Syndromic surveillance: two decades experience of sustainable systems – its people not just data!

AbstractSyndromic surveillance is a form of surveillance that generates information for public health action by collecting, analysing and interpreting routine health-related data on symptoms and clinical signs reported by patients and clinicians rather than being based on microbiologically or clinically confirmed cases. In England, a suite of national real-time syndromic surveillance systems (SSS) have been developed over the last 20 years, utilising data from a variety of health care settings (a telehealth triage system, general practice and emergency departments). The real-time systems in England have been used for early detection (e.g. seasonal influenza), for situational awareness (e.g. describing the size and demographics of the impact of a heatwave) and for reassurance of lack of impact on population health of mass gatherings (e.g. the London 2012 Olympic and Paralympic Games).We highlight the lessons learnt from running SSS, for nearly two decades, and propose questions and issues still to be addressed. We feel that syndromic surveillance is an example of the use of ‘big data’, but contend that the focus for sustainable and useful systems should be on the added value of such systems and the importance of people working together to maximise the value for the public health of syndromic surveillance services.

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What did Syndromic Surveillance Show During London 2012? Lessons for Mass Gatherings

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v7i1.5835 ◽

2015 ◽

Vol 7 (1) ◽

Author(s):

Dan Todkill ◽

Helen Hughes ◽

Alex Elliot ◽

Roger Morbey ◽

Obaghe Edeghere ◽

...

Keyword(s):

Public Health ◽

General Practitioner ◽

Syndromic Surveillance ◽

Lessons Learned ◽

Surveillance Systems ◽

Mass Gathering ◽

Daily Number ◽

Mass Gatherings ◽

London 2012 ◽

The Impact

This paper investigates the impact of the London 2012 Olympic and Paralympic Games on syndromic surveillance systems coordinated by Public Health England. The Games had very little obvious impact on the daily number of ED attendances and general practitioner consultations both nationally, and within London. These results provide valuable lessons learned for future mass gathering events.

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HIV testing by public health centers and municipalities, and new HIV cases during the COVID-19 pandemic in Japan

10.1101/2020.10.16.20213959 ◽

2020 ◽

Author(s):

Keisuke Ejima ◽

Yoshiki Koizumi ◽

Nao Yamamoto ◽

Molly Rosenberg ◽

Christina Ludema ◽

...

Keyword(s):

Public Health ◽

Hiv Testing ◽

Health Centers ◽

Added Value ◽

Sensitivity Analyses ◽

Related Data ◽

Time Restrictions ◽

Hiv Test ◽

Aids Diagnosis ◽

The Impact

AbstractBackgroundDuring the COVID-19 outbreak, medical resources were primarily allocated to COVID-19, which might have reduced facility capacity for HIV testing. Further, people may have opted against HIV testing during this period to avoid COVID-19 exposure. We investigate the influence of the COVID-19 pandemic on HIV testing and its consequences in Japan.MethodsWe analysed quarterly HIV/AIDS-related data from 2015 to the second quarter of 2020 using an anomaly detection approach. The data included the number of consultations that public health centers received, the number of HIV tests performed by public health centers or municipalities, and the number of newly reported HIV cases with and without AIDS diagnosis. As sensitivity analyses, we performed the same analysis for two subgroups: men who have sex with men (MSM) and non-Japanese.FindingsThe number of HIV tests (9,584 vs. 35,908 in the year-before period) and consultations (11,689 vs. 32,565) performed by public health centers significantly declined in the second quarter of 2020, while the proportion of HIV cases with AIDS diagnosis among all HIV cases (36·2% vs. 26·4%) significantly increased after removing the trend and seasonality effects. The number of HIV cases without AIDS diagnosis numerically decreased (166 vs. 217), although the reduction was not significant. We confirmed similar trend for the MSM and non-Japanese groups.InterpretationThe current HIV testing system including public health centers misses more HIV cases at the early phase of the infection during the pandemic. Given that the clear epidemiological picture of HIV incidence during the pandemic is still uncertain, continuously monitoring the situation as well as securing sufficient test resources using self-test is essential.FundingJapan Society for the Promotion of Science, Japan Science and Technology Agency, Japan Agency for Medical Research and Development.Research in contextEvidence before this studyBefore this study, we searched PubMed, Medline, and Google Scholar on Oct 12, 2020, for articles investigated the number of HIV test and HIV cases during the COVID-19 pandemic in Japan, using the search terms “novel coronavirus” or “SARS-CoV-2”, and “HIV” or “AIDS”, and “Japan”, with no time restrictions. We found no published work relevant to our study.Added value of this studyDuring the COVID-19 pandemic in Japan, the public health centers and municipalities temporarily suspended facility-based HIV testing to concentrate their limited resources to COVID-19 testing. We investigated the impact of the COVID-19 pandemic on the number of HIV tests in public health centers and municipalities, and on the number of HIV cases with and without AIDS diagnosis. We confirmed that the number of the test declined in the second quarter (April to June) of 2020, and the proportion of HIV with AIDS diagnosis among all HIV cases increased during the same period.Implications of all the available evidenceProviding sufficient HIV testing opportunities even during the pandemic, when facility-based testing is challenging, is necessary for better clinical and public health outcomes. Self-testing and home specimen collection (e.g. dried blood spot or oral fluid test) could be a key to fill the gap between the need for HIV testing and the constraints related to the COVID-19 outbreak.

