A Community Event-Based Surveillance System for Early Detection of

Epidemic-Prone Diseases and Other Public Health Threats

Manual of Operations

World Health Organization

Western Pacific Regional Office

Department of Health
Manila, Philippines

1st Edition

Barangay Alerto sa Sakit at Epidemiya

A Community Event-Based Surveillance System for
Early Detection of Epidemic-Prone Diseases and Other Public Health Threats

Manual of Operations
1st Edition

Barangay Alerto sa Sakit at Epidemiya

A Community Event-Based Surveillance System for
Early Detection of Epidemic-Prone Diseases and Other
Public Health Threats

Manual of Operations

Table of Contents

Acknowledgement

iii

Acronyms. v
1. Rationale for an Early Warning System..

Its Getting Hotter

Global Warming and Impact to Human Health
The Importance of an Early Warning System

6
7
7

2. Overview of the BASE System..

What is Barangay Alerto sa Sakit at Epidemiya or BASE?.........................................

Why do we need BASE?.............................................................................................
Guiding Principles.
Goal
Objective.
Surveillance Approach..

9
9
9
10
10
10

3. The BASE Framework

12

Event-based Surveillance
Coordination Between BASE and the Notifiable Disease Reporting System of
PIDSR.

12
13

4. Establishing a BASE System.................................................................................. 14

Minimum Requirements.
The BASE Unit.
Steps in Establishing a BASE System

14
14
15

5. Surveillance Procedures.

17

Reportable Events
Detection of an Event
Reporting Methods.
Verification
Event Assessment.
Event Updates.
Responding to an Event
Feedback and Monitoring..

17
20
21
21
23
26
27
29

Annexes
Annex A - Verification of an Event
Annex B Assessment of an Event
Annex C Event Update
4

Annex D PIDSR Guidelines

Acronyms and Abbreviations

BOQ

Bureau of Quarantine

CHD

Center for Health Development

CESU

City Epidemiology and Surveillance Unit

EBS

Event-based Surveillance

HAI

Human avian influenza

HEMS

Health Emergency Management Staff

ILI

Influenza-like Illness

NEC

National Epidemiology Center

NIC

National Influenza Center

PESU

Provincial Epidemiology and Surveillance Unit

PHSID

Public Health Surveillance and Informatics Division

PIDSR

Philippine Integrated Disease Surveillance and Response

RESU

Regional Epidemiology and Surveillance Unit

RITM

Research Institute for Tropical Medicine

SARS

Severe Acute Respiratory Syndrome

Section 1

Rationale for an Early Warning System

Its Getting Hotter

The earths climate is changing. In most places, average temperatures are rising.
Scientists have observed a warming trend beginning around the late 1800s. The
most rapid warming has occurred in recent decades. Most of this recent warming
is very likely the result of human activities.1

The earth is heating up because gases (e.g. carbon dioxide) produced from
vehicles, power plants, deforestation, and other sources are building up in the
atmosphere, acting like a thick blanket over our planet. The levels of these gases
are increasing at a faster rate than at any time in hundreds of thousands of years.
This thick blanket of gases traps heat. We call this phenomenon as greenhouse
effect (Figure 1).

If more gases accumulate in the atmosphere, the greenhouse effect is enhanced

resulting to increases in global temperatures (also known as global warming) that
will have significant long-term effects on people and the environment.
Figure 1. The Greenhouse Effect

http://epa.gov/climatechange/basicinfo.html

Global Warming and Impact to Human Health

Because global temperatures, precipitation, sea levels and the frequency of some
extreme weather are expected to increase, global warming could affect you in
many ways. Our health, agriculture, forests, water resources, energy, coasts,
wildlife and recreational opportunities would all react to climate changes.

In a warming climate, extreme events like floods and droughts are likely to
become more frequent. More frequent floods and droughts will affect water
quality and availability. For example, increases in drought in some areas may
increase the frequency of water shortages and lead to more restrictions on water
usage. An overall increase in precipitation may increase water availability in
some regions, but also create greater flood potential.

Global warming will have a direct effect on human health but many of the
changes will have mainly indirect effects by changing natural ecosystems,
affecting such aspects as food production, vector-borne diseases, and a number
of other infectious and non-infectious diseases. Figure 2 displays the chain of
events that results from an increasing accumulation of gases in the atmosphere.

The Importance of an Early Warning System

In order to minimize the health impact of

climate change, one of the important
strategies that should be improved is
health monitoring and surveillance.
Since global warming can trigger outbreaks
of a number of infectious and noninfectious diseases, early warning systems
and prompt intervention to contain an
outbreak can be highly cost-effective as
well as saving lives.
The primary objective of an early warning
system is early detection and response to
epidemics. In this manner, disease burden
and deaths are reduced if not totally
prevented.

Box 1
What is an early warning
system?
It is a system that provides
timely and effective information
that allows individuals exposed
to a hazard to take action to
avoid or reduce their risk and
prepare for effective response.

