Comparison of statistical algorithms for syndromic surveillance aberration detection

Syndromic surveillance involves monitoring big health datasets to provide early warning of threats to public health. Public health authorities use statistical detection algorithms to interrogate these datasets for aberrations that are indicative of emerging threats. The algorithm currently in use at Public Health England (PHE) for syndromic surveillance is the ‘rising activity, multi-level mixed effects, indicator emphasis’ (RAMMIE) method (Morbey et al, 2015), which fits a mixed model to counts of syndromes on a daily basis.

January 21, 2018

Updating syndromic surveillance baselines following public health interventions

Public Health England's syndromic surveillance service monitor presentations for gastrointestinal illness to detect increases in health care seeking behaviour driven by infectious gastrointestinal disease. We use regression models to create baselines for expected activity and then identify any periods of signficant increases. The introduction of a rotavirus vaccine in England during July 2013 (Bawa, Z. et al. 2015) led to a reduction in incidence of the disease, requiring a readjustment of baselines.


January 21, 2018

Using real-time syndromic surveillance to monitor the health effects of air pollution

The negative effect of air pollution on human health is well documented illustrating increased risk of respiratory, cardiac and other health conditions. Currently, during air pollution episodes Public Health England (PHE) syndromic surveillance systems provide a near real-time analysis of the health impact of poor air quality.

January 21, 2018

What value can Google search data add to existing syndromic surveillance systems?

Globally, there have been various studies assessing trends in Google search terms in the context of public health surveillance1. However, there has been a predominant focus on individual health outcomes such as influenza, with limited evidence on the added value and practical impact on public health action for a range of diseases and conditions routinely monitored by existing surveillance programmes. A proposed advantage is improved timeliness relative to established surveillance systems.

January 25, 2018

Syndromic Surveillance Revolution? Public Health Benefits of Modernizing the Emergency Care Patient Health Record in England

Emergency medicine is a recognized specialty in the United Kingdom (UK), with formal training and accreditation conducted and governed by the Royal College of Emergency Medicine. Health care in the UK is publicly funded and provided by the National Health Service (NHS) through a residence-based (rather than insurance-based) system. Emergency care within emergency departments (EDs) is currently provided free at the point of delivery for everyone, including non-UK residents.

August 28, 2017

Infant fever trends following the launch of the meningococcal B vaccine in the UK

From 1 September 2015, babies in the United Kingdom (UK) born on/after 1 July 2015 became eligible to receive the MenB vaccine, given at 2 and 4 months of age, with a booster at 12 months. Early trials found a high prevalence of fever (over 38°C) in babies given the vaccine with other routine vaccines at 2 and 4 months. We used syndromic surveillance data to assess whether there had been increased family doctor (general practitioner (GP)) consultations for fever in young infants following the introduction of the vaccine. 


July 06, 2017

Interpreting specific and general respiratory indicators in syndromic surveillance

Public Health England (PHE) uses syndromic surveillance systems to monitor for seasonal increases in respiratory illness. Respiratory illnesses create a considerable burden on health care services and therefore identifying the timing and intensity of peaks of activity is important for public health decision-making. Furthermore, identifying the incidence of specific respiratory pathogens circulating in the community is essential for targeting public health interventions e.g. vaccination.

July 10, 2017

Syndromic surveillance of air pollution incidents across international borders

The impact of poor air quality (AQ) on human health is a global issue, with periods of poor AQ known to occur in multiple locations, across different countries at, or around the same time. The Public Health England (PHE) Emergency Department Syndromic Surveillance System (EDSSS) is a public health legacy of the London 2012 Olympic and Paralympic Games, monitoring anonymised daily attendance data in near real-time from a sentinel network of up to 38 EDs across England and Northern Ireland during 2014.

August 20, 2017

The importance of age-specific data in routine syndromic surveillance

When monitoring public health incidents using syndromic surveillance systems, Public Health England (PHE) uses the age of the presenting patient as a key indicator to further assess the severity, impact of the incident, and to provide intelligence on the likely cause. However the age distribution of cases is usually not considered until after unusual activity has been identified in the allages population data. We assessed whether monitoring specific age groups contemporaneously could improve the timeliness, specificity and sensitivity of public health surveillance.

August 20, 2017

Ensuring the Week Goes Smoothly - Improving Daily Surveillance Visualization

Real-time syndromic surveillance requires daily surveillance of a range of health data sources. Most real-time data sources from health care systems exhibit large day of the week fluctuations as service provision and patient behaviour varies by day of the week. Regular day of the week effects are further complicated by the occurrence of public holidays (usually 8 per year in England), which can limit the availability of certain services and affect patient behaviour.

August 29, 2017


Contact Us

NSSP Community of Practice



This website is supported by Cooperative Agreement # 6NU38OT000297-02-01 Strengthening Public Health Systems and Services through National Partnerships to Improve and Protect the Nation's Health between the Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial Epidemiologists. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. CDC is not responsible for Section 508 compliance (accessibility) on private websites.

Site created by Fusani Applications