Real-Time Surveillance

  • Al-Tawfiq JA, Zumla A, Gautret P, et al. (2014.) Surveillance for emerging respiratory viruses. Lancet Infectious Diseases, 14(10), 992-1000.
    • In 2003, WHO issued a worldwide alert for an unknown emerging illness, later named severe acute respiratory syndrome (SARS). The disease caused by a novel coronavirus (SARS-CoV) rapidly spread worldwide, causing more than 8000 cases and 800 deaths in more than 30 countries with a substantial economic impact. Since then, the world has witnessed the emergence of several other viral respiratory pathogens including influenza viruses (avian influenza H5N1, H7N9, and H10N8; variant influenza A H3N2 virus), human adenovirus-14, and Middle East respiratory syndrome coronavirus (MERS-CoV). This paper aims to provide a review of active surveillance systems for emerging and re-emerging respiratory viruses.
  • Aramaki E, Maskawa S, Morita M. (2011). Twitter catches the flu: detecting influenza epidemics using Twitter. In: Proceedings of the conference on empirical methods in natural language processing. Stroudsburg: Association for Computational Linguistics.
    • With the recent rise in popularity and scale of social media, there is a growing for systems that can extract useful information from huge amounts of data. These authors attempt to address this issue by using Twitter to detect influenza epidemics. The proposed system extracts influenza-related tweets using Twitter API. Then, only tweets that mention actual influenza patients are extracted by the support vector machine based classifier. The experiment results demonstrate the feasibility of the proposed approach, especially at the start of the outbreak and early spread.
  • Baker MG, Fidler DP. (2006). Global public health surveillance under new international health regulations. Emerging Infectious Diseases, 12(7), 1058.
    • One of the most important aspects of IHR 2005 is the establishment of a global surveillance system for public health emergencies of international concern. This article assesses the surveillance system in IHR 2005 by applying well-established frameworks for evaluating public health surveillance.
  • Balajee SA, Arthur R, Mounts AW. (2016). Global health security: building capacities for early event detection, epidemiologic workforce, and laboratory response. Health Security, 14(6), 424-32.  
    • The Global Health Security Agenda (GHSA) was launched in February 2014 to bring countries with limited capacity into compliance with the International Health Regulations (IHR 2005). This article focuses on 3 aspects of the GHSA that will lead to improved capacities for the detection and response to outbreaks as required by the IHR: (i) early detection and reporting of events, (ii) laboratory capacity, and (iii) a trained epidemiologic workforce.
  • Bansal S, Chowell G, Simonsen L, et al. (2016). Big data for infectious disease surveillance and modeling. Journal of Infectious Diseases, 214(S4), 375-79.      
    • This special issue of the Journal of Infectious Diseases reviews the recent advances of big data in strengthening disease surveillance, monitoring medical adverse events, informing transmission models, and tracking patient sentiments and mobility. The special issue highlights several cross-cutting areas that require further research, including representativeness, biases, volatility, and validation, and the need for robust statistical and hypothesis-driven analyses.
  • Bravata DM, McDonald KM, Smith WM, et al. (2004). Systematic review: surveillance systems for early detection of bioterrorism-related diseases. Annals of Internal Medicine, 140(11), 910-22.
    • Given the threat of bioterrorism and the increasing availability of electronic data for surveillance, surveillance systems for the early detection of illnesses and syndromes potentially related to bioterrorism have proliferated. This study critically evaluates the potential utility of existing surveillance systems for illnesses and syndromes related to bioterrorism.
  • Brinkel J, Krämer A, Krumkamp R, et al. (2014). Mobile Phone-Based mHealth Approaches for Public Health Surveillance in Sub-Saharan Africa: A Systematic Review. International Journal of Environmental Research and Public Health, 11(11), 11559–82.
    • Whereas mobile phone-based surveillance has the potential to provide real-time validated data for disease clustering and prompt respond and investigation, little evidence is available on current practice in sub-Sahara Africa. The objective of this review was to examine mobile phone-based mHealth interventions for Public Health surveillance in the region. Results suggest that mobile phone-based surveillance projects in the sub-Saharan African countries are on small scale, fragmented and not well documented.
  • Brownstein JS, Freifeld CC, Reis BY, et al. (2008). Surveillance Sans Frontières: Internet-Based Emerging Infectious Disease Intelligence and the HealthMap Project. PLoS Med, 5(7), e151.
    • Web-based electronic information sources can play an important role in early event detection and support situational awareness by providing current, highly local information about outbreaks, even from areas relatively invisible to traditional global public health efforts. Still, information overload and difficulties in distinguishing “signal from noise” pose substantial barriers to fully utilizing this information. This article describes the HealthMap Project – a freely accessible, automated real-time system that monitors, organizes, integrates, filters, visualizes, and disseminates online information about emerging diseases.