Figure 2. Effects of climate change to human health and the role of health monitoring and
surveillance

Increase in the
level of carbon
dioxide, methane,
nitrous oxide in
the atmosphere

Enhanced
greenhouse
effect

Global
warming

Climate
Change

Direct effects
to human
health

Heat stroke
Alterations in immune
response

Indirect effects
to human
health

Child and adult malnutrition

Increase in the incidence of
vector-borne diseases (e.g.,
malaria, dengue fever,
schistosomiasis, Japanese
encephalitis, filariasis).
Increase in the incidence of foodand water-borne diseases such as
diarrhea (caused by cholera,
shigella, E, coli, and viruses),
hepatitis A, poliomyelitis, typhoid
fever, and amoebic dysentery.
Occurrence of airborne diseases
(e.g., influenza and
meningococcal disease) could
also increase

Health
Monitoring and
Surveillance

Section 2

Overview of the BASE System

What is Barangay Alerto sa Sakit at Epidemiya (BASE)?

BASE is an early warning system at the community level for early detection and
response to epidemic-prone diseases and other public health threats.

Basically, BASE functions as a smoke detector that calls for prompt

investigation and response.

Why do we need BASE?

We need BASE to increase the sensitivity

of existing routine (or indicator-based)
surveillance system (Philippine
Integrated Disease Surveillance System
or PIDSR) for detection of outbreaks and
other events of public health
importance. Because BASE involves the
community in surveillance activities,
disease outbreaks and other events
could easily be identified and reported.
This prompts a more timely response
and prevents more cases and deaths.

Box 2
What is sensitivity?
Sensitivity refers to the ability of a
disease surveillance system to
identify all cases of diseases or
conditions under surveillance.
Among the mechanisms used to
make the system more sensitive
includes the use of broad case
definitions and reporting of rumors
as in the case of event-based
surveillance.

We need BASE to link surveillance

activities with community action. When
the community has developed the
capacity to respond early to epidemics
and other public health threats, then cases and deaths are minimized if not
totally prevented. Ultimately, community actions are linked to national and
international systems to enable top-down assistance when needed.

Guiding Principles

BASE is owned by the community and operates in the context of our health-our
good-our responsibility. Local people should be the health analysts and
presenters of their own health situation while health workers play the role of
catalytic facilitation.

BASE is a tool that helps a community cope better with the effects of climate of
change. It is an important instrument for sustainable development.
9

BASE upholds the principle of transparency in providing warning and response.

BASE is apolitical in performing its functions. Its operation is objective and

uninfluenced by local or national politics.

BASE is an adjunct to, not a replacement of, routine disease surveillance (PIDSR).

The goal of BASE is to minimize

morbidity, mortality and
disability caused by infectious
diseases and other conditions.

Goal
BASE aims to compliment NOT
replace the Philippine Integrated
Disease Surveillance and Response
system.

Objective

To detect outbreaks of infectious diseases and other public health threats at its
earliest possible stage in order to implement timely and effective public health
response.

Surveillance Approach

BASE utilizes the event-based

surveillance approach.2 Unlike the
routine disease surveillance, eventbased surveillance is not based on
the routine collection of data and
automated thresholds for action but
rather on unstructured descriptions
and reports.

Box 3
What is event-based
surveillance?
Event-based surveillance is the
organized and rapid capture of
information about events that are
a potential risk to public health.

BASE defines the term event as

any information or observation
believed by the reporting unit or individual as a potential threat to public health.

Event can be rumors and other ad-hoc reports transmitted through formal
channels (i.e. PIDSR) and informal channels (i.e. media, health workers and
nongovernmental organizations reports).

Events also include those related to the occurrence of disease in humans, such as
clustered cases of a disease or syndromes, unusual disease patterns or
unexpected deaths as recognized by health workers and other key informants in
the community; and events related to potential exposure for humans, such as

A guide to establishing event-based surveillance. WPRO. 2008

10

events related to diseases and deaths in animals, contaminated food products or

water, and environmental hazards including chemical and radio-nuclear events.

11

Section 3

The BASE Framework

Event-based Surveillance

Event-based reporting is the main surveillance mechanism in which BASE

operates. The system operates at the barangay level with the following basic
activities: 1) event detection, 2) event assessment and 3) response (Figure 3).

Figure 3. The BASE Framework

Philippine Integrated Disease Surveillance and Response
Barangay Alerto sa Sakit at Epidemiya
(BASE)

Notifiable Disease Reporting

System

Barangay Sensors
- Health workers
- Designated community
members
- General public

WHO
Barangay
BASE Unit
NEC

Event
Other Sensors
- Health facilities
- Media
- Schools

CESU/MESU
RESU

PESU

Events are detected and reported by barangay sensors that include health care
workers, schools and designated community groups (e.g., Barangay officials,
Barangay Health Workers, traditional healers).
12

The BASE Unit receives reports from the sensors and conducts event
confirmation and preliminary assessment. If the event does not fit into the
definition of a reportable event then no further action is needed and the case
is considered closed. The whole process of reporting and response to an event is
discussed in Section 5.