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

Epidemiology and Infection ◽

10.1017/s0950268816000686 ◽

2016 ◽

Vol 144 (11) ◽

pp. 2251-2259 ◽

Cited By ~ 5

Author(s):

S. NEWITT ◽

A. J. ELLIOT ◽

R. MORBEY ◽

H. DURNALL ◽

M. E. PIETZSCH ◽

...

Keyword(s):

Climate Change ◽

Real Time ◽

Syndromic Surveillance ◽

Ecological Study ◽

Health Impact ◽

Extreme Weather Events ◽

Surveillance Systems ◽

Out Of Hours ◽

Baseline Incidence ◽

The Impact

SUMMARYClimate 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.

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Syndromic surveillance insights from a symptom assessment app before and during COVID-19 measures in Germany and the United Kingdom: results from repeated cross-sectional analyses

10.1101/2020.06.16.20126466 ◽

2020 ◽

Author(s):

Alicia Mehl ◽

Francois Bergey ◽

Caoimhe Cawley ◽

Andreas Gilsdorf

Keyword(s):

Public Health ◽

United Kingdom ◽

Real Time ◽

Syndromic Surveillance ◽

Symptom Assessment ◽

Assessment Tools ◽

Added Value ◽

Cross Sectional ◽

Syndromic Surveillance System ◽

The United Kingdom

AbstractBackgroundUnprecedented lockdown measures have been introduced in countries across the world to mitigate the spread and consequences of COVID-19. While attention has focused on the effects of these measures on epidemiological indicators relating directly to the infection, there is increased recognition of their broader health implications. However, assessing these implications in real time is a challenge, due to limitations of existing syndromic surveillance data and tools.ObjectiveTo explore the added value of mobile phone app-based symptom assessment tools as real time health insight providers to inform public health policy makers.MethodsA comparative and descriptive analysis of the proportion of all self-reported symptoms entered by users during an Ada assessment in Germany and the United Kingdom (UK) was conducted between two periods: before and after the implementation of “Phase One” COVID-19 measures. Additional analyses were performed to explore the association between symptom trends and seasonality, and symptom trends and weather. Differences in the proportion of unique symptoms between the periods were analysed using Pearson’s Chi-squared test and reported as Log2 Fold Changes (Log2 FC).ResultsBetween 48,300-54,900 symptomatic users reported 140,500-170,400 symptoms during the Baseline and Measures periods in Germany. Between 34,200-37,400 symptomatic users in the UK reported 112,100-131,900 symptoms during the Baseline and Measures periods. The majority of symptomatic users were female (Germany 68,600/103,200, 66.52%; UK 51,200/71,600, 72.74%). The majority (Germany 68,500/100,000, 68.45%; UK 50,900/68,800, 73.91%) were aged between 10 and 29 years, and about a quarter (Germany 26,200/100,000, 26.15%; UK 14,900/68,800, 21.65%) were between 30-59 years. 103 symptoms were reported either more or less frequently (with statistically significant differences) during the Measures as compared to the Baseline period, and 34 of these were found in both countries. The following mental health symptoms (Log2 FC, P-value) were reported less often during the Measures period: inability to manage constant stress and demands at work (−1.07, P<.001), memory difficulty (−0.56, P<.001), depressed mood (−0.42, P<.001), and impaired concentration (−0.46, P<.001). Diminished sense of taste (2.26, P<.001) and hyposmia (2.20, P<.001) were reported more frequently during the Measures period. None of the 34 symptoms were found to be different between the same dates in 2019. Fourteen of the 34 symptoms had statistically significant associations with weather variables.ConclusionsSymptom assessment apps have an important role to play in facilitating improved understanding of the implications of public health policies such as COVID-19 lockdown measures. Not only do they provide the means to complement and cross-validate hypotheses based on data collected through more traditional channels, they can also generate novel insights through a real-time syndromic surveillance system.