  • Brownstein JS, Freifeld CC, Madoff LC. (2009). Digital Disease Detection-Harnessing the Web for Public Health Surveillance. New England Journal of Medicine, 360, 2153-57.
    • The Internet has become a critical medium for clinicians, public health practitioners, and laypeople seeking health information. Data about diseases and outbreaks are disseminated not only through online announcements by government agencies but also through informal channels, ranging from press reports to blogs to chat rooms to analyses of Web searches. This article provides an overview of these sources.
  • Calain P. (2007). Exploring the international arena of global public health surveillance. Health Policy and Planning, 22(1), 2-12.
    • This paper explores external factors influencing political commitment to comply with the 2005 International Health Regulations (IHR) and illustrates the adverse effects generated by a number of selected challenges.
  • Calain P. (2007). From the field side of the binoculars: a different view on global public health surveillance. Health Policy and Planning, 22(1), 13-20.
    • In developing countries, the multiplication of supra-national public health surveillance initiatives reflects a focus on the exclusive interests and priorities of donor countries or institutions. But, at the country level, the global public health surveillance agenda runs the risk of being translated into new categorical programmes ignoring deficits in health systems and local public health priorities. This paper describes the risks posed by this trend and describes several pilot initiatives at sub-national level showing that the empowerment of frontline health workers and communities is a key element for an efficient surveillance system.
  • Carneiro HA, Mylonakis E. (2009). Google trends: a web-based tool for real-time surveillance of disease outbreaks. Clinical Infectious Diseases, 49(10), 1557-64.
    • Google Flu Trends can detect regional outbreaks of influenza 7–10 days before conventional Centers for Disease Control and Prevention surveillance systems. This article describes the Google Trends tool, explains how the data are processed, presents examples, and discusses the strengths and limitations of this unique tool.
  • Cash RA, Narasimhan V. (2000). Impediments to global surveillance of infectious diseases: consequences of open reporting in a global economy. Bulletin of the World Health Organization, 78, 1358-67.
    • Globalization has led to an increase in the spread of emerging and re-emerging infectious diseases. International efforts are being launched to control their dissemination through global surveillance, a major hindrance to which is the failure of some countries to report outbreaks. This article discusses the shortcomings of guidelines and regulations on emerging and re-emerging infectious diseases, notably that they do not sufficiently account for the disproportionately heavy social and economic consequences that follow reporting an outbreak. The article presents two cases — plague in India and cholera in Peru — that illuminate some of the limitations of current practices.
  • Centers for Disease Control and Prevention. SurvCost: A Tool to Estimate the Cost of Integrated Disease Surveillance and Response.

    • SurvCost is a spreadsheet-based tool developed to aid public health officials to estimate the cost of Integrated Disease Surveillance and Response systems at national, regional, district, and local levels. It estimates the costs of seven categories of resources: personnel, office operating items, transportation, laboratory materials and supplies, treatment and programmatic response items, media or public awareness campaigns, and capital items. 

  • Chretien JP, Tomich NE, Gaydos JC, et al. (2009). Real-time public health surveillance for emergency preparedness. American Journal of Public Health, 99(8), 1360-63.

    • Public health agencies conduct surveillance to identify and prioritize health issues and evaluate interventions. Recently, natural and deliberate epidemics have motivated supplementary approaches to traditional surveillance methods based on physician and laboratory reporting, known as syndromic surveillance. Still, these systems have often proven unreliable for detecting natural and simulated epidemics, real-time health-related data hold promise for public health. This article discusses how, if redesigned to reliably perform beyond outbreak detection, syndromic systems could demonstrate unprecedented capabilities in responding to public health emergencies.

  • Ciotti M. (2013). Health security and disease detection in the European Union. In: Biopreparedness and Public Health. Springer, Dordrecht.         
    • The European Centre for Disease Control and Prevention (ECDC) has developed an epidemic intelligence framework that encompasses all activities related to early identification of potential health hazards, their verification, assessment and investigation, in order to recommend public health control measures. Since June 2005, about 900 threats have been monitored by ECDC. Several threats made it necessary to develop formal risk assessments or to dispatch ECDC experts to outbreak areas. This chapter presents examples of recent events, identified through the epidemic intelligence activity, to illustrate the course of action from threat detection through risk management in Europe.
  • Cordes KM, Cookson ST, Boyd AT, et al. (2017). Real-time surveillance in emergencies using the early warning alert and response network. Emerging Infectious Diseases, 23(S1), 131.
