Establishing a nationwide emergency department-based syndromic surveillance system for better public health responses in Taiwan.
BACKGROUND
With international concern over emerging infectious diseases (EID) and bioterrorist attacks, public health is being required to have early outbreak detection systems. A disease surveillance team was organized to establish a hospital emergency department-based syndromic surveillance system (ED-SSS) capable of automatically transmitting patient data electronically from the hospitals responsible for emergency care throughout the country to the Centers for Disease Control in Taiwan (Taiwan-CDC) starting March, 2004. This report describes the challenges and steps involved in developing ED-SSS and the timely information it provides to improve in public health decision-making.


METHODS
Between June 2003 and March 2004, after comparing various surveillance systems used around the world and consulting with ED physicians, pediatricians and internal medicine physicians involved in infectious disease control, the Syndromic Surveillance Research Team in Taiwan worked with the Real-time Outbreak and Disease Surveillance (RODS) Laboratory at the University of Pittsburgh to create Taiwan's ED-SSS. The system was evaluated by analyzing daily electronic ED data received in real-time from the 189 hospitals participating in this system between April 1, 2004 and March 31, 2005.


RESULTS
Taiwan's ED-SSS identified winter and summer spikes in two syndrome groups: influenza-like illnesses and respiratory syndrome illnesses, while total numbers of ED visits were significantly higher on weekends, national holidays and the days of Chinese lunar new year than weekdays (p < 0.001). It also identified increases in the upper, lower, and total gastrointestinal (GI) syndrome groups starting in November 2004 and two clear spikes in enterovirus-like infections coinciding with the two school semesters. Using ED-SSS for surveillance of influenza-like illnesses and enteroviruses-related infections has improved Taiwan's pandemic flu preparedness and disease control capabilities.


CONCLUSIONS
Taiwan's ED-SSS represents the first nationwide real-time syndromic surveillance system ever established in Asia. The experiences reported herein can encourage other countries to develop their own surveillance systems. The system can be adapted to other cultural and language environments for better global surveillance of infectious diseases and international collaboration.
Wu
Tsung-Shu Joseph
TS
Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei City, Taiwan. wcsg@msn.com
Shih
Fuh-Yuan Frank
FY
Yen
Muh-Yong
MY
Wu
Jiunn-Shyan Julian
JS
Lu
Shiou-Wen
SW
Chang
Kevin Chi-Ming
KC
Hsiung
Chao
C
Chou
Jr-How
JH
Chu
Yu-Tseng
YT
Chang
Hang
H
Chiu
Chan-Hsien
CH
Tsui
Fu-Chiang Richard
FC
Wagner
Michael M
MM
Su
Ih-Jen
IJ
King
Chwan-Chuen
CC
D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000517:prevention & control; D003199:Computer Systems; D003659:Decision Making, Organizational; D004196:Disease Outbreaks / Q000145:classification / Q000517:prevention & control* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004769:Enterovirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D005843:Geography; D006801:Humans; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D038801:International Classification of Diseases; D011159:Population Surveillance / Q000379:methods*; D011635:Public Health Administration / Q000379:methods*; D040442:Public Health Informatics; D013577:Syndrome; D013624:Taiwan / Q000453:epidemiology; D014218:Triage