The effectiveness of syndromic surveillance for the early detection of waterborne outbreaks: a systematic review

Abstract

Background Waterborne outbreaks are still a risk in high-income countries, and their early detection is crucial to limit their societal consequences. Although syndromic surveillance is widely used for the purpose of detecting outbreaks days earlier than traditional surveillance systems, evidence of the effectiveness of such systems is lacking. Thus, our objective was to conduct a systematic review of the effectiveness of syndromic surveillance to detect waterborne outbreaks. Method We searched the Cochrane Library, Medline/PubMed, EMBASE, Scopus, and Web of Science for relevant published articles using a combination of the keywords ‘drinking water’, ‘surveillance’, and ‘waterborne disease’ for the period of 1990 to 2018. The references lists of the identified articles for full-text record assessment were screened, and searches in Google Scholar using the same key words were conducted. We assessed the risk of bias in the included articles using the ROBINS-I tool and PRECEPT for the cumulative body of evidence. Results From the 1959 articles identified, we reviewed 52 articles, of which 18 met the eligibility criteria. Twelve were descriptive/analytical studies, whereas six were simulation studies. There is no clear evidence for syndromic surveillance in terms of the ability to detect waterborne outbreaks (low sensitivity and high specificity). However, one simulation study implied that multiple sources of signals combined with spatial information may increase the timeliness in detecting a waterborne outbreak and reduce false alarms. Conclusion This review demonstrates that there is no conclusive evidence on the effectiveness of syndromic surveillance for the detection of waterborne outbreaks, thus suggesting the need to focus on primary prevention measures to reduce the risk of waterborne outbreaks. Future studies should investigate methods for combining health and environmental data with an assessment of needed financial and human resources for implementing such surveillance systems. In addition, a more critical thematic narrative synthesis on the most promising sources of data, and an assessment of the basis for arguments that joint analysis of different data or dimensions of data (e.g. spatial and temporal) might perform better, should be carried out. Trial registration PROSPERO: International prospective register of systematic reviews. 2019. CRD42019122332.

A Community Waterborne Salmonella Bovismorbificans Outbreak in Greece

“…These often lead to outbreaks and reveal the serious effects of low-quality water (even short-term) on developed countries [1][2][3]. Monitoring mechanisms and surveillance for early detection are important for developed countries and should not be neglected [4][5][6][7]. Although 2 of 14 uncommon in industrialized countries, community waterborne outbreaks (WBOs) may affect a large number of people in a short period of time, as contaminated drinking water reaches several households via the regional water supply system [8][9][10].…”

AI-aided geometric design of anti-infection catheters

“…Mainstream strategies to prevent bacterial contamination include the following: (i) physical barriers, such as filters or membranes (33)(34)(35)(36)(37)(38); (ii) antimicrobial agents, such as antibiotics (36,37); (iii) surface modifications of medical equipment to reduce bacterial adhesion and biofilm formation (38)(39)(40)(41)(42)(43)(44); (iv) control of physical/ chemical environment, such as high/low temperatures, low oxygen levels, or disinfectants to suppress bacterial growth and survival (45)(46)(47)(48); (v) strict sterilization procedures, such as gloving and gowning (49)(50)(51); and (vi) regularly monitoring patient conditions to detect and treat bacterial contamination early on (52)(53)(54). Although various surface modifications or coatings have been proposed to reduce bacterial adhesion, none has been shown to prevent upstream swimming or catheter contamination effectively (38)(39)(40).…”

Correction to: The effectiveness of syndromic surveillance for the early detection of waterborne outbreaks: a systematic review

“…Following the publication of the original article [1], some errors were identified in the text and in Table 1:…”