Using emergency department syndromic surveillance to investigate the impact of a national vaccination program: A retrospective observational study

Abstract

Background Rotavirus infection is a common cause of gastroenteritis in children worldwide, with a high mortality burden in developing countries, particularly during the first two years of life. Rotavirus vaccination was introduced into the United Kingdom childhood vaccination schedule in July 2013, with high coverage (>90%) achieved by June 2016. We used an emergency department (ED) syndromic surveillance system to assess the impact of the rotavirus vaccination programme, specifically through the demonstration of any immediate and continuing impact on ED gastroenteritis visits in England. Methods This retrospective, observational study used syndromic surveillance data collected from 3 EDs in the two years before (July 2011-June 2013) and 3 years post (July 2013-June 2016) introduction of rotavirus vaccination. The weekly levels of ED visits for gastroenteritis (by age group and in total) during the period before rotavirus vaccination was first described alongside the findings of laboratory surveillance of rotavirus during the same period. An interrupted time-series analysis was then performed to demonstrate the impact of rotavirus vaccination introduction on gastroenteritis ED visit levels. Results During the two years before vaccine introduction ED visits for gastroenteritis in total and for the 0-4 years age group were seen to rise and fall in line with the seasonal rotavirus increases reported by laboratory surveillance. ED gastroenteritis visits by young children were lower in the three years following introduction of rotavirus vaccination (reduced from

Early Detection and Monitoring of Gastrointestinal Infections Using Syndromic Surveillance: A Systematic Review

“…The 29 studies identified from the full screen included a range of different syndromic surveillance systems from ten countries and territories across Korea, United States, France, Sweden, Netherlands, Spain, Canada, United Kingdom, Japan, and Portugal. Just over half of the studies (52%, 15/29) were reported from the United States and United Kingdom [8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25]. About 55% (16/29) [13,16,[22][23][24][25][26][27][28][29][30][31][32][33][34][35] of the studies indicated that syndromic surveillance exhibited the potential to detect GI infections earlier than traditional surveillance, while a further 10% (3/29) of studies indicated that syndromic surveillance exhibits the potential to detect GI infections or symptoms at an early stage but with limitations [15,20,36]; a further 3% (1/29) highlighted that syndromic surveillance exhibits potential to detect GI infections or symptoms at an early stage only when combined with traditional surveillance system [18].…”

“…The usefulness of syndromic surveillance in identifying GI infections or symptoms at an early stage was deemed unclear in 24% (7/29) of the included studies [8,12,17,19,21,37,38], while 2/29 of the included studies suggested that syndromic surveillance was incapable of detecting GI infections at an earlier stage in comparison to traditional surveillance [14,39].…”

“…The use of syndromic surveillance systems for continuous day to day monitoring of GI infections to either track seasonal peaks, surges, or irregular occurrences of GI infections were explicitly stated in 90% (27/29) of the included studies [8,12,13,15,16,.…”

“…The syndromic surveillance systems reported in the selected studies described different sources of syndromic data, of which the emergency department (ED) setting was the most frequently utilized [12,[15][16][17]19,24,27,33,34,36]. Of the included studies, 3/29 reported the use of multiple or combined syndromic surveillance systems [24,25,27].…”

A Cross-sectional Survey to Assess Awareness of Syndromic Surveillance by Clinicians Practicing Emergency Medicine: An Opportunity for Education and Collaboration

“…4 Syndromic surveillance has also been used to prove the efficacy of vaccination initiatives by demonstrating a decrease in patients presenting to EDs for target diseases. 6,7 Furthermore, SyS has been used to analyze extreme weather events, providing information to assist in statewide response plans. [8][9][10] The public health applications of SyS are as vast as the data SyS obtains from EHR-documented symptoms and diagnoses, and the data can be used to more rapidly respond to emerging health threats than traditional sources of public health information.…”