Model for integrated influenza surveillance in tamil nadu, india (miisti) - acute respiratory infections (aris) top of the table for mortality and morbidity among infectious diseases killing almost…

Model for integrated influenza surveillance in tamil nadu, india (miisti) - acute respiratory infections (aris) top of the table for mortality and morbidity among infectious diseases killing almost 4 million people every year resulting in an economic loss of 71 to 167 billion US$. Viruses cause around 30-70% of aris, which may assume epidemic or pandemic proportions as is currently happening with the covid-19 pandemic. The influenza virus alone caused 10-20% of severe acute respiratory infections (sari). Surveillance for influenza-like illness (ILI) and sari are key to early identification of flu related outbreaks. India, the 2ND most populous country in the world is currently reporting the largest number of daily covid-19 cases. Around 15.93 million cases and 184,687 deaths have been reported from india so far. India established ILI and sari surveillance in various states and stepped-up surveillance for cases of influenza from march 2020 after the first case was detected. The indian council of medical research (icmr) expanded india?s testing capacity for covid-19 from a few laboratories then to more than 12000 by end of 2020.although figures of ILI, sari and covid-19 cases are available, detailed information on the denominators and the extent of these infections are not known in india. The veterinary department also has surveillance for avian influenza, but IT is rarely connected to the health system. With emergence of covid-19 testing for influenza viruses, non-influenza respiratory infections other than those caused by sars-COV-2 has almost been suspended, even in the virus research and diagnostic laboratories (n=100 approximately) that had been established by the department of health research (DHR) across the country primarily for timely identification of viruses of epidemic and/or bioterrorism potential. This national level network is rarely connected to the state systems other than some reporting through the integrated disease surveillance programme (idsp) which is managed by the states. Most states and central go vernment does not carry out routine surveillance for all possible influenza and non-influenza acute respiratory infections. There is no system in place to capture early signs of an emerging outbreak to trigger any immediate response. Epidemiology (field) and laboratory linkages are often non-existent. There is also lack of sample archives from which future vaccines and diagnostics can be developed. Furthermore, the skills and expertise of the staff engaged in various tiers of healthcare, both at the private and the public sector, require training on current tools and practices that are vital in epidemiology.to strengthen and integrate existing surveillance systems and response capacities for pandemic-prone diseases like influenza and non-influenza respiratory infections and to build a sustainable network for early identification of outbreaks and response, IT is proposed to establish a model for integrated influenza surveillance in tamil nadu, the largest state in south india by population (72.1 million), which would help expand the model to other states of the country as well. The model uses a four-step approach comprising of (i) assessment of existing system to identify pitfalls, bottlenecks and gaps in influenza surveillance and testing, (II) develop `plug INS? To address them, (II) roll out and evaluate strengthened surveillance (IV) transfer and dissemination of the benefits for scale up at national level. IT is expected that operationalization of the model would not only serve to improve capacity and infrastructure of health system, but IT is also expected to trigger early warning signals for impending outbreaks, enable early roll out of public health response and ultimately minimize morbidity, mortality and economic impact. The model is also expected to provide information on disease trends, burden and advanced epidemiological characteristics about etiological agents of influenza and non-influenza respirat