Short communication: Strengthening sub‐national communicable disease surveillance in a remote Pacific Island country by adapting a successful African outbreak surveillance model

Summary Successful communicable disease surveillance depends on effective bidirectional information flow between clinicians at the periphery and communicable disease control units at regional, national and global levels. Resource‐poor countries often struggle to establish and maintain the crucial link with the periphery. A simple syndrome‐based outbreak surveillance system initially developed and evaluated in Mpumalanga Province, South Africa was adapted for the Pacific island nation of Tuvalu. Eight syndromes were identified for surveillance: acute flaccid paralysis (poliomyelitis), profuse watery diarrhoea (cholera), diarrhoea outbreak, dysentery outbreak, febrile disease with abdominal symptoms and headache (typhoid), febrile disease with generalized non‐blistering rash (measles), febrile disease with intense headache and/or neck stiffness with or without haemorrhagic rash (meningococcal meningitis), and outbreaks of other febrile diseases of unknown origin. A user‐oriented manual, the Tuvalu Outbreak Manual (http://www.wepi.org/books/tom/), was developed to support introduction of the surveillance system. Nurses working in seven outer island clinics and the hospital outpatient department on the main island rapidly report suspected outbreaks and submit weekly zero‐reports to the central communicable disease control unit. An evaluation of the system after 12 months indicated that the Outbreak Manual was regarded as very useful by clinic nurses, and there was early evidence of improved surveillance and response to the disease syndromes under surveillance. Le succès de la surveillance des maladies contagieuses dépend d'une efficace transmission bidirectionnelle de l'information entre les cliniciens au niveau périphérique et les unités de contrôle des maladies infectieuses au niveau national et global. Les pays à ressources limitées ont souvent des difficultés àétablir et maintenir une connexion cruciale avec la périphérie. Un système simple de surveillance de l’épidèmie, initialement développé et évalué dans la Province de Mpumalanga en Afrique du Sud, et basé sur les syndromes, a été adapté pour la nation de Tuvalu dans les Iles Pacifiques. Huit syndromes différents ont été identifiés pour la surveillance: paralysie flasque aigue des membres (poliomyélite), diarrhée profuse aqueuse (cholera), épidémie de diarrhée, épidémie de dysenterie, état fébrile avec symptômes abdominaux et mal de tête (typhoïde), état fébrile avec réaction cutanée généralisée mais n