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The COVID-19 pandemic: a new challenge for syndromic surveillance

Epidemiology and Infection ◽

10.1017/s0950268820001314 ◽

2020 ◽

Vol 148 ◽

Cited By ~ 7

Author(s):

Alex J. Elliot ◽

Sally E. Harcourt ◽

Helen E. Hughes ◽

Paul Loveridge ◽

Roger A. Morbey ◽

...

Keyword(s):

Public Health ◽

Health System ◽

Syndromic Surveillance ◽

Surveillance Data ◽

Surveillance Systems ◽

Clinical Coding ◽

Public Health Response ◽

Specific Symptom ◽

Health And Social Care ◽

The Impact

Abstract The COVID-19 pandemic is exerting major pressures on society, health and social care services and science. Understanding the progression and current impact of the pandemic is fundamental to planning, management and mitigation of future impact on the population. Surveillance is the core function of any public health system, and a multi-component surveillance system for COVID-19 is essential to understand the burden across the different strata of any health system and the population. Many countries and public health bodies utilise ‘syndromic surveillance’ (using real-time, often non-specific symptom/preliminary diagnosis information collected during routine healthcare provision) to supplement public health surveillance programmes. The current COVID-19 pandemic has revealed a series of unprecedented challenges to syndromic surveillance including: the impact of media reporting during early stages of the pandemic; changes in healthcare-seeking behaviour resulting from government guidance on social distancing and accessing healthcare services; and changes in clinical coding and patient management systems. These have impacted on the presentation of syndromic outputs, with changes in denominators creating challenges for the interpretation of surveillance data. Monitoring changes in healthcare utilisation is key to interpreting COVID-19 surveillance data, which can then be used to better understand the impact of the pandemic on the population. Syndromic surveillance systems have had to adapt to encompass these changes, whilst also innovating by taking opportunities to work with data providers to establish new data feeds and develop new COVID-19 indicators. These developments are supporting the current public health response to COVID-19, and will also be instrumental in the continued and future fight against the disease.

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An Observational Study Using English Syndromic Surveillance Data Collected During the 2012 London Olympics – What did Syndromic Surveillance Show and What Can We Learn for Future Mass-gathering Events?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x16000923 ◽

2016 ◽

Vol 31 (6) ◽

pp. 628-634 ◽

Cited By ~ 9

Author(s):

Dan Todkill ◽

Helen E. Hughes ◽

Alex J. Elliot ◽

Roger A. Morbey ◽

Obaghe Edeghere ◽

...

Keyword(s):

