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@#The coronavirus disease 2019 (COVID-19) pandemic has uncovered the need for health systems to be strengthened in order to be able to respond quickly to any potential future outbreaks. In response, the Pacific Syndromic Surveillance System (PSSS) is currently being used by many countries within the Pacific Islands for tracking and addressing infectious disease outbreaks, including COVID-19. To maximise its usefulness as an early warning system, investments must be made in strengthening data quality, data sharing, health facility capacity, technology, and ongoing evaluation of surveillance systems. Doing so will ensure that the PSSS and other surveillance systems can remain effective tools for monitoring and respond to infectious disease outbreaks in the Pacific Islands
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Pohnpei State’s Division of Primary Health Care implemented enhanced surveillance for early warning and detection of disease to support the 8th Micronesian Games (the Games) in July 2014. The surveillance comprised 11 point-of-care sentinel sites around Pohnpei, Federated States of Micronesia, collecting data daily for eight syndromes using standard case definitions. Each sentinel site reported total acute care encounters, total syndrome cases and the total for each syndrome. A public health response, including epidemiological investigation and laboratory testing, followed when syndrome counts reached predetermined threshold levels. The surveillance was implemented using the web-based Suite for Automated Global Electronic bioSurveillance Open-ESSENCE (SAGES-OE) application that was customized for the Games. Data were summarized in daily situation reports (SitReps) issued to key stakeholders and posted on PacNet, a Pacific public health e-mail network. Influenza-like illness (ILI) was the most common syndrome reported (55%, n = 225). Most syndrome cases (75%) were among people from Pohnpei. Only 30 cases out of a total of 408 syndrome cases (7%) presented with acute fever and rash, despite the large and ongoing measles outbreak at the time. No new infectious disease outbreak was recorded during the Games. Peaks in diarrhoeal and ILI cases were followed up and did not result in widespread transmission. The technology was a key feature of the enhanced surveillance. The introduction of the web-based tool greatly improved the timeliness of data entry, analysis and SitRep dissemination, providing assurance to the Games organizers that communicable diseases would not adversely impact the Games.
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OBJECTIVES: For earlier detection of infectious disease outbreaks, a digital syndromic surveillance system based on search queries or social media should be utilized. By using real-time data sources, a digital syndromic surveillance system can overcome the limitation of time-delay in traditional surveillance systems. Here, we introduce an approach to develop such a digital surveillance system. METHODS: We first explain how the statistics data of infectious diseases, such as influenza and Middle East Respiratory Syndrome (MERS) in Korea, can be collected for reference data. Then we also explain how search engine queries can be retrieved from Google Trends. Finally, we describe the implementation of the prediction model using lagged correlation, which can be calculated by the statistical packages, i.e., SPSS (Statistical Package for the Social Sciences). RESULTS: Lag correlation analyses demonstrated that search engine data/Twitter have a significant temporal relationship with influenza and MERS data. Therefore, the proposed digital surveillance system can be used to predict infectious disease outbreaks earlier. CONCLUSIONS: This prediction method could be the core engine for implementing a (near-) real-time digital surveillance system. A digital surveillance system that uses Internet resources has enormous potential to monitor disease outbreaks in the early phase.
