University of New South Wales, Sydney, NSW, Australia.
The George Institute for Global Health, Newtown, NSW, Australia.
Trop Med Int Health. 2020 Aug;25(8):906-918. doi: 10.1111/tmi.13448. Epub 2020 Jun 11.
Due to their tropical location, development status and the limited capacity of health systems, Pacific island counties and territories are particularly susceptible to infectious disease outbreaks; but evidence as to the optimal way in which outbreaks are detected is scarce. In this review, we synthesise evidence from literature about how outbreaks are detected in Pacific island countries and territories and critique factors identified as inhibiting surveillance practice.
For this systematic review, we searched electronic databases Embase, Global Health, MEDLINE and MEDLINE Epub from 1 January 2010 and 31 March 2019 for reports describing infectious disease outbreaks occurring in the Pacific islands. Reports were included if they reported the method by which an outbreak was detected or the time between an outbreak's onset and its detection. We extracted information about the report type and authors, the outbreak and its method/s of detection, and pertinent issues inhibiting surveillance practice.
Of 860 articles identified, 37 reports describing 39 outbreaks met the inclusion criteria. Most outbreaks (n = 30) were identified through formal event-based surveillance; six through syndromic surveillance; and two by ad hoc notification from the community. Barriers to early outbreak detection included population isolation; lack of resources and infrastructure to support surveillance implementation and signal investigation; and broader health system factors such as preparedness planning and availability of laboratory services.
Most surveillance-related gain in the Pacific islands may be made through building formal event-based surveillance systems and streamlining reporting processes to facilitate outbreak notification. This observation is pertinent given the focus on establishing and expanding syndromic surveillance approaches for outbreak detection in the islands over the last decade.
由于地理位置处于热带、发展状况以及卫生系统能力有限，太平洋岛国和领土特别容易受到传染病暴发的影响；但是，关于如何最佳发现暴发的证据却很少。在本综述中，我们综合了有关太平洋岛国和领土如何发现暴发的文献证据，并对被确定为抑制监测实践的因素进行了批判。
在这项系统综述中，我们从 2010 年 1 月 1 日至 2019 年 3 月 31 日，在 Embase、全球卫生、MEDLINE 和 MEDLINE Epub 电子数据库中搜索了描述发生在太平洋岛屿的传染病暴发的报告。如果报告描述了发现暴发的方法或暴发从开始到被发现的时间，则报告被纳入。我们提取了报告类型和作者、暴发及其检测方法以及抑制监测实践的相关问题等信息。
在 860 篇文章中，有 37 篇报告描述了 39 起暴发，符合纳入标准。大多数暴发（n=30）是通过正式的基于事件的监测发现的；6 起是通过症状监测发现的；还有 2 起是通过社区的临时通知发现的。早期暴发检测的障碍包括人口隔离；缺乏资源和基础设施来支持监测的实施和信号调查；以及更广泛的卫生系统因素，如准备规划和实验室服务的可用性。
在太平洋岛屿，通过建立正式的基于事件的监测系统和简化报告流程以促进暴发通知，可能会在监测方面取得最大的收益。鉴于过去十年中，该地区一直专注于建立和扩大综合征监测方法以用于暴发检测，这一观察结果是相关的。
