Meeting the International Health Regulations (2005) surveillance core capacity requirements at the subnational level in Europe: the added value of syndromic surveillance

BACKGROUND: The revised World Health Organization's International Health Regulations (2005) request a timely and all-hazard approach towards surveillance, especially at the subnational level. We discuss three questions of syndromic surveillance application in the European context for assessing public health emergencies of international concern: (i) can syndromic surveillance support countries, especially the subnational level, to meet the International Health Regulations (2005) core surveillance capacity requirements, (ii) are European syndromic surveillance systems comparable to enable cross-border surveillance, and (iii) at which administrative level should syndromic surveillance best be applied? DISCUSSION: Despite the ongoing criticism on the usefulness of syndromic surveillance which is related to its clinically nonspecific output, we demonstrate that it was a suitable supplement for timely assessment of the impact of three different public health emergencies affecting Europe. Subnational syndromic surveillance analysis in some cases proved to be of advantage for detecting an event earlier compared to national level analysis. However, in many cases, syndromic surveillance did not detect local events with only a small number of cases. The European Commission envisions comparability of surveillance output to enable cross-border surveillance. Evaluated against European infectious disease case definitions, syndromic surveillance can contribute to identify cases that might fulfil the clinical case definition but the approach is too unspecific to comply to complete clinical definitions. Syndromic surveillance results still seem feasible for comparable cross-border surveillance as similarly defined syndromes are analysed. We suggest a new model of implementing syndromic surveillance at the subnational level. In this model, syndromic surveillance systems are fine-tuned to their local context and integrated into the existing subnational surveillance and reporting structure. By enhancing population coverage, events covering several jurisdictions can be identified at higher levels. However, the setup of decentralised and locally adjusted syndromic surveillance systems is more complex compared to the setup of one national or local system. SUMMARY: We conclude that syndromic surveillance if implemented with large population coverage at the subnational level can help detect and assess the local and regional effect of different types of public health emergencies in a timely manner as required by the International Health Regulations (2005)

Automated DNA Sequence-Based Early Warning System for the Detection of Methicillin-Resistant Staphylococcus aureus Outbreaks

BACKGROUND: The detection of methicillin-resistant Staphylococcus aureus (MRSA) usually requires the implementation of often rigorous infection-control measures. Prompt identification of an MRSA epidemic is crucial for the control of an outbreak. In this study we evaluated various early warning algorithms for the detection of an MRSA cluster. METHODS AND FINDINGS: Between 1998 and 2003, 557 non-replicate MRSA strains were collected from staff and patients admitted to a German tertiary-care university hospital. The repeat region of the S. aureus protein A (spa) gene in each of these strains was sequenced. Using epidemiological and typing information for the period 1998–2002 as reference data, clusters in 2003 were determined by temporal-scan test statistics. Various early warning algorithms (frequency, clonal, and infection control professionals [ICP] alerts) were tested in a prospective analysis for the year 2003. In addition, a newly implemented automated clonal alert system of the Ridom StaphType software was evaluated. A total of 549 of 557 MRSA were typeable using spa sequencing. When analyzed using scan test statistics, 42 out of 175 MRSA in 2003 formed 13 significant clusters (p < 0.05). These clusters were used as the “gold standard” to evaluate the various algorithms. Clonal alerts (spa typing and epidemiological data) were 100% sensitive and 95.2% specific. Frequency (epidemiological data only) and ICP alerts were 100% and 62.1% sensitive and 47.2% and 97.3% specific, respectively. The difference in specificity between clonal and ICP alerts was not significant. Both methods exhibited a positive predictive value above 80%. CONCLUSIONS: Rapid MRSA outbreak detection, based on epidemiological and spa typing data, is a suitable alternative for classical approaches and can assist in the identification of potential sources of infection

Effektivität eines MRSA Screenings im Krankenhaus mit Hilfe zweier Frequenz-Algorithmen zur frühen Ausbruchsdetektion – ein Vergleich mit einer klonalen Clusteranalyse

Methicillin resistente Staphylococcus aureus (MRSA) sind in vielen Kranken-häusern weltweit endemisch. Surveillance- und Frühwarnsysteme zur rechtzeitigen Ausbruchsdetektion können dazu beitragen die Ausbreitung von nosokomialen Erkrankungen zu überwachen und zu verringern. In dieser Studie wurde die Effektivität zweier einfacher Frequenz-Algorithmen zur frühen Ausbruchs-detektion von MRSA-Infektionen auf Krankenhausebene getestet.Methicillin resistant Staphylococcus aureus (MRSA) are endemic in many hospitals worldwide. Clusters or outbreaks of nosocomial infections are linked with small case numbers. This circumstance is the major problem when creating an early warning system in a hospital setting. The use of several methods has been proposed. The aim of this study is to evaluate two methods of hospital surveillance with early-warning systems based on simple frequency algorithms in the detection of significant MRSA clusters. A comparison with a clonal cluster analysis allows an assertion of how many cases might get lost

Patientenorientierung in der ambulanten Versorgung. Ergebnisse des NRW-Gesundheitssurveys 2012

Bluemke D, Rosenkötter N, Mensing M. Patientenorientierung in der ambulanten Versorgung. Ergebnisse des NRW-Gesundheitssurveys 2012. Das Gesundheitswesen. 2015;16(P05)

Individual health service use – results of a representative cross-sectional study in North Rhine-Westphalia, Germany

Rosenkötter N, Mensing M, Borrmann B. Individual health service use – results of a representative cross-sectional study in North Rhine-Westphalia, Germany. European Journal of Public Health. 2017;24(Suppl_2):334