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. 2025 Nov 3;15(1):38281.
doi: 10.1038/s41598-025-13675-z.

Establishing and validating syndromic surveillance of gastrointestinal infections using routine emergency department data, Germany, 2019-2023

Jonathan Hans Josef Baum  1   2   3 , Achim Dörre  4   5 , Tamara Sonia Boender  4   6   7 , Katharina Heldt  8 , Hendrik Wilking  4 , Susanne Drynda  9 , Bernadett Erdmann  10 , Rupert Grashey  11 , Caroline Grupp  12 , Kirsten Habbinga  13 , Eckard Hamelmann  14 , Amrei Heining  15 , Heike Höger-Schmidt  16 , Clemens Kill  17 , Friedrich Reichert  18 , Joachim Riße  17 , Tobias Schilling  19 ; AKTIN Research Group; Madlen Schranz  4   20
Collaborators, Affiliations

Establishing and validating syndromic surveillance of gastrointestinal infections using routine emergency department data, Germany, 2019-2023

Jonathan Hans Josef Baum et al. Sci Rep. .

Abstract

Gastrointestinal infections in Germany account for 24.5 million outpatient visits annually. To enhance outbreak detection and trend monitoring, we developed and validated a syndrome definition for syndromic surveillance of gastrointestinal infections in emergency departments. We selected presenting complaints (Canadian Emergency Department Information System) and diagnoses (ICD-10) to develop the syndrome definition. Validation involved cross-correlation analysis of syndromic and laboratory-based surveillance trends (norovirus-gastroenteritis, rotavirus-gastroenteritis, campylobacteriosis and salmonellosis notifications). We included emergency departments from the German AKTIN registry with continuous data transmission (01/2019-06/2023). Our novel syndrome definition combined complaints (diarrhoea, vomiting, nausea) and diagnoses (intestinal infectious diseases). Across 864,353 visits in 7 emergency departments, 2.1% (n = 18,158) were gastrointestinal infection cases. Of those, 57% (n = 10,424) were female; 23% were aged 0-19 years (n = 4108); and 23% 20-39 years (n = 4116). Trends were similar between surveillance systems. Cross-correlation was 0.73 (95%-confidence interval 0.61-0.85; p < 0.001) at lag - 1, indicating a 1-week relative reporting delay of laboratory-based surveillance. Coherent trends and significant cross-correlation validated our syndrome definition. This novel automated syndromic surveillance complements laboratory-based surveillance while offering improved timeliness and reduced workload. Therefore, it was implemented in Germany's national routine surveillance of emergency departments.

Keywords: Emergency department; Emergency service, hospital; Gastroenteritis; Gastrointestinal diseases; Gastrointestinal infection; Public health surveillance; Sentinel surveillance; Syndromic surveillance.

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Conflict of interest statement

Declarations. Ethics approval: The AKTIN emergency department registry received ethics approval from the Ethics Committee of the medical facility of the Otto von Guericke University in Magdeburg (ethics approval: 160/15 and 52/21). Primary data is stored (pseudonymized and decentralized) in local data warehouses at each hospital. AKTIN provides anonymized data to researchers after approval from their Data Use and Access Committee. Therefore, an additional ethics approval for this specific study is not required. Moreover, the use of routine emergency department data for surveillance was approved by the data protection officer at the Robert Koch Institute (BDS/ISB, 09-01-2019). Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Syndrome definition used for surveillance of gastrointestinal infections in emergency departments by presenting complaint according to the Canadian Emergency Department Information System and ICD-10 codes. Germany, 2019–2023.
Fig. 2
Fig. 2
Visual comparison of emergency department indicator (orange) and combined reference indicator (blue) trends as 5-week-moving-averages. Please note different scales on left and right y-axes. Germany, between week 01/2019 and up to week 23/2023.
Fig. 3
Fig. 3
Visual comparison of emergency department indicator (orange) and reference indicator (blue) trends as 5-week-moving-averages stratified by age groups. Please note different scales on left and right y-axis. Germany, between week 01/2019 and up to week 23/2023.
See this image and copyright information in PMC

References

    1. National Cancer Institute. NCI’s Dictionary of Cancer Terms. n.d. [cited 2023 Feb 02]. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/gastro....
    1. World Health Organization. Global Health Estimates 2019: Deaths by Cause, Age, Sex, by Country and by Region, 2000–2019. 2020 [cited 2022 Mar 02]. https://www.who.int/data/gho/data/themes/mortality-and-global-health-est....
    1. Wilking, H. et al. Acute gastrointestinal illness in adults in Germany: a population-based telephone survey. Epidemiol. Infect.141(11), 2365–2375 (2013). - PMC - PubMed
    1. Robert Koch-Institut. Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2019. Berlin 2020.
    1. Robert Koch-Institut. Falldefinitionen des Robert Koch-Instituts zur Übermittlung von Erkrankungs-oder Todesfällen und Nachweisen von Krankheitserregern gemäß § 11 Abs. 2 des Gesetzes zur Verhütung und Bekämpfung von Infektionskrankheiten beim Menschen (Infektionsschutzgesetz-IfSG). Berlin; 2019.

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