Evaluation of an Adjustable Epidemiologic Information System

BACKGROUND: In order to facilitate public health response and to achieve early control of infectious disease epidemics, an adjustable epidemiologic information system (AEIS) was established in the Taiwan public health network in February 2006. METHODOLOGY/PRINCIPAL FINDINGS: The performance of AEIS for the period 2006 through 2008 was evaluated based on a number of response times (RT) and the public health impact. After implementation of the system, the apparent overall shortened RT was mainly due to the shortening of personnel response time (PRT) and the time needed to draft a new questionnaire that incurred as personnel-system interface (PSI); PRT dropped from a fluctuating range of 9.8 ∼28.8 days in the first four months to <10 days in the following months and remained low till 2008 (0.88±1.52 days). The PSIs for newly emerged infectious diseases were 2.6 and 3.4 person-hours for H5N1 in 2007 and chikungunya in 2008, respectively, a much improvement from 1142.5 person-hours for SARS in 2003. The duration of each rubella epidemic cluster was evaluated as public health impact and showed a shortening trend (p = 0.019) that concurred with the shortening of PRT from 64.8±47.3 to 25.2±38.2 hours per cluster (p<0.0001). CONCLUSIONS/SIGNIFICANCE: The first evaluation of the novel instrument AEIS that had been used to assist Taiwan's multi-level government for infectious diseases control demonstrated that it was well integrated into the existing public health infrastructure. It provided flexible tools and computer algorithms with friendly interface for timely data collection, integration, and analysis; as a result, it shortened RTs, filled in gaps of personnel lacking sufficient experiences, created a more efficient flow of response, and identified asymptomatic/mild cases early to minimize further spreading. With further development, AEIS is anticipated to be useful in the application of other acute public health events needing immediate orchestrated data collection and public health actions

Establishing a nationwide emergency department-based syndromic surveillance system for better public health responses in Taiwan

Background. With international concern over emerging infectious diseases (EID) and bioterrorist attacks, public health is being required to have early outbreak detection systems. A disease surveillance team was organized to establish a hospital emergency department-based syndromic surveillance system (ED-SSS) capable of automatically transmitting patient data electronically from the hospitals responsible for emergency care throughout the country to the Centers for Disease Control in Taiwan (Taiwan-CDC) starting March, 2004. This report describes the challenges and steps involved in developing ED-SSS and the timely information it provides to improve in public health decision-making. Methods. Between June 2003 and March 2004, after comparing various surveillance systems used around the world and consulting with ED physicians, pediatricians and internal medicine physicians involved in infectious disease control, the Syndromic Surveillance Research Team in Taiwan worked with the Real-time Outbreak and Disease Surveillance (RODS) Laboratory at the University of Pittsburgh to create Taiwan's ED-SSS. The system was evaluated by analyzing daily electronic ED data received in real-time from the 189 hospitals participating in this system between April 1, 2004 and March 31, 2005. Results. Taiwan's ED-SSS identified winter and summer spikes in two syndrome groups: influenza-like illnesses and respiratory syndrome illnesses, while total numbers of ED visits were significantly higher on weekends, national holidays and the days of Chinese lunar new year than weekdays (p < 0.001). It also identified increases in the upper, lower, and total gastrointestinal (GI) syndrome groups starting in November 2004 and two clear spikes in enterovirus-like infections coinciding with the two school semesters. Using ED-SSS for surveillance of influenza-like illnesses and enteroviruses-related infections has improved Taiwan's pandemic flu preparedness and disease control capabilities. Conclusion. Taiwan's ED-SSS represents the first nationwide real-time syndromic surveillance system ever established in Asia. The experiences reported herein can encourage other countries to develop their own surveillance systems. The system can be adapted to other cultural and language environments for better global surveillance of infectious diseases and international collaboration. © 2008 Wu et al; licensee BioMed Central Ltd

Low Seroprevalence of Parvovirus B19 in Taiwanese Children and Young Adults

This study aimed to evaluate the prevalence of parvovirus B19 antibodies in children and young adults aged = 30 years old in Taiwan. Methods: Stored serum samples from healthy volunteers aged 1-29 years in Taipei were randomly selected and tested for antiparvovirus B19 immunoglobulin G by enzyme immunoassay. Results: A total of 277 serum samples were tested. The overall seroprevalence of parvovirus B19 in Taiwanese children and young adults was 23.1% (64/277) in 2004. The positive rate increased slightly with age; it ranged from 15.0% in those aged 1-4 years to 30.8% in those aged 25-29 years (trend test, p = 0.01). The age-adjusted anti-B19 immunoglobulin G seropositive rate was slightly higher in males (27.8%) than in females (18.8%; adjusted odds ratio: 0.56; 95% confidence interval: 0.32-0.99). Conclusion: Most children and young adults in Taipei City are not immune to parvovirus B19, suggesting that no parvovirus B19 epidemic has occurred in the last few decades

Daily ED Counts in Nation-wide Hospital Emergency Department-based Syndromic Surveillance System in Taiwan, April 1, 2004 – March 31, 2005

<p><b>Copyright information:</b></p><p>Taken from "Establishing a nationwide emergency department-based syndromic surveillance system for better public health responses in Taiwan"</p><p>http://www.biomedcentral.com/1471-2458/8/18</p><p>BMC Public Health 2008;8():18-18.</p><p>Published online 18 Jan 2008</p><p>PMCID:PMC2249581.</p><p></p

Geographical Distributions of the Participated Hospitals in Nation-wide ED-based Syndromic Surveillance System and Coverage Rates of the 4 Regions in Taiwan

<p><b>Copyright information:</b></p><p>Taken from "Establishing a nationwide emergency department-based syndromic surveillance system for better public health responses in Taiwan"</p><p>http://www.biomedcentral.com/1471-2458/8/18</p><p>BMC Public Health 2008;8():18-18.</p><p>Published online 18 Jan 2008</p><p>PMCID:PMC2249581.</p><p></p

Daily Taiwan Nation-wide ED-SSS time series plots of total ED visits of respiratory and ILI syndrome groups plus asthma visits, Apr

<p><b>Copyright information:</b></p><p>Taken from "Establishing a nationwide emergency department-based syndromic surveillance system for better public health responses in Taiwan"</p><p>http://www.biomedcentral.com/1471-2458/8/18</p><p>BMC Public Health 2008;8():18-18.</p><p>Published online 18 Jan 2008</p><p>PMCID:PMC2249581.</p><p></p> 1, 2004 – Mar. 31, 2005

Weekly Taiwan Nation-wide ED-SSS time series plots of total ED visits of the 11 syndrome groups plus asthma visits, Apr

<p><b>Copyright information:</b></p><p>Taken from "Establishing a nationwide emergency department-based syndromic surveillance system for better public health responses in Taiwan"</p><p>http://www.biomedcentral.com/1471-2458/8/18</p><p>BMC Public Health 2008;8():18-18.</p><p>Published online 18 Jan 2008</p><p>PMCID:PMC2249581.</p><p></p> 1, 2004 – Mar. 31, 2005

Daily Taiwan Nation-wide ED-SSS time series plots of total ED visits of the 11 syndrome groups plus asthma visits, Apr

<p><b>Copyright information:</b></p><p>Taken from "Establishing a nationwide emergency department-based syndromic surveillance system for better public health responses in Taiwan"</p><p>http://www.biomedcentral.com/1471-2458/8/18</p><p>BMC Public Health 2008;8():18-18.</p><p>Published online 18 Jan 2008</p><p>PMCID:PMC2249581.</p><p></p> 1, 2004 – Mar. 31, 2005