Surveillance Systems

Biosurveillance in resource-limited settings is essential because of both enhanced risk of diseases rarely seen elsewhere (e.g. cholera) and pandemic threats (e.g. avian influenza). However, access to care and laboratory test capability are typically inadequate in such areas, amplifying the importance of syndromic surveillance. Such surveillance in turn may be a challenge because of insufficient data history and systematic or seasonal behavior. The Suite for Automated Global Electronic bioSurveillance (SAGES) is a collection of modular, freely-available software tools to enable electronic surveillance in these settings. These tools require statistical alerting methods appropriate for SAGES data, and development of such methods is the subject of this effort. We evaluated alerting methods for two main uses: weekly surveillance for seasonal outbreaks such as dengue fever and influenza, and daily syndromic data for settings where monitoring and response on a daily basis are practical. The latter situation has the added complication that day-of-week clinical visit patterns differ widely, (e.g. clinic closure on Sundays and Thursdays) and may evolve over time.

Objective

The authors develop open-source temporal alerting algorithms for data environments characteristic of resource-limited geographic settings and recommend appropriate usage of each.

Early warning surveillance (EWS) is a key factor in the fight against tropical infectious diseases(1). However, the process of carrying out EWS is complex as it involves several actors and requires the use of diverse human, material and technological resources for data collection, analysis, and diffusion(2). Modern EWS systems make use of state of the art technologies and technics which require much financial input and adequate technological expertise for the users. More so, the culture and habits of users in DCs make it very difficult to run such EWS systems in this milieu. In this paper, we propose a generic early warning surveillance architecture that tackles the stages from just after data collection, through data analysis to feedback and that is adapted to the context of limited resource countries.

Objective

Build a computer aided Early warning disease surveillance system adapted for Developing Countries (DCs) facing limited financial, human, intellectual, organizational, technological, and infrastructural resources.

In Rwanda, communicable diseases represent about 90% of all reported medical consultations in health centers. The country has often faced epidemics including emerging and re-emerging infectious diseases. To enhance its preparedness to identify and respond to outbreaks and prevent epidemics, the Government of Rwanda has developed and deployed a nationwide electronic Integrated Disease Surveillance and Response system (eIDSR) using mobile technology. The US Centers for Disease Control and Prevention has funded Voxiva to build, operate and support this program. The design of eIDSR system was completed in November 2011, and then 1524 end-users were progressively trained for the national roll out of the system until April 2013. All 521 health facilities in Rwanda have been trained and are currently using the electronic system (100 % of national coverage since April 2013).

Objective

There are important lessons learned from the successful implementation of this national electronic system and this abstract outlines those lessons.

Karachi is the largest metropolitan, principal port city and commercial hub of Pakistan. Although there is a national database for registering vital evens such as births and deaths but like in any other developing country the coverage of the system is sub optimal with many of birth and death not recorded. Undercounting of these events leads to inaccurate estimates of vital indicators for informed decision and planning for health at local and national level. In these settings demographic surveillance systems have the potential to supplement data from the vital registration systems and provide avenues for research by virtue of having a well-defined cohort and continuous surveillance. The Department of Paediatrics and Child Health of Aga Khan University Karachi, Pakistan maintains health and demographic surveillance system at four peri-urban and one urban community in Karachi with focus on maternal and child health. This also provide platform for many epidemiological and interventional studies as well as vaccination programs using a well-established identification procedures providing linkage to health and socio-economic data. In 2010 the surveillance system was reorganized to follow INDEPTH methodology and guidelines.

Objective

The purpose of Karachi Health and Demographic Surveillance System (HDSS) is to generate longitudinal information on health and demographics of a geographically defined population of low socioeconomic status and provide platform for larger projects in efforts for diseases control.

In response to major epidemic and pandemic outbreaks, WHO-AFRO and its Member States have adopted the Integrated Disease Surveillance and Response (IDSR) strategy to address International Health Regulations (2005) as well as individual Member State’s national disease control objectives. Significant progress has been made scaling-up capacity for disease surveillance and response using the IDSR guidelines, including implementation of IHR, the WHO African Region has experienced many challenges in designing, developing and implementing electronic surveillance systems. Over the past decade or more, many local and international stakeholders have independently pursued solutions for electronic surveillance and reporting in African countries. This has resulted in multiple systems of varying effectiveness and minimum interoperability due, in part, to limited agreement among stakeholders on data collecting and reporting standards. This complicated situation prevents most African countries from reaping the full benefits of having electronic systems to help detect, report, and respond to endemic, emerging and priority disease threats.

