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Respiratory cases		Gastrointestinal cases		Emergencies
Selecting Targeted Symptoms/Syndromes for Syndromic Surveillance in Rural China

Authors:	Li Tan Jie Zhang Liwei Cheng Weirong Yan Vinod K Diwan Lu Long Shaofa Nie

Institution:	1.Tongji Medical College, Wuhan City, China;;2.Karolinska Institutet, Stockholm, Sweden

Abstract:	Objective To select the potential targeted symptoms/syndromes as early warning indicators for epidemics or outbreaks detection in rural China. Introduction Patients’ chief complaints (CCs) as a common data source, has been widely used in syndromic surveillance due to its timeliness, accuracy and availability (1). For automated syndromic surveillance, CCs always classified into predefined syndromic categories to facilitate subsequent data aggregation and analysis. However, in rural China, most outpatient doctors recorded the information of patients (e.g. CCs) into clinic logs manually rather than computers. Thus, more convenient surveillance method is needed in the syndromic surveillance project (ISSC). And the first and important thing is to select the targeted symptoms/syndromes. Methods Epidemiological analysis was conducted on data from case report system in Jingmen City (one study site in ISSC) from 2004 to 2009. Initial symptoms/syndromes were selected by literature reviews. And finally expert consultation meetings, workshops and field investigation were held to confirm the targeted symptoms/syndromes. Results 10 kinds of infectious diseases, 6 categories of emergencies, and 4 bioterrorism events (i.e. plague, anthrax, botulism and hemorrhagic fever) were chose as specific diseases/events for monitoring (
Name	%	Name	%	Name	Events (No.)
^*Pulmonary tuberculosis	82.38	^†Hand-foot-mouth diseases	41.73	^†A(H1N1)	10
^†Mumps	9.14	^†Bacillary dysentery	28.56	^†Mumps	5
^†Measles	3.35	^†Hepatitis A	15.36	^†Hand-foot-mouth diseases	1
^†Varicella	2.00	^† Infectious diarrhea	6.58	^†Bacillary dysentery	1
^†Influenza/A(H1N1)	1.79	^†Hepatitis E	4.30	^†Food poisoning	2
^†Rubella	0.72	Typhoid	3.03	^†Unknown reason dermatitis	1
Scarlet fever	0.44	Paratyphoid	0.22
Pertussis	0.15	Amebic dysentery	0.22
Meningococcal meningitis	0.03
Total	100.00	Total	100.00	Total	20

Open in a separate window^*Chronic infectious diseases (excluded).^†Selected specific diseases (top 5) or events (non-infectious excluded).

Table 2

List of symptoms/syndromes

^*Scheme 1				^**Scheme 2
No.	Symptoms	No.	Symptoms	No.	Syndromes
1	Abdominal pain	11	^† Headache	1	Coma/sudden death
2	Bone/muscle/joint Pain	12	Hematochezia	2	Fever
3	Chills	13	Jaundice	3	Gastrointestinal
4	Conjunctival hyperemia	14	^†Mucocutaneous hemorrhage	4	Hemorrhagic
5	^†Convulsion	15	Nasal congestion/Rhinorrhea	5	Influenza like illness
6	^†Cough	16	^†Nausea/Vomitting	6	Neurological
7	^†Diarrhea	17	^†Rach	7	Rash
8	^†Disturbance of consciousness	18	^†Sore throat	8	Respiratory
9	Fatigue	19	Tenesmus
10	^†Fever

Open in a separate window^*The incidence of symptom was >= 20% of specific disease(s)/event(s).^**The number of times of syndromes monitored was >= 4 times. Asthma (4 times) and diarrhea (5 times) were excluded due to study objectives.^†Final targeted symptoms.

Conclusions

We should take the simple, stability and feasibility of operation, and also the local conditions into account before establishing a surveillance system. Symptoms were more suitable for monitoring compared to syndromes in resource-poor settings. Further evaluated and validated would be conducted during implementation. Our study might provide methods and evidences for other developing countries with limited conditions in using automated syndromic surveillance system, to construct similar early warning system.

Keywords:

Syndromic surveillance Chief complaint Early warning

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Objective

Introduction

Methods

Results

Table 2

Conclusions