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

Abstract

Background Global pandemics have occurred with increasing frequency over the past decade reflecting the sub-optimum operationalization of surveillance systems handling human health data. Despite the wide array of current surveillance methods, their effectiveness varies with multiple factors. Here, we perform a systematic review of the effectiveness of alternative infectious diseases Early Warning Systems (EWSs) with a focus on the surveillance data collection methods, and taking into consideration feasibility in different settings. Methods We searched PubMed and Scopus databases on 21 October 2022. Articles were included if they covered the implementation of an early warning system and evaluated infectious diseases outbreaks that had potential to become pandemics. Of 1669 studies screened, 68 were included in the final sample. We performed quality assessment using an adapted CASP Checklist. Results Of the 68 articles included, 42 articles found EWSs successfully functioned independently as surveillance systems for pandemic-wide infectious diseases outbreaks, and 16 studies reported EWSs to have contributing surveillance features through complementary roles. Chief complaints from emergency departments’ data is an effective EWS but it requires standardized formats across hospitals. Centralized Public Health records-based EWSs facilitate information sharing; however, they rely on clinicians’ reporting of cases. Facilitated reporting by remote health settings and rapid alarm transmission are key advantages of Web-based EWSs. Pharmaceutical sales and laboratory results did not prove solo effectiveness. The EWS design combining surveillance data from both health records and staff was very successful. Also, daily surveillance data notification was the most successful and accepted enhancement strategy especially during mass gathering events. Eventually, in Low Middle Income Countries, working to improve and enhance existing systems was more critical than implementing new Syndromic Surveillance approaches. Conclusions Our study was able to evaluate the effectiveness of Early Warning Systems in different contexts and resource settings based on the EWSs’ method of data collection. There is consistent evidence that EWSs compiling pre-diagnosis data are more proactive to detect outbreaks. However, the fact that Syndromic Surveillance Systems (SSS) are more proactive than diagnostic disease surveillance should not be taken as an effective clue for outbreaks detection.

Zoonotic spillover and viral mutations from low and middle-income countries: improving prevention strategies and bridging policy gaps

“…In 2019, Madagascar confronted its most extensive documented measles outbreak in history. Spanning from September 2018 to January 2020, the outbreak affected nearly 225,000 individuals, resulting in slightly over 1,000 fatalities ( Meckawy et al, 2022 ). Madagascar, being one of the world’s poorest nations with one of the least funded health systems, faced significant challenges in managing the outbreak due to its weak healthcare infrastructure and struggling surveillance systems ( Finnegan et al, 2020 ).…”

Harnessing Data Insights for Crisis Management in U.S. Public Health: Lessons Learned and Future Directions

“…Syndromic surveillance systems monitor non-specific indicators of illness, such as fever or respiratory symptoms, to detect outbreaks early. These systems analyze data from sources such as emergency department visits, school absenteeism, pharmacy sales, and telehealth consultations to identify unusual patterns or clusters of symptoms that may indicate a public health threat (Meckawy et al, 2022). Disease surveillance networks collect and analyze data on reportable diseases, laboratory test results, and case investigations to monitor the spread of infectious diseases.…”

Preparing for future outbreaks in Ghana: An overview of current COVID-19, monkeypox, and Marburg disease outbreaks

“…This can be achieved through the implementation of robust surveillance mechanisms, such as real-time data collection, analysis, and reporting systems. 61 Integration of advanced technologies, including genomic sequencing and rapid diagnostic tests, can significantly improve the accuracy and speed of case detection and response. 62 , 63 Moreover, using and harmonizing digital surveillance tools in the country can improve the quality and efficiency of surveillance and case finding.…”