Background In late 2020, the European Centre for Disease Prevention and Control and Epiconcept started implementing a surveillance system for severe acute respiratory infections (SARI) across Europe. Objective We sought to describe the process of digitizing and upgrading SARI surveillance in Malta, an island country with a centralized health system, during the COVID-19 pandemic from February to November 2021. We described the characteristics of people included in the surveillance system and compared different SARI case definitions, including their advantages and disadvantages. This study also discusses the process, output, and future for SARI and other public health surveillance opportunities. Methods Malta has one main public hospital where, on admission, patient data are entered into electronic records as free text. Symptoms and comorbidities are manually extracted from these records, whereas other data are collected from registers. Collected data are formatted to produce weekly and monthly reports to inform public health actions. From October 2020 to February 2021, we established an analogue incidence-based system for SARI surveillance. From February 2021 onward, we mapped key stakeholders and digitized most surveillance processes. Results By November 30, 2021, 903 SARI cases were reported, with 380 (42.1%) positive for SARS-CoV-2. Of all SARI hospitalizations, 69 (7.6%) were admitted to the intensive care unit, 769 (85.2%) were discharged, 27 (3%) are still being treated, and 107 (11.8%) died. Among the 107 patients who died, 96 (89.7%) had more than one underlying condition, the most common of which were hypertension (n=57, 53.3%) and chronic heart disease (n=49, 45.8%). Conclusions The implementation of enhanced SARI surveillance in Malta was completed by the end of May 2021, allowing the monitoring of SARI incidence and patient characteristics. A future shift to register-based surveillance should improve SARI detection through automated processes.

BACKGROUND Background: In late 2020, the European Centre for Disease Prevention and Control and Epiconcept started implementing a surveillance system for severe acute respiratory infections (SARI) across Europe. Our objective is to describe how SARI surveillance was digitised in Malta and describe the characteristics of people included in the surveillance system. We also compare different SARI case definitions including their advantages and disadvantages. OBJECTIVE Objective: To describe the process of digitising and upgrading SARI surveillance in an island country with a centralized health system during a pandemic, discussing the process, output and future for SARI and other public health surveillance opportunities. METHODS Methods: Malta has one main public hospital where, on admission, patient data are entered into electronic records as free text. Symptoms and comorbidities are manually extracted from these records, while other data are collected from registers. Collected data are formatted to produce weekly and monthly reports to inform public health actions. RESULTS Results: From October 2020 to February 2021, we established an analogue incidence-based system for SARI surveillance. From February 2021 onwards we mapped key stakeholders and digitised most surveillance processes. By 30 November 2021, 903 SARI cases were reported, with 380 (42.2%) positive for SARS-CoV-2. Of all SARI hospitalisations, 69 (7.6%) were admitted to ICU, 769 (85.2%) have been discharged, 27 (2.9%) are still being treated, and 107 (11.8%) have died. Among those who died, 96 (89.7%) had more than one underlying condition, the most common of which were hypertension (57; 53.3%) and chronic heart disease (49; 45.8%). CONCLUSIONS Conclusion: The implementation of an enhanced SARI surveillance in Malta was completed by the end of May 2021, allowing monitoring of SARI incidence and patient characteristics. A future shift to register-based surveillance should improve SARI detection through automated processes.

No abstract