Meeting the International Health Regulations (2005) surveillance core capacity requirements at the subnational level in Europe: the added value of syndromic surveillance

BMC Public Health

Thomas Krafft⁷  Helmut Brand¹  Gernot Vergeiner⁵  Freddy K Lippert³  Alexander Krämer⁴  Matthias Fischer⁶  Luis Garcia-Castrillo Riesgo²  Nicole Rosenkötter¹  Alexandra Ziemann¹ 

[1] Department of International Health, School of Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6200, MD, The Netherlands;Department of Medical Sciences and Surgery, Faculty of Medicine, University of Cantabria, Avenida de los Castros s/n, Santander, 39005, Spain;Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, Copenhagen, 2100, Denmark;Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, 33501, Germany;Dispatch Centre Tyrol (Leitstelle Tirol Gesellschaft mbH), Hunoldstrasse 17a, Innsbruck, 6020, Austria;Department of Anaesthesia and Intensive Care, Klinik am Eichert, Göppingen, 73006, Germany;Institute for Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, A11 Datun Road, Beijing 100101, China

关键词: World Health Organization;    Europe;    Public health surveillance;   

Others  :  1121469
DOI  :  10.1186/s12889-015-1421-2

 received in 2014-01-18, accepted in 2015-01-15,  发布年份 2015

【 摘 要 】

Background

The revised World Health Organization’s International Health Regulations (2005) request a timely and all-hazard approach towards surveillance, especially at the subnational level. We discuss three questions of syndromic surveillance application in the European context for assessing public health emergencies of international concern: (i) can syndromic surveillance support countries, especially the subnational level, to meet the International Health Regulations (2005) core surveillance capacity requirements, (ii) are European syndromic surveillance systems comparable to enable cross-border surveillance, and (iii) at which administrative level should syndromic surveillance best be applied?

Discussion

Despite the ongoing criticism on the usefulness of syndromic surveillance which is related to its clinically nonspecific output, we demonstrate that it was a suitable supplement for timely assessment of the impact of three different public health emergencies affecting Europe. Subnational syndromic surveillance analysis in some cases proved to be of advantage for detecting an event earlier compared to national level analysis. However, in many cases, syndromic surveillance did not detect local events with only a small number of cases.

The European Commission envisions comparability of surveillance output to enable cross-border surveillance. Evaluated against European infectious disease case definitions, syndromic surveillance can contribute to identify cases that might fulfil the clinical case definition but the approach is too unspecific to comply to complete clinical definitions. Syndromic surveillance results still seem feasible for comparable cross-border surveillance as similarly defined syndromes are analysed.

We suggest a new model of implementing syndromic surveillance at the subnational level. In this model, syndromic surveillance systems are fine-tuned to their local context and integrated into the existing subnational surveillance and reporting structure. By enhancing population coverage, events covering several jurisdictions can be identified at higher levels. However, the setup of decentralised and locally adjusted syndromic surveillance systems is more complex compared to the setup of one national or local system.

Summary

We conclude that syndromic surveillance if implemented with large population coverage at the subnational level can help detect and assess the local and regional effect of different types of public health emergencies in a timely manner as required by the International Health Regulations (2005).