    • Strengthening capacity for simplified early warning surveillance for diseases of epidemic potential enhances countries’ abilities to detect events affecting public health and acute threats to global health security during emergencies. Early Warning Alert and Response Network (EWARN) systems have been useful sources of information where no other data were available during many emergencies, including conflicts and natural disasters, in more than a dozen countries around the world. This article discusses how the early detection and control of outbreaks through EWARN has prevented their spread and is an important component of global health security efforts, and what is needed to support the Network moving forward.
  • Corley CD, Lancaster MJ, Brigantic RT, et al. (2012). Assessing the Continuum of Event-Based Biosurveillance Through an Operational Lens. Biosecurity & Bioterrorism, 10(1), 131-44.
    • Models and complex systems have been developed to detect or forecast chemical, biological, and radiological events that have a significant impact on the One Health landscape. This article frames the continuum of event-based biosurveillance systems, models, and constructs through an operational lens.
  • Cowling BJ, Wong IO, Ho LM, et al. (2006). Methods for monitoring influenza surveillance data. International Journal of Epidemiology, 35(5), 1314-21.  

    • In this paper, the three methods in this latter group of statistical approaches requiring only data from recent weeks to generate alerts are compared on influenza sentinel surveillance data from Hong Kong and the US. This may be particularly interesting for and applicable to surveillance networks in subtropical settings or with fewer numbers of reporting sentinels, where reported inter-epidemic levels of ILI are subject to more fluctuation and peak seasons can be less distinct.

  • Denecke K, Dolog P, Smrz P. (2012). Making use of social media data in public health. In: Proceedings of the 21st International Conference on World Wide Web. New York: ACM.       
    • Disease surveillance systems exist to offer an easily accessible epidemiological snapshot on up-to-date summary statistics for numerous infectious diseases. However, these indicator-based systems represent only part of the solution. Experiences show that they fail when confronted with agents that are new emerging like the agents causing the lung disease SARS in 2002. Further, due to slow reporting mechanisms, the time until health threats become visible to public health officials can be long. The M-Eco project provides an event-based approach to the early detection of emerging health threats. The developed technologies exploit content from social media and multimedia data as input and analyze it by sophisticated event-detection techniques to identify potential threats. Alerts for public health threats are provided to the user in a personalized way.
  • Ginsberg J, Mohebbi MH, Patel RS, et al. (2009). Detecting influenza epidemics using search engine query data. Nature, 457(7232), 1012-14.
    • One option for improving the early detection of infectious disease outbreaks is to monitor health-seeking behavior in the form of queries to online search engines, which are submitted by millions of users around the world each day. This article presents a method of analyzing large numbers of Google search queries to track influenza-like illness in a population, which may make it possible to use search queries to detect influenza epidemics in areas with a large population of web search users.
  • Gresham LS, Smolinski MS, Suphanchaimat R, et al. (2013). Creating a global dialogue in infectious disease surveillance: connecting organizations for regional disease surveillance. Emerging Health Threats Journal, 6: 1-8.
    • Connecting Organizations for Regional Disease Surveillance (CORDS) is an international non-governmental organization focused on information exchange between disease surveillance networks in different areas of the world. By linking regional disease surveillance networks, CORDS builds a trust-based social fabric of experts who share best practices, surveillance tools and strategies, training courses, and innovations. This paper describes the history, culture, and commitment of CORDS; and the novel and necessary role that CORDS serves in the existing international infectious disease surveillance framework.
  • Harder KM, Andersen PH, Bæhr I, et al. (2011). Electronic real-time surveillance for influenza-like illness: experience from the 2009 influenza A (H1N1) pandemic in Denmark. Eurosurveillance, 16(3), 19767.           
    • To enhance surveillance for influenza-like illness (ILI) in Denmark, a year-round electronic reporting system was established in collaboration with the Danish medical on-call service (DMOS). In order to achieve real-time surveillance of ILI, a checkbox for ILI was inserted in the electronic health record and a system for daily transfer of data to the national surveillance centre was implemented. This paper describes the DMOS surveillance system and reports data from the influenza A(H1N1)2009 pandemic from May 2009 to January 2010 where this surveillance system allowed a risk assessment of ILI trends on a daily basis.
  • Heffernan R. (2004). Syndromic surveillance in public health practice, New York City. Emerging Infectious Diseases, 10(5), 858-64.
    • The New York City Department of Health and Mental Hygiene has established a syndromic surveillance system that monitors emergency department visits to detect disease outbreaks early. Routinely collected chief complaint information is transmitted electronically to the health department daily and analyzed for temporal and spatial aberrations. Respiratory, fever, diarrhea, and vomiting are the key syndromes analyzed. This paper describes the methods and chief results from the first 12 months of experience with this system.
  • Henning KJ. (2004). What is syndromic surveillance?. Morbidity and Mortality Weekly Report, 7-11.