Public Health ◽

Observational Study ◽

Real Time ◽

Syndromic Surveillance ◽

Olympic Games ◽

Surveillance Data ◽

Surveillance Systems ◽

Mass Gathering ◽

Opening Ceremony ◽

London 2012

AbstractIntroductionIn preparation for the London 2012 Olympic Games, existing syndromic surveillance systems operating in England were expanded to include daily general practitioner (GP) out-of-hours (OOH) contacts and emergency department (ED) attendances at sentinel sites (the GP OOH and ED syndromic surveillance systems: GPOOHS and EDSSS).Hypothesis/ProblemThe further development of syndromic surveillance systems in time for the London 2012 Olympic Games provided a unique opportunity to investigate the impact of a large mass-gathering event on public health and health services as monitored in near real-time by syndromic surveillance of GP OOH contacts and ED attendances. This can, in turn, aid the planning of future events.MethodsThe EDSSS and GPOOHS data for London and England from July 13 to August 26, 2012, and a similar period in 2013, were divided into three distinct time periods: pre-Olympic period (July 13-26, 2012); Olympic period (July 27 to August 12); and post-Olympic period (August 13-26, 2012). Time series of selected syndromic indicators in 2012 and 2013 were plotted, compared, and risk assessed by members of the Real-time Syndromic Surveillance Team (ReSST) in Public Health England (PHE). Student’s t test was used to test any identified changes in pattern of attendance.ResultsVery few differences were found between years or between the weeks which preceded and followed the Olympics. One significant exception was noted: a statistically significant increase (P value = .0003) in attendances for “chemicals, poisons, and overdoses, including alcohol” and “acute alcohol intoxication” were observed in London EDs coinciding with the timing of the Olympic opening ceremony (9:00 pm July 27, 2012 to 01:00 am July 28, 2012).ConclusionsSyndromic surveillance was able to provide near to real-time monitoring and could identify hourly changes in patterns of presentation during the London 2012 Olympic Games. Reassurance can be provided to planners of future mass-gathering events that there was no discernible impact in overall attendances to sentinel EDs or GP OOH services in the host country. The increase in attendances for alcohol-related causes during the opening ceremony, however, may provide an opportunity for future public health interventions.TodkillD, HughesHE, ElliotAJ, MorbeyRA, EdeghereO, HarcourtS, HughesT, EndericksT, McCloskeyB, CatchpoleM, IbbotsonS, SmithG. An observational study using English syndromic surveillance data collected during the 2012 London Olympics – what did syndromic surveillance show and what can we learn for future mass-gathering events?Prehosp Disaster Med. 2016;31(6):628–634.

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Field Team Syndromic Surveillance for Mass Gatherings: NCAA Final Four 2017

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v10i1.8900 ◽

2018 ◽

Vol 10 (1) ◽

Author(s):

William E. Smith ◽

Rebecca Scranton ◽

Melissa Kretschmer ◽

Karen Zabel ◽

Kristen Pogreba-Brown

Keyword(s):

Public Health ◽

Real Time ◽

Syndromic Surveillance ◽

Field Data ◽

Situational Awareness ◽

First Aid ◽

Pain Reliever ◽

Epidemiologic Surveillance ◽

Field Team ◽

Additional Field

ObjectiveTo describe and present results of field-based near-real time syndromic surveillance conducted at first aid stations during the 2017 National Collegiate Athletic Association Division I Men’s College Basketball Championship (Final Four) events, and the use of field team data to improve situational awareness for Mass Gathering events.IntroductionFinal Four-associated events culminated in four days of intense activity from 3/31/17-4/3/17, which attracted an estimated 400,000 visitors to Maricopa County (population 4.2 million). Field teams of staff and volunteers were deployed to three days of Music Fest, four days of Fan Fest, and three Final Four games (Games) as part of an enhanced epidemiologic surveillance system.MethodsAttendees presenting to first aid stations were requested to complete an electronic questionnaire which captured illness and injury syndromes (after needed care was given). Emergency Medical Services technicians and nurses (EMS) conducted patient care. These were submitted and epidemiologically assessed in near-real-time to rapidly identify threats. Syndrome-specific data were mapped during events to identify spatial clustering. Field Teams were provided with case contact log sheets, suspicious substance investigation and exposure registry forms to allow rapid investigation of significant public health events. Patient Presentation Rates (PPR) and Transport to Hospital Rates (TTHR) were calculated per 10,000 attendees. Patients presenting per hour of event and transports per hour of event were calculated. Field reports were included in daily reports to inter-disciplinary partners, and shared during regular Multi-Agency Coordination Center briefings.Results301 field questionnaires were completed, including 146 from Final Four games (Games), 127 from the Music Fest, and 28 from the Fan Fest (see Figure).Among the 153,780 attendees of the three Games, there were 146 cases who presented to one of five first aid stations (over 12 hours). There were 27 illness cases who sought care (18.5% of Games cases), among whom 21 (78%) were assessed by EMS. Illness cases not assessed by EMS (n=6) included mostly allergy symptoms/medication needs. There were 50 injury cases who sought care (34.2% of Games cases), among whom 10 (20%) were assessed by EMS. Sixty (41.1%) persons presented seeking a pain reliever, and 9 (6.2%) presented seeking an antacid. Games experienced a PPR of 9.5, and a TTHR of 0.52. Patients presented at 12.2 per hour on average and there were eight transports to medical facilities (0.66 per hour).There were 127 cases among an estimated 135,000 Music Fest attendees who presented to one of two first aid stations (and at times 2 roving teams) over 3 days (22.5 hours) from 3/31 to 4/2. Illnesses accounted for 29 cases (22.8% of Music Fest cases) and 28 of 29 were assessed by EMS. There were 68 injury cases who sought care (53.5% of Music Fest cases), among whom 22 (32.4%) were assessed by EMS. Twenty-seven persons (21.3%) presented seeking a pain reliever and 2 (1.6%) sought an antacid. Music Fest results included a PPR of 9.4, and a TTHR of 0.15. There were 5.6 patients presenting per hour on average, and there were two transports to the hospital (0.09 per hour).At the Fan Fest there were 28 cases among an estimated 50,803 attendees presenting to the first aid station (or roving teams) from 3/31-4/3 (over 37 hours). Most cases sought care for an injury (n=22, 78.6% of cases). Four persons sought care for an illness (14.3%), all with relatively minor complaints. For the Fan Fest, there was a PPR of 5.5, and a TTHR of 0 (there were no transports to the hospital). There were 0.76 patient presentations per hour on average.No geographic clustering or public health threats requiring investigation were identified at any of the three sites. Interdisciplinary partners requested additional field data during the response.ConclusionsInjuries were more common than illnesses at all three sites. Visits requiring pain relievers only were more common at Games (41.1%) than at Music Fest (21.3%) or Fan Fest (3.6%).A greater percentage of visits requiring EMS assessment were seen at the Fan Fest (78.6%) than at the Music Fest (40.2%) or the Games (21.2%).The PPRs per 10,000 attendees were highest at the Games (9.5) and Music Fest (9.4), compared to the Fan Fest (5.5). The TTHR per 10,000 attendees was highest at the Games (0.52), compared to the Music Fest (0.15) and Fan Fest (0.0). The Music Fest field team reported greater effectiveness at fixed first aid stations compared to traveling with roving EMS teams. Field reports enhanced health and medical situational awareness and information sharing as evidenced by requests from interdisciplinary partners for additional field data.