The process of filtering reports at the barangay and municipal/city levels offers
two advantages: 1) It triggers prompt response at the barangay level, 2) The
higher levels of the system (e.g., national or provincial) are not overwhelmed by
the voluminous reports from the local level and they can focus most of their time
on routine disease surveillance activities and providing technical assistance to
local levels.

Coordination Between BASE and the

Notifiable Disease Reporting System of PIDSR

The CESU/MESU performs both the event-based and routine surveillance

systems. The routine surveillance refers to the Notifiable Disease Reporting
System (NDRS) of the Philippine Integrated Disease Surveillance and Response
(PIDSR) system.

Some events may not necessarily be detected and reported early at the barangay
level. For example, an increase in the number of deaths of cholera in a particular
hospital is an event that warrants immediate investigation. This type of event
could be detected by the routine surveillance system. Once this event is
recognized, the BASE Unit is informed immediately so that they can conduct
further search of similar cases or deaths in their barangay and implement
immediate public health measures.

Suspected cases of notifiable diseases detected at the community level are

reported to CESU/MESU.

13

Section 4

Establishing a BASE System

Minimum Requirements
The following requirements should be in place before running a BASE system:
1. Functional MESU or CESU

BASE could not operate effectively without a functional MESU or CESU. These
units are responsible in the day-to-day operations of BASE. This includes
verification or confirmation of reported events, outbreak investigation, provision
of technical support, maintenance of event database and capability building.

2. Organized Municipal/City Outbreak Response Team (ORT)

The critical role of ORT is to provide immediate and appropriate response to a

confirmed outbreak. If this team does not exist, response to an outbreak
becomes delayed or chaotic and may lead to increase in cases and deaths. In
addition, when the community does not see any immediate response to a
confirmed outbreak, the enthusiasm to report events in the future will gradually
decline.

The BASE Unit

The BASE unit should be established in the Barangay Hall. The Barangay
Chairman shall designate a BASE coordinator (a BHW or a non-health
personnel) to man the unit. In addition to the BASE coordinator, the midwife
assigned in the area shall automatically be a staff of the BASE unit. Members
of the Barangay Health Emergency Response Team (BHERT) could also be a
member of the BASE staff.

The BASE unit should have a space in the Barangay Hall and equipped with
following logistics:
1)
2)
3)
4)
5)
6)

Chairs and table

BASE bulletin board
Office supplies
Hotline (landline or cellphone)
Computer unit (optional)
Internet connection (optional)

14

The primary function of the BASE unit is to receive reports and conduct
preliminary assessment of the event. The details of this are discussed in the
succeeding parts of this section.

Steps in Establishing a BASE System

If the minimum requirements are met, the following steps in establishing a BASE system
should be followed:
Step 1. The Municipal or City Health Officer takes the leadership in establishing BASE

The MHOs or CHOs are the most senior officials at the local level that should
provide overall leadership and direction during the process. Without their
commitment and support it would be difficult to convince the barangay officials
and other community stakeholders to participate in the BASE system.

Step 2. Prepare for the establishment of BASE

This step involves the following activities:
a) Designate MESU/CESU staff to carry out Step 2 activities and act as secretariat
for the succeeding activities in the establishment of BASE.
b) Prepare all materials needed for the establishment of BASE. This includes
advocacy materials (e.g., powerpoint presentations, flyers, videos), BASE manual,
PIDSR manual, guidelines, local ordinances and other relevant documents.
c) Coordinate with the PESU, RESU or NEC if technical assistance is needed.
d) Mobilize resources (e.g. budget) for the conduct of preliminary activities such as
advocacy meetings and planning.
Step 3. Come up with a consensus among stakeholders for the BASE system

Identify all stakeholders and orient them about the BASE. The rationale, goal,
objective and implementation arrangements of BASE should be clear to them
before coming up with a consensus.

Consensus means that ALL stakeholders agree on the concept of BASE. It also
means that ALL barangays are committed to participate in the implementation of
BASE. The MHO/CHO will determine if a memorandum of agreement is necessary
among stakeholders as an official declaration of their consensus.

Step 4. Develop a Municipal/City BASE operational plan of action

Conduct a planning workshop with all the primary stakeholders. These are the
Barangay Chairpersons, Barangay BASE Unit staff, MESU/CESU staff and other
15

stakeholders the MHO/CHO believes would have a major role to play in the
surveillance operations.

The final output of Step 4 is an approved plan with the corresponding budget.
The plan should be part of the overall PIDSR plan of the RHU/CHO.

Step 5. Implement the plan

The MESU/CESU staff shall be responsible in overseeing the implementation of

the plan.

Among the priority activities under this step are training, installation of the
software, coordination and response.

