ISDS Annual Conference Proceedings 2017. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution,  
and reproduction in any medium, provided the original work is properly cited.

ISDS 2016 Conference Abstracts

Key elements of infectious disease syndromic 
surveillance systems: A scoping review
Stephanie L. Hughes*1, Alex J. Elliot2, Scott A. McEwen1, Amy Greer1, Ian Young3 and 
Andrew Papadopoulos1
1Population Medicine, University of Guelph, Guelph, ON, Canada; 2Public Health England, Birmingham, United Kingdom; 3Ryerson 
University, Toronto, ON, Canada

Introduction
Syndromic surveillance is an alternative type of public health 

surveillance which utilises pre-diagnostic data sources to detect 
outbreaks earlier than conventional (laboratory) surveillance and 
monitor the progression of illnesses in populations. These systems are 
often noted for their ability to detect a wider range of cases in under-
reported illnesses, utilise existing data sources, and alert public health 
authorities of emerging crises. In addition, they are highly versatile 
and can be applied to a wide range of illnesses (communicable and 
non-communicable) and environmental conditions. As a result, their 
implementation in public health practice is expanding rapidly. This 
scoping review aimed to identify all existing literature detailing the 
necessary components in the defining, creating, implementing, and 
evaluating stages of human infectious disease syndromic surveillance 
systems.

Methods
A full scoping review protocol was developed a priori. The 

research question posed for the review was “What are the essential 
elements of a fully functional syndromic surveillance system for 
human infectious disease?” Five bibliographic databases (Pubmed, 
Scopus, CINAHL, Web of Science, ProQuest) and eleven websites 
(Google, Public Health Ontario, Public Health England, Public Health 
Agency of Canada, Centers for Disease Control and Prevention, 
European Centre for Disease Prevention and Control, International 
Society for Disease Surveillance, Syndromic Surveillance Systems in 
Europe, Eurosurveillance, Kingston Frontenac, Lennox & Addington 
Public Health (x2)) were searched for peer-reviewed, government, 
academic, conference, and book literature. A total of 1237 unique 
citations were identified from this search and uploaded into the 
scoping review software Covidence. The titles and abstracts were 
screened for relevance to the subject material, resulting in 142 
documents for full-text screening. Following this step, 55 documents 
remained for data extraction and inclusion in the scoping review. Two 
independent reviewers conducted each step.

Results
The scoping review identified many essential elements in the 

defining, creating, implementing, and evaluating of syndromic 
surveillance systems. These included the defining of “syndromic 
surveillance”, classification of syndromes, data quality and 
completeness, statistical methods, privacy and confidentiality 
issues, costs, operational challenges, management composition, 
collaboration with other public health agencies, and evaluation 
criteria. Several benefits and limitations of the systems were also 
identified, when comparing them to other public health surveillance 
methods. Benefits included the timeliness of analyses and reporting, 
potential cost savings, complementing traditional surveillance 
methods, high sensitivity, versatility, ability to perform short- and 
long-term surveillance, non-specificity of the systems, ability to fill 
in gaps of under-reported illnesses, and the collaborations which 
are fostered through its platform; limitations included the potential 
resources and costs required, inability to replace traditional healthcare 

and surveillance methods, the false alerts which may occur, non-
specificity of the systems, poor data quality and completeness, time 
lags in analyses, limited effectiveness at detecting smaller-scale 
outbreaks, and privacy issues with accessing data.

Conclusions
Over the past decade, syndromic surveillance systems have become 

an integral part of public health practice internationally. Their ability 
to monitor a wide variety of illnesses and conditions, detect illnesses 
earlier than traditional surveillance methods, and be created using 
existing data sources make them a valuable public health tool. 
The results from this scoping review demonstrate the benefits and 
limitations and overall role of the systems in public health practice.  
In addition, this study also shows that a complete set of key elements 
are required in order to properly define, create, implement, and 
evaluate these systems to ensure their effectiveness and performance.

Keywords
Syndromic surveillance; Elements; Scoping review

Acknowledgments
I would like to acknowledge the kindness from Public Health England, 
Public Health Ontario, Kingston, Frontenac and Lennox & Addington 
Public Health, and Sykes Assistance Services Corporation in the 
development and execution of my project.

*Stephanie L. Hughes
E-mail: shughes@uoguelph.ca

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 9(1):e110, 2017