ICMR-NIE Study: Why Year-Round Respiratory Surveillance is Crucial for Health

The research, based on an in-depth evaluation in Tamil Nadu, reveals that the current approach leaves significant gaps in detecting and managing respiratory diseases, which are a major cause of illness and death in the country. This transition is presented as essential for strengthening pandemic preparedness and protecting public health against a constant, not just seasonal, threat.

Currently, surveillance efforts often intensify only during known outbreaks or specific seasons, creating a blind spot for illnesses that circulate consistently throughout the year.

The study, which meticulously evaluated disease surveillance systems across four districts in Tamil Nadu from 2023 to 2024, engaged over 370 stakeholders from 85 healthcare facilities and 23 laboratories. While acknowledging Tamil Nadu's strong foundation in respiratory illness surveillance, the findings clearly indicate that consistency, routine monitoring, and an enhanced capacity to respond to emerging threats are essential for future preparedness.

Key Points:

• Persistent Threat: The study emphasizes that respiratory viruses circulate throughout the year, making seasonal or outbreak-only surveillance insufficient for early detection and response.

• Significant Surveillance Gaps: Research in several districts found that only 51.8% of healthcare centers were reporting cases of influenza-like illness (ILI) and severe acute respiratory infections (SARI), with a mere 42% collecting clinical samples for testing.

• Inadequate Preparedness: Critical deficiencies were identified in infrastructure and training, with less than 30% of medical officers and allied health staff having received specific training for ILI/SARI surveillance, particularly at the primary and secondary care levels.

In essence, the ICMR-NIE's findings highlight an urgent need to overhaul India's surveillance framework. By advocating for continuous monitoring, improved laboratory capacity, and consistent training, the study provides a roadmap to build a more resilient and proactive public health system capable of addressing the ongoing challenge of respiratory infections.

Dr. Rizwan also highlighted the disparity in testing facilities, with most concentrated in larger hospitals, leaving primary and secondary care facilities underequipped. The Integrated Health Information Platform (IHIP), though widely used in public health centers, grappled with inconsistent data entry, overlapping reporting formats, and limited participation from private healthcare providers.

The study's call for year-round surveillance is particularly poignant given that respiratory viruses are not confined to specific seasons.

This includes prioritizing influenza testing and developing infrastructure for identifying novel pathogens. A clear gap in awareness among health workers, particularly community health workers, regarding the importance of influenza surveillance also emerged.

To address these challenges, the researchers advocate for structured training programs, frequent monitoring, and robust feedback mechanisms to ensure accurate and complete data. They also stressed the need for greater involvement of the private sector in surveillance activities.

Embracing a "One Health" Vision

A key recommendation from the study is the adoption of a "One Health" approach. This involves a collaborative effort across various sectors, coupled with transparent data-sharing mechanisms. Dr. Manoj Murhekar, Director of NIE, noted that plans are already underway in Tamil Nadu to establish a "One Health" secretariat to improve inter-departmental coordination and surveillance of zoonotic diseases. These initiatives, he believes, will significantly bolster the state's capacity to track influenza and other respiratory threats.

Ultimately, surveillance is the bedrock of effective public health. It provides the crucial scientific and factual evidence needed for informed decision-making and timely public health interventions. The study's participants offered actionable solutions, including scaling up training for healthcare workers, improving digital infrastructure, expanding participation from private healthcare, and engaging a wider range of health professionals.

A Critical Early Warning System for Pandemics

In an interconnected world, the risk of emerging and re-emerging infectious diseases is constant. A robust, continuous surveillance system acts as a national tripwire, providing the crucial early warnings needed to contain threats before they become full-blown crises.

• Early Detection of Novel Pathogens: The system is designed to spot anomalies, such as clusters of severe illness with no known cause, which could signal the emergence of a new virus. This early detection is paramount for triggering rapid response measures, including epidemiological investigations and the development of diagnostics and treatments.

• Tracking Zoonotic Spillover: The threat of viruses jumping from animals to humans, like the highly pathogenic avian influenza (H5N1), makes continuous monitoring essential. The Indian Council of Medical Research (ICMR) has emphasized that "active surveillance... and infrastructure strengthening [are] essential for managing respiratory outbreaks," a lesson reinforced by its ongoing efforts to develop a human vaccine for H5N1^[2] .

• Monitoring Viral Evolution: Continuous genomic sequencing of samples collected through surveillance allows scientists to track how known viruses like influenza and coronaviruses are evolving. As the ICMR-NIE Director stated, "continuous monitoring is crucial to identify trends and respond effectively to outbreaks," which includes identifying new variants that may be more transmissible or severe^[3]

Key Recommendations from the Study

To translate the vision of continuous surveillance into a functional reality, the ICMR-NIE study puts forth a comprehensive, multi-pronged strategy aimed at systematically dismantling the barriers identified in its analysis. These practical recommendations provide a clear roadmap for strengthening India's public health infrastructure from the ground up, focusing on empowering personnel, upgrading technology, and fostering unprecedented collaboration across sectors. The proposed reforms are designed to create a resilient, integrated, and proactive surveillance ecosystem capable of safeguarding the nation against both everyday respiratory threats and future pandemics.

In a global context where respiratory infections contribute to morbidity and mortality, the insights from this ICMR-NIE study offer perspectives on how to approach public health preparedness. The findings are intended to inform state-level policy and contribute to readiness for respiratory disease outbreaks.

(Rh/Dr. Divina Johncy Rosario/MSM/SE)