Enhanced surveillance during a public health emergency in a resource-limited setting: Experience from a large dengue outbreak in Solomon Islands, 2016-17.

Between August-2016 and April-2017, Solomon Islands experienced the largest and longest-running dengue outbreak on record in the country, with 12,329 suspected cases, 877 hospitalisations and 16 deaths. We conducted a retrospective review of related data and documents, and conducted key informant interviews to characterise the event and investigate the adaptability of syndromic surveillance for enhanced and expanded data collection during a public health emergency in a low resource country setting. While the outbreak quickly consumed available public and clinical resources, we found that authorities were able to scale up the conventional national syndrome-based early warning surveillance system to support the increased information demands during the event demonstrating the flexibility of the system and syndromic surveillance more broadly. Challenges in scaling up included upskilling and assisting staff with no previous experience of the tasks required; managing large volumes of data; maintaining data quality for the duration of the outbreak; harmonising routine and enhanced surveillance data and maintaining surveillance for other diseases; producing information optimally useful for response planning; and managing staff fatigue. Solomon Islands, along with other countries of the region remains vulnerable to outbreaks of dengue and other communicable diseases. Ensuring surveillance systems are robust and able to adapt to changing demands during emergencies should be a health protection priority.

Early warning epidemic surveillance in the Pacific island nations: an evaluation of the Pacific syndromic surveillance system.

OBJECTIVE: The Pacific Syndromic Surveillance System (PSSS), launched in 2010, provides a simple mechanism by which 121 sentinel surveillance sites in 21 Pacific island countries and areas perform routine indicator- and event-based surveillance for the early detection of infectious disease outbreaks. This evaluation aims to assess whether the PSSS is meeting its objectives, what progress has been made since a formative evaluation of the system was conducted in 2011, and provides recommendations to enhance the PSSS's performance in the future. METHODS: Twenty-one informant interviews were conducted with national operators of the system and regional public health agencies that use information generated by it. Historic PSSS data were analysed to assess timeliness and completeness of reporting. RESULTS: The system is simple, acceptable and useful for public health decision-makers. The PSSS has greatly enhanced Pacific island countries' ability to undertake early warning surveillance and has contributed to efforts to meet national surveillance-related International Health Regulation (2005) capacity development obligations. Despite this, issues with timeliness and completeness of reporting, data quality and system stability persist. CONCLUSION: A balance between maintaining the system's simplicity and technical advances will need to be found to ensure its long-term sustainability, given the low-resource context for which it is designed.

Designs and methods used in published Australian health promotion evaluations 1992-2011.

OBJECTIVE: To describe the designs and methods used in published Australian health promotion evaluation articles between 1992 and 2011. METHODS: Using a content analysis approach, we reviewed 157 articles to analyse patterns and trends in designs and methods in Australian health promotion evaluation articles. The purpose was to provide empirical evidence about the types of designs and methods used. RESULTS: The most common type of evaluation conducted was impact evaluation. Quantitative designs were used exclusively in more than half of the articles analysed. Almost half the evaluations utilised only one data collection method. Surveys were the most common data collection method used. Few articles referred explicitly to an intended evaluation outcome or benefit and references to published evaluation models or frameworks were rare. CONCLUSION: This is the first time Australian-published health promotion evaluation articles have been empirically investigated in relation to designs and methods. There appears to be little change in the purposes, overall designs and methods of published evaluations since 1992. IMPLICATIONS: More methodologically transparent and sophisticated published evaluation articles might be instructional, and even motivational, for improving evaluation practice and result in better public health interventions and outcomes.

Pacific-wide simplified syndromic surveillance for early warning of outbreaks.

The International Health Regulations require timely detection and response to outbreaks. Many attempts to set up an outbreak early warning system in Pacific island countries and territories (PICTs) have failed. Most were modelled on systems from large countries; large amounts of data often overwhelmed small public health teams. Many conditions required overseas laboratory confirmation, further reducing timeliness and completeness. To improve timeliness and reduce the data burden, simplified surveillance was proposed, with case definitions based on clinical signs and symptoms without the need for laboratory confirmation or information on symptoms, location, sex and age. After trials in three PICTs, this system was implemented throughout the Pacific. Enthusiastic adoption by public health staff resulted in 20 of 22 PICTs reporting weekly to the World Health Organization within 12 months of starting to use the system. In the first year, the system has detected many infectious disease outbreaks and facilitated timely implementation of control measures. For several Pacific countries and territories, this is the first functional and timely infectious disease surveillance system. When outbreak detection is the principal objective, simplification of surveillance should be a priority in countries with a limited public health system capacity.

An extreme bushfire smoke pollution event: health impacts and public health challenges.

AIMS: To determine the health impacts of smoke and the effectiveness of public health advisories during a severe bushfire smoke event in Albury, NSW. METHODS: The NSW Department of Environment and Climate Change provided PM(10) data. A computer-assisted telephone survey using random digit dialling was conducted following the smoke event to assess health impacts and the effectiveness of advisories. RESULTS: The smoke event lasted 38 days. The maximum daily PM(10) level was 415 microg/m(3). Public health advisories were based on alerts for air pollution issued by NSW Department of Health. From the survey, a total of 389 interviews were available for analysis. At least one health effect of the smoke was reported by 70% of respondents and 5% reported seeking medical treatment. Over 74% reported seeing, hearing or reading the health advisories. Behaviour change was significantly greater in this group (odds ratio = 2.74; 95% confidence interval 1.50-5.02). CONCLUSION: High rates of health effects may be experienced by populations exposed to bushfire smoke pollution. Public health advisories can support behaviour change to reduce exposure to bushfire smoke.