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Review
. 2023 Sep 25;20(19):6822.
doi: 10.3390/ijerph20196822.

Emergency Department Syndromic Surveillance to Monitor Tick-Borne Diseases: A 6-Year Small-Area Analysis in Northeastern Italy

Massimiliano Colucci  1 , Marco Fonzo  2 , Liana Miccolis  2 , Irene Amoruso  2 , Sara Mondino  1 , Andrea Trevisan  2 , Romina Cazzaro  1 , Tatjana Baldovin  2 , Chiara Bertoncello  2
Affiliations
Review

Emergency Department Syndromic Surveillance to Monitor Tick-Borne Diseases: A 6-Year Small-Area Analysis in Northeastern Italy

Massimiliano Colucci et al. Int J Environ Res Public Health. .

Abstract

Tick-borne diseases (TBD) are endemic in Europe. However, surveillance is currently incomplete. Alternative strategies need to be considered. The aim of this study was to test an Emergency Department Syndromic Surveillance (EDSyS) system as a complementary data source to describe the impact of tick bites and TBD using a small-area analysis approach and to monitor the risk of TBD to target prevention. ED databases in the Local Health Authority 8 District (Veneto, Italy) were queried for tick-bite and TBD-related visits between January 2017 and December 2022. Hospitalisations were also collected. Events involving the resident population were used to calculate incidence rates. A total of 4187 ED visits for tick-bite and 143 for TBD were recorded; in addition, 62 TBD-related hospitalisations (of which 72.6% in over 50 s and 22.6% in over 65 s). ED visits peaked in spring and in autumn, followed by a 4-week lag in the increase in hospital admissions. The small-area analysis identified two areas at higher risk of bites and TBD. The use of a EDSyS system allowed two natural foci to be identified. This approach proved useful in predicting temporal and geographic risk of TBD and in identifying local endemic areas, thus enabling an effective multidisciplinary prevention strategy.

Keywords: Italy; Lyme disease; emergency department; epidemic intelligence; incidence; small-area analysis; syndromic surveillance; tick-bites; tick-borne diseases; tick-borne encephalitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Number of bite-related ED visits (ED-bite events; primary y-axis on the left), TBD-related ED visits (ED-TBD events, secondary y-axis on the right), and overall number of TBE-related hospitalisations (hos-TBD events, secondary y-axis on the right) per age group of study population. Local Health Authority 8 (Azienda ULSS Berica), Veneto Region, Italy, 2017–2022.
Figure 2
Figure 2
Number of bite-related ED visits (ED-bite events; primary y-axis on the left), TBD-related ED visits (ED-TBD events, secondary y-axis on the right), and overall number of TBE-related hospitalisations (hos-TBD events, secondary y-axis on the right) per month of the year. Local Health Authority 8 (Azienda ULSS Berica), Veneto Region, Italy, 2017–2022.
Figure 3
Figure 3
(a) Incidence of tick-bites (ED-bites events/1000 population/6-year) per municipality; municipalities with incidence >7.0 are grouped in the two subareas of interest (marked with red dotted line) (b) Mean elevation of municipalities in the LHA district; (c) Localisation of the study area. Local Health Authority 8 (Azienda ULSS Berica), Vicenza, Veneto Region, Italy, 2017–2022.
See this image and copyright information in PMC

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