    • Innovative electronic surveillance systems are being developed to improve the early detection of outbreaks attributable to biologic terrorism or other causes. This article presents a review of the rationale, goals, definitions, and realistic expectations for these surveillance systems is a crucial first step toward establishing a framework for further research and development in this area. This commentary provides such a review for current syndromic surveillance systems.
  • Jajosky RA, Groseclose SL. (2004). Evaluation of reporting timeliness of public health surveillance systems for infectious diseases. BMC Public Health, 4(1), 29-38.    
    • Timeliness is a key performance measure of public health surveillance systems but can vary by disease, intended use of the data, and public health system level. This paper reviewed studies to describe methods used to evaluate timeliness and the reporting timeliness of National Notifiable Diseases Surveillance System (NNDSS) data to evaluate if this system could support timely notification and state response to multistate outbreaks.
  • Kass-Hout TA, Alhinnawi H. (2013). Social media in public health. British Medical Bulletin, 1-20.
    • While social media interactions are currently not fully understood, as individual health behaviors and outcomes are shared online, social media offers an increasingly clear picture of the dynamics of these processes. Importantly, it is becoming an increasingly common platform among clinicians and public health officials to share information with the public, track or predict diseases. This paper highlights areas of agreement and controversy, and where more research is needed for the role of social media in public health.
  • Katz R, May L, Baker J, et al. (2011). Redefining syndromic surveillance. Journal of Epidemiology and Global Health, 1(1), 21-31.
    • With growing concerns about international spread of disease and expanding use of early disease detection surveillance methods, the field of syndromic surveillance has received increased attention over the last decade. The purpose of this article is to clarify the various meanings that have been assigned to the term syndromic surveillance and to propose a refined categorization of the characteristics of these systems.
  • Keller M, Blench M, Tolentino H, et al. (2009). Use of unstructured event-based reports for global infectious disease surveillance. Emerging Infectious Diseases, 15(5), 689.     
    • Free or low-cost sources of unstructured information, such as Internet news and online discussion sites, provide detailed local and near real-time data on disease outbreaks, even in countries that lack traditional public health surveillance. To improve public health surveillance and, ultimately, interventions, these authors examined 3 primary systems that process event-based outbreak information: Global Public Health Intelligence Network, HealthMap, and EpiSPIDER.
  • Kimball AM, Moore M, French HM, et al. (2008). Regional infectious disease surveillance networks and their potential to facilitate the implementation of the international health regulations. Med Clin North Am, 92(6), 1459-71.
    • The International Health Regulations (IHR) 2005 present a challenge and opportunity for global surveillance and control of infectious diseases. This article examines the opportunity for regional networks to address this challenge. Two regional infectious disease surveillance networks, established in the Mekong Basin and the Middle East, are presented as case studies.
  • Lawpoolsri S, Khamsiriwatchara A, et al. (2014). Real-time monitoring of school absenteeism to enhance disease surveillance: a pilot study of a mobile electronic reporting system. JMIR Mhealth and Uhealth, 2(2), e22-32.
    • School absenteeism is a common source of data used in syndromic surveillance, which can eventually be used for early outbreak detection. However, the absenteeism reporting system in most schools, especially in developing countries, relies on a paper-based method that limits its use for disease surveillance or outbreak detection. The objective of this study was to develop an electronic real-time reporting system on school absenteeism for syndromic surveillance.
  • MacDonald PD, Darcy N, Sembajwe R, et al. (2017). Advancing GHSA: Lessons learned about strengthening HIS and disease surveillance. Online Journal of Public Health Informatics, 9(1), e172.
    • This paper aims to discuss two decades of international experience in health information and disease surveillance systems strengthening and synthesize lessons learned as applicable to implementation of the Global Health Security Agenda (GHSA).
  • Mandl KD, Overhage JM, Wagner MM, et al. (2004). Implementing syndromic surveillance: a practical guide informed by the early experience. Journal of the American Medical Informatics Association, 11(2), 141-50.   
    • Syndromic surveillance refers to methods relying on detection of individual and population health indicators that are discernible before confirmed diagnoses are made. In particular, prior to the laboratory confirmation of an infectious disease, ill persons may exhibit behavioral patterns, symptoms, signs, or laboratory findings that can be tracked through a variety of data sources. Syndromic surveillance systems are being developed locally, regionally, and nationally. The efforts have been largely directed at facilitating the early detection of a covert bioterrorist attack, but the technology may also be useful for general public health, clinical medicine, quality improvement, patient safety, and research. This report is intended to serve as a guide for informaticians, public health managers, and practitioners who are currently planning the deployment of such systems in their regions.
