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. 2010 Jul 30;00:45–58. doi: 10.1007/978-90-481-9637-1_6

Strengthening the Early-Warning Function of the Surveillance System: The Macedonian Experience

Elisaveta Stikova 1_6,2_6,✉, Dragan Gjorgjev 1_6,2_6, Zarko Karadzovski 2_6
Editors: Kevin P O'Connell1, Evan W Skowronski2, Alexander Sulakvelidze3, Lela Bakanidze4
PMCID: PMC7187948

Abstract

Epidemics and pandemics can place sudden and intense demands on health systems. The world requires a global system that can identify and contain public health emergencies rapidly and reduce panic and disruption of trade, travel, and society in general. Strengthening public health preparedness requires establishing an integrated global alert and response system for epidemics and other public health emergencies along the lines of the World Health Organization’s International Health Regulations. The revised International Health Regulations provide a global framework to address these needs through a collective approach to the prevention, detection, and timely response to any public health emergency of international concern. A standardized approach for readiness and response to major epidemic-prone diseases should be developed. An early-warning and rapid-alert system is one of the possibilities to improve readiness at the local, regional, national, and international level to limit the spread of disease and to reduce health, economic, and social damage. The Republic of Macedonia, with World Health Organization support, has implemented an earlywarning system (ALERT) for priority communicable diseases to complement the routine surveillance system that reports individual confirmed cases. ALERT relies on reporting of eight syndromes by primary care facilities. Data are analyzed weekly at the regional level and transmitted to national epidemiologists. It is perceived to be a simple and flexible tool for detecting and triggering timely investigation and control of outbreaks. ALERT was identified as a useful instrument for forecasting and detecting the start of the influenza season.

Keywords: Severe Acute Respiratory Syndrome, Severe Acute Respiratory Syndrome, Rift Valley Fever, Syndromic Surveillance, Public Health Emergency

