The study urges year-round surveillance instead of seasonal monitoring, calling for better lab capacity at all care levels and greater participation from private hospitals and labs to enhance data and response
Published Jul 21, 2025 | 7:00 AM ⚊ Updated Jul 21, 2025 | 7:00 AM
Need for a stronger respiratory health system in Tamil Nadu (iStock)
Synopsis: A new ICMR-NIE study published in Discover Health Systems reveals critical gaps in Tamil Nadu’s surveillance of influenza-like illness (ILI) and severe acute respiratory infections (SARI). Conducted across four districts from 2023–2024, the research found that despite foundational systems, testing remains limited to major hospitals, data entry is inconsistent, and private sector involvement is lacking
A recent public health study by ICMR’s National Institute of Epidemiology (NIE), published in the journal Discover Health Systems last month, has thrown light on how Tamil Nadu monitors and responds to influenza‑like illness (ILI) and severe acute respiratory infections (SARI).
The study evaluated surveillance systems in four districts from 2023 to 2024, engaging more than 370 stakeholders across 85 healthcare facilities and 23 laboratories. It found that while a basic foundation for respiratory illness surveillance exists in the state, many gaps remain that need urgent attention.
Surveillance of respiratory illnesses in Tamil Nadu currently intensifies only during outbreaks or certain seasons, even though respiratory viruses circulate throughout the year. Testing facilities are concentrated in larger hospitals, leaving primary and secondary care centres without the equipment and resources needed to conduct timely tests.
Public health centres widely use the Integrated Health Information Platform (IHIP), but data entry is inconsistent, reporting formats overlap, and participation from private hospitals and labs remains minimal.
These findings highlight a system that needs to move from seasonal monitoring to continuous, routine surveillance. With changing ecological conditions, efforts are needed to ensure year‑round reporting and to build infrastructure for testing influenza and other novel pathogens. Structured training for trainers and regular sessions for community health workers are among the measures recommended. Frequent monitoring and structured feedback loops are needed to improve data quality and provide a clearer understanding of disease trends.
More than half of the facilities surveyed already have systems in place to report influenza‑like illness and severe acute respiratory infections, but only 42 per cent regularly collect clinical samples for testing. Few health workers, especially at community level, have received specific training to identify and report such cases.
The study recommends that surveillance should no longer be treated as a seasonal exercise but as a continuous system, with improvements in laboratory capacity and resources across all levels of care. Involvement of private hospitals and laboratories, currently partial, must be expanded to strengthen data collection and response.
The report also calls for a One Health approach, linking human, animal and environmental health. It urges data‑sharing mechanisms across sectors to ensure transparency and early detection of threats. Tamil Nadu has introduced the Laboratory Information Management System (LIMS) to streamline sample collection and transport, and plans are in place to establish a One Health secretariat to improve inter‑departmental coordination and surveillance of zoonotic diseases.
To understand how these recommendations could work in practice, Dr. Sameer Bansal, Senior Consultant Pulmonologist at Vaayu Chest and Sleep Specialists and Apollo Hospital, Bangalore, shared detailed observations to South First, on how Tamil Nadu can strengthen its respiratory health surveillance.
He mentioned that having a regular system of notification or surveys for influenza and similar illnesses could make a big difference. According to him, “There should be notification for influenza and influenza‑like disease. If not notification, some kind of a regular survey.” He pointed out that even though large‑scale implementation may be difficult, assigning a nodal officer to oversee data collection from a set of centres could help track trends and trigger early action.
On the ground‑level improvements needed, Dr. Bansal explained that training medical staff should come first. He noted that awareness about identifying suspected influenza cases and reporting them is still lacking in many places. He added that the government should expand point‑of‑care testing facilities, which, he said, “Can give results in a couple of hours and are available easily now.”
Structured guidance is also essential, he said, and suggested creating modules that use an algorithmic approach for different diseases. These modules, according to him, would guide health workers on how to identify cases, what steps to follow, which tests to order, and what initial therapy to start. He stated that such a system would improve reporting and ensure better compliance with antimicrobial stewardship principles.
When asked about the role of the private sector, Dr. Bansal said that greater participation could be encouraged through accreditation incentives or by involving private centres in advisory roles. He also mentioned that “involving private practitioners in government‑funded research activities may help bring them on board.”
He further noted that a One Health approach could significantly strengthen early warnings and reduce response delays. “This approach helps enhance predictive capability, supports precision public health, and reduces response lag in respiratory outbreaks,” he said, emphasising that effective communication between stakeholders is crucial for it to work.
Speaking on digital upgrades, Dr. Bansal explained that while tools like LIMS and mobile reporting platforms are invaluable for early warnings and coordination, successful implementation requires more than technology alone. He stated that these systems “are not just IT projects, but public health assets,” and called for infrastructure investment, capacity building and policy support to ensure they work effectively on the ground.
Speaking to South First, Dr. Tirupathi, Pulmonologist at SIMS Hospital in Chennai, the impact of respiratory infections depends greatly on a person’s immunity and existing health conditions. He explained that patients undergoing treatments such as cancer therapy or transplant medication are far more susceptible to even mild infections.
He noted that public health efforts should pay special attention to those most at risk. Influenza, for instance, may not pose a serious threat to everyone, but children, pregnant women, older adults, and people with underlying conditions can face severe illness. To protect them, he said, good personal health management and adherence to prescribed treatments are important, along with adult vaccinations that reduce the severity of infections.
Many patients misunderstand what vaccines can and cannot do, Dr. Tirupathi observed. People often expect complete protection and question why they still fall ill after vaccination. He explained that vaccines do not guarantee zero infections but help the body fight illness more effectively. He recommended influenza and pneumococcal vaccines for vulnerable populations and added that guidelines now advise RSV and shingles vaccines, especially for those with chronic respiratory issues like COPD.
On preparing for future outbreaks, Dr. Tirupathi pointed out that viral mutations are constant and unpredictable. He recalled how the Delta variant of COVID‑19 caused severe illness even in younger people and said new mutations can emerge in a similar way.
He also highlighted how systems should learn from Kerala’s response to outbreaks. He described how officials there tracked contacts and diagnosed the first Nipah case with precision, calling it “like a crime story.” Tamil Nadu, he suggested, should build similar vigilance, investigate unusual cases quickly, and ensure samples reach the right laboratories in time. This, he said, would make early detection and timely public warnings possible.
(Edited by Ananya Rao)