【 授权许可】

   
2015 Ziemann et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]World Health Organization: International Health Regulations (2005). World Health Organization, Geneva; 2008.
• [2]Paquet C, Coulombier D, Kaiser R, Ciotti M: Epidemic intelligence: a new framework for strengthening disease surveillance in Europe. Euro Surveill 2006, 11(12):212-214.
• [3]World Health Organization: European Strategy Meeting for implementation of the International Health Regulations (2005) - Scope and purpose. World Health Organization, Copenhagen; 2013.
• [4]Allebeck P: Which health data for Europe? Eur J Public Health 2012, 22(5):611.
• [5]European Parliament and Council of the European Union: Decision on serious cross-border threats to health and repealing Decision No 2119/98/EC (1082/2013/EU) Off J Eur Union 2013, L 293:1-15.
• [6]European Commission: Commission Implementing Decision amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council (2012/506/EU) Off J Eur Union 2012, L262:1-57.
• [7]Mostashari F, Hartman J: Syndromic surveillance: a local perspective. J Urban Health 2003, 80(2 Suppl 1):i1-i7.
• [8]McManus J, Huebner K, Scheulen J: The science of surge: Detection and situational awareness. Acad Emerg Med 2006, 13(11):1179-1182.
• [9]Lyytikainen O, Kuusi M, Snellman M, Virtanen M, Eskola J, Ronkko E, et al.: Surveillance of influenza in Finland during the 2009 pandemic, 10 May 2009 to 8 March 2010. Euro Surveill 2011, 16(27):ᅟ. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19908
• [10]Wilson K, McDougall C, Forster A: The responsibility of healthcare institutions to protect global health security. Healthc Q 2009, 12(1):56-60.
• [11]Altmann M, Spode A, Altmann D, Wadl M, Benzler J, Eckmanns T, et al.: Timeliness of surveillance during outbreak of Shiga Toxin-producing Escherichia coli infection, Germany, 2011. Emerg Infect Dis 2011, 17(10):1906-1909.
• [12]Triple S: Assessment of syndromic surveillance in Europe. Lancet 2011, 378(9806):1833-1834.
• [13]Conti S, Kanieff M, Rago G. Inventory of syndromic surveillance systems in Europe. Triple S-AGE project; 2012. [http://www.syndromicsurveillance.eu/triple-s_inventory_report.pdf]
• [14]Ziemann A, Krafft T. Guidelines for assessment of data sources. Triple S-AGE project; 2013. [http://www.syndromicsurveillance.eu/triple-s_guidelines_datasources.pdf]
• [15]Paterson BJ, Durrheim DN: The remarkable adaptability of syndromic surveillance to meet public health needs. J Epidemiol Global Health 2013, 3(1):41-47.
• [16]Kaydos-Daniels SC, Rojas Smith L, Farris TR: Biosurveillance in outbreak investigations. Biosecur Bioterror 2013, 11(1):20-28.
• [17]Koopmans M: Surveillance strategy for early detection of unusual infectious disease events. Curr Opin Virol 2013, 3(2):185-191.
• [18]Morse SS: Public health surveillance and infectious disease detection. Biosecur Bioterror 2012, 10(1):6-16.
• [19]Revision of the International Health Regulations: Progress report, February 2001 Wkly Epidemiol Rec 2001, 8:61-63.
• [20]Ziemann A, Krafft T, Sala Soler M, Sypniewska P. Country visits. Triple S-AGE project; 2013 [http://syndromicsurveillance.eu/images/stories/Final_material/triple-S_country_visits.pdf]
• [21]Rosenkötter N, Ziemann A, Garcia-Castrillo Riesgo L, Gillet JB, Vergeiner G, Krafft T, et al.: Validity and timeliness of syndromic influenza surveillance during the autumn/winter wave of A(H1N1) influenza 2009: results of emergency medical dispatch, ambulance and emergency department data from three European regions. BMC Public Health 2013, 13(1):905. BioMed Central Full Text
• [22]Bollaerts K, Antoine J, Robesyn E, Van Proeyen L, Vomberg J, Feys E, et al.: Timeliness of syndromic influenza surveillance through work and school absenteeism. Arch Public Health 2010, 68:115-120. BioMed Central Full Text
• [23]Harder KM, Andersen PH, Baehr I, Nielsen LP, Ethelberg S, Glismann S, et al.: Electronic real-time surveillance for influenza-like illness: experience from the 2009 influenza A(H1N1) pandemic in Denmark. Euro Surveill 2011, 16(3):ᅟ. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19767
• [24]Gerbier-Colomban S, Potinet-Pagliaroli V, Metzger MH: Can epidemic detection systems at the hospital level complement regional surveillance networks: case study with the influenza epidemic? BMC Infect Dis 2014, 14:381. BioMed Central Full Text
• [25]Brabazon ED, Carton MW, Murray C, Hederman L, Bedford D: General practice out-of-hours service in Ireland provides a new source of syndromic surveillance data on influenza. Euro Surveill 2010, 15(31):ᅟ. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19632
• [26]Ansaldi F, Orsi A, Altomonte F, Bertone G, Parodi V, Carloni R, et al.: Emergency department syndromic surveillance syndromic surveillancetem for early detection of 5 syndromes: a pilot project in a reference teaching hospital in Genoa. Italy. J Prev Med Hyg 2008, 49(4):131-135.