  • Milinovich GJ, Williams GM, Clements AC, et al. (2014). Internet-based surveillance systems for monitoring emerging infectious diseases. Lancet Infectious Diseases, 14(2), 160-68.
    • This article reviews recent studies that have exploited internet use and search trends to monitor two acute-onset viral illnesses of worldwide importance that have substantial seasonal and geographic variation: influenza and dengue. The authors critically analyze the effectiveness of monitoring internet data to track these diseases and discuss the advantages and limitations of this approach and make recommendations for future research into these systems.
  • Morse SS. (2012). Public health surveillance and infectious disease detection. Biosecurity and Bioterrorism, 10(1), 6-16.
    • Emerging infectious diseases, such as HIV/AIDS, SARS, and pandemic influenza, and the anthrax attacks of 2001, have demonstrated that we remain vulnerable to health threats caused by infectious diseases. The importance of strengthening global public health surveillance to provide early warning has been the primary recommendation of expert groups for at least the past 2 decades. This review discusses progress toward that goal and considers perspectives for the future. In general, there have been improvements in the past decade, but public health surveillance capabilities remain limited and fragmented, with uneven global coverage.
  • Morse SS. (2007). Global infectious disease surveillance and health intelligence. Health Affairs, 26(4), 1069-77.  
    • Current concerns about the spread of infectious diseases, especially unexpected (emerging) infections such as pandemic influenza or severe acute respiratory syndrome (SARS), have renewed focus on the critical importance of global early warning and rapid response. Although considerable progress has been made, many gaps remain. A number of the gaps can be addressed through increased political will, resources for reporting, improved coordination and sharing of information, raising clinicians’ awareness, and additional research to develop more rigorous triggers for action.
  • Ngwa MC, Liang S, Mbam Mbam L, et al. (2016). Cholera public health surveillance in the Republic of Cameroon-opportunities and challenges. Pan African Medical Journal, 24, 222.
    • Cholera has periodically resurfaced in Cameroon since it was first reported in 1971. In 2003, Cameroon adapted the Integrated Disease Surveillance and Response (IDSR) strategy to strengthen surveillance in the country. This study presents an in-depth description and assessment of the structure, core and support functions, and attributes of the current cholera surveillance system in Cameroon. It also discussed its strengths and challenges with the hope that lessons learned could improve the system in Cameroon and in other countries in Africa implementing the IDSR strategy.
  • Nsoesie EO, Brownstein JS. (2015). Computational approaches to influenza surveillance: beyond timeliness. Cell Host & Microbe, 17(3), 275-78.         
    • Several digital data sources and systems have been advanced for use in augmenting traditional influenza surveillance systems. Although timeliness is one of the main advantages of these tools, there are several other recognizable uses and potential impact of these systems on the public and global public health. This article summarizes established approaches, discusses recent advances, and examines the known and potential utility of these tools.
  • Ope M, Sonoiya S, Kariuki J, et al. (2013). Regional Initiatives in Support of Surveillance in East Africa: The East Africa Integrated Disease Surveillance Network (EAIDSNet) Experience. Emerging Health Threats Journal, 6, 1-7.
    • The East African Integrated Disease Surveillance Network (EAIDSNet) was formed in response to a growing frequency of cross-border malaria outbreaks in the 1990s and a growing recognition that fragmented disease interventions, coupled with weak laboratory capacity, were making it difficult to respond in a timely manner to the outbreaks of malaria and other infectious diseases. The East Africa Community (EAC) partner states, with financial support from the Rockefeller Foundation, established EAIDSNet in 2000 to develop and strengthen the communication channels necessary for integrated cross-border disease surveillance and control efforts. The objective of this paper is to review the regional EAIDSNet initiative and highlight achievements and challenges in its implementation.
  • Ortiz JR, Sotomayor V, Uez OC, et al. (2009). Strategy to Enhance Influenza Surveillance Worldwide. Emerging Infectious Diseases, 15(8), 1271-79.
    • Ortiz and colleagues describe a sentinel surveillance system that could enhance the quality of influenza epidemiologic and laboratory data and strengthen a country’s capacity for seasonal, novel, and pandemic influenza detection and prevention. Such a system would (1) provide data for a better understanding of the epidemiology and extent of seasonal influenza, (2) provide a platform for the study of other acute febrile respiratory illnesses, (3) provide virus isolates for the development of vaccines, (4) inform local pandemic planning and vaccine policy, (5) monitor influenza epidemics and pandemics, and (6) provide infrastructure for an early warning system for outbreaks of new virus subtypes.
  • Paquet C, Coulombier D, Kaiser R, et al. (2006). Epidemic intelligence: a new framework for strengthening disease surveillance in Europe. Eurosurveillance, 11(12), 212-14.      
