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ISDS 2016 Conference Abstracts

Establishing a National Syndromic Surveillance 
System among Asylum Seekers
Mariette Hooiveld*1, 2, Madelief Mollers2, Stephanie van Rooden1, Robert A. Verheij1 and 
Susan J. Hahné2
1NIVEL, Utrecht, Netherlands; 2RIVM, Centre for Infectious Disease Control, Bilthoven, Netherlands

Objective
Facing challenges to establish a new national syndromic 

surveillance system in the Netherlands for infectious diseases among 
asylum seekers.

Introduction
Most European countries are facing a continuous increased influx 

of asylum seekers [1]. Poor living conditions in crowded shelters and 
refugee camps increase the risk for - outbreaks of - infectious diseases 
in this vulnerable population. In line with ECDC recommendations 
[2], we aim to improve information on infectious diseases among 
asylum seekers by establishing a new syndromic surveillance system 
in the Netherlands. This system will complement the notifiable 
disease system for infectious diseases.

The aim of the syndromic surveillance system is to improve the 
detecting of outbreaks of infectious diseases in asylum seekers’ 
centres in an early stage of development to be able to take adequate 
and timely measures to prevent further spread, and to collect 
information on the burden of infection within this population.

Methods
Primary health care for asylum seekers in the Netherlands is 

organized nationally by the Asylum Seekers Health Centre, with 
general practitioners providing care in each reception centre. General 
practitioners (GPs) act as gatekeepers for specialized, secondary 
health care and the GP is the first professional to consult for health 
problems. Therefore, electronic health records (EHR) kept by GPs 
provide a complete picture of this population. These EHRs contain 
data on diagnoses/symptoms and treatment of asylum seekers, using 
the International Classification of Primary Care (ICPC). This data is 
recorded routinely, as part of the health care process. During summer 
2016, about 30,000 asylum seekers were housed in about 60 reception 
centres across the Netherlands.

Results
The governance structure was layed down in a collaboration 

agreement between the Asylum Seekers Health Centre, the national 
institute of public health RIVM and NIVEL. To ensure privacy of 
the asylum seekers, a privacy protocol has been drawn, taking into 
account strict privacy regulations in the Netherlands. The information 
system provider of the health care centre developed an extraction tool 
that automatically generates weekly data extracts from the electronic 
health records system to a Trusted Third Party (TTP). Before 
transferring the data to NIVEL, the TTP removes directly identifying 
patient information, indirectly identifying information like date of 
birth is replaced by quarter and year, and the personal identification 
number is replaced by a pseudonym. At NIVEL, all data is stored 
in a relational database, from which weekly research extracts are 
generated for infectious disease surveillance at RIVM after applying 
a second pseudonymisation step (two-way pseudonimisation) [3]. 
First data extracts are being expected mid-October 2016, after which 
data quality will be evaluated. Weekly, or daily, consultations rates 
will be calculated based on the number of cases meeting predefined 
definitions, stratified by immigration centre, age group, sex and 

nationality. Numerators will be based on the number of population 
housed in the immigration centres.

Conclusions
With the cooperation of a national health care centre, providing 

primary care to asylum seekers housed at several locations, and the 
information system provider of the health care centre, EHRs can be 
used for syndromic surveillance, taking into account strict privacy 
regulations. The new surveillance system will be evaluated after one 
year, focusing on data quality, usefulness, and the added value above 
to the notification of diseases.

Keywords
Asylum seekers; Syndromic surveillance; Electronic Health Records; 
Governance

References
1. Catchpole M, Coulombier D. Refugee crisis demands European Union-

wide surveillance! Euro Surveill 2015,20.
2. European Centre for Disease Prevention and Control (ECDC).

Communicable disease risks associated with the movement of
refugees in Europe during the winter season. Rapid risk assessment.
Stockholm: ECDC; 2015.

3. Kuchinke W, Ohmann C, Verheij RA, van Veen EB, Delaney B.
Development towards a learning health system – experiences with the 
privacy protection model of the TRANSFoRm project. In: Gutwirth
S, et al (eds). Data protection on the move. Springer, Dordrecht: 2016.

*Mariette Hooiveld
E-mail: m.hooiveld@nivel.nl

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 9(1):e84, 2017