title: The use of syndromic surveillance to monitor the incidence of arthropod bites requiring healthcare in England, 2000-2013: a retrospective ecological study.
abstract: Climate change experts predict the number of nuisance-biting arthropods in England will increase but there is currently no known surveillance system in place to monitor or assess the public health impact of arthropod bites. This retrospective ecological study utilized arthropod bites requiring healthcare from five national real-time syndromic surveillance systems monitoring general practitioner (GP) consultations (in-hours and out-of-hours), emergency department (ED) attendances and telephone calls to remote advice services to determine baseline incidence in England between 2000 and 2013 and to assess the association between arthropod bites and temperature. During summer months (weeks 20-40) we estimated that arthropod bites contribute a weekly median of ~4000 GP consultations, 750 calls to remote advice services, 700 ED and 1300 GP out-of-hours attendances. In all systems, incidence was highest during summer months compared to the rest of the year. Arthropod bites were positively associated with temperature with incidence rate ratios (IRRs) that ranged between systems from 1·03 [95% confidence interval (CI) 1·01-1·06] to 1·14 (95% CI 1·11-1·16). Using syndromic surveillance systems we have established and described baseline incidence of arthropod bites and this can now be monitored routinely in real time to assess the impact of extreme weather events and climate change.
authors.affiliation: Field Epidemiology Training Programme,Field Epidemiology Service,West Midlands,Public Health England,Birmingham,UK.
authors.forename: S
authors.initials: S
authors.lastname: Newitt
authors.affiliation: Real-time Syndromic Surveillance Team,National Infection Service, Public Health England,Birmingham,UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Elliot
authors.affiliation: Real-time Syndromic Surveillance Team,National Infection Service, Public Health England,Birmingham,UK.
authors.forename: R
authors.initials: R
authors.lastname: Morbey
authors.affiliation: Royal College of General Practitioners Research and Surveillance Centre,CIRC,London,UK.
authors.forename: H
authors.initials: H
authors.lastname: Durnall
authors.affiliation: Emergency Response Department Science & Technology,Public Health England,Porton Down,Salisbury,Wilts,UK.
authors.forename: M E
authors.initials: ME
authors.lastname: Pietzsch
authors.affiliation: Emergency Response Department Science & Technology,Public Health England,Porton Down,Salisbury,Wilts,UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Medlock
authors.affiliation: Emergency Response Department Science & Technology,Public Health England,Porton Down,Salisbury,Wilts,UK.
authors.forename: S
authors.initials: S
authors.lastname: Leach
authors.affiliation: Real-time Syndromic Surveillance Team,National Infection Service, Public Health England,Birmingham,UK.
authors.forename: G E
authors.initials: GE
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002648:Child; D002675:Child, Preschool; D057231:Climate Change; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007299:Insect Bites and Stings / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011634:Public Health; D012189:Retrospective Studies; D013696:Temperature; D064927:Tick Bites / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
keywords: Arthropod bite; climate change; mosquito; syndromic surveillance; temperature; tick