHSC under Yakshum PHC / MO PHC and District RRT / Controlled in time
Focal outbreak of Measles Detected in May 2011 / Reported by DSO North District / MO PHC and District RRT / MO PHC and District RRT
Focal outbreak of Diarrhoeal(post earthquake Oct. 2011 in Gangtok urban area) / Reported by MO STNM Hospital Gangtok / State RRT / Controlled in time
Out break of food poisoning at Lingdok, East Sikkim on 1st Jan 2012. / Reported by STNMH / RRT and Senior Health Dept. Official / Controlled in time

5. Capacity building (Workshops and training) –

Sl NO / Trainees / Year of Training / Total Trained
1 / MO / 2011-12 / 20
2 / DM/DEO, IDSP / 2011-12 / 11
3 / MPHW / 2011-12 / 28

6. Committee and surveillance –

State Surveillance Unit and District Surveillance Unit were formed established in year 2006. State surveillance committee was framed during the year 2006-07. In all four Districts and state RRT for outbreak investigation and control are in function. These RRTs were framed in year 2007-08. State and district Influenza epidemic preparedness and response committees formed in Jan 2009.