• [27]Amicizia D, Cremonesi I, Carloni R, Schiaffino S: The response of the Liguria Region (Italy) to the pandemic influenza virus A/H1N1sv. J Prev Med Hyg 2011, 52(3):120-123.
• [28]Schrell S, Ziemann A, Garcia-Castrillo Riesgo L, Rosenkotter N, Llorca J, Popa D, et al.: Local implementation of a syndromic influenza surveillance syndromic surveillancetem using emergency department data in Santander, Spain. J Public Health (Oxf) 2013, 35(3):397-403.
• [29]Hulth A, Rydevik G, Linde A: Web queries as a source for syndromic surveillance. PLoS One 2009, 4(2):e4378.
• [30]Hulth A, Rydevik G: Web query-based surveillance in Sweden during the influenza A(H1N1)2009 pandemic, April 2009 to February 2010. Euro Surveill 2011, 16(18):ᅟ. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19856
• [31]Hulth A, Rydevik G: GET WELL: an automated surveillance syndromic surveillancetem for gaining new epidemiological knowledge. BMC Public Health 2011, 11:252. BioMed Central Full Text
• [32]Smith S, Smith GE, Olowokure B, Ibbotson S, Foord D, Maguire H, et al.: Early spread of the 2009 influenza A(H1N1) pandemic in the United Kingdom--use of local syndromic data, May-August 2009. Euro Surveill 2011, 16(3):ᅟ. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19771
• [33]Cooper DL, Verlander NQ, Elliot AJ, Joseph CA, Smith GE: Can syndromic thresholds provide early warning of national influenza outbreaks? J Public Health (Oxf) 2009, 31(1):17-25.
• [34]Harcourt SE, Smith GE, Elliot AJ, Pebody R, Charlett A, Ibbotson S, et al.: Use of a large general practice syndromic surveillance syndromic surveillancetem to monitor the progress of the influenza A(H1N1) pandemic 2009 in the UK. Epidemiol Infect 2012, 140(1):100-105.
• [35]Kara EO, Elliot AJ, Bagnall H, Foord DG, Pnaiser R, Osman H, et al.: Absenteeism in schools during the 2009 influenza A(H1N1) pandemic: a useful tool for early detection of influenza activity in the community? Epidemiol Infect 2012, 140(7):1328-1336.
• [36]Todd S, Diggle PJ, White PJ, Fearne A, Read JM: The spatiotemporal association of non-prescription retail sales with cases during the 2009 influenza pandemic in Great Britain. BMJ Open 2014, 4(4):e004869.
• [37]Kavanagh K, Robertson C, Murdoch H, Crooks G, McMenamin J: Syndromic surveillance of influenza-like illness in Scotland during the influenza A H1N1v pandemic and beyond. J R Stat Soc (Series A) 2012, 175:939-958.
• [38]Valdivia A, Lopez-Alcalde J, Vicente M, Pichiule M, Ruiz M, Ordobas M: Monitoring influenza activity in Europe with Google Flu Trends: comparison with the findings of sentinel physician networks - results for 2009–10. Euro Surveill 2010, 15(29):ᅟ. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19621
• [39]European Centre for Disease Prevention and Control: Second Interim Threat Assessment. Ash cloud following volcanic eruption in Iceland, 20 April 11:00 CET. ECDC, Stockholm; 2010.
• [40]World Health Organization Regional Office for Europe. WHO/Europe expert group concludes Icelandic volcanic ash currently poses no threat to public health. [http://www.euro.who.int/en/health-topics/environment-and-health/air-quality/news/news/2010/05/whoeurope-expert-group-concludes-icelandic-volcanic-ash-currently-poses-no-threat-to-public-health]
• [41]Rosenkötter N, Ziemann A, Garcia-Castrillo Riesgo L, Vergeiner G, Fischer M, Krafft T, et al.: SIDARTHa Volcanic Ash Cloud Rapid Public Health Impact Assessment. Regional public health impact of volcanic ash cloud covering Europe after eruption of Eyjafjallajoekull, Iceland starting April 14th, 2010. Results as of May 15th, 2010. SIDARTHa project, Bad Honnef; 2010.
• [42]Elliot AJ, Singh N, Loveridge P, Harcourt S, Smith S, Pnaiser R, et al.: Syndromic surveillance to assess the potential public health impact of the Icelandic volcanic ash plume across the United Kingdom, April 2010. Euro Surveill 2010, 15(23):ᅟ. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19583
• [43]Robert Koch-Institut: Final presentation and evaluation of epidemiological findings in the EHEC O104:H4 Outbreak, Germany 2011. Robert Koch-Institute, Berlin; 2011.
• [44]Wadl M, Rieck T, Nachtnebel M, Greutelaers B, an der Heiden M, Altmann D, et al.: Enhanced surveillance during a large outbreak of bloody diarrhoea and haemolytic uraemic syndrome caused by Shiga toxin/verotoxin-producing Escherichia coli in Germany, May to June 2011. Euro Surveil 2011, 16(24):19893.
• [45]Dailey L, Watkins RE, Plant AJ: Timeliness of data sources used for influenza surveillance. J Am Med Inform Assoc 2007, 14(5):626-631.