Step 6. Feedback and monitoring

There should be an agreed mechanism of feedback. This includes regular

(monthly or quarterly) meeting with stakeholders and post-outbreak assessment.

Develop a simple monitoring tool that could be used to assess the performance
of the system. The performance indicators may include timeliness of reporting,
completeness of reports and timeliness of event assessment and response.

It should be emphasized that the main purpose of the assessment is to improve

the operations of the system and not on individual performance.

16

Section 5

Surveillance Procedures
Reportable Events
What are the two types of reportable events?

Box 4
What is a reportable event?

There are two types of events:

1. Human health events - these events
involve human cases of diseases
(known or unknown) and deaths (e.g.,
dengue fever, poliomyelitis, ebola).

A reportable event is any event

which may have a known,
suspected or possible impact to
human health.

2. Non-human health events these

events involve environmental hazards (e.g., contaminated food or water, oil
spill), diseases and deaths in animals (e.g., avian influenza).
What are the broad descriptions of reportable
events?
For purposes of BASE operations, the descriptions
of reportable events are the following:
1. Cluster of notifiable disease

This means 3 or more cases with

similar signs and symptoms in the
barangay.
There are two types of clusters
based on the speed of appearance
of the signs and symptoms of
cases:

Box 5
What are the reportable events?
1.
2.

3.

4.
5.
6.
7.

Cluster of notifiable disease

Occurrence of a single case of an
infectious disease that has already
been eradicated in the country or
in the community
Occurrence of a single case of an
unusual/unexpected disease in
the community
Cluster of deaths in humans
Dangerous exposure to humans
Disease outbreak
Any public health event that raises
concern, fear and alarm in the
community.

a) Sudden clustering - this occurs

within few minutes to one day
due to the fast development of
signs and symptoms of cases (e.g., chemical or food poisoning)
b) Slow clustering this occurs two days to two weeks since the
development of signs and symptoms of cases is gradual (e.g., dengue
fever, typhoid fever, leptospirosis, measles, malaria)
17

A cluster may occur in any of the

following places in the barangay:
a) in a house or group of houses
b) in one purok or street
c) in a public gathering (e.g., party,
fiesta, wedding ceremony)
d) in a school, food establishment,
company or office, and other
institutions
e) in a health facility (e.g., hospital,
clinic, laboratory)
f) any location within the barangay
as long as there are three or
more cases identified with
similar signs and symptoms
whether it is sudden or slow
clustering

Clusters could be due to a single

occurrence or combination of any of
the following signs and symptoms:
Fever
Fever with rash
Difficulty in breathing
Fever with difficulty in breathing
Diarrhea

Box 6
What is a cluster?
A cluster is an aggregation of cases
of a disease in a given area over a
particular period of time without
regard to whether the situation is
an outbreak or not.
Since most outbreaks often begin
as a cluster, therefore, clustering of
cases will serve as an early warning
sign of an impending outbreak.
This warrants immediate
investigation and implementation
of control measures.

Vomiting
Diarrhea with vomiting
Yellow discoloration of eyes or skin

Most of the diseases detected under this event could be endemic in some
areas of the country.

2. Occurrence of a single case of an infectious disease that has already been eradicated
or eliminated in the country or in the community

A good example to this is poliomyelitis. In 2000, the Philippines was certified

as a polio-free country. This means that polio has been eradicated in the
Philippines. Therefore, a single case of this disease would constitute an
outbreak.

Measles has been eliminated in our country. Therefore, a single case of this
disease is considered an outbreak.

Due to effective prevention and control program implementation, some

municipalities or cities are now declared as disease-free of particular
diseases previously endemic in their area (e.g., malaria, rabies). Therefore,
18

the occurrence of a single case of these diseases in their areas would

constitute an outbreak.

These diseases are captured by the routine disease surveillance system

(PIDSR) because these cases are most likely seen in health facilities.

3. Occurrence of a single case of an unusual/unexpected disease in the community

The deadly African Ebola Virus Hemorrhagic Fever disease does not exist in
any area of the Philippines. Therefore, one reported case of this disease and
laboratory-confirmed would constitute an outbreak. Among the emerging
diseases included in this category are SARS and human avian influenza.

This event would most likely be captured in the routine surveillance system.

4. Cluster of deaths in humans

The cause of death could be due to an infectious or non-infectious disease

(e.g., chemical poisoning, paralytic shellfish poisoning). This event could be
identified in the community or in a health facility.

A cluster of deaths of patients with respiratory symptoms could be an early

warning of a new emerging disease (e.g., SARS, human avian influenza, novel
influenza A H1N1). High case fatality is expected since most of us do not have
immunity to these diseases.

