The use of syndromic surveillance to monitor the incidence of arthropod bites requiring healthcare in England, 2000–2013: a retrospective ecological study

Abstract

Climate change experts predict the number of nuisance-biting arthropods in England will increase but there is currently no known surveillance system in place to monitor or assess the public health impact of arthropod bites. This retrospective ecological study utilized arthropod bites requiring healthcare from five national real-time syndromic surveillance systems monitoring general practitioner (GP) consultations (in-hours and out-of-hours), emergency department (ED) attendances and telephone calls to remote advice services to determine baseline incidence in England between 2000 and 2013 and to assess the association between arthropod bites and temperature. During summer months (weeks 20-40) we estimated that arthropod bites contribute a weekly median of ~4000 GP consultations, 750 calls to remote advice services, 700 ED and 1300 GP out-of-hours attendances. In all systems, incidence was highest during summer months compared to the rest of the year. Arthropod bites were positively associated with temperature with incidence rate ratios (IRRs) that ranged between systems from 1·03 [95% confidence interval (CI) 1·01-1·06] to 1·14 (95% CI 1·11-1·16). Using syndromic surveillance systems we have established and described baseline incidence of arthropod bites and this can now be monitored routinely in real time to assess the impact of extreme weather events and climate change.

Impact of extreme weather events and climate change for health and social care systems

“…Hospital admissions for respiratory diseases increase during heatwaves [ 41 ]. During very hot weather syndromic surveillance data show increases in GP activity [ 42 ] and emergency department use for some conditions likely to be associated with heatwaves, and in ambulance call-out rates [ 43 – 45 ] as well as additonal demand due to less urgent events such as arthropod bites [ 46 ]. Heatwaves also have adverse consequences for patients being treated for other conditions including cardiovascular diseases and mental illness, though these seem not to give rise to additional demands for health care [ 47 – 50 ].…”

Surveillance of a Pest Through a Public Health Information System: The Case of the Blackfly (Simulium erythrocephalum) in Zaragoza (Spain) during 2009–2015

“…There are few examples of either a national surveillance system or published studies investigating the epidemiology of arthropod bites in Europe [16]; and as far as we know, there is not one about blackfly bites. It is of paramount importance to study the epidemiology of pest bites that involves massive bites to the population, so as to know the health determinants involved; this could represent a valuable step in order to plan new interventions and subsequently evaluate the impact of the control measures established.…”

The passive surveillance of ticks using companion animal electronic health records

“…Rather than collecting and submitting ticks for further analyses, this system relies on the accurate diagnosis and recording of tick bites by medical practitioners within their patients’ EHRs, without the actual visualisation or collection of the tick. In a similar way, PHE use routine passive syndromic surveillance based on a predetermined list of clinical codes to monitor the incidence of arthropod bites in near real-time across various clinical settings including general practitioner consultations, emergency department attendance and telephone helplines [ 11 ]. However, constraints of the clinical diagnostic codes being used mean tick bites cannot be analysed separately from those of other arthropods.…”