Contributor Information

Kevin P. O'Connell, Email: kocon001@umaryland

Evan W. Skowronski, Email: evan.skowronski@us.army.mil

References

  • 1.World Health Organization . The World Health Report 2007 - a safer future: global public health security in the 21st century. Geneva: World Health Organization; 2007. [Google Scholar]
  • 2.World Health Organization . Enhancing health security: the challenges in the WHO European region and the health sector response. Copenhagen: World Health Organization Regional Office for Europe; 2006. [Google Scholar]
  • 3.Stikova E. Public health threats and disaster management. In: Donev D, Pavlekovic G, Kragelj L, editors. Health protection and diseases prevention. Hellweg Lage, Germany: Hans Jacobs Publishing Company; 2007. pp. 746–772. [Google Scholar]
  • 4.World Health Organization . Fifty-Eighth World Health Assembly. Resolution WHA58.3. Revision of the International Health Regulations. Geneva: World Health Organization; 2005. [Google Scholar]
  • 5.Baker MG, Fidler DP. Global public health surveillance under the new international health regulations. Emerg. Infect. Dis. 2006;12:1058–1065. doi: 10.3201/eid1207.051497. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Gill, N. 2002. Public health emergencies of international concern and the revision of the International Health Regulations - latest update. Eurosurveillance. Available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2136.
  • 7.Rockenschaub G, Pukkila J, Profili MC, editors. Towards health security. A discussion paper on recent health crises in the WHO European Region. Copenhagen: World Health Organization Regional Office for Europe; 2007. [Google Scholar]
  • 8.Multi-hazard identification and risk assessment. Washington, DC: Federal Emergency Management Agency; 1997. [Google Scholar]
  • 9.Risk reduction and emergency preparednes. WHO six-year strategy for the health sector and community capacity development. Geneva: World Health Organization; 2007. [Google Scholar]
  • 10.Hoyois P, Below JM, Guha-Sapiir D. Annual disaster statistical review: numbers and trends 2006. Brussels: Center for Research on the Epidemiology of Disasters; 2007. [Google Scholar]
  • 11.Cummings CE, Stikova E. Strengthening national public health preparedness and response to chemical biological and radiological threats. Amsterdam: IOS Press; 2007. [Google Scholar]
  • 12.Copola DP. Introduction to international disaster management. Burlington, MA: Butterworth-Heinemann; 2007. [Google Scholar]
  • 13.Global alert and response (GAR) Cumulative number of confirmed cases of avian influenza A/(H5N1) reported to WHO. Geneva: World Health Organization; 2008. [Google Scholar]
  • 14.Van Loock, F. Gill, O.N., Wallyn, S., Nicoll, A., Desenclos, J.C., Leinikki, P. 2002. Roles and functions of European Union Public Health Centre for Communicable Diseases and other threats to health. Eurosurveillance. Available at: http://www.eurosurveillance.org/em/v07n05/0705-225.asp. [DOI] [PubMed]
  • 15.World Health Organization . Fifty-Fourth World Health Assembly. Resolution WHA54.14. Global health security: epidemic alert and response. Geneva: World Health Organization; 2001. [Google Scholar]
  • 16.World Health Organization . Fifty-Ninth World Health Assembly. Resolution WHA59.2. Application of the international health regulations. Geneva: World Health Organization; 2006. [Google Scholar]
  • 17.Rodier, G., Hardiman, M., Plotkin, B., Ganter, B. 2006. Implementing the international health regulations (2005) in Europe. Eurosurveillance. Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=664. [PubMed]
  • 18.Buehler JW, Hopkins RS, Overhage JM, Sosin DM, Tong V, CDC Working Group Frame work for evaluating public health surveillance systems for early detection of outbreaks: recommendations from the CDC Working Group. MMWR Recomm. Rep. 2004;53:1–11. [PubMed] [Google Scholar]
  • 19.European Center for Disease Prevention and Control. Surveillance of communicable diseases in the European Union, a long-term strategy 2008–2013. Available at: http://www.ecdc.europa.eu/en/activities/surveillance/Pages/StrategiesPrinciples_Long-termStrategy.aspx. [PubMed]
  • 20.Krause, G., Benzler, J., Reiprich, G., Görgen, R. 2006. Improvement of a national public health surveillance system through use of a quality circle. Eurosurveillance. Available at: http://www.Eurosurveillance.org/ViewArticle.aspx?ArticleId=659. [PubMed]
  • 21.Krause G, Ropers G, Stark K. Notifiable disease surveillance and practicing physicians. Emerg. Infect. Dis. 2005;11:442–445. doi: 10.3201/eid1103.040361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Kaiser, R., Coulombier, D., Baldari, M., Morgan, D., Paquet, C. 2006. What is epidemic intelligence, and how is it being improved in Europe? Eurosurveillance. Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2892. [DOI] [PubMed]
  • 23.Reingold A. If syndromic surveillance is the answer, what is the question? Biosecur. Bioterror. 2003;1:1–5. doi: 10.1089/153871303766275745. [DOI] [PubMed] [Google Scholar]
  • 24.Green MS, Kaufman Z. Surveillance for early detection and monitoring of infectious disease outbreaks associated with bioterrorism. Isr. Med. Assoc. J. 2002;4:503–506. [PubMed] [Google Scholar]
  • 25.Mykhalovskiy E, Weir L. The Global Public Health Intelligence Network and early warning outbreak detection: a Canadian contribution to global public health. Can, J. Public Health. 2006;97:42–44. doi: 10.1007/BF03405213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Valenciano, M., Bergeri, I., Jankovic, D., Milic, N., Parli, M., Coulombier, D. 2004. Strengthening early warning function of surveillance in the Republic of Serbia: lessons learned after a year of implementation. Eurosurveillance. Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=465. [DOI] [PubMed]
  • 27.Wagner MM, Tsui FC, Espino JU, Dato VM, Sittig DF, Caruana RA, McGinnis LF, Deerfield DW, Druzdzel MJ, Fridsma DB. The emerging science of very early detection of disease outbreaks. J. Public Health Manag. Pract. 2001;7:51–59. doi: 10.1097/00124784-200107060-00006. [DOI] [PubMed] [Google Scholar]
  • 28.Mostashari F, Hartman J. Syndromic surveillance: a local perspective. J. Urban Health. 2003;80(Suppl 1):1–7. doi: 10.1093/jurban/jtg042. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Henning K.J. Syndromic surveillance. In: Smolinski MS, Hamburg MA, Lederberg J, editors. Microbial threats to health: emergence, detection, and response. Washington, DC: National Academies Press; 2003. pp. 309–350. [PubMed] [Google Scholar]
  • 30.Buehler JW, Berkelman RL, Hartley DM, Peters CJ. Syndromic surveillance and bioterrorism-related epidemics. Emerg. Infect. Dis. 2002;9:1197–1204. doi: 10.3201/eid0910.030231. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Das D, Weiss D, Mostashari F, Treadwell T, McQuiston J, Hutwagner L, Karpati A, Bornschlegel K, Seeman M, Turcios R, Terebuh P, Curtis R, Heffernan R, Balter S. Enhanced drop-in syndromic surveillance in New York City following September 11, 2001. J. Urban Health. 2003;80(Suppl. 1):i76–88. doi: 10.1007/PL00022318. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Duchin JS. Epidemiological response to syndromic surveillance signals. J. Urban Health. 2003;80(Suppl. 1):i115–116. doi: 10.1007/PL00022322. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.German RR, Lee LM, Horan JM, Milstein RL, Pertowski CA, Waller MN, Guidelines Working Group Centers for Disease Control and Prevention (CDC) Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group. MMWR Recomm. Rep. 2001;50(RR13):1–36. [PubMed] [Google Scholar]
  • 34.Paquet CL, Coulombier D, Kaiser R, Ciotti M. Epidemic intelligence: a new framework for strengthening disease surveillance in Europe. Eurosurveillance. 2006;11:212–214. [PubMed] [Google Scholar]
  • 35.Pavlin JA. Investigation of disease outbreaks detected by syndromic surveillance systems. J. Urban Health. 2003;80(Suppl 1):i107–114. doi: 10.1007/PL00022321. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Heffernan R, Mostashari F, Das D, Karpati A, Kulldorff M, Weiss D. Syndromic surveillance in public health practice, New York City. Emerg. Infect. Dis. 2004;10:858–864. doi: 10.3201/eid1005.030646. [DOI] [PubMed] [Google Scholar]
  • 37.Heymann DL, Rodier G. Hot spots in a wired world: WHO surveillance of emerging and reemerging infectious diseases. Lancet Infect. Dis. 2001;1:345–353. doi: 10.1016/S1473-3099(01)00148-7. [DOI] [PubMed] [Google Scholar]
  • 38.Kluger MD, Sofair AN, Heye CJ, Meek JI, Sodhi RK, Hadler JL. Retrospective validation of a surveillance system from unexplained illness and death: New Haven County. Connecticut. Am J Public Health. 2001;91:1214–1219. doi: 10.2105/AJPH.91.8.1214. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Centers for Disease Control and Prevention . Syndrome definitions for diseases associated with critical bioterrorism-associated agents. Atlanta: Centers for Disease Control and Prevention; [Google Scholar]
  • 40.Guglielmetti P, Coulombier D, Thinus G, Van Loock F, Schreck S. The early warning and response system for communicable diseases in the EU: an overview from 1999 to 2005. Eurosurveillance. 2006;11:215–220. [PubMed] [Google Scholar]
  • 41.Epidemic alert and verification: summary report for 2005. Wkly. Epidemiol. Rec. 2006;81:357–362. [PubMed] [Google Scholar]

