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A Guide to Early Warning and Reporting System (EWARS)

by Public Health Update

A Guide to Early Warning and Reporting System (EWARS) (Revised Edition- 2019)

Public health surveillance is the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice. Main objectives of public health surveillance are:

  • Early detection and timely response to outbreaks and other public health emergencies
  • To monitor trends of diseases, health problems and determinants of health

Importance of surveillance

Early warning and detection of outbreaks

  • Timely detection and response to outbreaks and other public health emergencies
  • Surveillance provides alerts on the burden of notifiable diseases
  • Helps in emergency planning and preparedness

Assessing the health status and issues of the population

  • Keeps the record of existing health problems
  • Helps in the interpretation of mortality and morbidity status

Detecting change in the trend of diseases

  • Continuous recording/reporting of data notifies about the disease trend
  • Keeps the track of disease

Collection of data for Planning, Monitoring and Evaluation

  • Helpful for evidence-based planning and policy formation and setting priorities
  • Useful to monitor the progress and evaluate the effectiveness of health programmes

Early Warning and Reporting System (EWARS) in Nepal

Early Warning and Reporting System (EWARS) is operational in Nepal to perform EWAR function. EWARS is a hospital based sentinel surveillance system where the selected hospitals send immediate and weekly reports (including zero reports) on six priority diseases and outbreaks of any diseases. It is designed to provide timely report of selected epidemic prone, vector-borne, water and food borne diseases for the early detection of outbreaks. It was established in 1997 first in 8 sentinel sites and expanded to 24 sites in 1998, 26 sites in 2002, 28 sites in 2003, 40 sites in 2008 and 82 sites in 2016. In May 2019, additional 36 sites (private hospitals and medical colleges across Nepal) were declared as sentinel sites by the DOHS. Thus,  the total number of current sentinel sites is 118.


Sentinel sites include all the central hospitals, provincial hospitals, district hospitals, medical colleges including selected private hospitals. The main objective of EWARS is to strengthen the flow of information on outbreak prone infectious diseases and vector borne diseases from the districts and to facilitate prompt outbreak response to be carried out by rapid response teams (RRTs) at federal, provincial and local level. It is designed to provide timely report for the early detection of selected vector-borne, water and food borne diseases with outbreak potential.

Reportable diseases/health events

Currently, six diseases are reported in EWARS as shown in the box.

Epidemic prone diseases

  1. Acute Gastroenteritis (AGE)
  2. Cholera
  3. Severe Acute Respiratory Infection (SARI)

Vector borne diseases

  1. Malaria
  2. Dengue
  3. Kala-azar
  4. Scrub typhus and ILI cases have also been reported since few years. So these diseases have also been included in this guide. Besides these prioritized diseases, other infectious diseases also need to be reported in EWARS in case of their outbreaks.

Early Warning Reporting System (EWARS), Nepal

Mechanism of information flow

Screen Shot 2019 09 10 at 22.13.12

Immediate reporting

The sentinel hospitals should immediately report, i.e. within 24 hours of confirmation of diagnosis (clinical and/or laboratory) of EWARS reportable diseases in following cases:

  • One confirmed case of Cholera
  • One case of confirmed Malaria
  • One case of confirmed case of Dengue
  • Five or more cases of AGE or SARI from same geographical area within one week
  • One case of confirmed Kala-azar

Consolidated immediate reports should be verified and forwarded by medical recorder of the hospital and sent to EDCD and VBDRTC.

Weekly reporting

The sentinel hospitals should prepare weekly report based on the epidemiological week calendar which starts on the first week of January (Epidemiological Week 1) and ends on lasts week of December (Epidemiological Week 52). Each week starts on Sunday and ends on SaturdayFor example, for the year 2019, Epidemiological Week 1 is or starts from December 30, 2018 (Epidemiological Week 1) and ends on December 28, 2019 (Epidemiological Week 52).

Consolidated weekly reports should be prepared for the epidemiological week and sent to EDCD and VBDRTC by Friday of the following week.

Based on timeliness of reporting, reports are categorised as:

  • On time: Report of an epidemiological week received within Friday of the following week.
  • No Report: Not receiving of Report till Friday



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