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Communicable Diseases , Coronavirus Infections , Disease Outbreaks , Influenza, Human , Information Storage and Retrieval , Internet , Korea , Methods , Search Engine , Social MediaABSTRACT
The Ministry of Health in Samoa, in partnership with the Pacific Community, successfully implemented enhanced surveillance for the high-profile Third United Nations Conference on Small Island Developing States held concurrently with the popular local Teuila festival during a widespread chikungunya outbreak in September 2014. Samoa’s weekly syndromic surveillance system was expanded to 12 syndromes and 10 sentinel sites from four syndromes and seven sentinel sites; sites included the national hospital, four private health clinics and three national health service clinics. Daily situation reports were produced and were disseminated through PacNet (the email alert and communication tool of the Pacific Public Health Surveillance Network) together with daily prioritized line lists of syndrome activity to facilitate rapid response and investigation by the Samoan EpiNet team. Standard operating procedures for surveillance and response were introduced, together with a sustainability plan, including a monitoring and evaluation framework, to facilitate the transition of the mass gathering surveillance improvements to routine surveillance. The enhanced surveillance performed well, providing vital disease early warning and health security assurance. A total of 2386 encounters and 708 syndrome cases were reported. Influenza-like illness was the most frequently seen syndrome (17%). No new infectious disease outbreaks were recorded. The experience emphasized: (1) the need for a long lead time to pilot the surveillance enhancements and to maximize their sustainability; (2) the importance of good communication between key stakeholders; and (3) having sufficient staff dedicated to both surveillance and response.
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Objective To evaluate the influence of data quality on the sensitivity of early warning syndromic surveillance system based on medical institutions in Qianjiang,Hubei province and explore the relationship between data quality and sensitivity of early warning of the system.Methods The delay reporting rate and underreporting rate were calculated for the evaluation of the data quality.Data obtained from semi-synthetic simulated outbreak and area under the curve (AUC) were used in combination to test the sensitivity of early warning of various models and select the optimal model.Time-series generalized additive model (GAM) was used to analyze the curve fitting and threshold effect between data quality and early warning sensitivity of the system.Results A total of 179 905 cases were reported from April 1,2012 to January 31,2014,in which 8 744 were not reported timely (16.45％).Averagely 416 reporting were delayed in each month.There were 2 566 cases which were underreported (4.83％).Compared with other early warning models,i.e.Cumulative Sum (CUSUM),Shewhart,Exponentially Weighted Moving Average (EWMA),Early Aberration Reporting System (EARS-3C),the MA model had the maximum area under the curve (AUC=0.93),and the difference was significant (P＜0.001).The early warning sensitivity ranged from 84.89％ to 97.25％ during the operation period of the syndromic surveillance system.Underreporting had influence on early warning sensitivity,when underreporting rate was over 2.78％,the sensitivity would decrease obviously.No obvious associations were observed between the delay reporting rate and early warning sensitivity of the system.Conclusion The data quality had influence on the early warning sensitivity of the syndromic surveillance system based on medical institution in Qianjiang.In the context of this study,underreporting had the main influence on the sensitivity of early warning.
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Objective To evaluate the influence of data quality on the sensitivity of early warning syndromic surveillance system based on medical institutions in Qianjiang,Hubei province and explore the relationship between data quality and sensitivity of early warning of the system.Methods The delay reporting rate and underreporting rate were calculated for the evaluation of the data quality.Data obtained from semi-synthetic simulated outbreak and area under the curve (AUC) were used in combination to test the sensitivity of early warning of various models and select the optimal model.Time-series generalized additive model (GAM) was used to analyze the curve fitting and threshold effect between data quality and early warning sensitivity of the system.Results A total of 179 905 cases were reported from April 1,2012 to January 31,2014,in which 8 744 were not reported timely (16.45％).Averagely 416 reporting were delayed in each month.There were 2 566 cases which were underreported (4.83％).Compared with other early warning models,i.e.Cumulative Sum (CUSUM),Shewhart,Exponentially Weighted Moving Average (EWMA),Early Aberration Reporting System (EARS-3C),the MA model had the maximum area under the curve (AUC=0.93),and the difference was significant (P＜0.001).The early warning sensitivity ranged from 84.89％ to 97.25％ during the operation period of the syndromic surveillance system.Underreporting had influence on early warning sensitivity,when underreporting rate was over 2.78％,the sensitivity would decrease obviously.No obvious associations were observed between the delay reporting rate and early warning sensitivity of the system.Conclusion The data quality had influence on the early warning sensitivity of the syndromic surveillance system based on medical institution in Qianjiang.In the context of this study,underreporting had the main influence on the sensitivity of early warning.