    • In a rapidly changing environment, national institutions in charge of health security can no longer rely only on traditional disease reporting mechanisms that are not designed to recognise emergence of new hazards. Epidemic intelligence provides a conceptual framework within which countries may adapt their public health surveillance system to meet new challenges.
  • Paul MJ, Dredze M. (2011). You are what you Tweet: Analyzing Twitter for public health. Palo Alto: AAAI.
    • Analyzing user messages in social media can measure different population characteristics, including public health measures. For example, recent work has correlated Twitter messages with influenza rates in the United States; but this has largely been the extent of mining Twitter for public health. In this work, the authors consider a broader range of public health applications for Twitter.
  • Rajatonirina S, Heraud JM, Randrianasolo L et al. (2012). Short message service sentinel surveillance of influenza-like in Madagascar, 2008-2012. Bulletin of the World Health Organization, 90, 385-89.
    • The revision of the International Health Regulations (IHR) and the threat of influenza pandemics and other disease outbreaks with a major impact on developing countries have prompted bolstered surveillance capacity, particularly in low-resource settings. Before 2007, Madagascar’s disease surveillance was based on the passive collection and reporting of data aggregated weekly or monthly. The system did not allow for the early identification of outbreaks or unexpected increases in disease incidence. This article describes changes and lessons learned to improve the surveillance system.
  • Randrianasolo L, Raoelina Y, Ratsitorahina M, et al. (2010). Sentinel surveillance system for early outbreak detection in Madagascar. BMC Public Health, 10(1), 31-39.       
    • Following the outbreak of chikungunya in the Indian Ocean, the Ministry of Health directed the necessary development of an early outbreak detection system. A disease surveillance team including the Institut Pasteur in Madagascar (IPM) was organized to establish a sentinel syndromic-based surveillance system. The system, which was set up in March 2007, transmits patient data on a daily basis from the various voluntary general practitioners throughout the six provinces of the country to the IPM. This paper describes the challenges and steps involved in developing a sentinel surveillance system and the well-timed information it provides for improving public health decision-making.
  • Reintjes R, Thelen M, Reiche R, et al. (2007). Benchmarking national surveillance systems: a new tool for the comparison of communicable disease surveillance and control in Europe. European Journal of Public Health, 17(4), 375–80.
    • Communicable diseases do not respect national boundaries and are important challenges to health internationally. Considerable variation exists in the structure and performance of surveillance systems for communicable disease prevention and control. European Union countries should share ideas to improve the quality of surveillance systems. The study aims to support the improvement and integration of surveillance systems of communicable diseases in Europe while using benchmarking for the comparison of national surveillance systems.
  • Romanowska M, Nowak I, Rybicka K, et al. (2008). The introduction of the SENTINEL influenza surveillance system in Poland – experiences and lessons learned from the first three epidemic seasons. Eurosurveillance, 13(8).
    • Influenza surveillance provides information on virus activity and is necessary for the selection of vaccine strains and early warning. To improve this surveillance in Poland, a sentinel surveillance system was introduced in 2004-5 influenza season (SENTINEL). This paper describes how this sentinel influenza surveillance system was developed in Poland in order to fulfill international requirements and presents how it has operated during the first three influenza epidemic seasons.
  • Shuai J, Buck P, Sockett P, et al. (2006). A GIS-driven integrated real-time surveillance pilot system for national West Nile virus dead bird surveillance in Canada. International Journal of Health Geographics, 5(1), 17-31.
    • An extensive West Nile virus surveillance program of dead birds, mosquitoes, horses, and human infection has been launched as a result of West Nile virus first being reported in Canada in 2001. Some desktop and web GIS have been applied to West Nile virus dead bird surveillance. There have been urgent needs for a comprehensive GIS services and real-time surveillance. This paper presents a real-time GIS-driven surveillance pilot system, its context, its architecture and components, its various GIS functionalities, and examples of its outputs.
  • Siedner MJ, Goston LO, Cranmer HH, et al. (2015) Strengthening the Detection of and Early Response to Public Health Emergencies: Lessons from the West African Ebola Epidemic. PLoS Med, 12(3), e1001804-12.
    • The international response to the West African Ebola virus disease epidemic has exemplified the great potential of the global public health community. However, the protracted early response also revealed critical gaps, which likely resulted in exacerbation of the epidemic. This article offers lessons from the West African Ebola epidemic and proposes solutions for future international health emergencies.
  • Simonsen L, Gog JR, Olson D, et al (2016). Infectious disease surveillance in the big data era: towards faster and locally relevant systems. Journal of Infectious Diseases, 214(S4), 380-85.  