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Syndromic Surveillance Insights from a Symptom Assessment App Before and During COVID-19 Measures in Germany and the United Kingdom: Results From Repeated Cross-Sectional Analyses (Preprint)

10.2196/preprints.21364 ◽

2020 ◽

Cited By ~ 1

Author(s):

Alicia Mehl ◽

Francois Bergey ◽

Caoimhe Cawley ◽

Andreas Gilsdorf

Keyword(s):

Public Health ◽

United Kingdom ◽

Real Time ◽

Syndromic Surveillance ◽

Symptom Assessment ◽

Assessment Tools ◽

Added Value ◽

Cross Sectional ◽

Syndromic Surveillance System ◽

The United Kingdom

BACKGROUND Unprecedented lockdown measures have been introduced in countries worldwide to mitigate the spread and consequences of COVID-19. Although attention has been focused on the effects of these measures on epidemiological indicators relating directly to the infection, there is increased recognition of their broader health implications. However, assessing these implications in real time is a challenge, due to the limitations of existing syndromic surveillance data and tools. OBJECTIVE The aim of this study is to explore the added value of mobile phone app–based symptom assessment tools as real-time health insight providers to inform public health policy makers. METHODS A comparative and descriptive analysis of the proportion of all self-reported symptoms entered by users during an assessment within the Ada app in Germany and the United Kingdom was conducted between two periods, namely before and after the implementation of “Phase One” COVID-19 measures. Additional analyses were performed to explore the association between symptom trends and seasonality, and symptom trends and weather. Differences in the proportion of unique symptoms between the periods were analyzed using a Pearson chi-square test and reported as log2 fold changes. RESULTS Overall, 48,300-54,900 symptomatic users reported 140,500-170,400 symptoms during the Baseline and Measures periods in Germany. Overall, 34,200-37,400 symptomatic users in the United Kingdom reported 112,100-131,900 symptoms during the Baseline and Measures periods. The majority of symptomatic users were female (Germany: 68,600/103,200, 66.52%; United Kingdom: 51,200/71,600, 72.74%). The majority were aged 10-29 years (Germany: 68,500/100,000, 68.45%; United Kingdom: 50,900/68,800, 73.91%), and about one-quarter were aged 30-59 years (Germany: 26,200/100,000, 26.15%; United Kingdom: 14,900/68,800, 21.65%). Overall, 103 symptoms were reported either more or less frequently (with statistically significant differences) during the Measures period as compared to the Baseline period, and 34 of these were reported in both countries. The following mental health symptoms (log2 fold change, P value) were reported less often during the Measures period: inability to manage constant stress and demands at work (–1.07, P<.001), memory difficulty (–0.56, P<.001), depressed mood (–0.42, P<.001), and impaired concentration (–0.46, P<.001). Diminished sense of taste (2.26, P<.001) and hyposmia (2.20, P<.001) were reported more frequently during the Measures period. None of the 34 symptoms were found to be different between the same dates in 2019. In total, 14 of the 34 symptoms had statistically significant associations with weather variables. CONCLUSIONS Symptom assessment apps have an important role to play in facilitating improved understanding of the implications of public health policies such as COVID-19 lockdown measures. Not only do they provide the means to complement and cross-validate hypotheses based on data collected through more traditional channels, they can also generate novel insights through a real-time syndromic surveillance system.