Additional Reading

  1. Biological and chemical terrorism: strategic plan for preparedness and response Recommendations of the CDC Strategic Planning Workgroup. MMWR Recomm. Rep. 2000;49(RR-4):1–14. [PubMed] [Google Scholar]
  2. Centers for Disease Control and Prevention (CDC) Syndromic surveillance for bioterrorism following the attacks on the World Trade Center-New York City, 2001. MMWR Morb. Mortal. Wkly. Rep. 2002;51(Spec. No.):13–15. [PubMed] [Google Scholar]
  3. Hutwagner L, Thompson W, Seeman GM, Treadwell T. The bioterrorism preparedness and response early aberration reporting system (EARS) J. Urban Health. 2003;80(Suppl. 1):89–96. doi: 10.1007/PL00022319. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Kaiser, R., Coulombier, D. Different approaches to gathering epidemic intelligence in Europe. Eurosurveillance. Available at: http://www.eurosurveillance.org/ew/2006/060427.asp#1. [DOI] [PubMed]
  5. Ostroff SM. The epidemic intelligence service in the United States. Eurosurveillance. 2001;6:34–36. doi: 10.2807/esm.06.03.00216-en. [DOI] [PubMed] [Google Scholar]
  6. Pavlin JA, Mostashari F, Kortepter MG, Hynes NA, Chotani RA, Mikol YB, Ryan MA, Neville JS, Gantz DT, Writer JV, Florance JE, Culpepper RC, Henretig FM, Kelley PW. Innovative surveillance methods for rapid detection of disease outbreaks and bioterrorism: results of an interagency workshop on health indicator surveillance. Am. J. Public Health. 2003;93:1230–1235. doi: 10.2105/AJPH.93.8.1230. [DOI] [PMC free article] [PubMed] [Google Scholar]

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