This article is part of the supplement: Proceedings of the 2007 Disease Surveillance Workshop. Disease Surveillance: Role of Public Health Informatics

Open Access Proceedings

EWORS: using a syndromic-based surveillance tool for disease outbreak detection in Indonesia

Hadi Siswoyo1*, Meda Permana1, Ria P Larasati2, Jeffryman Farid2, Asep Suryadi2 and Endang R Sedyaningsih1

Author Affiliations

1 Biomedic and Pharmacy Research Center, National Institute of Health Research and Development, Indonesian Ministry of Health, Jakarta, Indonesia

2 U.S. Naval Medical Research Unit No. 2 (NAMRU-2), Jakarta, Indonesia

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BMC Proceedings 2008, 2(Suppl 3):S3  doi:

Published: 14 November 2008



Electronic syndromic surveillance for early outbreak detection may be a simple, effective tool to rapidly bring reliable and actionable outbreak data to the attention of public health authorities in the developing world.


Twenty-nine signs and symptoms from patients with conditions compatible with infectious diseases are collected from selected Provincial hospitals and analyzed daily. Data is e-mailed on a daily basis to a central data management and analysis center. Automated data analysis may be viewed at the hospital or the Early Warning Outbreak Response System (EWORS) hub at the central level (National Institute of Health Research and Development/NIHRD).


The Indonesian Ministry of Health (MoH) has adopted EWORS since 2006 and will use it as a complementary surveillance tool in wider catchment areas throughout the country. Socialization to more users is still being conducted under collaboration of three Directorate Generals (DGs) of the MoH; DG of NIHRD, DG of Medical Services and DG of Communicable Disease Control and Prevention. Currently, EWORS is being adapted to facilitate detecting a potential outbreak of pandemic influenza in the region, and automated procedures for outbreak detection have been added.