A Study of Influenza Surveillance System and Policy Recommendations for Improving Responses to Emerging Respiratory Infectious Diseases in Bangkok, 2016

Abstract

Influenza has been a major public health problem in Thailand, particularly in Bangkok, where the incidence rates were 3 times greater than that of the country. Thus, an effective influenza surveillance system is necessary for the responses to emerging respiratory infectious diseases. Unfortunately, the exist-ing influenza surveillance system in Thailand does not cover all private hospitals in Bangkok. The objective of this study was to assess influenza surveillance system of selected hospitals in Bangkok in order to provide policy recommendations for improving the surveillance system and work mechanism for influenza and other respiratory infectious diseases. The design was a descriptive cross-sectional study including both qualitative and quantitative methods. A survey was conducted by disseminating questionnaire to all hospi-tals in Bangkok to be completed by infection control officers. The questionnaire was completed by 45 hospitals; and 100% of the respondents acknowledged influenza as a notifiable disease in the national reporting system (the Report 506 system). Every hospital assigned infection control nurses to report influenza cases, but only 77.8% of the hospitals had Influenza-like illness (ILI) system in place. Influenza rapid test was commonly used in 81.8% of the hospitals; and negative pressure room and airborne infec-tion isolation room (AIIR) for isolation of severe cases of respiratory infection were available in 61.5% of them. Screening post for all diseases and specifically for influenza and other respiratory diseases existed in 68.2% and 9.1%, respectively. Hospital staff were given free influenza vaccination in 71.1% of the hospitals. From in-depth interview and focus group discussion, hospital screening of patients with respi-ratory infections was not perfect due to limited space and inadequate room; and screening was performed at different areas as appropriate. The use of surveillance data was low and lack of statistical analysis. Based on medical records reviews, sensitivity and positive predictive value of reporting were 27.5 and 26.6, respectively; and the timeliness of the reporting within 3 day was 52.5. Policy recommendations include the need to collaborate with Private Hospital Association to implement policies on influenza surveillance, prevention and control; strengthening influenza surveillance network between public and private health sectors in order to jointly utilize data; supporting private hospitals to provide free influenza vaccines to their personnel; promoting laboratory testing for influenza subtype for monitoring seasonal influenza epi-demic and epidemiology of the disease; and stockpiling medicines and vaccines. To enhance hospital infection control capacity to effectively screen and control of outbreak, preparedness plan and support for personnel training on surveillance, prevention and control of influenza and other respiratory infections should be done. In addition, it is necessary to implement a policy in private hospitals for having adequate isolation rooms or modifying AIIR for in-patients diagnosed with pneumonia.