Date of Award


Degree Type

Closed Thesis

Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. Karen Gieseker - Chair

Second Advisor

Dr. Hardeep Sandhu

Third Advisor

Dr. Richard Rothenberg


This document describes an evaluation of acute (meningitis)-encephalitis syndrome (AES/AMES) surveillance established in India, Bangladesh and China. The key objectives of the project included 1) building on existing networks for syndromic surveillance and laboratory confirmation, 2) establishing laboratory-based surveillance for vaccine-preventable causes of encephalitis and meningitis, 3) enhancing capacity to use data to guide disease control and prevention programs, and 4) improving capacity to recognize new or emerging diseases. The syndromes encompass several diseases, including Japanese encephalitis (JE), pneumococcal meningitis, Haemophilus influenzae type b (Hib), and meningococcal meningitis. The purpose of the evaluation is to assess the extent to which the key objectives were met in the three project countries, compare and contrast the experiences among the countries, document the strengths and weaknesses, and make recommendations. The indicators used in the evaluation include feasibility of integration, availability of country protocols, appropriate training, data quality, sensitivity, specificity, positive predictive value, negative predictive value, representativeness, timeliness, integration with AFP surveillance, simplicity and efficiency, acceptability, usefulness, flexibility, stability, and sustainability. The criteria and standards are based on WHO recommendations. Data sources include AES/AMES epidemiologic and laboratory data sets, trip reports, country reports, field observations, and published bulletins. All countries made substantial progress in a relatively short period of time using the infrastructure and technical tools of existing surveillance and laboratory networks for acute flaccid paralysis. After one year, India and Bangladesh collects and maintains high quality epidemiologic data, exceeds targets for timeliness of reporting, and has quality-assured capacity for laboratory confirmation of Japanese encephalitis (JE) virus infection. India now has regional laboratory capacity for reference testing on virology and bacteriology. After two years of operations, China has population-based surveillance data for JE that meets targets for timeliness. Several levels have well-established capacity for laboratory confirmation of JE virus infection. The national level has the technical ability to provide proficiency testing for virology and to provide reference testing for bacteriology. In all countries, challenges in building capacity for basic bacteriology, quality control and quality assurance for all laboratory testing, and management of laboratory data.