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In 2012, Vanuatu designed and implemented a syndromic surveillance system based on the guidelines developed by the Pacific Community and the World Health Organization to provide early warning of outbreaks and other important public health events. Four core syndromes were endorsed for surveillance: acute fever and rash, prolonged fever, influenza-like illness and acute watery diarrhoea. In March 2015, Vanuatu was struck by Cyclone Pam, after which several important changes and improvements to the country's syndromic surveillance were made. To date, there has been no formal evaluation of whether regular reports are occurring or that core syndromes are being documented. We therefore carried out a descriptive study in the 11 sentinel sites in Vanuatu conducting syndromic surveillance between July and December 2015. There was a total of 53 822 consultations which were higher in the first 13 weeks (n = 29 622) compared with the last 13 weeks (n = 24 200). During the six months, there were no cases of acute fever and rash or prolonged fever. There were cases with influenza-like illness from week 27 to 35, but no case was reported after week 35. Acute watery diarrhoea occurred in one or two cases per week during the whole study period. For these two core syndromes, there were generally more females than males, and about one third were children aged under 5 years. In conclusion, Vanuatu implemented changes to its new syndromic surveillance system from July to December 2015, although laboratory components had not yet been incorporated. The laboratory components are working in 2016 and will be the subject of a further report.
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Mass gatherings pose public health challenges to host countries, as they can cause or exacerbate disease outbreaks within the host location or elsewhere. In July 2012, the 11th Festival of Pacific Arts (FOPA), a mass gathering event involving 22 Pacific island states and territories, was hosted by Solomon Islands. An enhanced syndromic surveillance (ESS) system was implemented for the event. Throughout the capital city, Honiara, 15 sentinel sites were established and successfully took part in the ESS system, which commenced one week before the FOPA (25 June) and concluded eight days after the event (22 July). The ESS involved expanding on the existing syndromic surveillance parameters: from one to 15 sentinel sites, from four to eight syndromes, from aggregated to case-based reporting and from weekly to daily reporting. A web-based system was developed to enable data entry, data storage and data analysis. Towards the end of the ESS period, a focus group discussion and series of key informant interviews were conducted. The ESS was considered a success and played an important role in the early detection of possible outbreaks. For the period of the ESS, 1668 patients with syndrome presentations were received across the 15 sentinel sites. There were no major events of public health significance. Several lessons were learnt that are relevant to ESS in mass gathering scenarios, including the importance of having adequate lead in time for engagement and preparation to ensure appropriate policy and institutional frameworks are put in place.
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Combining theory and practice at home and abroad in recent years ,construction plan of the military infectious diseases syndromic surveillance system was discussed from aspects of data collection and transmission , data analysis and early warning , incident response based on the core business requirements of syndromic surveillance for infectious diseases . The study provides the demand traction for the system construction .
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The paper discusses the feasibility and urgency of building the military syndromic surveillance system ( SSS) against biological threats in China .Based on the external environment and necessary conditions for our military SSS , the study proposeds a strategic construction plan for implementing our military biodefense SSS , involving the function objectives and performance indexes , system principles and framework , functional modules , syndromic classification and task flow analysis.
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Syndromic surveillance , based on non-specific pre-diagnosis and other information , is capable of nearly real-time detection and early warning of potential bioterrorism and emerging infectious threats .Developed countries , led by the U.S., have conducted in-depth and front research in this area while China has just started syndromic surveillance re -search in the exploratory trial stage .The Chinese army is facing an urgent need for syndromic surveillance .This paper makes a case study of foreign military syndromic surveillance practices , typically the U.S.representative system ESSENSE , which was developed by the U .S.Department of Defense and deployed in all military treatment facilities .Some suggestions for the Chinese army are also discussed .
