Strengthening early warning function of surveillance in the Republic of Serbia: lessons learned after a year of implementation

Abstract

The Republic of Serbia, with WHO support, has implemented an early warning system (ALERT) for priority communicable diseases, to complement the routine surveillance system which notifies individual confirmed cases. The results of its evaluation, conducted one year after implementation is presented here. ALERT relies on notification of 11 syndromes by primary care facilities. Data is analysed weekly at district level and transmitted to national epidemiologists. ALERT is perceived to be a simple and flexible tool. Acceptability is higher at national level than at district level. Some districts perceive ALERT as a parallel system poorly connected to control measures. Sensitivity of ALERT in detecting cases of meningitis is 93%, and 37% for cases of hepatitis. Retrospective analysis of ALERT data identified 9 outbreaks, 5 of which had been recognized by epidemiologists. ALERT was the timeliest system for detecting 4 outbreaks identified by both systems. ALERT was useful for triggering timely investigation and control of outbreaks of hantavirus and salmonellosis and for detecting the start of the influenza season. However, ALERT did not detect clusters of brucellosis and tularaemia targeted by the unexplained fever syndrome. This evaluation underlined the need for a global review of surveillance activities when implementing new components such as ALERT. While control measures based on notification of individual confirmed cases are well understood and implemented, the investigation and verification process that should result from an increase in ALERT syndromes is not fully understood. Field epidemiology training programmes, such as the EPIET programme, are best suited to bring about this change of perspective.

Disease Surveillance System

“…As seen in similar scenarios in other developing countries, traditionally, priority is given to issues relating to provision of curative services on an individual patient level, whereas the community-wide or containment of risks approach is yet to seep in. 15 Reporting of notifiable diseases is another issue that needs immediate attention. Currently, there is no system for the notification of diseases of public health importance by the health service providers in Pakistan.…”

Syndromic surveillance in early detection of outbreaks of infectious diseases

“…This is achieved by strengthening syndromic surveillance of infectious diseases as a function of the early warning and response of the public health surveillance system, which also helps to collect important data on the epidemiology of endemic diseases. This early warning system was implemented in Albania during the influx of Kosovar refugees in April 1999 (27,28). This was carried out in collaboration with the Institut de Veille Sanitaire (InVS) and the World Health Organization (WHO).…”

Food poisoning hazards and their consequences over food safety

“…Human health surveillance of foodborne diseases in Albania is led by the Public Health Institute within the Ministry of Health, which collates data supplied by regional departments of public health. An early warning surveillance system operates across all of Albania (similar to the system that operates in Serbia and Macedonia [234]), and the case definitions are the same as for syndromic surveillance under the International Health Regulations. Key indicators of foodborne disease are the annual rates of reported gastro intestinal illness (approximately 56 000 cases per year, approximately 2 000 cases per 100 000 population) and cases reported as food poisoning (approximately 2800 cases per year, approximately 100 cases per 100 000 population).…”