Priority Diseases for Early Warning Alert and Response Networks(EWARN) 1997-2016 Open Access

Sahu Khan, Aalisha (2017)

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Background: Forcibly displaced populations experience increased mortality and morbidity. Communicable diseases, with or without malnutrition, are the major causes of illness and death when control measures are inadequate. Early warning for outbreaks of communicable disease is critical in mitigating impact on vulnerable displaced populations. Prioritising diseases for an early warning alert and response network (EWARN) surveillance system is essential to ensure minimal and necessary information is collected.The WHO 2012 EWARN Implementation Guidelines aim to increase data quality, timeliness, completeness, and in turn efficacy through standardising the process of setting up an EWARN. This study will focus on disease/syndrome prioritisation, specifically comparing disease selection for EWARN-like systems from 1997-2017 with recommendations of the WHO 2012 guidelines.

Methods: Articles listing diseases selected for EWARN-like systems from January 1997 to June 2017 were collected from PubMed/MEDLINE, ProQuest, Google Scholar, and the website and database of WHO (WHOLIS). Grey literature was included in the search. Data extracted included lists of diseases/syndromes included in each surveillance system.

Results: A total of 3,066 articles were identified, and 1,471 duplicates removed, leaving 1,595. After applying the exclusion criteria the final dataset included 33 articles listing diseases/syndromes for 20 EWARN-like systems in 17 countries from 1997-2016. Of the systems, 35% (n=6) were for emergencies or disasters in the Eastern Mediterranean, 20% (n=4) Africa, 20% (n=4) Western Pacific, 15% (n=3) Europe, 10% (n=2) South East Asia, and 5% (n=1) in the Americas. Overall, 25% (n=5) of systems were set up after 2012, and 75% (n=15) of systems were established from 1997-2012. Pakistan (2005) and Somalia (2013) included all 8 WHO recommended diseases/syndromes. Most frequently left out of the systems were acute flaccid paralysis (40%) and acute haemorrhagic fever (30%). All 20 systems (100%) included acute watery diarrhoea (suspected cholera), acute bloody diarrhoea (suspected shigellosis), and suspected measles.

Conclusion: The omission of acute flaccid paralysis, particularly from systems established after 2012, was unexpected. This emphasizes the need to understand the context of an emergency (e.g., endemic disease, complementary surveillance systems) while also carefully evaluating any potential health system breakdown increasing risk of previously eradicated disease, e.g. lack of vaccination against polio virus.

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