Integration of COVID-19 testing into existing ILI surveillance system in Ghana

The similarities between the presentations of Influenza-Like Illness (ILI) and COVID-19, generated calls for the integration of COVID-19 surveillance into the existing ILI surveillance system. The aim was to optimize outcomes through efficient use of resources. Ghana responded to the World Health Organization call to integrate the two systems. We share the processes undertaken to integrate SARS-CoV-2 into the ILI surveillance system in Ghana. Stakeholders from Disease Surveillance Department of Ghana Health Service, National Influenza Center and the University of Ghana School of Public Health were engaged to understand the existing ILI surveillance system and determine leverage points for integration. Forms, processes and reports for both COVID-19 and ILI were reviewed and modified. Additional symptoms were added to the ILI case investigation form and risk of exposure section modified to COVID-19. Also, all ILI specimens received in the laboratory were tested for SARS-CoV-2 as well. The integrated system was piloted in 24 sites from April - June 2021 and subsequently rolled out to all sentinel sites across the nation. Integration of the ILI/SARS-CoV-2 surveillance system was rolled out to all 29 sentinel sites in June 2021. Samples collected from the sentinel sites were transported and received by the lab within 48 hours and upon receipt were tested within 24 hours. From June 16 to September 10, a total of 1520 suspected influenza samples were received and tested for SARS-CoV-2 of which 297 tested positive for SARS-CoV-2. The flexibility of the ILI surveillance system in Ghana aided the integration of the COVID-19 surveillance into the existing system. Prudent supervisory measures should be instituted by the Ghana Health Service and the National Influenza Center to ensure sentinel sites submit samples on weekly basis for testing.