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.

Keywords:

• early warning
• syndromic surveillance
• Pacific
• infectious diseases
• outbreak detection
• outbreak response

Acknowledgements

We would like to acknowledge the contributions from the following people whose support was crucial to make the Pacific syndromic surveillance system a success:

Pacific island countries and territories health ministries and departments:

American Samoa – Ms Sharmain Mageo, Mrs Siitia Soliai Lemusu, Ms Mua'au Liufau; Cook Islands – Mr Charlie Ingaua; Fiji – Dr Eric Rafai, Dr Prem Singh, Dr Mike Kama, Mr Apolosi Senibulu; French Polynesia – Dr Henri-Pierre Philippe Mallet, Ms Elise Daudens; Guam – Dr Robert Haddock; Kiribati – Dr Kenneth Tabutoa, Mr Teanibuaka Tabunga, Maryanne Utiera; Republic of the Marshall Islands – Ms Edlen Anzures; Federated States of Micronesia – Mr Marcus Samo; Republic of Nauru – Dr Alani Tangitau, Dr Sunia Soakai, Dr Htut Soe; New Zealand – Dr Darren Hunt, Dr Virginia Hope; Niue – Mr Manila Nosa, Ms Anne McLean, Ms Grizelda Mokoia; Commonwealth of the Northern Mariana Islands – Mr Edward Diaz, Dr Richard Brostrom; Republic of Palau – Ms Losii Samsel, Ms Laura McDonald; Papua New Guinea – Mr Samuel Daniels Hurim, Dagina Rosheila; Pitcairn Islands – Dr Kevin Donovan, Dr Peter Cardon; Samoa – Dr Take Naseri, Dr Tile Ah Leong-Lui; Solomon Islands – Ms Alison Sio, Ms Sarah Farnbach; Tokelau – Dr Tekie Timu Iosefa, Ms Faimanifo Mareta Peseta, Ms Lee Pearce; Tonga – Dr Siale Akau'ola, Mr Clifton Latu, Vaiolupe Finau, Ms Louise Fonua, Dr Malakai Heneli Ake; Tuvalu – Dr Stephen Homasi, Mr Vine Sosene, Dr Nese Ituaso-Conway; Wallis and Futuna – Dr Vel Velmourougane, Dr Nafiou Igue.

The Secretariat of the Pacific Community: Dr Pascal Frison, Dr Justus Benzler, Ms Christelle Lepers, Ms Salanieta Elbourne, Dr Seini Kupu, Dr Narendra Singh, Ms Elise Benyon and Dr Tomasz Kiedrzynski.The US Centers for Disease Control and Prevention: Dr Tai-Ho Chen.

The World Health Organization in the Pacific: Ms Akanisi Dawainavesi, Ms Melinda Manglay, Ms Deltina Solomon, Dr Eric Nilles, Dr Sunghye Kim, Mr Alex Rosewell, Dr Jayaprakash Valiakolleri, Dr Juliet Fleischl, Mr Wayne Antkowiak, Dr André Reiffer, Ms Pamela Borg, Dr William Adu-Krow, and Dr Ken Chen.

This project was made possible through financial contributions from:

WHO member states; The US Centers for Disease Control and Prevention; The New Zealand Agency for International Development; The Australian Agency for International Development.