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| Key component of recognition of dengue cases* | Extent to which activities were undertaken in Nepal in 2010 | Reasons for problems identified and how to improve |
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| Guidelines on dengue disease notification used | National clinical management guidelines available. Did not include guidelines on public health response. | Dengue not previously identified as a public health priority. New guidelines were commissioned in 2011. |
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| Active and passive data collection | Sentinel site surveillance, only 39 sites. Not in all districts. Did not include private hospitals. Not representative of country population. | Limited funds available for widespread surveillance. |
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| Active data collection during outbreak | Fever surveillance only occurred during the outbreak in two districts. | |
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| Well-defined indicators for a dengue outbreak | Well-defined outbreak threshold: one or more dengue cases reported in nonendemic districts or five or more cases in endemic districts. Poor case definition of dengue. | Standard national guidelines available for dengue case definition but not consistently applied by participants. |
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| Linking surveillance to response activities | EDCD collects and analyses the data and coordinate response measures. Poor coordination between central and periphery, confusion over which agency was in charge. No continuity of response. | Need better coordination with district offices to improve response time. Municipality meetings planned. |
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| Training on surveillance | Despite 9 participants noted that training on surveillance was available, this was very limited and described as “not functioning at present.” Internet-based reporting had been introduced but training not provided. | More in-depth training requested by participants. |
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| Dengue as a notifiable disease | Dengue is one of 6 notifiable diseases through the Early Warning and Response System in Nepal. | Clinicians are inexperienced with dengue and need to consider it as a differential of fever. |
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| Appropriate level of financial resources | Budget was deemed insufficient by all participants. | |
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| Appropriate level of human resources | More hospitals and staff need to be included in the surveillance system. | |
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| Viral surveillance | Unable to undertake viral surveillance. | Facilities for PCR should be made available in Nepal. |
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| Laboratory diagnostics- serological and virological | Serological tests (IgG/IgM, either RDT or ELISA) were used for diagnosis. ELISA available in “five or six centres only.” Only one participant had access to PCR (not available in general public or private facilities). | Lack of regional facilities identified as key limitation. Concern over accuracy of RDT kits. |
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| Quality control of diagnostics. | No systematic measurement. | Introduce regional laboratory facilities to allow quality control. |
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| Monitoring of environmental risk factors | Rainfall, temperature, and housing conditions not systematically linked into dengue surveillance system. | |
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