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Syndromic Surveillance Insights from a Symptom Assessment App Before and During COVID-19 Measures in Germany and the United Kingdom: Results From Repeated Cross-Sectional Analyses

JMIR mhealth and uhealth ◽

10.2196/21364 ◽

2020 ◽

Vol 8 (10) ◽

pp. e21364

Author(s):

Alicia Mehl ◽

Francois Bergey ◽

Caoimhe Cawley ◽

Andreas Gilsdorf

Keyword(s):

Public Health ◽

United Kingdom ◽

Real Time ◽

Syndromic Surveillance ◽

Symptom Assessment ◽

Assessment Tools ◽

Added Value ◽

P Value ◽

Syndromic Surveillance System ◽

The United Kingdom

Background Unprecedented lockdown measures have been introduced in countries worldwide to mitigate the spread and consequences of COVID-19. Although attention has been focused on the effects of these measures on epidemiological indicators relating directly to the infection, there is increased recognition of their broader health implications. However, assessing these implications in real time is a challenge, due to the limitations of existing syndromic surveillance data and tools. Objective The aim of this study is to explore the added value of mobile phone app–based symptom assessment tools as real-time health insight providers to inform public health policy makers. Methods A comparative and descriptive analysis of the proportion of all self-reported symptoms entered by users during an assessment within the Ada app in Germany and the United Kingdom was conducted between two periods, namely before and after the implementation of “Phase One” COVID-19 measures. Additional analyses were performed to explore the association between symptom trends and seasonality, and symptom trends and weather. Differences in the proportion of unique symptoms between the periods were analyzed using a Pearson chi-square test and reported as log2 fold changes. Results Overall, 48,300-54,900 symptomatic users reported 140,500-170,400 symptoms during the Baseline and Measures periods in Germany. Overall, 34,200-37,400 symptomatic users in the United Kingdom reported 112,100-131,900 symptoms during the Baseline and Measures periods. The majority of symptomatic users were female (Germany: 68,600/103,200, 66.52%; United Kingdom: 51,200/71,600, 72.74%). The majority were aged 10-29 years (Germany: 68,500/100,000, 68.45%; United Kingdom: 50,900/68,800, 73.91%), and about one-quarter were aged 30-59 years (Germany: 26,200/100,000, 26.15%; United Kingdom: 14,900/68,800, 21.65%). Overall, 103 symptoms were reported either more or less frequently (with statistically significant differences) during the Measures period as compared to the Baseline period, and 34 of these were reported in both countries. The following mental health symptoms (log2 fold change, P value) were reported less often during the Measures period: inability to manage constant stress and demands at work (–1.07, P<.001), memory difficulty (–0.56, P<.001), depressed mood (–0.42, P<.001), and impaired concentration (–0.46, P<.001). Diminished sense of taste (2.26, P<.001) and hyposmia (2.20, P<.001) were reported more frequently during the Measures period. None of the 34 symptoms were found to be different between the same dates in 2019. In total, 14 of the 34 symptoms had statistically significant associations with weather variables. Conclusions Symptom assessment apps have an important role to play in facilitating improved understanding of the implications of public health policies such as COVID-19 lockdown measures. Not only do they provide the means to complement and cross-validate hypotheses based on data collected through more traditional channels, they can also generate novel insights through a real-time syndromic surveillance system.