    • While big data have proven immensely useful in fields such as marketing and earth sciences, public health is still relying on more traditional surveillance systems and awaiting the fruits of a big data revolution. A new generation of big data surveillance systems is needed to achieve rapid, flexible, and local tracking of infectious diseases, especially for emerging pathogens. In this opinion piece, the authors reflect on the long and distinguished history of disease surveillance and discuss recent developments related to use of big data.
  • Smith GE, Cooper DL, Loveridge P, et al. (2006). A national syndromic surveillance system for England and Wales using calls to a telephone helpline. Eurosurveillance, 11(12), 220-24.   
    • Although syndromic surveillance systems based on data from regional telephone triage systems exist, the use of data from a national telephone health help line (NHS Direct) is unique in the field of syndromic surveillance. The NHS Direct syndromic surveillance system is also the only national daily surveillance system in UK and provides a timely national snapshot of community morbidity for selected symptoms. The main benefits of using NHS Direct telephone triage data for public health surveillance have been in providing early warning of rises in infectious disease and disease caused by environmental factors, tracking and verification of trends in community morbidity, and reassurance that widespread disease is not occurring when there is a perceived high public health risk.
  • Toyama Y, Ota M, Beyene BB. (2015). Event-based surveillance in north-western Ethiopia: experience and lessons learnt in the field. Western Pacific Surveillance and Response Journal, 6(3), 22-28.
    • This study piloted an event-based surveillance system at the health centre (HC) level in Ethiopia. The system collects rumors in the community and registers them in rumor logbooks to record events of disease outbreaks and public health emergencies. The implementation cost was minimal, requiring only printing and distribution of rumor logbooks to the HCs and brief orientations to focal persons. In countries where routine surveillance is still weak, an event-based surveillance system similar to this should be considered as a supplementary tool for disease monitoring.
  • Velasco E, Agheneza T, Denecke K, et al. (2014). Social media and Internet‐Based data in global systems for public health surveillance: A systematic review. Milbank Quarterly, 92(1), 7-33.  
    • The exchange of health information on the Internet has been heralded as an opportunity to improve public health surveillance. In a field that has traditionally relied on an established system of mandatory and voluntary reporting of known infectious diseases by doctors and laboratories to governmental agencies, innovations in social media and so‐called user‐generated information could lead to faster recognition of cases of infectious disease. More direct access to such data could enable surveillance epidemiologists to detect potential public health threats such as rare, new diseases or early‐level warnings for epidemics. But how useful are data from social media and the Internet, and what is the potential to enhance surveillance? This article reviewed event-based surveillance systems, in order to examine the usefulness of event-based surveillance to existing surveillance efforts and its potential to improve future comprehensive infectious disease surveillance systems.
  • Vrbova, L, Stephen, C, Kasman, N, et al. (2010). Systematic review of surveillance systems for emerging zoonoses. Transboundary and Emerging Diseases, 57(3), 154-161.
    • Surveillance for zoonoses is necessarily a multi‐disciplinary endeavor, crossing not only human and animal health, but also environmental health and public health practice and policy. The interconnected roles of agricultural animals, pets, wildlife, human populations and their environment for zoonosis transmission and pathogenesis creates a number of distinct challenges for surveillance. Information is needed on how best to structure these interdisciplinary surveillance efforts. There are published recommendations for evaluating various types of surveillance systems available, but little attention has been focused on whether or not emerging infectious disease (EID) surveillance requires a different set of criteria for design and evaluation when compared with systems intended to keep endemic and non‐infectious diseases under surveillance. This review documents the extent of EID surveillance system evaluation, determines what criteria have been used to evaluate these systems, and seeks common features of successful systems.
  • Wilson K, Brownstein JS. (2009). Early detection of disease outbreaks using the Internet. Canadian Medical Association Journal, 180(8), 829-31.
    • Rapidly identifying an infectious disease outbreak is critical, both for effective initiation of public health intervention measures and timely alerting of government agencies and the general public. Surveillance capacity for such detection can be costly, and many countries lack the public health infrastructure to identify outbreaks at their earliest stages. Furthermore, there may be economic incentives for countries to not fully disclose the nature and extent of an outbreak. The Internet, however, is revolutionizing how epidemic intelligence is gathered, and it offers solutions to some of these challenges. This paper provides an overview of health surveillance using the internet and presents several benefits and challenges to Internet-based surveillance.         
  • Wolicki, SB, Nuzzo, JB, Blazes, DL, et al. (2016). Public health surveillance: at the core of the Global Health Security Agenda. Health Security, 14(3), 185-88.
    • Global health security involves developing the infrastructure and capacity to protect the health of people and societies worldwide. The acceleration of global travel and trade poses greater opportunities for infectious diseases to emerge and spread. The International Health Regulations (IHR) were adopted in 2005 with the intent of proactively developing public health systems that could react to the spread of infectious disease and provide better containment. Various challenges delayed adherence to the IHR. The Global Health Security Agenda came about as an international collaborative effort, working multilaterally among governments and across sectors, seeking to implement the IHR and develop the capacities to prevent, detect, and respond to public health emergencies of international concern. This article examine the West African Ebola epidemic as a case study for global health security to identify both strengths and weaknesses in the public health response.