5. Dangerous exposure to humans

These are events in which humans are exposed to a particular condition that
has the potential to cause serious disease or death. This includes the
following:
a) diseases and deaths in animals (e.g., avian influenza, reston-ebola
infection in pigs or monkeys)
b) contaminated food products or water (e.g., contaminated milk product)
c) environmental hazards including chemical and radio-nuclear events
(e.g., mosquito breeding areas, sulfur dioxide leaks in a geothermal
plant, oil spill)

6. Disease outbreak

Even if the BASE system failed to detect the early stage of an outbreak and
prevent its spread, a full-blown disease outbreak in any area of the country
should be reported.

The primary purpose of reporting is to inform public health officials at all

levels so that appropriate and immediate control measures can be
19

implemented to prevent the spread of the outbreak to other areas of the

country and possibly to international communities.
7. Any public health event that raises concern, fear and alarm in the community. This
includes rumors of a new disease, disease outbreaks, or breakdown of the public health
system.

Detection of an Event
Who will detect or identify the events in the barangay?
Primary Sensors
a) Barangay Health Workers (BHW) the BHWs are primary event identifiers in
the barangay. This would be part of their routine activity in the barangay that
includes household visits.
b) Health Care Workers (HCW) - the HCWs are the midwives and nurses of the
RHU/CHO assigned in the barangay. This also includes malaria field personnel in
malaria endemic areas. The HCWs and BHWs are the primary event identifiers in
the barangay. Since BASE does not involve routine reporting, the participation of
HCWs in this activity does not necessarily add significant load to the HCWs daily
activities.
c) Disease Surveillance Coordinators (DSC) these are designated surveillance
personnel in hospitals and other health care facilities involved in routine disease
surveillance reporting under PIDSR. This also includes DSCs in schools with clinics.
d) Allied Health Professionals this includes physicians and other health
professionals in the private sector.
Secondary Sensors
a) Designated Community Members this includes the Barangay Officials, BHERT,
traditional healers, and other community groups identified by the MHO/CHO.
b) Other Sectors this includes other government agencies (e.g., DA) and nongovernment organizations (NGOs), etc.
c) General Public this includes all people in the barangay. However, inclusion of
the general public in reporting events should only be considered if the BASE
system is prepared enough to accommodate voluminous reports from the
community. Preparation includes community awareness campaigns to ensure
that the general public knows what to report and where to report, assessment
and response mechanisms are in place.

20

Reporting Methods
How do members of the community report an event to BASE?
Hotline
A hotline communication should be established at the BASE Unit and MESU/CESU.
The hotline could be a dedicated cell phone/telephone landline or both. These
hotlines should be open to the general public 24 hours a day, 7 days a week.
Direct Reporting
Any member of the community may report to the BASE Unit by personal
appearance, through text (SMS), radio or by phone. The report should have the
what, where, when, and who information about the event. There is no form that the
reporter needs to fill in. It is the primary responsibility of the BASE staff to extract
this information from the reporter or from other reliable sources during the
verification process.

Verification
Who will verify the reported event and
how is it done?

The BASE coordinator or any of the

BASE trained staff are responsible in
the verification and preliminary
assessment of a reported event.
Verification refers to the process of
determining whether the event exists
or not.
Verification of an event includes any
or a combination of the following
methods:

Box 7
Transparency
Transparency is very important in
the verification and assessment
stage particularly if the event is a
public health risk. If there is a
motive of concealing the event for
fear of repercussions or other
reasons, then the system fails and
everybody will be at risk.

1) Obtain from the reporter

information on what, where,
when, and who of the event. Dont
forget to get the reporters identification.
2) Call any of the barangay officials, community leaders or friends who may have
knowledge of the event.
3) Conduct ocular inspection of the place where the event occurred. If this is not
feasible, you may request other persons (e.g. barangay officials, barangay tanod,
community leaders, BHWs, friends) who are near or living in the area where the
event occurred to conduct the ocular inspection.
21

4) Inquire for case/s of the reported illness that may have been admitted or sought
consultation from any of the health facilities in the area.
5) Inquire from local media practitioners who may have knowledge of the event.
The BASE unit staff should explore other appropriate methods of determining the
existence of the reported event.

Whenever an event is reported, the BASE staff will obtain basic information of the
event and record this in a logbook. A sample logbook is shown in Annex B. In
barangays where BASE units have access to computer and internet connection, the
data could be entered directly into an electronic database.
Part 1 of the logbook contains the basic information gathered during the verification
process. This includes the following:

Event ID.......................

Date and time report

received..

What is the event?..........

Where did this

happen?...........................

When did this

happen?...........................

This is a unique identification number assigned to each event

reported. The number contains the abbreviated name of the region,
province, municipality or city, barangay and the number assigned to
that specific event. For example the Event ID R5-Bicol-Daraga-Naba001 means that the event comes from Region 5, Bicol province,
Daraga municipality, Barangay Nabasan. The number 001 indicates
that this is first event reported in the barangay. The primary aim of
assigning an Event ID is to create a unique identification of each
event to prevent duplication of reports. In a computerized system,
the computer will automatically create the Event ID.