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Objective To reveal the characteristics and stability of the system through the analyzing the surveillance data of respiratory-feverous syndrome via the syndromic surveillance system which was established during the Shanghai World Expo in Pudong New District and provide references for the development and operation optimization on this Mass Gatherings Surveillance Systems.Methods Data used was from the surveillance data of respiratory-feverous syndrome collected from Pudong New District Syndromic Surveillance System,through May 1 to October 31,2010.On the basis of description of data characteristics,correlation analyses were conducted,when compared to the surveillance data of respiratory-feverous syndrome and Pudong influenza-like illness (ILI) used as reference.Comparison of variances on the surveillance data and the report lag time of the earlier and later surveillance periods were also carried out to evaluate the quality and stability of data.Results Reports on the respiratory-feverous syndrome showed a peak in late September with day-of-week effects and holiday effects.Correlation between respiratory-feverous syndrome and ILI was the strongest in the same day (r=0.596,P＜0.05).In the earlier surveillance period from 2010-05-01 to 2010-07-31,the correlation between respiratory-feverous syndrome and ILI was not obvious (r=-0.058,P＞0.05) ; however,the two-time series showed consistent trend with the correlation coefficient as 0.798 (P＜0.05),in the later period from 2010-08-01 to 2010-10-31.In addition,variability of the surveillance data on respiratory-feverous syndrome was less in the later period than in the earlier one,with quality of the report on relatcd data better in the later period.Analyses on the correlations of reference sequence,variability and quality of report indicated that the stability of the later surveillance period was better than the earlier one.Conclusion Only with the operation of syndromic surveillance system for a certain period of time,could data in the system maintain stability.Surveillance data showed both day-of-week effects and holiday effects,suggesting that there was a need to choose early warning models with short baseline data.
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Objective To evaluate the burden of paratyphoid fever A in Hongta district, Yuxi city, Yunnan province from May 1, 2008 to April 30, 2009 so as to provide information for the development of comprehensive intervention measures. Methods Based on the Fever Syndromic Surveillance System, information as attendance rate of patients with fever, rate of patients being sampled, laboratory testing rate, sensitivity on the detection of blood culture and the rate of case reporting etc. were calculated. According to the pyramid model of food-borne disease on disease burden, the local actual incidence of paratyphoid fever A was estimated and analyzed. Results Under the Fever Syndromic Surveillance System, there were 6642 fever cases being detected, among whom 6570 cases were sampled and undergone testing, with the sampling rate as 98.92% and all the samples received laboratory testing. There were 354 positive cases of paratyphoid fever A reported,all from the Hongta district. Data showed that the attendance rate of the feverish patients was 73.53%,with the highest rate seen in whose under 10 years old (100%). Assumed that the sensitivity of paratyphoid fever blood culture was 70%, and the case reporting rate was 90%, we estimated that the annual incidence of paratyphoid fever A in Hongta was 220.33 (95% CI: 170.1-521.4) per 100 thousand, with 965 (95%CI: 745-2284) as new cases. Among all the age groups, the incidence in the age group from 15 to 44 years old was estimated to be at the highest (318.27 per 100 thousand).Conclusion Hongta seemed to be an endemic region for paratyphoid fever A, with the highest incidence occurred in the age group of between 15 and 44 years old. These findings highlighted the urgent need to carry out further investigation on the risk factors and to implement targeted effective prevention and control measures.
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With the aim of identifying the etiology of acute febrile illness in patients suspected of having dengue, yet with non reagent serum, a descriptive study was conducted with 144 people using secondary serum samples collected during convalescence. The study was conducted between January and May of 2008. All the exams were re-tested for dengue, which was confirmed in 11.8 percent (n = 17); the samples that remained negative for dengue (n = 127) were tested for rubella, with 3.9 percent (n = 5) positive results. Among those non reactive for rubella (n = 122), tests were made for leptospirosis and hantavirus. Positive tests for leptospirosis were 13.9 percent (n = 17) and none for hantavirus. Non reactive results (70.8 percent) were considered as Indefinite Febrile Illness (IFI). Low schooling was statistically associated with dengue, rubella and leptospirosis (p = 0.009), dyspnea was statistically associated with dengue and leptospirosis (p = 0.012), and exanthem/petechia with dengue and rubella (p = 0.001). Among those with leptospirosis, activities in empty or vacant lots showed statistical association with the disease (p = 0.013). Syndromic surveillance was shown to be an important tool in the etiologic identification of IFI in the Federal District of Brazil.
