JMIR Publications

ABSTRACT

Background:

Diarrhoeal disease, which affects 1 in 4 people in the UK annually, is the most common cause of outbreaks in community and healthcare settings. Traditional surveillance tends to detect point-source outbreaks of diarrhoea and vomiting; it is less effective at identifying low-level and intermittent food supply contamination. Further, it can take up to nine weeks for infections to be confirmed, reducing ‘slow-burn’ outbreak recognition, potentially impacting hundreds or thousands of people over wide geographical areas. There is a need to address fundamental problems in traditional diarrhoeal disease surveillance due to: under-reporting and subsequent unconfirmed infection by patients and general practitioners (GPs); varying submission practices and selective testing of samples in laboratories; limitations in traditional microbiological diagnostics meaning that the timeliness of sample testing and aetiology of most cases remains unknown; and poorly integrated human and animal surveillance systems meaning that identification of zoonoses is delayed or missed. Objectives: These are to: detect anomalous patterns in gastrointestinal disease incidence in the (human) community; target sampling; test traditional diagnostics against rapid modern sensitive molecular and genomic microbiology methods, identifying and characterising responsible pathogens rapidly and more completely; determine the cost-effectiveness of rapid modern sensitive molecular and genomic microbiology methods.

Methods:

Syndromic surveillance will be used to aid identification of anomalous patterns in microbiological events based upon temporal associations, demographic similarities amongst patients/animals, and changes in trends in acute gastroenteritis cases, using a pointprocess statistical model. Stool samples will be obtained from patients consulting GPs, to improve upon timeliness of cluster-detection and characterise the pathogens responsible, allowing health protection professionals to investigate and control outbreaks quickly, limiting their size and impact. The cost-effectiveness of the proposed system will be examined using formal cost-utility analysis to inform decisions on national implementation.

Results:

The project was funded, starting 1st April 2013. Favourable opinion was obtained from the Research Ethics Committee on 15th June 2015, and the first patient was recruited on 13th October 2015, with 1407 patients recruited and samples processed using traditional laboratory techniques as of March 2017.

Conclusions:

The overall aim is to create a new, 'One Health' paradigm for detecting and investigating diarrhoea and vomiting in the community in near-real-time, shifting from passive human surveillance and management of laboratory-confirmed infection towards an integrated, interdisciplinary enhanced surveillance system including management of people with symptoms.