Alexey Clara, MD, Karen A. Alroy, DVM, and Djebo C. Gourmanon, MD, are Epidemiologists, and S. Arunmozhi Balajee, PhD, is Associate Director of Global Health Security; all in the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Serigne M. Ndiaye, PhD, is Program Director; Mamadou Diarrassouba, MD, is Emergency Management Lead; and Ramatou Toure-Adechoubou, PharmD, is a Public Health Specialist for Laboratory; all in the Division of Global Health Protection, Country Office Côte d'Ivoire, Center for Global Health, Centers for Disease Control and Prevention (CDC), Abidjan, Côte d'Ivoire. Benie Joseph is a Professor and Director of Public Health, and Daouda Coulibaly, MD, MPH, is Deputy Director, Epidemiology Hygiene Research; both at the National Institute of Public Hygiene, Abidjan, Côte d'Ivoire. Maurice A. Nzogu holds a master's degree in humanitarian aid and international cooperation and is the Deputy Health Coordinator; Koffi Ange Houngbedji, MD, MPH, is Health Coordinator; and Henry Banny Attiey has a master's degree in monitoring evaluation and is Monitoring Evaluation Health Coordinator Health Sector; all at the International Rescue Committee, Abidjan, Côte d'Ivoire. Dr. Clara and Dr. Ndiaye contributed equally to this article. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Health Secur. 2020 Jan;18(S1):S23-S33. doi: 10.1089/hs.2019.0062.
Community-based surveillance can be an important component of early warning systems. In 2016, the Côte d'Ivoire Ministry of Health launched a community-based surveillance project in 3 districts along the Guinea border. Community health workers were trained in detection and immediate reporting of diseases and events using a text-messaging platform. In December 2017, surveillance data from before and after implementation of community-based surveillance were analyzed in intervention and control districts. A total of 3,734 signals of priority diseases and 4,918 unusual health events were reported, of which 420 were investigated as suspect diseases and none were investigated as unusual health events. Of the 420 suspected cases reported, 23 (6%) were laboratory confirmed for a specific pathogen. Following implementation of community-based surveillance, 5-fold and 8-fold increases in reporting of suspected measles and yellow fever clusters, respectively, were documented. Reporting incidence rates in intervention districts for suspected measles, yellow fever, and acute flaccid paralysis were significantly higher after implementation, with a difference of 29.2, 19.0, and 2.5 cases per 100,000 person-years, respectively. All rate differences were significantly higher in intervention districts ( < 0.05); no significant increase in reporting was noted in control districts. These findings suggest that community-based surveillance strengthened detection and reporting capacity for several suspect priority diseases and events. However, the surveillance program was very sensitive, resulting in numerous false-positives. Learning from the community-based surveillance implementation experience, the ministry of health is revising signal definitions to reduce sensitivity and increase specificity, reviewing training materials, considering scaling up sustainable reporting platforms, and standardizing community health worker roles.
基于社区的监测可以成为早期预警系统的一个重要组成部分。2016 年，科特迪瓦卫生部在与几内亚接壤的 3 个地区启动了一个基于社区的监测项目。社区卫生工作者接受了使用短信平台发现和立即报告疾病和事件的培训。2017 年 12 月，在干预和对照地区分析了实施基于社区的监测前后的监测数据。共报告了 3734 起优先疾病信号和 4918 起异常卫生事件，其中 420 起被调查为疑似疾病，没有一起被调查为异常卫生事件。在报告的 420 例疑似病例中，有 23 例（6%）经实验室确认为特定病原体。实施基于社区的监测后，疑似麻疹和黄热病聚集的报告分别增加了 5 倍和 8 倍。实施后，干预地区疑似麻疹、黄热病和急性弛缓性麻痹的报告发病率显著升高，差异分别为每 10 万人 29.2、19.0 和 2.5 例/人年。所有差异均显著高于干预地区（ < 0.05）；对照地区没有注意到报告显著增加。这些发现表明，基于社区的监测加强了对几种疑似优先疾病和事件的发现和报告能力。然而，监测方案非常敏感，导致大量假阳性。从基于社区的监测实施经验中吸取教训，卫生部正在修订信号定义，以降低敏感性并提高特异性，审查培训材料，考虑扩大可持续报告平台，并规范社区卫生工作者的角色。