This is the date and time in which BASE unit staff received the report
or knew the existence of the event. This information is used in
determining the reporting (time of event to reporting) and response
time (time of report to the time action was initiated).
This refers to any event that fits the description of a reportable event
discussed under Section 5 of this manual.

This means the specific place where the event occurred. First, the
barangay/s affected should be clearly stated. Second, the specific
location of the event in the barangay should be described (e.g.,
street, purok, house, school, food establishment, farm). This
information is important in determining the probable source of the
outbreak or risk of illness.

This means date and time when the event occurred. The time should
be indicated particularly on events where there is sudden clustering
of cases of a disease or injury (e.g., food poisoning, chemical burns).
This information is critical in determining the probable source of the
outbreak or the nature of the disease.

22

Description of the case/s

No. of cases

Indicate how many individuals were affected or having the illness.

This could just be an estimate at the beginning particularly if the
event involves a lot of cases. Write none or 0 if there were no
cases.

Age and sex

Specify the age and sex if there are few (<10) cases. If there are
more cases, just provide the range of ages (youngest to oldest). This
information is very important particularly in determining the nature
of the disease and the management or treatment that should be
provided.

Number of
deaths

Indicate the number of deaths among the cases. This information is

very important in determining the severity of the disease or illness.

Other information

These are information that could provide better description of the

event. This includes information such as hospitalization, course or
status of the event, availability of health services in the area,
preliminary actions, coordination, etc.

Reporter information

Indicate the name and contact number/s of the reporter. This is

important in determining the validity of the report and obtaining
follow-up information of the event from the reporter.

Verification status
Verification
ongoing.

Event does not

exist.

Event exists

The purpose of indicating this option is to inform the barangay

leaders, local and national health authorities that the event has
already been addressed by the BASE unit, MESU or CESU.

This option is selected if there is not enough evidence or information

to show that the event really exists. This suggests that the event
could just be a hoax, rumor or make-believe story. In some occasions
however, it may be necessary to determine the motive behind the
rumor.
This option is selected if there is enough evidence or information to
show that the event really exists.

Transparency is very important at this stage particularly if the event is a public health
risk. If there is a motive of concealing the event for fear of possible repercussions or
other reasons, then the system fails and everybody will be at risk.

A reported event is more likely to be true if they are confirmed by multiple different
sources of information, reported by a trained health worker or contains clear
information about the event as to time, place and person.
23

Event Assessment

Event assessment is the process by which the available information about an

existing event is analyzed and a judgment is made as to whether it poses a risk to
public health.

Once an event is confirmed to be real, the BASE coordinator or any of the BASE
trained staff shall proceed in the preliminary assessment. If the BASE unit has no
technical capacity to perform the assessment, the MESU/CESU shall take the lead in
the assessment.

Table 1 presents the questions that will guide the assessment process. If any of the
questions has a YES answer, then the event is considered a potential public health
risk and a response is triggered.

Table 1. Guide questions for the assessment of events

Type of Event

Assessment Question

Response
YES

Human health
events

Non-human
health events

NO

Does the event involve a notifiable disease or syndrome

(i.e diphtheria, watery diarrhoea)?
Can the suspected disease cause outbreaks with a high potential for
spread (i.e. cholera, measles)?
Is there a higher than expected mortality or morbidity from the
disease?
Is the disease unusual/unexpected in the community?
Is there a cluster of cases or deaths with similar symptoms
(i.e. bloody diarrhoea, haemorrhagic signs and symptoms)?
Could the disease be caused by a contaminated, commercially
available product (i.e. food item)?
Does the disease have possible consequences for trade or travel
(i.e. SARS)?
Is there suspected nosocomial spread of the infection (i.e. is the
infection being transmitted within a health care setting)?
Does the event have a known consequence for human health
(i.e. chemical spill, suspected Nipah outbreak in animals, unexplained
deaths in animals)?
Does the event have a possible consequence for human health
(i.e. suspected zoontic disease outbreak in animals)?

Source: A guide to establishing event-based surveillance.WHO.2008

If the event is a non-human health event, the BASE staff should coordinate with the
appropriate government agency in the verification and assessment process. For
example, the Bureau of Animal Industry (BAI) should be involved if the event is about
deaths in animals. Events like chemical spill, release of poisonous gas, etc, BASE
should coordinate with the Department of Environment and Natural Resources
(DENR).
24

After the assessment, Part 2 of the event logbook (Annex B) should be filled up
which includes the following information:

Event ID.........................

This is the same unique identification number assigned to the event

specified in Part 1.

Is the event a potential risk

to public health?...................

This could only be answered if a thorough assessment was done.

Check YES if the answer of one of the questions presented in Table 1
is YES. Check the option could not be determined if there is not
enough evidence to neither confirm nor deny its potential risk to
public health.

Actions taken.