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Using real-time syndromic surveillance to monitor the health effects of air pollution

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v10i1.8651 ◽

2018 ◽

Vol 10 (1) ◽

Author(s):

Sally Harcourt ◽

Lydia Izon-Cooper ◽

Felipe D. Colón-González ◽

Roger Morbey ◽

Gillian Smith ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Air Pollution ◽

Syndromic Surveillance ◽

Health Care Seeking ◽

Surveillance Systems ◽

Care Seeking ◽

Health Care Seeking Behaviour ◽

The Impact ◽

Care Seeking Behaviour

ObjectiveTo explore the utility of syndromic surveillance systems for detecting and monitoring the impact of air pollution incidents on health-care seeking behaviour in England between 2012 and 2017.IntroductionThe negative effect of air pollution on human health is well documented illustrating increased risk of respiratory, cardiac and other health conditions. [1] Currently, during air pollution episodes Public Health England (PHE) syndromic surveillance systems [2] provide a near real-time analysis of the health impact of poor air quality. In England, syndromic surveillance has previously been used on an ad hoc basis to monitor health impact; this has usually happened during widespread national air pollution episodes where the air pollution index has reached ‘High’ or ‘Very High’ levels on the UK Daily Air Quality Index (DAQI). [3-5]We now aim to undertake a more systematic approach to understanding the utility of syndromic surveillance for monitoring the health impact of air pollution. This would improve our understanding of the sensitivity and specificity of syndromic surveillance systems for contributing to the public health response to acute air pollution incidents; form a baseline for future interventions; assess whether syndromic surveillance systems provide a useful tool for public health alerting; enable us to explore which pollutants drive changes in health-care seeking behaviour; and add to the knowledge base.MethodsThe systematic approach will involve accessing historical data for air pollution incidents and syndromic surveillance data over the period 2012-17 across England. We will use PM10, PM2.5, ozone, NO2 , SO2 and DAQI data to define air pollution periods, and historical syndromic surveillance system data for respiratory syndromes (asthma, difficulty breathing, wheeze, cough, bronchitis, sore throat and allergic rhinitis), cardiac (all cardiovascular and myocardial infarction) and eye irritation/conjunctivitis syndromes. We will use regression modelling and cross-correlation analyses to determine the effects of air pollution, weather and pollen upon these syndromes and thus provide evidence of the sensitivity of these systems. Historical data on additional environmental variables including temperature and precipitation, humidity and thunderstorm activity, pollen and fungal spores will be accounted for in the regression models, as well as data on influenza and respiratory syncytial virus (RSV) laboratory reports. We will include sub-national geographies and age/gender analyses in the study depending on the data availability and suitability.ResultsInitial results presented will include the preliminary descriptive epidemiology with a focus on asthma and the impact of air pollution incidents on health-care seeking behaviour using data from the PHE national syndromic surveillance systems.ConclusionsWe aim to demonstrate an innovative use of syndromic surveillance data to explore the impact of air pollution incidents on health-care seeking behaviour in England, in turn improving our understanding of the sensitivity and specificity of these systems for detecting the impact of air pollution incidents and to contribute to the knowledge base. This understanding will improve the public health response to future incidents.References1. World Health Organization (WHO). Preventing disease through healthy environments. Exposure to air pollution: A major public health concern. (http://www.who.int/ipcs/features/air_pollution.pdf). Accessed 28/09/20172. Public Health England. Syndromic surveillance: systems and analyses. (https://www.gov.uk/government/collections/syndromic-surveillance-systems-and-analyses). Accessed 20/09/20173. Department for Environment Food and Rural Affairs (Defra). Daily Air Quality Index (DAQI). (https://uk-air.defra.gov.uk/air-pollution/daqi). Accessed 28/06/20174. Smith GE, et al. Using real-time syndromic surveillance systems to help explore the acute impact of the air pollution incident of March/April 2014 in England. Environ Res 2015; 136: 500-504.5. Elliot AJ, et al. Monitoring the effect of air pollution episodes on health care consultations and ambulance call-outs in England during March/April 2014: A retrospective observational analysis. Environ Pollut 2016; 214: 903-911.

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