Com o objetivo de identificar a etiologia de doenças febris agudas, em suspeitos de dengue com sorologia não reagente, realizou-se estudo descritivo com 144 pessoas utilizando amostras de soro coletados na convalescença, entre janeiro e março de 2008. Todos os exames foram re-testados para dengue, sendo as amostras negativas, processadas para rubéola (n = 127). Dentre as não reagentes para rubéola, submeteu-se ao teste para leptospirose (n = 122), e em se permanecendo sem diagnóstico, testou-se para hantavirose. Confirmou-se dengue em 11,8 por cento (n = 17), rubéola em 3,9 por cento (n = 5) e leptospirose em 13,9 por cento (n = 17). Os resultados não reagentes foram considerados como doença febril aguda indiferenciada (DFI) em 70.8 por cento dos casos. Verificou-se associação estatística em baixa escolaridade nos casos de dengue, rubéola e leptospirose (p = 0,009), assim como dispnéia para dengue e leptospirose (p = 0,012), e exantema/petéquias para dengue e rubéola (p = 0,001). Dentre os doentes com leptospirose, as atividades em terreno baldio mostraram-se com diferença estatística significante (p = 0,013). A vigilância sindrômica demonstrou-se como importante ferramenta na identificação de doenças febris agudas no Distrito Federal.
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Dengue/diagnosis , Fever of Unknown Origin/diagnosis , Leptospirosis/diagnosis , Rubella/diagnosis , Acute Disease , Brazil/epidemiology , Dengue/epidemiology , Educational Status , Enzyme-Linked Immunosorbent Assay , Fever of Unknown Origin/epidemiology , Leptospirosis/epidemiology , Population Surveillance , Risk Factors , Rubella/epidemiology , Seasons , Young AdultABSTRACT
INTRODUCTION: To review measles IgM-positive cases of febrile rash illnesses in the State of São Paulo, Brazil, over the five-year period following interruption of measles virus transmission. METHODS: We reviewed 463 measles IgM-positive cases of febrile rash illness in the State of São Paulo, from 2000 to 2004. Individuals vaccinated against measles < 56 days prior to specimen collection were considered to be exposed to the vaccine. Serum from the acute and convalescent phases was tested for evidence of measles, rubella, parvovirus B19 and human herpes virus-6 infection. In the absence of seroconversion to measles immunoglobulin-G, measles IgM-positive cases were considered false positives in individuals with evidence of other viral infections. RESULTS: Among the 463 individuals with febrile rash illness who tested positive for measles IgM antibodies during the period, 297 (64 percent) were classified as exposed to the vaccine. Among the 166 cases that were not exposed to the vaccine, 109 (66 percent) were considered false positives based on the absence of seroconversion, among which 21 (13 percent) had evidence of rubella virus infection, 49 (30 percent) parvovirus B19 and 28 (17 percent) human herpes virus-6 infection. CONCLUSIONS: Following the interruption of measles virus transmission, thorough investigation of measles IgM-positive cases is required, especially among cases not exposed to the vaccine. Laboratory testing for etiologies of febrile rash illness aids interpretation of these cases.
