WHO has published a feature article: Nepal ramps up disease surveillance after earthquakes. Excerpt:
Every morning since the first of two recent earthquakes struck Nepal on 25 April, Dr Sharmila Shrestha and researcher Sanjita Thapa have made the hour-long journey from Kathmandu to Kavrepulanchok, a district east of Kathmandu valley, with one goal in mind – to protect people against disease outbreaks.
Following the buckled Araniko Highway toward the hilltop town of Dhulikhel, the district headquarters, the pair pick up Chief District Health Officer Rajendra Prasad Shaha before arriving at the district health office for their morning meeting.
Amid the pleasantries, the strength of their working relationship – which predates the recent disaster – is clear. Such ties are proving critical to addressing immediate public health challenges, including monitoring and controlling communicable diseases, such as diarrhoeal disease, seasonal flu and upper respiratory tract infection. There is a heightened risk of outbreaks following the first and subsequent 12 May earthquakes due to disruption of shelter, water and sanitation, as well as the coming rainy season.
“Before the earthquakes I was a WHO surveillance medical officer monitoring routine immunization drives in four districts. Now I am focusing on one district, Kavre, which I visit daily” says Dr Shrestha, who now works for the WHO supporting the Ministry of Health and Population’s (MoHP) Emergency Disease Surveillance programme (EDS).
The EDS programme monitors the 14 most affected districts, using nine surveillance medical officers from pre-existing WHO monitoring programmes in Nepal, in addition to five Nepali staff drafted in from WHO offices around the world.
According to Dr Shrestha, familiarity with the “zero-reporting strategy,” first implemented in Nepal as a result of WHO’s worldwide polio eradication campaign that began in 1988, has allowed authorities to gain daily intelligence on disease prevalence in outlying areas since the earthquakes. Though cases of communicable diseases have been documented, an outbreak has not yet occurred.
“Zero reporting means that every ward, every day, must report to the district office on each and every case they have received during that day. If no cases have been received, then they must still report,” says Dr Shrestha. “If there are any issues, the local authorities can then investigate.”