• [46]Rosenkötter N, Ziemann A, Krafft T, Riesgo LG, Vergeiner G, Brand H: Non-infectious events under the International Health Regulations (2005) in Europe - a case for syndromic surveillance. J Public Health Policy 2014, 35(3):311-326.
• [47]Coory MD, Kelly H, Tippett V: Assessment of ambulance dispatch data for surveillance of influenza-like illness in Melbourne, Australia. Public Health 2009, 123(2):163-168.
• [48]Xing J, Burkom H, Tokars J: Method selection and adaptation for distributed monitoring of infectious diseases for syndromic surveillance. J Biomed Inform 2011, 44(6):1093-1101.
• [49]van den Wijngaard C, van Asten L, van Pelt W, Nagelkerke NJ, Verheij R, de Neeling AJ, et al.: Validation of syndromic surveillance for respiratory pathogen activity. Emerg Infect Dis 2008, 14(6):917-925.
• [50]Mook P, Joseph C, Gates P, Phin N: Pilot scheme for monitoring sickness absence in schools during the 2006/07 winter in England: can these data be used as a proxy for influenza activity? Euro Surveill 2007, 12(12):E11-E12.
• [51]Schmidt WP, Pebody R, Mangtani P: School absence data for influenza surveillance: a pilot study in the United Kingdom. Euro Surveill 2010, 15(3):ᅟ. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19467
• [52]Aguilera JF, Paget WJ, Mosnier A, Heijnen ML, Uphoff H, van der Velden J, et al.: Heterogeneous case definitions used for the surveillance of influenza in Europe. Eur J Epidemiol 2003, 18(8):751-754.
• [53]Paget J, Marquet R, Meijer A, van der Velden K: Influenza activity in Europe during eight seasons (1999–2007): an evaluation of the indicators used to measure activity and an assessment of the timing, length and course of peak activity (spread) across Europe. BMC Infect Dis 2007, 7:141. BioMed Central Full Text
• [54]Kissling E, Valenciano M, Falcao J, Larrauri A, Widgren K, Pitigoi D, et al.: “I-MOVE” towards monitoring seasonal and pandemic influenza vaccine effectiveness: lessons learnt from a pilot multi-centric case–control study in Europe, 2008–9. Euro Surveill 2009, 14(44):ᅟ. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19388
• [55]EuroMOMO. [http://www.euromomo.eu]
• [56]Medina S, Fouillet A, Ziemann A, Krafft T, Cooper D, Dupuy C, et al. Proposal for a European strategy for syndromic surveillance. Toward comparability of reporting from syndromic surveillance systems in Europe. Triple S-AGE project. 2013 [http://syndromicsurveillance.eu/Triple-S_proposal.pdf].
• [57]Cooper DL, Smith G, Baker M, Chinemana F, Verlander N, Gerard E, et al.: National symptom surveillance using calls to a telephone health advice service–United Kingdom, December 2001-February 2003. MMWR Morb Mortal Wkly Rep 2004, 53(Suppl):179-183.
• [58]Flamand C, Larrieu S, Couvy F, Jouves B, Josseran L, Filleul L: Validation of a syndromic surveillance syndromic surveillancetem using a general practitioner house calls network, Bordeaux, France. Euro Surveill 2008, 13(25):ᅟ. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18905
• [59]Josseran L, Nicolau J, Caillere N, Astagneau P, Brucker G: Syndromic surveillance based on emergency department activity and crude mortality: two examples. Euro Surveill 2006, 11(12):225-229.
• [60]Guasticchi G, Giorgi Rossi P, Lori G, Genio S, Biagetti F, Gabriele S, et al.: Syndromic surveillance: sensitivity and positive predictive value of the case definitions. Epidemiol Infect 2009, 137(5):662-671.
• [61]Davies GR, Finch RG: Sales of over-the-counter remedies as an early warning syndromic surveillancetem for winter bed crises. Clin Microbiol Infect 2003, 9(8):858-863.
• [62]Buehler JW, Hopkins RS, Overhage JM, Sosin DM, Tong V: Framework for evaluating public health surveillance systems for early detection of outbreaks: recommendations from the CDC Working Group. MMWR Recomm Rep 2004, 53(RR-5):1-11.
• [63]Ziemann A, Krafft T. Scientific visit guidelines for knowledge exchange on syndromic surveillance in Europe. Triple S-AGE project. 2011 [http://syndromicsurveillance.eu/triple-s_scientific_visit_guidelines.pdf]
• [64]Bounoure F, Beaudeau P, Mouly D, Skiba M, Lahiani-Skiba M: Syndromic surveillance of acute gastroenteritis based on drug consumption. Epidemiol Infect 2011, 139(9):1388-1395.
• [65]Buehler JW, Whitney EA, Smith D, Prietula MJ, Stanton SH, Isakov AP: Situational uses of syndromic surveillance. Biosecur Bioterror 2009, 7(2):165-177.
• [66]EuroREACH. Good practice on data linkages and performance measurement in relation to access to national health care data systems. [http://www.euroreach.net/sites/default/files/EuroREACH-WP3%20Final%20Report.pdf]
• [67]SIDARTHa. [http://www.sidartha.eu]
• [68]Ziemann A, Rosenkötter N, Garcia-Castrillo Riesgo L, Schrell S, Kauhl B, Vergeiner G, et al.: A concept for routine emergency-care data-based syndromic surveillance in Europe. Epidemiol Infect 2014, 142(11):2433-2446.