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Open Access Research article

The use of syndromic surveillance for decision-making during the H1N1 pandemic: A qualitative study

Anna Chu1, Rachel Savage1, Don Willison123, Natasha S Crowcroft124, Laura C Rosella12, Doug Sider1, Jason Garay1, Ian Gemmill5, Anne-Luise Winter1, Richard F Davies6 and Ian Johnson12*

Author Affiliations

1 Public Health Ontario, Toronto, ON, Canada

2 Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

3 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

4 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

5 Kingston, Frontenac and Lennox and Addington Public Health, Kingston, ON, Canada

6 University of Ottawa Heart Institute, Ottawa, ON, Canada

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BMC Public Health 2012, 12:929  doi:10.1186/1471-2458-12-929

Published: 30 October 2012

Abstract

Background

Although an increasing number of studies are documenting uses of syndromic surveillance by front line public health, few detail the value added from linking syndromic data to public health decision-making. This study seeks to understand how syndromic data informed specific public health actions during the 2009 H1N1 pandemic.

Methods

Semi-structured telephone interviews were conducted with participants from Ontario’s public health departments, the provincial ministry of health and federal public health agency to gather information about syndromic surveillance systems used and the role of syndromic data in informing specific public health actions taken during the pandemic. Responses were compared with how the same decisions were made by non-syndromic surveillance users.

Results

Findings from 56 interviews (82% response) show that syndromic data were most used for monitoring virus activity, measuring impact on the health care system and informing the opening of influenza assessment centres in several jurisdictions, and supporting communications and messaging, rather than its intended purpose of early outbreak detection. Syndromic data had limited impact on decisions that involved the operation of immunization clinics, school closures, sending information letters home with school children or providing recommendations to health care providers. Both syndromic surveillance users and non-users reported that guidance from the provincial ministry of health, communications with stakeholders and vaccine availability were driving factors in these public health decisions.

Conclusions

Syndromic surveillance had limited use in decision-making during the 2009 H1N1 pandemic in Ontario. This study provides insights into the reasons why this occurred. Despite this, syndromic data were valued for providing situational awareness and confidence to support public communications and recommendations. Developing an understanding of how syndromic data are utilized during public health events provides valuable evidence to support future investments in public health surveillance.

Keywords:
Decision making; Pandemic influenza; Public health; Surveillance; Syndromic surveillance