Surveillance on speed: Being aware of infectious diseases in migrants mass accommodations - an easy and flexible toolkit for field application of syndromic surveillance, Germany, 2016 to 2017

Abstract

Europe received an increased number of migrants in 2015. Housing in inadequate mass accommodations (MA) made migrants prone to infectious disease outbreaks. In order to enhance awareness for infectious diseases (ID) and to detect clusters early, we developed and evaluated a syndromic surveillance system in three MA with medical centres in Berlin, Germany. Healthcare workers transferred daily data on 14 syndromes to the German public health institute (Robert Koch-Institute). Clusters of ID syndromes and single cases of outbreak-prone diseases produced a signal according to a simple aberration-detection algorithm that computes a statistical threshold above which a case count is considered unusually high. Between May 2016–April 2017, 9,364 syndromes were reported; 2,717 (29%) were ID, of those 2,017 (74%) were respiratory infections, 262 (10%) skin parasites, 181 (7%) gastrointestinal infections. The system produced 204 signals, no major outbreak was detected. The surveillance reinforced awareness for public health aspects of ID. It provided real-time data on migrants' health and stressed the burden of non-communicable diseases. The tool is available online and was evaluated as being feasible and flexible. It complements traditional notification systems. We recommend its usage especially when laboratory testing is not available and real-time data are needed.

Syndromic Surveillance of Infectious Diseases

“…A total of 204 signals were generated by the syndromic surveillance system. However, no significant outbreak was detected during the evaluation period [36].…”

“…The alarms which were triggered by cases of watery diarrhea, respiratory tract disease, and parasite skin infection subsided spontaneously within 1-3 days, indicating to health authorities that there was no need to initiate an outbreak response [35]. A recent syndromic surveillance system, using 14 syndromes, was established in migrant accommodations in Berlin, Germany, to detect infectious diseases among asylum seekers [36]. The most common infectious diseases syndromes, reported during the evaluation period which lasted 1.5 years, were respiratory infections, cutaneous parasites, and gastrointestinal infections.…”

Infectious disease surveillance for refugees at borders and in destination countries: a scoping review

“…Countries included were diverse, but predominantly European (i.e. 13 sources), 4 for Italy, 2 for Greece, 1 each for Albania, Germany, Macedonia, and Spain, while 1 included six European countries, and 2 discussed Europe as a region [17][18][19][20][21][28][29][30][31][32][33][34][35]. Three from the Africa region discussed camp-based surveillance in Cote d'Ivoire and Sudan, disputed Sudan-Chad borders, and Minawao in Cameroon [36][37][38].…”

“…preparatory, pilot, implementation) on establishing syndromic surveillance systems for countries receiving refugees [13,14]. This helped countries such as Germany, Greece, Italy, and Spain, develop syndromic surveillance to respond more quickly to migrants taking the Mediterranean route [15,[17][18][19][20][21].…”

A litmus test for harmonized mosquito monitoring across Europe and Africa

“…We are witnessing the rising of once neglected arboviral tropical diseases carried by native and invasive mosquitoes, namely dengue fever, Zika, chikungunya and West Nile, which are quickly becoming pandemic and pose a current threat for Europe and Africa (Benelli and Mehlhorne 2016, Weaver et al 2018). Accelerated human mobility facilitates the movement of infected individuals (Sarma et al 2018), global trade is intensifying introduction of non-native vectors, and changing climates and anthropization are creating suitable habitats for mosquitoes, thus magnifying proliferation and risk of transmission (Derraik and Slaney 2007). Furthermore, malaria incidence is locally increasing in high-risk areas of Africa and South America and resurging unexpectedly in Greece (Danis et al 2011, Whitty and Ansah, 2019).…”