INTRODUÇÃO: Revisar os casos de doenças febris exantemáticas com IgM reagente contra o sarampo, no Estado de São Paulo, Brasil, durante os cinco anos seguidos a interrupção da transmissão do vírus do sarampo. MÉTODOS: Nós revisamos 463 casos de doenças febris exantemáticas com IgM reagente contra o sarampo, no Estado de São Paulo, Brasil, de 2000 a 2004. Indivíduos vacinados contra o sarampo 56 dias antes da coleta de amostra foram considerados expostos à vacina. Soros da fase aguda e de convalescença foram testados para a evidência de infecção de sarampo, rubéola, parvovírus B19 e herpes vírus 6. Na ausência de soroconversão para imunoglobulina G contra o sarampo, casos com IgM reagente contra o sarampo foram considerados falsos positivos em pessoas com evidência de outras infecções virais. RESULTADOS: Entre as 463 pessoas com doenças febris exantemáticas que testaram positivo para anticorpos IgM contra o sarampo durante o período, 297 (64 por cento) pessoas foram classificadas como expostas à vacina. Entre os 166 casos não expostos à vacina, 109 (66 por cento) foram considerados falsos positivos baseado na ausência de soroconversão, dos quais 21 (13 por cento) tiveram evidência de infecção por vírus da rubéola, 49 (30 por cento) parvovírus B19 e 28 (17 por cento) infecção por herpes vírus humano 6. CONCLUSÕES: Após a interrupção da transmissão do vírus do sarampo é necessária exaustiva investigação dos casos com IgM reagente contra o sarampo, especialmente dos casos não expostos à vacina. Testes laboratoriais para etiologias das doenças febris exantemáticas ajudam na interpretação destes casos.
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Humans , Exanthema/diagnosis , Immunoglobulin M/blood , Measles Vaccine/immunology , Measles virus/immunology , Measles/diagnosis , Brazil/epidemiology , Exanthema/epidemiology , False Positive Reactions , Immunoglobulin M/immunology , Measles/epidemiology , Measles/prevention & control , Population Surveillance , Parvoviridae Infections/diagnosis , Parvoviridae Infections/epidemiology , Roseolovirus Infections/diagnosis , Roseolovirus Infections/epidemiology , Rubella/diagnosis , Rubella/epidemiologyABSTRACT
Objective To find out the data sources of respiratory syndromes and their components from the outpatients of general hospitals and to describe the time distribution and mutual relations of different respiratory syndromes. Feasibility of respiratory syndromes used for early warning surveillance on respiratory infectious disease was also under research. Methods Retrospective investigation on Hospital Information System (HIS) was implemented in a general hospital in Guangzhou, 2005, and data of outpatients was collected and classified into different syndromes. The respiratory syndromes with its time distribution similar to influenza like illness (ILI),were selected, and cross-correlation analyses were conducted to inveshgate the feasibility of respiratory syndromes for early warning surveillance on respiratory infection diseases (influenza as an example). Results Primary sub-classification of respiratory syndromes in outpatient department would include upper respiratory infection(URI)(51.20%), trachitis/bronchitis (18.80%), asthma ( 17.52% ), etc. Pulmonary infection accounted for only 2.26%. Time distributions of URI, trachitis/bronchitis, pulmonary infection, cough and asthma in outpatient department, X-ray tests and pneumonia/acute respiratory distress syndromes (ARDSs) in outpatient X-ray room were similar, with two peaks observed. Cross-correlation functions were calculated with the data sets of 1st-28th week.The most significant correlation was detected between the time series of outpatient pulmonary infections and ILIs moved 4 weeks backward (r＝0.739, P＜0.01 ), and that was detected between URIs and ILIs moved 5 weeks backward (r=0.714, P＜0.01 ). Correlation between X-ray tests,pneumonia/ARDSs in outpatient X-ray room and ILIs was the strongest when ILIs time series moved 1 week backward (r=0.858, P＜0.001; r=0.821, P＜0.001 ). Conclusion Outpatient data from HIS system in general hospital could be applied to syndromic surveillance on respiratory diseases. For early warning epidemics or outbreaks of influenza or other respiratory infectious diseases, data of outpatient pulmonary infection appeared to be the most feasible for its specificity and timeliness, followed by URI and cough. X-ray tests and pneumonia/ARDSs in outpatient X-ray findings were important supplementary to verify the respiratory disease epidemics or outbreaks for its good specificity, but with no advantage for early warning.