Surveillance of severe acute respiratory infections (SARI) and influenza-like illness (ILI) in Tamil Nadu, India: a situation analysis

Evidence from the COVID-19 pandemic illustrates the substantial burden Influenza-like illness (ILI) and Severe acute respiratory infections (SARI) exert on our health system and community. While there are no large-scale studies comprehensively evaluating ILI/ SARI surveillance in India, we conducted a situation analysis of Tamil Nadu’s surveillance system, assessing the strengths and gaps at different healthcare levels. We conducted a mixed-method cross-sectional study in four districts of Tamil Nadu. We evaluated surveillance activities at selected healthcare facilities and surveillance units using an observational checklist. We conducted questionnaire interviews with healthcare providers and in-depth interviews with key stakeholders to explore perspectives on ILI/ SARI surveillance. We performed descriptive statistical analysis to summarize quantitative data and a hybrid thematic approach to analyze qualitative data. Our study included four district surveillance units, 85 healthcare facilities, 23 laboratories, and 376 stakeholders. Forty-four (51.8%) healthcare centres reported ILI/ SARI cases. Thirty-six (42.4%) healthcare centres collected samples. Twenty-five (29.4%) healthcare facilities had at least one medical officer and 23 (27.1%) had at least one allied health staff who received training for ILI/ SARI surveillance. ILI/ SARI surveillance remains a seasonal event in Tamil Nadu. Although guidelines are in place, a gap exists in awareness amongst health workers. With changing ecological conditions, efforts should be made to ensure year round reporting of cases. Testing for influenza should be prioritized and infrastructure and testing for novel pathogens should be developed.