ISDS Annual Conference Proceedings 2018. 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 2018 Conference Abstracts Tablet-based participatory syndromic surveillance at Simhashta festival in India Vishal Diwan*1, 2, Anette Hulth2, Ponnaiah Manickam3, Viduthalai virumbi Balagurusamy3, Deepak Agnihotri1, Vivek Parashar1, Ashish Pathak1, 2, Kantilal Sahu4 and Vijay K. Mahadik1 1Public Health and Environment, R.D. Gardi Medical College, Ujjain, India; 2Karolinska Institutet, Stockholm, Sweden; 3National Institute of Epidemiology, Chennai, India; 4Department of Health and Family Welfare, Bhopal, India Objective To develop, test and study tablet-based participatory syndromic surveillance system for common infectious disease conditions at community level in Simhashta religious mass gathering in Ujjain, India, 2016. Introduction Infectious disease surveillance for generating early warnings to enable a prompt response during mass gatherings has long been a challenge in India 1,2 as well as in other parts of the world 3,4,5. Ujjain, Madhya Pradesh in Central India hosted one of the largest religious festival in the world called ‘Simhasth kumbh mela’ on the banks of River Kshipra, where more than 50 million attendees came for holy dip during April 22 to May 21, 2016. The attendees included pilgrims (residents and visitors), observers, officials and volunteers. We developed an android application with automated summary reports and an interactive dashboard for syndromic surveillance during the gathering. Methods We established the participatory surveillance at all 22 sectors of the festival area, and at 20 out-patient hospitals and 12 pharmacies. We trained 55 nursing and social work graduate trainees to collect data from all these settings. The data collectors visited designated spots daily during a fixed time and collected age, gender, residence and self-reported symptoms from consenting attendees during the festival period. The application automatically added date, time and location of interview to each record and data was transmitted to a web server. We monitored the data in the interactive dashboard and prepared summary report on a periodic basis. Daily summary report of self-reported symptoms by time, place and person was shared daily evening with the festival surveillance authority. Results Of the total 93,020 invited pilgrims, 91% participated in the surveillance. Almost 90% of those were from outside the festival city, 60% were men and 57% were aged 15 to 44 years. Almost 50% of them self-reported presence of at least one symptom. Most frequently reported symptoms were dehydration due to heat (13%), cold (13%), fever (7%) and loose stool (5%). During the festival period of over one month, surveillance data indicated increasing trends of self-reported cough and fever and declining trends of self-reported dehydration (Figure-1). The designated public health authorities for the festival did make use of the information for appropriate action. This tablet- based application was able to collect, process and visualise around 2500 records per day from the community without any data loss. Conclusions To our knowledge, this is the first report from India documenting real-time surveillance of the community using hand-held devices during a mass gathering. Despite some implementation issues and limitations in the approach and data collected, the use of digital technology provided well-timed information avoiding tedious manual work and reduced a good amount of human resources and logistics involved in reporting symptoms with a traditional paper- based method in such a large population. In retrospect, the main utility of the surveillance output was that of giving reassurance to the officials, as no major outbreaks occurred during the event. We believe that this experience and further analyses will provide input for the establishment and use of such a surveillance system during mass gatherings. The team of investigators propose improving the methods and tools for future use. Keywords Mass Gatherings; participatory; syndromic surveillance; India; Tablet based Acknowledgments We are grateful for the Department of Health and Family Welfare, Government of Madhya Pradesh for study permission, R.D. Gardi Medical College, Ujjain for financial Support. We are also thankul to study participants and project team References 1. David S, Roy N. Public health perspectives from the biggest human mass gathering on earth: Kumbh Mela, India. International Journal of Infectious Diseases. 2016 Jan 28. 2. Sridhar S, Gautret P, Brouqui P. A comprehensive review of the Kumbh Mela: identifying risks for spread of infectious diseases. Clinical Microbiology and Infection. 2015;21(2):128-33. 3. Tam JS, Barbeschi M, Shapovalova N, Briand S, Memish ZA, Kieny MP. Research agenda for mass gatherings: a call to action. The Lancet infectious diseases. 2012;12(3):231-9. 4. Nsoesie EO, Kluberg SA, Mekaru SR, Majumder MS, Khan K, Hay SI, Brownstein JS. New digital technologies for the surveillance of infectious diseases at mass gathering events. Clinical Microbiology and Infection. 2015;21(2):134-40. 5. World Health Organization. Communicable disease alert and response for mass gatherings. InTechnical Workshop. Geneva, Switzerland 2008 Apr (pp. 29-30). 6. Cariappa MP, Singh BP, Mahen A, Bansal AS. Kumbh Mela 2013: Healthcare for the millions. Medical Journal Armed Force India. 2015; 71 278e81 *Vishal Diwan E-mail: vishaldiwan@hotmail.com Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 10(1):e182, 2018