2014.ISDS.Abstracts.Final.pdf


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ISDS 2014 Conference Abstracts

A Syndromic Surveillance Service Supporting 
Environmental Public Health Incidents
Alex Elliot, Helen Hughes*, Roger Morbey, Paul Loveridge, Sally Harcourt, Sue Smith, 
Zharain Bawa, Leandro Carrilho and Gillian Smith

Public Health England, Birmingham, United Kingdom

Objective
To deliver a national syndromic surveillance service, linking 

analytical and statistical methods with public health action to 
provide surveillance support for national public health programmes 
monitoring the spread of infectious diseases and the health impact of 
environmental incidents in England.

Introduction
Public Health England has developed a suite of syndromic 

surveillance systems, collecting data from a number of health care 
sources, and linking to public health action to try and improve the 
public health benefit of the surveillance.1 We aim to describe this 
national syndromic service, highlighting the flexibility of the systems 
in responding to a range of environmental incidents.

Methods
Syndromic surveillance data from general practitioners (‘in hours’ 

and ‘out of hours’), sentinel ED attendances and telehealth calls were 
received on a daily basis using automated and secure data transfer 
processes. Data were analysed using a number of statistical and 
analytical processes generating statistically significant spikes in data, 
or increases compared to baselines.

Results
Syndromic surveillance reporting
Routine weekly surveillance bulletins are produced from each 

syndromic system: these reports present the current indicator 
trends and encapsulate the main summary findings from the weeks 
surveillance, providing a number of key messages for health 
professionals.1

Heatwave surveillance
Syndromic surveillance plays an important part in assessing the 

health impact of heatwaves and plays an integral role in the Heatwave 
Plan for England. During summer 2013 England experienced a 
heatwave: significant increases in heat/sunstroke were observed 
during 7-10 July 2013 (figure).2 In addition to the direct impact of 
heat, syndromic surveillance systems detected a spike in ED asthma 
attendances during a series of thunderstorms that followed the 
heatwave.3

Cold weather surveillance
A cold weather plan for England was launched in 2011 with the aim 

of reducing preventable mortality and morbidity due to severe cold 
weather. Syndromic surveillance plays a part in this plan: emergency 
department cold weather indicators have been developed and are used 
each winter to assess the impact of cold weather on public health.4

Air pollution
During March/April 2014 an air pollution event affected large 

parts of the UK; syndromic surveillance was used to assess the public 
health impact. Indicators for the presentation of asthma, difficulty 
breathing and wheeze all showed marked and significant increases 
during the air pollution episode, illustrating the impact of the episode.

Flooding
During early 2014 there was severe flooding across several areas 

of England. Syndromic surveillance systems were used, monitoring 

indicators of gastroenteritis, diarrhoea and vomiting. Daily data were 
compared between affected and unaffected areas to determine whether 
there had been an impact on health. There were no gross changes in 
the incidence of syndromic indicators in flooded areas, thus providing 
reassurance to national and local response teams.

Conclusions
Historically, syndromic surveillance systems have been primarily 

targeted towards supporting national infectious disease surveillance 
programmes e.g. influenza. However, the flexibility of the syndromic 
surveillance systems, and in particular the clinical indicators, 
allow these surveillance systems to monitor the health impact of 
environmental incidents.

Syndromic surveillance ‘heatwave’ indicators during summer 2013

Keywords
syndromic surveillance; heatwave; flooding; air pollution; 
thunderstorm asthma

References

1. Public Health England. Real-time Syndromic Surveillance. 2014.
https://www.gov.uk/government/collections/syndromic-surveillance-
systems-and-analyses (accessed 29 Aug 2014).

2. Elliot AJ, Bone A, Morbey R, et al. Using real-time syndromic
surveillance to assess the health impact of the 2013 heatwave in
England. Environ. Res. 2014:doi 10.1016/j.envres.2014.08.031.

3. Elliot AJ, Hughes HE, Hughes TC, et al. The impact of thunderstorm
asthma on emergency department attendances across London during
July 2013. Emerg Med J 2014;31:675-8.

4. Hughes HE, Morbey R, Hughes TC, et al. Using an emergency
department syndromic surveillance system to investigate the impact
of extreme cold weather events. Public Health 2014;128:628-35.

*Helen Hughes
E-mail: helen.hughes@phe.gov.uk    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 7(1):e126, 2015