A Syndrome-Based Surveillance System for Infectious Diseases Among Asylum Seekers in Austrian Reception Centers, 2015-2018: Analysis of Reported Data

Abstract

BackgroundAustria has been among the main European countries hosting incoming asylum seekers since 2015. Consequently, there was an urgent need to predict any public health threats associated with the arriving asylum seekers. The Department of Surveillance and Infectious Disease Epidemiology at the Austrian Agency for Health and Food Safety (AGES) was mandated to implement a national syndrome-based surveillance system in the 7 reception centers by the Austrian Ministry of Interior and Ministry of Health.ObjectiveWe aimed to analyze the occurrence and spread of infectious diseases among asylum seekers using data reported by reception centers through the syndrome-based surveillance system from September 2015 through February 2018.MethodsWe deployed a daily data collection system for 13 syndromes: rash with fever; rash without fever; acute upper respiratory tract infection; acute lower respiratory tract infection; meningitis or encephalitis; fever and bleeding; nonbloody gastroenteritis or watery diarrhea; bloody diarrhea; acute jaundice; skin, soft tissue, or bone abnormalities; acute flaccid paralysis; high fever with no other signs; and unexplained death. General practitioners, the first professionals to consult for health problems at reception centers in Austria, sent the tally sheets on identified syndromes daily to the AGES.ResultsWe identified a total of 2914 cases, presenting 8 of the 13 syndromes. A total of 405 signals were triggered, and 6.4% (26/405) of them generated alerts. Suspected acute upper respiratory tract infection (1470/2914, 50.45% of cases), rash without fever (1174/2914, 40.29% of cases), suspected acute lower respiratory tract infection (159/2914, 5.46% of cases), watery diarrhea (73/2914, 2.51% of cases), and skin, soft tissue, or bone abnormalities (32/2914, 1.10% of cases) were the top 5 syndromes.ConclusionsThe cooperation of the AGES with reception center health care staff, supported by the 2 involved ministries, was shown to be useful for syndromic surveillance of infectious diseases among asylum seekers. None of the identified alerts escalated to an outbreak.

Effectiveness of early warning systems in the detection of infectious diseases outbreaks: a systematic review

“…Next, the previously stated countries with low activity of measles show less efficient predictions, such as Spain and UK. 6 El-Khatib, Z. et al, 2019 [ 57 ] Syndrome-Based Surveillance System (SbSS) for Infectious Diseases Among Asylum Seekers Staff 13 syndromes (rash with fever, rash without fever, acute upper respiratory tract infection, acute lower respiratory tract infection, meningitis or encephalitis, fever and bleeding, non-bloody gastroenteritis or watery diarrhea, bloody diarrhea, acute jaundice, skin, soft tissue, or bone abnormalities, acute flaccid paralysis, high fever with no other signs, and unexplained death Austria Retrospective Effective First, this system has high sensitivity and low specificity. Second, the SbSS is considered as a reliable method for public health surveillance that is used in different contexts.…”

“…Also, El-Khatib et al pointed out the practicability of tally sheets of the Syndrome-Based Surveillance System (SbSS) for Infectious Diseases among Asylum Seekers which monitor easily recognizable manifestations of infectious diseases [ 57 ]. The Austrian system is a reliable one with high sensitivity and had the advantage of rapid implementation in emergencies [ 57 ]. Moreover, surveilling school children in Taiwan–for students’ absenteeism and family health status besides clinical and epidemiological data–addressed gaps within ED-SSS since the former tracked mild cases at pre-diagnosis levels while the latter collected data on severe illnesses from all age groups throughout the year [ 64 ].…”

“…Nevertheless, low specificity and false-negative reports are potential drawbacks of the designated EWS category [ 61 ]. For example, the SbSS for Infectious Diseases among Asylum Seekers did not have consistent availability of staff at reservation centers nor accurate daily registration of refugees, and if asylum seekers were admitted to hospitals immediately, underreporting and under-detection of syndromes are potential challenges [ 57 ]. Additionally, Murray et al disclosed that evacuees – to avert isolation placement – were likely to hide illnesses [ 61 ].…”

Children Immunization App (CImA) Among Syrian Refugees in Zaatari Camp, Jordan: Protocol for a Cluster Randomized Controlled Pilot Trial Intervention Study (Preprint)

“…There is growing evidence on the effectiveness of smartphone technologies in supporting health care services [14], though there remain gaps in the evidence of effectiveness. Smartphones provide a novel approach to solve problems with data registration, transmission, and storage [15][16][17][18]. Currently, there are over 5.2 billion users, in low-and middle-income countries [19].…”

Iraq Mass Gathering Preparedness and Public Health Recommendations

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