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. 2021 Jul 20;21(1):696.
doi: 10.1186/s12879-021-06387-y.

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

Susanne Hyllestad  1   2 , Ettore Amato  3 , Karin Nygård  3 , Line Vold  3 , Preben Aavitsland  3
Affiliations

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

Susanne Hyllestad et al. BMC Infect Dis. .

Erratum in

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 .

Keywords: Early detection; Gastrointestinal illness; Syndromic surveillance; Waterborne outbreaks.

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Conflict of interest statement

There is no competing interest.

Figures

Fig. 1
Fig. 1
Flow of studies identified and screened in the review
See this image and copyright information in PMC

References

    1. Mac Kenzie WR, Hoxie NJ, Proctor ME, Gradus MS, Blair KA, Peterson DE, Kazmierczak JJ, Addiss DG, Fox KR, Rose JB, Davis JP. A massive outbreak in Milwaukee of Cryptosporidium infection transmitted through the public water supply. N Engl J Med. 1994;331(3):161–167. doi: 10.1056/NEJM199407213310304. - DOI - PubMed
    1. Triple S Project. Assessment of syndromic surveillance in Europe. Lancet. 2011;378:1833–4. - PubMed
    1. Nygard K, Schimmer B, Sobstad O, Walde A, Tveit I, Langeland N, et al. A large community outbreak of waterborne giardiasis-delayed detection in a non-endemic urban area. BMC Public Health. 2006;6(1):141. doi: 10.1186/1471-2458-6-141. - DOI - PMC - PubMed
    1. Paterson BJ, Durrheim DN. The remarkable adaptability of syndromic surveillance to meet public health needs. J Epidemiol Glob Health. 2013;3(1):41–47. doi: 10.1016/j.jegh.2012.12.005. - DOI - PMC - PubMed
    1. Groeneveld GH, Dalhuijsen A, Kara-Zaïtri C, Hamilton B, de Waal MW, van Dissel JT, van Steenbergen JE. ICARES: a real-time automated detection tool for clusters of infectious diseases in the Netherlands. BMC Infect Dis. 2017;17(1):201. doi: 10.1186/s12879-017-2300-5. - DOI - PMC - PubMed

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