Pacific-wide simplified syndromic surveillance for early warning of outbreaks

Abstract

The International Health Regulations require timely detection and response to outbreaks. Many attempts to set up an outbreak early warning system in Pacific island countries and territories (PICTs) have failed. Most were modelled on systems from large countries; large amounts of data often overwhelmed small public health teams. Many conditions required overseas laboratory confirmation, further reducing timeliness and completeness. To improve timeliness and reduce the data burden, simplified surveillance was proposed, with case definitions based on clinical signs and symptoms without the need for laboratory confirmation or information on symptoms, location, sex and age. After trials in three PICTs, this system was implemented throughout the Pacific. Enthusiastic adoption by public health staff resulted in 20 of 22 PICTs reporting weekly to the World Health Organization within 12 months of starting to use the system. In the first year, the system has detected many infectious disease outbreaks and facilitated timely implementation of control measures. For several Pacific countries and territories, this is the first functional and timely infectious disease surveillance system. When outbreak detection is the principal objective, simplification of surveillance should be a priority in countries with a limited public health system capacity.

Epidemiological Investigation of a Diarrhea Outbreak in the South Pacific Island Nation of Tuvalu During a Severe La Niña–Associated Drought Emergency in 2011

“…During July and September, the rainfall approached the minimum rainfall needed to assure 15 lpd, the internationally recognized minimum during humanitarian emergencies as determined by the SPHERE standards 14 ; FIGURE 2. Weekly rainfall, weekly number of cases of diarrhea from the Pacific Syndromic Surveillance System, and interventions, December 2010-December 2011 (6). Green shading designates the period of international drought relief.…”

“…Cases of diarrheal disease were identified from the PSSS that since 2010 monitors four syndromes, including diarrhea, on a weekly basis from sentinel heath facilities in 23 Pacific island countries and territories including Tuvalu. 6 Tuvalu started reporting through the PSSS in November 2010. This study and the PSSS define a case of diarrhea as a person reporting three or more loose stools in a 24-hour period.…”

“…4,5 In 2011, a La Niña event triggered severe drought and state of emergency in the South Pacific island nation of Tuvalu. During the nadir of the drought in September 2011, the Pacific Syndromic Surveillance System (PSSS) 6 detected a simultaneous large diarrhea outbreak.…”

Concurrent outbreaks of dengue, chikungunya and Zika virus infections – an unprecedented epidemic wave of mosquito-borne viruses in the Pacific 2012–2014

“…It monitors four syndromes and aims at improved early warning to complement routine notifiable disease notification systems that generally are not timely and seldom used for regional surveillance purposes in the Pacific Region. The Syndromic Surveillance system is under development and currently includes sentinel reporting from primary healthcare or hospital sites in all countries [5]. Manifest dengue, chikungunya and Zika virus infections have a similar initial clinical presentation and may be reported as any of the first three of the following four monitored syndromes: (i) acute fever and rash, (ii) prolonged fever, (iii) influenza-like illness and (iv) diarrhoea.…”

Establishing an early warning alert and response network following the Solomon Islands tsunami in 2013

“…In May 2013, a repeated risk assessment found a decreased risk of epidemic transmission. On 20 May, the EWARN was transitioned to a four-syndrome early warning disease surveillance system that aligns with the Solomon Islands and Pacific Syndromic Surveillance Systems 8 . These systems monitor influenza-like illness, diarrhoea, acute fever and rash, and prolonged fever plus any unexpected or unusual event with potential health implications.…”