Objective

We report on the development of the African Surveillance Informatics Governing Board (ASIGB) as a conceptual strategy for strengthening eSurveillance in the African Region.

Clinical and public health microbiology laboratories of the world are a rich, underutilized resource in monitoring the changing epidemiology of microbial populations worldwide. Two areas of public health importance in which effective use of relevant local data are critical include: 1. guiding local treatment guidelines, informed by knowledge of local patterns of infection and antimicrobial resistance; and 2. the early identification and characterization of outbreaks.

Most laboratories in the developed world and many in the developing world have clinical databases designed to meet the day-to-day needs of clinical reporting, specimen processing, billing, and permanent information storage. Unfortunately, most such systems were not developed with the epidemiological needs of microbiologists, infection control staff, public health authorities, and policy-makers in mind. To address this critical gap, our group at the WHO Collaborating Centre for Surveillance of Antimicrobial Resistance has developed the WHONET and BacLink softwares to support local, national, and international infectious disease surveillance programs.

Objective

This paper describes two free softwares developed for the automated and semi-automated capture, processing, and analysis of microbiology laboratory data. Applications include early detection of hospital and community outbreaks, guiding local treatment guidelines and public health policy, and immediate alert of important pathogens and potential errors in laboratory testing.

In the Northern part of Norway, all General Practitioners (GPs) and hospitals use electronic health records (EHR). They are connected via an independent secure IP-network called the Norwegian Health Network. The newly developed “Snow Agent System” can utilize this environment by distributing processes to, and extracting epidemiological data directly from, the EHR system in a geographic area. This system may enable the GPs to discover local disease outbreaks that may have affected the current patient by providing epidemiological data from the local population. Currently, work is being done to add more functionality to the system. The overall goal for this project is to contribute to a system that will share epidemiological information between GPs and provide them with information about contagious diseases that may be useful in a clinical setting.

To achieve this, we need the GPs to accept and use the system. Nearly one half of information systems fail due to user resistance and staff interference despite the fact that they are technologically sound. One of the reasons for user resistance is lack of user involvement and bad design. The more specialized the system, the more you need user research to unsure success. With this in mind we have decided to take a User-Centred-Design approach to the project.

Objective

The Norwegian Centre for Telemedicine plans to establish a peer-to-peer symptom based surveillance network between all GPs, laboratories, accident and emergency units, and other relevant health providers in Northern Norway. This paper describes some initial results from a study of GPs’ user requirements, regarding what they want in return from the system.

In addition to utilizing syndromic surveillance data to respond to public health threats and prepare for major incidents, local health departments can utilize the data to examine patient volumes in the emergency departments (EDs) of local hospitals. The information obtained may be valuable to hospital and clinic administrators who are charged with allocating resources. 

Indianapolis represents 92% of Marion County’s population. The county’s public hospital and clinic network provide care for 1 in 3 county residents who are Medicaid enrollees or uninsured. To assess the need for extended hours at eight public primary care clinics in Marion County, Indiana, this study examined the hospital’s ED volume. We hypothesize that

changes in the ED volume trends that corresponded to the start or end of usual clinic hours (8am-5pm) would be evidence of clinic hours’ impact on ED use.

Objective

This paper highlights the use of syndromic surveillance data to examine daily trends in ED volume at an urban public hospital.

The South Carolina (SC) Department of Health and Environmental Control uses multiple surveillance systems to monitor influenza activity from October to May of each year, including participating in the U.S. Influenza Sentinel Providers Surveillance Network. A percentage of influenza-like-illness surpassing the national 2.5% baseline is considered evidence of increased influenza activity by the CDC; this baseline is historical and does not change throughout the influenza season. Though not a part of the national influenza surveillance, SC also requires health care providers in the state to report positive rapid influenza tests, by number, on a weekly basis. Currently, only a trend analysis is used on weekly reports of positive rapid influenza test data for SC. A more robust method for determining statistically significant increases in activity for these two influenza surveillance systems is needed, and would provide a more accurate assessment of the status of seasonal influenza activity in SC.

Objective

Use the Early Aberration Reporting System (EARS) to analyze influenza sentinel provider surveillance data and positive rapid influenza test reports to identify weeks where influenza activity was significantly increased in South Carolina. Demonstrate the utility of using EARS to detect increases in influenza activity using existing surveillance systems.