SCM: a practical tool to implement hospital-based syndromic surveillance.
BACKGROUND
Syndromic surveillance has been widely used for the early warning of infectious disease outbreaks, especially in mass gatherings, but the collection of electronic data on symptoms in hospitals is one of the fundamental challenges that must be overcome during operating a syndromic surveillance system. The objective of our study is to describe and evaluate the implementation of a symptom-clicking-module (SCM) as a part of the enhanced hospital-based syndromic surveillance during the 41st World Exposition in Shanghai, China, 2010.


METHODS
The SCM, including 25 targeted symptoms, was embedded in the sentinels' Hospital Information Systems (HIS). The clinicians used SCM to record these information of all the visiting patients, and data were collated and transmitted automatically in daily batches. The symptoms were categorized into seven targeted syndromes using pre-defined criteria, and statistical algorithms were applied to detect temporal aberrations in the data series.


RESULTS
SCM was deployed successfully in each sentinel hospital and was operated during the 184-day surveillance period. A total of 1,730,797 patient encounters were recorded by SCM, and 6.1 % (105,352 visits) met the criteria of the seven targeted syndromes. Acute respiratory and gastrointestinal syndromes were reported most frequently, accounted for 92.1 % of reports in all syndromes, and the aggregated time-series presented an obvious day-of-week variation over the study period. In total, 191 aberration signals were triggered, and none of them were identified as outbreaks after verification and field investigation.


CONCLUSIONS
SCM has acted as a practical tool for recording symptoms in the hospital-based enhanced syndromic surveillance system during the 41st World Exposition in Shanghai, in the context of without a preexisting electronic tool to collect syndromic data in the HIS of the sentinel hospitals.
Research Base of Key Laboratory of Surveillance and Early-warning on Infectious Disease in China CDC, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China.
Chuchu
C
Ye
Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
Zhongjie
Z
Li
Research Base of Key Laboratory of Surveillance and Early-warning on Infectious Disease in China CDC, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China.
Yifei
Y
Fu
Research Base of Key Laboratory of Surveillance and Early-warning on Infectious Disease in China CDC, West China School of Public Health, Sichuan University, Chengdu, China.
Yajia
Y
Lan
Research Base of Key Laboratory of Surveillance and Early-warning on Infectious Disease in China CDC, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China.
Weiping
W
Zhu
Research Base of Key Laboratory of Surveillance and Early-warning on Infectious Disease in China CDC, West China School of Public Health, Sichuan University, Chengdu, China.
Dinglun
D
Zhou
Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
Honglong
H
Zhang
Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.|Department of Geography and Environment, University of Southampton, Southampton, UK.
Shengjie
S
Lai
McGill University, Montreal, Canada.
David L
DL
Buckeridge
Research Base of Key Laboratory of Surveillance and Early-warning on Infectious Disease in China CDC, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China. qsun@pdcdc.sh.cn.
Qiao
Q
Sun
Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. ywz126@vip.sina.com.
Weizhong
W
Yang
D000465:Algorithms; D000846:Anniversaries and Special Events; D002681:China / Q000453:epidemiology; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000517:prevention & control*; D006751:Hospital Information Systems / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D062486:Public Health Surveillance / Q000379:methods*; D015203:Reproducibility of Results; D018571:Sentinel Surveillance; D013577:Syndrome
Early warning; Infectious disease; Mass gatherings; Outbreak detection; Syndromic surveillance