  • Woolhouse ME, Rambaut A, Kellam P. (2015). Lessons from Ebola: Improving infectious disease surveillance to inform outbreak management. Science Translational Medicine, 7(307), 307rv5.
    • The current Ebola virus disease outbreak in West Africa has revealed serious shortcomings in national and international capacity to detect, monitor, and respond to infectious disease outbreaks as they occur. Recent advances in diagnostics, risk mapping, mathematical modeling, pathogen genome sequencing, phylogenetics, and phylogeography have the potential to improve substantially the quantity and quality of information available to guide the public health response to outbreaks of all kinds.
  • World Health Organization. (2014). Early detection, assessment and response to acute public health events: Implementation of early warning and response with a focus on event-based surveillance, interim version. Geneva: WHO.
    • The goal of this document is to provide national health authorities, and stakeholders supporting them, with guidance for implementing or enhancing the all-hazards EWAR within national surveillance systems. It aims to provide direction regarding the implementation of surveillance capacities, especially EBS, in order to detect and to respond rapidly to all acute health events and risks from any origin. This document is also available in French, Russian, and Spanish.
  • World Health Organization, Regional Office for Africa. (2014). Integrated Disease Surveillance and Response in the African Region: A Guide for Establishing Community Based Surveillance. Brazzaville: WHO.
    • These guidelines start by covering the concepts of disease surveillance and integrated surveillance and response. Special considerations are given to how integrated disease surveillance works, as well as how the International Health Regulations can be implemented through IDSR. Next, an explanation of how surveillance functions are described in these guidelines is given and how districts can use these guidelines, with support from WHO in the African region, strengthen surveillance and response. Finally, priority diseases are recommended for IDSR.
  • World Health Organization. (2010). WHO Guidance for the Use of Annex 2 of the International Health Regulations (2005). Geneva: WHO.
    • Under the International Health Regulations (2005) (IHR (2005)), States Parties are required to carry out an assessment of public health events arising in their territories utilizing the decision instrument contained in Annex 2 of the Regulations, and then to notify WHO of all qualifying events within 24 hours of such an assessment. The purpose of the WHO guidance on Annex 2 is to help national authorities to use the decision instrument in assessing public health events that may require notification to WHO.
  • World Health Organization, Regional Office for the Western Pacific Region. (2008). A Guide to Establishing Event-based Surveillance. Geneva: WHO.
    • In line with the recommendations of the Asia Pacific technical Advisory Group (tAG) on emerging infectious diseases and in response to requests from Member States, the WHO Western Pacific Regional Office developed this guide for the design of event-based surveillance systems.
  • World Health Organization. (2006). Setting priorities in communicable disease surveillance. Geneva: WHO.
    • These guidelines aim to assist public health professionals at national level in the process of prioritization of communicable diseases/health events for public health surveillance. They represent a prototype for prioritization of communicable diseases, and describe the different steps in a prioritization exercise using a consensus methodology based on the Delphi method. They may need to be adapted depending on the organization of surveillance within a country, or for use in international collaborative settings where disease priorities may differ from those at national level.
  • Yang C, Yang J, Luo X, et al. (2009). Use of mobile phones in an emergency reporting system for infectious disease surveillance after the Sichuan earthquake in China. Bulletin of the World Health Organization, 87(8), 619-23.
    • Quick detection and response were essential for preventing outbreaks of infectious diseases after the Sichuan earthquake. However, the existing public health communication system in Sichuan province, China, was severely damaged by an earthquake. In response, the Chinese Center for Disease Control and Prevention set up a mobile phone emergency reporting system. This paper describes that system and the lessons learned from the utilization of mobile phones for infectious disease surveillance following the earthquake.
  • Zeller H, Marrama L, Sudre B, et al. (2013). Mosquito‐borne disease surveillance by the European Centre for Disease Prevention and Control. Clinical Microbiology and Infection, 19(8), 693-98.

    • For a few years, a series of traditionally tropical mosquito-borne diseases, such as chikungunya fever and dengue, have posed challenges to national public health authorities in the European region. Other diseases have re-emerged, such as malaria and West Nile fever. These diseases are reportable within the European Union (EU), and the European Centre for Disease Prevention and Control collects information in various ways to provide EU member states with topical assessments of disease threats, risks and trends for prompt and appropriate public health action. This paper provides an overview of the surveillance systems in place for these mosquito-borne diseases in the EU.