Establishing a web-based integrated surveillance system for early detection of infectious disease epidemic in rural China: a field experimental study

doi:10.1186/1472-6947-12-4

BMC Med Inform Decis Mak. 2012; 12: 4.

Published online 2012 February 3. doi: 10.1186/1472-6947-12-4

PMCID: PMC3395861

Establishing a web-based integrated surveillance system for early detection of infectious disease epidemic in rural China: a field experimental study

Wei-rong Yan,^1,² Shao-fa Nie,² Biao Xu,³ Heng-jin Dong,⁴ Lars Palm,⁵ and Vinod K Diwan¹

¹Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Nobelsvag 9, SE-17177, Stockholm, Sweden

²Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Science and Technology, Hangkong Road 13#, Wuhan, 430030, Hubei, China

³Department of Epidemiology, School of Public Health, Fudan University, No 138 Yi Xue Yuan Road, Shanghai, 200032, China

⁴Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China

⁵Future Position X (FPX), Nobelvägen 2, Box 975, SE-801 33, Gävle, Sweden

Corresponding author.

Wei-rong Yan: weirongy/at/gmail.com; Shao-fa Nie: sf_nie/at/mails.tjmu.edu.cn; Biao Xu: bxu/at/shmu.edu.cn; Heng-jin Dong: donghj/at/zju.edu.cn; Lars Palm: lars.palm/at/fpx.se; Vinod K Diwan: vinod.diwan/at/ki.se

Received January 10, 2012; Accepted February 3, 2012.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract

Background

A crucial goal of infectious disease surveillance is the early detection of epidemics, which is essential for disease control. In China, the current surveillance system is based on confirmed case reports. In rural China, it is not practical for health units to perform laboratory tests to confirm disease and people are more likely to get 'old' and emerging infectious diseases due to poor living conditions and closer contacts with wild animals and poultry. Syndromic surveillance, which collects non-specific syndromes before diagnosis, has great advantages in promoting the early detection of epidemics and reducing the necessities of disease confirmation. It will be especially effective for surveillance in resource poor settings.

Methods/Design

This is a field experimental study. The experimental tool is an innovative electronic surveillance system, combining syndromic surveillance with the existing case report surveillance in four selected counties in China. In the added syndromic surveillance, three types of data are collected including patients' major symptoms from health clinics, pharmaceutical sales from pharmacies and absenteeism information from primary school. In order to evaluate the early warning capability of the new added syndromic surveillance, the timelines and validity of the alert signals will be analyzed in comparison with the traditional case reporting system. The acceptability, feasibility and economic evaluation of the whole integrated surveillance system will be conducted in a before and after study design.

Discussions

Although syndromic surveillance system has mostly been established in developed areas, there are opportunities and advantages of developing it in rural China. The project will contribute to knowledge, experience and evidence on the establishment of an integrated surveillance system, which aims to provide early warning of disease epidemics in developing countries.

Keywords: Syndromic surveillance, infectious disease, early warning, resource limited settings

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