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Syndromic Surveillances based on the Emergency Department
Joon Pil Cho, Young Gi Min, and Sang Cheon Choi
Department of Emergency Medicine, Ajou University School of Medicine D u e t o h e i g h t e n e d c o n c e r n s r e g a r d i n g p o s s i b l e
bioterrorist attacks, the Korea Center for Disease Control and Prevention introduced syndromic surveillance systems, w h i c h h a v e b e e n r u n b y e m e r g e n c y d e p a r t m e n t s i n hospitals throughout Korea since 2002. These systems are designed to identify illness clusters before diagnoses are confirmed and reported to public health agencies, to mobilize a rapid response, and thereby to reduce morbidity and mortality.
The Korea Center for Disease Control and Prevention performed drop-in syndromic surveillance successfully d u r i n g t h e W o r l d C u p F o o t b a l l G a m e s i n 2 0 0 2 , t h e Universiad games in 2004, and the Asian Pacific Economic Cooperation meeting in 2005. In addition, sustainable syndromic surveillance system involving the collaborative
efforts of 125 sentinel hospitals has been in operation nationwide since 2002.
Because active data collection can bias decisions a physician makes, there is a need to generate an automatic and passive data collection system. Therefore, the Korea C e n t e r f o r D i s e a s e C o n t r o l a n d P r e v e n t i o n p l a n s t o establish computerized automatic data collection systems in the near future. These systems will be used not only for the early detection of bioterrorism but also for more effective public health responses to disease.
J Prev Med Public Health 2008;41(4):219-224
Key words : S y n d r o m e , S u r v e i l l a n c e , B i o t e r r o r i s m , Public health
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Table 1. Potential data sources for syndromic surveillance
Clinical data sources Alternative data sources
Emergency department (ED) or clinic total patient volume Total hospital admissions from ED
ED log of chief complaints ED visit outcome (diagnosis)
Ambulatory-care clinic outcome (diagnosis) Emergency medical system (119 or 1339) call type Clinical laboratory or radiology ordering volume Insurance claims data
ED: emergency department
Modified from Henning kj. What is syndromic surveillance? MMWR Morb Mortal Wkly Rep 2004; 53 suppl: 5-11 [1].
School absenteeism Work absenteeism
Over-the-counter medication sales
Table 2. Types of syndromic surveillance
Surveillance type Selected characteristics Advantages Disadvantages Event-based surveillance
Drop-in
Sustained surveillance Manual
Electronic
Active Defined duration ED
Active and passive Fax-based reporting ED triage staff typically log
and tally sheet Passive
Automated transfer of hospital or outpatient data
Transportable to various sites
Easy to initiate Detailed information
obtainable
Can be scalable Requires minimal or no
provider input Data available continuously Data are standardized
Labor-intensive Not sustainable Not scalable
Labor-intensive
Difficult to maintain 24 hours, 7days/week
Not sustainable
ED: emergency department
Modified from Henning kj. What is syndromic surveillance? MMWR Morb Mortal Wkly Rep 2004; 53 suppl: 5-11 [1].
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Table 3. Chronology of national syndromic surveillance system
Time Content
2002.1 2002.2 2002.3 2002.3 2002.4 2002.5 2003.8 2004.5 2005.7
Initiation of plan about enhancing infectious disease surveillance system Establishment of task force for developing the protocol of surveillance system Designation of sentinel hospital for syndromic surveillance system based on the ED Development of website and electronic program
Education for sentinel hospitals
Starting the operation of syndromic surveillance system based on the ED
The operation of enhanced syndromic surveillance system during universiade Daegu 2003 The operation of enhanced syndromic surveillance system during 37th annual meeting of the
board of governors of the asian development bank in Jeju
The operation of enhanced syndromic surveillance system during 13th asia-pacific economic cooperation (APEC) in Busan
ED: emergency department
Figure 1. Rationale for early detection in syndromic surveillance.
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KCDC*: Korea Center for Disease Control & Prevention, ED+: Emergency Department
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1. Henning KJ. What is syndromic surveillance?
MMWR Morb Mortal Wkly Rep 2004; 53 (Suppl): 5-11.
2. Buehler JW, Berkelman RL, Hartley DM, Peters CJ. Syndromic surveillance and bioterrorism-related epidemics. Emerg Infect Dis 2003; 9(10): 1197-1204.
3. Fleischauer AT, Silk BJ, Schumacher M, Komatsu K, Santana S, Vaz V, et al. The validity of chief complaint and discharge diagnosis in emergency department-based syndromic surveillance. Acad Emerg Med 2004;
11(12): 1262-1267.
4. Besculides M, Heffernan R, Mostashari F, Weiss D. Evaluation of school absenteeism data for early outbreak detection; New York city.
BMC Public Health 2005; 5: 105.
5. Muscatello DJ, Churches T, Kaldor J, Zheng W, Chiu C, Correll P, et al. An automated, broad- based, near real-time public health surveillance system using presentations to hospital emergency departments in New South Wales, Australia. BMC Public Health 2005; 5: 141.
6. Betancourt JA, Hakre S, Polyak CS, Pavlin JA.
Evaluation of ICD-9 codes for syndromic surveillance in the electronic surveillance system for the early notification of community-based epidemics. Mil Med 2007; 172(4): 346-352.
7. Division of bioterrorism preparedness and response, Department of infectious disease control Korea center for disease control and prevention. Preparedness and Response to Bioterrorism. [cited 2008 Jun 25]. Available from URL:http://bioterrorism.cdc.go.kr.
(Korean)
