Enhanced surveillance during a public health emergency in a resource-limited setting: Experience from a large dengue outbreak in Solomon Islands, 2016-17

Abstract

Between August-2016 and April-2017, Solomon Islands experienced the largest and longest-running dengue outbreak on record in the country, with 12,329 suspected cases, 877 hospitalisations and 16 deaths. We conducted a retrospective review of related data and documents, and conducted key informant interviews to characterise the event and investigate the adaptability of syndromic surveillance for enhanced and expanded data collection during a public health emergency in a low resource country setting. While the outbreak quickly consumed available public and clinical resources, we found that authorities were able to scale up the conventional national syndrome-based early warning surveillance system to support the increased information demands during the event demonstrating the flexibility of the system and syndromic surveillance more broadly. Challenges in scaling up included upskilling and assisting staff with no previous experience of the tasks required; managing large volumes of data; maintaining data quality for the duration of the outbreak; harmonising routine and enhanced surveillance data and maintaining surveillance for other diseases; producing information optimally useful for response planning; and managing staff fatigue. Solomon Islands, along with other countries of the region remains vulnerable to outbreaks of dengue and other communicable diseases. Ensuring surveillance systems are robust and able to adapt to changing demands during emergencies should be a health protection priority.

Surveillance strategies for the detection of disease outbreaks in the Pacific islands: meta‐analysis of published literature, 2010–2019

“…There was seven reported outbreaks in PNG [8,13–18]; six in each of Solomon Islands, [19–25] French Polynesia, [25–30] and FSM [31–36]; three in each of American Samoa[37–39] and Marshall Island[40–42]; two from Fiji [43,44] and Guam [45,46] and one in each of Kiribati, [47] Tuvalu, [48] New Caledonia, [30] and Wallis and Futuna [30]. The aetiological agents responsible for the outbreaks were dengue virus ( n = 7), [25,19,23,26,34,39,41] influenza virus ( n = 5), [16,30,31] chikungunya virus ( n = 3), [17,28,29] Hepatitis A causing Hepatovirus ( n = 3), [35,44,40] Shigella spp . ( n = 3), [13,16,38] Vibrio cholerae ( n = 2), [18,15,14,46] mumps virus ( n = 2), [32,45] Rotavirus ( n = 2), [21,47] Zika virus ( n = 2), [27,37] measles Rubeola virus ( n = 1), [33] Mumps, circulating vaccine‐derived poliovirus type 1 ( n = 1), [8] and Rickettsia parasite causing scrub typhus ( n = 1) [20].…”

“…For 15 reports, the first author was a staff member at a national institution including ministries of health, national laboratories and universities [8,13,17,18,25,22,26–29,35,34,42,44,47]. Of international first authors, nine were from the United States Centers for Disease Control and Prevention [33,32,39,37,38,40,41,46,45]; seven were staff of WHO or the Pacific Community (the two main technical agencies providing outbreak‐related support to PICTs) [15,16,14,24,23,31,36]; five were academics from non‐PICT countries [19,21,20,43,48]; and one was from the French Government, which has responsibility for French Pacific territories [30].…”

A Holistic-Comprehensive Approach: Best Practices to Improve Health Policy for COVID-19 Pandemic

“…Kinsman, et al, 23 (2018) Case study Preparedness and response plans during an epidemic 8 Afayo, et al, 24 (2019) Cross-sectional study The gap between preparedness and response to the outbreak 9 Craig, et al, 20 (2018) Surveillance…”

“…In a comprehensive surveillance plan, it is also important to identify key populations at increased risk of infectious disease, establish opportunities to manage pandemic, and identify the allocation of resources in the local community as low-income communities were disproportionately affected by the disease. 19,20 Lesson learned from the cases of Ebola, they built integrated surveillance health systems to strengthen their public health infrastructure, improved early warning systems, increased the capacity of health professionals, pro-vided adequate support and feedback during and after the implementation of programs. 21 The development of comprehensive planning presumably takes process, and it certainly needs support from whole societies for a successful program.…”

Epidemic surveillance in a low resource setting: lessons from an evaluation of the Solomon Islands syndromic surveillance system, 2017

“…Infectious and parasitic diseases remain marked contributors to the health burden in SI, causing an estimated 8% of all deaths [17] and more than 10% of disability-adjusted life years lost in 2015 [19]. While no log of outbreak events is available, it is understood that epidemics are common with a number of outbreaks challenging the country in recent years, including rubella in 2012/13 [20]; a rotavirus outbreak associated with > 4000 cases in 2014 [21]; a measles outbreak with 4563 cases in 2014 [16]; a Zika virus outbreak in 2015 [22, 23]; a cluster of meningococcal disease in 2015 [24]; and dengue outbreaks in 2013 [25] and again in 2016–17 [26] associated with more than 7000 and 12,000 suspected cases respectively.…”