Key elements of infectious disease syndromic surveillance systems: A scoping review

IntroductionSyndromic surveillance is an alternative type of public healthsurveillance which utilises pre-diagnostic data sources to detectoutbreaks earlier than conventional (laboratory) surveillance andmonitor the progression of illnesses in populations. These systems areoften noted for their ability to detect a wider range of cases in under-reported illnesses, utilise existing data sources, and alert public healthauthorities of emerging crises. In addition, they are highly versatileand can be applied to a wide range of illnesses (communicable andnon-communicable) and environmental conditions. As a result, theirimplementation in public health practice is expanding rapidly. Thisscoping review aimed to identify all existing literature detailing thenecessary components in the defining, creating, implementing, andevaluating stages of human infectious disease syndromic surveillancesystems.MethodsA full scoping review protocol was developeda priori. Theresearch question posed for the review was “What are the essentialelements of a fully functional syndromic surveillance system forhuman infectious disease?” Five bibliographic databases (Pubmed,Scopus, CINAHL, Web of Science, ProQuest) and eleven websites(Google, Public Health Ontario, Public Health England, Public HealthAgency of Canada, Centers for Disease Control and Prevention,European Centre for Disease Prevention and Control, InternationalSociety for Disease Surveillance, Syndromic Surveillance Systems inEurope, Eurosurveillance, Kingston Frontenac, Lennox & AddingtonPublic Health (x2)) were searched for peer-reviewed, government,academic, conference, and book literature. A total of 1237 uniquecitations were identified from this search and uploaded into thescoping review softwareCovidence. The titles and abstracts werescreened for relevance to the subject material, resulting in 142documents for full-text screening. Following this step, 55 documentsremained for data extraction and inclusion in the scoping review. Twoindependent reviewers conducted each step.ResultsThe scoping review identified many essential elements in thedefining, creating, implementing, and evaluating of syndromicsurveillance systems. These included the defining of “syndromicsurveillance”, classification of syndromes, data quality andcompleteness, statistical methods, privacy and confidentialityissues, costs, operational challenges, management composition,collaboration with other public health agencies, and evaluationcriteria. Several be