Specify the initial actions done to address the problem. Examples of

these activities include,
coordination with appropriate government agency/ies
BHERT or Outbreak investigation team sent to the area to
conduct further investigation
preliminary response activities such as early treatment and
referral of cases, provision of drugs and medicines,
community education campaign, etc.
house-to-house search for new cases

Remarks.

Indicate other information relevant or related to the event. This

includes information on whether,
the event has already reached the local/national media,
there is public panic and/or chaotic response activities,
there is a need for immediate assistance and type of
assistance,
the event has spread to other areas,
there are problems encountered in the response operations,
etc.

Status of the Event

Ongoing..

Check this option if there are still cases of the disease or the risk is
still exists (e.g., chemical spill) regardless of whether control
measures are being implemented or not.

Controlled.

Check this option if there are no new cases of the disease reported
or the risk has been eliminated.

Closed..

Check this option if the event is not a public health risk or the event
has already been controlled.

25

Event Updates

If the status of the event is Ongoing, then the BASE unit should provide regular
updates on the situation. The frequency of releasing updates may vary depending on
the severity or urgency of the situation. Daily update for at least three days to one
week is required for ongoing disease outbreaks and non-human health events such
as environmental hazards that are categorized to have high public health risk.

For ongoing events, the BASE staff should fill in Part 3 of the Event Logbook (Annex
C). If the system is computerized, then the update information shall be encoded into
an electronic database. The information required in Part 3 are the following:

Event ID.........................

This is the same unique identification number assigned to the event

specified in Parts 1 and 2.

Event update as of
(date and time)

Indicate the date and time the update was recorded into the event
logbook or encoded into the computer database.

Cases

Indicate the previous reported/recorded total number of cases,

number of new cases and add the two figures in the total of number
of cases column. This information provides guidance on whether
the event has been effectively controlled or not.

Deaths.

Indicate the previous reported/recorded total number of deaths,

number of new deaths and add the two figures in the total of
number of deaths column. This information provides guidance on
whether management of cases was effective or not.

Actions taken.

Indicate additional/other actions taken to address the problem. This

also includes previous actions that were discontinued after evidences
showed that these were ineffective or inappropriate.

Remarks.

Provide information as to the progress of the control measures being

implemented.

Status of the Event

Ongoing..

Check this option if there are still cases of the disease or the risk is
still exists (e.g., chemical spill) regardless of whether control
measures are being implemented or not.

Controlled.

Check this option if there are no new cases of the disease reported
or the risk has been eliminated.

Closed..

Check this option if the event is not a public health risk or the event
has already been controlled.

For ongoing events that are of national or international concern, the National
Epidemiology Center (NEC) of the Department of Health shall require LGUs to
26

provide regular update of the situation. NEC as the designated IHR (International
Health Regulation) focal point shall provide these updates to WHO.

Responding to an Event

Response to an event has two basic components. These are

1) investigation and surveillance, and
2) implementation of control measures.

Preliminary investigation and surveillance is the primary responsibility of the BASE

unit staff. This activity however, should be closely coordinated with the MESU/CESU.
In some situations, in-depth epidemiologic investigation of the event is required.
Since this is a highly technical work, only trained personnel from the RHU or CHO
should perform this activity.

The BHERT should be organized. The primary functions of the team includes the
following:
a. Provide preliminary response activities to a confirmed event. This includes
early detection and management of cases.
b. Conduct community information and education campaign.
c. Manage response activities to be more efficient and effective.
d. Coordinate and collaborate with other stakeholders and/or agencies.

Collaboration should be done with other appropriate government or nongovernment agencies depending on the nature of the event.

Once a suspected disease outbreak is confirmed, the BASE unit staff should inform
the CHO/MHO immediately. The PIDSR guidelines (Annex D) on procedures for
epidemic response, declaration and containment shall be followed.

The National Epidemiology Center should be informed immediately for any disease
outbreaks of national or international concern (Annex C, PIDSR Guidelines, Section
VIII, B4.d).

For all identified outbreaks, the MHO/CHO should assess whether they have
sufficient local capacity to undertake the outbreak investigation and response, and
arrange for additional assistance if required.

Figure 5 shows the flow of reporting, investigation and response to a reported event.
This algorithm serves as a guide to

27

Figure 5. Flow of reporting, investigation and response to a reported event

Event

Sensor collects
information and report
the event to BASE unit

No

Real
event?

BASE staff records and

confirms the report

Event
recorded
as closed

Yes
BASE staff conducts
event assessment

Event
recorded
as closed

No

Event is a
public health
risk?
BASE
cannot
decide
BASE
coordinator/staff
reports the event
to CESU/MESU.
BASE and
CESU/MESU
conduct joint event
assessment.

Yes

Event is of
national or
international
concern?

No

BASE
coordinator/staff
records and reports
the event to
CESU/MESU.

CESU/MESU
enters event into
the BASE
database.

Yes
BASE staff notifies
CESU/MESU within 24
hours after the event
was detected.

