Overview
The Epidemiology and Disease Control Division (EDCD) has released the updated National Standard Operating Procedure (SOP) for the Early Warning, Alert and Response System (EWARS) 2025. It incorporates critical lessons learned from recent global and national health emergencies, notably the COVID-19 pandemic, and aligns Nepal’s disease surveillance framework with the core capacities mandated under the International Health Regulations (IHR, 2005).
Previous version: A Guide to Early Warning and Reporting System (EWARS) 2019
The EWARS SOP 2025 provides a comprehensive and practical operational guide for Nepal’s disease surveillance system. It clearly outlines mechanisms for early warning, alert generation and verification, and coordinated response, ensuring alignment with national health priorities and internationally accepted standards. The revised SOP strengthens the linkage between surveillance and response, thereby supporting rapid, evidence-based public health action.
Related: Community Based Disease Surveillance Guideline, 2082
This edition introduces standardized case definitions, clarifies institutional roles and responsibilities, and integrates digital innovations to improve data quality, timeliness, and system interoperability. The SOP serves both as a policy reference and an operational manual for sentinel hospitals, laboratories, and health authorities involved in disease surveillance and outbreak response at all levels of the health system.
Rationale for the Revision
- Align with Article 49 of the Public Health Service Act, 2075.
- Align with the Government of Nepal’s official list of 52 priority infectious diseases.
- Redefine EWARS as the “Early Warning, Alert and Response System.”
- Align with the Rapid Response Team Guideline, 2079.
- Align with recent amendments to the IHR (2005).
- Clearly define the roles and responsibilities of the three tiers of government in public health surveillance and response.
- Incorporate critical lessons learned from recent health emergencies, such as the COVID-19 pandemic.
- Integrate the government’s recent initiatives regarding digitalization and interoperability.
Purpose
This SOP serves as an operational document for health professionals and sentinel hospitals involved in EWARS in Nepal. It aims to:
- Provide a standardized framework for the effective implementation and operation of the EWARS in Nepal.
- Enhance timely detection, generating early alerts, reporting, and response to epidemic-prone and notifiable diseases.
- Update procedures, roles, and responsibilities to align with current national priorities and international best practices.
- Integrate modern digital platforms (e.g., LIS, HMIS, SORMAS, EMR) to improve data flow, interoperability and real-time reporting.
Priority Diseases/Syndromes/Events to be reported in EWARS
- Though 52 notifiable infectious diseases have been identified for national surveillance, only 18 selected priority diseases, 8 syndromes, and public health events, as listed in Annexes III, IV and V, shall be reported through the EWARS system.
- The list of reportable conditions may be reviewed and updated periodically by DoHS based on public health importance and evolving disease trends.
Related documents
- A Guide to Early Warning and Reporting System (EWARS) (Revised Edition- 2019)
- Early Warning Reporting System (EWARS), Nepal
- Health Management Information System (HMIS) Guideline 2075
- National Plan, Policy & Guidelines
- Epidemiology and Disease Control Division
- Priority Infectious Diseases for Community-Based Surveillance in Nepal
- Community Based Disease Surveillance Guideline, 2082
