The Ministry of Health and Wellness’ surveillance system is a key element in the country’s fight against the novel coronavirus (COVID-19).
National Epidemiologist and head of the National Surveillance Unit, Dr. Karen Webster Kerr, explains that surveillance is an ongoing systematic look at a particular issue, paying attention to what is different or new as observed in a population.
“It is a general public health tool that comes in many forms, such as environmental surveillance and drinking water surveillance,” she tells JIS News.
She notes that epidemiological surveillance has to do with the health of people and the diseases and conditions that affect them.
Dr. Webster Kerr points out that the surveillance system in China played a role in picking up the unusual number of cases of pneumonia that led to the discovery of the novel coronavirus SARS-Cov2, which causes the COVID-19 disease.
“In a surveillance system, when you pick up an unusual disease, you investigate to see what is the cause of it, who is affected and try to determine the cause,” she informs, while adding that surveillance does not only look at acute illness and infectious disease, but also at health emergencies such as poisoning.
“Once you pick up something and see the magnitude of the problem, you look for things like similarities in cases, what they have been exposed to, and if there is something peculiar to a particular person, why they are not getting a disease while the rest of the population is getting it,” Dr. Webster Kerr says.
She notes that the surveillance system will also monitor increases or decreases in the different cases of whatever is being looked at.
According to Dr. Webster Kerr, who is also the Ministry’s Principal Medical Officer, the epidemiological surveillance system gathers information from many sources, including health facilities, ports of entry, occupational health and safety personnel, laboratories, morgues, and entities such as the Registrar General’s Department.
“We follow births and deaths over time. For example, during the Zika outbreak, we noticed that the number of births decreased. This was largely due to the caution persons took in having children at that time,” she states.
Dr. Webster Kerr also notes that Jamaica is part of a global network that focuses on respiratory viruses.
“Every week, we supply information on the respiratory viruses that would have been circulating and the number of persons we have coming from our sentinel sites as well as from the National Influenza Centre,” she says.
For her part, Director of the Emergency, Disaster Management and Special Services Branch in the Ministry, Dr. Nicole Dawkins-Wright explains that the surveillance system detects disease trends and informs the nation’s response.
She notes that with six billion people living in the world and with air travel allowing persons to move around the world in as few as three days, there is a large capacity for disease spread.
“Someone can leave a country with a disease and not even know that they have it. They arrive in your country within the incubation period, go through your fever scanners and all is fine, but they are still able to spread it,” she says.
Dr. Dawkins-Wright, however, notes that surveillance does not only take place at the airport, but that the system works in tandem with hotel surveillance, sentinel surveillance and laboratory surveillance.
“Hotels can have many persons from many different parts of the world coming together. So where it relates to hotel surveillance, the nursing personnel within the hotel are expected to report what they encounter in terms of disease trends on the property to the public health system, through the local health department,” she says.
The Director cites the number of cases of gastroenteritis as an example of what is to be reported to the parish health department by hotel nursing staff.
“Although they report to our local health department on a regular basis, we also go in and check the logs in the medical area of their facilities and go through to see if there is anything that was not reported to ensure that we are not missing anything, Dr. Dawkins-Wright states.
She further explains that within the system of active epidemiological surveillance that is in place, certain diseases are reported on a regular basis, and that increases in any of these situations would trigger an intervention.
Sentinel surveillance is used to garner high-quality data on a particular disease that cannot be obtained through a passive system.
Specialised medical staff are posted in health facilities who are equipped to diagnose, treat and report cases of diseases under surveillance.
“Each parish has a number of sentinel sites and there are certain parameters. We look at certain diseases in these particular sites. We see if there are any spikes and these will give us a better indication if something is about to happen, like an outbreak of gastroenteritis,” she says.
“We monitor these sites every week so we can see the trends, so you don’t have to wait until something explodes to act,” she adds.
There are 78 sentinel sites across the island. These include Black River Health Centre in St. Elizabeth, Darliston Health Centre in Westmoreland, Port Maria Health Centre in St. Mary, and Morant Bay Health Centre in St. Thomas. All public general hospitals in Jamaica are sentinel sites.
According to the Director of the Emergency, Disaster Management and Special Services, laboratory surveillance is another important component of the detection mechanism.
Laboratory surveillance is an important pillar in monitoring infectious disease trends, which uses data from private and public health labs to gather information.
She cites the example of the 2009 dengue outbreak as an example of this type of surveillance at work.
“When we had the dengue outbreak in 2009, it was detected from lab surveillance. The lab indicated to the Ministry that they were seeing an unusually high number of dengue cases coming in through the private doctors,” Dr. Dawkins-Wright says.
“That is how it was triggered, so it’s the whole system and you rely on each part of the system to work,” she adds.
Dr. Dawkins-Wright argues that this was very helpful, because although private practitioners are required to send notifications to the parish health department for certain diseases, many do not.
She, however, notes that Jamaica has a robust surveillance system that continues to monitor all health situations that may affect the population, so that the necessary interventions can be made in a timely manner to contain and control disease spread.