CESU/MESU notifies
PESU, RESU and NEC
within 24 hours and
enters event in the
BASE database

PHO and CHD provide

support in the
investigation and
response activities.

NEC informs
WHO, provides
support in the
investigation
and monitors
progress of the
situation.

BASE capable
for preliminary
investigation
and response
activities?

No
CHO/MHO provides
support for the
investigation and
response activities.

Yes

BASE in
coordination
with BHERT and
BHS conduct
preliminary
investigation and
response
activities.

BASE submits
report to
CESU/MESU and
records event as
closed.

CESU/MESU
updates BASE
database and
record event as
closed.

28

Feedback and Monitoring

The BASE unit should maintain an Event Bulletin Board. The bulletin contains basic
information of the recent events monitored. The board should be located in a
conspicuous place in the barangay hall. In this manner, the barangay hall officials,
employees and the public are aware of the events monitored by BASE. This type of
feedback should maintained even if the BASE unit is utilizing an electronic database
system.

Figure 6. Sample event bulletin board for public viewing

Event Bulletin Board
Event
Cases of
severe
diarrhea and
vomiting

Where
Bgy.
Nabasan,
Daraga,
Albay

When
First case:
08-19-10

Who
1st case: 5 yrs old,
male
2nd case: 20 yrs
old male
3rd case: 10 yrs old
female
1 death

Actions Taken

BHERT was deployed in the

area immediately 1 hour
after the report was verified
BHS is opened 24 hrs for
immediate treatment of
diarrhea cases
PHO, CHD, and NEC have
already been notified
Standby ambulance
provided by LGU for referral
of severe cases
Information campaign
intensified in the affected
and neighboring barangays

Status
Ongoing

Feedback meeting with all BASE staff should be conducted at least every quarter.
This activity should be led by the MESU/CESU.

The MESU/CESU staff should develop a simple mechanism of monitoring the BASE
system. Among the indicators that should be used in monitoring the performance of
BASE are the following: a) proportion of events verified, b) proportion of confirmed
events assessed, c) process of detection, reporting and response as described in the
algorithm (Figure 5).

29

Annex A

Sample Event Logbook

Part 1 Event Verification*

Event ID
R5-Alb-DarNaba-001

NCR-D1-MlaB10-001

NCR-D4-MlaB20-002

Date and
time
report
received
08-20-10
4:00 PM

08-24-10
9:00 am

08-24-10
9:00 am

Where did
this
happen?

When did
this
happen?

Cases of severe
diarrhea and
vomiting

Bgy.
Nabasan,
Daraga,
Albay

First case:
08-19-10

Foreigners
suspected of
having ebola

Manila

Not known

Chicken died of
avian flu sold in
public markets of
Manila

Not known

What is the
event?

Reporter Information

Description of the Case/s

No. of
cases

Age and sex

1st case: 5 yrs old, male
2nd case: 20 yrs old
male
3rd case: 10 yrs old
female

Not known

No. of
deaths

Name

Contact No.

Romeo
Cagas

09066506986

Two of the cases

were admitted in
Albay District
Hospital

James
Buhain

741-89-65

The cases were

reported to be
admitted in Manila
Doctors Hospital

The reporter got

this information
from the local
radionews

Meriam
Alamo

09153457891

Not known
none

none

Other
Information

none

Verification
Status
Verification
ongoing
Event does
not exist
Event exists
Verification
ongoing
Event does
not exist
Event exists
Verification
ongoing
Event does
not exist
Event exists

* The information contained in this form are subject to changes during the course of event verification.

30

Annex B
Part 2 Event Assessment and Initial Response
Is the event a
Event ID
potential risk to
public health?
R5-Alb-Dar-Naba-001

Yes
No
Could not be
determined

Actions Taken

BHERT was deployed in the area immediately 1 hour after the report
was verified
BHS is opened 24 hrs for immediate treatment of diarrhea cases
PHO, CHD, and NEC have already been notified
Standby ambulance provided by LGU for referral of severe cases
Information campaign intensified in the affected and neighboring
barangays

Remarks
This could be an early stage of a
cholera outbreak. Stool samples have
already been sent to RITM for culture.

Status of the Event

Ongoing
Controlled
Closed

The last case seen was on 08-21-10.

No more cases as of 08-25-10.

31

Annex C
Part 3 Event Update

Event ID
R5-Alb-DarNaba-001

Event update
as of
(date and
time)

Cases
Previous
no. of
cases

New
cases

Deaths
Total no.
of cases

Previous
no. of
deaths

Actions Taken
New
deaths

Total no.
of deaths

08-20-10
4:00 PM

10

13

Remarks

Additional cholera
treatment centers were
established in adjacent
barangays with suspected
cholera cases.
Residents were advised to
boil their drinking water and
practice personal hygiene

Initial investigation revealed

that the possible source of the
outbreak was the contaminated
water from local water district.

Status of the
Event
Ongoing
Controlled
Closed

32