title: ISS--an electronic syndromic surveillance system for infectious disease in rural China.
abstract: BACKGROUND
  Syndromic surveillance system has great advantages in promoting the early detection of epidemics and reducing the necessities of disease confirmation, and it is especially effective for surveillance in resource poor settings. However, most current syndromic surveillance systems are established in developed countries, and there are very few reports on the development of an electronic syndromic surveillance system in resource-constrained settings.
  
  
  OBJECTIVE
  This study describes the design and pilot implementation of an electronic surveillance system (ISS) for the early detection of infectious disease epidemics in rural China, complementing the conventional case report surveillance system.
  
  
  METHODS
  ISS was developed based on an existing platform 'Crisis Information Sharing Platform' (CRISP), combining with modern communication and GIS technology. ISS has four interconnected functions: 1) work group and communication group; 2) data source and collection; 3) data visualization; and 4) outbreak detection and alerting.
  
  
  RESULTS
  As of Jan. 31(st) 2012, ISS has been installed and pilot tested for six months in four counties in rural China. 95 health facilities, 14 pharmacies and 24 primary schools participated in the pilot study, entering respectively 74,256, 79,701, and 2330 daily records into the central database. More than 90% of surveillance units at the study sites are able to send daily information into the system. In the paper, we also presented the pilot data from health facilities in the two counties, which showed the ISS system had the potential to identify the change of disease patterns at the community level.
  
  
  CONCLUSIONS
  The ISS platform may facilitate the early detection of infectious disease epidemic as it provides near real-time syndromic data collection, interactive visualization, and automated aberration detection. However, several constraints and challenges were encountered during the pilot implementation of ISS in rural China.
authors.affiliation: Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. weirongy@ki.se
authors.forename: Weirong
authors.initials: W
authors.lastname: Yan
authors.forename: Lars
authors.initials: L
authors.lastname: Palm
authors.forename: Xin
authors.initials: X
authors.lastname: Lu
authors.forename: Shaofa
authors.initials: S
authors.lastname: Nie
authors.forename: Biao
authors.initials: B
authors.lastname: Xu
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhao
authors.forename: Tao
authors.initials: T
authors.lastname: Tao
authors.forename: Liwei
authors.initials: L
authors.lastname: Cheng
authors.forename: Li
authors.initials: L
authors.lastname: Tan
authors.forename: Hengjin
authors.initials: H
authors.lastname: Dong
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Diwan
mesh_terms: D002681:China / Q000453:epidemiology; D003141:Communicable Diseases / Q000453:epidemiology*; D004196:Disease Outbreaks; D006801:Humans; D020407:Internet; D010865:Pilot Projects; D040442:Public Health Informatics / Q000379:methods*; D062486:Public Health Surveillance / Q000379:methods*; D012424:Rural Population